A quantitative assessment of somatostatin-like and neuropeptide Y-like immunostained cells in the frontal and temporal cortex of patients with Alzheimer's disease

Immunocytochemical studies utilizing radioimmunoassay and morphological techniques have provided conflicting evidence for the involvement of somatostatin and neuropeptide Y in Alzheimer's disease (AD). However, previous investigators have not considered the effects of cortical atrophy in AD tissue on their findings. This study reports the numbers of somatostatin-like (SLI) and neuropeptide Y-like immunoreactive (NPYLI) neuronal perikarya and the length of SLI and NPYLI immunoreactive fibres, with appropriate corrections for atrophy in 6 control and 6 AD cases. There were significantly fewer SLI neurones in AD in layers II + III combined from the temporal cortex, and fewer NPYLI neurones in layers V + VI in both frontal and temporal cortices. Using a randomized method to quantify immunostained fibre length in the neuropil, an analysis of variance revealed no significant differences in the mean SLI or NPYLI fibre length per cortical strip between control and AD groups in frontal or temporal cortex. However, using a second measure of fibre length by tracing the fibres attached to consecutive immunostained perikarya, there were significant reductions in the AD brains in the mean fibre length per cell in layers V + VI for SLI in the temporal cortex, and for NPYLI in the frontal cortex. This reduction in fibre length per individual cell was presumably masked by the large variation in the fibre length found between cases using the randomized approach. It was concluded that in order to evaluate the involvement of these neuropeptides in AD from any measurements of concentration, it is essential to include some compensation for the extent of cortical atrophy that occurs with the disease.

Reversal of midazolam sedation with flumazenil following conservative dentistry

The purpose of this double-blind randomized study was to assess recovery of mental function following reversal of midazolam-induced sedation with the specific antagonist flumazenil (R015-1788) or placebo following conservative dental procedures. Recovery was assessed using choice reaction time and critical flicker fusion threshold, both objective tests of psychomotor function; linear analogue sedation scores and simple memory tests. Assessments were repeated up to 3 h after administration of flumazenil or placebo to discover whether recovery was sustained or whether resedation occurred due to the short duration of action of flumazenil. Flumazenil in doses from 0.5 to 1.0 mg rapidly reversed the sedative and amnesic effects of a mean dose of 8.2 mg of midazolam without apparent evidence of subsequent resedation. Since recovery of mental function in the control group had ordinarily occurred 45 min after administration of placebo, routine reversal of midazolam sedation with flumazenil cannot be justified. Nevertheless, in cases of undue sedation persisting after dental treatment, flumazenil may be used with minimal risk of resedation occurring.

A morphological analysis of senile plaques in the brains of non-demented persons of different ages using silver, immunocytochemical and lectin histochemical staining techniques

The prevalence and severity of senile plaque (SP) formation was investigated in the cerebral cortex, hippocampus and amygdala of 60 non-demented individuals of age range 6-84 years, using immunocytochemical (anti-A4 amyloid, anti-PHF protein), lectin histochemical (Con A binding) and silver (Methenamine (MS) and Palmgren), staining methods. By at least one of these methods, 18 patients showed the presence of SP within one or more of these brain regions; 15 of these patients were over 60 years of age. Comparisons between each staining method showed that, in the hippocampus and amygdala all five methods detected the presence and number of SP equally well, whereas, in the cerebral cortex, MS and anti-A4 staining demonstrated more SP in a greater number of patients than did either Con A or Palmgren silver and anti-PHF staining. The additional SP detected by these former two staining methods contained diffuse deposits of amyloid (A4) protein, and sometimes also large clumps of Con A positive material, but no neurites as detected by Palmgren or anti-PHF staining. Such SP closely resemble those seen in the cerebral cortex of young patients with Down's syndrome, and which are thought to be an early form of SP. The relationship between the pathological changes in these non-demented patients and a possible diagnosis of early Alzheimer's disease is discussed.

Immunocytochemical profile of neurofibrillary tangles in Down's syndrome patients of different ages

Brains were obtained at autopsy from 24 patients with Down's syndrome, ranging in age from 13 to 71 years. Neurofibrillary tangle containing neurones of the hippocampus were stained using a Palmgren silver method and immunocytochemically (PAP) using antisera to paired helical filament protein, human tau protein and ubiquitin, as primary antibody. Counts of cells stained by each method were compared. In patients under 50 years of age, in whom only a limited number of tangle bearing cells were present, the number of profiles visualized with silver, anti-paired helical filament and anti-tau methods were similar. However, in patients over 50 years of age (and in certain of those under 50), in whom numerous tangles were present, the number of cell profiles visualized with silver and anti-paired helical filament methods were still similar though anti-tau detected fewer positive cells. This was because of the increased presence, in such patients, of extracellular tangles which had "lost" anti-tau immunoreactivity. Such data suggest that although tau protein forms a major antigenic determinant of neurofibrillary tangles in Down's syndrome (as it does in Alzheimer's disease) this protein may only decorate the basic paired helical filament protein skeleton, and is removed by macrophagic activity upon neuronal death. In all patients, anti-ubiquitin revealed fewer tangles than any other method. It is possible that ubiquitin may be present only transiently, within tangles perhaps following initial formation and lasting only as long as the normal protein degradation processes remain viable within the diseased neurone.

An analysis of the morphology of senile plaques in Down's syndrome patients of different ages using immunocytochemical and lectin histochemical techniques

The morphology of the senile plaque (SP), within the hippocampus and the temporal cortex, has been examined in 21 patients with Down's syndrome (DS), dying between the ages of 13 and 65 years, using immunocytochemical and lectin histochemical methods, as well as with a conventional silver staining technique. The earliest changes detectable within these areas of brain in the younger patients involved a fine diffuse deposition of amyloid (A4) protein and a uniform granular accumulation of an oligosaccharide recognized by the lectin from Canavalia ensiformis (ConA). At this stage, these 'pre-plaque' areas are unrecognizable using silver staining. Later the conventional SP morphology becomes apparent; the A4 protein aggregates into the usual plaque core and neurites appear with silver staining. The fine ConA positive material concentrates into large clumps and becomes recognizable by other lectins such as PSA, WGA and ePHA, which bind to mannose containing structures in an increasingly complex form. It is suggested that the development of the pathological changes of Alzheimer's disease, in patients with DS (and also in AD itself) involves a primary deposition of amyloid protein in conjunction with the accumulation of an as yet unidentified oligosaccharide. These changes precede the neuronal response that is characterized by the formation of neurites and the accumulation of neurofibrillary tangles that ultimately leads to cell death.

Incidence of arrhythmias in dental anaesthesia: a cross-over comparison of halothane and isoflurane

Fifty patients received halothane anaesthesia during the surgical removal of 3rd molars from one side of the mouth and isoflurane during extractions on the other. Degree of surgical difficulty was matched, and end-tidal PCO2 did not differ significantly between sides. A significantly higher incidence of arrhythmias occurred during halothane, compared with isoflurane, anaesthesia. This difference occurred primarily when halothane was given for the first operated side. A clinically important feature of the stability of cardiac rhythm during isoflurane anaesthesia was demonstrated--when frequent ectopic beats occur during halothane anaesthesia, a significant decrease in the rate of premature contractions occurs within 3 min of discontinuing halothane and introducing isoflurane.

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.

Glycogen accumulations in the cerebral cortex in Alzheimer's disease

The fine structure of granular glycogen bodies (GGB) within the grey matter of the temporal cortex of 11 patients with Alzheimer's disease is described. GGB measure up to 50 microns in diameter and consist of densely packed alpha or beta glycogen granules (never both), neither of which are membrane bound. They were noted in axons, both myelinated and unmyelinated (sometimes close to the dystrophic neurites of senile plaques), and also in other processes of indeterminate origin. Their appearance may relate to disturbances of axonal transport resulting from damage to terminals within evolving senile plaques.

An ultrastructural analysis of the effects of accumulation of neurofibrillary tangle in pyramidal neurons of the cerebral cortex in Alzheimer's disease

Quantitative morphometric (stereological) methods have been used to assess the effects of accumulation of neurofibrillary material on the fine structure of pyramidal cells in biopsy specimens of temporal cortex from nine patients with Alzheimer's disease. When compared with non-tangled cells from the same patients, tangled cells show an increase in total area of cytoplasm due to the accumulation of tangle and a reduction in the area of the nucleus; the area proportion of the cell body occupied by total cytoplasm, therefore, increases whereas that of the nucleus decreases. Within the total cytoplasm, nucleolar and mitochondrial areas are maintained, but that of lipofuscin is increased, though all are increased when expressed as a proportion of the useful cytoplasm alone (i.e. total cytoplasmic area minus area occupied by tangle). Measures of the amount of rough endoplasmic reticulum and ribosomes are decreased overall in tangled cells, though when related to useful cytoplasm alone such measures approach non-tangled cell values. Measures of smooth endoplasmic reticulum are unaltered throughout. When related to the amount of tangle within cells it was found that the most heavily tangled cells retain 28% of useful cytoplasm, 72% of the nuclear area, 50% of the rough endoplasmic reticulum and 27% of ribosomes present within least tangled and non-tangled cells. By contrast, mitochondrial area is maintained and that of lipofuscin increased. The capacity for protein synthesis in tangled cells appears, therefore, to be progressively decreased with accumulation of tangle, whereas that for oxidative metabolism is maintained and lysosomal activity, perhaps, increased. Neurofibrillary tangle formation and accumulation may, therefore, lead to the eventual death of neurons and be the major cause of nerve cell loss in Alzheimer's disease.

A quantitative study of the ultrastructure of pyramidal neurons of the cerebral cortex in Alzheimer's disease in relationship to the degree of dementia

Quantitative morphometric (stereological) methods have been used to measure the number or amount of organelles in pyramidal nerve cells, unaffected by neurofibrillary degeneration, in biopsy specimens of temporal cortex from 11 patients with Alzheimer's disease, and to relate these to the degree of dementia, as measured by psychometric testing. Only areal proportion (AA) and surface area (SA) of rough endoplasmic reticulum were significantly reduced in line with the severity of the degree of dementia. It is suggested that these changes reflect a progressively diminishing requirement for packaging and transport of replacement proteins, particularly in relation to neurotransmitter metabolism in nerve terminals following the loss of synapses which we have shown to occur in these patients.

Effects of differential environments on the cerebral anatomy of rats as a function of previous and subsequent housing conditions

After 1 month in enriched or impoverished environments, groups of rats were housed for an additional month in either the same or the opposite environment. The cross-over design allowed us to see whether or not the cerebral effects of differential environments are modified by subsequent housing conditions, and also whether or not such effects might be influenced by previous experience. Differential housing for 1 month was associated with significant alterations in the weight and length of the cerebrum, the thickness of the occipital cortex, and the relative number of neurons and oligodendrocytes, and no change in the ratio of astrocytes to neurons. The effects of enrichment were not reduced in animals that were previously impoverished. When impoverishment followed enrichment, certain effects appeared to diminish, notably, the increase in cortical thickness. Other effects, however, such as the increase in the ratio of oligodendrocytes to neurons, were very stable. The gross cerebral alterations associated with differential housing did not differ significantly after 2 as opposed to 1 month's exposure, but the effects on neuronal density and the ratio of oligodendrocytes to neurons in layers V and VI of the cortex were, paradoxically, significantly smaller with the longer duration. We suggest that this decrease is due to the continuation of processes induced in the first month of differential experience rather than to their dissipation.

The comparative effects of early-life undernutrition and subsequent differential environments on the dendritic branching of pyramidal cells in rat visual cortex

Male rats were either undernourished or fed normally from birth to day 21, after which time food was made freely available. At 1 month of age littermate pairs from both nutritional groups were housed in either enriched or impoverished conditions for 30 days and then killed for brain measurements. Significant deficits due to undernutrition were observed in the weight and size of the cerebrum, but not in the thickness or area of the visual cortex. Although there were large differences of between 21 and 39% in the number of higher-order basal dendrites of layers II and III pyramidal cells, and of about 19% in the distal ring intersections, none except the fourth-order branches and intersections at 100 micron from the cell body approached statistical significance. Changes in cerebral weight and size also occurred as a result of differential housing, with the enriched rats showing increased values relative to their impoverished littermates. In contrast to the nutritional treatment, differential housing significantly affected cortical thickness and area, as well as basal dendritic branching of the pyramidal cells. Enriched rats had relative increases of 26% in the number of fifth-order branches and 45-80% in the number of distal ring intersections.

The separate and combined effects of early undernutrition and environmental complexity at different ages on cerebral measures in rats

Rats were either undernourished or fed normally during the suckling period, then at 1 and 5 months of age littermates were housed in enriched or impoverished environments for 30 days. The undernutrition caused lasting reductions in the weight and size of the cerebrum and in parameters of the hippocampus, but significant deficits were not observed in the thickness and area of the occipital cortex. Differential housing differed from early undernutrition in that its largest effects were on cortical parameters, but the effects of the two conditions did partly overlap. This meant that some nutritionally induced deficits could be modified later by manipulating environmental complexity. The cerebral response of the previously undernourished rats to differential environments was not distinguishable from that of well-fed controls on the basis of the gross anatomical changes that were measured. Furthermore, no significant differences were found between the environmental effects in young and mature rats, although the latter's response tended to be somewhat less for most parameters.

Effects of undernutrition at different ages early in life and later environmental complexity on parameters of the cerebrum and hippocampus in rats

Nutritional deprivation at different stages of development in rats was shown to cause reductions in some parameters of the cerebrum that could not be reversed by an extended period of adequate feeding. The deficits varied in magnitude, depending on whether undernutrition occurred during the suckling period alone or was combined with additional deprivation either before birth or after weaning. Whereas the weight, length, and width of the cerebrum were affected significantly by undernutrition at every age, effects on the thickness of the cortex and hippocampus were associated only with the combined pre- and postnatal deprivation. The deficits in weight, length, and cortical thickness could be modified later by housing in enriched and impoverished environments for 30 days. The previously undernourished rats responded similarly to environmental complexity regardless of the age at which they had been deprived, and their responses did not differ significantly from those of well fed controls. The degree to which enrichment can be said to have reduced deficits arising from undernutrition depends on the relative size of the nutritional and environmental effects on the particular parameters in question and on the choice of a "normal' baseline against which to assess recovery.

The effects of early-life undernutrition and subsequent environment on morphological parameters of the rat brain

The investigation examines the extent to which lasting effects of early-life undernutrition on the brain of rats can be modified by manipulating the amount of environmental stimulation later. Infant rats were undernourished during the vulnerable brain growth spurt in the lactation period; then after two months of unrestricted feeding, they were placed in enriched or impoverished environments. Measurements of the forebrain, posterior cerebral cortex and hippocampus showed that neither undernutrition nor environmental stimulation affected the brain uniformly and that some parameters were more susceptible to one condition than the other. Where nutritional and environmental conditions affected the same anatomical dimensions, their combined effects appeared to be additive rather than synergistic.

A stereological analysis of the cerebellar granule and Purkinje cells of 30-day-old and adult rats undernourished during early postnatal life

Male rats undernourished from birth to 30 days of age were nutritionally rehabilitated till 160 days of age. Quantitative stereological procedures at the light microscope level were used to estimate, among other things, the numerical densities of cerebellar granule and Purkinje cells on a "per unit volume of cortex" basis. These were subsequently used to calculate granule-to-Purkinje cell ratios. The 30-day-old undernourished rats had a mean +/- S.E. of 290 +/- 27 granule cells for every Purkinje cell present, compared to 395 +/- 34 for the controls. This was a deficit of about 27% (p < 0.05). At 160 days of age, the previously undernourished rats still showed a persisting deficit of about 25% (p < 0.05) in this ratio, despite the lengthy nutritional rehabilitation. There were no statistically significant age-related changes in this ratio. The numerical density of Purkinje cells, but not that of granule cells, was significantly greater in the previously undernourished rats than in controls, for both age groups, Increasing age caused a fall in the numerical density of both cell types. Granule and Purkinje cell nuclear diameters were unaffected by nutrition. However, Purkinje cell nuclei decreased in size by between 7%--13% with increasing age. These results indicate that undernutrition during early life can cause a permanent distortion of the relative number of the various cell types in the cerebellum.

Synapse-to-neuron ratios of the frontal and cerebellar cortex of 30-day-old and adult rats undernourished during early postnatal life

Male rats undernourished from birth to 30 days were nutritionally rehabilitated till 160 days of age. Quantitative stereological procedures at the light and electron microscopical levels were employed to estimate, among other things, the synapse-to-neuron ratios in the frontal cortex and granular layer of the cerebellum. In the frontal cortex, the 30-day-old undernourished rat had a mean +/- SE of about 14,020 +/- 1,540 synapses-per-neuron compared with 22,270 +/- 3,250 for the controls. This was a deficit of 37% (p < 0.05). By 160 days of age the previously undernourished rats showed no statistically significant deficit in this ratio compared with controls (11,800 +/- 690 and 13,360 +/- 1,110 respectively, p > 0.1). This was due mainly to a fall in the synapse-to-neuron ratio with age. A much larger fall in the ratio occurred in the control than in the previously undernourished group. In the granular layer of the cerebellum the 30-day-old undernourished rats had 341 +/- 17 synapses-per-neuron compared with 495 +/- 25 for the controls. This was a deficit of 31% (p < 0.01). By 160 days of age the previously undernourished rats again showed no statistically significant deficit in this ratio compared with controls (627 +/- 56 and 688 +/- 38, respectively (p > 0.1). These results show that the previously undernourished rats are capable of at least some (if not complete) "catch-up" with regard to the synapse-to-neuron ratio.

Deficits in synapse-to-neuron ratio due to early undernutrition show evidence of catch-up in later life

30-day-old rats undernourished from birth are known to have large deficits in the synapse-to-neuron ratio in certain brain regions. It has not been possible to demonstrate any statistically significant deficits in this ratio in animals undernourished from birth to 30 days but then provided with an ad libitum amount of food til 6 months of age.

Sensory projections from the wind-sensitive head hairs of the locust Schistocerca gregaria. Distribution in the central nervous system

The neurones from the wind-sensitive hairs on the locust head have been filled with cobalt chloride and intensified with silver. All the neurones project through the brain to the suboesophageal ganglion, some continue to the prothoracic ganglion and a few as far as the mesothoracic ganglion. Three different types of projection are described and a regrouping is proposed of Weis-Fogh's five hair fields into three areas. The distribution of the neurones from these areas is described in relation to other structures in the ganglion and is discussed in relation to the function of the hair fields in stability control and grooming.

A stereological analysis of the neuronal and synaptic content of the frontal and cerebellar cortex of weanling rats undernourished from birth

The frontal cortex and granular layer of the cerebellum have been examined in 30-day-old rats undernourished from birth. Quantitative stereological procedures at the light microscopical level have been used to estimate the volume proportion and numerical densities of neuronal nuclei. Similar methods at the electron microscopical level were employed to calculate the numerical densities of synapses. Hence, synapse-to-neuron ratios have been calculated in these brain regions. In the frontal cortex, the undernourished group of rats showed a 37% deficit (P less than 0.05) in the synapse-to-neuron ratio. This was due to a combination of an increase in the numberical density of neurons and a decrease in the numerical density of synapses, although, individually, neither of these reached statistical significance at the 5% level. In the granular layer of the cerebellum there was a 31% (P less than 0.01) deficit in the synapse-to-neuron ratio. This was a function of the reduced numerical density of synapses, with no difference in the numerical density of granule cells between groups. For the frontal cortex, the volume proportion of neuronal nuclei was significantly greater in the undernourished group of rats. There were no significant differences between control and undernourished rats in the volume of the 'forebrain' occupied by cortex. The mean diameters of neuronal nuclei and synaptic discs did not differ in any given region between treatment groups. These observations are discussed in context with the previously published results on synapses and neurons in undernourished animals.