Staging/typing of Lewy body related alpha-synuclein pathology: a study of the BrainNet Europe Consortium

Irina Alafuzoff, Paul G. Ince, Thomas Arzberger, Safa Al-Sarraj, Jeanne Bell, Istvan Bodi, Nenad Bogdanovic, Orso Bugiani, Isidro Ferrer, Ellen Gelpi, Stephen Gentleman, Giorgio Giaccone, James W. Ironside, Nikolaos Kavantzas, Andrew King, Penelope Korkolopoulou, Gabor G. Kovacs, David Meyronet, Camelia Monoranu, Piero ParchiLaura Parkkinen, Efstratios Patsouris, Wolfgang Roggendorf, Annemieke Rozemuller, Christine Stadelmann-Nessler, Nathalie Streichenberger, Dietmar R. Thal, Hans Kretzschmar

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

When 22 members of the BrainNet Europe (BNE) consortium assessed 31 cases with alpha-synuclein (alpha S) immunoreactive (IR) pathology applying the consensus protocol described by McKeith and colleagues in 2005, the inter-observer agreement was 80%, being lowest in the limbic category (73%). When applying the staging protocol described by Braak and colleagues in 2003, agreement was only 65%, and in some cases as low as 36%. When modifications of these strategies, i.e., McKeith's protocol by Leverenz and colleagues from 2009, Braak's staging by Muller and colleagues from 2005 were applied then the agreement increased to 78 and 82%, respectively. In both of these modifications, a reduced number of anatomical regions/blocks are assessed and still in a substantial number of cases, the inter-observer agreement differed significantly. Over 80% agreement in both typing and staging of alpha S pathology could be achieved when applying a new protocol, jointly designed by the BNE consortium. The BNE-protocol assessing alpha S-IR lesions in nine blocks offered advantages over the previous modified protocols because the agreement between the 22 observers was over 80% in most cases. Furthermore, in the BNE-protocol, the alpha S pathology is assessed as being present or absent and thus the quality of staining and the assessment of the severity of alpha S-IR pathology do not alter the inter-observer agreement, contrary to other assessment strategies. To reach these high agreement rates an entity of amygdala-predominant category was incorporated. In conclusion, here we report a protocol for assessing alpha S pathology that can achieve a high inter-observer agreement for both the assignment to brainstem, limbic, neocortical and amygdala-predominant categories of synucleinopathy and the Braak stages.

Original languageEnglish
Pages (from-to)635-652
Number of pages18
JournalActa Neuropathologica
Issue number6
Publication statusPublished - Jun 2009


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