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Aspects of Cortical Destruction in Alzheimer’s Disease

  • Conference paper
Connections, Cognition and Alzheimer’s Disease

Part of the book series: Research and Perspectives in Alzheimer’s Disease ((ALZHEIMER))

Summary

Alzheimer’s disease is an immutably progressing dementing disorder. Its major pathologic hallmark is the development of cytoskeletal changes in a few susceptible neuronal types. These changes do not occur inevitably with advancing age, but once the disease has begun, spontaneous recovery or remissions are not observed.

The initial cortical changes develop in the poorly myelinated transentorhinal region of the medial temporal lobe. The destructive process then follows a predictable pattern as it extends into other cortical areas. Location of the tanglebearing neurons and the severity of changes allow the distinction of six stages in disease propagation (transentorhinal stages I–II: clinically silent cases; limbic stages III-IV: incipient Alzheimer’s disease; neocortical stages V-VI: fully developed Alzheimer’s disease). A small number of cases display particularly early changes, indicating that advanced age is not a prerequisite for the evolution of the lesions. Alzheimer’s disease is thus an age-related, but not an agedependent, disease. The degree of brain destruction at stages III–IV often leads to the appearance of initial clinical symptoms, while stages V–VI represent fully developed Alzheimer’s disease. Assessment of stage V–VI cases allows estimation of the rate of prevalence of the disease.

The pattern of appearance of the neurofibrillary changes bears a striking resemblance to the inverse sequence of cortical myelination. Factors released by oligodendrocytes exert important influence upon nerve cells and suppress disordered neuritic outgrowth. The lack of such factors due to premature dysfunction of oligodendrocytes could contribute to imbalances in the neuronal cytoskeleton and eventually initiate the development of neurofibrillary changes.

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Authors and Affiliations

  1. Department of Anatomy, J.W. Goethe University, Theodor Stern Kai 7, D-60590, Frankfurt, Germany

    H. Braak

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  1. H. Braak
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  2. E. Braak
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Editors and Affiliations

  1. Nuerology Service, Massachusetts General Hospital, Fruit Street, 02114, Boston, MA, USA

    B. T. Hayman M.D., Ph.D.

  2. Laboratoire de Neuropathologie R. Escourolle, Hôpital de La Salpêtrière, Blvd. de l’Hôpital, 75651, Paris Cedex 16, France

    C. Duyckaerts M.D., Ph.D.

  3. Fondation IPSEN, 24, rue Erlanger, 75651, Paris Cedex 16, France

    Y. Christen Ph.D.

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Braak, H., Braak, E. (1997). Aspects of Cortical Destruction in Alzheimer’s Disease. In: Hayman, B.T., Duyckaerts, C., Christen, Y. (eds) Connections, Cognition and Alzheimer’s Disease. Research and Perspectives in Alzheimer’s Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-60680-9_1

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  • DOI: https://doi.org/10.1007/978-3-642-60680-9_1

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