Consensus Paper

Acta Neuropathologica

, Volume 123, Issue 1, pp 1-11

First online:

National Institute on Aging–Alzheimer’s Association guidelines for the neuropathologic assessment of Alzheimer’s disease: a practical approach

  • Thomas J. MontineAffiliated withDepartment of Pathology, University of Washington School of Medicine Email author 
  • , Creighton H. PhelpsAffiliated withNational Institute on Aging
  • , Thomas G. BeachAffiliated withCivin Laboratory for Neuropathology, Banner Sun Health Research Institute
  • , Eileen H. BigioAffiliated withDepartment of Pathology and Northwestern Alzheimer Disease Center, Northwestern University Feinberg School of Medicine
  • , Nigel J. CairnsAffiliated withDepartments of Neurology and Pathology & Immunology, Washington University School of Medicine
  • , Dennis W. DicksonAffiliated withDepartment of Neuroscience, Mayo Clinic
  • , Charles DuyckaertsAffiliated withService de Neuropathologie Raymond Escourolle, Hôpital de la Salpêtriére
  • , Matthew P. FroschAffiliated withC.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Harvard Medical School
  • , Eliezer MasliahAffiliated withDepartments of Neurosciences and Pathology, School of Medicine, University of California, San Diego
    • , Suzanne S. MirraAffiliated withDepartment of Pathology, SUNY Downstate Medical Center
    • , Peter T. NelsonAffiliated withSanders-Brown Center on Aging, University of Kentucky
    • , Julie A. SchneiderAffiliated withDepartments of Pathology and Neurological Sciences, Rush Alzheimer’s Disease Center, Rush University Medical Center
    • , Dietmar Rudolf ThalAffiliated withLaboratory of Neuropathology, Institute of Pathology, University of Ulm
    • , John Q. TrojanowskiAffiliated withDepartment of Pathology and Laboratory Medicine, Institute on Aging, Center for Neurodegenerative Disease Research, University of Pennsylvania School of Medicine
    • , Harry V. VintersAffiliated withDepartments of Pathology & Laboratory Medicine (Neuropathology) and Neurology, University of California Los Angeles
    • , Bradley T. HymanAffiliated withNeurology Department, Massachusetts General Hospital, Harvard University

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We present a practical guide for the implementation of recently revised National Institute on Aging–Alzheimer’s Association guidelines for the neuropathologic assessment of Alzheimer’s disease (AD). Major revisions from previous consensus criteria are: (1) recognition that AD neuropathologic changes may occur in the apparent absence of cognitive impairment, (2) an “ABC” score for AD neuropathologic change that incorporates histopathologic assessments of amyloid β deposits (A), staging of neurofibrillary tangles (B), and scoring of neuritic plaques (C), and (3) more detailed approaches for assessing commonly co-morbid conditions such as Lewy body disease, vascular brain injury, hippocampal sclerosis, and TAR DNA binding protein (TDP)-43 immunoreactive inclusions. Recommendations also are made for the minimum sampling of brain, preferred staining methods with acceptable alternatives, reporting of results, and clinico-pathologic correlations.