In a consecutive autopsy series comprising 284 subjects > or = 50 years, 22 cases (7.7%) revealed Lewy bodies (LBs) of whom 21 had LBs in substantia nigra and/or locus ceruleus and 9 (3.2%) in the cerebral cortex. Only one case had cortical LBs without concomitant inclusions in the brain stem. The mean age of subjects with LBs was significantly higher than in those without (78.0 vs. 72.3 years). Cortical LBs had not been demonstrated in routine HE stains in any case and their identification necessitated the use of staining for ubiquitin. Although great care was taken not to interpret globose neurofibrillary tangles (NFTs) as LBs, anti-tau staining revealed that many of the suspected LBs were in fact NFTs. Thus, we recommend to apply both anti-ubiquitin and anti-tau staining for the demonstration of cortical LBs. In this material 21 of the 22 cases with LBs (95.5%) also revealed Alzheimer type of pathology as compared with 187 of 262 cases without LBs (71.4%). This difference may be explained by the higher age of subjects with LBs. Altogether 96 of the 284 cases (33.8%) had cerebrovascular lesions. None of the 9 cases with cortical LBs were clinically demented, and our results do not support the assertion that Lewy body-associated dementias should outnumber those of vascular origins.