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To stage, or not to stage.

Kelly Del Tredici1, Heiko Braak1

  • 1Clinical Neuroanatomy Section/Department of Neurology, University of Ulm, 89081 Ulm, Germany.

Current Opinion in Neurobiology
|December 22, 2019
PubMed
Summary

Neuropathological staging for Alzheimer's and Parkinson's diseases relies on protein deposits. This review examines current staging methods and questions their continued relevance in neurodegenerative disease research.

Area of Science:

  • Neuropathology
  • Neurodegenerative Diseases
  • Disease Staging

Background:

  • Current neurodegenerative disease staging primarily uses the spread and severity of protein aggregates.
  • Associated features like cell and synapse loss are assessed but not formally staged.
  • This approach is standard for sporadic Alzheimer's and Parkinson's diseases.

Purpose of the Study:

  • To review the evolution of neuropathological staging systems for sporadic Alzheimer's and Parkinson's diseases.
  • To identify challenges inherent in current staging methodologies.
  • To critically evaluate the ongoing relevance of established neuropathological staging practices.

Main Methods:

  • Literature review of neuropathological staging development.
  • Analysis of semiquantitative assessment methods for proteinaceous inclusions.

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  • Discussion of associated pathological phenomena (cell loss, synapse loss).

    • Main Results:

    • Neuropathological staging has historically focused on the anatomical distribution and density of protein inclusions.
    • Associated pathological changes are recognized but typically not incorporated into formal staging.
    • Challenges include the semiquantitative nature of assessments and the exclusion of other disease markers.

    Conclusions:

    • Neuropathological staging for Alzheimer's and Parkinson's diseases is well-established but faces challenges.
    • The relevance of current staging systems, which primarily track protein aggregates, needs re-evaluation.
    • Future staging may require integration of broader pathological features beyond protein inclusions.