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Neuropathology and Cognitive Impairment in Alzheimer Disease: A Complex but Coherent Relationship
Open accessAbstract
Amyloid plaques and neurofibrillary tangles (NFTs) are the pathological hallmarks of Alzheimer disease (AD). There is controversy regarding the use of current diagnostic criteria for AD and whether amyloid plaques and NFTs contribute to cognitive impairment. Because AD is specific to humans, rigorous and comprehensiveclinicopathologic studies are necessary to test and refine hypotheses of AD diagnosis and pathogenesis. Neither the clinical nor the pathological aspects of AD evolve in a linear manner, but thepredictable sequence of AD pathology allows for stage-based correlations with cognitive deterioration. We discuss subsets of patients with clinical dementia who lack amyloid plaques and NFTs and, conversely, whether individuals without antemortem cognitive impairment can harbor severe AD-type pathological findings at autopsy. There are many medical, technical, and anatomical challenges to clinicopathologic studies in AD. For example, at least two thirds of persons older than 80 years have non-AD brain diseases that can effect on cognitive function. We argue that existing data strongly support the hypothesis that both amyloid plaques and NFTs contribute to cognitive impairment.
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“leading to dysfunction and loss of synapses and eventual neuronal death1,2.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“AD is characterized by an accumulation of senile plaques (SP) [composed mostly of fibrillary amyloid beta-peptide (Aβ) and dystrophic neurites] and neurofibrillary tangles (NFT) [composed of hyperphosphorylated tau protein] in the brain”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [1]
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“Clinically, AD is characterized by several features, notably a progressive cognitive decline involving loss of memory and higher executive functioning1.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [1]
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“It is expected that many persons die with brains that exhibit AD neuropathologic change in the preclinical phase of AD; indeed, data support the modeled expectations (44, 142).”
From Correlation of Alzheimer Disease Neuropathologic Changes With Cognitive Status: A Review of the Literature (2012) · cites this paper as [142]
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In the citing paper
“Evaluation of AD status was conducted by the AD Center Neuropathology and Clinical Cores using guidelines set forth by the National Institute on Aging Reagan Institute that included evaluation of neurofibrillary tangles and neuritic senile plaques [36–38].”
From Predominant expression of Alzheimer’s disease-associated BIN1 in mature oligodendrocytes and localization to white matter tracts (2016) · cites this paper as [37]
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In the citing paper
“Indeed, the first pathological insults to neurons in AD and aMCI occur at pre- and post-synaptic membranes1,3.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [1]
Experimental — accuracy not yet measuredIn the citing paper
“Indeed, this is precisely the observation reported by one of the largest autopsy series to date (142) and is well supported by AD biomarker studies (143-145).”
From Correlation of Alzheimer Disease Neuropathologic Changes With Cognitive Status: A Review of the Literature (2012) · cites this paper as [142]
In the citing paper
“It is important to emphasize that, among thousands of cases from dozens of CPC studies worldwide, there never has been a report of a thoroughly documented individual with truly “end-stage” neocortical NFT pathology who lacked antemortem cognitive impairment proximal to death (142, 151).”
From Correlation of Alzheimer Disease Neuropathologic Changes With Cognitive Status: A Review of the Literature (2012) · cites this paper as [142]
In the citing paper
“In a review of 11 different studies comprising 555 subjects without dementia, a total of 12 brains were assessed as Braak stage V (2.2%); 3 were assessed as Braak stage VI (0.5%) (142).”
From Correlation of Alzheimer Disease Neuropathologic Changes With Cognitive Status: A Review of the Literature (2012) · cites this paper as [142]
In the citing paper
“However, not all Braak stage VI brains were the same; there was significant variation in NFT burden in these cases (142, 151).”
From Correlation of Alzheimer Disease Neuropathologic Changes With Cognitive Status: A Review of the Literature (2012) · cites this paper as [142]
In the citing paper
“In a review of 11 different studies comprising 555 subjects without dementia, a total of 12 brains were assessed as Braak stage V (2.2%); 3 were assessed as Braak stage VI (0.5%) (142).”
From Correlation of Alzheimer Disease Neuropathologic Changes With Cognitive Status: A Review of the Literature (2012) · cites this paper as [142]
In the citing paper
“There have been many clinicopathological studies that have correlated amyloid plaques with cognitive deficits in AD, with an emerging picture that the strongest correlation exists in the earliest stages of the disease and this association greatly weakens as NFTs and neocortical degeneration become more widespread [9, 102, 103, 157, 160, 169].”
From Alzheimer's disease: experimental models and reality (2017) · cites this paper as [103]
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Metadata
- Authors
- Nelson, P. T., Braak, H., & Markesbery, W. R.
- Affiliations
- University of Kentucky HealthCare (US)
- University of Kentucky (US)
- Corresponding author
- Nelson, Peter T.
- Venue
- Journal of Neuropathology & Experimental Neurology
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-01
- Volume
- 68
- Issue
- 1
- Pages
- 1-14
- ISSN
- 0022-3069 (ISSN-L)
- 1554-6578
- PMC
- PMC2692822
- OpenAlex
- W1985747467
- Cited by
- 643
- References
- 155
- Citations by year
- 2026: 21 · 2025: 43 · 2024: 48 · 2023: 46 · 2022: 33 · 2021: 45 · 2020: 44 · 2019: 33 · 2018: 32 · 2017: 32 · 2016: 37 · 2015: 32 · 2014: 35 · 2013: 42 · 2012: 41
- FWCI
- 2.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neuropathology & Experimental Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- National Institutes of Health (AG028 383)
- National Institute on Aging (P30AG028383)
- National Institute of Neurological Disorders and Stroke (R01NS061933, K08NS050110)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
- Keywords
- Alzheimer's disease, amyloid plaques, neurofibrillary tangles, cognitive impairment, clinicopathological correlation, Alzheimer's disease diagnosis, Alzheimer disease pathogenesis, autopsy findings
- MeSH terms
- Alzheimer Disease, Cognition Disorders, Humans, Neurofibrillary Tangles, Plaque, Amyloid
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