The Japanese journal of neuropsychology

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ArticleTitle	Pathology of dementia
Language	J
AuthorList	Kenji Ishihara
Affiliation	Asahi Hospital of Neurology and Rehabilitation
Publication	Japanese Journal of Neuropsychology: 37 (3), 181-190, 2021
Received
Accepted
Abstract	Here, several points concerning neuropathology of dementia are described. 1. In progressive aphasia, each clinical phenotype has strong correlation with pathological background: progressive non-fluent aphasia with left posterior frontal lobe degeneration due to frontotemporal lobar degeneration (FTLD) of tau pathology, semantic dementia with left anterior temporal lobe degeneration due to FTLD-TDP type C, and logopenic progressive aphasia with left temporal and parietal lobe degeneration due to Alzheimer disease. 2. Basic procedure of neuropathological presentation is as follows: First, show macroscopic findings, including sections of the cerebrum and brainstem, and the brain weight; Second, reveal histopathological findings, including immunohistochemistry, required for and support the pathological diagnosis; Finally, distribution of pathology should be shown in order to discuss clinical and pathological correlation. 3. Those following points would be important in clinical and neuropathological discussion: 1) The co-existence of other neuropathological findings, for example Alzheimer pathology in dementia with Lewy bodies, should be considered. 2) It is important to consider time difference between clinical evaluation and pathological examination. In cases with a long clinical illness and widespread severe degenerative lesions, initial clinical symptoms and pathological feature (distribution and degree of lesions) do not necessarily correlate. 3) Quantitative analysis of white matter lesion of each neuronal fiber bundle is difficult, because it is hard to distinguish one fiber bundle from the other in routine pathological specimens.
Keywords	dementia, progressive aphasia, neuropathology, proteinopathy