Cell loss in the locus coeruleus in senile dementia of Alzheimer type

Quantitation of catecholamine neurons in the locus coeruleus in human brains of normal young and older adults and in depression

A quantitative study of the morphology and distribution of norepinephrinergic neurons in the human locus coeruleus (LC) is given for normal young and older adult brain. Norepinephrine (NE)-producing neurons are identified by immunocytochemistry of two NE biosynthetic enzymes, tyrosine hydroxylase (TH) and dopamine-beta-hydroxylase (DBH), visualized by the peroxidase-antiperoxidase and immunogold-silver-staining methods. TH and DBH immunoreactions yield equivalent results. Both immunocytochemical visualization methods allow detailed analysis of neuronal morphology. The neurons of the human LC fall into four classes: large multipolar neurons with round or multiangular somata, large elliptical "bipolar" neurons, small multipolar neurons, and small ovoid "bipolar" neurons. Though most of the neurons contain neuromelanin pigment, some larger neurons lack pigmentation. Dendritic arborization of all neurons is extensive. Computer-assisted quantitative measurements of the parameters somatic size, dendritic arbor length, surface area, and volume are given. Somatic areas of LC neurons of all four classes are decreased in older adult brain, but dendritic arborization is equally extensive as in the younger. The rostrocaudal length of the LC is approximately 15 mm, and no age-dependent decrease is observed. Computer-assisted mapping of immunoreactive neurons and three-dimensional reconstruction allow division of the LC into rostral, middle, and caudal parts with characteristic distribution of neurons. Small neurons predominate in all parts, but the relative contribution of larger cells decreases in a rostrocaudal direction. A cell loss of 27-37% occurs in older adult brains and to 55% in the brain of a chronically depressed patient without dementia. Cell loss is highest in the rostral part, lower in the middle, and absent in the caudal part, and more small cells are lost than larger ones.

Alterations in catecholamine neurons of the locus coeruleus in senile dementia of the Alzheimer type and in Parkinson's disease with and without dementia and depression

The present study provides qualitative and quantitative investigations of the norepinephrine (NE) neurons in the locus coeruleus (LC) in two neurodegenerative disorders, the senile dementia of the Alzheimer type (SDAT) and Parkinson's disease (PD). The group of PD subjects was subdivided into cases without dementia (P - D), cases with dementia, L-dopa responsive (P + D), and cases with fulminant dementia whose motor disorder symptoms were L-dopa nonresponsive (P + D/L-dopa non-responsive). NE neurons were demonstrated by immunocytochemistry against tyrosine hydroxylase (TH). Quantitations of neuronal parameters and cell numbers and three-dimensional reconstructions of the LC were carried out with a computer-assisted system. In SDAT cases, the rostrocaudal LC length (13 +/- 2.2 mm) is shorter than in controls (14.9 +/- 1.4 mm). The four basic LC neuron classes found in the normal human brain (large multipolar, large "bipolar," small multipolar, and small "bipolar" neurons; Chan-Palay and Asan: J. Comp. Neurol. this issue) are recognizable, but many cell somata are swollen and misshapen with fore-shortened, thick, and less branched dendrites. LC neuron numbers are reduced (between -3.5% and -87.5%). Neuron loss is greatest in the rostral part, less in the middle, and least in the caudal part. In PD cases, the rostrocaudal length (12.4 +/- 1.5 mm) is shorter than in SDAT and controls. The neuronal morphology is more severely altered than in SDAT. The basic neuron classes are hardly distinguishable. Most cell bodies are swollen; they frequently contain Lewy bodies; and the dendrites are short and thin with absent or reduced arborizations. Neuron numbers are more reduced than in SDAT (between -26.4% and -94.4%). Alterations are as severe caudally as rostrally in P - D, and P + D/L-dopa nonresponsive cases. P + D cases are more severely affected rostrally. The presence of depression in SDAT and Parkinson's patients is accompanied by the greatest loss of LC neurons. On the basis of morphological alterations of the TH-immunoreactive neurons, and the degree and topographical distribution of neuron loss, a differentiation is possible between the LC in normal brain and that in SDAT and PD for diagnostic purposes.

Quantitation of cerebral atrophy in preclinical and end-stage Alzheimer's disease

Morphometric analysis of standardized gross cerebral slices from 16 patients with end-stage Alzheimer's disease (AD), 14 controls without neuropathological lesions or neurological disease, and 4 neurologically intact nondemented patients with histopathological lesions of AD was used to measure cross-sectional areas of cerebral cortex, white matter, subcortical nuclei, and the ventricular system. In AD, there was global cerebral atrophy of both cortex and white matter, selective atrophy of the amygdala and hippocampus, and ex vacuo hydrocephalus. In addition, in half the cases of AD, white matter atrophy was associated with overt histopathological evidence of patchy rarefaction of fibers and gliosis. Patients with preclinical AD had prominent and selective shrinkage of white matter comparable to that observed in AD, yet their cortical areas were normal. These observations suggest that white matter degeneration is an intrinsic component of AD. Moreover, its presence in preclinical AD where cortical atrophy is not evident indicates that cytoskeletal abnormalities associated with axonal degeneration may precede and perhaps cause the cortical atrophy observed in clinically manifested AD.

A neuroanatomical and biochemical basis for attention deficit disorder with hyperactivity in children: a defect in tonic adrenaline mediated inhibition of locus coeruleus stimulation

Attention deficit disorder with hyperactivity (ADDH) is characterized by a high level of inappropriate activity, distractability and impulsivity as well as learning deficits. In mammals, the protective mechanism for acquisition of sensory information, processed for its survival value, can be termed "vigilance". In ADDH, a low threshold for novel or sensory stimuli, results in a "hard wired" mammalian response, orienting, followed by exploratory behavior, the orienting reaction. This behavior is mediated in the brainstem through sensory neurons in the reticular formation regulating the discharge of locus coeruleus noradrenergic neurons. It is proposed that adrenaline acts as a tonic inhibitor of these neurons, modulating the level of sensory stimulation necessary to elicit locus coeruleus excitation. An imbalance in adrenaline formation or alpha-2 adrenergic receptor number (or affinity) leads to the inability to maintain the appropriate threshold for discharge of locus coeruleus neurons. The consequences are inability to maintain focused attention, difficulty in falling asleep or light levels of sleep, inattention to consumptive behavior, and probable inappropriate response for reward as all these behaviors require disruption of processing of sensory stimuli. Cognitive deficits may occur secondarily.

Noradrenergic innervation of human pineal gland: abnormalities in aging and Alzheimer's disease

Using previously characterized polyclonal antibody directed against dopamine beta-hydroxylase (DBH), immunoreactive fibers were demonstrable in pineals of 6 controls of various ages and of 3 individuals with Alzheimer's disease (AD). Abnormal, swollen axons were present in pineals from aged individuals and from individuals with AD. The pathology of noradrenergic axons in a structure innervated by the superior cervical ganglion suggests that peripheral noradrenergic systems may be affected in aging and in AD.

The neurobiology of Alzheimer's disease

The defining histological characteristics of Alzheimer's disease (AD) are neurofibrillary tangles and neuritic plaques, although neither is pathognomonic for this disorder. The distribution of AD histopathology suggests selective neuronal vulnerability, with specific cell populations affected within discrete regions of the cerebral hemispheres and within certain subcortical and brain-stem nuclear areas. At the ultrastructural level, tangles and plaque neurites contain paired helical filaments whose composition is unknown but may include altered cytoskeletal elements. Amyloid, deposited in plaque cores and often focally present within the cerebral vasculature, contains a polypeptide ("beta-protein," or "beta-amyloid") encoded by a chromosome 21 gene. At least in occasional families, AD has been linked to a separate chromosome 21 locus, but different underlying genetic factors may operate in other cases. Inorganic substances, including aluminum and silicon, are reported to co-localize within tangle-bearing neurons and plaque cores. Specific environmental agents have not been confirmed to be pathogenetically important, however, but may eventually prove to exert a permissive, facilitatory, or even causative role in many AD patients.

Noradrenergic systems in human cerebellum

Thin, beaded axons, immunostained with antisera to human dopamine beta-hydroxylase (DBH), were present in all layers of the anterior vermis of human cerebellum. This plexus appears similar to that described in rodents and provides information complementary to receptor autoradiographic studies that show significant noradrenergic innervation of mammalian cerebellum. Moreover, in two aged controls, we demonstrated abnormal, swollen, tortuous axons not visualized in young controls.

The substantia nigra and ventral tegmental area in Alzheimer's disease and Down's syndrome

Degenerative changes in the substantia nigra and ventral tegmental area were investigated in 104 cases of Alzheimer's disease and 13 cases of Down's syndrome. Frequencies of tangles in three groups of patients with Alzheimer's disease were 86%, 44% and 46% (54% overall) respectively. About half of those with tangles, but no Lewy bodies, had excess nigral cell loss, and 16% had moderate or severe neuronal fallout, but none had a Parkinsonian syndrome. Cases with nigral tangles were younger, tended to have more hippocampal and cortical tangles and plaques, and lower activities of cortical choline acetyltransferase. In most cases of Alzheimer's disease degeneration in nigral and tegmental areas was greater than controls, and tangles were evenly distributed. All the cases of Down's syndrome had tangles in the nigra and eight showed mild cell loss. Mild degenerative changes accompanied by tangles in the substantia nigra and ventral tegmental area are common in Alzheimer's disease, but severe cell loss is rare. When a Parkinsonian syndrome occurs in Alzheimer's disease it is likely to be due to Lewy body pathology.

The topography of nerve cell loss from the locus caeruleus in elderly persons

A topographical analysis of nerve cell loss from the locus caeruleus in "mentally normal" old people shows cell loss to be uniformly diffuse throughout the whole nucleus with no preferential involvement of any one particular area. Such findings contrast with those of ours on Alzheimer's disease and suggest differing mechanisms underlying the cell loss of old age and Alzheimer's disease. Cell loss in Alzheimer's disease is thought to relate to primary pathogenetic events in terminal fields of cerebral cortex. In "normal" old age, cell loss may be determined by changes occurring at perikaryal level possibly in respect of the cytotoxic effects of noradrenaline degradation and neuromelanin accumulation.

Neurochemical characteristics of aluminum-induced neurofibrillary degeneration in rabbits

Aluminum-induced neurofibrillary degeneration in rabbits is known to affect particular populations of neurons. The neurotransmitter alterations which accompany aluminum neurofibrillary degeneration were examined in order to assess how closely they mimic those of Alzheimer's disease. There was a significant reduction in choline acetyltransferase activity in entorhinal cortex and hippocampus as well as significant reductions in cortical concentrations of serotonin and norepinephrine in the aluminum-treated rabbits. Significant reductions in glutamate, aspartate and taurine were found in frontoparietal and posterior parietal cortex. Concentrations of GABA were unchanged in cerebral cortex. Both substance P and cholecystokinin immunoreactivity were significantly reduced in entorhinal cortex but there were no significant changes in somatostatin, neuropeptide Y and vasoactive intestinal polypeptide. The five neuropeptides were unaffected in striatum, thalamus, cerebellum and brainstem. Neurochemical changes were found in the regions with the most neurofibrillary degeneration while regions with little or no neurofibrillary degeneration were unaffected. The reductions in choline acetyltransferase activity, serotinin and noradrenaline suggest that some neuronal populations preferentially affected in Alzheimer's disease are also affected by aluminum-induced neurofibrillary degeneration; however, the cortical somatostatin deficit which is a feature of Alzheimer's disease is not replicated in the aluminum model.

Polypeptide composition of paired helical filaments

Immunocytochemical studies using antibodies to cytoskeletal proteins have provided conflicting data on the components of paired helical filaments (PHF), due solely to immunological cross-reactivities. To avoid such ambiguity, we developed a protein chemical approach to the identification of the PHF components. After treatment with formic acid, PHF were digested with lysylendopeptidase and the resultant peptides were separated by HPLC. All major peaks were analysed for their amino acid compositions and sequences. From the PHF digest, proteolytic fragments of ubiquitin, tau and beta protein were sequenced. Ubiquitin in PHF appears to be in a conjugated form, while its target protein remains unidentified. Tau is integrated into PHF at the site of its carboxyl third. The presence of beta protein fragments is best interpreted as being due to contamination of amyloid filaments in the PHF preparation. Thus, ubiquitin and tau are the two definite components of PHF.

The carboxyl third of tau is tightly bound to paired helical filaments

To obtain definitive evidence that tau is a component of paired helical filaments (PHF) in Alzheimer's disease, we fractionated and sequenced PHF-derived peptides according to a previously described procedure. In the PHF digest, we found four independent tau peptides that were located in the carboxyl third of tau. Subsequent extensive analysis of the PHF digest did not provide any other tau peptides. The conventional PHF antiserum and a new antiserum directed toward formic acid-denatured PHF reacted with the distinct CNBr fragments of tau localized on the carboxy-terminal portion of tau by protein sequencing. From these observations, we conclude that the carboxyl third of tau is tightly bound to PHF.

Regional changes in [3H]D-aspartate and [3H]TCP binding sites in Alzheimer's disease brains

The specific binding of [3H]D-aspartate, a marker for the presynaptic glutamate uptake site, and [3H]N-(1-[2-Thienyl]cyclohexyl)-piperidine [( 3H]TCP), a high affinity ligand for the N-methyl-D-aspartate (NMDA)-associated phencyclidine binding site, was measured in homogenates of brain from normal subjects and from subjects with neuropathologically confirmed Alzheimer's disease. Alzheimer's disease was associated with a reduction in [3H]D-aspartate binding density in temporal cortex and caudate nucleus. By contrast, a reduction in the receptor density for [3H]TCP binding was only recorded in the frontal cortex. Thus, glutamate-containing nerve terminals are severely reduced in Alzheimer's disease, whilst the postsynaptic NMDA-phencyclidine receptor complex is much less affected. These findings have implications for theories of glutamate neurotoxicity in Alzheimer's disease.

Neuron numbers and sizes in aging brain: comparisons of human, monkey, and rodent data

One of the several sources of interest in aging animal brains is their potential as models of the aging human brain. In this review we examine whether neuron numbers and sizes change similarly in aging human, monkey and rodent brain regions which data are available from more than one species. The number of brain regions studied in more than one species is surprisingly limited. Some regions show correspondence in age-related changes between humans and selected animal models (primary visual cortex, CA1 of hippocampus). For the majority of regions the data are conflicting, even within one species (e.g., somatosensory cortex, frontal cortex, cerebellum, cholinergic forebrain areas, locus coeruleus). Although some of the conflicting data may be attributed to procedural differences, particularly when data are expressed as density changes, much must be attributed to real species and/or strain differences in rodents. We conclude that neuron numbers and sizes may show similar age-related changes in human and animal brains only for sharply defined brain regions, animal species and/or strains, and age ranges.

A unifying theory of movement and madness: involvement of free radicals in disorders of the isodendritic core of the brainstem

Parkinson's disease and Alzheimer's disease are both neuro-degenerative disorders which affect a large number of the older population. Schizophrenia is a neuropsychiatric illness with a variable course which, sometimes, results in a deteriorated state, the so-called schizophrenic burnout. Although the pathogenesi(e)s of these syndromes is (are) not known, it has been suggested that the reported neuropathological findings are concentrated in neuronal systems located within the isodendritic core of the brainstem. It has also been proposed that oxyradicals might play an important role in the development, the manifestation, and the course of these syndromes. The present article provides a theoretical synthesis of these ideas.

The neuropathology of aminergic nuclei in Alzheimer's disease

Neuronal loss and the presence of neurofibrillary tangles (NFTs) within aminergic nuclei were examined in a series of patients with Alzheimer's disease (AD). Neuromelanin-containing neurons within the locus ceruleus and large nucleolus-containing neurons within the dorsal raphe nucleus and the central superior (raphe) nucleus were counted in 25 patients with AD and in 12 age-matched control subjects. Numbers of NFTs were quantified in the same regions. Counts were compared with clinical data, including psychiatric evaluations, available for 21 of the patients with AD. Within the locus ceruleus in the patients with AD, abnormalities were more severe at mid level than at caudal or rostral levels (p less than 0.01). Within the dorsal raphe nucleus, neuronal loss was most severe caudally (p less than 0.05). NFTs, but not neuronal loss, were demonstrated within the central superior nucleus. Neuronal and NFT counts did not correlate at individual levels; the relative severity of both pathological processes was consistent from level to level within nuclei but was less consistent between nuclei. Neuronal loss correlated inversely with age, particularly within the locus ceruleus. Duration of disease correlated inversely with counts of NFTs, particularly within the dorsal raphe nucleus, implying a correlation between NFT counts and rate of progression of disease as all but 3 patients had severe dementia. Significantly, patients with AD complicated by major depression had fewer neurons at the mid level of the locus ceruleus and at the rostral level of the central superior nucleus in comparison with nondepressed patients. There was a trend suggesting greater loss of neurons at all levels of the locus ceruleus and dorsal raphe nucleus in depressed individuals.

The origin of tyrosine hydroxylase-immunoreactive fibers in the regions of the nucleus basalis magnocellularis of the rat

The simultaneous use of acetylcholinesterase (AChE) histochemistry and tyrosine hydroxylase (T-OH) immunocytochemistry permitted demonstration of the existence of a dense catecholaminergic network surrounding cholinergic neurons within the nucleus basalis magnocellularis (NBM) of the rat. The origin of this catecholaminergic network was investigated by combining T-OH immunocytochemistry with horseradish peroxidase (HRP) retrograde labelling using a slow release gel, unilaterally implanted in the area of the NBM. Retrogradely transported HRP was detected in some of the aminergic cell groups of the substantia nigra (A9) and locus coeruleus (A6). In these areas, approximately 1% of the tyrosine hydroxylase immunoreactive neurons were retrogradely labelled with HRP. In the substantia nigra, dually labelled neurons were found predominantly in the pars lateralis.

The differential involvement of subcortical nuclei in senile dementia of Alzheimer's type

Cell counts have been performed on cholinergic subcortical nuclei, dorsal raphe nucleus, and locus caeruleus from up to 18 cases of Alzheimer's disease and 10 age-matched control subjects. In general, the extent of cell loss in these structures was similar. In the basal nucleus the anteromedial subdivision was the least, and the posterior subdivision the most affected. A subgroup of demented subjects with Alzheimer's disease had a relatively preserved basal nucleus, and frontal lobe (CAT) choline acetyltransferase activities similar to those in control subjects, but significantly more neuronal loss in the locus caeruleus.

Locus ceruleus morphometry in aging and schizophrenia

The locus ceruleus (LC), a pigmented brainstem nucleus rich in noradrenergic neurons, has been proposed to be involved in the pathophysiology of aging and schizophrenia. We undertook a quantitative neuropathological study of the LC in these two conditions. A computing planimeter was employed to count the total number of neurons and measure the volume of the LC, neuronal cross-sectional area, and percent of neuronal area occupied by neuromelanin in the brains of 39 subjects; 13 "normative", 15 leucotomized schizophrenic (most had died in the preneuroleptic era), and 11 leucotomized non-schizophrenic control patients, ranging in age from 11 to 94 years. There was a significant inverse correlation between age and total number of LC neurons, neuronal size, and LC volume, and a significant positive correlation between age and the percentage of neuronal area occupied by neuromelanin. Although schizophrenics did not differ significantly from control groups on any of the parameters of LC morphology, there was a trend for reduced LC volume in schizophrenic brains. Also, the LC of leucotomized patients tended to have increased neuromelanin content and slightly increased cell counts compared to normals, although the importance of this finding is not clear.

Innervation of human hippocampus by noradrenergic systems: normal anatomy and structural abnormalities in aging and in Alzheimer's disease

Immunocytochemical studies, using an antibody directed against human dopamine beta-hydroxylase, identified an extensive plexus of noradrenergic axons/terminals in normal human hippocampus. In hippocampi of individuals with Alzheimer's disease, the density of noradrenergic innervation was reduced and abnormal noradrenergic axons, which exhibited multifocal enlargements, were present in the neuropil. Some of these neurites were clustered around deposits of amyloid (senile plaques), and these abnormalities were most common in CA3-4, a region normally showing a relatively high density of noradrenergic terminals. This investigation provides direct evidence for structural abnormalities of noradrenergic axons/nerve terminals in hippocampi of individuals with Alzheimer's disease.

Mitochondrial function in brain tissue in primary degenerative dementia

Previous in vitro and in vivo studies of the brain in Alzheimer's disease indicated alterations in metabolism related to energy production although the relationships between these changes remains obscure. To help resolve this issue, in vitro oxygen uptake by homogenates of fresh samples of frontal neocortex from patients with dementia and neurosurgical controls has been examined as a measure of energy-related metabolism and mitochondrial function. Maximal respiratory rates (measured in the presence of an uncoupling agent) were similar for samples from 7 controls, 5 patients with Alzheimer's disease and two patients diagnosed clinically as Pick's disease, suggesting that there was little or no effect of these dementias on the maximal metabolic capacity of the tissue. However, under some conditions producing sub-maximal metabolic activity (which are of potentially greater physiological relevance) oxygen uptake rates were significantly elevated in the dementia group. The ratio of oxygen uptake rates in the presence and absence of ADP was significantly reduced (to 58% of control; P less than 0.02) for the dementia patients compared with controls, possibly indicative of partial mitochondrial uncoupling. These results indicate metabolic changes expressed in vitro which may be relevant to the pathogenesis of Alzheimer's disease and some related dementias.

Neuron numbers and dendritic extent in normal aging and Alzheimer's disease

Factors which limit the interpretation of studies of aging brain include: secular trends, species and strain differences, effects of tissue processing, and bias which may be introduced at many levels of an experimental design. With these limitations considered, evidence is reviewed regarding neuron numbers and dendritic extent in normally aging rodent, monkey and human brain and in Alzheimer's disease. It is concluded that neuron loss and change in dendritic extent in normal aging are regionally specific, and that corresponding brain regions do not always change in similar ways in rodents and primates. It is suggested that such differences may, in part, be due to inconsistent definitions of 'aged' among species. In Alzheimer's disease there is excess neuron loss and dendritic regression in some, but not all, brain regions. Measures of the morphological substrates of brain function show appreciable overlap between AD and control groups. It is hypothesized that the static, post-mortem status of brain morphology may not adequately reflect the functional capabilities of the dynamic morphology of the living brain.

Neuronal loss in old people: the effects of ageing or disease?

There is abundant evidence to show that the brains of many persons, who do not suffer from overt neurological or psychiatric disease, deteriorate in structure in old age. However, it still remains uncertain as to whether these changes stem from the effects of an ageing process per se or whether the simply reflect the minor pathological results of clinically incipient disorders such as Alzheimer's disease or Parkinson's disease (conditions which become increasingly widespread in later life) or the cerebral manifestations of systemic disease.

Aminergic systems in Alzheimer's disease and Parkinson's disease

Biochemical markers for serotoninergic and catecholaminergic neurons in frontal and temporal poles were examined post mortem in brains of patients with Alzheimer's disease, Parkinson's disease, and the two combined. Binding of [3H] citalopram to serotoninergic uptake sites and levels of serotonin were decreased by 40 to 50% in brains of persons in each disease category. In contrast, significant reductions of catecholaminergic markers were not detected. In all three disease groups, the choline acetyltransferase activity was reduced by 50 to 60%. Binding sites for adenosine (A1), muscarinic cholinergic, phencyclidine, beta-adrenergic, and calcium antagonist receptors were unchanged. We conclude that substantial damage to serotoninergic neurons occurs in persons with Parkinson's and Alzheimer's diseases.

Reduction of arginine-vasopressin in the cerebral cortex in Alzheimer type senile dementia

Arginine-vasopressin (AVP) concentrations in five cortical areas were measured post mortem in nine patients with senile dementia of Alzheimer's type (SDAT), and compared with the control group of comparable ages. In SDAT patients, AVP was significantly reduced in Brodmann areas 4, 7 and 10 (p less than 0.05). In areas 17 and 22, the detectability and the mean concentrations of AVP were also lower than those of control patients, although not significantly.

Catecholaminergic neurones assessed ante-mortem in Alzheimer's disease

Indices of dopaminergic and noradrenergic varicosities were assayed in neocortical tissue obtained at diagnostic craniotomy from patients with Alzheimer's disease in the presenium. Dopaminergic markers (concentrations of dopamine, dihydroxyphenylacetic acid and homovanillic acid) were not significantly different from controls in either frontal or temporal cortex. In the frontal cortex, the release of endogenous dopamine and noradrenaline (in the presence of both resting and stimulating concentrations of potassium) was also unaffected whereas release of endogenous serotonin was significantly reduced. In the temporal cortex, noradrenergic markers (concentration of noradrenaline and uptake of radiolabelled noradrenaline) were significantly reduced, to at least 47% of mean control values. These deficits are interpreted as reflecting denervation and were present in patients examined only some two years after developing symptoms of dementia. The ratio of 3-methoxy-4-hydroxyphenylglycol to noradrenaline (a putative index of noradrenaline turnover) was elevated in the temporal cortex, suggesting increased activity of the remaining noradrenergic varicosities. Noradrenergic markers did not correlate with either clinical or histological indices of the severity of the disease which contrasts with presynaptic cholinergic and serotonergic markers.

Selective involvement of large neurons in the neostriatum of Alzheimer's disease and senile dementia: a morphometric investigation

In order to evaluate the quantitative changes in the neostriatum of Alzheimer type (SDAT), sections of the caudate head (CN) and putamen (PT) from 4 AD/SDAT and 6 age-matched control cases were stained with Klüver-Barrera, and the cell body and nuclear areas of the neurons were measured by a digitizer. This study revealed a significant decrease in the number of large neurons (nuclear area; greater than 101 micron 2) and good preservation of the number of small neurons (nuclear area; less than 100 micron 2) in CN and PT of AD/SDAT.

A quantitative morphometric analysis of the neuronal and synaptic content of the frontal and temporal cortex in patients with Alzheimer's disease

A quantitative morphometric analysis was used to estimate neurone and synapse densities in cerebral cortical biopsy tissues from patients with dementia under 65 years of age and pathologically verified as suffering from Alzheimer's disease. Estimates of the numerical density of neurones and synapses were made in layers II-III and V of both frontal and temporal cortex. A greater loss of synapses than that of neurones was found in Alzheimer's disease, amounting to a minimum (uncorrected for atrophy) of 25% in layers II-III and 36% in layer V of the temporal cortex, and 27% in layer V of the frontal cortex. Values of synapse to neurone ratio also demonstrated this greater loss of synapses, there being on average 38% fewer synapses associated with each surviving neurone in layers II-III of the temporal cortex, 30% fewer in layer V, and a deficit of 14% in layer V of the frontal cortex. It is concluded that a major loss of synapses occurred in this group of patients with Alzheimer's disease, probably at an early stage of the disease, and that the loss is likely to form a fundamental part of the pathological process that underlies the cortical damage of this condition.

Changes in beta-adrenergic receptor subtypes in Alzheimer-type dementia

Using ligand binding techniques, we studied beta-adrenergic receptor subtypes in brains obtained at autopsy from seven histologically normal controls and seven histopathologically verified cases with Alzheimer-type dementia (ATD). Inhibition of [3H]dihydroalprenolol [( 3H]DHA) binding by the selective beta 1 antagonist, metoprolol, results in nonlinear Hofstee plots, suggesting the presence of the two receptor subtypes in the human brain. The calculated ratios of beta 1/beta 2-adrenergic receptors in control brains are as follows: frontal cortex, 49:51; temporal cortex, 31:69; hippocampus, 66:34; thalamus, 23:77; putamen, 70:30; caudate, 48:52; nucleus basalis of Meynert (NbM), 43:57; cerebellar hemisphere, 25:75. Compared with the controls, total concentrations of beta-adrenergic receptors were significantly reduced only in the thalamus of the ATD brains. beta 1-Adrenergic receptor concentrations were significantly reduced in the hippocampus and increased in the NbM and cerebellar hemisphere, whereas beta 2-adrenergic receptor concentrations were significantly reduced in the thalamus, NbM, and cerebellar hemisphere and increased in the hippocampus and putamen of the ATD brains. These results suggest that beta 1- and beta 2-adrenergic receptors are present in the human brain and that there are significant changes in both receptor subtypes in selected brain regions in patients with ATD.

Dopaminergic neurotransmitter systems in Alzheimer's disease and in Down's syndrome at middle age

In 15 patients with Alzheimer's disease and in 10 with Down's syndrome at middle age, there was severe atrophy, neurofibrillary degeneration and loss of pigmented dopaminergic nerve cells from ventral tegmental area (A10) whereas nerve cells in neighbouring substantia nigra (A9) were much less affected in all three respects. It is suggested that these findings may represent different patterns of damage within the two systems in these conditions which may relate to the presence of Alzheimer type changes (senile plaques) within their respective projection fields.

Distribution of biogenic amines and their catabolites in brains from patients with Alzheimer's disease

Norepinephrine, epinephrine, dopamine, serotonin and their major catabolites were measured in 17 regions of the left hemisphere of two brains obtained from two brothers with Alzheimer's disease with very early onset. The clinical diagnosis was confirmed by histological examination of the right hemispheres and brain stems. The quantitative data were compared with our values in normal brains. In the patient suffering from the less severe dementia, there was a severe reduction of the serotonin concentration in all examined neocortical areas and its concentration was even below the detection limit in the nucleus amygdalis, hippocampus, caudate nucleus, putamen, globus pallidus and substantia nigra. In the other patient, who suffered from a more pronounced dementia with myoclonus, the serotonin concentration was below the detection limit in all examined structures. In contrast with these findings, the noradrenergic, adrenergic and dopaminergic systems appeared to be relatively unaffected by the disease process. Focusing our attention on the nuclei wherein the monoamine transmitter systems originate, it appeared that neuronal losses and neurofibrillary tangles clearly predominated in the substantia grisea subependymalis, the nucleus centralis superior and the nucleus raphe dorsalis, origin of the main serotonergic system. The serotonin deficiency sheds light on possible mechanisms of myoclonus in Alzheimer's disease.

Decreased somatostatin-like immunoreactivity in cerebral cortex and cerebrospinal fluid in Alzheimer's disease

To investigate changes in the somatostatinergic neurons of patients with Alzheimer's disease (AD), we determined the somatostatin-like immunoreactivity (SLI) in post-mortem brain tissue of histopathologically confirmed AD patients and in CSF of probable AD patients (according to DSM III). The CSF values were then correlated with psychological test scores. In 6 AD patients the SLI values were decreased 42% (P less than 0.005) in the frontal cortex, 28% (P less than 0.05) in the temporal cortex and 42% (P less than 0.01) in the parietal cortex but not in the thalamus and putamen compared to 11 control patients. In some brain areas there were statistical correlations between SLI values and cholinergic markers, choline acetyltransferase and acetylcholine esterase activities, suggesting a relationship between these two neurotransmitter systems. In the CSF among 75 AD patients SLI was 35% lower (P less than 0.001) than in controls. Severely demented power (P less than 0.001) than in controls. Severely demented patients showed lower SLI values than moderately demented individuals, but this difference was not significant. There was a weak but statistically significant correlation between SLI values in CSF and neuropsychological test scores. This study further confirms the involvement of somatostatinergic neurons in AD and suggests that this involvement may be related to the progression of dementia symptoms.

Monoaminergic innervation of the frontal and temporal lobes in Alzheimer's disease

Seven markers of ascending (corticopetal) dopaminergic, noradrenergic and serotonergic neurones and choline acetyltransferase activity have been studied postmortem in frontal and temporal cortex from subjects with Alzheimer's disease and compared with a matched group of controls. Dopaminergic neurones (concentrations of dopamine, dihydroxyphenylacetic acid and homovanillic acid) were not deficient but some markers of the other neurones were affected. Noradrenaline and serotonin concentrations were reduced whereas the concentrations of their metabolites were either unaltered (5-hydroxyindoleacetic acid) or increased (3-methoxy-4-hydroxyphenylglycol). All deficits were most pronounced in the temporal cortex. Severely demented subjects had evidence of generalized neuronal loss, whereas those with moderate dementia showed significant loss of only choline acetyltransferase activity. In Alzheimer subjects, a significant relationship (inverse) was found between 5-hydroxyindoleacetic acid concentration and the number of neurofibrillary tangles.

The topography of cell loss from locus caeruleus in Alzheimer's disease

A topographical analysis of nerve cell loss from locus caeruleus in Alzheimer's disease has shown that cell loss is confined to the dorsal areas and occurs uniformly throughout the rostrocaudal length of the locus. By contrast there is no significant cell loss from ventral parts of the locus, at any point along its rostrocaudal length. Dorsally located neurones of the locus project to cerebral cortex; ventrally located neurones to non-cortical areas such as basal ganglia, cerebellum and spinal cord. These data suggest that damage to nerve cells of locus caeruleus in Alzheimer's disease relates primarily to pathological events within their terminal fields, with perikaryal loss following as a secondary retrograde change. The senile plaque may represent the actual site of the damage to nerve terminals.

Characterization of L-[3H]nicotine binding in human cerebral cortex: comparison between Alzheimer's disease and the normal

Putative nicotine receptors in the human cerebral cortex were characterized with L-[3H]nicotine, L-[3H]Nicotine binding was enhanced by the addition of Ca2+ and abolished in the presence of Na3EDTA. Association and dissociation of the ligand were rapid at 25 degrees C with t1/2 values of 2 and 3 min, respectively. Saturation binding analysis revealed an apparent single class of sites with a dissociation constant of 5.6 nM and a Hill coefficient of 1.05. There was no effect of postmortem interval on the density of binding sites assayed up to 24 h in rat frontoparietal cortex. Nicotine binding in human cortical samples was also unaltered by increasing sampling delay. In human cortical membranes, binding site density decreased with normal aging. Receptor affinity and concentration in samples of frontal cortex (Brodmann area 10) from patients with Alzheimer's disease were comparable to age-matched control values. Samples of infratemporal cortex (Brodmann area 38) from patients with Alzheimer's disease had a 50% reduction in the number of L-[3H]nicotine sites. Choline acetyltransferase activity was significantly decreased in both cortical areas. Enzyme activities in the temporal pole were reduced to 20% of control values. These data indicate that postsynaptic nicotine receptors are spared in the frontal cortex in Alzheimer's disease. In the infratemporal cortex, significant numbers of receptors remain despite the severe reduction in choline acetyltransferase activity. Replacement therapy directed at these sites may be warranted in Alzheimer's disease.

Vasopressin in Alzheimer's disease: a study of postmortem brain concentrations

Vasopressin (AVP) and its analogues are reported to improve learning- and memory-related performance in experimental animals, and perhaps also in humans. Memory impairment is a clinical hallmark of the dementing disorder, Alzheimer's disease. We have examined AVP concentrations in postmortem brain tissue from 12 patients with histologically confirmed Alzheimer's disease and 13 control subjects. AVP was measured by a highly specific and sensitive radioimmunoassay, validated by parallel inhibition curves and high-performance liquid chromatography. Alzheimer brains had either normal or slightly increased AVP levels in the neocortex, which does not have AVP cell bodies. Significant reductions in AVP content were found in the hippocampus, nucleus accumbens, and globus pallidus interna. Levels were normal in all other regions studied. Abnormalities of the brain vasopressin system may contribute to the memory deficit associated with Alzheimer's disease.

A postmortem study of amino acid neurotransmitters in Alzheimer's disease

Concentrations of putative neurotransmitter amino acids were measured in postmortem brains from 10 patients with Alzheimer's disease and 10 controls. Glutamate, aspartate, taurine, gamma-aminobutyric acid (GABA), and alanine levels were examined in 9 cortical regions, hippocampus, thalamus, and basal ganglia using high-performance liquid chromatography with electrochemical detection. There were no significant alterations in aspartate, taurine, or alanine levels in any of the regions examined. Widespread significant reductions in cortical GABA concentrations were observed in the Alzheimer's brains, with the largest decreases in the temporal lobe. Overall values for glutamate concentrations in temporal and frontal cortices showed a significant 12% reduction in Alzheimer's brains, but the only individual cortical region showing a significant reduction in glutamate was the inferior temporal gyrus. These results suggest that gamma-aminobutyric acidergic neurons in Alzheimer's cerebral cortex may be selectively vulnerable to the disease process.

Neuropeptides in neurological disease

Neuropeptides are widely distributed in the central nervous system, where they serve as neuroregulators. Recent interest has focused on their role in degenerative neurological diseases. We describe the normal anatomy of neuropeptides in both the cerebral cortex and basal ganglia as a framework for interpreting neuropeptide alterations in Alzheimer's disease (AD), Huntington's disease, and Parkinson's disease. Concentrations of cortical somatostatin are reduced in AD and in dementia associated with Parkinson's disease. Concentrations of neuropeptide Y and corticotropin-releasing factor are also reduced in AD cerebral cortex. The reduced cortical concentrations of somatostatin and neuropeptide Y in AD cerebral cortex may reflect a loss of neurons or terminals in which these two peptides are co-localized. In Huntington's disease, basal ganglia neurons in which somatostatin and neuropeptide Y are co-localized are selectively preserved. Cerebrospinal fluid concentrations of neuropeptides in AD reflect alterations in cortical concentrations. Improved understanding of neuropeptides in degenerative neurological illnesses will help define which neuronal populations are specifically vulnerable to the pathological processes, and this could lead to improved therapy.

Comparison of counts of neurons in the locus coeruleus made from serial sections and from a single section at the centre of the nucleus

This paper describes the comparability of counts in the locus coeruleus made from serial sections and those made from a single section at the point of greatest density of neurons. Samples of the locus coeruleus neuronal population derived from single section counts though not exactly comparable, are of comparable utility to those obtained from more laborious total neuronal counts. The simpler method was used to examine the hypothesis that there are subtypes of senile dementia of the Alzheimer type. Separation into two groups was achieved when independent variables of cortical neuronal counts and tangle estimates were used. This finding adds to the growing evidence that Alzheimer's disease of the senile type is not a unitary disorder.