Non-demented Cases Research Articles

Senile Dementia of Lewy Body Type and Alzheimer Type Are Biochemically Distinct in Terms of Paired Helical Filaments and Hyperphosphorylated Tau Protein (Part 2 of 2)

We have used biochemical assays to examine cingulate and occipital cortices from age-matched cases of Alzheimer's disease (AD; n = 12), senile dementia of the Lewy body type (SDLT; n = 13), Parkinson's disease (PD; 5 non-demented cases and 7 cognitively impaired cases) and controls (n = 11) for paired helical filaments (PHFs), phosphorylated and normal tau protein and Β/A4-protein. Whereas cingulate cortex is characterised by relatively high densities of cortical Lewy bodies in the SDLT cases and lower numbers in PD, these inclusion bodies were absent in the cingulate cortex from AD and control cases. Protease-resistant PHFs and hyperphosphorylated tau protein were found in AD and, at low levels, in a minority of SDLT cases. Qualitatively, both of these preparations were indistinguishable in SDLT from those found in AD but levels of both parameters in SDLT were less than 5% of those in AD. SDLT, PD and control groups did not differ from each other in terms of the quantity of protease-resistant PHFs or the level of hyperphosphorylated tau. Furthermore, PHF accumulation did not distinguish between PD cases with or without dementia. The levels of normal tau protein did not differ between the four groups. Β/A4 protein levels did not distinguish between PD and control groups, between AD and SDLT groups, or between SDLT and control groups for either cingulate or occipital cortices. Thus extensive accumulation of PHFs in either neurofibrillary tangles or dystrophic neurites is not a feature of either SDLT or PD. Our findings provide molecular support for the neuropathological and clinical separation of SDLT as a form of dementia that is distinct from AD.

Is Hypertension a Cause of Dementia in the Elderly? : A Clinico-Pathological Study

To elucidate whether hypertension can be a cause of dementia in the elderly, and, if so, what mechanisms are involved in, a clinicopathological analysis was performed in 109 consecutive necropsied patients aged over 65 years. The diagnosis of vascular dementia was established in 17 cases, of which 11 showed leuko-araiosis (L-A) on CT scans and six did not. Of the 17 cases with vascular dementia and 71 nondemented cases, the pathological findings for the brain in 40 cases with L-A were compared with 48 cases without L-A, and those in 11 demented cases with L-A with those in 29 nondemented cases with L-A. Statistical analysis revealed that hypertensive changes of the intracerebral arteries (such as fibrinoid necrosis), lacunes, arteriosclerosis of subcortical white matter arteries, atherosclerosis of Willis circle, and cerebral amyloid angiopathy-associated vasculopathy (CAA-AV) were significantly more frequently found in the cases with L-A than in the cases without L-A. Among the cases with L-A, the incidence of hypertensive changes of the intracerebral arteries and lacunes was significantly higher in those with dementia than in those without. These results suggest that effects of hypertension on small parenchymal arteries and on cerebral atherosclerosis play important roles in the occurrence of L-A, and that the presence of lacunes is an important factor in the development of dementia. Although the proportion of cases with CAA-AV was small, L-A was thought to be caused by CAA-AV independently from the hypertensive and atherosclerotic processes. Senile changes are also suggested to play some role in the development of vascular dementia. (Hypertens Res 1994; 17 Suppl. I: S97-S101)

Senile dementia of Lewy body type and Alzheimer type are biochemically distinct in terms of paired helical filaments and hyperphosphorylated tau protein.

We have used biochemical assays to examine cingulate and occipital cortices from age-matched cases of Alzheimer's disease (AD; n = 12), senile dementia of the Lewy body type (SDLT; n = 13), Parkinson's disease (PD; 5 non-demented cases and 7 cognitively impaired cases) and controls (n = 11) for paired helical filaments (PHFs), phosphorylated and normal tau protein and beta/A4-protein. Whereas cingulate cortex is characterised by relatively high densities of cortical Lewy bodies in the SDLT cases and lower numbers in PD, these inclusion bodies were absent in the cingulate cortex from AD and control cases. Protease-resistant PHFs and hyperphosphorylated tau protein were found in AD and, at low levels, in a minority of SDLT cases. Qualitatively, both of these preparations were indistinguishable in SDLT from those found in AD but levels of both parameters in SDLT were less than 5% of those in AD. SDLT, PD and control groups did not differ from each other in terms of the quantity of protease-resistant PHFs or the level of hyperphosphorylated tau. Furthermore, PHF accumulation did not distinguish between PD cases with or without dementia. The levels of normal tau protein did not differ between the four groups. beta/A4 protein levels did not distinguish between PD and control groups, between AD and SDLT groups, or between SDLT and control groups for either cingulate or occipital cortices. Thus extensive accumulation of PHFs in either neurofibrillary tangles or dystrophic neurites is not a feature of either SDLT or PD. Our findings provide molecular support for the neuropathological and clinical separation of SDLT as a form of dementia that is distinct from AD.

Immunocytochemical distribution of peptidergic and cholinergic fibers in the human amygdala: their depletion in Alzheimer's disease and morphologic alteration in non-demented elderly with numerous senile plaques

As part of an ongoing investigation devoted to understanding the pathogenesis of senile plaques, we employed histochemical and immunocytochemical techniques to examine the distribution and cytologic features of acetylcholinesterase (AChE), choline acetyltransferase (ChAT), somatostatin (SOM), neurotensin (NT) and substance P (SP) containing fibers and neurons within the amygdala of: (1) patients with alzheimer's disease (AD); (2) age-matched non-demented controls (NC); and (3) a group of non-demented cases, who postmorten neuropathologic examination exhibited sufficient numbers of senile plaques to be classified as AD. This latter group was referred to as high plaque non-demented (HPND). For every case, the distribution of immunolabeled fibers and neurons were determined for each transmitter throughput the various subnuclei of the amygdala. In addition, in the AD and HPND cases the topographic distribution of senile plaques was determined throughout the amygdala using thioflavine-S and Bielschowsky silver methods. In the amygdala, the distribution and density of senile plaques were not bound by conventional cytoarchitectural groupings but rather were most dense in the ventromedial regions of the amygdala with decreasing density in dorsal and lateral directions. Importantly, the density and distribution of senile plaques failed to correlate with the normal topography and/or density of the various peptidergic or cholinergic fibers within the amygdala. The finding that plaques do not correlate with the topographic distribution of any specific transmitter system suggests that plaques likely do not arise from the degeneration of a single neurotransmitter system (i.e., the cholinergic system). However, the finding that in AD a transmitter is most markedly depleted in regions of greatest plaque density, suggests certain constituents of the plaque (e.g. β-amyloid) may be contributing to the degeneration of local fibers. The extent to which a transmitter was depleted in AD patients varied considerably among those four investigated with the cholinergic and NT systems displaying the most dramatic reductions, followed by SP and SOM. Despite these differential reductions in fiber density, all four neurotransmitters were found localized within dystrophic neurites and in most instances these dystrophic neurites were associated with thioflavine-positive senile plaques. In contrast to the AD cases, the HPND cases were characterized by no significant reductions in immunolabeled fibers, although immunostained dystrophic neurites were very prevalent in the HPND cases. These data sugggst that dystrophic neurites occur very early in the disease process and likely precede the actual loss of fibers when or if it occurs. Moreover, the absence of any significant loss of labeled fibers in the HPND case versus the marked reduction of fibers in the AD cases underscores the putative importance of fiber and/or synaptic loss as an anatomical correlate to dementia.

Ubiquitin immunocytochemistry in human spongiform encephalopathies.

The distribution of ubiquitin was studied by immunocytochemistry in eight cases of human spongiform encephalopathy and compared with the findings in seven age- and sex-matched cases of Alzheimer's disease and six non-demented control cases. The results were also compared with the immunocytochemical distribution of prion protein and the lysosomal aspartic protease cathepsin D. In the human spongiform encephalopathies, ubiquitin immunoreactivity was found in a punctate distribution at the periphery of prion protein amyloid plaques and in a finely granular pattern in the neuropil around and within areas of spongiform change. Cortical nerve cells contained scanty ubiquitinated dot-like inclusions, and occasional microglia around the areas of spongiform change also gave a positive staining reaction for ubiquitin, as did multiple irregular thread-like structures in the neuropil and white matter. The ubiquitin-containing structures at the plaque periphery in human spongiform encephalopathies resemble the neuritic processes at the periphery of the senile plaque in Alzheimer's disease. The granular positivity for ubiquitin associated with areas of spongiform change closely resembles the pattern of immunostaining seen with the antibodies to the prion protein and cathepsin D, consistent with the reported accumulation of ubiquitinated proteins and prion protein in lysosomes in the murine scrapie model. Further studies are required to investigate the role of lysosomes in this group of disorders, and to study the localization of other cell stress proteins and prion protein in spongiform encephalopathies.

Residential care and risk of proximal femur fracture

The risk of hip fracture is higher among persons living in long-term care than among persons living at home. The aim of this study was to explain the difference in risk between the two types of residence by identifying differences in the respective risk factor profiles. Information from the Mediterranean osteoporosis (MEDOS) study questionnaire was used for statistical analyses of 107 non-demented female cases and 225 neighbourhood controls matched for age, sex, and residential area. The statistical analyses incorporated adjustments of the risk estimates by unconditional multivariate logistic regression. Urban background, activity, and morbidity were found to differ between the two types of residence. The detected differences in risk factor profiles were, however, not considered to be sufficient as an explanation for the difference in risk of fracture.

An assessment of the usefulness of demographic data provided by surrogate respondents in a case-control study of Parkinson's disease

This study, based upon data from 40 non-demented Parkinson's disease cases and 101 community controls, and similar data provided by either the spouse ( n = 110) or an adult child ( n = 31) of each index subject, attempted to assess the usefulness of various demographic data provided by the surrogate respondents for the index subjects. The data were collected by personal interview using a structured questionnaire specifically developed for this study. Ninety-one percent of the index subjects and their surrogates provided information on the annual family income and 98% provided other demographic information. The analysis was done by three groups: the case-surrogates, the control-surrogates and the combined index subject-surrogates, and within each group by the two types of surrogates for the index subjects: the spouse vs adult child. The overall percent agreement between the index subjects and their surrogates varied from moderate for annual family income (54.1%), to good for educational level (61.6%) and to excellent for ethnic origin (82.6%), for age ± 1 year (97.9%) and for marital status (100.0%). No significant differences in agreement were found for any of these demographic variables either between the case-surrogate group and the control-surrogate group, or between the spouse surrogates and the child surrogates. These findings suggest that spouses and adult children can provide valid information and are equally reliable informants concerning the demographic characteristics of index subjects in a case-control study of Parkinson's disease and, possibly, of other diseases.

The distribution of tangles, plaques and related immunohistochemical markers in healthy aging and Alzheimer's disease

Neurofibrillary tangles and senile plaques, together with cells immunoreactive for the Alz-50 antibody (A50-ir cells) or for an antibody against paired helical filaments (PHF-ir cells), and amyloid deposits stained with antibodies against β-(or A4)-amyloid, have been mapped throughout the ventral forebrains of 25 old people. The cognitive status of each individual was assessed and a “Clinical Dementia Rating” (CDR) assigned, either before death in the Memory and Aging Project of Washington University, or by a postmortem interview, with an appropriate collateral source. The cases studied included 13 nondemented cases (CDR = 0), six very mildly to mildly demented cases (CDR = 0/0.5 to 1) and six more severely demented cases (CDR = 2 to 3). Because even the very mildly demented brains showed substantial pathological change, emphasis was placed on examining the nondemented cases for the earliest changes that could be associated with Alzheimer's disease. Different distributions were found for tangles and plaques. Tangles (and A50-ir and PHF-ir cells) were present in all of the brains examined. In the younger nondemented cases (aged 54 to 63) there were a few affected cells in the anterior olfactory nucleus and the parahippocampal gyrus. In older nondemented cases (aged 73–89) more tangles were found in the same areas, and also in hippocampal field CA1. The very mildly demented cases had many more tangles, but their distribution was similar. Only in the severely demented cases were large numbers of tangles present in the neocortex. In contrast, no plaques (or β-amyloid immunoreactivity) were found in any of the younger nondemented cases or in four of the eight older nondemented cases. In three older nondemented cases there were a few primitive plaques, which were restricted to localized regions of the neocortex (e.g., a portion of the inferior temporal cortex). In one nondemented case and all of the very mildly to mildly demented cases there were very large numbers of mostly primitive plaques, particularly in the neocortex. With greater severity of dementia there is a shift from primitive to mature plaques. These results were interpreted to imply that the first development of tangles and plaques occurs in different parts of the brain. Tangles appear during aging in the anterior olfactory nucleus, the parahippocampal gyrus and the hippocampus, but are rare in the neocortex except in demented brains. Conversely plaques may develop first in the neocortex. Unlike tangles, plaques are not a consistent feature of aging, at least up to age 80.

Immunohistological study on brains of Alzheimer's disease using antibodies to fetal antigens, C-series gangliosides and microtubule-associated protein 5

An immunohistological study of Alzheimer's brains was performed using antibodies to C-series gangliosides and microtubule-associated protein 5 (MAP5), and their staining patterns were compared with those of antibodies to tau and beta-amyloid precursor protein. Antibodies to C-series gangliosides and MAP5, both of which are known to preferentially expressed in the fetal brains, immunostained dystrophic neurites of senile plaques, neurofibrillary tangles and neuropil threads abundant in 3rd and 5th layers in the cerebral cortex, all of which are considered to be pathological hallmarks of Alzheimer's disease. The immunostaining patterns of these structures by antibodies to C-series gangliosides and MAP5 were similar to those by the antibody to tau. These three antibodies also immunostained some neurons in Alzheimer's brain, although their staining patterns were slightly different from one another; i.e., both diffuse and granular patterns were seen by the antibody to tau, but only granular pattern by the antibodies to C-series gangliosides and MAP5. These neurons immunostained by these three types of antibodies appeared to be the precursors of the classical neurofibrillary tangles, as positively stained neurons were not seen in the brains of non-demented cases. The presence of fetal antigens such as the C-series gangliosides and MAP5 in Alzheimer's brain may suggest that regeneration or sprouting of neurons is ongoing in association with the re-induction of gene expression characteristic for the brain in the early stage of development.

Electron microscopic localization of cholinesterase activity in Alzheimer brain tissue

Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity was localized by electron microscopic enzyme cytochemistry in cortex from Alzheimer brains and brains from non-demented cases. In the tangle-rich medial temporal cortex of the Alzheimer brain, most of the neuronal AChE was associated with neurofibrillary tangles. These structures also contained BChE activity. In normal neurons AChE activity was found in the rough endoplasmic reticulum, nuclear envelope and Golgi apparatus. Little BChE activity was noted in normal cortex. In neuritic plaques, AChE and BChE activity was associated mostly with the amyloid, but also with the neuritic component.

Nerve growth factor receptor immunoreactivity within the nucleus basalis (Ch4) in Parkinson's disease: reduced cell numbers and co-localization with cholinergic neurons

In a effort to better define the role cholinergic basal forebrain neurons play in human cognitive processes, a quantitative assessment of cholinergic nucleus basalis (Ch4) neurons was carried out in 5 patients with Parkinson's disease (PD; 4 non-demented and 1 demented) and 4 age-matched controls using nerve growth factor (NGF) receptor immunohistochemistry as a direct marker for cholinergic basal forebrain neurons. Virtually all (>90%) NGF receptor-containing neurons co-localize with the specific cholinergic marker choline acetyltransferase (ChAT) within the nucleus basalis in PD. NGF receptor-containing neurons were reduced on average by 68% (range 38.6–87.4%) in the non-demented PD cases and by 88.6% in the demented PD patient. Loss of these neurons was heterogeneous across the nucleus basalis subfields with only the anterolateral and posterior Ch4 subregions demonstrating significant reductions of NGF receptor-containing neurons. The reduction in NGF receptor-containing neurons was accompanied by a decrease of acetylcholinesterase (AChE) containing fibers within temporal cortex and in some cases ChAT immunoreactivity in the basolateral amygdaloid nucleus. The numerous non-cholinergic AChE-rich pyramidal cells which were observed throughout the cortex of aged controls were also virtually absent in PD. Although PD patients exhibited severe reductions in Ch4 neurons, few neuritic plaques or neurofibrillary tangles were observed within the PD cortex or Ch4 and similar numbers of these AD-type pathologies were seen within age-matched controls. This suggests that Ch4 degeneration alone is not sufficient to induce such cytoskeletal abnormalities and that the neuron loss seen within Ch4 in AD and PD may be mediated through different processes. These results, coupled with the extensive basic and clinical literature linking acetylcholine and memory function, further indicate that Ch4 degeneration without additional cortical and/or subcortical pathology is not sufficient to impair cognition in PD. Perhaps additional pathology must be superimposed upon nucleus basalis degeneration to induce dementia in humans.

Prevalence of Parkinson’s Disease in Izumo City, Japan

The prevalence of Parkinson's disease was studied in Izumo City, the Shimane prefecture having the largest population of the elderly in the country. The adult population of Izumo City (56,869 people over 20 years of age) were screened by means of questionnaires sent by mail and by other methods. A total of 66 people, 18 males and 48 females, were found to have Parkinson's disease. The prevalence of this disease was 82.0/100,000 population, the highest reported in Japan to date. Of the patients affected, 17.1% showed apparent dementia. Those with dementia were older and were classified at a more advanced Yahr stage than were the nondemented cases. The prevalence of Parkinson's disease in the growing geriatric population has major medical and socioeconomic implications.

Pathological alterations in the amygdala in Alzheimer's disease

The amygdala is severely and consistently affected by pathology in Alzheimer's disease. The distribution of Thioflavin S-stained neurofibrillary tangles and neuritic plaques was examined in the various nuclei that form the amygdala in 20 cases of clinically diagnosed Alzheimer's disease and five non-demented control cases. Large numbers of neurofibrillary tangles and neuritic plaques were observed in the accessory basal and cortical nuclei and the cortical transition area, while there was lesser involvement of the mediobasal nucleus. The medial, lateral, laterobasal and central nuclei were relatively spared. The distribution of neurofibrillary tangles and neuritic plaques was compared with neuroanatomic connections known from non-human primate experimental studies. This comparison suggests that (1) nuclei receiving and giving rise to hippocampal projections are consistently affected by neuropathological alterations in Alzheimer's disease; (2) the nuclei which receive strong cholinergic projections from the nucleus basalis of Meynert (e.g. laterobasal nucleus) have, in general, relatively few neuritic plaques; and (3) nuclei which receive olfactory projections are not uniformly affected, the cortical nucleus being heavily affected but the medial nucleus consistently spared.

Prevalence of thyroid abnormalities is not increased in Alzheimer's disease

The aim of this study was to compare the prevalence of pathologically and clinically documented thyroid disorders in patients with Alzheimer's disease (AD) and nondemented individuals. We reviewed the records of 31 patients with a pathological diagnosis of AD and 31 age-matched nondemented patients selected from autopsy files. We examined the pathological findings in the thyroid gland in both groups. Twenty-four cases (77.4%) with AD and 21 patients (67.7%) in the control group showed pathological abnormalities in the thyroid gland. The prevalence of specific types of thyroid gland abnormalities on pathological examination did not differ significantly between the AD and nondemented cases. For the 19 AD and 18 control patients in whom clinical thyroid function had been documented adequately during life, the percentage of patients with abnormal thyroid function was similar in the AD (15.7%) and control (11.1%) groups. These results do not support a relationship between AD and thyroid abnormalities.

Muscarinic cholinergic receptor subtypes in hippocampus in human cognitive disorders.

Total muscarinic receptor levels, the levels of the subtypes exhibiting high and low affinity for pirenzepine, and the high- and low-affinity agonist states of the receptor were investigated in hippocampal tissue obtained at autopsy from mentally normal individuals and the following pathological groups: Alzheimer's disease, Parkinson's disease, Down's syndrome, alcoholic dementia, Huntington's chorea, and motor-neurone disease. A moderate decrease in the density of both high-affinity pirenzepine and high-affinity agonist subtypes was found in Alzheimer's disease, whereas a trend towards an increase in the overall muscarinic receptor density was apparent in the parkinsonian patients without dementia, mainly due to an increase in the low-affinity agonist state; the differences between the Alzheimer's disease and nondemented parkinsonian cases were highly significant. As previously reported, the levels of both choline acetyltransferase and acetylcholinesterase were markedly reduced in both Alzheimer's disease and Parkinson's disease--with a greater loss of both enzymes in the demented subgroup of parkinsonian patients. Activities of the cholinergic enzymes were also extensively reduced in Down's syndrome, accompanied by a loss of high-affinity pirenzepine binding. There were no significant receptor or enzyme alterations in the other groups studied. These observations suggest that in the human brain, extensive degeneration of cholinergic axons to the hippocampus, as indicated by a loss of cholinergic enzymes, is not necessarily accompanied by extensive muscarinic receptor abnormalities (as might be expected if a major subpopulation were presynaptic). Moreover, the opposite changes in muscarinic binding in Parkinson's and Alzheimer's diseases may be related to the greater severity of dementia in the latter disease.

The relationship between formation of senile plaques and neurofibrillary tangles and changes in nerve cell metabolism in Alzheimer type dementia

Nerve cell nucleolar volume is reduced, in senile dementia of Alzheimer type, by 15–25% in nerve cells not containing neurofibrillary tangles and by over 35% in those which do contain such changes, in a wide variety of brain regions, when compared to similar cells from non-demented control cases, suggesting that interference with production of proteins may be an early consequence of the pathogenic process. The extent to which nucleolar volume is decreased in the non-tangle-bearing cells is related to frequencies of both neurofibrillary tangle and senile-plaque formation within that region, but the reduction in volume in the tangle-bearing cells correlated with neurofibrillary changes only. It seems, therefore, that the severity with which the dementing process affects an area of brain is initially shown by alterations in cell metabolism, which may invoke reductions in protein synthesis in non-tangle-bearing cells, and is later marked by the proportion of these affected cells which go on to form neurofibrillary tangles. Changes in nerve cell function do not seem to be as well indicated by the density of senile plaques within that area.

Neurochemical activities in human temporal lobe related to aging and Alzheimer-type changes

Activities relating to 3 neurotransmitter and 4 neuropeptide systems have been examined in human temporal lobe (post mortem) for their relationships with age and Alzheimer-type changes (senile plaques and cognitive function). Significant alterations with increasing age (from 61 to 92 years) in a series of non-demented cases included a reduction of the cholinergic enzyme, choline acetyltransferase, and an increase in vasoactive intestinal peptide immunoreactivity. In cases of Alzheimer's disease the only neurochemical activity investigated which correlated significantly with cognitive impairment (assessed from a Mental Test Score obtained shortly before death) and with the severity of Alzheimer-type abnormalities (senile plaques density) was choline acetyltransferase. Further analyses of the data in relation to the severity of plaque formation suggest that alterations in other neurochemical activities including reductions in dopamine-β-hydroxylase activity, cholecystokinin octapeptide (aqueous extracted) and somatostatin immunoreactivities and an increase in substance P immunoreactivity, may occur at later stages of the disease process. These comparative data suggest that biochemical changes in this brain area associated with age and earlier stages of Alzheimer's disease may be relatively selective.

Neuropathological and biochemical observations on the noradrenergic system in Alzheimer's disease

Abnormalities of the noradrenergic system in Alzheimer's disease have been investigated by comparing quantitative histological and biochemical components of this transmitter system (locus coeruleus neuron counts and cortical dopamine β-hydroxylase (DBH) activity, respectively) in a series of demented and non-demented cases. Cortical activities of the noradrenergic enzyme, DBH, did not correlate significantly with the number of locus coeruleus neurons, a finding which contrasts with the previous observations in animal brains of reductions in cortical DBH following locus coeruleus lesions. The extent of Alzheimer-type abnormalities, assessed from either morphological measures (mean plaque counts) or clinical measures (Mental Test Scores) of severity, was not significantly related to the cortical activity of DBH in the present series of cases, although non-significant trends were apparent. In contrast the activity of the cholinergic enzyme choline acetyltransferase did, as previously reported, correlate significantly with the extent of Alzheimer-type abnormalities, suggesting that abnormalities of the cholinergic system are more closely associated with specific aspects of the Alzheimer disease process than those of the noradrenergic system.

Dendritic growth in the aged human brain and failure of growth in senile dementia.

Golgi-stained dendrites of single randomly chosen layer-II pyramidal neurons in the human parahippocampal gyrus were quantified with a computer-microscope system. In nondemented aged cases (average age, 79.6 years), dendritic trees were more extensive than in adult cases (average age, 51.2), with most of the difference resulting from increases in the number and average length of terminal segments of the dendritic tree. These results provide morphological evidence for plasticity in the mature and aged human brain. In senile dementia (average age, 76.0), dendritic trees were less extensive than in adult brains, largely because their terminal segments were fewer and shorter. Cells with shrunken dendritic trees were found in all brains. These data suggest a model of aging in the central nervous system in which one population of neurons dies and regresses and the other survives and grows. The latter appears to be the dominant population in aging without dementia.

Aluminium-Gel—Adsorbed Sheep Pox Virus Vaccine

Giannakopoulos Panteleimon, Patrick R. Hof, Philippe G. Vallet, Anne-Séverine Giannakopoulos, Yves Chamay, and Constantin Bouras: Quantitative Analysis of Neuropathologic Changes in the Cerebral Cortex of Centenarians. Prog. Neuro-Psychopharmacol. & Biol. Psychiat. 1995, 19(4): 577–592. 1.1. The quantitative distribution of neurofibrillary tangles and senile plaques was studied in the brains of 65 elderly patients aged from 96 to 104 years by immunohistochemistry.2.2. According to the clinical and neuropathological diagnoses, three groups of cases were considered: 19 patients with Alzheimer's disease, 22 patients with mixed dementia (vascular and degenerative) and 24 patients with no or very mild cognitive impairment.3.3. Moderate to high neurofibrillary tangle densities were always present in the hippocampus and entorhinal cortex. The inferior temporal cortex was very frequently affected in demented and nondemented cases whereas the superior frontal cortex was spared in the majority of cases independently of the clinical diagnosis. Quantitatively, Alzheimer's disease cases showed significantly higher NFT densities than cases with no clinical findings of dementia only in the CA1 field of the hippocampus.4.4. The hippocampus and entorhinal cortex were often devoid of senile plaques in non-demented cases while the vast majority of Alzheimer's disease cases had few SP in these regions.The frontal and temporal cortex were more frequently involved than the limbic structures in both non-demented and Alzheimer's disease cases. The SP densities in layers II and III of the inferior temporal and superior frontal cortex were significantly higher in Alzheimer's disease than in non-demented cases.5.5. These observations suggest that the dementing process in nonagenarians and centenarians may differ to that described in younger demented individuals in that neurofibrillary tangles involve principally the hippocampal formation with relative sparing of the neocortex. Furthermore, they indicate that both the neurofibrillary tangle densities in the CA1 field and senile plaque densities in the superficial layers of the neocortex must be considered for the neuropathological diagnosis of Alzheimer's disease in this age group.