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Unified staging system for Lewy body disorders: correlation with nigrostriatal degeneration, cognitive impairment and motor dysfunction.
Acta Neuropathol. 2009 Jun; 117(6):613-34.AN

Abstract

The two current major staging systems in use for Lewy body disorders fail to classify up to 50% of subjects. Both systems do not allow for large numbers of subjects who have Lewy-type alpha-synucleinopathy (LTS) confined to the olfactory bulb or who pass through a limbic-predominant pathway that at least initially bypasses the brainstem. The results of the current study, based on examination of a standard set of ten brain regions from 417 subjects stained immunohistochemically for alpha-synuclein, suggest a new staging system that, in this study, allows for the classification of all subjects with Lewy body disorders. The autopsied subjects included elderly subjects with Parkinson's disease, dementia with Lewy bodies, incidental Lewy body disease and Alzheimer's disease with Lewy bodies, as well as comparison groups without Lewy bodies. All subjects were classifiable into one of the following stages: I. Olfactory Bulb Only; IIa Brainstem Predominant; IIb Limbic Predominant; III Brainstem and Limbic; IV Neocortical. Progression of subjects through these stages was accompanied by a generally stepwise worsening in terms of striatal tyrosine hydroxylase concentration, substantia nigra pigmented neuron loss score, Mini Mental State Examination score and score on the Unified Parkinson's Disease Rating Scale Part 3. Additionally, there were significant correlations between these measures and LTS density scores. It is suggested that the proposed staging system would improve on its predecessors by allowing classification of a much greater proportion of cases.

Authors+Show Affiliations

Sun Health Research Institute, Sun City, AZ 85351, USA. thomas.beach@bannerhealth.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19399512

Citation

Beach, Thomas G., et al. "Unified Staging System for Lewy Body Disorders: Correlation With Nigrostriatal Degeneration, Cognitive Impairment and Motor Dysfunction." Acta Neuropathologica, vol. 117, no. 6, 2009, pp. 613-34.
Beach TG, Adler CH, Lue L, et al. Unified staging system for Lewy body disorders: correlation with nigrostriatal degeneration, cognitive impairment and motor dysfunction. Acta Neuropathol. 2009;117(6):613-34.
Beach, T. G., Adler, C. H., Lue, L., Sue, L. I., Bachalakuri, J., Henry-Watson, J., Sasse, J., Boyer, S., Shirohi, S., Brooks, R., Eschbacher, J., White, C. L., Akiyama, H., Caviness, J., Shill, H. A., Connor, D. J., Sabbagh, M. N., & Walker, D. G. (2009). Unified staging system for Lewy body disorders: correlation with nigrostriatal degeneration, cognitive impairment and motor dysfunction. Acta Neuropathologica, 117(6), 613-34. https://doi.org/10.1007/s00401-009-0538-8
Beach TG, et al. Unified Staging System for Lewy Body Disorders: Correlation With Nigrostriatal Degeneration, Cognitive Impairment and Motor Dysfunction. Acta Neuropathol. 2009;117(6):613-34. PubMed PMID: 19399512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unified staging system for Lewy body disorders: correlation with nigrostriatal degeneration, cognitive impairment and motor dysfunction. AU - Beach,Thomas G, AU - Adler,Charles H, AU - Lue,LihFen, AU - Sue,Lucia I, AU - Bachalakuri,Jyothi, AU - Henry-Watson,Jonette, AU - Sasse,Jeanne, AU - Boyer,Sarah, AU - Shirohi,Scophil, AU - Brooks,Reed, AU - Eschbacher,Jennifer, AU - White,Charles L,3rd AU - Akiyama,Haru, AU - Caviness,John, AU - Shill,Holly A, AU - Connor,Donald J, AU - Sabbagh,Marwan N, AU - Walker,Douglas G, AU - ,, Y1 - 2009/04/28/ PY - 2008/12/18/received PY - 2009/04/10/accepted PY - 2009/04/08/revised PY - 2009/4/29/entrez PY - 2009/4/29/pubmed PY - 2009/6/19/medline SP - 613 EP - 34 JF - Acta neuropathologica JO - Acta Neuropathol VL - 117 IS - 6 N2 - The two current major staging systems in use for Lewy body disorders fail to classify up to 50% of subjects. Both systems do not allow for large numbers of subjects who have Lewy-type alpha-synucleinopathy (LTS) confined to the olfactory bulb or who pass through a limbic-predominant pathway that at least initially bypasses the brainstem. The results of the current study, based on examination of a standard set of ten brain regions from 417 subjects stained immunohistochemically for alpha-synuclein, suggest a new staging system that, in this study, allows for the classification of all subjects with Lewy body disorders. The autopsied subjects included elderly subjects with Parkinson's disease, dementia with Lewy bodies, incidental Lewy body disease and Alzheimer's disease with Lewy bodies, as well as comparison groups without Lewy bodies. All subjects were classifiable into one of the following stages: I. Olfactory Bulb Only; IIa Brainstem Predominant; IIb Limbic Predominant; III Brainstem and Limbic; IV Neocortical. Progression of subjects through these stages was accompanied by a generally stepwise worsening in terms of striatal tyrosine hydroxylase concentration, substantia nigra pigmented neuron loss score, Mini Mental State Examination score and score on the Unified Parkinson's Disease Rating Scale Part 3. Additionally, there were significant correlations between these measures and LTS density scores. It is suggested that the proposed staging system would improve on its predecessors by allowing classification of a much greater proportion of cases. SN - 1432-0533 UR - https://www.unboundmedicine.com/medline/citation/19399512/Unified_staging_system_for_Lewy_body_disorders:_correlation_with_nigrostriatal_degeneration_cognitive_impairment_and_motor_dysfunction_ L2 - https://dx.doi.org/10.1007/s00401-009-0538-8 DB - PRIME DP - Unbound Medicine ER -