This cross-sectional study staged amyloid and tau at autopsy in 2711 Sao Paulo decedents, 2004 to 2025. Mean age was 73.4 years, 49.4% were female, and clinical status used the Clinical Dementia Rating. Thal phase 3-5 with Braak stage IV-VI, the biomarker-detectable range, was present in 19.6%, amyloid alone 10.0%, tau alone 7.6%. This combined state rose from 0% at ages 23-50 to 14.5% at 71-80 and 45.9% at 91-111. A CDR above 0 rose from 16.3% at Braak stage 0 to 86.6% at stage VI. Without the combined state, impairment affected 15.3% with no coexisting pathology and 58.5% with it; the sample is decedents only.
Why it is interesting: It gives tissue-based rather than biomarker-based prevalence for the population a test would be applied to. It also separates how much impairment sits with other brain disease.
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