CRITERIA FOR ALZHEIMERS-DISEASE AND THE NOSOLOGY OF DEMENTIA WITH LEWY BODIES

Dementia with brainstem and neocortical Lewy bodies (LB) is a source o f ongoing nosologic controversy and confusion. Differing opinions abou t concomitant Alzheimer's disease (AD) have produced competing nomencl atures. We applied neocortical plaque-based criteria for the diagnosis of AD from the National Institute on Aging and from the Consortium to Establish a Registry for AD for definite, probable, and possible AD t o 58 dementia brains with LB, 10 elderly nondemented controls, and 58 brains with neuropathologically pure AD. We also employed diagnostic c riteria requiring both neocortical plaques and tangles, and assessed t he extent of neurofibrillary pathology in all 126 specimens using a mo dified version of the Braak and Braak staging protocol for changes rel ated to AD. The percentages of mixed LB disease and AD versus pure LB disease varied from 91% mixed and 9% pure to 34% mixed and 66% pure, d epending upon which diagnostic criteria for AD were employed. Most dem entia brains with LB occupied higher modified Braak stages than contro ls, but lower ones than pure AD specimens. A minority of the dementia brains with LB had no more AD-type pathology than controls.