Application of the Condensed Protocol for the NIA-AA guidelines for the neuropathologic assessment of Alzheimer's disease in an academic clinical practice

Abstract

Aims

In response to concerns regarding resource expenditures required to fully implement the 2012 NIA-AA Sponsored Guidelines for the neuropathologic 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. Over the course of one year, 73 cases were sampled using the CP; of those, 53 (72.6%) contained histologic features that prompted CP workup. We found that the CP resulted in increased identification of AD and Lewy body disease neuropathologic changes from what was expected using a clinical history-driven workup 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 unrecognized neurodegenerative disease processes in the general aging community.

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