title: Neuropathologic findings of dementia with lewy bodies (DLB) in a population-based Vantaa 85+ study.
abstract: The consortium on dementia with Lewy bodies has established consensus guidelines for the neuropathologic diagnosis of dementia with Lewy bodies (DLB) including the likelihood that the neuropathologic findings associate with the clinical syndrome. Nevertheless, clinico-pathological correlations remain controversial. We applied the consensus guidelines for determining Lewy-related pathology (LRP) and evaluated the clinical presentation in the prospective, population-based Vantaa 85+ study consisting of individuals at least 85 years of age. LRP was seen in 36% of 304 subjects and categorized as follows: 3% brainstem-predominant, 14% limbic, 15% diffuse neocortical type (4% could not be categorized). The likelihood that the neuropathology predicts the DLB clinical syndrome was low in 6%, intermediate in 13%, and high in 13% of all 304 subjects. In the latter two groups, 77% were demented, 35% had at least one extrapyramidal symptom, and 15% had visual hallucinations. Surprisingly, DLB clinical features associated better with high neurofibrillary stage than with diffuse neocortical LRP. Moreover, the neurofibrillary stage, substantia nigra neuron loss, and grade of Lewy neurites in hippocampal CA2-3 region, each showed a significant association with the extent of LRP. In conclusion, the neuropathologic DLB in this very elderly population was common, but the clinical symptoms tended to associate better with severe neurofibrillary pathology than with extensive LRP.
authors.affiliation: Department of Pathology, University of Helsinki, and Helsinki University Central Hospital, P.O. Box 21 (Haartmaninkatu 3), FI-00014 Helsinki, Finland. minna.oinas@helsinki.fi
authors.forename: Minna
authors.initials: M
authors.lastname: Oinas
authors.forename: Tuomo
authors.initials: T
authors.lastname: Polvikoski
authors.forename: Raimo
authors.initials: R
authors.lastname: Sulkava
authors.forename: Liisa
authors.initials: L
authors.lastname: Myllykangas
authors.forename: Kati
authors.initials: K
authors.lastname: Juva
authors.forename: Irma-Leena
authors.initials: IL
authors.lastname: Notkola
authors.forename: Sari
authors.initials: S
authors.lastname: Rastas
authors.forename: Leena
authors.initials: L
authors.lastname: Niinistö
authors.forename: Hannu
authors.initials: H
authors.lastname: Kalimo
authors.forename: Anders
authors.initials: A
authors.lastname: Paetau
mesh_terms: D000369:Aged, 80 and over; D001921:Brain / Q000378:metabolism / Q000473:pathology*; D001933:Brain Stem / Q000378:metabolism / Q000473:pathology; D002391:Catchment Area, Health; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D020961:Lewy Body Disease / Q000453:epidemiology* / Q000378:metabolism / Q000473:pathology; D008032:Limbic System / Q000378:metabolism / Q000473:pathology; D008297:Male; D016874:Neurofibrillary Tangles / Q000378:metabolism / Q000473:pathology; D011159:Population Surveillance / Q000379:methods*; D051844:alpha-Synuclein / Q000378:metabolism
chemical_list: D051844:alpha-Synuclein