Dementia of the Alzheimer type

Genetics of Alzheimer's disease: recent advances

Alzheimer's disease is a progressive neurodegenerative disorder with high prevalence in old age. It is the most common cause of dementia, with a risk reaching 50% after the age of 85 years, and with the increasing age of the population it is one of the biggest healthcare challenges of the 21st century. Genetic variation is an important contributor to the risk for this disease, underlying an estimated heritability of about 70%. Alzheimer's genetics research in the 1990s was successful in identifying three genes accounting for most cases of early-onset disease with autosomal dominant inheritance, and one gene involved in the more common late-onset disease, which shows complex inheritance patterns. Despite the presence of significant remaining genetic contribution to the risk, the identification of genes since then has been elusive, reminiscent of most other complex disorders. In the past decade there have been significant efforts towards a systematic evaluation of the multiple genetic association studies for Alzheimer's disease, while the first genome-wide association studies are now being reported with promising results. As sample sizes grow through new collections and collaborative efforts, and as new technologies make it possible to test alternative hypotheses, it is expected that new genes involved in the disease will soon be identified and confirmed. The gene discoveries of the 1990s have taught us a lot about Alzheimer's disease pathogenesis, providing many therapeutic targets that are currently at various stages of testing for future clinical use. As new genes become known and the biological pathways leading to disease are further explored, the possibility of prevention and successful personalized treatment is becoming tangible, providing hope for the millions of patients with Alzheimer's disease and their caregivers.

Disruption of fast axonal transport is a pathogenic mechanism for intraneuronal amyloid beta

The pathological mechanism by which Abeta causes neuronal dysfunction and death remains largely unknown. Deficiencies in fast axonal transport (FAT) were suggested to play a crucial role in neuronal dysfunction and loss for a diverse set of dying back neuropathologies including Alzheimer's disease (AD), but the molecular basis for pathological changes in FAT were undetermined. Recent findings indicate that soluble intracellular oligomeric Abeta (oAbeta) species may play a critical role in AD pathology. Real-time analysis of vesicle mobility in isolated axoplasms perfused with oAbeta showed bidirectional axonal transport inhibition as a consequence of endogenous casein kinase 2 (CK2) activation. Conversely, neither unaggregated amyloid beta nor fibrillar amyloid beta affected FAT. Inhibition of FAT by oAbeta was prevented by two specific pharmacological inhibitors of CK2, as well as by competition with a CK2 substrate peptide. Furthermore, perfusion of axoplasms with active CK2 mimics the inhibitory effects of oAbeta on FAT. Both oAbeta and CK2 treatment of axoplasm led to increased phosphorylation of kinesin-1 light chains and subsequent release of kinesin from its cargoes. Therefore pharmacological modulation of CK2 activity may represent a promising target for therapeutic intervention in AD.

Regeneration in a degenerating brain: potential of allopregnanolone as a neuroregenerative agent

Confronting the efficacy of a regenerative therapeutic is the degenerative environment that is characterized by neuronal loss, physical plague and glial scar barriers and inflammation. But perhaps more fundamental from a regenerative perspective, are changes in the biochemical milieu of steroid and peptide growth factors, cytokines and neurotransmitter systems. Data from multiple levels of analysis indicate that gonadal steroid hormones and their metabolites can promote neural health whereas their decline or absence are associated with decline in neural health and increased risk of neurodegenerative disease including Alzheimer’s. Among the steroids in decline, is allopregnanolone (APα), a neurosteroid metabolite of progesterone, which was found to be reduced in the serum [1,2] and plasma [3] and brain of aged vs. young subjects [4]. Further, Alzheimer disease (AD) victims showed an even further reduction in plasma and brain levels of APα relative to age-matched neurologically normal controls [1,4,5]. Our earlier work has shown that APα is a neurogenic agent for rodent hippocampal neural progenitors and for human neural progenitor cells derived from the cerebral cortex [6]. Our ongoing research seeks to determine the neurogenic potential of APα in the triple transgenic mouse model of Alzheimer’s disease (3xTgAD) as AD related pathology progresses from imperceptible to mild to severe. Initial analyses suggest that neurogenic potential changes with age in nontransgenic mice and that the neurogenic profile differs between non-transgenic and 3xTgAD mice. Comparative analyses indicate that APα modifies neurogenesis in both non-transgenic and 3xTgAD mice. Preliminary data suggest that APα may modify Alzheimer’s pathology progression. Together the data indicate that APα may maintain the regenerative ability of the brain and modify progression of AD related pathology. Challenges for efficacy of regenerative agents within a degenerative milieu are discussed.

Restraint stress induces beta-amyloid precursor protein mRNA expression in the rat basolateral amygdala

Several studies have shown the involvement of beta-amyloid precursor proteins (APP) isoforms in physiological process like development of the central nervous system (CNS), functional roles in mature brain, and in pathological process like Alzheimer's disease, neuronal experimental damage, and stress, among others. However, the APP functions are still not clear. In the brain, APP(695) isoform is predominantly found in neurons while APP(751/770) isoforms are predominantly found in astroglial cells and have been associated to neurodegenerative processes. Acute or chronic stress in rats may trigger specific response mechanisms in several brain areas such as amygdala, hippocampus and cortex with the involvement of multiple neurotransmitters. Chronic stress may also induce neuronal injury in rat hippocampus. In situ hybridization (ISH) was used to investigate the expression of APP(695) and APP(751/770) mRNA in amygdala and hippocampus of male Wistar rats (n=4-6 per group) after acute (2 or 6h) or chronic (2h daily/7 days or 6h daily/21 days) restraint stress. Only the APP(695) mRNA expression was significantly increased in the basolateral amygdaloid nuclei following acute or chronic restraint. No APP isoform changed in hippocampus after any stress condition. These results suggest that restraint stress induces changes in gene expression of APP(695) in basolateral amygdaloid nucleus, an area related to stress response.

Amyloid deposition in the hippocampus and entorhinal cortex: quantitative analysis of a transgenic mouse model

Various transgenic mouse models of Alzheimer's disease (AD) have been developed that overexpress mutant forms of amyloid precursor protein in an effort to elucidate more fully the potential role of beta-amyloid (A beta) in the etiopathogenesis of the disease. The present study represents the first complete 3D reconstruction of A beta in the hippocampus and entorhinal cortex of PDAPP transgenic mice. A beta deposits were detected by immunostaining and thioflavin fluorescence, and quantified by using high-throughput digital image acquisition and analysis. Quantitative analysis of amyloid load in hippocampal subfields showed a dramatic increase between 12 and 15 months of age, with little or no earlier detectable deposition. Three-dimensional reconstruction in the oldest brains visualized previously unrecognized sheets of A beta coursing through the hippocampus and cerebral cortex. In contrast with previous hypotheses, compact plaques form before significant deposition of diffuse A beta, suggesting that different mechanisms are involved in the deposition of diffuse amyloid and the aggregation into plaques. The dentate gyrus was the hippocampal subfield with the greatest amyloid burden. Sublaminar distribution of A beta in the dentate gyrus correlated most closely with the termination of afferent projections from the lateral entorhinal cortex, mirroring the selective vulnerability of this circuit in human AD. This detailed temporal and spatial analysis of A beta and compact amyloid deposition suggests that specific corticocortical circuits express selective, but late, vulnerability to the pathognomonic markers of amyloid deposition, and can provide a basis for detecting prior vulnerability factors.

Regulation of cerebral cortical blood flow by the basal forebrain cholinergic fibers and aging

This article reviews the study of neural vasodilator mechanisms of the cerebral cortex by basal forebrain cholinergic nerve fibers and their age-related function in rats. During the last decade, we have demonstrated a neural regulatory system of cerebral blood flow in rats involving intracerebral cholinergic vasodilator nerve fibers originating in the basal forebrain and projecting to the cerebral cortex. Activation of these cholinergic vasodilator fibers results in the release of acetylcholine (ACh) within the cortex, activation of both nicotinic and muscarinic ACh receptors, and vasodilatation without coupling to glucose metabolic rates. This cholinergic vasodilator system has been shown to decline with age in rats mainly due to age-related declines of nicotinic ACh receptor activity. However, muscarinic ACh receptor activity and the release of ACh into the extracellular space in the cortex are well maintained during aging. The present age-related decline of the intracerebral cholinergic vasodilator system found in rats seems to affect cognitive function during aging, although this cholinergic vasodilator system has not yet been demonstrated in humans.

Phenylethanolamine N-methyltransferase (PNMT) gene and early-onset Alzheimer disease

The activity of human phenylethanolamine N-methyltransferase (PNMT) is reduced in the neurons of those cells in many subcortical areas of the brain that are known to undergo neurodegeneration in Alzheimer disease (AD). Others have reported that PNMT is decreased in brains of persons with AD and that the decrease in enzymatic activity is due to a reduced amount of the enzyme protein. We have previously described two polymorphisms, G-353A and G-148A, in the promoter region of the gene coding for PNMT. These markers were tested for their association with the occurrence of sporadic AD. Genotyping of 131 necropsy confirmed AD cases, and 947 adult nondemented controls were completed. We observed a significant association between both of the PNMT gene polymorphisms and early-onset AD (EOAD) (P < or = 0.007), but not in late-onset AD (LOAD). These data suggest that genetic variation in the promoter of the PNMT gene is associated with increased susceptibility to the sporadic form of EOAD.

Acetylcholinesterase and butyrylcholinesterase histochemical activities and tumor cell growth in several brain tumors

BACKGROUND

The hydrolysis enzymes of the acetylcholine, acetylcholinesterase, and butyrylcholinesterase are involved in non-cholinergic functions such as proliferation processes and cellular adhesion. These enzymes have been found in several tumors other from brain tumors.

METHODS

Thirty fresh brain tumor specimens were obtained from biopsies taken during neurosurgical procedures. The specimens were cut in two parts, one designated for routine histopathological control and the other for histochemical and growth studies. The formalin fixed specimens were serially cut at 10 microm in a freezing cryostat, mounted in gelatin-coated slides, and processed for sensitive histochemical detection of acetylcholinesterase and butyrylcholinesterase. The other specimens were processed for a HMEM cell growth culture.

RESULTS

The results show the coexistence of acetylcholinesterase and butyrylcholinesterase in all tumors studied. Type II and III gliomas and oligodendrogliomas show moderate activity of both cholinesterases, whereas in type IV glioma and meningiomas the labeling of both cholinesterases was high. In the craniopharyngiomas a high acetylcholinesterase activity was observed and low level of butyrylcholinesterase labeling. The cell growth was high only in the cases in which butyrylcholinesterase activity was high, such as type IV glioma. In type II and III gliomas, oligodendroglioma, and craniopharyngioma the growth rate was slow.

CONCLUSIONS

These results could indicate a possible relationship between the presence of butyrylcholinesterase and acetylcholinesterase in brain tumor tissue and cellular proliferation in tumorigenesis.

Localization of amino acids, neuropeptides and cholinergic markers in neurons of the septum-diagonal band complex projecting to the retrosplenial granular cortex of the rat

Retrograde labelling was combined with immunohistochemistry to localize neurons containing choline acetyltransferase, gamma-aminobutyric acid (GABA), glutamate, leu-enkephalin, neurotensin, and substance P-like immunoreactivity in the projection pathways from the septum-diagonal band complex to the retrosplenial granular cortex in the rat. Injections of horseradish peroxidase conjugated to subunit B of cholera toxin (CT-HRP) into the retrosplenial granular cortex resulted in retrogradely labelled neurons in the ipsilateral nuclei of the diagonal band of Broca, especially in the horizonatal nucleus of the diagonal band, and small numbers of CT-HRP-labelled neurons were also found in the medial septal nucleus. In the horizontal and vertical nuclei of the diagonal band of Broca, 90-95% of CT-HRP-labelled neurons (35-45 per section) were immunoreactive for choline acetyltransferase and small numbers of retrogradely labelled neurons (2 to 4-5 per section) were also immunoreactive for GABA, glutamate, neurotensin, leu-enkephalin, or substance P. In the medial septal nucleus approximately 75-80% of the retrogradely labelled neurons (8-10 per section) were immunoreactive for choline acetyltransferase and up to 25% of the CT-HRP labelled neurons (1-3 per section) in the medial septal nucleus also displayed GABA-, glutamate-, neurotensin-, leu-enkephalin-, or substance P-immunoreactivity. These results suggest that the complexity of the neurotransmitter(s)/neuromodulator(s) of septum-diagonal band complex projections to the retrosplenial granular cortex should be taken into account when considering the mechanisms of cortical activation.

Oxidative stress and a key metabolic enzyme in Alzheimer brains, cultured cells, and an animal model of chronic oxidative deficits

Oxidative stress and diminished metabolism occur in several neurodegenerative disorders. Brains from Alzheimer's disease (AD) patients exhibit several indicators of oxidative stress and have reduced activities of the alpha-ketoglutarate dehydrogenase complex (KGDHC), a key mitochondrial enzyme. Whether these abnormalities are secondary to neurodegenerative processes or are inherent properties of the cells cannot be determined in autopsy brain. Studies in cultured fibroblasts suggest that AD-related differences in oxidative stress and KGDHC reflect inherent properties of AD cells. KGDHC is sensitive to oxidative stress whether the enzyme is studied in cells, in purified mitochondria, or as an isolated protein. Reductions of brain KGDHC in living rodents lead to oxidative stress and selective cell death. The results suggest that KGDHC participates in a deleterious cascade of events related to oxidative stress that are critical in selective neuronal loss in neurodegenerative diseases.

Multiple receptors for neuropeptide Y in the hippocampus: putative roles in seizures and cognition

Neuropeptide Y (NPY) is widely distributed throughout the central nervous system (CNS) and is one of the most conserved peptides in evolution, suggesting an important role in the regulation of basic physiological functions, including learning and memory. In addition, experimental studies have suggested that NPY, together with its receptors, may have a direct implication in several pathological disorders, including epilepsy/seizure. NPY-like immunoreactivity and NPY receptors have been shown to be present throughout the brain, but is concentrated in the hippocampus. The hippocampal formation has been repeatedly implicated in the modulation of cognition, as well as the pathogenesis of seizure. This review will concentrate on the hippocampal distribution of NPY, its receptors and the putative role played by this peptide in seizure, together with the regulation of cognitive function associated with learning and memory.

Galanin and learning

A number of studies indicate that galanin (GAL) is a potent modulator of basal acetylcholine release in the rat forebrain e.g. in the cholinergic neurons of the septo-hippocampal projections. Thus, GAL perfused through the microdialysis probe decreased basal acetylcholine release in the ventral hippocampus, while it enhanced acetylcholine release in the dorsal hippocampus. This finding indicates that GAL may act via different mechanisms within the subsystems of the hippocampus. This hypothesis has received support from studies using the Morris swim maze, a learning task dependent on hippocampal mechanisms. GAL (3 nmol/rat) infused into the ventral hippocampus impaired spatial learning acquisition, while it tended to facilitate when injected into the dorsal hippocampus. However, the effects of GAL on acetylcholine release and on spatial learning, which are due to activation of GAL-receptors, appear to be indirectly mediated possibly via noradrenaline transmission. GAL is also a potent inhibitor of mesencephalic 5-HT neurotransmission in vivo. These findings are discussed in relation to the role of acetylcholine and serotonin in cognition.

Dynamics of plaque formation in Alzheimer's disease

Plaques that form in the brains of Alzheimer patients are made of deposits of the amyloid-beta peptide. We analyze the time evolution of amyloid-beta deposition in immunostained brain slices from transgenic mice. We find that amyloid-beta deposits appear in clusters whose characteristic size increases from 14 microm in 8-month-old mice to 22 microm in 12-month-old mice. We show that the clustering has implications for the biological growth of amyloid-beta by presenting a growth model that accounts for the experimentally observed structure of individual deposits and predicts the formation of clusters of deposits and their time evolution.

Nucleus subputaminalis (Ayala): the still disregarded magnocellular component of the basal forebrain may be human specific and connected with the cortical speech area

The small magnocellular group located within the rostrolateral extension of the basal forebrain was named and described as the nucleus subputaminalis in the human and chimpanzee brain by Ayala. Analysis of cytoarchitectonic and cytochemical characteristics of this cell group has been largely disregarded in both classical and more current studies. We examined the nucleus subputaminalis in 33 neurologically normal subjects (ranging from 15 weeks of gestation to 71 years-of-age) by using Nissl staining, choline acetyltransferase immunohistochemistry, acetyl cholinesterase histochemistry and nerve growth factor receptor immunocytochemistry. In addition, we applied reduced nicotinamide adenine dinucleotide phosphate-diaphorase histochemistry and calbindin-D28k immunocytochemistry in three neurologically normal subjects. At the most rostrolateral levels we describe the previously poorly characterized component of the lateral (periputaminal) subdivision of the subputaminal nucleus, which may be human specific since it is not described in non-human primates. Moreover, we find the human subputaminal nucleus best developed at the anterointermediate level, which is the part of the basal nucleus that is usually much smaller or missing in monkeys. The location of subputaminal cholinergic neurons within the frontal lobe, the ascension of their fibers through the external capsule towards the inferior frontal gyrus, the larger size of the subputaminal nucleus on the left side at the most rostral and anterointermediate levels and the most protracted development among all magnocellular aggregations within the basal forebrain strongly suggest that they may be connected with the cortical speech area. These findings give rise to many hypotheses about the possible role of the subputaminal nucleus in various neurodegenerative, neurological and psychiatric disorders, particularly Alzheimer's disease and primary progressive aphasia. Therefore, future studies on the basal forebrain should more carefully investigate this part of the basal nucleus.

Effects of postmortem delay on serotonin and (+)8-OH-DPAT-mediated inhibition of adenylyl cyclase activity in rat and human brain tissues

The reproducibility of serotonin (5-HT) and (+)8-OH-DPAT-mediated inhibition of adenylyl cyclase activity was assessed in membranes, stimulated by forskolin, of rat frontal cortex postmortem as well as of human fronto-cortical, hippocampal and dorsal raphe tissues obtained from autopsy brains. The results revealed that differences between basal and forskolin-stimulated enzyme activities were still significant after 48 h postmortem in rat cortex and in all human brain regions up to 46 h after death. However, a decrease of about 17 and 26% in forskolin-stimulated adenylyl cyclase activity was observed at 24 and 48 h, respectively, in rat cortex. 5-HT and the 5-HT1A receptor agonist, (+)8-hydroxy-2(di-N-propylamino)tetraline (8-OH-DPAT), were able to inhibit forskolin-stimulated adenylyl cyclase activity in a dose-dependent manner for 48 h after death in rat and human brain. In rat cortex, both 5-HT and (+)8-OH-DPAT potencies (EC50, nM) and efficacies (percent of maximum inhibition capacity, %) varied significantly with postmortem delay. Conversely, in human tissues, postmortem delay and subject age did not modify agonist potencies and efficacies. Furthermore, a regionality of 5-HT potency and efficacy was revealed in the human brain. 5-HT was equally potent in cortex and raphe nuclei, while being more potent but less effective in hippocampus. (+)8-OH-DPAT was more active in hippocampus and raphe nuclei than in cortex. (+)8-OH-DPAT behaved as an agonist in all areas, as its efficacy was similar or greater than those obtained with 5-HT. The (+)8-OH-DPAT dose-response curve was completely reversed by 5-HT1A receptor antagonists in rat cortex and all human brain areas. In conclusion, we suggest here that differences between rat and human brain might exist at the level of postmortem degradation of 5-HT-sensitive adenylyl cyclase activity. In human brain, 5-HT1A receptor-mediated inhibition of adenylyl cyclase seems to be reproducible, suggesting that reliable experiments can be carried out on postmortem specimens from patients with neuropsychiatric disorders.

Modulation of acetylcholine and serotonin transmission by galanin. Relationship to spatial and aversive learning

This paper presents evidence that galanin is a potent in vivo modulator of basal acetylcholine release in the rat brain with qualitatively and quantitatively differential effects in the dorsal and ventral hippocampus. Galanin perfused through the microdialysis probe decreased basal acetylcholine release in the ventral hippocampus, while it enhanced acetylcholine release in the dorsal hippocampus. Galanin (3 nmol/rat) infused into the ventral hippocampus impaired spatial learning acquisition, while it tended to facilitate acquisition when injected into the dorsal hippocampus. These effects appear to be related to activation of GAL-R1 (ventral hippocampus) and GAL-R2 (dorsal hippocampus) receptors, respectively. However, the effects of galanin on acetylcholine release and on spatial learning appear not to be directly related to cholinergic mechanisms, but they may also involve interactions with noradrenaline and/or glutamate transmission. Galanin administered into the lateral ventricle failed to affect acetylcholine release, while this route of administration produced a long-lasting reduction in 5-HT release in the ventral hippocampus, indicating that galanin is a potent inhibitor of mesencephalic 5-HT neurotransmission in vivo. Subsequent studies supported this hypothesis, showing that the effects on 5-HT release in vivo are most likely mediated by a galanin receptor in the dorsal raphe. The implications of these findings are discussed in relation to the role of acetylcholine in cognitive functions in the forebrain and the role of the raphe 5-HT neurons in affective disorders.

Increased peroxidation and reduced antioxidant enzyme activity in Alzheimer's disease

The overall peroxidation activity in brain tissue by region from patients with Alzheimer's disease (AD) and age-matched controls was determined employing the thiobarbituric acid-reactive substances (TBARS) assay, a measure of lipid peroxidation, followed by a determination the activities of the antioxidant enzymes Cu/Zn superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT), in the frontal, temporal, and cerebellar cortex of 10 AD and 9 control brains. The level of TBARS was elevated in all regions, with particular statistical significance in the temporal cortex when compared to age-matched controls. SOD activity was significantly decreased in AD frontal and AD temporal cortex, while catalase activity was significantly decreased in AD temporal cortex. There was no significant difference in GSH-Px activity found in any of the regions examined. This study supports the theory that in AD the brain is affected by increased oxidative stress which, when combined with a decrease in SOD activity, produces oxidative alterations, seen most significantly in temporal cortex in AD, where the pathophysiologic changes are most severe.

Tri-axial recording of event-related potentials during passive cognitive tasks in patients with Alzheimer's disease

Standard methods used to assess cognitive function in patients with Alzheimer's Disease (AD) often use instructions to direct attention and gauge task difficulty, and measure only the output of processing, i.e., the patient's behavioral response. Because this may focus assessment on functions that are observable and to periods when patient comprehension is not compromised, the present study presented stimuli without instruction, manipulated task difficulty by varying stimulus factors, and used the brain's electrical response as the dependent variable. Because the recording electrode's position on the scalp may limit full examination of the voltage distribution of these responses, a Tri-Axial method of recording electrical activity within a Cartesian coordinate system was used. Results suggest attention may inhibit habituation so that inputs can be represented, discriminated and consolidated. For the control group, the levels of task difficulty modulated electrical peaks presumed to reflect the brain's ability to perform these functions. In the AD group, these responses were attenuated or absent, suggesting that dysfunctional attentional processing may underlie response errors often attributed to memory.

Cerebrospinal fluid apo E and apo A-I concentrations in early- and late-onset Alzheimer's disease

We compared cerebrospinal fluid (CSF) apolipoprotein (apo) A-I and apo E concentrations in early- and late-onset Alzheimer's disease (EOAD (n = 11), LOAD (n = 15), respectively) with those in control subjects (n = 23). CSF apo A-I levels in both EOAD and LOAD were consistent with control subjects. However, CSF apo E levels were significantly lower in EOAD group (mean +/- SD; 2.65 +/- 1.69 mg/l, P < 0.05) and higher in LOAD group (5.90 +/- 1.94 mg/l, P < 0.01) than those in control group (4.16 +/- 1.69 mg/l). In addition, the epsilon4 allele frequency was not different between EOAD and LOAD groups. Although the reason for the difference in CSF apo E concentrations between two groups is unknown, CSF apo E concentration seems to be associated with the pathogenesis of EOAD and LOAD. The rate of apo E production and/or catabolism in the brain may be different between them.

Alterations of peptide metabolism and neuropeptidase activity in senile dementia of the Alzheimer's type

Work in our laboratory has shown that in addition to previously characterized changes in the level of neuropeptides in SDAT brain, the activity of degradative enzymes responsible for peptide metabolism is also affected. In addition to other reported alterations in peptide metabolism, we have observed that SS-28 degradation is increased in Brodmann area 22 whereas substance P degradation is increased in temporal cortex. Changes in the degradation of these neuropeptides known to be affected in SDAT correlate well with alterations in the activity of specific neuropeptidases. Trypsin-like serine protease activity is increased in SDAT Brodmann area 22 which parallels the increased degradation of SS-28. The activity of MEP 24.15 is decreased in temporal cortex which corresponds to the decreased degradation of substance P. Changes in the activity of these degradative enzymes in SDAT brain can potentially affect the action of other neuropeptide substrates because the neuropeptidases discussed here terminate the action of several neuropeptides. As more neuropeptide and degradative peptidase alterations are discovered in SDAT, greater emphasis may be placed on the role that peptides and neuropeptidases play in the progression of SDAT.

The nucleus basalis of Meynert of the human brain: a Golgi and electron microscope study

The nucleus basalis of Meynert of normal brains, aged from 15 to 73 years was studied in Golgi preparations and in electron microscopy. The nucleus is composed of large triangular, polyhedral and bipolar cells which are intermixed with numerous small or medium-sized spiny neurons. All of the neurons form a dense three dimensional dendritic arborization, with numerous secondary and tertiary dendritic branches studded with spines. The ultrastructural analysis revealed numerous axodendritic and axosomatic synapses between the spines. The ultrastructural analysis revealed numerous axodendritic and axosomatic synapses between the spiny neurons and the large triangular and polyhedral neurons. The presynaptic axonic profiles are plenty of ellipsoid and round synaptic vesicles. Large presynaptic terminals are seen frequently surrounded by numerous dendritic spines forming synaptic glomeruli, in all the areas of the nucleus basalis of Meynert. An age depended decrease of the number of neurons was noticed affecting mainly the population of the spiny neurons. Although in senile and presenile dementias an impressive loss of the cholinergic neurons of the nucleus basalis was reported, in normal aging the large cholinergic neurons of the nucleus basalis seems to be intact, whereas the medium and small shaped spiny neurons are decreased in number suggesting that the GABA-ergic neurons are principally affected.

Chromosomal fragility associated with familial Alzheimer's disease

To test whether chromosomal instability is associated with familial Alzheimer's disease, we examined breakage on X chromosomes of fibroblasts derived from patients with familial Alzheimer's disease, using gene cotransfer methodology. The X chromosome is a convenient target for analyzing DNA breakage because of its numerous markers and ease of selection in rodent-human hybrid cells. Patients with familial Alzheimer's disease, including the large Nova Scotia Alzheimer's kindred, show a significantly lower cotransfer of the X-linked glucose-6-phosphate dehydrogenase (G6PD) gene with the selected HPRT gene in hybrid cells, indicating breakage between the markers. Lower cotransfer of the more distant X-linked gene, MIC-2, was statistically significant in this kindred, but not in other patients with familial Alzheimer's disease. The distance between MIC2 and HPRT is sixfold to ninefold greater than that between HPRT and G6PD, suggesting that there may be a "hot spot" for breakage in the latter interval on the X chromosome of patients with familial Alzheimer's disease. The somatic cell hybrid model provides insights into underlying mechanisms for chromosomal breakage induced by the Alzheimer defect. A hypothesis implicating a candidate gene, C1-THF synthase, in the generation of chromosome instability in the pathogenesis of familial Alzheimer's disease, is presented.

Galanin-like immunoreactivity is increased in the postmortem cerebral cortex from patients with Alzheimer's disease

Galanin is a peptide that is associated with cholinergic neurons of the basal forebrain, and, thus, of interest for the neuropathology of Alzheimer's disease. In the present study, human galanin-like immunoreactivity was measured in postmortem human cerebral cortical tissues by using a homologous radioimmunoassay. In an initial study, six cerebral cortical regions were evaluated from nine elderly controls, 13 neuropathologically verified Alzheimer's disease patients, and 19 elderly schizophrenics. A significant 65% increase in galanin was found in frontal cortex Brodmann area 8 of Alzheimer's disease patients compared with controls. In contrast, cerebral cortical tissues from elderly schizophrenics were not different from those from elderly controls in any region. In a second study, 10 cerebral cortical regions were evaluated from 50 neuropathologically verified Alzheimer's disease patients and nine elderly controls. Concentrations of galanin were increased significantly 26-61% in six of 10 cerebral cortical regions examined (Brodmann areas F8, F44, T20, T21, T36, and P22). Purification of brain extracts by size-exclusion Sephadex G-50 chromatography revealed that human galanin-like immunoreactivity eluted in two peaks of different molecular weights. These studies reveal increased concentrations of galanin in the cerebral cortex of Alzheimer's disease, similar to previous findings in basal forebrain tissue. Because galanin inhibits cholinergic neurotransmission, these findings may have important implications in the understanding of Alzheimer's disease neuropathology and associated cognitive deficits.

Effects of nefiracetam on drug-induced impairment of latent learning in mice in a water finding task

We investigated the effects of nefiracetam (DM-9384), a pyrrolidone derivative, on chlordiazepoxide-, apomorphine-, and methamphetamine-induced impairment of latent learning in a water finding test in mice. Pretreatment with nefiracetam reversed the inhibitory effects of chlordiazepoxide and apomorphine, but not those of methamphetamine, on latent learning. The ameliorative effects of nefiracetam on apomorphine-induced, but not chlordiazepoxide-induced impairment of latent learning were antagonized by scopolamine. These results provide further evidence that nefiracetam has anti-amnesic effects. Further, it is suggested that the cholinergic neuronal system may be involved in the ameliorative effects exerted by nefiracetam on apomorphine-induced impairment of latent learning.

Beta APP gene expression is increased in the rat brain after motor neuron axotomy

The response of the beta APP gene to neuronal injury was studied in the facial and hypoglossal nerve nuclei of the rat after corresponding nerve axotomy. Increased levels of beta APP 695, 714, 751 and 770 mRNAs were observed after either facial or hypoglossal nerve axotomy in the parent ipsilateral motor neurons. The increase was gradual, with maximal values 7 days after axotomy. beta APP mRNA expression returned to normal values 60 days after the lesion. Increased beta APP immunostaining was also detected in ipsilateral chromatolytic motor neurons. No change in beta APP immunoreactivity was observed in oligodendrocytes, another cell type expressing beta APP under normal conditions. A rapid increase in the expression of the GFAP gene was observed in reactive astrocytes surrounding chromatolytic neurons in the ipsilateral facial or hypoglossal nuclei. Thus, in contrast with other models of neuronal injury, where only the Kunitz protease inhibitor-containing beta APP mRNA isoforms are increased, all beta APP mRNAs are increased in the axotomy model. Furthermore, although beta APP expression has been shown to be increased in reactive astrocytes following neuronal injury, in the present study the increase was essentially found in the motor neurons reacting to axotomy.

Partial restoration of choline acetyltransferase activities in aging and AF64A-lesioned rat brains by vitamin E

It has been suggested that the activity of the enzyme responsible for the synthesis of acetylcholine, choline acetyltransferase (ChAT), is substantially reduced in the neocortex and hippocampus of Alzheimer's and other aging brains. d-alpha-Tocopherol (vitamin E), a free radical scavenger fat-soluble vitamin, was utilized in the present study to determine whether its supplementation in aging and ethylcholine mustard aziridinium (AF64A)-lesioned rats would improve the cholinergic hypofunction. Vitamin E (given 24 h and 15 min prior to AF64A administration) significantly (P < 0.01) reversed the effect of AF64A in hippocampal choline acetyltransferase activity, but it did not cause any change of this enzyme activity in other brain regions (striatum and frontal cortex), nor did it cause any significant change after 30-day daily treatment in AF64A-lesioned rats. Furthermore, vitamin E (50 mg/kg, i.p. for 30-day treatment) significantly (P < 0.01) partially restored the enzyme activity in striatum of aging (20-28 month old) rats. The present result indicates that vitamin E can partly restore the hypofunction of the cholinergic system in aging and partly prevent the toxicity in AF64A-lesioned rats.

Differential regional and cellular distribution of beta-amyloid precursor protein messenger RNAs containing and lacking the Kunitz protease inhibitor domain in the brain of human, rat and mouse

The beta-amyloid precursor protein is the precursor of the main component of senile plaques (the beta-amyloid peptide or beta/A4) found in the brain of aged humans and, in higher amounts, in the brain of Alzheimer's disease and Down's syndrome subjects. Four different forms of beta-amyloid precursor protein messenger RNAs have been described in humans and rodents: beta-amyloid precursor protein 695, beta-amyloid precursor protein 714, beta-amyloid precursor protein 751 and beta-amyloid precursor protein 770 messenger RNAs (numbers corresponding to the number of encoded amino acids). The two latter forms are characterized by containing in their sequence a region with high homology to the Kunitz family of serine protease inhibitors. We have used oligonucleotide probes to study the distribution of the different messenger RNAs encoding each of the four beta-amyloid precursor proteins by in situ hybridization histochemistry in human, rat and mouse brain. We found that beta-amyloid precursor protein 695, beta-amyloid precursor protein 714 and beta-amyloid precursor protein 751 messenger RNAs were widely distributed in the human, rat and mouse brain and that their distribution was roughly similar in most brain areas in these three species. The distribution of beta-amyloid precursor protein 770 messenger RNA was not so wide and differed among the three species studied. beta-amyloid precursor protein 751 and 770 messenger RNAs were the only forms present at significant levels in rodent choroid plexus and meninges, while beta-amyloid precursor protein messenger RNA isoforms containing and lacking the Kunitz domain were detected in the human choroid plexus. We also observed that the relative levels of beta-amyloid precursor protein 751 and 770 messenger RNAs in the rat cerebral white matter as well as in the mouse and human striatum were higher than those of the beta-amyloid precursor protein messenger RNAs lacking the Kunitz domain. While the most abundant beta-amyloid precursor protein messenger RNAs in the brain of all three species under study were, in descending order, beta-amyloid precursor protein 695 and beta-amyloid precursor protein 751 messenger RNAs, the least abundant form was not the same for all species: in human it was beta-amyloid precursor protein 714 messenger RNA and in rat and mouse brain it was beta-amyloid precursor protein 770 messenger RNA. Our results show differences both inter- and intraspecies of the relative abundance and distribution of four beta-amyloid precursor protein messenger RNAs in rat, mouse and human brain.(ABSTRACT TRUNCATED AT 400 WORDS)

Increased levels of the Kunitz protease inhibitor-containing beta APP mRNAs in rat brain following neurotoxic damage

Deposits of beta-amyloid are one of the main pathological characteristics of Alzheimer's disease. The beta-amyloid peptide (or beta/A4) constituent of these deposits is derived from the beta-amyloid precursor protein (beta APP), which is expressed in several isoforms. It has been suggested that an imbalance in the normal ratio between the Kunitz protease inhibitor (KPI)-containing beta APPs versus the non containing forms could result in altered processing of beta APP and progressive beta/A4 deposition. We have studied the expression of four beta APP isoforms in the rat brain after intracerebroventricular application of kainic acid. Increased levels of the KPI-containing beta APP and GFAP mRNAs were observed in tissues surrounding areas of neuronal damage. A parallel increase of beta APP and GFAP immunoreactivity was observed in reactive astrocytes in these areas. These results suggest that the normal ratio of beta APP isoforms may be profoundly altered as a result of neuronal damage and that non-neuronal cells may respond to neuronal injury by increased expression of the KPI-containing beta APP isoforms.

Age-dependent cerebral metabolic effects of unilateral nucleus basalis magnocellularis ablation in rats

To investigate the age-dependent functional importance of cholinergic neocortical inputs, and to explore whether cortical cholinergic denervation in aged animals might better model the cerebral metabolic changes of Alzheimer's disease, the effects of unilateral ablation of the nucleus basalis magnocellularis (NBM) on cerebral glucose metabolism were studied in young and aged rats. Regional cerebral metabolic rates for glucose (rCMRglc) were determined, using the [14C]deoxyglucose method, in 48 brain regions of 3- and 24-month old Fischer-344 rats at 3, 7, 14 and 28 days after stereotaxic injection of ibotenate into the right NBM, and in sham-operated animals at 3 and 14 days later. For both ages the peak effect of unilateral NBM ablation occurred 3 days later: in young rats, rCMRglc was significantly reduced (compared to the contralateral side) in all 24 anterior cortical areas examined (mean decline 20%), whereas in aged animals, only 9 of 24 areas showed a significant decline in glucose utilization, and the magnitude of rCMRglc reduction (9%) was smaller. Near complete recovery of rCMRglc occurred by 7 days in young and old rats. We conclude that the basalocortical cholinergic projection plays a smaller role in neocortical function of aged rats, possibly because its tonic activity is reduced. Both young and aged rats undergo cortical metabolic normalization after unilateral NBM ablation; hence the NBM-lesioned aged rat is not a better model of the progressive decline in rCMRglc that occurs in Alzheimer's disease.

Regulation of regional cerebral blood flow by cholinergic fibers originating in the basal forebrain

We review mainly recent studies on vasodilative regulation of cortex and hippocampus by central cholinergic nerves originating in the basal forebrain. We also briefly review the influence of other central noradrenergic fibers originating in the locus ceruleus, serotonergic fibers originating in the dorsal raphe nucleus, dopaminergic fibers originating in the substantia nigra, and peripheral sympathetic and parasympathetic nerve fibers upon regulation of regional cerebral blood flow. Local metabolites have long been considered to play an important physiological role in regulating regional cerebral blood flow. However, the evidence reviewed here emphasizes that the regulation of regional cerebral blood flow by these central cholinergic nerves is independent of regional metabolism. We propose through this review that although studies investigating neural regulation of cortical and hippocampal blood flow by cholinergic fibers originating in the basal forebrain have added much to the understanding of regulation of regional cerebral blood flow further studies are needed to determine the physiological relevance of regional cerebral blood flow in relation to higher nervous functions such as memory, learning, and personality, and changes in these cognitive functions with aging and pathology such as Alzheimer's disease.

Axotomized medial septal-diagonal band neurons express Jun-like immunoreactivity

The expression of the transcription factors Fos and Jun was studied in rat brain after transection of the fornix-fimbria (FF) using polyclonal antibodies to these proteins and immunocytochemical detection methods. FF-transection lead to a massive induction of Jun-like immunoreactivity (JLI) in neurons in the medial septal nucleus and in the vertical limb of the diagonal band of Broca, within 48 hours and lasting up to 14 days after lesion. Fos was not induced in these neurons after FF-transection. These results indicate that axotomized medial septal and diagonal band of Broca neurons selectively and rapidly express JLI. The role of Jun expression in axonal regeneration or neuronal death is discussed.

Deficits in the somatostatin SS1 receptor sub-type in frontal and temporal cortices in Alzheimer's disease

The aim of this study was to evaluate the possible differential alterations of somatostatin (SRIF) receptor sub-types in Alzheimer's disease (AD). Consequently the binding profile of cortical SRIF receptors were examined in normal and AD brains using non-selective ([125I]Tyr0, D-Trp8-SRIF14) and SS1 receptor sub-type-selective ([125I]SMS204-090) radioligands. Maximal binding capacities, but not affinities, were reduced for both ligands in the temporal cortex. In contrast, only the maximal binding capacity of [125I]SMS204-090 was significantly reduced (68%) in the frontal cortex; no alterations were detected using the non-selective probe. This reveals that while the maximal binding capacity of the SS1 receptor sub-type is altered in frontal and temporal cortices in AD, other putative cortical SRIF receptor classes (such as SS2 sites) are not as broadly affected. This could be of significance for eventual therapeutic approaches using SRIF-related analogues.

Senile plaques and neurofibrillary changes in the brain of an aged lemurian primate, Microcebus murinus

In some aged Microcebus brains (8- to 11-year-old animals) dramatic atrophy is found, particularly of the cortex, the hippocampus, the basal ganglia, the brainstem and the cerebellum, associated with a conspicuous increase in the size of the cerebral ventricles. These morphological changes are accompanied by certain histological profiles indicative of pathology. In the cortex, these histological changes consist of 1) a large number of senile plaques composed of degenerated neurites sometimes surrounding an amyloid plaque, 2) amyloid deposits in the vascular walls and 3) dense bundles of argyrophilic filaments in numerous pyramidal neurons. All these lesions resemble changes associated with Alzheimer's disease in man. The degenerative changes observed in the Microcebus brain are accompanied by behavioral changes. At the moment these preliminary studies, carried out on the smallest of all primates, do not prove that the degeneration is of the Alzheimer type, but do indicate that Microcebus murinus may well be a good model for the study of cerebral aging, providing a comparison with cerebral ageing in humans. The size, life span and cost of the animal provide further advantages when compared with other nonhuman primates.

Effects of THA on passive avoidance retention performance of intact, nucleus basalis, frontal cortex and nucleus basalis + frontal cortex-lesioned rats

Unilateral quisqualic acid lesions of the nucleus basalis magnocellularis (NBM) produced marked choline acetyltransferase depletion (-67% ipsilateral to lesion) and impaired passive avoidance (PA) retention at 24 hours. Pretraining injections of tacrine (THA: 1, 3 and 5 mg/kg), an anticholinesterase, failed to facilitate PA retention in intact rats. However, the retention performance of NBM-lesioned rats was improved by pretraining administration of THA at 3 mg/kg but not at either 1 or 5 mg/kg. Frontal cortex lesioning did not impair PA retention, and THA at 3 mg/kg had no effect on the PA retention of frontal cortex-lesioned rats. THA at 3 mg/kg failed to improve retention performance of NBM + frontal cortex-lesioned rats. After 10 days of chronic treatment with THA, NBM lesion-induced PA retention deficits were partially restored at both 3- and 5-mg/kg doses. The results suggest that 1) the insult to cholinergic neurons in the NBM may be involved in the PA memory consolidation deficit induced by nonselective quisqualic acid lesioning; 2) the beneficial effects of THA on NBM lesion-induced PA retention deficit occur in a narrow dose range; 3) the alleviating effects of THA on NBM lesion-induced PA memory deficits are blocked by frontal cortex lesions; and 4) the dose-response window for THA-induced PA retention performance improvement is broadened by repeated treatment.

Neuropeptide Y receptor binding sites in human brain. Possible alteration in Alzheimer's disease

Neuropeptide Y (NPY) and peptide YY (PYY) receptor sites were studied in human brain using saturation binding experiments and receptor autoradiography. Additionally, the affinities and densities of [3H]NPY binding sites were compared in the temporal cortex, hippocampus and putamen of patients dying from Alzheimer's disease (AD) and aged matched controls. High densities of [3H]NPY binding sites were found in the putamen (192 +/- 32 fmol/mg protein), followed by the hippocampus (165 +/- 42 fmol/mg protein) and temporal cortex (118 +/- 19 fmol/mg protein). Receptor autoradiography revealed that these sites were especially concentrated in certain layers of the hippocampus, laminae I and IV-V of the temporal cortex and the amygdalo-hippocampal area. No significant changes in [3H]NPY binding affinities were seen between the AD and aged-matched groups (Kd ranges: 2.5-6.8 nM). However, significant decreases in [3H]NPY receptor densities (Bmax) were found in temporal cortex (-43%) and hippocampus (-49%) in AD brains. No significant change in [3H]NPY Bmax values was found in the putamen. It is therefore possible that decreases in [3H]NPY receptor densities may be associated to the degenerative process taking place in certain brain regions in AD, although further work will be necessary to confirm this hypothesis. Part of this work was presented at the 17th Annual Meeting of the Society for Neuroscience.

Brain membrane fluidity and lipid peroxidation in Alzheimer's disease

Membrane fluidity and lipid peroxidation in 4 brain areas from patients with Alzheimer's disease (AD) and matched controls were determined by measuring fluorescence anisotropy of the lipophilic probe 1,6-diphenyl-1,3,5-hexatriene (DPH) and by the thiobarbituric acid test respectively. Fluorescence anisotropy of DPH was not changed in any of the 4 areas in AD compared to controls. Basal levels of malondialdehyde (MDA; an intermediate in the lipid peroxidation process) were also not changed in different brain regions of AD and controls. However, stimulated MDA production determined by incubating tissue with FeSO4 plus H2O2 produced significantly higher MDA levels in AD brain than in controls.

Microangiopathy, the vascular basement membrane and Alzheimer's disease: a review

The present review focuses on the vascular basement membrane (VBM) and its relationship to the lesions of Alzheimer's disease (AD). Examination of the fine structure of the microvasculature reveals AD-associated VBM alterations, which include both thickening and vacuolization. Immunocytochemistry confirms that all three intrinsic VBM components [collagen type IV, laminin, and heparan sulfate proteoglycan (HSPG)] outline the capillary bed, which is pathologically altered in AD patients (microangiopathy). Ultrastructural analyses of AD tissue samples demonstrate that HSPG's normal staining pattern is disrupted on the endothelial surface of the VBM in brain regions affected by Alzheimer lesions. Similarly altered VBM is reported to occur in the kidney of patients with diabetes mellitus, where it is associated with a leakage of protein. All three VBM components immunolabel capillaries, amyloid and plaque-associated glial processes, suggesting a link between microangiopathy and senile plaque formation. In addition, the consistent colocalization of HSPG with several forms of amyloid implies an involvement in amyloidogenesis. Finally, the neurotrophic effects of beta-amyloid, combined with neurite-promoting effects of laminin and HSPG, could create a strong focus for an aberrant sprouting response. Such a response is postulated to result in plaque-associated degenerating neurites. Thus, VBM components could serve as a nidus for plaque formation, playing a role in the development of neuritic as well as amyloidotic elements.

Gene therapy in the CNS: intracerebral grafting of genetically modified cells

Grafting cells to the CNS has been suggested and applied as a potential approach to CNS therapy through the selective replacement of cells lost as a result of disease or damage. Independently, studies aimed at direct genetic therapy in model systems have recently begun to suggest conceptually new approaches to the treatment of several kinds of human genetic disease, especially those caused by single gene enzyme deficiencies. We suggest that a combination of these two approaches, namely the graftment into the CNS of genetically modified cells, may provide a new approach toward the restoration of some functions in the damaged or diseased CNS. We present evidence for the feasibility of this approach, including a description of some current techniques for mammalian cell gene transfer and CNS grafting, and several possible approaches to clinical applications. Specifically, we report that fibroblasts, genetically modified to secrete NGF by infection with a retroviral vector and implanted into the brains of rats with a surgical lesion of the fimbria-fornix, prevented the degeneration of cholinergic neurons that would die without treatment.

The opioid system in neurologic and psychiatric disorders and in their experimental models

Evidence from experimental and clinical studies suggests the involvement of the endogenous opioid system in several neurologic and psychiatric disorders (Alzheimer's, Huntington's and Parkinson's diseases, drug-induced movement disorders, Gilles de la Tourette syndrome, stroke, ischemia, brain and spinal cord injury, epilepsy, schizophrenia and affective disorders). However, its involvement is rather a secondary one, perhaps being a severe consequence of a primary, nonopioid disturbance. Thus, treatment of an opioidergic manifestation of a disorder of nonopioidergic origin is necessarily symptomatic and targets only the restoration of the opioid system; such treatment may be beneficial in ameliorating the clinical symptoms of the disorder.

Cellular signaling mechanisms common to the development and degeneration of neuroarchitecture. A review

The present review examines the hypothesis that similar cellular signaling mechanisms are involved in neural development and in age- or disease-associated degeneration. It is hoped that approaching the problem of the regulation of brain structure from this perspective will spur future studies on the links between development, aging and disease. In order for functional neural circuitry to form, the component neurons must interact in highly specific ways. Growth factors and neurotransmitters constitute two major classes of intercellular signals that sculpt neuroarchitecture. These signals influence the neuronal growth cone behaviors which ultimately determine the details of neuritic form. In addition, growth factors and neurotransmitters can influence neuronal survival and synapse formation, and thereby determine both the presence of neurons within circuits and their specific connectivity patterns. Imbalances in growth factor and/or neurotransmitter systems may lead to neurodegeneration in aging and in specific neurodegenerative disorders such as Alzheimer's disease. Developmental, functional and pathological studies of excitatory amino acid neurotransmitters provide a compelling example of how a common intercellular signal can be involved in neuronal development, plasticity and degeneration. Intracellular signaling systems mediate neuroarchitectural responses to neurotransmitters and growth factors by altering the status of the cytoskeletal and vesicular substrates that are the basis of neuronal form. These signal transduction systems include ion channels and second messengers such as calcium, cyclic nucleotides and diacylglycerol. Cytoskeletal and vesicular substrates may be influenced directly by second messenger kinases, or indirectly via actions on the biosynthetic and degradative systems of the cell. Alterations in these various intracellular neuroarchitecture-regulating systems can lead to neurodegeneration. Taken together, the data presented here indicate that similar cellular and molecular mechanisms are involved in nervous system development, function, adaptive plasticity and degeneration.

Acquired cognitive disorders of the elderly

Many gaps still exist in our understanding of the etiology and the management of dementing disorders. However, there are fairly well established guidelines for the clinical diagnosis of Alzheimer's disease, the major cause of acquired cognitive disorders in the elderly. The management of patients with dementing disorders should involve the entire family. The medical needs pale beside the functional and psychosocial issues. Therefore, a multidisciplinary approach in a team setting is ideal, where goals can be established and coordinated and communication with the family, patient, and consultants can be facilitated. Patients and family members need to know that life beyond the diagnosis can be meaningful. With the help of support groups, they learn to maximize the positive aspects and can cope with the struggle ahead. It should not be forgotten, however, that not all families had good relationships before the onset of the decline and often are in great need of counseling to manage the anger and guilt they will often experience. Future research is needed not only on the search for better medical treatments but also on the establishment of guidelines for the physician and family to deal with complex social issues such as when one is no longer safe to drive an automobile. Prospective studies on victims of head injury could establish the link of trauma to Alzheimer's disease, that has been proposed. The role of physicians in public policy for prevention of high risk behaviors (such as boxing) is controversial, but at the very least, physicians should play a major role in educating their patients of these dangers. Because of the rapid aging of our population, pressure for research and policy changes in national health and long term care financing has been growing, largely due to the impressive efforts of the Alzheimer's Association. In order to give the kind of attention that is required in the care of these patients, there must be a change in the present system of reimbursement. This will never happen, unless it can be demonstrated that lower costs of health care can be achieved by anticipating the needs of these patients and their families. It is quite possible that costs can be reduced by delaying the need for nursing home placement or decreasing utilization of emergency medical care and hospitalization. However, these assumptions must be investigated further.

Midlatency auditory evoked responses: differential abnormality of P1 in Alzheimer's disease

The human 'P1' middle latency evoked potential is postulated to be generated in the thalamus by a cholinergic component of the ascending reticular activating system. To test the hypothesis that P1 and its generator substrate are abnormal in Alzheimer's disease (AD), a disorder of marked cholinergic deficiency, recordings of middle latency responses to click stimuli were carried out. Comparisons between the AD and age-matched control groups indicated normal auditory brain-stem and Pa responses but a significant decrease in P1 amplitude. This P1 abnormality suggests that the midbrain cholinergic cells in AD may be dysfunctional.