title: Hippocampal Sclerosis of Aging Can Be Segmental: Two Cases and Review of the Literature.
abstract: Hippocampal sclerosis of aging (HS-Aging) is a neurodegenerative disease that mimics Alzheimer disease (AD) clinically and has a prevalence rivaling AD in advanced age. Whereas clinical biomarkers are not yet optimized, HS-Aging has distinctive pathological features that distinguish it from other diseases with "hippocampal sclerosis" pathology, such as epilepsy, cerebrovascular perturbations, and frontotemporal lobar degeneration. By definition, HS-Aging brains show neuronal cell loss and gliosis in the hippocampal formation out of proportion to AD-type pathology; it is strongly associated with aberrant TDP-43 pathology and arteriolosclerosis. Here, we describe 2 cases of "segmental" HS-Aging in which "sclerosis" in the hippocampus was evident only in a subset of brain sections by hematoxylin and eosin (H&E) stain. In these cases, TDP-43 pathology was more widespread on immunostained sections than the neuronal cell loss and gliosis seen in H&E stains. The 2 patients were cognitively intact at baseline and were tracked longitudinally over a decade using cognitive studies with at least 1 neuroimaging scan. We discuss the relevant HS-Aging literature, which indicates the need for a clearer consensus-based delineation of "hippocampal sclerosis" and TDP-43 pathologies in aged subjects.
authors.affiliation: From Department of Pathology, Division of Neuropathology (JHN, PTN), Department of Neurology (GAJ, FAS, CDS), Department of Statistics (RJK), Department of Epidemiology (ELA), Sanders-Brown Center on Aging (GAJ, FAS, ELA, RJK, CDS, TD, SA, EL, AB, LVE, PTN), and Department of Anatomy and Neurobiology (ETI, LVE, PTN), University of Kentucky, Lexington, Kentucky.
authors.forename: Eseosa T
authors.initials: ET
authors.lastname: Ighodaro
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Jicha
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Schmitt
authors.forename: Janna H
authors.initials: JH
authors.lastname: Neltner
authors.forename: Erin L
authors.initials: EL
authors.lastname: Abner
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kryscio
authors.forename: Charles D
authors.initials: CD
authors.lastname: Smith
authors.forename: Taylor
authors.initials: T
authors.lastname: Duplessis
authors.forename: Sonya
authors.initials: S
authors.lastname: Anderson
authors.forename: Ela
authors.initials: E
authors.lastname: Patel
authors.forename: Adam
authors.initials: A
authors.lastname: Bachstetter
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Van Eldik
authors.forename: Peter T
authors.initials: PT
authors.lastname: Nelson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D004268:DNA-Binding Proteins / Q000378:metabolism; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008297:Male; D019636:Neurodegenerative Diseases / Q000150:complications* / Q000473:pathology; D012598:Sclerosis / Q000209:etiology / Q000473:pathology
chemical_list: D004268:DNA-Binding Proteins