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Stanley Fahn Lecture 2005: The staging procedure for the inclusion body pathology associated with sporadic Parkinson's disease reconsidered
Braak H, Bohl JR, Müller CM, Rüb U, de Vos RA, Del Tredici K.. Movement disorders : official journal of the Movement Disorder Society, 2006-12-01
Topic: Brain proteins, microglia and lab models
The synucleinopathy known as sporadic Parkinson's disease (PD) is a multisystem disorder that severely damages predisposed nerve cell types in circumscribed regions of the human nervous system. A recent staging procedure for the inclusion body pathology associated with PD proposes that, in the brain, the pathological process (formation of proteinaceous intraneuronal Lewy bodies and Lewy neurites) begins at two sites and continues in a topographically predictable sequence in six stages, during which components of the olfactory, autonomic, limbic, and somatomotor systems become progressively involved. In stages 1 to 2, the Lewy body pathology is confined to the medulla oblongata/pontine tegmentum and anterior olfactory structures. In stages 3 to 4, the substantia nigra and other nuclei of the basal mid- and forebrain become the focus of initially subtle and, then, severe changes. During this phase, the illness probably becomes clinically manifest. In the final stages 5 to 6, the lesions appear in the neocortex. This cross-sectional study originally was performed on 168 autopsy cases using material from 69 incidental cases and 41 clinically diagnosed PD patients as well as 58 age- and gender-matched controls. Here, the staging hypothesis is critically reconsidered and discussed.
Key findings
- A recent staging procedure for the inclusion body pathology associated with PD proposes that, in the brain, the pathological process (formation of proteinaceous intraneuronal Lewy bodies and Lewy neurites) begins at two sites and continues in a topographically predictable sequence in six stages, during which components of the olfactory, autonomic, limbic, and somatomotor systems become progressively involved.
Why it matters
This lecture revisits a six-stage scheme in which Lewy body pathology in sporadic Parkinson's disease is proposed to start in the lower brainstem and olfactory areas, then involve the substantia nigra — when symptoms "probably" appear — and finally reach the neocortex. The scheme came from a cross-sectional study of 168 autopsy brains, so the order is inferred from different people rather than tracked in one person over time. It concerns Parkinson's, not Alzheimer's, and reports no treatment, cure or prevention.
Study details
- Study designcross-sectional
- Evidence strengthLow
How this study scored 53/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Movement disorders : official journal of the Movement Disorder Society) |
| Journal's citation record | 3 / 4 | Movement Disorders: journal h-index 281 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2006 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 632 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 28.7 citations a year over 22 year(s) since 2006 |
| Impact for its field and year | 5 / 6 | Cited 20.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 10 other studies in this library |
| Still being cited | 2 / 4 | Cited 39 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Kelly Del Tredici: h-index 77 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Goethe University Frankfurt: institution h-index 958 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 17078043) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 53 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Braak, H., Bohl, JR., Müller, C. M., Rüb, U., de Vos, R. A., & Del Tredici, K. (2006). Stanley Fahn Lecture 2005: The staging procedure for the inclusion body pathology associated with sporadic Parkinson's disease reconsidered. Movement disorders : official journal of the Movement Disorder Society. https://doi.org/10.1002/mds.21065
Vancouver
Braak H, Bohl JR, Müller CM, Rüb U, de Vos RA, Del Tredici K. Stanley Fahn Lecture 2005: The staging procedure for the inclusion body pathology associated with sporadic Parkinson's disease reconsidered. Movement disorders : official journal of the Movement Disorder Society. 2006. doi:10.1002/mds.21065. PMID: 17078043.
BibTeX
@article{braak2006-17078043,
author = {Braak, H. and Bohl, JR. and Müller, C. M. and Rüb, U. and de Vos, R. A. and Del Tredici, K.},
title = {{Stanley Fahn Lecture 2005: The staging procedure for the inclusion body pathology associated with sporadic Parkinson's disease reconsidered}},
journal = {Movement disorders : official journal of the Movement Disorder Society},
year = {2006},
doi = {10.1002/mds.21065},
pmid = {17078043},
url = {https://doi.org/10.1002/mds.21065}
}
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