Bergem AL, Engedal K, Kringlen E. The role of heredity in late-onset Alzheimer disease and vascular dementia. A twin study. Arch Gen Psychiatry. 1997 Mar;54(3):264-70.

BACKGROUND: This study compares the relative importance of heredity and environment in the development of Alzheimer disease and vascular dementia. The relationship between apolipoprotein E and dementia is also tested. METHODS: A total of 23,000 cognitively impaired subjects from Norwegian institutions for the elderly were identified, and their files were checked against the records of 26,000 twin pairs from the Norwegian Twin Register. A sample of 72 twin pairs was selected and thoroughly investigated clinically. The mean age of the sample was 80 years. RESULTS: The pairwise concordance rate for Alzheimer disease was 78% (7/9) among monozygotic and 39% (9/23) among dizygotic twin pairs. The probandwise concordance rate was 83% (10/12) among monozygotic and 46% (12/26) among dizygotic twin pairs. There was no significant difference in the rate of apolipoprotein E epsilon 4 allele between twin pairs concordant and discordant for Alzheimer disease. By using tetrachoric correlations, the estimated heritability was approximately 0.6. Environmental factors shared by cotwins seemed to explain most of the remaining variance. In vascular dementia, there was no significant difference in pairwise concordance rates among monozygotic (1/6 [17%]) and dizygotic (4/16 [25%]) twin pairs or in probandwise concordance rates among monozygotic (2/7 [29%]) and dizygotic (5/17 [29%]) twin pairs. CONCLUSION: Heredity is the major causal factor in late onset Alzheimer disease, whereas environmental factors dominate in vascular dementia.

Ince PG, McArthur FK, Bjertness E, Torvik A, Candy JM, Edwardson JA. Neuropathological diagnoses in elderly patients in Oslo: Alzheimer's disease, Lewy body disease, vascular lesions. Dementia. 1995 May-Jun;6(3):162-8.

Neuropathological changes in elderly residents of Oslo, Norway were characterised with respect to the cerebral substrates of dementia. Ninety-two brains were examined, representing 41% of all deaths occurring in 10 nursing homes during a 9-month period. The autopsy cohort showed a similar mean age (85 years) and sex ratio (73% female) and proportion of demented patients (75%) compared to all the patients resident in these homes who died during the same period. Clinical data was compiled retrospectively. Diagnosis was made using the CERAD protocol, and criteria for the diagnosis of Lewy body dementia. Lewy body formation was present in 20% and cerebral infarction in 21% of patients. In the demented group (69 patients) 90% fulfilled CERAD criteria for definite or probable Alzheimer's disease. Eight demented cases had absent neocortical neurofibrillary tangles and 6 other cases showed Lewy body dementia (9% of demented patients). A further 8 of these demented cases had brain stem Lewy bodies with only minimal cortical involvement. Thirteen cases (19% of the sample) had cerebral infarcts but these were considered to be clinically significant in only 4 (6%). In the non-demented patients (23) 4 patients had brain stem Lewy bodies and 6 had cerebral infarcts. Despite inclusion criteria biased towards the collection of Alzheimer's disease and normal patients, both Lewy body dementia (7%) and cerebral infarcts contributing to dementia (6%) were frequent.