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Acta Neuropathol. 2019 Sep 7. doi: 10.1007/s00401-019-02071-3. [Epub ahead of print]

Lewy-related pathology exhibits two anatomically and genetically distinct progression patterns: a population-based study of Finns aged 85.

Author information

1
Department of Pathology, HUSLAB, Helsinki University Hospital, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland.
2
Translational Immunology, Research Programs Unit, University of Helsinki, Helsinki, Finland.
3
Department of Neurology, Helsinki University Hospital, P.O. Box 63, 00014, Helsinki, Finland.
4
Department of Pathology, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland.
5
Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland.
6
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
7
Department of Pathology, HUSLAB, Helsinki University Hospital, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland. liisa.myllykangas@helsinki.fi.

Abstract

According to a generally accepted concept Lewy-related pathology (LRP) follows hierarchical caudo-rostral progression. LRP is also frequently present concomitantly with Alzheimer's disease (AD), and it has been hypothesized that AD-associated LRP forms a distinct type of α-synucleinopathy, where LRP originates in the amygdala. The frequency of distinct forms of LRP progression types has not been studied in a population-based setting. We investigated the distribution and progression of LRP and its relation to AD pathology and apolipoprotein (APOE) ε4 in a population-based sample of Finns aged over 85 years (N = 304). Samples from spinal cord to neocortical areas representing 11 anatomical sites without any hierarchical selection were analyzed immunohistochemically (α-synuclein antibody clone 5G4). LRP was present in 124 individuals (41%) and according to DLB Consortium guidelines 19 of them were categorized as brainstem, 10 amygdala-predominant, 41 limbic, and 43 diffuse neocortical type, whereas 11 could not be classified. To determine the LRP progression patterns, a systematic anatomical scoring was carried out by taking into account the densities of the semiquantitative LRP scores in each anatomic site. With this scoring 123 (99%) subjects could be classified into two progression pattern types: 67% showed caudo-rostral and 32% amygdala-based progression. The unsupervised statistical K-means cluster analysis was used as a supplementary test and supported the presence of two progression patterns and had a 90% overall concordance with the systematic anatomical scoring method. Severe Braak NFT stage, high CERAD score and APOE ε4 were significantly (all p < 0.00001) associated with amygdala-based, but not with caudo-rostral progression type (all p > 0.2). This population-based study demonstrates two distinct common LRP progression patterns in the very elderly population. The amygdala-based pattern was associated with APOE ε4 and AD pathology. The results confirm the previous progression hypotheses but also widen the concept of the AD-associated LRP.

KEYWORDS:

Aged, 80 and over; Alzheimer’s disease; Lewy body diseases; Lewy-related pathology; Population-based; α-Synuclein

PMID:
31494694
DOI:
10.1007/s00401-019-02071-3

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