131 ISSN 1479-6708 10.2217/FNL.14.9 © 2014 Future Medicine Ltd Future Neurol. (2014) 9(2), 131–134 The amyloid cascade hypothesis predicts that pathological processes in Alzheimer’s disease (AD) begin with an alteration in the balance between the clearance and production of amyloid precursor protein. The disruption of this balance leads to the formation of b-amyloid (Ab) plaques, aggregation of phosphorylated tau into neurofibrillary tangles (NFTs), neuronal dysfunction and death, and finally dementia [1,2]. These processes are not ubiquitous throughout the brain; rather the strength [3] and timing [4] of each pathology varies between brain regions. Understanding the underlying physiological properties that allow some cortical structures to be resistant to pathology may lead to new strategies for treating and preventing AD. With the advancement of imaging techniques over the last decade, in vivo mapping of AD pathology is possible. Amyloid deposition can be measured using Pittsburgh compound B PET [5] or similar amyloid tracers; glucose metabolism can be imaged with fluorodeoxyglucose PET; and structural atrophy can be assessed by volumetric analyses of MRI. PET tracers for tau are only now being introduced [6]. Early post-mortem examinations in humans found a relatively diffuse distribution of Ab plaques throughout the brain and across subjects [7]. Amyloid imaging, primarily with Pittsburgh compound B and other radioligands, has affirmed that Ab is widely deposited in both cortical and subcortical brain structures [3,4,8], but has demonstrated that there is a discernable spatial pattern to these depositions. As measured with PET, there is both an anterior locus of high plaque depositions encompassing the anterior cingulate, orbitofrontal, medial frontal and lateral frontal cortices, as well as a posterior locus consisting of the precuneus and posterior cingulate (Figure 1A) [3,4,8]. Primary sensory and motor areas, as well as the medial temporal lobes show relatively low levels of plaque pathology. Although often overlooked, there are significant subcortical deposition of amyloid, particularly in the basal ganglia and thalamus [4,9]. In addition to the formation of Ab plaques and tau NFTs, the amyloid cascade theory predicts metabolic disruption. fluorodeoxyglucose PET is a measure of glucose metabolism, which in turn indexes neuronal health and functioning. There is
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