Neuropathologic Findings of Dementia with Lewy Bodies (DLB) in a Population-based Vantaa 85+ Study

Issue title: Mini-Forum: Clinical-Pathologic Correlations in Population- and Community-Based Studies of Brain Aging

Guest editors: Thomas Montine and Joshua Sonnen

Article type: Research Article

Authors: Oinas, Minna^{a; b; *} | Polvikoski, Tuomo^c | Sulkava, Raimo^d | Myllykangas, Liisa^{a; e} | Juva, Kati^f | Notkola, Irma-Leena^g | Rastas, Sari^h | Niinistö, Leenaⁱ | Kalimo, Hannu^a | Paetau, Anders^a

Affiliations: [a] Department of Pathology, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland | [b] Department of Neurosurgery, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland | [c] Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK | [d] School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, and Rheumatism Foundation Hospital, Heinola, Finland | [e] Folkhälsan institute of Genetics, Helsinki, Finland | [f] Department of Psychiatry, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland | [g] Finnish Information Centre for Register Research, Helsinki, Finland | [h] Kauniala Disabled, War Veterans Hospital, Kauniainen, Finland | [i] Katriina Geriatric Hospital, Vantaa, Finland

Correspondence: [*] Corresponding author: Minna Oinas, Department of Pathology, University of Helsinki, P.O. Box 21 (Haartmaninkatu 3), FI-00014 University of Helsinki, Helsinki, Finland. Tel.: +358 50 576 8677; Fax: +358 9 191 26551; E-mail: minna.oinas@helsinki.fi.

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.

Keywords: Aging, α-synuclein, Alzheimer's disease, dementia with Lewy bodies, Lewy-related pathology, neurofibrillary pathology, population-based study

DOI: 10.3233/JAD-2009-1169

Journal: Journal of Alzheimer's Disease, vol. 18, no. 3, pp. 677-689, 2009