A closer look at LATE: a Case Report on a subtly evolving neurodegenerative disorder.
Maria Luisa Di Giesi, Francesco Motolese, Davide Norata et al.
✦ AI-curated · Sources linked
Case in brief
A 71-year-old presented with isolated episodic memory impairment, preserved global cognition, and intact daily function. Initial cerebrospinal fluid (CSF) Alzheimer’s disease (AD) biomarkers were negative, and 18F-FDG PET showed mild bilateral medial temporal hypometabolism. As memory declined over subsequent years, MRI showed bilateral medial temporal atrophy. Repeat CSF testing remained negative for AD biomarkers, with markedly elevated neurofilament light chain levels. PET showed worsening bilateral medial temporal hypometabolism but preserved inferolateral temporal metabolism. The slowly progressive, medial temporal-predominant amnestic syndrome supported a diagnosis of limbic-predominant age-related TDP-43 encephalopathy (LATE).
What made this case unusual
Despite an amnestic presentation resembling AD, inferolateral temporal metabolism—typically reduced in AD—remained preserved as medial temporal hypometabolism progressed.
Diagnostic / clinical pearl
In an older adult with a hippocampal-type amnestic syndrome, persistently negative AD biomarkers alongside medial temporal-predominant neurodegeneration should prompt consideration of LATE.
Why it matters
Recognizing this diagnostic possibility may help avoid ineffective anti-amyloid therapy and refine clinical trial selection.