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Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.1 no.4 São Paulo Oct./Dec. 2007 

Original Articles

Clinicopathological correlates of Alzheimer's disease in a general autopsy series from Brazil

Correlação clinicopatológica na doença de Alzheimer em casuística de autópsia no Brasil

Lea Tenenholz Grinberg 1   2  

Renata Eloah de Lucena Ferretti 1   3  

Renata E.P. Leite 1  

Jose Marcelo Farfel 1   3  

Silmara P. Pacheco 1  

Ana Teresa Di Lorenzo Alho 1   2  

Renata P. Grisoli 1   2  

Heidy T.M. Matos 1   2  

Eliza G. Moreira 1   2  

Erika S. Balbino 1   2  

Katia C. Oliveira 1  

Sergio Rosemberg 1  

Heráclito Barbosa Carvalho 4  

Carlos Augusto G. Pasquallucci 1  

Paulo Hilario N. Saldiva 1  

Wilson Jacob-Filho 3  

Ricardo Nitrini 5  

1Department of Pathology, University of São Paulo Medical School.

2Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo.

3Division of Geriatrics, University of São Paulo Medical School.

4Department of Preventive Medicine, University of São Paulo Medical School .

5Behavioral and Cognitive Neurology Unit, Department of Neurology, and Cognitive Disorders Refeence Center (CEREDIC). Hospital das Clínicas of the University of São Paulo Medical School.


The current neuropathological staging models of Alzheimer's disease (AD) have been developed within the last 20 years. Nevertheless, they were mostly tested on Caucasians of Northern European ancestry or on Asians. Objective: To verify which of the accepted neuropathologic criteria best discriminates AD from normal aging in a well characterized Brazilian clinicopathological series. Methods: A random sample consisting of 89 subjects belonging to the Brazilian Brain Bank of the Aging Brain Study were clinically and neuropathologically fully assessed using immunohistochemistry. Clinical and functional statuses were assessed by interviewing a reliable informant. The Clinical dementia rating scale (CDR) was compared to Braak and Braak stage, the consortium to establish a registry for Alzheimer's disease (CERAD) score and NIA-Reagan (National Institute of Aging - Reagan Institute) score. Subjects with a neuropathologic diagnosis other then AD were excluded (n=27). Results: The CDR score distribution for the 62 selected subjects was as follows: CDR0=39, CDR0.5=9, CDR³1=14. There were no differences regarding age, gender and education among the groups. CDR score correlated best with the CERAD score (r=0.5303; p<0.001) . Braak and Braak stage was significantly higher in subjects with higher CDR. Correlation of the NIA-Reagan criteria was partially disrupted because a large proportion of subjects did not fit any of its categories. Conclusions: In this series, CERAD criteria better correlated with the CDR groups. Consistent with earlier studies, some cognitively normal subjects have AD neuropathological diagnosis.

Key words: Alzheimer's disease; dementia; diagnostic criteria; neuropathological criteria; brain bank


Os modelos de estadiamento neuropatológico da doença de Alzheimer (DA) têm sido desenvolvidos nos últimos 20 anos. Entretanto, têm sido quase exclusivamente testados em caucasianos de ascendência norte-européia ou em asiáticos. Objetivos: verificar quais dos critérios neuropatológicos discrimina melhor entre a DA e o envelhecimento normal em uma casuística clinicopatológica brasileira bem caracterizada. Métodos: uma amostra aleatória de 89 casos do Banco Brasileiro de Encéfalos do Estudo de Envelhecimento Cerebral foi submetida à avaliação neuropatológica completa com imunohistoquímica. As condições clínicas e funcionais foram avaliadas mediante entrevista com informante confiável. Os escores na Clinical Dementia Rating Scale (CDR) foram comparados com os escores dos estágios de Braak e Braak, do CERAD (Consortium to Establish a Registry for Alzheimer's Disease) e do consórcio NIA-Reagan (National Institute of Aging-Reagan Institute). Casos com diagnósticos neuropatológicos diferentes de DA foram excluídos (n=27). Resultados: Os 62 casos foram classificados em: CDR0=39, CDR0,5=9, CDR³1=14. Não havia diferenças quanto a idade, gênero e escolaridade entre os grupos. Os escores no CERAD correlacionaram-se melhor com os do CDR (r=0,5303; p<0,001). Os escores nos estágios de Braak e Braak foram significativamente mais elevados nos casos com CDR mais altos. A correlação do CDR com os escores dos critérios NIA-Reagan foi parcialmente rompida porque grande proporção de casos não se enquadrava em nenhuma das categorias diagnósticas destes critérios. Conclusões: Nesta casuística, os critérios do CERAD correlacionam-se melhor com os do CDR. Como observado por outros estudos, alguns casos de indivíduos cognitivamente normais, preencheram critérios neuropatológicos para o diagnóstico de DA.

Palavras-chave: doença de Alzheimer; demência; critérios diagnósticos; critérios neuropatológicos; banco de encéfalos; banco de cérebros

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Received: October 11, 2007; Revised: October 28, 2007; Accepted: November 27, 2007

Lea Tenenholz Grinberg - Avenida Dr. Arnaldo, 455 / 1st floor / room 1351 - 01246-903 São Paulo SP - Brazil. E-mail:

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