Progression of clinical deterioration and pathological changes in patients with Alzheimer disease evaluated at biopsy and autopsy.
OBJECTIVE
To quantify the progression of senile plaques, neurofibrillary tangles, cerebral amyloid angiopathy, and microglial activation in the cortex and white matter of patients with Alzheimer disease evaluated at both biopsy and subsequent autopsy and correlate these changes with the progression of neurologic impairment.


METHODS
Academic referral center for patient with Alzheimer disease.


METHODS
Four patients meeting the clinical criteria for Alzheimer disease, enrolled in a pilot study for the evaluation of response to intracerebroventricular administration of bethanechol chloride. The patients were followed up until death occurred and autopsy was performed.


RESULTS
All 4 patients had progressive deterioration from the time of biopsy to autopsy (9-11 years). Pathological investigations showed a striking increase in the density of senile plaques and neurofibrillary tangles in 2 of 4 patients from biopsy to autopsy, and a significant increase in microglial activation in 1 of 4 cases. Severity of cerebral amyloid angiopathy varied significantly among patients, 1 of whom displayed striking amyloid deposition with associated subcortical white matter atrophy.


CONCLUSIONS
These unique data demonstrate that the progressive neurologic impairment in Alzheimer disease is accompanied by a significant increase in senile plaque and neurofibrillary tangle counts in the frontal cortex and, possibly in some patients, by increased microglial cell activation. Cerebral amyloid angiopathy was associated with significant white matter disease.
Di Patre
P L
PL
Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Medical Center, 90095-1732, USA. dipatre@ucla.edu
Read
S L
SL
Cummings
J L
JL
Tomiyasu
U
U
Vartavarian
L M
LM
Secor
D L
DL
Vinters
H V
HV
D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D016229:Amyloid beta-Peptides / Q000032:analysis; D015703:Antigens, CD / Q000032:analysis; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D001057:Apolipoproteins E / Q000235:genetics; D018723:Bethanechol / Q000008:administration & dosage; D001706:Biopsy; D001921:Brain / Q000473:pathology*; D001923:Brain Chemistry; D003072:Cognition Disorders / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D018450:Disease Progression; D006801:Humans; D007276:Injections, Intraventricular; D008297:Male; D008565:Membrane Proteins / Q000235:genetics; D017628:Microglia / Q000473:pathology; D008875:Middle Aged; D018721:Muscarinic Agonists / Q000008:administration & dosage; D016874:Neurofibrillary Tangles / Q000473:pathology; D058225:Plaque, Amyloid / Q000473:pathology; D053764:Presenilin-1; D000097382:CD68 Molecule
D016229:Amyloid beta-Peptides; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D001057:Apolipoproteins E; D018723:Bethanechol; D008565:Membrane Proteins; D018721:Muscarinic Agonists; D053764:Presenilin-1; C067980:CD68 antigen, human; D000097382:CD68 Molecule; C508853:PSEN1 protein, human