Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
J Neuropathol Exp Neurol. 2023 Jan 20;82(2):103-109. doi: 10.1093/jnen/nlac114.
Concerns about the costs associated with autopsy assessment of Alzheimer disease and related dementias according to 2012 NIA-AA Guidelines have been expressed since the publication of those guidelines. For this reason, we designed and validated a Condensed Protocol for the neuropathologic diagnoses of Alzheimer disease neuropathologic change, Lewy Body disease neuropathologic change, as well as chronic microvascular lesions, hippocampal sclerosis of aging, and cerebral amyloid angiopathy. In this study, the Condensed Protocol is updated to include frontotemporal lobar degeneration [FTLD] tau (corticobasal degeneration, progressive supranuclear palsy, and Pick disease), FTLD-TDP, and limbic-predominant, age-related TDP-43 encephalopathy. The same 20 brain regions are sampled and processed in 5 tissue cassettes, which reduces reagent costs by approximately 65%. Three board-certified neuropathologists were blinded to the original Northwestern University Alzheimer's Disease Research Center Original Protocol neuropathological diagnoses and all clinical history information. The results yielded near uniform agreement with the original comprehensive Alzheimer's Disease Research Center neuropathologic assessments. Diagnostic sensitivity was not impacted. In summary, our recent results show that our updated Condensed Protocol is also an accurate and less expensive alternative to the comprehensive protocols for the additional neuropathologic diagnoses of FTLD Tau and TDP43 proteinopathies.
自这些指南发布以来，人们一直对根据 2012 年 NIA-AA 指南进行阿尔茨海默病尸检评估相关成本表示担忧。出于这个原因，我们设计并验证了一个简化协议，用于阿尔茨海默病神经病理改变、路易体病神经病理改变以及慢性微血管病变、老化性海马硬化和脑淀粉样血管病的神经病理学诊断。在这项研究中，简化协议进行了更新，以包括额颞叶变性[FTLD]tau（皮质基底节变性、进行性核上性麻痹和 Pick 病）、FTLD-TDP 和边缘为主、与年龄相关的 TDP-43 脑病。相同的 20 个脑区在 5 个组织盒中进行采样和处理，这将试剂成本降低了约 65%。三位经过 board-certified 的神经病理学家对原始的西北大学阿尔茨海默病研究中心原始协议神经病理学诊断和所有临床病史信息进行了盲法评估。结果与原始的阿尔茨海默病研究中心神经病理学评估非常一致。诊断灵敏度没有受到影响。总之，我们最近的结果表明，我们的更新的简化协议也是一个准确且更经济的替代方案，用于 FTLD Tau 和 TDP43 蛋白病的额外神经病理学诊断。
