One of Brain Support Network’s mission is to help families with brain donation arrangements. We’ve seen lots of neuropathology reports come back with different descriptions of the term “Alzheimer’s.” Most of the neuropathology reports I read are from the Mayo Clinic in Jacksonville. The neuropathologist there, Dr. Dennis Dickson, is one of the top in the world. This blog post is an attempt to explain the descriptions used by Dr. Dickson.
If the term used is “Alzheimer’s pathology,” this refers to Alzheimer’s type pathology that doesn’t rise to the level of being considered “Alzheimer’s Disease.”
If the term used in “Alzheimer’s Disease,” then this means that there are both neurofibrillary tangles (made of tau protein) and plaques (made up of amyloid protein). Sometimes the tangles are called NFTs. Sometimes the plaques are called senile plaques.
In the neuropathology community, there are several ways to describe the severity of Alzheimer’s Disease. Dr. Dickson uses the Braak staging method, defined by German anatomist Heiko Braak in 2991. That staging method in AD is found in this important paper:
“Neuropathological stageing of Alzheimer-related changes”
Braak, H.; Braak, E.
Acta Neuropathologica. 82 (4): 239–59. 1991.
Abstract on PubMed (ID# 1759558)
Braak staging in AD has six stages — I through VI. The staging focuses on the location of NFTs. Stages I and II are when the NFTs are limited to the transentorhinal region of the brain. Stages III and IV are when the NFTs are in the limbic regions, which includes the hippocampus. And stages V and VI are when the NFTs are extensive in the neocortical regions of the brain.
Surprising to me, Braak stage IV is called early stage, Braak V is called mid-pathologic stage, and Braak VI is called advanced stage.
Let me know if you have questions!
Robin