Neuropathological findings of PSP in the elderly without clinical PSP: Possible incidental PSP?

Virgilio Gerald H. Evidente, Charles H. Adler, Marwan N. Sabbagh, Donald J. Connor, Joseph G. Hentz, John N. Caviness, Lucia I. Sue, Thomas G. Beach

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Aims: We aimed to describe cases with incidental neuropathological findings of progressive supranuclear palsy (PSP) from the Banner Sun Health Research Institute Brain and Body Donation Program. Methods: We performed a retrospective review of 277 subjects with longitudinal motor and neuropsychological assessments who came to autopsy. The mean Gallyas-positive PSP features grading for subjects with possible incidental neuropathological PSP was compared to those of subjects with clinically manifest disease. Results: There were 5 cases with histopathological findings suggestive of PSP, but no parkinsonism, dementia or movement disorder during life. Cognitive evaluation revealed 4 of the 5 cases to be cognitively normal; one case had amnestic mild cognitive impairment (MCI) in her last year of life. The mean age at death of the 5 cases was 88.9 years (range 80-94). All 5 individuals had histopathologic microscopic findings suggestive of PSP. Mean Gallyas-positive PSP features grading was significantly lower in subjects with possible incidental neuropathological PSP than subjects with clinical PSP, particularly in the subthalamic nucleus. Conclusions: We present 5 patients with histopathological findings suggestive of PSP, without clinical PSP, dementia or parkinsonism during life. These incidental neuropathological PSP findings may represent the early or pre-symptomatic stage of PSP. The mean Gallyas-positive PSP features grading was significantly lower in possible incidental PSP than in clinical PSP, thus suggesting that a threshold of pathological burden needs to be reached within the typically affected areas in PSP before clinical signs and symptoms appear.

Original languageEnglish (US)
Pages (from-to)365-371
Number of pages7
JournalParkinsonism and Related Disorders
Volume17
Issue number5
DOIs
StatePublished - Jun 1 2011

Keywords

  • Autopsy
  • Incidental
  • Neuropathology
  • PSP
  • Parkinsonism
  • Progressive supranuclear palsy

ASJC Scopus subject areas

  • Neurology
  • Geriatrics and Gerontology
  • Clinical Neurology

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