Most cases with Lewy pathology in a population-based cohort adhere to the Braak progression pattern but 'failure to fit' is highly dependent on staging system applied. (July 2019)

• Record Type: Journal Article
• Authors: Coughlin, David G.; Petrovitch, Helen; White, Lon R.; Noorigian, Joseph; Masaki, Kamal H.; Ross, G. Webster; Duda, John E.
• Is Part Of: Parkinsonism & related disorders. Volume 64(2019)
• Page Start: 124
• Page End: 131
• Publication Date: 2019-07
• Subjects: Lewy body -- Braak staging -- Parkinson's disease -- Incidental lewy body disease -- Dementia with lewy bodies; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2019.03.023
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Braak et al.'s 2003 paper detailing the caudo-rostral progression of Lewy body pathology (LP) formed the foundation of current understanding of disease spread in Parkinson's disease (PD); however, its methods are difficult to recreate and consequently multiple new staging systems emerged to recapitulate Braak's staging system using standard neuropathological methods and to account for other patterns of LP. Studies using these systems have documented widely variable rates of cases that 'fail to fit' expected patterns of LP spread. This could be due to population differences, features of individual systems, or may constitute under-recognized patterns of disease. We examined 324 neuropathological cases from the Honolulu Asia Aging Study and applied four different LP staging systems to determine the proportion of cases adhering to different staging methodologies and those that 'fail to fit' expected patterns of LP. Of 141 cases with LP (24: PD, 8: Dementia with Lewy bodies (DLB), 109: Incidental Lewy body disease (ILBD)), our application of Braak et al., 2003 classified 83.7%, Müller et al., 2005 classified 87.9%, Beach et al., 2009 classified 100%, and Leverenz et al., 2008 classified 98.6%. There were significant differences in the cases classifiable by the Leverenz and Beach systems versus the Braak and Müller systems (p < 0.001 for each). In this population-based autopsy cohort with a high prevalence of ILBD, the majority of cases were consistent with the progression characterized by the Braak et al. however, the determination of cases as atypical is highly dependent on the staging system applied. Highlights: This is a large autopsy series derived from a population-based cohort. We applied four Lewy pathology staging systems to 141 cases with Lewy pathology. The large majority of cases exhibited the expected caudo-rostral progression. 'Failure to fit' designation is highly dependent on the classification system applied.