Stages in the development of Parkinson’s disease-related pathology

Abstract

The synucleinopathy, idiopathic Parkinson’s disease, is a multisystem disorder that involves only a few predisposed nerve cell types in specific regions of the human nervous system. The intracerebral formation of abnormal proteinaceous Lewy bodies and Lewy neurites begins at defined induction sites and advances in a topographically predictable sequence. As the disease progresses, components of the autonomic, limbic, and somatomotor systems become particularly badly damaged. During presymptomatic stages 1–2, inclusion body pathology is confined to the medulla oblongata/pontine tegmentum and olfactory bulb/anterior olfactory nucleus. In stages 3–4, the substantia nigra and other nuclear grays of the midbrain and forebrain become the focus of initially slight and, then, severe pathological changes. At this point, most individuals probably cross the threshold to the symptomatic phase of the illness. In the end-stages 5–6, the process enters the mature neocortex, and the disease manifests itself in all of its clinical dimensions.

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Acknowledgements

We thank Jürgen Bohl (Department of Pathology, Johannes Gutenberg University, Mainz) and Rob A.I. de Vos (Laboratorium Pathologie Oost Nederland, Enschede) for autopsy material, and Ms. I. Szász-Jacobi for her skillful technical support with the graphics.

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Correspondence to Heiko Braak.

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Funding for this project was made available by the German Research Council (Deutsche Forschungsgemeinschaft)

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Braak, H., Ghebremedhin, E., Rüb, U. et al. Stages in the development of Parkinson’s disease-related pathology. Cell Tissue Res 318, 121–134 (2004). https://doi.org/10.1007/s00441-004-0956-9

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Keywords

  • Alpha-synuclein
  • Lewy bodies
  • Lewy neurites
  • Parkinson’s disease
  • Pathoarchitectonics
  • Staging