Prevalence of mixed neuropathologies in age‐related neurodegenerative diseases: A community‐based autopsy study in China

Abstract INTRODUCTION Despite extensive studies on mixed neuropathologies, data from China are limited. This study aims to fill this gap by analyzing brain samples from Chinese brain banks. METHODS A total of 1142 brains from six Chinese brain banks were examined using standardized methods. Independent pathologists conducted evaluations with stringent quality control. Prevalence and correlations of neurological disorders were analyzed. RESULTS Significant proportions of brains displayed primary age‐related tauopathy (PART, 35%), limbic‐predominant age‐related TDP‐43 encephalopathy (LATE, 46%), and aging‐related tau astrogliopathy (ARTAG, 12%). Alzheimer's disease neuropathological change (ADNC, 48%), Lewy body disease (LBD, 13%), and cerebrovascular disease (CVD, 63%) were also prevalent, often co‐occurring with regional variations. CVD emerged as the potential most early contributor to neuropathological changes. DISCUSSION This analysis highlights the prevalence of PART, LATE, ARTAG, ADNC, LBD, and CVD, with regional differences. The findings suggest CVD may be the earliest contributing factor, potentially preceding other neuropathologies. Highlights The prevalence of primary age‐related tauopathy (PART), limbic‐predominant age‐related TDP‐43 encephalopathy (LATE), aging‐related tau astrogliopathy (ARTAG), Alzheimer's disease neuropathologic change, Lewy body disease, and cerebrovascular disease (CVD) in China, increasing with age, is comparable to other countries. Significant regional differences in the prevalences of diseases are noted. CVD develops prior to any other disorders, including PART, LATE, and ARTAG.