Acta Neuropathologica

, Volume 119, Issue 6, pp 715–722 | Cite as

α-Synuclein pathology in the spinal cord autonomic nuclei associates with α-synuclein pathology in the brain: a population-based Vantaa 85+ study

  • Minna Oinas
  • Anders Paetau
  • Liisa Myllykangas
  • Irma-Leena Notkola
  • Hannu Kalimo
  • Tuomo Polvikoski
Original Paper


In most subjects with Parkinson’s disease and dementia with Lewy bodies, α-synuclein (αS) immunoreactive pathology is found not only in the brain but also in the autonomic nuclei of the spinal cord. However, neither has the temporal course of αS pathology in the spinal cord in relation to the brain progression been established, nor has the extent of αS pathology in the spinal cord been analyzed in population-based studies. Using immunohistochemistry, the frequency and distribution of αS pathology were assessed semiquantitatively in the brains and spinal cord nuclei of 304 subjects who were aged at least 85 in the population-based Vantaa 85+ study. αS pathology was common in the spinal cord; 102 (34%) subjects had classic αS pathology in the thoracic and/or sacral autonomic nuclei. Moreover, 134 (44%) subjects showed grain- or dot-like immunoreactivity in neuropil (mini-aggregates) without classic Lewy neurites or Lewy bodies (LBs). The latter type of αS accumulation is associated with age, but also the classic αS pathology was found more often in the oldest compared to the youngest age group. The severity of αS pathology in the spinal cord autonomic nuclei is significantly associated with the extent and severity of αS pathology in the brain. Of the subjects, 60% with moderate to severe thoracic αS pathology and up to 89% with moderate to severe sacral αS pathology had diffuse neocortical type of LB pathology in the brain. αS pathology exclusively in the spinal cord was rare. Our study indicates that in general αS pathology in the spinal cord autonomic nuclei is associated with similar pathology in the brain.


α-Synuclein Spinal cord Dementia with Lewy bodies Parkinson’s disease Population-based study αS pathology Lewy-related pathology 



The authors thank Mrs Tuija Järvinen for excellent technical assistance. This study was financially supported by the Finnish Medical Foundation and the Helsinki University Central Hospital competitive research fund (EVO).

Conflict of interest statement

The authors report no conflicts of interest.


  1. 1.
    Barkhof F, Polvikoski TM, van Straaten EC, Kalaria RN, Sulkava R, Aronen HJ, Niinisto L, Rastas S, Oinas M, Scheltens P, Erkinjuntti T (2007) The significance of medial temporal lobe atrophy: a postmortem MRI study in the very old. Neurology 69:1521–1527CrossRefPubMedGoogle Scholar
  2. 2.
    Beach TG, Adler CH, Lue L, Sue LI, Bachalakuri J, Henry-Watson J, Sasse J, Boyer S, Shirohi S, Brooks R, Eschbacher J, White CL III, Akiyama H, Caviness J, Shill HA, Connor DJ, Sabbagh MN, Walker DG, Arizona Parkinson’s Disease Consortium (2009) Unified staging system for Lewy body disorders: correlation with nigrostriatal degeneration, cognitive impairment and motor dysfunction. Acta Neuropathol (Berl) 117:613–634CrossRefGoogle Scholar
  3. 3.
    Beach TG, White CL, Hamilton RL, Duda JE, Iwatsubo T, Dickson DW, Leverenz JB, Roncaroli F, Buttini M, Hladik CL, Sue LI, Noorigian JV, Adler CH (2008) Evaluation of alpha-synuclein immunohistochemical methods used by invited experts. Acta Neuropathol (Berl) 116:277–288CrossRefGoogle Scholar
  4. 4.
    Bloch A, Probst A, Bissig H, Adams H, Tolnay M (2006) Alpha-synuclein pathology of the spinal and peripheral autonomic nervous system in neurologically unimpaired elderly subjects. Neuropathol Appl Neurobiol 32:284–295CrossRefPubMedGoogle Scholar
  5. 5.
    Braak H, Braak E (1991) Neuropathological stageing of Alzheimer-related changes. Acta Neuropathol (Berl) 82:239–259CrossRefGoogle Scholar
  6. 6.
    Braak H, Del Tredici K, Rub U, de Vos RA, Jansen Steur EN, Braak E (2003) Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 24:197–211CrossRefPubMedGoogle Scholar
  7. 7.
    Braak H, Muller CM, Rub U, Ackermann H, Bratzke H, de Vos RA, Del Tredici K (2006) Pathology associated with sporadic Parkinson’s disease—where does it end? J Neural Transm Suppl 70:89–97Google Scholar
  8. 8.
    Del Tredici K, Rub U, De Vos RA, Bohl JR, Braak H (2002) Where does parkinson disease pathology begin in the brain? J Neuropathol Exp Neurol 61:413–426PubMedGoogle Scholar
  9. 9.
    Halliday G, Hely M, Reid W, Morris J (2008) The progression of pathology in longitudinally followed patients with Parkinson’s disease. Acta Neuropathol (Berl) 115:409–415CrossRefGoogle Scholar
  10. 10.
    Jellinger KA (2008) A critical reappraisal of current staging of Lewy-related pathology in human brain. Acta Neuropathol (Berl) 116:1–16CrossRefGoogle Scholar
  11. 11.
    Kaufmann H, Biaggioni I (2003) Autonomic failure in neurodegenerative disorders. Semin Neurol 23:351–363CrossRefPubMedGoogle Scholar
  12. 12.
    Kaufmann H, Hague K, Perl D (2001) Accumulation of alpha-synuclein in autonomic nerves in pure autonomic failure. Neurology 56:980–981PubMedGoogle Scholar
  13. 13.
    Kaufmann H, Nahm K, Purohit D, Wolfe D (2004) Autonomic failure as the initial presentation of Parkinson disease and dementia with Lewy bodies. Neurology 63:1093–1095PubMedGoogle Scholar
  14. 14.
    Klos KJ, Ahlskog JE, Josephs KA, Apaydin H, Parisi JE, Boeve BF, DeLucia MW, Dickson DW (2006) Alpha-synuclein pathology in the spinal cords of neurologically asymptomatic aged individuals. Neurology 66:1100–1102CrossRefPubMedGoogle Scholar
  15. 15.
    McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, Salmon DP, Lowe J, Mirra SS, Byrne EJ, Lennox G, Quinn NP, Edwardson JA, Ince PG, Bergeron C, Burns A, Miller BL, Lovestone S, Collerton D, Jansen EN, Ballard C, de Vos RA, Wilcock GK, Jellinger KA, Perry RH (1996) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 47:1113–1124PubMedGoogle Scholar
  16. 16.
    McKeith IGFM, Dickson DW, Lowe JDM, Emre M, O’Brien JTDM, Feldman HCM, Cummings J, Duda JE, Lippa C, Perry EKDS, Aarsland D, Arai H, Ballard CG, Boeve B, Burn DJFRCP, Costa D, Del Ser T, Dubois B, Galasko D, Gauthier SFRCPC, Goetz CG, GomezTortosa E, Halliday G, Hansen LA, Hardy J, Iwatsubo T, Kalaria RNFRCP, Kaufer D, Kenny RA, Korczyn A, Kosaka K, Lee VMY, Lees A, Litvan I, Londos E, Lopez OL, Minoshima S, Mizuno Y, Molina JA, MukaetovaLadinska EB, Pasquier F, Perry RHDS, Schulz JB, Trojanowski JQ, Yamada M, for the Consortium on DLB (2005) Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 65:1863–1872CrossRefPubMedGoogle Scholar
  17. 17.
    Minguez-Castellanos A, Chamorro CE, Escamilla-Sevilla F, Ortega-Moreno A, Rebollo AC, Gomez-Rio M, Concha A, Munoz DG (2007) Do alpha-synuclein aggregates in autonomic plexuses predate Lewy body disorders? A cohort study. Neurology 68:2012–2018CrossRefPubMedGoogle Scholar
  18. 18.
    Oinas M, Polvikoski T, Sulkava R, Myllykangas L, Juva K, Notkola I-L, Rastas S, Niinistö L, Kalimo H, Paetau A (2009) Neuropathologic findings of Dementia with Lewy bodies (DLB) in a population-based Vantaa 85+ study. J Alzheimers Dis 18:677–689PubMedGoogle Scholar
  19. 19.
    Oinas M, Sulkava R, Polvikoski T, Kalimo H, Paetau A (2007) Reappraisal of a consecutive autopsy series of patients with primary degenerative dementia: Lewy-related pathology. APMIS 115:820–827CrossRefPubMedGoogle Scholar
  20. 20.
    Parkkinen L, Pirttila T, Alafuzoff I (2008) Applicability of current staging/categorization of alpha-synuclein pathology and their clinical relevance. Acta Neuropathol (Berl) 115:399–407CrossRefGoogle Scholar
  21. 21.
    Polvikoski T, Kalaria RN, Perry R, Miller V, Kenny RA (2006) Carotid sinus hypersensitivity associated with focal alpha-synucleinopathy of the autonomic nervous system. J Neurol Neurosurg Psychiatry 77:1064–1066CrossRefPubMedGoogle Scholar
  22. 22.
    Polvikoski T, Sulkava R, Myllykangas L, Notkola IL, Niinisto L, Verkkoniemi A, Kainulainen K, Kontula K, Perez-Tur J, Hardy J, Haltia M (2001) Prevalence of Alzheimer’s disease in very elderly people: a prospective neuropathological study. Neurology 56:1690–1696PubMedGoogle Scholar
  23. 23.
    Probst A, Bloch A, Tolnay M (2008) New insights into the pathology of Parkinson’s disease: does the peripheral autonomic system become central? Eur J Neurol 15:1–4CrossRefPubMedGoogle Scholar
  24. 24.
    Spillantini MG, Crowther RA, Jakes R, Hasegawa M, Goedert M (1998) alpha-Synuclein in filamentous inclusions of Lewy bodies from Parkinson’s disease and dementia with lewy bodies. Proc Natl Acad Sci USA 95:6469–6473CrossRefPubMedGoogle Scholar
  25. 25.
    Wakabayashi K, Takahashi H (1997) Neuropathology of autonomic nervous system in Parkinson’s disease. Eur Neurol 38:2–7CrossRefPubMedGoogle Scholar
  26. 26.
    Zaccai J, Brayne C, McKeith I, Matthews F, Ince PG, MRC Cognitive Function, Ageing Neuropathology Study (2008) Patterns and stages of alpha-synucleinopathy: relevance in a population-based cohort. Neurology 70:1042–1048CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Minna Oinas
    • 1
    • 2
  • Anders Paetau
    • 1
  • Liisa Myllykangas
    • 1
  • Irma-Leena Notkola
    • 3
  • Hannu Kalimo
    • 1
  • Tuomo Polvikoski
    • 4
  1. 1.Department of Pathology, Helsinki University Central HospitalUniversity of HelsinkiHelsinkiFinland
  2. 2.Department of Neurosurgery, Helsinki University Central HospitalUniversity of HelsinkiHelsinkiFinland
  3. 3.Finnish Information Centre for Register ResearchHelsinkiFinland
  4. 4.Institute for Ageing and Health, Campus of Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK

Personalised recommendations