title: Early Stage of Progressive Supranuclear Palsy: A Neuropathological Study of 324 Consecutive Autopsy Cases.
abstract: Diagnosing clinical progressive supranuclear palsy (PSP) is challenging. We hypothesize that there are more cases of pathological PSP than have been clinically identified, but its diagnosis is challenging because the initial lesions and progression of PSP have not yet been clarified. The purpose of our study was to clarify the incidence of PSP in consecutive autopsy cases and identify pathological characteristics of early PSP. We investigated 324 consecutive autopsy patients from a general geriatric hospital (age, mean±SD=82.5±8.7 years). Paraffin sections of the midbrain were immunostained with anti 4-repeat tau antibodies (RD4). We selected cases showing RD4-positive neurofibrillary tangles and tufted astrocytes in the midbrain sections. Then, we used anti-phosphorylated tau antibody to immunostain sections from the basal ganglia, subthalamic nucleus, midbrain, pons, medulla, and cerebellum. Of the 324 patients, 35 had RD4-positive structures in the midbrain. From these 35 cases, we excluded those for which autopsies confirmed definite PSP (n=5) and cases of corticobasal degeneration (n=1), Alzheimer's disease (n=11), dementia of grain (n=10), and neurofibrillary tangles predominant forms of senile dementia (n=2), leaving 8 cases. We diagnosed these 8 cases as pure PSP-type tauopathy. Pure PSP-type tauopathy was detected in 2.5% of the consecutive autopsy cases, and this incidence was 1.6 times greater than that of neuropathologically definite PSP. This pure PSP-type tauopathy likely indicates preclinical stages of PSP. Furthermore, the novel neuropathological finding, which we term "preclinical PSP," is unique and has not previously been reported. In order to elucidate the causes and pathological mechanisms of PSP, preclinical PSP should be investigated further.
authors.affiliation: Department of Neuropathology and Neurology, Tokyo Metropolitan Geriatric Hospital & Institute of Gerontology.
authors.forename: Akane
authors.initials: A
authors.lastname: Nogami
authors.forename: Mineo
authors.initials: M
authors.lastname: Yamazaki
authors.forename: Yuko
authors.initials: Y
authors.lastname: Saito
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hatsuta
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Sakiyama
authors.forename: Masaki
authors.initials: M
authors.lastname: Takao
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Shigeo
authors.initials: S
authors.lastname: Murayama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000378:metabolism; D016229:Amyloid beta-Peptides / Q000378:metabolism; D001344:Autopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008636:Mesencephalon / Q000378:metabolism / Q000473:pathology*; D008875:Middle Aged; D016874:Neurofibrillary Tangles / Q000378:metabolism / Q000473:pathology; D012720:Severity of Illness Index; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis* / Q000378:metabolism; D024801:Tauopathies / Q000175:diagnosis* / Q000378:metabolism; D051844:alpha-Synuclein / Q000378:metabolism; D016875:tau Proteins / Q000378:metabolism
chemical_list: D016229:Amyloid beta-Peptides; D051844:alpha-Synuclein; D016875:tau Proteins