Cited by 33Dementia and Cognitive Impairment ResearchAmyotrophic Lateral Sclerosis ResearchNeurological Disease Mechanisms and Treatments

Hippocampal Sclerosis in Older Patients: Practical Examples and Guidance With a Focus on Cerebral Age-Related TDP-43 With Sclerosis

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Cykowski, Matthew D., Powell, Suzanne Z., Schulz, Paul E., Takei, Hidehiro, Rivera, Andreana L., Jackson, Robert E., Roman, Gustavo, Jicha, Gregory A. +1 more·2017·Archives of Pathology & Laboratory Medicine

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.

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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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Research works printed but not linked: 2

  1. [17]Nag S Yu L Capuano AW Hippocampal sclerosis and TDP-43 pathology in aging and Alzheimer disease Ann Neurol 2015 77 6 942 952 25707479 PMC4447563
  2. [43]Mai JK Paxinos G The Human Nervous System 3 Amsterdam, Boston Elsevier Academic Press 2012

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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)
Venue
Archives of Pathology & Laboratory Medicine
Published
2017-05-03
Volume
141
Issue
8
Pages
1113-1126
ISSN
  • 0003-9985 (ISSN-L)
  • 1543-2165
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
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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