We do biopsies on patients who are getting VP shunts for normal pressure hydrocephalus, and we analyze them for neurodegenative disease pathology because a proportion of them have Alzheimer's disease pathology. This is not very often, and so yes, the major need for neurodegenerative disease neuropathologists is to handle the autopsy services. When we have a suspected prion disease biopsy, we tend to send the tissue over the Prion Surveillance Center (at Case Western).
The need stems from the fact that there are many NIH funded core centers for Alzheimer's disease, Parkinson's disease, Huntington's disease, frontotemporal dementia, ALS, etc. etc. The major academic centers tend to have multiple of these centers, and each of these centers usually has a neuropathology core which is run by a neuropathologist who is charged with doing the post, and banking tissue/fluids/DNA/etc. It's usually not enough to just run these tissue bank/autopsy services and so people either signout surgical neuropath and/or general surgical pathology, or run their own research lab.
