Cited by 279Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsAmyotrophic Lateral Sclerosis Research

Hippocampal sclerosis in advanced age: clinical and pathological features

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Nelson, Peter T., Schmitt, Frederick A., Lin, Yushun, Abner, Erin L., Jicha, Gregory A., Patel, Ela, Thomason, Paula C., Neltner, Janna H. +9 more·2011·Brain

Abstract

Hippocampal sclerosis is a relatively common neuropathological finding (∼10% of individuals over the age of 85 years) characterized by cell loss and gliosis in the hippocampus that is not explained by Alzheimer's disease. Hippocampal sclerosis pathology can be associated with different underlying causes, and we refer to hippocampal sclerosis in the aged brain as hippocampal sclerosis associated with ageing. Much remains unknown about hippocampal sclerosis associated with ageing. We combined three different large autopsy cohorts: University of Kentucky Alzheimer's Disease Centre, the Nun Study and the Georgia Centenarian Study to obtain a pool of 1110 patients, all of whom were evaluated neuropathologically at the University of Kentucky. We focused on the subset of cases with neuropathology-confirmed hippocampal sclerosis (n=106). For individuals aged≥95 years at death (n=179 in our sample), each year of life beyond the age of 95 years correlated with increased prevalence of hippocampal sclerosis pathology and decreased prevalence of 'definite' Alzheimer's disease pathology. Aberrant TAR DNA protein 43 immunohistochemistry was seen in 89.9% of hippocampal sclerosis positive patients compared with 9.7% of hippocampal sclerosis negative patients. TAR DNA protein 43 immunohistochemistry can be used to demonstrate that the disease is usually bilateral even when hippocampal sclerosis pathology is not obvious by haematoxylin and eosin stains. TAR DNA protein 43 immunohistochemistry was negative on brain sections from younger individuals (n=10) after hippocampectomy due to seizures, who had pathologically confirmed hippocampal sclerosis. There was no association between cases with hippocampal sclerosis associated with ageing and apolipoprotein E genotype. Age of death and clinical features of hippocampal sclerosis associated with ageing (with or without aberrant TAR DNA protein 43) were distinct from previously published cases of frontotemporal lobar degeneration TAR DNA protein 43. To help sharpen our ability to discriminate patients with hippocampal sclerosis associated with ageing clinically, the longitudinal cognitive profile of 43 patients with hippocampal sclerosis associated with ageing was compared with the profiles of 75 controls matched for age, gender, education level and apolipoprotein E genotype. These individuals were followed from intake assessment, with 8.2 (average) longitudinal cognitive assessments. A neuropsychological profile with relatively high-verbal fluency but low word list recall distinguished the hippocampal sclerosis associated with ageing group at intake (P<0.015) and also 5.5-6.5 years before death (P<0.005). This may provide a first step in clinical differentiation of hippocampal sclerosis associated with ageing versus pure Alzheimer's disease in their earliest stages. In summary, in the largest series of autopsy-verified patients with hippocampal sclerosis to date, we characterized the clinical and pathological features associated with hippocampal sclerosis associated with ageing.

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Authors
Nelson, P. T., Schmitt, F. A., Lin, Y., Abner, E. L., Jicha, G. A., Patel, E., Thomason, P. C., Neltner, J. H., Smith, C. D., Santacruz, K. S., Sonnen, J. A., Poon, L. W., Gearing, M., Green, R. C., Woodard, J. L., Van Eldik, L. J., & Kryscio, R. J.
Affiliations
  • University of Kentucky (US)
  • University of Minnesota (US)
  • University of Washington (US)
  • University of Georgia (US)
  • Emory University (US)
  • Boston University (US)
  • Wayne State University (US)
Venue
Brain
Published
2011-05
Volume
134
Issue
5
Pages
1506-1518
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
OpenAlex
W2059980851
Cited by
279
References
77
Citations by year
2026: 13 · 2025: 21 · 2024: 19 · 2023: 24 · 2022: 16 · 2021: 17 · 2020: 18 · 2019: 20 · 2018: 21 · 2017: 22 · 2016: 16 · 2015: 16 · 2014: 16 · 2013: 23 · 2012: 9
FWCI
12.33
Type
journal article
Language
en
Open access
Locations
  • Brain (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Kentucky
  • National Institute on Aging (R01AG019241, P01-AG17553, R01 AG19241, P30AG028383, U01AG016976, P01AG017553, K24AG027841)
  • National Institute of Neurological Disorders and Stroke (R01NS061933, K08NS050110)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
Keywords
hippocampal sclerosis, Alzheimer's disease, centenarians, gliosis, APOE genotype, frontotemporal lobar degeneration, cognitive profile, verbal fluency, word list recall, neuropathology, brain aging, differential diagnosis of dementia, Nun Study, Georgia Centenarian Study
MeSH terms
Aged, 80 and over, Aging, Alzheimer Disease, DNA-Binding Proteins, Female, Hippocampus, Humans, Male, Mental Status Schedule, Neuropsychological Tests, Sclerosis, Cohort Studies

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