Familial prion disease with alzheimer disease-like tau pathology and clinical phenotype

Familial prion disease with alzheimer disease-like tau pathology and clinical phenotype


Suman Jayadev MD1, David Nochlin MD2, Parvoneh Poorkaj PhD3, Ellen J. Steinbart RN, MA3, James A. Mastrianni MD, PhD4, Thomas J. Montine MD, PhD5, Bernardino Ghetti MD6,7, Gerard D. Schellenberg PhD8, Thomas D. Bird MD1,3,9, James B. Leverenz MD1,10,11,12,*

Article first published online: 17 MAR 2011

DOI: 10.1002/ana.22264

Abstract

Objective

To describe the Alzheimer disease (AD)-like clinical and pathological features, including marked neurofibrillary tangle (NFT) pathology, of a familial prion disease due to a rare nonsense mutation of the prion gene (PRNP).

Methods

Longitudinal clinical assessments were available for the proband and her mother. After death, both underwent neuropathological evaluation. PRNP was sequenced after failure to find immunopositive Aß deposits in the proband and the documentation of prion protein (PrP) immunopositive pathology.

Results

The proband presented at age 42 years with a 3-year history of progressive short-term memory impairment and depression. Neuropsychological testing found impaired memory performance, with relatively preserved attention and construction. She was diagnosed with AD and died at age 47 years. Neuropathologic evaluation revealed extensive limbic and neocortical NFT formation and neuritic plaques consistent with a Braak stage of VI. The NFTs were immunopositive, with multiple tau antibodies, and electron microscopy revealed paired helical filaments. However, the neuritic plaques were immunonegative for Aß, whereas immunostaining for PrP was positive. The mother of the proband had a similar presentation, including depression, and had been diagnosed clinically and pathologically as AD. Reevaluation of her brain tissue confirmed similar tau and PrP immunostaining findings. Genetic analysis revealed that both the proband and her mother had a rare PRNP mutation (Q160X) that resulted in the production of truncated PrP.

Interpretation

We suggest that PRNP mutations that result in a truncation of PrP lead to a prolonged clinical course consistent with a clinical diagnosis of AD and severe AD-like NFTs. Ann Neurol 2010;

http://onlinelibrary.wiley.com/doi/10.1002/ana.22264/abstract



I suggest it's a Transmissible Spongiform Encephalopathy i.e. prion disease. ...TSS


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ENLARGING SPECTRUM OF PRION-LIKE DISEASES Prusiner Colby et al 2011

Prions

David W. Colby1,* and Stanley B. Prusiner1,2

http://betaamyloidcjd.blogspot.com/2011/01/enlarging-spectrum-of-prion-like.html



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TSS