Original Paper

Acta Neuropathologica

, Volume 119, Issue 6, pp 703-713

First online:

Lewy pathology in the submandibular gland of individuals with incidental Lewy body disease and sporadic Parkinson’s disease

  • Kelly Del TrediciAffiliated withClinical Neuroanatomy, Center for Clinical Research, Department of Neurology, University of Ulm Email author 
  • , Christopher H. HawkesAffiliated withNeuroscience Centre, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry
  • , Estifanos GhebremedhinAffiliated withDepartment of Anatomy and Developmental Biology, School of Biomedical Sciences, University of QueenslandLaboratory for Neuropathology, Institute of Pathology, Center for Clinical Research, University of Ulm
  • , Heiko BraakAffiliated withClinical Neuroanatomy, Center for Clinical Research, Department of Neurology, University of Ulm

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A retrospective autopsy-based study of the human submandibular gland, one of the three major salivary glands, together with anatomically related peripheral structures (cervical superior ganglion, cervical sympathetic trunk, vagal nerve at the level of the carotid bifurcation), was conducted on a cohort consisting of 33 individuals, including 9 patients with neuropathologically confirmed Parkinson’s disease (PD), three individuals with incidental Lewy body disease (iLBD), 2 individuals with neuropathologically confirmed multiple system atrophy (MSA), and 19 controls, using α-synuclein immunohistochemistry in 100 μm polyethylene glycol-embedded tissue sections. Lewy pathology (LP) was present in the submandibular glands and cervical superior ganglia in PD (9/9 cases) and iLBD (2/3 cases) but not in MSA or controls. The cervical sympathetic trunk (7/9 PD cases, 2/3 iLBD cases) and peripheral vagal nerves (9/9 PD cases, 2/3 iLBD cases) also displayed LP. The results are discussed within the context of hyposmia as well as autonomic dysfunction in PD (sialorrhea, sialopenia, dysphagia). Potential disease-related changes in salivary volume, contents, and viscosity might make it possible, in combination with other tests, to employ human saliva as a biomarker.


Alpha-synuclein Autonomic nervous system/ganglia Dysphagia Esophagus Lewy body disease Lewy neurites Parkinson’s disease Peripheral nervous system Sialopenia Sialorrhea Submandibular gland Superior cervical ganglion Synucleinopathy