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Application of the condensed protocol for the NIA ‐ AA guidelines for the neuropathological assessment of Alzheimer's disease in an academic clinical practice
Author(s) -
Bharadwaj Rajnish,
Cimino Patrick J,
Flanagan Margaret E,
Latimer Caitlin S,
GonzalezCuyar Luis F,
JuricSekhar Gordana,
Montine Thomas J,
Marshall Desiree A,
Keene C. Dirk
Publication year - 2018
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13345
Subject(s) - neuropathology , disease , medicine , protocol (science) , alzheimer's disease , clinical practice , pathology , family medicine , alternative medicine
Aims In response to concerns regarding resource expenditures required to implement fully the 2012 National Institute on Aging and the Alzheimer's Association ( NIA ‐ AA ) Sponsored Guidelines for the neuropathological assessment of Alzheimer's disease ( AD ), we previously developed a sensitive and cost‐reducing condensed protocol ( CP ) at the University of Washington ( UW ) Alzheimer's Disease Research Center ( ADRC ) that consolidated the recommended NIA ‐ AA protocol into fewer cassettes requiring fewer immunohistochemical stains. The CP was not designed to replace NIA ‐ AA protocols, but instead to make the NIA ‐ AA criteria accessible to clinical and forensic neuropathology practices where resources limit full implementation of NIA ‐ AA guidelines. Methods and results In this regard, we developed practical criteria to instigate CP sampling and immunostaining, and applied these criteria in an academic clinical neuropathological practice. During the course of 1 year, 73 cases were sampled using the CP ; of those, 53 (72.6%) contained histological features that prompted CP work‐up. We found that the CP resulted in increased identification of AD and Lewy body disease neuropathological changes from what was expected using a clinical history‐driven work‐up alone, while saving approximately $900 per case. Conclusions This study demonstrates the feasibility and cost‐savings of the CP applied to a clinical autopsy practice, and highlights potentially unrecognised neurodegenerative disease processes in the general ageing community.