Alzheimer

Rules Updated for Postmortem Dx of Alzheimer's

By John Gever, Senior Editor, MedPage Today Published: January 18, 2012 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. A new guideline for the National Institute on Aging and the Alzeimer's Association recommends the "ABC" system for standardizing neuropathologic staging of Alzheimer's brain pathology on autopsy. Note that the "ABC" system scores beta-amyloid plaques, neurofibrillary tangles, and neuritic plaques for an assessment of neuropathologic changes of Alzheimer's independent of premortem cognitive impairment. Individuals who were cognitively normal at the time of death can nevertheless be diagnosed with Alzheimer's disease on the basis of autopsy findings alone, according to new guidelines endorsed by the National Institute on Aging (NIA) and the Alzheimer's Association. The guidelines for postmortem assessment of Alzheimer's disease, which replace criteria issued in 1997, also call on pathologists to base diagnoses on an "ABC" risk score that combines assessments of beta-amyloid plaques, neurofibrillary tangles, and neuritic plaques. Also new to the guidelines are specific protocols for evaluating other pathologies related to cognitive impairment and dementia, such as Lewy body disease, vascular brain injury, and hippocampal sclerosis. The new guidelines were developed by a team led by Thomas Montine, MD, of the University of Washington in Seattle, and Bradley Hyman, MD, of Massachusetts General Hospital in Boston. They were published in two papers: one in the January issue of Acta Neuropathologica describing the practical assessment, and another online in Alzheimer's & Dementiathat reviewed the evidence base for the update./.../