Navigating Neuropsychology 180 | Limbic-Predominant Age-Related TDP-43 Encephalopathy (LATE) – A Conversation With Dr. David Wolk
Dec 1, 2025
In this enlightening discussion, Dr. David Wolk, a neurology professor and director at the Penn Alzheimer's Disease Research Center, delves into Limbic-Predominant Age-Related TDP-43 Encephalopathy (LATE). He unpacks the role of TDP-43, its ties to ALS and hippocampal sclerosis, and contrasts LATE's clinical profile with Alzheimer's. Wolk highlights crucial diagnostic criteria, advanced neuroimaging markers, and the significance of understanding LATE's prevalence as we age. His insights pave the way for better identification and management of this complex condition.
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Use MRI Plus Amyloid To Support LATE
- Use MRI hippocampal atrophy plus amyloid biomarkers to separate probable LATE from AD.
- If MRI shows disproportionate hippocampal atrophy and amyloid is negative, consider probable LATE.
Check Tau If Amyloid Is Positive
- When amyloid is positive, check for tau; amyloid+/tau- with marked hippocampal atrophy suggests LATE.
- Treat such cases as possible LATE and consider further biomarker workup before assuming AD is primary.
Imaging Patterns That Point To LATE
- Visual MRI clues (anterior hippocampal/uncal atrophy, widened collateral sulcus) help flag LATE.
- Quantitative anterior extra‑hippocampal measures improve discrimination from AD.
