Fig. 3

Histopathological features of DLB. Midbrain section at the level of the superior colliculus stained with H&E where dopaminergic neurons in the substantia nigra are vulnerable in DLB patients (a). Brainstem LBs are classically detected using H&E (b – black arrow) and frequently in the pigmented neurons of the SN (c – white arrows). Cortical LB pathology (e.g. cingulate cortex) affects all layers of the neocortex, most notably layers V and VI (d – red arrows). Cortical LBs and LNs can be visualised by α-syn immunohistochemistry (e - LB blue arrow head, LN blue arrow). α-syn phosphorylated at serine 129 detects a greater abundance of LB pathology compared to staining with phosphorylation independent antibodies (f - green arrows illustrate LBs, LNs, and Lewy dots). Alzheimer’s disease pathology is also a frequent finding in post-mortem tissue from DLB patients including hyperphosphorylated tau tangles (g) and Aβ plaques (h). Of note photomicrographs E-H were taken from sequential sections of the cingulate cortex of the same DLB patient. Abbreviations: SN, substantia nigra; WM, white matter; LB, Lewy body; LN, Lewy neurite; α-syn, α-synuclein. Scale bar represents 0.5cm in A, 20μm in B and C, 500 μm D, and 50μm in E-H