The diseased brain is from a patient who had had cognitive decline for 5 years and died of aspiration pneumonia.
What is the most likely diagnosis and neuropathologic finding?
- a.Pick disease; tau protein deposits in neurons
- b.Lewy body dementia; α-synuclein deposits in neurons
- c.Hepatic encephalopathy; Alzheimer type II gliosis
- d.Alzheimer disease; neurofibrillary tangles and neuritic plaques
Answer: d. Alzheimer disease; neurofibrillary tangles and neuritic plaques
Alzheimer disease is the most common neurodegenerative disease, and unlike the other diseases listed, classically exhibits global cerebral atrophy.
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The atrophy is typically greatest in the medial temporal lobe/hippocampus. Alzheimer disease is characterized by tau and amyloid protein deposition. Tau protein forms neurofibrillary tangles within affected neurons and also forms neuritic plaques in conjunction with β-amyloid protein.2
β-Amyloid protein may also deposit as diffuse plaques within the cortex or as amyloid angiopathy within leptomeningeal and cortical vessels.
References
- Mild cognitive impairment and mild dementia: a clinical perspective.Mayo Clin Proc. 2014; 89: 1452-1459
- Quantitative neurofibrillary tangle density and brain volumetric MRI analyses in Alzheimer's disease presenting as logopenic progressive aphasia.Brain Lang. 2013; 127: 127-134
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© 2016 Mayo Foundation for Medical Education and Research
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