2007 Heart-Brain summit proceedings

Insular Alzheimer disease pathology and the psychometric correlates of mortality

Donald R. Royall, MD

Departments of Psychiatry, Medicine, and Pharmacology, South Texas Veterans Health System Audie L. Murphy Division GRECC (Geriatric Research Education and Clinical Center), and The University of Texas Health Science Center,
San Antonio, TX

royall@uthscsa.edu

ABSTRACT

Right hemisphere dysfunction is associated with mortality in Alzheimer’s disease (AD) and other neurologic conditions. These associations may be mediated by insular pathology, as insular lesions result in demonstrable changes in cardiovascular and autonomic control. AD affects the insulae at a preclinical stage, and insular AD pathology may be present in up to 40% of non-demented septuagenarians and octogenarians. This pathology can affect in vivo cardiac conduction and thereby dispose to cardiac arrhythmias and sudden death. Thus, AD pathology should be considered as a possible explanation for autonomic morbidity and mortality in nondemented elderly persons.

CITATIONS

  1. Braak H, Braak E.
    Evolution of neuronal changes in the course of Alzheimer’s disease. J Neural Transm Suppl 1998; 53:127–140.
    http://www.ncbi.nlm.nih.gov/pubmed/9700651
  2. Royall DR, Gao JH, Kellogg DL Jr.
    Insular Alzheimer’s disease pathology as a cause of “age-related” autonomic dysfunction and mortality in the non-demented elderly. Med Hypotheses 2006; 67:747–758.
    http://www.ncbi.nlm.nih.gov/pubmed/16806725
  3. Oppenheimer S.
    Forebrain lateralization of cardiovascular function: physiology and clinical correlates. Ann Neurol 2001; 49:555–556.
    http://www.ncbi.nlm.nih.gov/pubmed/11357943 (No abstract available.)
  4. Pearson RCA, Powell TPS.
    The neuroanatomy of Alzheimer’s disease. Rev Neurosci 1987; 2:101–122. (No web link found.) 5. Tasaki H, Serita T, Irita A, et al.
    A 15-year longitudinal follow-up study of heart rate and heart rate variability in healthy elderly persons. J Gerontol A Biol Sci Med Sci 2000; 55:M744–M749.
    http://www.ncbi.nlm.nih.gov/pubmed/11129397
  5. Lipsitz LA, Wei JY, Rowe JW.
    Syncope in an elderly, institutionalised population: prevalence, incidence, and associated risk. Q J Med 1985; 55:45–54.
    http://www.ncbi.nlm.nih.gov/pubmed/4011842
  6. Moossy J, Zubenko GS, Martinez AJ, Rao GR.
    Bilateral symmetry of morphologic lesions in Alzheimer’s disease. Arch Neurol 1988; 45:251–254.
    http://www.ncbi.nlm.nih.gov/pubmed/3341948
  7. Claus JJ, Walstra GJ, Bossuyt PM, Teunisse S, Van Gool WA.
    A simple test of copying ability and sex define survival in patients with early Alzheimer’s disease. Psychol Med 1999; 29:485–489.
    http://www.ncbi.nlm.nih.gov/pubmed/10218940
  8. Swan GE, Carmelli D, LaRue A.
    Perfomance on the digit symbol substitution test and 5-year mortality in the Western Collaborative Group Study. Am J Epidemiol 1995; 141:32–40.
    http://www.ncbi.nlm.nih.gov/pubmed/7801963
  9. Royall DR, Chiodo LK, Mouton C, Polk MJ.
    Cognitive predictors of mortality in elderly retirees: results from the Freedom House study. Am J Geriatr Psychiatry 2007; 15:243–251.
    http://www.ncbi.nlm.nih.gov/pubmed/17322135
  10. Lavery LL, Starenchak SM, Flynn WB, Stoeff MA, Schaffner R, Newman AB.
    The clock drawing test is an independent predictor of incident use of 24-hour care in a retirement community. J

    Gerontol A Biol Sci Med Sci 2005; 60:928–932.
    http://www.ncbi.nlm.nih.gov/pubmed/16079220