Cortical inputs to the CA1 field of the monkey hippocampus originate from the perirhinal and parahippocampal cortex but not from area TE

Hippocampal Network Dysfunction in Early Psychosis: A 2-Year Longitudinal Study

Background

Hippocampal abnormalities are among the most consistent findings in schizophrenia. Numerous studies have reported deficits in hippocampal volume, function, and connectivity in the chronic stage of illness. While hippocampal volume and function deficits are also present in the early stage of illness, there is mixed evidence of both higher and lower functional connectivity. Here, we use graph theory to test the hypothesis that hippocampal network connectivity is broadly lowered in early psychosis and progressively worsens over 2 years.

Methods

We examined longitudinal resting-state functional connectivity in 140 participants (68 individuals in the early stage of psychosis, 72 demographically similar healthy control individuals). We used an anatomically driven approach to quantify hippocampal network connectivity at 2 levels: 1) a core hippocampal-medial temporal lobe cortex (MTLC) network; and 2) an extended hippocampal-cortical network. Group and time effects were tested in a linear mixed effects model.

Results

Early psychosis patients showed elevated functional connectivity in the core hippocampal-MTLC network, but contrary to our hypothesis, did not show alterations within the broader hippocampal-cortical network. Hippocampal-MTLC network hyperconnectivity normalized longitudinally and predicted improvement in positive symptoms but was not associated with increasing illness duration.

Conclusions

These results show abnormally elevated functional connectivity in a core hippocampal-MTLC network in early psychosis, suggesting that selectively increased hippocampal signaling within a localized cortical circuit may be a marker of the early stage of psychosis. Hippocampal-MTLC hyperconnectivity could have prognostic and therapeutic implications.

The Effective Connectivity of the Human Hippocampal Memory System

Effective connectivity measurements in the human hippocampal memory system based on the resting-state blood oxygenation-level dependent signal were made in 172 participants in the Human Connectome Project to reveal the directionality and strength of the connectivity. A ventral "what" hippocampal stream involves the temporal lobe cortex, perirhinal and parahippocampal TF cortex, and entorhinal cortex. A dorsal "where" hippocampal stream connects parietal cortex with posterior and retrosplenial cingulate cortex, and with parahippocampal TH cortex, which, in turn, project to the presubiculum, which connects to the hippocampus. A third stream involves the orbitofrontal and ventromedial-prefrontal cortex with effective connectivity with the hippocampal, entorhinal, and perirhinal cortex. There is generally stronger forward connectivity to the hippocampus than backward. Thus separate "what," "where," and "reward" streams can converge in the hippocampus, from which back projections return to the sources. However, unlike the simple dual stream hippocampal model, there is a third stream related to reward value; there is some cross-connectivity between these systems before the hippocampus is reached; and the hippocampus has some effective connectivity with earlier stages of processing than the entorhinal cortex and presubiculum. These findings complement diffusion tractography and provide a foundation for new concepts on the operation of the human hippocampal memory system.

Extensive cortical functional connectivity of the human hippocampal memory system

The cortical connections of the human hippocampal memory system are fundamental to understanding its operation in health and disease, especially in the context of the great development of the human cortex. The functional connectivity of the human hippocampal system was analyzed in 172 participants imaged at 7T in the Human Connectome Project. The human hippocampus has high functional connectivity not only with the entorhinal cortex, but also with areas that are more distant in the ventral 'what' stream including the perirhinal cortex and temporal cortical visual areas. Parahippocampal gyrus TF in humans has connectivity with this ventral 'what' subsystem. Correspondingly for the dorsal stream, the hippocampus has high functional connectivity not only with the presubiculum, but also with areas more distant, the medial parahippocampal cortex TH which includes the parahippocampal place or scene area, the posterior cingulate including retrosplenial cortex, and the parietal cortex. Further, there is considerable cross connectivity between the ventral and dorsal streams with the hippocampus. The findings are supported by anatomical connections, which together provide an unprecedented and quantitative overview of the extensive cortical connectivity of the human hippocampal system that goes beyond hierarchically organised and segregated pathways connecting the hippocampus and neocortex, and leads to new concepts on the operation of the hippocampal memory system in humans.

Extensive Cortical Connectivity of the Human Hippocampal Memory System: Beyond the "What" and "Where" Dual Stream Model

The human hippocampus is involved in forming new memories: damage impairs memory. The dual stream model suggests that object "what" representations from ventral stream temporal cortex project to the hippocampus via the perirhinal and then lateral entorhinal cortex, and spatial "where" representations from the dorsal parietal stream via the parahippocampal gyrus and then medial entorhinal cortex. The hippocampus can then associate these inputs to form episodic memories of what happened where. Diffusion tractography was used to reveal the direct connections of hippocampal system areas in humans. This provides evidence that the human hippocampus has extensive direct cortical connections, with connections that bypass the entorhinal cortex to connect with the perirhinal and parahippocampal cortex, with the temporal pole, with the posterior and retrosplenial cingulate cortex, and even with early sensory cortical areas. The connections are less hierarchical and segregated than in the dual stream model. This provides a foundation for a conceptualization for how the hippocampal memory system connects with the cerebral cortex and operates in humans. One implication is that prehippocampal cortical areas such as the parahippocampal TF and TH subregions and perirhinal cortices may implement specialized computations that can benefit from inputs from the dorsal and ventral streams.

The Parahippocampal Cortex and its Functional Connection with the Hippocampus are Critical for Nonnavigational Spatial Memory in Macaques

The Hamilton Search Task (HST) is a test of nonnavigational spatial memory that is dependent on the hippocampus. The parahippocampal cortex (PHC) is a major route for spatial information to reach the hippocampus, but the extent to which the PHC and hippocampus function independently of one another in the context of nonnavigational spatial memory is unclear. Here, we tested the hypotheses that (1) bilateral pharmacological inactivation of the PHC would impair HST performance, and (2) that functional disconnection of the PHC and hippocampus by contralateral (crossed) inactivation would likewise impair performance. Transient inactivation of the PHC impaired HST performance most robustly with 30 s intertrial delays, but not when color cues were introduced. Functional disconnection of the PHC and hippocampus, but not separate unilateral inactivation of either region, also selectively impaired long-term spatial memory. These findings indicate a critical role for the PHC and its interactions with the hippocampus in nonnavigational spatial memory.

Connections of the Mouse Orbitofrontal Cortex and Regulation of Goal-Directed Action Selection by Brain-Derived Neurotrophic Factor

BACKGROUND

Distinguishing between actions that are more likely or less likely to be rewarded is a critical aspect of goal-directed decision making. However, neuroanatomic and molecular mechanisms are not fully understood.

METHODS

We used anterograde tracing, viral-mediated gene silencing, functional disconnection strategies, pharmacologic rescue, and designer receptors exclusively activated by designer drugs (DREADDs) to determine the anatomic and functional connectivity between the orbitofrontal cortex (OFC) and the amygdala in mice. In particular, we knocked down brain-derived neurotrophic factor (Bdnf) bilaterally in the OFC or generated an OFC-amygdala "disconnection" by pairing unilateral OFC Bdnf knockdown with lesions of the contralateral amygdala. We characterized decision-making strategies using a task in which mice selected actions based on the likelihood that they would be reinforced. Additionally, we assessed the effects of DREADD-mediated OFC inhibition on the consolidation of action-outcome conditioning.

RESULTS

As in other species, the OFC projects to the basolateral amygdala and dorsal striatum in mice. Bilateral Bdnf knockdown within the ventrolateral OFC and unilateral Bdnf knockdown accompanied by lesions of the contralateral amygdala impede goal-directed response selection, implicating BDNF-expressing OFC projection neurons in selecting actions based on their consequences. The tyrosine receptor kinase B agonist 7,8-dihydroxyflavone rescues action selection and increases dendritic spine density on excitatory neurons in the OFC. Rho-kinase inhibition also rescues goal-directed response strategies, linking neural remodeling with outcome-based decision making. Finally, DREADD-mediated OFC inhibition weakens new action-outcome memory.

CONCLUSIONS

Activity-dependent and BDNF-dependent neuroplasticity within the OFC coordinate outcome-based decision making through interactions with the amygdala. These interactions break reward-seeking habits, a putative factor in multiple psychopathologies.

Scene-selective coding by single neurons in the human parahippocampal cortex

Imaging, electrophysiological, and lesion studies have shown a relationship between the parahippocampal cortex (PHC) and the processing of spatial scenes. Our present knowledge of PHC, however, is restricted to the macroscopic properties and dynamics of bulk tissue; the behavior and selectivity of single parahippocampal neurons remains largely unknown. In this study, we analyzed responses from 630 parahippocampal neurons in 24 neurosurgical patients during visual stimulus presentation. We found a spatially clustered subpopulation of scene-selective units with an associated event-related field potential. These units form a population code that is more distributed for scenes than for other stimulus categories, and less sparse than elsewhere in the medial temporal lobe. Our electrophysiological findings provide insight into how individual units give rise to the population response observed with functional imaging in the parahippocampal place area.

Medial prefrontal-perirhinal cortical communication is necessary for flexible response selection

The ability to use information from the physical world to update behavioral strategies is critical for survival across species. The prefrontal cortex (PFC) supports behavioral flexibility; however, exactly how this brain structure interacts with sensory association cortical areas to facilitate the adaptation of response selection remains unknown. Given the role of the perirhinal cortex (PER) in higher-order perception and associative memory, the current study evaluated whether PFC-PER circuits are critical for the ability to perform biconditional object discriminations when the rule for selecting the rewarded object shifted depending on the animal's spatial location in a 2-arm maze. Following acquisition to criterion performance on an object-place paired association task, pharmacological blockade of communication between the PFC and PER significantly disrupted performance. Specifically, the PFC-PER disconnection caused rats to regress to a response bias of selecting an object on a particular side regardless of its identity. Importantly, the PFC-PER disconnection did not interfere with the capacity to perform object-only or location-only discriminations, which do not require the animal to update a response rule across trials. These findings are consistent with a critical role for PFC-PER circuits in rule shifting and the effective updating of a response rule across spatial locations.

Complementary subicular pathways to the anterior thalamic nuclei and mammillary bodies in the rat and macaque monkey brain

The origins of the hippocampal (subicular) projections to the anterior thalamic nuclei and mammillary bodies were compared in rats and macaque monkeys using retrograde tracers. These projections form core components of the Papez circuit, which is vital for normal memory. The study revealed a complex pattern of subicular efferents, consistent with the presence of different, parallel information streams, whose segregation appears more marked in the rat brain. In both species, the cells projecting to the mammillary bodies and anterior thalamic nuclei showed laminar separation but also differed along other hippocampal axes. In the rat, these diencephalic inputs showed complementary topographies in the proximal–distal (columnar) plane, consistent with differential involvement in object‐based (proximal subiculum) and context‐based (distal subiculum) information. The medial mammillary inputs, which arose along the anterior–posterior extent of the rat subiculum, favoured the central subiculum (septal hippocampus) and the more proximal subiculum (temporal hippocampus). In contrast, anterior thalamic inputs were largely confined to the dorsal (i.e. septal and intermediate) subiculum, where projections to the anteromedial nucleus favoured the proximal subiculum while those to the anteroventral nucleus predominantly arose in the distal subiculum. In the macaque, the corresponding diencephalic inputs were again distinguished by anterior–posterior topographies, as subicular inputs to the medial mammillary bodies predominantly arose from the posterior hippocampus while subicular inputs to the anteromedial thalamic nucleus predominantly arose from the anterior hippocampus. Unlike the rat, there was no clear evidence of proximal–distal separation as all of these medial diencephalic projections preferentially arose from the more distal subiculum.

The Role of the Human Entorhinal Cortex in a Representational Account of Memory

Connectivity studies in animals form the basis for a representational view of medial temporal lobe (MTL) subregions. In this view, distinct subfields of the entorhinal cortex (EC) relay object-related and spatial information from the perirhinal and parahippocampal cortices (PRC, PHC) to the hippocampus (HC). Relatively recent advances in functional magnetic resonance imaging (fMRI) methodology allow examining properties of human EC subregions directly. Antero-lateral and posterior-medial EC subfields show remarkable consistency to their putative rodent and nonhuman primate homologs with regard to intra- and extra-MTL functional connectivity. Accordingly, there is now evidence for a dissociation of object-related vs. spatial processing in human EC subfields. Here, variance in localization may be integrated in the antero-lateral vs. posterior-medial distinction, but may additionally reflect process differences. Functional results in rodents further suggest material-specific representations may be more integrated in EC compared to PRC/PHC. In humans, however, evidence for such a dissociation between EC and PRC/PHC is lacking. Future research may elucidate on the unique contributions of human EC to memory, especially in light of its high degree of intrinsic and extrinsic connectivity. A thorough characterization of EC subfield function may not only advance our understanding of human memory, but also have important clinical implications.

A network convergence zone in the hippocampus

The hippocampal formation is a key structure for memory function in the brain. The functional anatomy of the brain suggests that the hippocampus may be a convergence zone, as it receives polysensory input from distributed association areas throughout the neocortex. However, recent quantitative graph-theoretic analyses of the static large-scale connectome have failed to demonstrate the centrality of the hippocampus; in the context of the whole brain, the hippocampus is not among the most connected or reachable nodes. Here we show that when communication dynamics are taken into account, the hippocampus is a key hub in the connectome. Using a novel computational model, we demonstrate that large-scale brain network topology is organized to funnel and concentrate information flow in the hippocampus, supporting the long-standing hypothesis that this region acts as a critical convergence zone. Our results indicate that the functional capacity of the hippocampus is shaped by its embedding in the large-scale connectome.

Contributions of the hippocampus and entorhinal cortex to rapid visuomotor learning in rhesus monkeys

The hippocampus and adjacent structures in the medial temporal lobe are essential for establishing new associative memories. Despite this knowledge, it is not known whether the hippocampus proper is essential for establishing such memories, nor is it known whether adjacent regions like the entorhinal cortex might contribute. To test the contributions of these regions to the formation of new associative memories, we trained rhesus monkeys to rapidly acquire arbitrary visuomotor associations, i.e., associations between visual stimuli and spatially directed actions. We then assessed the effects of reversible inactivations of either the hippocampus (Experiment 1) or entorhinal cortex (Experiment 2) on the within-session rate of learning. For comparison, we also evaluated the effects of the inactivations on performance of problems of the same type that had been well learned prior to any inactivations. We found that inactivation of the entorhinal cortex but not hippocampus produced impairments in acquiring novel arbitrary associations. The impairment did not extend to the familiar, previously established associations. These data indicate that the entorhinal cortex is causally involved in establishing new associations, as opposed to retrieving previously learned associations. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Direct evidence for domain-sensitive functional subregions in human entorhinal cortex

The medial temporal lobes (MTL) are known to play a crucial role in memory processes. Anatomical findings from animal studies suggest partially segregated MTL pathways converge in the hippocampus, with a posterior stream including parahippocampal and medial lateral entorhinal cortex and an anterior stream including perirhinal and lateral entorhinal cortex. These streams may operate on spatial and nonspatial information, respectively. In humans, such a functional dissociation has been suggested between parahippocampal and perirhinal cortex. Data from rodents and nonhuman primates suggest a similar dissociation between medial and lateral entorhinal cortex, which are reciprocally connected to parahippocampal and perirhinal cortex, but evidence for functional subregions within entorhinal cortex in humans is lacking. We addressed this issue using high-resolution fMRI with improved spatial normalization. Volunteers (n = 28) performed a working memory paradigm involving the retrieval of spatial (scenes) and nonspatial (faces) information after distraction. A clear dissociation between MTL subcircuits emerged. A perirhinal-lateral entorhinal pathway was more involved in the retrieval of faces after distraction, whereas a parahippocampal-medial entorhinal pathway was more involved in the retrieval of scenes after distraction. A cluster in posterior hippocampus showed a deactivation for the retrieval of faces after distraction. Our data thus provide direct evidence for a functional specialization within human entorhinal cortex and thereby strongly support MTL models that emphasize the importance of partially segregated parallel processing streams.

Lesions affecting the right hippocampal formation differentially impair short-term memory of spatial and nonspatial associations

Converging evidence from behavioral and imaging studies suggests that within the human medial temporal lobe (MTL) the hippocampal formation may be particularly involved in recognition memory of associative information. However, it is unclear whether the hippocampal formation processes all types of associations or whether there is a specialization for processing of associations involving spatial information. Here, we investigated this issue in six patients with postsurgical lesions of the right MTL affecting the hippocampal formation and in ten healthy controls. Subjects performed a battery of delayed match-to-sample tasks with two delays (900/5,000 ms) and three set sizes. Subjects were requested to remember either single features (colors, locations, shapes, letters) or feature associations (color-location, color-shape, color-letter). In the single-feature conditions, performance of patients did not differ from controls. In the association conditions, a significant delay-dependent deficit in memory of color-location associations was found. This deficit was largely independent of set size. By contrast, performance in the color-shape and color-letter conditions was normal. These findings support the hypothesis that a region within the right MTL, presumably the hippocampal formation, does not equally support all kinds of visual memory but rather has a bias for processing of associations involving spatial information. Recruitment of this region during memory tasks appears to depend both on processing type (associative/nonassociative) and to-be-remembered material (spatial/nonspatial).

Hippocampal neuronal responses during signaled licking of gustatory stimuli in different contexts

Neuroanatomical studies suggest that hippocampal formation (HF) receives information from all sensory modalities including taste via the parahippocampal cortices. To date, however, no neurophysiological study has reported that HF neurons encode taste information. In the present study, we recorded CA1 HF neurons from freely behaving rats during performance of a visually-guided licking task in two different triangular chambers. When a cue lamp came on, the rats were required to press a bar to trigger a tube to protrude into the chambers for 3 s. During this period, the rats could lick one of six sapid solutions: [0.1M NaCl (salty), 0.3M sucrose (sweet), 0.01 M citric acid (sour), 0.0001 M quinine HCl (bitter), 0.01 M monosodium L-glutamate (MSG, umami), and a mixture of MSG and 0.001 M disodium-5'-inosinate (IMP) (MSG+IMP)], and distilled water. Of a total 285 pyramidal and interneurons, the activity of 173 was correlated with at least one of the events in the task-illumination of cue lamps, bar pressing, or licking the solution. Of these, 137 neurons responded during licking, and responses of 62 of these cells were greater to sapid solutions than to water (taste neurons). Multivariate analyses of the taste neurons suggested that, in the HF, taste quality might be encoded based on hedonic value. Furthermore, the activity of most taste neurons was chamber-specific. These results implicate the HF in guiding appetitive behaviors such as conditioned place preference.

Origins of landmark encoding in the brain

The ability to perceive one's position and directional heading relative to landmarks is necessary for successful navigation within an environment. Recent studies have shown that the visual system dominantly controls the neural representations of directional heading and location when familiar visual cues are available, and several neural circuits, or streams, have been proposed to be crucial for visual information processing. Here, we summarize the evidence that the dorsal presubiculum (also known as the postsubiculum) is critically important for the direct transfer of visual landmark information to spatial signals within the limbic system.

Multiple anatomical systems embedded within the primate medial temporal lobe: implications for hippocampal function

A review of medial temporal lobe connections reveals three distinct groupings of hippocampal efferents. These efferent systems and their putative memory functions are: (1) The 'extended-hippocampal system' for episodic memory, which involves the anterior thalamic nuclei, mammillary bodies and retrosplenial cortex, originates in the subicular cortices, and has a largely laminar organisation; (2) The 'rostral hippocampal system' for affective and social learning, which involves prefrontal cortex, amygdala and nucleus accumbens, has a columnar organisation, and originates from rostral CA1 and subiculum; (3) The 'reciprocal hippocampal-parahippocampal system' for sensory processing and integration, which originates from the length of CA1 and the subiculum, and is characterised by columnar, connections with reciprocal topographies. A fourth system, the 'parahippocampal-prefrontal system' that supports familiarity signalling and retrieval processing, has more widespread prefrontal connections than those of the hippocampus, along with different thalamic inputs. Despite many interactions between these four systems, they may retain different roles in memory which when combined explain the importance of the medial temporal lobe for the formation of declarative memories.

Neural correlates of an illusory touch experience investigated with fMRI

When asked to judge the presence or absence of near-threshold tactile stimuli, participants often report touch experiences when no tactile stimulation has been delivered ('false alarms'). The simultaneous presentation of a light flash during the stimulation period can increase the frequency of touch reports, both when touch is and is not present. Using fMRI, we investigated the BOLD response during both light-present and light-absent false alarms, testing predictions concerning two possible neural mechanisms underlying these illusory touch experiences: activation of a tactile representation in primary somatosensory cortex (SI) and/or activation of a tactile representation in late processing areas outside of sensory-specific cortex, such as medial prefrontal cortex (MPC). Our behavioural results showed that participants made false alarms in light-present and light-absent trials, both of which activated regions of the medial parietal and medial prefrontal cortex including precuneus, posterior cingulate and paracingulate cortex, suggesting the same underlying mechanism. However, only a non-significant increase in SI activity was measured in response to false alarm vs. correct rejection trials. We argue that our results provide evidence for the role of top-down regions in somatic misperception, consistent with findings from studies in humans and non-human primates.

High-resolution fMRI of content-sensitive subsequent memory responses in human medial temporal lobe

The essential role of the medial temporal lobe (MTL) in long-term memory for individual events is well established, yet important questions remain regarding the mnemonic functions of the component structures that constitute the region. Within the hippocampus, recent functional neuroimaging findings suggest that formation of new memories depends on the dentate gyrus and the CA(3) field, whereas the contribution of the subiculum may be limited to retrieval. During encoding, it has been further hypothesized that structures within MTL cortex contribute to encoding in a content-sensitive manner, whereas hippocampal structures may contribute to encoding in a more domain-general manner. In the current experiment, high-resolution fMRI techniques were utilized to assess novelty and subsequent memory effects in MTL subregions for two classes of stimuli--faces and scenes. During scanning, participants performed an incidental encoding (target detection) task with novel and repeated faces and scenes. Subsequent recognition memory was indexed for the novel stimuli encountered during scanning. Analyses revealed voxels sensitive to both novel faces and novel scenes in all MTL regions. However, similar percentages of voxels were sensitive to novel faces and scenes in perirhinal cortex, entorhinal cortex, and a combined region comprising the dentate gyrus, CA(2), and CA(3), whereas parahippocampal cortex, CA(1), and subiculum demonstrated greater sensitivity to novel scene stimuli. Paralleling these findings, subsequent memory effects in perirhinal cortex were observed for both faces and scenes, with the magnitude of encoding activation being related to later memory strength, as indexed by a graded response tracking recognition confidence, whereas subsequent memory effects were scene-selective in parahippocampal cortex. Within the hippocampus, encoding activation in the subiculum correlated with subsequent memory for both stimulus classes, with the magnitude of encoding activation varying in a graded manner with later memory strength. Collectively, these findings suggest a gradient of content sensitivity from posterior (parahippocampal) to anterior (perirhinal) MTL cortex, with MTL cortical regions differentially contributing to successful encoding based on event content. In contrast to recent suggestions, the present data further indicate that the subiculum may contribute to successful encoding irrespective of event content.

Are the dorsal and ventral hippocampus functionally distinct structures?

One literature treats the hippocampus as a purely cognitive structure involved in memory; another treats it as a regulator of emotion whose dysfunction leads to psychopathology. We review behavioral, anatomical, and gene expression studies that together support a functional segmentation into three hippocampal compartments: dorsal, intermediate, and ventral. The dorsal hippocampus, which corresponds to the posterior hippocampus in primates, performs primarily cognitive functions. The ventral (anterior in primates) relates to stress, emotion, and affect. Strikingly, gene expression in the dorsal hippocampus correlates with cortical regions involved in information processing, while genes expressed in the ventral hippocampus correlate with regions involved in emotion and stress (amygdala and hypothalamus).

Untangling memory from perception in the medial temporal lobe

An active debate in the learning and memory literature centers on the question of whether the perirhinal cortex, part of the medial temporal lobe (MTL), plays its major role in declarative/relational learning and memory or if it also makes an important contribution to high- level perception, similar to the functions of the adjacent visual area TE. Here I consider evidence from neuroanatomical and neurophysiological studies and argue that the perirhinal cortex has distinct and dissociable structure and function from area TE, making its major contribution to declarative/relational learning and memory. I propose additional neurophysiological studies that could help differentiate between these two debated roles of the perirhinal cortex: memory alone or memory plus high- level perception.

Perirhinal cortex lesions delay ejaculation in rats

Afferents from the perirhinal cortex (PRh) form a major input to the hippocampal formation, which is known to be involved in sexual behavior in rodents. But there is a lacuna in literature regarding the role of the PRh in sexual behavior. Bilateral neurotoxic lesions of the PRh delayed the ejaculation latency and prolonged the mean inter-intromission interval significantly, suggesting a facilitatory role of the PRh in male rat sex behavior.

Posterior parahippocampal gyrus pathology in Alzheimer's disease

The posterior parahippocampal gyrus (PPHG) of the non-human primate brain has a distinct dual role in cortical neural systems. On the one hand, it is a critical link in providing the entorhinal cortex and hippocampal formation with cortical input, while on the other hand it receives output from these structures and projects widely by disseminating the medial temporal lobe output to the cortex. Layer III of TF and TH areas largely mediate the former (input) while layer V mediates the latter (output). We have examined areas TF and TH in the normal human brain and in Alzheimer's disease (AD) using pathological stains (Nissl, Thioflavin S) and phenotype specific stains non-phosphorylated neurofilament protein (SMI32) and parvalbumin (PV). Seven clinically and pathologically confirmed AD cases have been studied along with six age-compatible normal cases. Our observations reveal that neurofibrillary tangles (NFTs) heavily invest the area TF and TH neurons that form layers III and V. In both cortical areas, the large pyramids that form layer V contain a greater number of NFTs. These changes, and possibly, pyramidal cell loss, greatly alter the cytoarchitectural picture and diminish SMI32 staining patterns. Layer III of area TH loses the majority of SMI32 immunoreactivity, whereas this change is more conspicuous in layer V of area TF. PV-staining in both areas is largely unaffected. Normal cases contained no evidence of pathology or altered cytoarchitecture. These observations reveal a further disruption of memory-related temporal neural systems in AD where pathology selectively alters both the input to the hippocampal formation and its output to the cortex.

The human hippocampal formation mediates short-term memory of colour-location associations

The medial temporal lobe (MTL) has long been considered essential for declarative long-term memory, whereas the fronto-parietal cortex is generally seen as the anatomical substrate of short-term memory. This traditional dichotomy is questioned by recent studies suggesting a possible role of the MTL for short-term memory. In addition, there is no consensus on a possible specialization of MTL sub-regions for memory of associative information. Here, we investigated short-term memory for single features and feature associations in three humans with post-surgical lesions affecting the right hippocampal formation and in 10 healthy controls. We used three delayed-match-to-sample tasks with two delays (900/5000 ms) and three set sizes (2/4/6 items). Subjects were instructed to remember either colours, locations or colour-location associations. In colour-only and location-only conditions, performance of patients did not differ from controls. By contrast, a significant group difference was found in the association condition at 5000 ms delay. This difference was largely independent of set size, thus suggesting that it cannot be explained by the increased complexity of the association condition. These findings show that the hippocampal formation plays a significant role for short-term memory of simple visuo-spatial associations, and suggest a specialization of MTL sub-regions for associative memory.

Gray matter differences correlate with spontaneous strategies in a human virtual navigation task

Young healthy participants spontaneously use different strategies in a virtual radial maze, an adaptation of a task typically used with rodents. Functional magnetic resonance imaging confirmed previously that people who used spatial memory strategies showed increased activity in the hippocampus, whereas response strategies were associated with activity in the caudate nucleus. Here, voxel based morphometry was used to identify brain regions covarying with the navigational strategies used by individuals. Results showed that spatial learners had significantly more gray matter in the hippocampus and less gray matter in the caudate nucleus compared with response learners. Furthermore, the gray matter in the hippocampus was negatively correlated to the gray matter in the caudate nucleus, suggesting a competitive interaction between these two brain areas. In a second analysis, the gray matter of regions known to be anatomically connected to the hippocampus, such as the amygdala, parahippocampal, perirhinal, entorhinal and orbitofrontal cortices were shown to covary with gray matter in the hippocampus. Because low gray matter in the hippocampus is a risk factor for Alzheimer's disease, these results have important implications for intervention programs that aim at functional recovery in these brain areas. In addition, these data suggest that spatial strategies may provide protective effects against degeneration of the hippocampus that occurs with normal aging.

Cytoarchitectonic and chemoarchitectonic subdivisions of the perirhinal and parahippocampal cortices in macaque monkeys

Although the perirhinal and parahippocampal cortices have been shown to be critically involved in memory processing, the boundaries and extent of these areas have been controversial. To produce a more objective and reproducible description, the architectonic boundaries and structure of the perirhinal (areas 35 and 36) and parahippocampal (areas TF and TH) cortices were analyzed in three macaque species, with four different staining methods [Nissl and immunohistochemistry for parvalbumin, nonphosphorylated neurofilaments (with SMI-32), and the m2 muscarinic acetylcholine receptor]. We further correlated the architectonic boundary of the parahippocampal cortex with connections to and from different subregions of anterior area TE and with previously published connections with the prefrontal cortex and temporal pole (Kondo et al. [2005] J. Comp. Neurol. 493:479-509). Together, these data provided a clear delineation of the perirhinal and parahippocampal areas, although it differs from previous descriptions. In particular, we did not extend the perirhinal cortex into the temporal pole, and the lateral boundaries of areas 36 and TF with area TE were placed more medially than in other studies. The lateral boundary of area TF in Macaca fuscata was located more laterally than in Macaca fascicularis or Macaca mulatta, although there was no difference in architectonic structure. We recognized a caudal, granular part of the parahippocampal cortex that we termed "area TFO." This area closely resembles the laterally adjacent area TE and the caudally adjacent area V4 but is clearly different from the more rostral area TF. These areas are likely to have distinct functions.

Doing the right thing: A common neural circuit for appropriate violent or compassionate behavior

Humans have a considerable facility to adapt their behavior in a manner that is appropriate to social or societal context. A failure of this ability can lead to social exclusion and is a feature of disorders such as psychopathy and disruptive behavior disorder. We investigated the neural basis of this ability using a customized video game played by 12 healthy participants in an fMRI scanner. Two conditions involved extreme examples of context-appropriate action: shooting an aggressive humanoid assailant or healing a passive wounded person. Two control conditions involved carefully matched stimuli paired with inappropriate actions: shooting the person or healing the assailant. Surprisingly, the same circuit, including the amygdala and ventromedial prefrontal cortex, was activated when participants acted in a context-appropriate manner, whether being compassionate towards an injured conspecific or aggressive towards a violent assailant. The findings indicate a common system that guides behavioral expression appropriate to social or societal context irrespective of its aggressive or compassionate nature.

Distribution and morphology of serotonin-immunoreactive axons in the retrohippocampal areas of the New Zealand white rabbit

This study provides a detailed light microscopic description of the morphology and distribution of serotonin-immunoreactive axons in the paleocortical retrohippocampal areas, viz. the subiculum, presubiculum, parasubiculum and entorhinal area, and the adjoining neocortical perirhinal and retrosplenial cortices of the New Zealand white rabbit. Serotonergic axons could be segregated into three different fiber types named fine fibers, beaded fibers and stem-axons. Fine fibers were evenly distributed thin axons with small fusiform/granular varicosities. Beaded fibers were thin axons with large varicosities, predominantly located in the retrohippocampal supragranular layers, where they often formed pericellular arrays. Stem-axons were thick straight, nonvaricose axons seen in the white matter of psalterium dorsale, alveus and the plexiform layer. The paleocortical retrohippocampal areas had a dense supragranular innervation with numerous tortuous fine and beaded fibers, intermingled in conglomerates with conspicuous varicosities forming pericellular arrays. In contrast, the neocortical area 17 and the lateral part of the perirhinal cortex (area 36) were innervated by evenly distributed fine fibers with a moderate number of small varicosities and few ramifications, whereas, the retrosplenial cortex (areas 29e, 29ab and 29cd), and the medial part of the perirhinal cortex (area 35) displayed an intermediate innervation pattern, probably reflecting the transitional nature of these areas being located between the paleo- and the neocortex. The described dualistic innervation pattern may functionally enable the serotonergic system to exert a strong influence on the supragranular layers of the retrohippocampal areas and thus on the neural input entering these areas from the perirhinal and neighboring polymodal association neocortices, whereas the innervation pattern in the adjoining neocortical areas points towards a more diffuse and general modulation of neural activity herein.

Zinc-enriched amygdalo- and hippocampo-cortical connections to the inferotemporal cortices in macaque monkey

Synaptic zinc (Zn), a co-factor in some glutamatergic synapses, has been implicated in plasticity effects, as well as in several excitotoxic and other pathophysiological conditions. In this study, we provide information about the distribution of Zn in inferotemporal cortex, a region at the interface of the visual and hippocampal networks. In brief, we found a lateral to medial increase in Zn, where TEad, a unimodal visual area, showed low levels of Zn; TEav, intermediate levels; and perirhinal cortex, a multimodal limbic area, high levels. The distribution of parvalbumin, a calcium binding protein, showed a reverse gradient to that of Zn. The neurons of origin of the Zn+ termination were identified by making intracortical injections sodium selenite (Na2SeO3). This substance interacts with Zn to form precipitates of ZnSe and in this form is transported retrogradely to the soma. A mixed population of labeled neurons was visualized, which included Zn+ neurons in CA1 of the hippocampus and in several amygdala subnuclei. In CA1, Zn+ neurons were restricted to the upper part of stratum pyramidale. Zn is thought to contribute to activity-dependent synaptic plasticity. The specifically high level in perirhinal cortex, and its origin from neurons in CA1 and the amygdala, may relate to cellular events involved in visual long-term memory formation.

Mild topographical memory impairment following crossed unilateral lesions of the mediodorsal thalamic nucleus and the inferotemporal cortex

Monkeys with crossed unilateral lesions of the dorsomedial thalamus and contralateral ablations of the inferotemporal cortex were mildly impaired on acquisition and retention of visual conditional tasks requiring the integration of information about objects and their positions in space. They were not impaired on other conditional and nonconditional tasks. This impairment pattern resembles, qualitatively, that found following crossed unilateral lesions of the anterior thalamus and the inferotemporal cortex or bilateral lesions of the anterior and mediodorsal thalamic nuclei. Although the flow of visual information from the inferotemporal cortex through the hippocampal-fornix-anterior thalamic circuit plays a major part in memory for objects in places, the flow of information between inferotemporal cortex and mediodorsal thalamus, possibly by means of the frontal cortex, also makes some contribution.

Direct projections from CA1 to the superior temporal sulcus in the monkey, revealed by single axon analysis

Anterograde tracer injections in the middle sector of CA1 in macaque monkeys demonstrate a direct projection to the fundus of the anterior superior temporal sulcus, in area IPa. Terminations are predominantly in layer 3. With regard to both terminal and arbor configuration, these hippocampal-cortical connections are morphologically similar to corticocortical connections to temporal association cortex. This report provides additional evidence of direct CA1 connections to particular multimodal cortical areas.

Topographical memory impairments after unilateral lesions of the anterior thalamus and contralateral inferotemporal cortex

Monkeys with crossed unilateral excitotoxic lesions of the anterior thalamus and unilateral inferotemporal cortex ablation were severely impaired at learning two tasks which required the integration of information about the appearance of objects and their positions in space. The lesioned monkeys were also impaired at learning a spatial task and a task which required the integration of information about the appearance of objects and the background on which the objects were situated. Monkeys with only one of the unilateral lesions were not impaired and previous work has shown that monkeys with bilateral lesions of the anterior thalamus were not impaired on these tasks. These results indicate that the whole of the inferotemporal cortex-anterior thalamic circuit, which passes via the hippocampus, fornix, mamillary bodies and mamillothalamic tract, is essential for the topographical analysis of information about specific objects in different positions in space. Together with previous work, the results show that a unilateral lesion may affect cognition in the presence of other brain damage when an equivalent bilateral lesion alone does not. The tasks required the slow acquisition of information into long term memory and therefore assessed semantic knowledge although other research has shown impairment on topographical processing within working or episodic memory following lesions of the hippocampal-diencephalic circuit. It is argued that the hippocampal-diencephalic circuit does not have a role in a specific form of memory such as episodic memory but rather is involved in topographical analysis of the environment in perception and across all types of declarative memory.

Connections between the anterior inferotemporal cortex (area TE) and CA1 of the hippocampus in monkey

In addition to the trisynaptic perforant pathway from entorhinal cortex to CA1, there are multiple direct parallel pathways between several cortical regions and CA1. These may be supposed to function cooperatively, in conjunction with the perforant pathway; but neither the functional nor anatomical organization of the extended network is well understood. In this report, we further investigate the connections between anterior inferotemporal cortex (area TE) and CA1. Injections of tracer substances demonstrate that part of the dorsal subdivision of TE sends projections to CA1, but does not receive reciprocating projections back. This contrasts with the bi-directional connections between the more ventral subdivision, TEav, and CA1, as reported by previous studies (and corroborated by tracer injections in this report). The corticohippocampal projections from dorsal TE are likely to be unimodal visual. They partially converge in the posterior portion of CA1 with connections from posterior TE and from the inferior parietal lobule, perhaps constituting a network related to visual or visuospatial processes.

Where are the perirhinal and parahippocampal cortices? A historical overview of the nomenclature and boundaries applied to the primate medial temporal lobe

Strong evidence has emerged over the last 15 years showing that the perirhinal and parahippocampal cortices play an important role in normal memory function. Despite our progress in understanding the mnemonic functions of these areas, controversy still exists concerning the precise location of the boundaries of these areas in the primate brain. To provide a context for understanding the current discrepancies in the literature, we present a historical overview of the different boundary schemes and nomenclatures that have been applied to the medial temporal lobe cortices in both humans and nonhuman primates. We describe how the boundaries and the names applied to these regions have evolved over time, starting with the classic cytoarchitectonisists working in the early 1900s, and ending with the various schemes being used in the contemporary literature. We show that the current controversies concerning the boundaries of the perirhinal and parahippocampal cortices can be traced directly to the classic cytoarchitectonic literature.

Changes in NOS protein expression and activity in the rat hippocampus, entorhinal and postrhinal cortices after unilateral electrolytic perirhinal cortex lesions

The integrity of the perirhinal cortex is critical for certain types of learning and memory. One important issue relating to the function of this region is its interaction with other brain areas that play a role in memory processing. This study investigates the time course of changes in activity and protein expression of nitric oxide synthase (NOS), which transforms L-arginine into nitric oxide (NO) and citrulline, in the hippocampus and the entorhinal and postrhinal cortices after unilateral electrolytic lesions of the perirhinal cortex. Electrolytic lesions of the perirhinal cortex resulted in long lasting changes in NOS activity and protein expression in the entorhinal and postrhinal cortices (< or = 2 weeks post-lesion). In contrast, there was a small and transient decrease in nNOS expression (with no change in NOS activity) in the dorsal portion of the hippocampus. iNOS was not expressed in any region examined at any time point. These findings provide the first evidence that electrolytic lesions of the perirhinal cortex can result in long-term neurochemical changes in its anatomically related structures. Given that NO has been implicated in neuroplasticity processes, the interpretation of memory impairments induced by electrolytic lesions of the perirhinal cortex (and possibly, therefore, other brain regions) need to be considered with regard to these findings.

Perirhinal and parahippocampal cortices of the macaque monkey: cytoarchitectonic and chemoarchitectonic organization

Findings from recent tract-tracing studies examining the cortical and subcortical connectivity of the medial temporal lobe showed that the pattern of connections of areas TH and TF of the parahippocampal cortex were consistent with previous boundary demarcations of this region. In contrast, the connections of the perirhinal cortex (areas 35 and 36) indicated that the border of area 36 should be placed several millimeters more lateral than in earlier descriptions in the literature. The connections of this region also suggested that the perirhinal cortex extends rostrodorsally to include the medial portion of what is typically referred to as the temporal pole (areas TG, 38, or Pro). To determine if cyto- and chemoarchitectonic characteristics are consistent with the boundary scheme suggested by our tract-tracing studies, we carried out a detailed analysis of Nissl- and SMI-32-stained material throughout the perirhinal and parahippocampal cortices of the macaque monkey. The staining patterns seen in both these preparations are in excellent agreement with the boundaries defined by earlier connectional studies. Based on these studies, we recognize areas 35 and area 36 of the perirhinal cortex and area 36 contains five subdivisions. The parahippocampal cortex is composed of areas TH and TF and area TF contains two subdivisions. For both the perirhinal and parahippocampal cortices, we provide descriptions of the cytoarchitectonic and chemoarchitectonic features that are most useful for defining each cortical subdivision, as well as the features most useful for defining the boundaries with adjacent cortical regions. We discuss these findings in the context of the results of previous tract-tracing studies.

Input and output stations of the entorhinal cortex: superficial vs. deep layers or lateral vs. medial divisions?

Based on the results of recent electrophysiological and anatomical studies, we argue that the classical division of the entorhinal cortex (EC) into a superficial layer input station and deep layer output station is no longer tenable. We point out that the anatomical data suggest that the medial and lateral divisions of EC are separate, and recent studies of the propagation of signals originating in the lateral olfactory tract and perirhinal cortex to the EC [J. Neurophysiol. 83 (2000) 1924-1931; Biella and de Curtis, 2000) indicate that the lateral division is the input station, and the medial division the output station for information processed in the hippocampus and subiculum.

Perirhinal cortex lesions produce variable patterns of retrograde amnesia in rats

Two experiments examined the contribution of the perirhinal cortex (PRh) to retrograde memory for the location of a platform in a water maze. In a previous study, we found that electrolytic lesions of the PRh produced retrograde amnesia, without a temporal gradient, for water-maze problems acquired 4 weeks and 2 days before surgery [Behav. Brain. Res. 114 (2000) 119]. In Experiment 1, we used the same mixed design as in our previous report (time of learning was a within-subjects factor), but PRh lesions were made by aspiration. Contrary to our earlier report, these PRh rats displayed good retention of both platform locations. Combined, these findings indicate that the lesion method may contribute importantly to the pattern of deficits observed. Experiment 2 was conducted similar to Experiment 1, except that a completely between-subjects design was used (time of learning was a between-subjects factor). Rats that received PRh lesions approximately 2 days after the last training session displayed impaired retention of the platform's location, whereas rats that received PRh lesions 4 weeks after training did not. This finding of a temporally graded retrograde amnesia is consistent with our earlier report, and further suggests that the involvement of the PRh in the retention of water-maze problems is time-limited. However, also consistent with our earlier report, the PRh-lesioned rats in Experiment 2 that displayed a retention deficit rapidly reacquired the task. This finding, combined with the negative findings in Experiment 1, suggests that the contribution of the PRh to retrograde memory for platform locations is subtle and may not be due to impaired spatial memory abilities. Additionally, the conflicting results of Experiments 1 and 2 underscore the importance of the design employed in studies of retrograde amnesia in animals.

Unilateral hippocampal and inferotemporal cortex lesions in opposite hemispheres impair learning of single-pair visual discriminations as well as visuovisual conditional tasks in monkeys

Monkeys with unilateral ablations of the inferotemporal (IT) cortex were not impaired on learning or retention of single-pair object discriminations or visuovisual conditional tasks. Addition of an excitotoxic hippocampal lesion to the hemisphere opposite to the IT ablation impaired retention and acquisition of single-pair object discriminations and visuovisual conditional tasks. Histology revealed no areas of bilaterally symmetrical damage. Previous experiments have shown that bilateral excitotoxic hippocampal lesions do not impair single-pair object discriminations although they do produce a substantial impairment on visuovisual conditional tasks. Bilateral IT ablations produce impairment on single-pair object discrimination tasks. It is argued that the hippocampus in the hemisphere with the IT ablation is deprived of feed-forward visual input and that this, in addition to the contralateral hippocampal lesion, accounts for the impairment on the visuovisual conditional tasks. It is also argued that feed-back projections from the hippocampus to the IT cortex influence the learning of single-pair object discriminations. This influence may be difficult to demonstrate by the addition of hippocampal lesions to IT lesions because of the substantial effect of the IT lesion alone. It may be difficult to demonstrate by bilateral hippocampal lesions alone since the effect may be below that which generates an observable impairment. Nonetheless, an effect may be seen when a hippocampal lesion is made in monkeys with some IT damage, as in this experiment, as well as by the general observation that large lesions of the temporal lobes produce larger perceptuo-mnemonic impairments than lesions confined to the hippocampus or temporal neocortex in monkeys and man.

Multiple routes to memory: distinct medial temporal lobe processes build item and source memories

A central function of memory is to permit an organism to distinguish between stimuli that have been previously encountered and those that are novel. Although the medial temporal lobe (which includes the hippocampus and surrounding perirhinal, parahippocampal, and entorhinal cortices) is known to be crucial for recognition memory, controversy remains regarding how the specific subregions within the medial temporal lobe contribute to recognition. We used event-related functional MRI to examine the relation between activation in distinct medial temporal lobe subregions during memory formation and the ability (i) to later recognize an item as previously encountered (item recognition) and (ii) to later recollect specific contextual details about the prior encounter (source recollection). Encoding activation in hippocampus and in posterior parahippocampal cortex predicted later source recollection, but was uncorrelated with item recognition. In contrast, encoding activation in perirhinal cortex predicted later item recognition, but not subsequent source recollection. These outcomes suggest that the subregions within the medial temporal lobe subserve distinct, but complementary, learning mechanisms.

Distribution of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate-type glutamate receptor subunits (GluR2/3) along the ventral visual pathway in the monkey

By using immunohistochemical methods, we examined the distribution of cells expressing subunits of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA)-selective glutamate receptors (GluR2/3) in the cortical areas of the occipitotemporal pathway in monkeys. GluR2/3-immunoreactive (-ir) cells were primarily pyramidal cells; this category, however, also included large stellate cells in layer IVB of the striate cortex (V1) and fusiform cells in layer VI of all the areas examined. GluR2/3 immunoreactivity differed among the areas in laminar distribution and intensity. In V1, GluR2/3-ir cells were identified mainly in layers II, III, IVB, and VI. The prestriate areas V2 and V4 and the inferior temporal areas TEO and TE contained GluR2/3-ir cells in layers II, III, and VI. In the TE, GluR2/3-ir cells were also abundant in layer V. In area 36 of the perirhinal cortex, neurons in layers II, III, V, and VI were labeled in a similar manner to the TE labeling, but with greater staining intensity and numbers, especially in layer V. Thus, GluR2/3 immunoreactivity increased rostrally along the pathway. Within V1 and V2, cells strongly stained for GluR2/3 formed clusters that colocalized with cytochrome oxidase (CO)-rich regions. These distinct laminar and regional distribution patterns of GluR2/3 expression may contribute to the specific physiological properties of neurons within various visual areas and compartments.

Distribution of perihippocampo-hippocampal projection neurons in the lesser hedgehog tenrec

The entorhinal cortex in the Madagascan lesser hedgehog tenrec is thought to be part of the three-layered subrhinal paleocortex (PCx) but cyto- and chemoarchitectural studies have failed so far to identify the area. To reach this goal tracer injections were made into the tenrec's hippocampus. Retrogradely labeled cells were found in dorsal portion of the posterior PCx, the adjacent rhinal cortex (RCx) and the so-called area XCx. The main paleocortical portion in the ventral PCx, however, remained unlabeled with the exception of a caudal region possibly equivalent to the amygdalo-piriform transition area. The labeled neurons showed a bilaminar distribution with the cells in the layer 2A giving rise to fibers to predominantly the dentate area and the cells in the layer 3A mainly projecting to the cornu ammonis and the subiculum. The latter regions, in addition, gave rise to a feedback projection to the layer 3B of especially the caudal RCx and the XCx. The analysis of the terminal projections, however, was hampered by the fact, that under certain conditions retrogradely transported biotinylated dextran was also transported in anterograde direction via collaterals of the entorhino-dentate fibers. The findings are compared with equivalent regions in more differentiated mammals particularly with regard to the perirhinal area showing little if any connections with the dentate gyrus.

Brain glucose hypometabolism after perirhinal lesions in baboons: implications for Alzheimer disease and aging

The authors previously reported that excitotoxic lesions of both the perirhinal and entorhinal cortices in baboons induce remote neocortical and hippocampal hypometabolism reminiscent of that observed in Alzheimer disease (AD), suggesting that disconnection may play a role in AD. Because the cerebral metabolic rate of glucose (CMR ) was preferentially correlated with perirhinal damage, the area first affected by neurofibrillary tangles in both AD and normal aging, the present series of experiments aimed at assessing the specific metabolic effects of perirhinal lesions. Using PET, CMR was measured before surgery and sequentially over the ensuing 10 months. Compared with sham-operated baboons, perirhinal lesions induced significant-albeit late and transient-CMR decreases in several brain regions, which significantly correlated with histologic damage for some of these regions. Among them, the temporal and hippocampal regions are metabolically affected after extensive rhinal lesions, in early AD, and aging, while the prefrontal region is affected in aging only. Furthermore, in contrast to AD and rhinal lesions, the posterior cingulate cortex was spared. Both the progressive but significant metabolic effects and specific hypometabolic pattern after perirhinal lesions were confirmed by direct comparisons with previous data obtained after combined lesions of both rhinal areas. Thus, although perirhinal damage appears in itself insufficient to induce sustained CMR decreases, it may contribute to the hypometabolic profile of both AD and normal aging, most likely with a stronger contribution in the latter.