Empiric refinement of the pathologic assessment of Lewy-related pathology in the dementia patient.
Lewy-related pathology (LRP) is a common pathologic finding at autopsy in dementia patients. Recently criteria for categorizing types of LRP in dementia patients were published, though these criteria have yet to be systematically applied to large dementia samples. We examined a large (n = 208) referral-based autopsy sample for LRP, and applied the published criteria for LRP categorization to these cases. We found almost half (49%) of LRP positive cases from this sample were not classifiable. However, modifying the published criteria by reducing the number of regions requiring examination, allowing more variability in LRP severity scores within specific brain regions, and adding an amygdala predominant category permitted classification of 97% of LRP positive cases from the referral-based sample. Application of the modified criteria to an unrelated community-based autopsy sample (n = 226) allowed classification of 96% of LRP positive cases. Modest modifications in the published criteria permit a significantly greater number of dementia cases with LRP to be classified. In addition, this modification allows for more limited sampling of brain regions for classification of LRP. We propose that these modified criteria for the categorization of LRP be utilized in patients with a history of dementia.
Leverenz
James B
JB
Department of Veterans Affairs Northwest Network Mental Illness and Parkinson's Disease Research, University of Washington, Seattle, WA 98108, USA. leverenz@u.washington.edu
Hamilton
Ronald
R
Tsuang
Debby W
DW
Schantz
Aimee
A
Vavrek
Darcy
D
Larson
Eric B
EB
Kukull
Walter A
WA
Lopez
Oscar
O
Galasko
Douglas
D
Masliah
Eliezer
E
Kaye
Jeffrey
J
Woltjer
Randall
R
Clark
Christopher
C
Trojanowski
John Q
JQ
Montine
Thomas J
TJ
D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001921:Brain / Q000473:pathology*; D005260:Female; D006801:Humans; D016631:Lewy Bodies / Q000473:pathology*; D020961:Lewy Body Disease / Q000473:pathology*; D008297:Male; D012720:Severity of Illness Index