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Whilst immune activation is well-described in Parkinson\u2019s disease (PD), how it links to protein aggregation and its role in PD dementia has not been explored. We hypothesized that neuroinflammatory processes are a critical contributor to the pathology of PDD. To address this hypothesis, we examined 7 brain regions at postmortem from 17 PD patients with no dementia (PDND), 11 patients with PD dementia\u00a0(PDD), and 14 age and sex-matched neurologically healthy controls. Digital quantification after immunohistochemical staining showed a significant increase in the severity of \u03b1-synuclein pathology in the hippocampus, entorhinal and occipitotemporal cortex of PDD compared to PDND cases. In contrast, there was no difference in either tau or amyloid-\u03b2 pathology between the groups in any of the examined regions. Importantly, we found an increase in activated microglia in the amygdala of demented PD brains compared to controls which correlated significantly with the extent of \u03b1-synuclein pathology in this region. Significant infiltration of CD4<jats:sup>+<\/jats:sup> T lymphocytes into the brain parenchyma was commonly observed in PDND and PDD cases compared to controls, in both the substantia nigra and the amygdala. Amongst PDND\/PDD cases, CD4<jats:sup>+<\/jats:sup> T cell\u00a0counts in the amygdala correlated with activated microglia, \u03b1-synuclein and tau pathology. Upregulation of the pro-inflammatory cytokine interleukin 1\u03b2 was also evident in the substantia nigra as well as the frontal cortex in PDND\/PDD versus controls with a concomitant upregulation in Toll-like receptor 4 (TLR4)\u00a0in these regions, as well as the amygdala. The evidence presented in this study show an increased immune response in limbic and cortical brain regions, including increased microglial activation, infiltration of T lymphocytes, upregulation of pro-inflammatory cytokines and TLR gene expression, which has not been previously reported in the postmortem PDD brain.<\/jats:p>","DOI":"10.1186\/s40478-020-01083-5","type":"journal-article","created":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T10:03:49Z","timestamp":1606989829000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":195,"title":["Neuroinflammation and protein pathology in Parkinson\u2019s disease dementia"],"prefix":"10.1186","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6553-6154","authenticated-orcid":false,"given":"Antonina","family":"Kouli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Camacho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieren","family":"Allinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline H.","family":"Williams-Gray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,12,3]]},"reference":[{"key":"1083_CR1","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1002\/ana.20635","volume":"58","author":"D Aarsland","year":"2005","unstructured":"Aarsland D, Perry R, Brown A, Larsen JP, Ballard C (2005) Neuropathology of dementia in Parkinson\u2019s disease: a prospective, community-based study. 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