Consensus Paper

Acta Neuropathologica

, Volume 123, Issue 1, pp 1-11

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, University of Washington School of MedicineDepartment of Pathology, SUNY Downstate Medical Center
    • , Peter T. NelsonAffiliated withDepartment of Pathology, University of Washington School of MedicineSanders-Brown Center on Aging, University of Kentucky
    • , Julie A. SchneiderAffiliated withDepartment of Pathology, University of Washington School of MedicineDepartments of Pathology and Neurological Sciences, Rush Alzheimer’s Disease Center, Rush University Medical Center
    • , Dietmar Rudolf ThalAffiliated withDepartment of Pathology, University of Washington School of MedicineLaboratory of Neuropathology, Institute of Pathology, University of Ulm
    • , John Q. TrojanowskiAffiliated withDepartment of Pathology, University of Washington School of MedicineDepartment of Pathology and Laboratory Medicine, Institute on Aging, Center for Neurodegenerative Disease Research, University of Pennsylvania School of Medicine
    • , Harry V. VintersAffiliated withDepartment of Pathology, University of Washington School of MedicineDepartments of Pathology & Laboratory Medicine (Neuropathology) and Neurology, University of California Los Angeles
    • , Bradley T. HymanAffiliated withDepartment of Pathology, University of Washington School of MedicineNeurology Department, Massachusetts General Hospital, Harvard University

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Abstract

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.