A simplified brain blocking protocol optimized for the diagnosis of neurodegenerative disease saves time and money while preserving anatomic relationships

Abstract

Context.-Postmortem evaluation for neurodegenerative disease is expensive in time and materials. These challenges can be met by implementing simpler sampling protocols while preserving anatomic relations. Objective.-To determine the diagnostic effectiveness and cost-effectiveness of a simplified brain blocking protocol compared with the standard blocking protocol used in our Alzheimer's Disease Research Center (ADRC). Design.-We prospectively compared the neuropathologic diagnoses established from our standard 19-cassette/ 19 brain sites ADRC protocol to a simplified 6-cassette/12 brain sites protocol in 52 consecutive cases. The simplified protocol generated 14 slides for comparison to 52 slides from our standard protocol. Results.-Compared with the ADRC protocol the simplified protocol produced Alzheimer Disease Neuropathologic Changes probability scores that were the same in 50 of 52 cases (r ¼ 0.99). Staging for Lewy pathology was equivalent in 45 of 52 (r ¼ 0.98), scoring for cerebral amyloid angiopathy was equivalent in 48 of 52 (r ¼ 0.97), and grading for arteriolosclerosis was the same in 45 of 52 cases (r ¼ 0.92). Progressive supranuclear palsy (n ¼ 4), multiple system atrophy (n ¼ 2), and corticobasal degeneration (n ¼ 1) could be diagnosed by either protocol independently. The estimated savings per case was 72% or $1744.89 ($2436.37 [ADRC] versus $691.48 [simplified]). Conclusions.-The diagnosis of neurodegenerative disease at autopsy can be done accurately with a less expensive, simplified protocol. Our protocol is similar to those of previously published approaches, but it has a simpler organization scheme. This method should be valuable to institutions where autopsy cost considerations may be important.