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Cited by 102Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchNeuroinflammation and Neurodegeneration Mechanisms

Basal forebrain cholinergic system in the dementias: Vulnerability, resilience, and resistance

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Geula, Changiz, Dunlop, Sara R., Ayala, Ivan, Kawles, Allegra S., Flanagan, Margaret E., Gefen, Tamar, Mesulam, Marek‐Marsel·2021·Journal of Neurochemistry
DOI 10.1111/jnc.15471PMC PMC8458251
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Abstract

The basal forebrain cholinergic neurons (BFCN) provide the primary source of cholinergic innervation of the human cerebral cortex. They are involved in the cognitive processes of learning, memory, and attention. These neurons are differentially vulnerable in various neuropathologic entities that cause dementia. This review summarizes the relevance to BFCN of neuropathologic markers associated with dementias, including the plaques and tangles of Alzheimer's disease (AD), the Lewy bodies of diffuse Lewy body disease, the tauopathy of frontotemporal lobar degeneration (FTLD‐TAU) and the TDP‐43 proteinopathy of FTLD‐TDP. Each of these proteinopathies has a different relationship to BFCN and their corticofugal axons. Available evidence points to early and substantial degeneration of the BFCN in AD and diffuse Lewy body disease. In AD, the major neurodegenerative correlate is accumulation of phosphotau in neurofibrillary tangles. However, these neurons are less vulnerable to the tauopathy of FTLD. An intriguing finding is that the intracellular tau of AD causes destruction of the BFCN, whereas that of FTLD does not. This observation has profound implications for exploring the impact of different species of tauopathy on neuronal survival. The proteinopathy of FTLD‐TDP shows virtually no abnormal inclusions within the BFCN. Thus, the BFCN are highly vulnerable to the neurodegenerative effects of tauopathy in AD, resilient to the neurodegenerative effect of tauopathy in FTLD and apparently resistant to the emergence of proteinopathy in FTLD‐TDP and perhaps also in Pick's disease. Investigations are beginning to shed light on the potential mechanisms of this differential vulnerability and their implications for therapeutic intervention. image

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  • Selective vulnerability of basal forebrain cholinergic neurons is often attributed to deficiency of NGF, which normally sustains them.

    “This selective vulnerability is often attributed to a deficiency of nerve growth factor (NGF), which normally sustains basal forebrain cholinergic neurons.”

    From Toward a Unified Framework in Molecular Neurobiology of Alzheimer’s Disease: Revisiting the Pathophysiological Hypotheses (2026) · cites this paper as [97]

    Section 5 says Ch1–Ch4 neurons depend on NGF for survival and considers NGF deficiency a conceivable cause of selective vulnerability. It does not say this explanation is often invoked; it also reports no loss or an increase in cortical and hippocampal NGF in AD, consistent with defective transport instead. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Loss of trophic support combined with metabolic and proteostatic stressors renders basal forebrain cholinergic neurons especially susceptible to degeneration in AD.

    “Loss of trophic support, combined with metabolic and proteostatic stressors, renders these neurons especially susceptible to degeneration in AD [97].”

    From Toward a Unified Framework in Molecular Neurobiology of Alzheimer’s Disease: Revisiting the Pathophysiological Hypotheses (2026) · cites this paper as [97]

    Section 5, “Selective Vulnerability of Basal Forebrain Cholinergic System” (page unavailable), says disrupted retrograde NGF transport is likely to contribute to cholinergic neuron loss in AD. It also links neurofibrillary tangles to degeneration, but the cited passages do not establish metabolic stress or characterize the pathology as proteostatic stress acting in combination with lost trophic support. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • In AD, the cholinergic system is disrupted at multiple levels: ChAT activity is markedly reduced impairing ACh synthesis; Aβ toxicity disrupts nutrient balance and vesicular storage/release; and alterations in receptor signaling compromise cholinergic neurotransmission.

    “In AD, this finely tuned system is disrupted at multiple levels, such as (i) ChAT activity is markedly reduced, impairing ACh synthesis; (ii) Aβ toxicity disrupts nutrient balance and interferes with vesicular storage and release; and (iii) alterations in receptor signaling further compromise cholinergic neurotransmission [97].”

    From Toward a Unified Framework in Molecular Neurobiology of Alzheimer’s Disease: Revisiting the Pathophysiological Hypotheses (2026) · cites this paper as [97]

    Split into 3 atoms — 1 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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Authors
Geula, C., Dunlop, S. R., Ayala, I., Kawles, A. S., Flanagan, M. E., Gefen, T., & Mesulam, M.
Affiliations
  • Northwestern University (US)
  • Mesulam Center for Cognitive Neurology and Alzheimer’s Disease Feinberg School of Medicine Chicago Northwestern University Chicago Illinois USA
Corresponding author
Geula, Changiz
ORCID
Venue
Journal of Neurochemistry
Publisher
Wiley
Published
2021-08-06
Volume
158
Issue
6
Pages
1394-1411
ISSN
  • 0022-3042 (ISSN-L)
  • 1471-4159
DOI
10.1111/jnc.15471
PMC
PMC8458251
OpenAlex
W3179818940
Cited by
102
References
9
Citations by year
2026: 25 · 2025: 21 · 2024: 26 · 2023: 12 · 2022: 15 · 2021: 3
FWCI
1.85
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Neurochemistry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Neurological Disorders and Stroke (NS085770)
  • National Institute on Deafness and Other Communication Disorders (DC008552)
  • National Institute on Aging (AG013854, AG062566, AG065463)
Topics
  • Health Sciences › Medicine › Physiology › 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
basal forebrain cholinergic neurons, dementia, Alzheimer's disease, dementia with Lewy bodies, frontotemporal lobar degeneration, FTLD-tau, FTLD-TDP, Pick's disease, tauopathy, TDP-43 proteinopathy, neurofibrillary tangles, Lewy bodies, corticofugal axons, neuronal vulnerability, neuronal resilience
MeSH terms
Alzheimer Disease, Animals, Choline O-Acetyltransferase, Dementia, Disease Susceptibility, Humans, Nerve Degeneration, Receptors, Cholinergic, Lewy Body Disease, Tauopathies, Resilience, Psychological, Frontotemporal Lobar Degeneration, Cholinergic Neurons, Basal Forebrain

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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