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Alzheimer disease pathology — MRCPsych Paper A MCQ

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EasyNeuropathologyAlzheimer disease pathologyMRCPsych Paper A

An 81-year-old woman developed insidious, steadily progressive episodic memory impairment, followed several years later by visuospatial and other cognitive difficulties. She had no early cognitive fluctuations, recurrent visual hallucinations or spontaneous parkinsonism. Which post-mortem neuropathological finding is most characteristic of the likely diagnosis?

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Correct answer: E — Extracellular amyloid-beta plaques and intracellular neurofibrillary tangles composed of hyperphosphorylated tau

The presentation is typical of Alzheimer disease: insidious episodic memory impairment followed by progressive involvement of other cognitive domains. Its defining neuropathological lesions are extracellular amyloid-beta plaques and intracellular neurofibrillary tangles containing hyperphosphorylated tau. Alpha-synuclein Lewy bodies suggest Lewy body disease, for which early fluctuations, recurrent visual hallucinations, REM sleep behaviour disorder or spontaneous parkinsonism would be more characteristic. Prion disease produces rapidly progressive cognitive and neurological deterioration with spongiform change rather than a course evolving over several years. Periventricular demyelinating plaques are associated with multiple sclerosis, while copper-related hepatolenticular degeneration is characteristic of Wilson disease and is not a plausible explanation in this clinical context.

Reference: King A, et al. The Neuropathological Diagnosis of Alzheimer's Disease—The Challenges of Pathological Mimics and Concomitant Pathology. Brain Sciences. 2020;10(8):479. https://pubmed.ncbi.nlm.nih.gov/32722332/