Hippocampal sclerosis in older patients practical examples and guidance with a focus on cerebral age-related TDP-43 with sclerosis

Matthew D. Cykowski, Suzanne Z. Powell, Paul E. Schulz, Hidehiro Takei, Andreana L. Rivera, Robert E. Jackson, Gustavo Roman, Gregory A. Jicha, Peter T. Nelson

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Context.-Autopsy studies of the older population (65 years of age), and particularly of the "oldest-old" (85 years of age), have identified a significant proportion (~20%) of cognitively impaired patients in which hippocampal sclerosis is the major substrate of an amnestic syndrome. Hippocampal sclerosis may also be comorbid with frontotemporal lobar degeneration, Alzheimer disease, and Lewy body disease. Until recently, the terms hippocampal sclerosis of aging or hippocampal sclerosis dementia were applied in this context. Recent discoveries have prompted a conceptual expansion of hippocampal sclerosis of aging because (1) cellular inclusions of TAR DNA-binding protein 43 kDa (TDP-43) are frequent; (2) TDP-43 pathology may be found outside hippocampus; and (3) brain arteriolosclerosis is a common, possibly pathogenic, component. Objective.-To aid pathologists with recent recommendations for diagnoses of common neuropathologies in older persons, particularly hippocampal sclerosis, and highlight the recent shift in diagnostic terminology from HS-Aging to cerebral age-related TDP-43 with sclerosis (CARTS). Data Sources.-Peer-reviewed literature and 5 autopsy examples that illustrate common age-related neuropathologies, including CARTS, and emphasize the importance of distinguishing CARTS from late-onset frontotemporal lobar degeneration with TDP-43 pathology and from advanced Alzheimer disease with TDP-43 pathology. Conclusions.-In advanced old age, the substrates of cognitive impairment are often multifactorial. This article demonstrates common and frequently comorbid neuropathologic substrates of cognitive impairment in the older population, including CARTS, to aid those practicing in this area of pathology.

Original languageEnglish (US)
Pages (from-to)1113-1126
Number of pages14
JournalArchives of Pathology and Laboratory Medicine
Volume141
Issue number8
DOIs
StatePublished - Aug 2017

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Fingerprint Dive into the research topics of 'Hippocampal sclerosis in older patients practical examples and guidance with a focus on cerebral age-related TDP-43 with sclerosis'. Together they form a unique fingerprint.

Cite this