Lewy body pathology in normal elderly subjects

Abstract

Lewy bodies and Lewy neurites are the hallmark neuropathologic findings in Parkinson disease, Parkinson disease with dementia, dementia with Lewy bodies, and other alpha-synucleinopathies. They have also been described in the brains of normal older individuals and referred to as incidental Lewy body disease. The purpose of this study was to determine the prevalence of Lewy bodies and Lewy neurites (Lewy body pathology [LBP]) in 139 autopsies from our normal volunteer control group of the University of Kentucky Alzheimer's Disease Center. All subjects were followed longitudinally and were cognitively normal and without any type of movement disorder, neuropsychiatric features, or other CNS findings. The brains of 33 of 139 normal subjects contained LBP in various regions. The most common regions involved were the medulla (26%), amygdala (24%), pons (20%), and midbrain (20%). No mean statistical differences were found between those with and without LBP on any demographic or cognitive variable, Braak stage, or neurofibrillary tangle and neuritic plaque quantitation. An explanation for the high prevalence of LBP in our elderly, well-educated study group is not clear, although it does not seem to be related to aging or the presence of Alzheimer disease pathology. Overall, our findings support the concept that incidental Lewy body disease most likely represents preclinical or presymptomatic Parkinson disease, Parkinson disease with dementia, or dementia with Lewy bodies.

FIGURE

All figures are alpha-synuclein immunostained. (Magnifications are the original magnifications.) Moderate (Grade 2)Lewy body and Lewy neurite formation in the dorsal motor glossopharyngeal/vagal complex of the medulla (40x). Inset: Two Lewy bodies (arrows) (A) (200x). Moderate (Grade 2)Lewy bodies in the locus ceruleus (arrows) (B) (400x). Moderate (Grade 2)Lewy bodies (arrows) and Lewy neurites in a portion of the substantia nigra (100x). Inset: Higher magnification of Lewy body (C) (500x). Severe (Grade 3)involvement of amygdala with many Lewy bodies and Lewy neurites (D) (200x). Moderate (Grade 2)Lewy body and Lewy neurite formation in the nucleus basalis of Meynert (E) (300x). Mild (Grade 1)Lewy body formation in the temporal pole cortex (F) (100x.)