Essential pathologic feature: presence of Lewy bodies
Variable findings:
(1) Lewy-related neurites
(2) plaques
(3) neurofibrillary tangles (NFT)
(4) regional neuronal loss
(5) spongiform change (microvacuolization) with synapse loss (seen in the temporal lobes of some cases)
(6) neurochemical and neurotransmitter abnormalities
Staining methods may include:
(1) H&E (may be insensitive and nonspecific)
(2) silver stains
(3) immunostains with anti-ubiquitin antibodies
(4) immunostains with anti-tau antibodies (Lewy bodies negative; globose NFT positive)
Areas which should be examined:
(1) brainstem
(2) subcortical nuclei
(3) limbic cortex (amygdala, cingulated, entorhinal)
(4) neocortex (most often temporal, but also frontal and parietal)
