Morphology of Alzheimer’s disease and related disorders
The diagnosis of Alzheimer’s disease (AD) can made with certainty only by histological examination of the brain, either on biopsy or at autopsy, using current criteria that are critically discussed. The morphologic diagnosis of AD is based on the finding of more than certain minimum age-related numbers of neuritic plaques (NP) and neurofibrillary tangles (NFT) that may occur independently from each other and show specific, often bilaterally symmetrical distribution patterns. Although both NFT and NP represent useful diagnostic markers and their concentrations in neocortex correlate reasonably well with certain mental status tests and some biochemical data, progressive loss of neurons and synapses in cortex and brainstem appear to be more correlated with both dementia and neuromediator changes, but their causal relationship with amyloid deposition and cytoskeletal lesions is not clear. Cortical atrophy with 40 to 60% loss of large neurons and 45 to 55% decline of synaptic density in frontal, temporal, parietal cortex and hippocampus are probable correlates of progressive dementia. Many mediator specific brainstem nuclei show progressive neuronal loss and presence of NFT with severe involvement of cholinergic nucleus basalis of Meynert (15 to 90% cell loss and atrophy of large neurons), pedunculopontine and Westphal-Edinger nuclei, serotonergic dorsal raphe nucleus (10 to 76% cell loss), noradrenergic locus ceruleus (40 to 80% cell loss in topographic relation to temporal targets) and, less, the dopaminergic striatonigral system. The morphologic heterogeneity of AD shows overlaps with Parkinson’s, diffuse Lewy body disease, cerebrovascular and other brain lesions. In autopsy series, the accuracy rates for clinical diagnosis of AD are about 80 to 85%, but more standardized morphologic criteria are needed.
KeywordsAlzheimer Disease Cerebral Amyloid Angiopathy Neuritic Plaque Diffuse Lewy Body Disease Mental Status Test
Unable to display preview. Download preview PDF.
- Ball MJ (1989) Neuropathology in the diagnosis of Alzheimer’s disease. In: Hovaguimian T, Henderson S, Khachaturian Z, Orley J (eds) Classification and diagnosis of Alzheimer’s disease. An international perspective. Hogrefe and Huber, Toronto, pp 135–143Google Scholar
- Gibb WRG (1989) The neuropathology of parkinsonian disorders. In: Jankovic J, Tolosa E (eds) Parkinson’s disease and movement disorders. Urban and Schwarzenberg, Baltimore Munich, pp 205–223Google Scholar
- Jellinger K (1989) Morphologie des alternden Gehirns and der (prä)senilen Demenzen. In: Platt D, Österreich K (Hrsg) Handbuch der Gerontologie, Bd 5. Fischer, Stuttgart New York, S 3–56Google Scholar
- Jellinger K, Danielczyk W, Fischer P, Gabriel E (1990) Clinicopathological analysis of dementia disorders in the elderly. J Neurol Sci 95 (in press)Google Scholar
- Kosaka K, Tsuchiya K, Yoshimura M (1988) Lewy body disease with and without dementia. A clinicopathologic study of 35 cases. Clin Neuropathol 7: 299 —305Google Scholar
- Lassmann H, Fischer P, Bancher C, Jellinger K (1990) Immunocytochemical and ultrastructural pathology of nerve cells in Alzheimer’s disease and related disorders. In: Maurer K, Riederer P, Beckmann H (eds) Lassmann H, Fischer P, Bancher C, Jellinger K, pp 171–179 ( Key Topics in Bra in Research)Google Scholar
- Probst A, Anderton BH, Brion JP, Ulrich JU (1989) Senile plaque neurites fail to demonstrate anti-paired helical filament and anti-microtubule-associated protein-tau immunoreactive proteins in the absence of neurofibrillary tangles in the neocortex. Acta Neuropathol (Berl) 77: 430–436CrossRefGoogle Scholar
- Purohit C, Perry RH, Irvinb D (1989) Alzheimer-type pathology in dentate gyrus of the hippocampus. J Neuropathol Exp Neurol 48: 340Google Scholar
- Sulkova R, Erkinjuntti T, Haltia M, et al (1989) Non-Alzheimer dementias fulfilling the NINCDS-ADRDA criteria for probable Alzheimer’s disease. Aging of the brain and dementia: ten years later. Florence, May 31– June 3, 1989, p 125 (Abstr)Google Scholar
- Tomlinson BE, Henderson G (1976) Some quantitative cerebral findings in normal and demented old people. In: Terry RD, Gershon S (eds) Neurobiology of aging. Raven Press, New York, pp 183–209Google Scholar
- Vogels OJM, Broere CA J, Renkawek K (1989) Neuron numbers and sizes of nucleus basalis Meynert in Alzheimer’s disease. Aging of the brain and dementia: ten years later. Florence, May 31– June 3, 1989, p 77 (Abstr)Google Scholar
- Weis S, Wenger E, Jellinger K (1989) The corpus callosum in normal aging and Alzheimer disease. Aging of the brain and dementia: ten years later. Florence, May 31– June 3, 1989, p 79 (Abstr)Google Scholar