Incidental Lewy body disease: Do some cases represent a preclinical stage of dementia with Lewy bodies?

Roberta Frigerio, Hiroshige Fujishiro, Tae Beom Ahn, Keith A. Josephs, Demetrius M. Maraganore, Anthony DelleDonne, Joseph E. Parisi, Kevin J. Klos, Bradley F. Boeve, Dennis W. Dickson, J. Eric Ahlskog

Research output: Contribution to journalArticlepeer-review

86 Scopus citations

Abstract

Lewy pathology occurs in 8-17% of neurologically normal people age >60, termed incidental Lewy body disease (iLBD). It is often assumed to represent preclinical Parkinson disease (PD). However, some iLBD cases have diffuse pathology inconsistent with preclinical PD. We analyzed iLBD cases (α-synuclein immunohistochemistry) using the Braak PD staging scheme and determined if some had a neuropathological pattern suggestive of preclinical dementia with Lewy bodies (DLB). Of the 235 brains examined, 34 had iLBD (14.5%) and all but one could be assigned a Braak PD stage. The distribution of α-synuclein pathology in the 33 cases fell into three patterns: (1) diffuse cortical and subcortical α-synuclein pathology; (2) no cortical α-synuclein pathology, but a caudal-to-rostral ascending pattern, primarily involving brainstem; and (3) intermediate between these two categories. Also, 6/33 cases failed to follow the pattern of contiguous spread proposed by Braak. These findings suggest dichotomy in the distribution of iLBD: some cases fit the Braak ascending scheme, conceptually consistent with preclinical PD, whereas others displayed prominent cortical involvement that might represent preclinical DLB.

Original languageEnglish (US)
Pages (from-to)857-863
Number of pages7
JournalNeurobiology of aging
Volume32
Issue number5
DOIs
StatePublished - May 2011

Keywords

  • Dementia with Lewy bodies
  • Incidental Lewy body disease
  • Parkinson disease

ASJC Scopus subject areas

  • Neuroscience(all)
  • Aging
  • Clinical Neurology
  • Developmental Biology
  • Geriatrics and Gerontology

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