180 | Limbic-Predominant Age-Related TDP-43 Encephalopathy (LATE) – A Conversation With Dr. David Wolk

This episode is a conversation about the current state of knowledge with respect to the clinical-pathological entity of LATE. Topics covered include the relevant proteinopathy, pathologic overlap with FTLD and hippocampal sclerosis, the LATE clinical syndrome, similarities to and differences from Alzheimer’s disease, the utility of clinical diagnostic criteria, neuroimaging markers, fluid biomarkers, clinical trials, and advice for identification and diagnosis of LATE.

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Guest disclosures: Dr. Wolk receives grant funding paid to his institution by Biogen. He also receives payment for consulting activities from Eli Lilly and Beckman Coulter, as well as from GSK for DSMB service.

About Dave

Dr. David Wolk is Professor of Neurology, Chief of the Division of Cognitive Neurology, Director of the National Institute of Aging funded Penn Alzheimer’s Disease Research Center, Co-Director of the Penn Institute on Aging, and Co-Director of the Penn Memory Center.

Dr. Wolk’s primary clinical interest has been in the diagnosis and care of individuals with a variety of neurodegenerative conditions.  His research has focused on the cognitive neuroscience of memory decline associated with aging and Alzheimer’s Disease using techniques including behavioral testing, structural and functional MRI, and FDG and molecular PET imaging. Much of this work is also directed at examining biomarkers, including behavioral and neuroimaging, that differentiate healthy aging from the earliest transition to AD and their potential role in understanding disease mechanisms and incorporation into treatment trials. Another related thread of his work has been to better understand, classify and predict sources of heterogeneity in AD.  Dr. Wolk has had sustained NIH support since 2003 and has been the principal or co-investigator on numerous local, national and international studies, including therapeutic trials.

References

Besser, L. M., Teylan, M. A., & Nelson, P. T. (2020). Limbic predominant age-related TDP-43 encephalopathy (LATE): clinical and neuropathological associations. Journal of Neuropathology & Experimental Neurology, 79(3), 305-313.

Duong, M. T., & Wolk, D. A. (2022). Limbic-predominant age-related TDP-43 encephalopathy: LATE-breaking updates in clinicopathologic features and biomarkers. Current neurology and neuroscience reports, 22(11), 689-698.

Hiya, S., Maldonado-Díaz, C., Walker, J. M., & Richardson, T. E. (2024). Cognitive symptoms progress with limbic-predominant age-related TDP-43 encephalopathy stage and co-occurrence with Alzheimer disease. Journal of Neuropathology & Experimental Neurology, 83(1), 2-10.

Kapasi, A., Yu, L., Boyle, P. A., Barnes, L. L., Bennett, D. A., & Schneider, J. A. (2020). Limbic-predominant age-related TDP-43 encephalopathy, ADNC pathology, and cognitive decline in aging. Neurology, 95(14), e1951-e1962.

Mikhailenko, E., Colangelo, K., Tuimala, J., Kero, M., Savola, S., Raunio, A., … & Myllykangas, L. (2025). Limbic-predominant age-related TDP-43 encephalopathy in the oldest old: a population-based study. Brain, 148(1), 154-167.

Nag, S., & Schneider, J. A. (2023). Limbic-predominant age-related TDP43 encephalopathy (LATE) neuropathological change in neurodegenerative diseases. Nature Reviews Neurology, 19(9), 525-541.

Nelson, P. T., Dickson, D. W., Trojanowski, J. Q., Jack, C. R., Boyle, P. A., Arfanakis, K., … & Schneider, J. A. (2019). Limbic-predominant age-related TDP-43 encephalopathy (LATE): consensus working group report. Brain, 142(6), 1503-1527.

Nelson, P. T., Fardo, D. W., Wu, X., Aung, K. Z., Cykowski, M. D., & Katsumata, Y. (2024). Limbic-predominant age-related TDP-43 encephalopathy (LATE-NC): Co-pathologies and genetic risk factors provide clues about pathogenesis. Journal of Neuropathology & Experimental Neurology, 83(6), 396-415.

Wesseling, A., Calandri, I. L., Bouwman, M. M., Reijner, N., Deshayes, N. A., Barkhof, F., … & Jonkman, L. E. (2025). Amygdalar and hippocampal volume loss in limbic-predominant age-related TDP-43 encephalopathy. Brain, awaf201.

Wolk, D. A., Nelson, P. T., Apostolova, L., Arfanakis, K., Boyle, P. A., Carlsson, C. M., … & Schneider, J. A. (2025). Clinical criteria for limbic‐predominant age‐related TDP‐43 encephalopathy. Alzheimer’s & Dementia, 21(1), e14202.

 

 

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