Neurotransmitter deficits in Alzheimer's disease: criteria for significance

Longitudinal study on oral health in subjects with Alzheimer's disease

OBJECTIVE

To examine longitudinal oral health changes in unmedicated, generally healthy subjects with Alzheimer's disease (AD) and compare them to age- and gender-matched healthy, unmedicated control subjects.

DESIGN

Oral health parameters were evaluated over 2 to 3 years and the results compared between subjects with AD and controls.

SETTING

Clinical Center of the National Institutes of Health, Bethesda, Maryland.

PARTICIPANTS

Twenty-one community-dwelling subjects with a clinical diagnosis of AD and 21 age- and gender-matched control subjects. Neither population was being treated for any other systemic condition nor taking any prescription medications.

MEASUREMENTS

Unstimulated and stimulated major salivary gland flow rates were measured, and gingival, periodontal, dental, and oral mucosal tissues assessed.

MAIN RESULTS

In general, subjects with AD demonstrated decreased salivary flow rates and diminished oral health, but most longitudinal changes in oral health status were not significantly different than controls.

CONCLUSIONS

Patients with AD are susceptible to a variety of oral health problems, and progression of AD can lead to a deterioration in oral health and function. These patients require aggressive preventive care to maintain function for as long as possible, which necessitates close cooperation among numerous health care professionals.

Molecular and cellular biology of Alzheimer amyloid

Alzheimer's Disease (AD), a disorder of unknown etiology, is the most common form of adult-onset dementia and is characterized by severe intellectual deterioration. The definitive diagnosis of AD is made by postmortem examination of the brain, which reveals large quantities of neurofibrillary tangles (NFT) and senile plaques within the parenchyma. The NFT are composed of paired helical filaments associated with several cytoskeletal proteins. The primary protein component of senile plaques is beta/A4 amyloid, a 42-43 amino acid peptide derived from a much larger molecule, the amyloid precursor protein (APP). Vascular beta/A4 amyloidosis is also prevalent in the disease. The mechanism by which beta/A4 amyloid accumulates in the AD brain is unknown. Recent research has demonstrated that the precursor molecule, APP, is a transmembrane protein with a large extracytoplasmic domain, a membrane spanning region that includes the portion that gives rise to beta/A4 amyloid, and a short intracytoplasmic domain. The precursor has multiple forms among which are those that differ by a variable length insert within the extracytoplasmic domain. The insert has sequence homology to the family of Kunitz protease inhibitor proteins. Cellular and animal models have been developed to study the nature of APP processing and the biological and behavioral consequences of beta/A4 amyloidosis. The results of such studies indicate that the normal processing of APP involves enzymatic cleavage of the molecule within the beta/A4 amyloid region, thus preventing the accumulation of beta/A4 in the normal brain. The factors leading to abnormal processing of APP, and consequent beta/A4 amyloid accumulation within the AD brain, have yet to be identified. In cell culture, the biological effects associated with beta/A4 amyloid include neurotrophic and neurotoxic activities, while the peptide has also been shown to have dramatic behavioral effects in animal models.

Endocrine responses to growth hormone releasing hormone and corticotropin releasing hormone in early-onset Alzheimer's disease

In a study of the hypothalamic-pituitary-somatotropic (HPS) and the hypothalamic-pituitary-adrenal (HPA) systems in early-onset Alzheimer's disease (AD), 10 drug-naive patients and matched controls were given 50 micrograms growth hormone releasing hormone (GHRH) at 9 a.m. and 100 micrograms corticotropin releasing hormone (CRH) at 6 p.m. as an i.v. bolus dose. Compared with controls, patients with AD showed attenuated GHRH-induced growth hormone (GH) responses and decreased adrenocorticotropic hormone (ACTH) but normal cortisol secretion following CRH. GH responses to GHRH were negatively correlated with the plasma insulin-like growth factor (IGF-I) concentrations and the severity of dementia. A positive correlation was found between GHRH-evoked GH release and ACTH responses to CRH. The results suggest a pathological process at the level of the pituitary or the hypothalamus, possibly involving a cholinergic, monoaminergic, or peptidergic imbalance in AD, and support the view that altered HPS and HPA secretory dynamics in AD are related to the underlying brain dysfunction.