Table 3.
Recommended brain regions to be sampled and evaluated
| Region | CTE | ||
|---|---|---|---|
| Middle frontal gyrus* | pTaua | pTDP-43 | Aβc |
| Superior and middle temporal gyri* | pTaua | ||
| Inferior parietal lobule* | pTaua | Aβc | |
| Hippocampus and entorhinal cortex | pTau | pTDP-43b | Aβc |
| Amygdala | pTau | pTDP-43b | |
| Thalamus | pTau | ||
| Basal ganglia with basal nucleus of Meynert | pTau | ||
| Midbrain including substantia nigra | pTau | ||
| Pons including locus coeruleus | pTau | ||
| Medulla including dorsal motor nucleus of vagus | pTau | ||
| Cerebellar cortex and dentate nucleus | pTau | ||
| Additional sections if high suspicion | |||
| Superior frontal gyrus | pTaud | ||
| Temporal pole | pTaud | pTDP-43 | |
| Hypothalamus including mammillary body | pTaud | ||
In addition to the NIA-AA recommended regions for the evaluation of Alzheimer’s disease (AD) neuropathologic change and Lewy body disease (LBD) [34], we recommend wider p-tau screening to capture CTE and other tauopathies. In addition, if there is a high index of suspicion of CTE, we recommend taking extra sections of frontal and temporal cortices, and hypothalamus including the mammillary body
Bilateral representative sections from each region are recommended if both cerebral hemispheres are available for microscopic analysis
* Most valuable for detecting CTE neuropathology
aAT8 or equivalent Tau (CP-13 or PHF-1) on all cortical sections, if positive: stain other areas and possibly sample additional areasd. We do not recommend thioflavin or silver stains for the detection of CTE lesions
bTDP-43: amygdala and hippocampus, if positive then temporal pole and frontal cortex
cAβ: middle frontal gyrus, inferior parietal lobule and hippocampus and entorhinal cortex; if positive wider sampling is recommended
dIf there is a high index of suspicion consider taking extra sections, specifically superior frontal gyrus, temporal pole, and hypothalamus including mammillary body