Hippocampal Sclerosis in Older Patients: Practical Examples and Guidance With a Focus on Cerebral Age-Related TDP-43 With Sclerosis
Open accessAbstract
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.
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Hippocampal sclerosis of aging almost always includes TDP-43 deposits and sometimes arteriolosclerosis.
“Hippocampal sclerosis of aging is now recognized to almost always include TDP-43 deposits and sometimes arteriolosclerosis that lead to intracellular and neuritic deposits of TDP-43 in the hippocampus during the preclinical state and eventually hippocampal sclerosis and cerebral atrophy in the disease state [130, 131].”
From The neuropathological diagnosis of Alzheimer's disease (2019) · cites this paper as [131]
The Abstract (Context; page not provided) says TDP-43 inclusions are frequent in hippocampal sclerosis of aging and brain arteriolosclerosis is a common, possibly pathogenic component. The Abstract (Conclusions; page not provided) calls TDP-43 pathology a critical diagnostic feature, but does not establish the stronger “almost always” frequency. It also does not establish the citing sentence’s proposed causal sequence from deposits in a preclinical state to sclerosis and cerebral atrophy. (LLM, conf=0.84)
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Ure, J. A. (2020) · Neurología Argentina · doi:10.1016/j.neuarg.2020.07.001 · Cited by 1 · see citing works
Iwasaki, Y., Deguchi, A., Mori, K., Ito, M., Kawai, Y., Akagi, A., Mimuro, M., Miyahara, H., & Yoshida, M. (2018) · Neuropathology · doi:10.1111/neup.12521
Prévot, T. D., Sumitomo, A., Tomoda, T., Knutson, D. E., Li, G., Cook, J. M., & Sibille, E. L. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.02.28.964742
Neurodegenerative Diseases in Elders
Reichard, R. R., Iles, L. E., Swanson, A. A., & Crain, B. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781316823040.019
Brain Banking in Dementia Studies
Işık, A. T., Kaya, D., & Gökden, M. (2024) · Methods in molecular biology · doi:10.1007/978-1-0716-3774-6_17
- Authors
- Cykowski, M. D., Powell, S. Z., Schulz, P. E., Takei, H., Rivera, A. L., Jackson, R. E., Roman, G., Jicha, G. A., & Nelson, P. T.
- Affiliations
- Houston Methodist (US)
- ORCID
- Venue
- Archives of Pathology & Laboratory Medicine
- Published
- 2017-05-03
- Volume
- 141
- Issue
- 8
- Pages
- 1113-1126
- ISSN
- 0003-9985 (ISSN-L)
- 1543-2165
- PMC
- PMC5922266
- OpenAlex
- W2610434432
- Cited by
- 33
- References
- 44
- Citations by year
- 2025: 5 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 8 · 2019: 8 · 2018: 4 · 2017: 1
- FWCI
- 4.72
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Archives of Pathology & Laboratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (P30AG028383, R01AG057187, R21AG050146, R01AG042475)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Keywords
- hippocampal sclerosis, TDP-43 pathology, frontotemporal lobar degeneration, Alzheimer's disease, Lewy body disease, amnestic syndrome, cognitive impairment in older adults, oldest old
- MeSH terms
- Aged, Aged, 80 and over, Brain Diseases, Dementia, DNA-Binding Proteins, Female, Hippocampus, Humans, Male, Sclerosis
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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