Table of Contents
Washington University Experience | NEURODEGENERATION | Hippocampal Sclerosis of Aging | 6E Case 6 Denouement
Neuropathology Final Diagnosis ---- Alzheimer Disease Neuropathologic Change, low (ADNC, A1B2C0); Hippocampal sclerosis of aging; Aging-related tau astrogliopathy (ARTAG) ---- Neuro Diagnosis Comment: The main neuropathological findings of this case are low Alzheimer disease neuropathologic change (ADNC). Beta-amyloid plaques and neurofibrillary tangles are present in small numbers (except for the amygdala) in the majority of brain structures. In the more recent NIA-AA criteria (A1B2C0) grading scheme the findings in this case are not present at levels extensive enough to contribute definitively to dementia in this patient. In this case it is possible that tangles in the absence of beta amyloid pathology represent primary age-related tauopathy (PART) which consists of neurofibrillary tangles which are commonly observed in the brains of normally aged individuals and that can occur independently of the amyloid plaques of Alzheimer's disease. There are a few collections of tau immunoreactive astrocytes, which are consistent with aging-related tau astrocytopathy (ARTAG). There is a hint of possible argyrophilic grain disease in the amygdala which is not confirmed with Bielschowsky staining. There are no Lewy bodies to suggest the possibility of “Dementia with Parkinson Disease” in cortex or in the substantia nigra. Mild vascular pathology in the forms of arteriolosclerosis, amyloid angiopathy, and mild atherosclerosis is observed. The role of hippocampal sclerosis and patient’s dementing syndrome is unclear but would be likely to participate in her memory issues. TDP-43 deposition in the hippocampus dentate gyrus is consistent with hippocampal sclerosis of aging. Although there are scattered TDP43 inclusions in the amygdala, they are not found in the frontal or extra-hippocampal temporal lobe. A few pTau inclusions are seen in the shape of tufted astrocytes and possible glial plaques which are not accompanied by swollen neurons; the diagnosis of corticobasal degeneration or progressive supranuclear palsy is not substantially supported.
