Brain autopsies were conducted at pre-determined sites across the US, with a mean postmortem interval of 8.3 (SD=8.0) hours. The cerebellar and cerebral hemispheres were cut coronally into 1cm slabs. Slabs not designated for freezing were fixed for at least 48–72 hours. Neuropathologic evaluations were performed at the Rush, blinded to clinical data, and reviewed by a board-certified neuropathologist, as reported elsewhere.16 (link),17 (link) A uniform examination included assessment for common vascular and neurodegenerative conditions in aging. Examination for cerebral infarcts documented age (acute/subacute/chronic), size, and location (side and region) of infarcts visible to the naked eye on fixed slabs.17 (link) All grossly visualized and suspected macroscopic infarcts were dissected for histologic confirmation. For analyses, chronic macroscopic infarcts were characterized as present or absent.17 (link)
A minimum of nine regions in one hemisphere were examined for microinfarcts on 6µm paraffin-embedded sections, stained with hematoxylin/eosin. We examined six cortical regions (midfrontal, middle temporal, entorhinal, hippocampal, inferior parietal, and anterior cingulate cortices), two subcortical regions (anterior basal ganglia, thalamus), and midbrain. Locations of microinfarcts were recorded. Because acute and subacute microinfarcts were unlikely to be related to dementia, we only considered chronic microinfarcts for this study. These included cavitated or incomplete infarcts, with few remaining macrophages and fibrillary gliosis. In primary analyses, each case was classified according to whether any chronic microinfarct was present. We created additional variables for secondary analyses. For quantity, we created a predictor with three levels: no (reference level), one, and multiple microinfarcts. For location, we created two variables: cortical (presence of any microinfarcts in any cortical region; reference = no cortical microinfarcts) and subcortical microinfarcts (presence of any microinfarcts in any subcortical region; reference = no subcortical microinfarcts). To investigate quantity and location simultaneously, we created four variables: one cortical microinfarct and multiple cortical microinfarcts (compared to no cortical microinfarcts), and one subcortical microinfarct and multiple subcortical microinfarcts (compared to no subcortical microinfarcts).
Each brain was examined for pathological markers of other common neurodegenerative conditions associated with dementia. AD pathology was assessed in fixed tissue which was paraffin embedded, cut into 6µm sections, and mounted on slides.17 (link) Using a modified Bielschowsky silver stain, we counted neuritic plaques, diffuse plaques, and neurofibrillary tangles. Counts were scaled separately in each region and averaged across regions to create summary scores of each markers for each subject. For analyses, we created a summary score of global AD pathology, by averaging the summary scores of the three markers.16 (link) Lewy body pathology was identified in 6µm sections of cortex and substantia nigra, using α-synuclein immunohistochemistry (Zymed, 1:100).18 (link) For analyses, Lewy body data was dichotomized as present (if identified in any brain region) vs. absent.
A minimum of nine regions in one hemisphere were examined for microinfarcts on 6µm paraffin-embedded sections, stained with hematoxylin/eosin. We examined six cortical regions (midfrontal, middle temporal, entorhinal, hippocampal, inferior parietal, and anterior cingulate cortices), two subcortical regions (anterior basal ganglia, thalamus), and midbrain. Locations of microinfarcts were recorded. Because acute and subacute microinfarcts were unlikely to be related to dementia, we only considered chronic microinfarcts for this study. These included cavitated or incomplete infarcts, with few remaining macrophages and fibrillary gliosis. In primary analyses, each case was classified according to whether any chronic microinfarct was present. We created additional variables for secondary analyses. For quantity, we created a predictor with three levels: no (reference level), one, and multiple microinfarcts. For location, we created two variables: cortical (presence of any microinfarcts in any cortical region; reference = no cortical microinfarcts) and subcortical microinfarcts (presence of any microinfarcts in any subcortical region; reference = no subcortical microinfarcts). To investigate quantity and location simultaneously, we created four variables: one cortical microinfarct and multiple cortical microinfarcts (compared to no cortical microinfarcts), and one subcortical microinfarct and multiple subcortical microinfarcts (compared to no subcortical microinfarcts).
Each brain was examined for pathological markers of other common neurodegenerative conditions associated with dementia. AD pathology was assessed in fixed tissue which was paraffin embedded, cut into 6µm sections, and mounted on slides.17 (link) Using a modified Bielschowsky silver stain, we counted neuritic plaques, diffuse plaques, and neurofibrillary tangles. Counts were scaled separately in each region and averaged across regions to create summary scores of each markers for each subject. For analyses, we created a summary score of global AD pathology, by averaging the summary scores of the three markers.16 (link) Lewy body pathology was identified in 6µm sections of cortex and substantia nigra, using α-synuclein immunohistochemistry (Zymed, 1:100).18 (link) For analyses, Lewy body data was dichotomized as present (if identified in any brain region) vs. absent.