The main pathological features were as follows: (i) Lewy bodies were scattered in the substantia nigra, locus ceruleus, dorsal vagal nucleus, substantia innominata and so on (Parkinson disease [PD] pathology); (ii) the most characteristic finding was the presence of numerous palely eosinophilic round or oval inclusion bodies in small neurons at the deeper cortical buy AZD6244 layers. These cortical bodies were quite similar to brain stem Lewy bodies on both various histochemical stainings and electron microscopic findings; and (iii) numerous senile plaques and neurofibrillary tangles were found throughout the whole brain (AD pathology). This case can be now diagnosed as having the common form9 (especially AD form10) of DLBD.

We re-examined the brain of this case using alpha-synuclein, beta-amyloid, AT8 and TDP43 immunostaining preparations from archived paraffin blocks

of the brain. The most remarkable LY2109761 feature on alpha-synuclein immunostaining preparations was the presence of numerous Lewy bodies and Lewy neurites in the hippocampal and parahippocampal areas, other limbic areas and neocortices. In the hippocampus, many Lewy bodies were found in the CA1 and subiculum, and more marked Lewy neurites in the CA2–3 (Fig. 1). As for the cerebral cortex, Lewy neurites were highly predominant in the superficial cortical layers, and plaque-like Lewy neurites were also scattered in some neocortical cortices (Fig. 2). Lewy bodies were mainly detected in the deeper cortical layers (Fig. 3). However, fewer signs of Lewy

pathology consisting of Lewy bodies and Lewy neurites were found in the pre- and post-central, transverse and visual cortices. In addition, Lewy pathology was more prominent in the amygdala (Fig. 4), Paclitaxel concentration and was also marked in the nucleus basalis of Meynert and claustrum. In the brain stem, the substantia nigra, locus ceruleus, reticular formation, raphe nuclei, and dorsal vagal nucleus and so on, were the predirection sites of Lewy pathology. In beta-amyloid immunostained preparations, numerous senile plaques were found throughout the whole cerebral cortex. On AT8 immunostaining, numerous neurofibrillary tangles were scattered throughout the hippocampus, cerebral cortices and amygdala. On TDP43-immunostained preparations, TDP43-positive neurons were scattered throughout the hippocampus, parahippocampus and amygdala. Positive neurons were also rarely present in the limbic cortices. At the 50th Anniversary of the Japanese Society of Neuropathology, I (KK) was requested to present our first DLBD case1 showing progressive dementia and parkinsonism, which we had reported in Acta Neuropathologica in 1976. I had been the patient’s attending physician when she was admitted to our hospital. At that time, she had already become severely demented and had marked parkinsonism. I clinically diagnosed the patient as having AD. At that time, it had been thought that both AD and Pick’s disease were rare in Japan.