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Staging of Alzheimer-Related Cortical Destruction
Abstract
The gradual intraneuronal accumulation of an insoluble fibrous material which partly consists of abnormally phosphorylated tau protein (neurofibrillary change) represents an important neuropathological hallmark of Alzheimer’s disease. Neurofibrillary tangles and neuropil threads formed from this material develop in only a few types of cortical pyramidal cells. The first changes are seen in the entorhinal cortex. The destructive process then spreads into the hippocampal formation and eventually encroaches upon the isocortex. This sequence of events permits the distinction of six stages with a progressive increase in the severity of cortical destruction. The entorhinal region serves as an important interface between the isocortex and hippocampus. This interface function is markedly impaired due to the early deterioration of the entorhinal cortex. Severe entorhinal involvement is considered to represent the morphological counterpart of clinically incipient Alzheimer’s disease. Similar changes are found in mentally impaired individuals suffering from Parkinson’s disease or progressive supranuclear palsy.
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“On the basis of the review of an enormous sample of cross-sectional autopsy data, the pattern of NFT development across the clinical spectrum of disease has been integrated in Braak neuropathologic staging (60, 298, 299).”
From Correlation of Alzheimer Disease Neuropathologic Changes With Cognitive Status: A Review of the Literature (2012) · cites this paper as [299]
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Judith Miklossy, A., Mackenzie, I. R., Dorovini‐Zis, K., Calne, D. B., Wszołek, Z. K., Klegeris, A., & McGeer, P. L. (2005) · Acta Neuropathologica · doi:10.1007/s00401-005-1007-7 · Cited by 74
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Vulnerability of the Hippocampus to Insults: Links to Blood–Brain Barrier Dysfunction
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“The entorhinal cortex [215] and the adjacent hippocampal structures [211] are clearly implicated in AD.”
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Sorl1 as an Alzheimer’s Disease Predisposition Gene?
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Characterization of Memory Profile in Subjects with Amnestic Mild Cognitive Impairment
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Interaction of neurons and astrocytes underlies the mechanism of Aβ-induced neurotoxicity
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“Diminished recall accuracy, impaired problem-solving and cognition emerge when neocortical regions are affected.(17,20,21) By the time treatment starts, the disease has already progressed due to late diagnosis.”
Plagman, A. K., Hoscheidt, S. M., McLimans, K. E., Klinedinst, B. S., Pappas, C. A., Anantharam, V., Kanthasamy, A. G., & Willette, A. A. (2019) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2019.01.002 · Cited by 70
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Early Selective Vulnerability of the CA2 Hippocampal Subfield in Primary Age-Related Tauopathy
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BackgroundArrestins and two receptor kinases are upregulated in Parkinson's disease with dementia
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Serial brain MRI at 3–6 month intervals as a surrogate marker for Alzheimer's disease
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Pathological Aging of the Brain
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BackgroundClinical Validity of Aß-Protein Deposition Staging in Brain Aging and Alzheimer Disease
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“1991) and had Braak stages of 4–6 (Braak et al. 1993), while controls had no history of cognitive impairment or neurological/psychiatric disorder.”
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Wirth, M., Oh, H., Mormino, E. C., Markley, C., Landau, S. M., & Jagust, W. J. (2013) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2012.10.012 · Cited by 70
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“According to the Braak staging of AD, hyperphosphory-lated Tau spreads from the transentorhinal cortex (stages I-II), to the limbic allocortex and adjacent neocortex (stages III-IV) and finally to the neocortex affecting primary and secondary areas [3].”
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“In the process of AD, the hippocampus is the main region damaged in the brain and is one of the earliest areas to be affected, and the pathological changes are particularly evident there (Braak et al., 1993; Ikonomovic et al., 2008).”
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“Indeed, the latter themselves are closely linked to amnesia (Aggleton 2008) and early pathology in AD (Braak et al. 1993; Thal et al. 2002).”
Early Onset Alzheimer’s Disease and Oxidative Stress
Meraz‐Ríos, M. A., Franco-Bocanegra, D., Toral-Ríos, D., & Campos‐Peña, V. (2014) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2014/375968 · Cited by 65
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“A possible interpretation is that these are neocortical regions associated with amyloid deposition and early FDG hypometabolism in AD [60], [61], [62], [63], [64], [65].”
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“For example, the highly influential Braak and Braak model for staging of AD neuropathology (Braak et al. 1993) could be tested using longitudinal, in-vivo data to address progression of changes in region-specific medial temporal and neocortical brain measures, how they relate to CSF Aβ and tau, and how they correspond…”
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“As AD progresses, it greatly compromises the cerebral cortex and eventually induces global brain deterioration (Braak et al. 1993; Schliebs 2005).”
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“This appears to be different from the early involvement of hippocampus in AD patients [43].”
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“We were unable to directly assess CA1, a hippocampal region affected early on in AD [11], but found marked interneuron loss in CA3 and CA4 in our ISH analysis.”
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“Prion-like mechanisms in PMDs A well-known but only recently revisited feature of several neurodegenerative diseases is a characteristic spread of disease pathology during disease progression (Braak et al., 1993; Braak et al., 2002; Brundin et al., 2010).”
BackgroundSearch for Alzheimer's Disease Biomarkers in Blood Cells: Hypotheses-Driven Approach
Wojsiat, J., Laskowska-Kaszub, K., Mietelska‐Porowska, A., & Wojda, U. (2017) · Biomarkers in Medicine · doi:10.2217/bmm-2017-0041 · Cited by 61
The contribution of the study of neurodegenerative disorders to the understanding of human memory
Panegyres, P. K. (2004) · QJM · doi:10.1093/qjmed/hch096 · Cited by 60
“This finding correlated with pathological involvement of the MTLs as found by Braack and Braack.11,12 These findings, confirmed by magnetic resonance imaging (MRI), showed that in early AD, impaired verbal and episodic memory correlates with a reduced volume of the hippocampal formation and entorhinal cortex, which ma…”
ResultAlzheimer's disease presenting as corticobasal syndrome
Chand, P., Grafman, J. H., Dickson, D. W., Ishizawa, K., & Litvan, I. (2006) · Movement Disorders · doi:10.1002/mds.21055 · Cited by 60
“Wechsler Adult Intelligence Scale-Revised Score (Percentile) Full Scale IQ 96 (40) 80 (9) Untestable Verbal IQ 113 (81) 94 (34) 76 (5) Information 11 7 Digit Span 5 2 Vocabulary 11 9 Arithmetic 5 2 Comprehension 12 10 Similarities 10 7 Performance IQ 78 (7) 61 (1) Untestable Picture Completion 4 Picture Arrangement 2…”
MethodComparison of symptomatic and asymptomatic persons with primary age-related tauopathy
Besser, L. M., Crary, J. F., Mock, C., & Kukull, W. A. (2017) · Neurology · doi:10.1212/wnl.0000000000004521 · Cited by 59
“In AD, cross-sectional autopsy studies suggest that NFTs develop in the medial temporal lobe early and then progress to neocortical regions.(4) Occasional NFTs in the medial temporal lobe are ubiquitous in brain aging, and some patients with dementia without amyloid plaques, tau mutations, or other classifiable tauopa…”
BackgroundSynaptic β-amyloid precursor proteins increase with learning capacity in rats
Huber, G., Bailly, Y. J. R., Martin, J. R., Mariani, J., & Brugg, B. (1997) · Neuroscience · doi:10.1016/s0306-4522(97)00120-6 · Cited by 59
In vivo Quantification of Brain Volumes in Subcortical Vascular Dementia and Alzheimer’s Disease
Pantel, J., Schröder, J., Essig, M., Jauß, M., Schneider, G., Eysenbach, K., von Kummer, R., Baudendistel, K. T., Schad, L. R., & Knopp, M. V. (1998) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000017082 · Cited by 59
Sensory evoked and event related oscillations in Alzheimer’s disease: a short review
Yener, G., & Başar, E. (2010) · Cognitive Neurodynamics · doi:10.1007/s11571-010-9138-5 · Cited by 57
Chronic traumatic encephalopathy and other neurodegenerative proteinopathies
Tartaglia, M. C., Hazrati, L., Davis, K. D., Green, R., Wennberg, R. A., Mikulis, D. J., Ezerins, L., Keightley, M., & Tator, C. H. (2014) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2014.00030 · Cited by 64
A 2-process model for neuropathology of Alzheimer's disease
Mungas, D., Tractenberg, R., Schneider, J. A., Crane, P. K., & Bennett, D. A. (2014) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2013.08.007 · Cited by 58
“This is the fundamental observation underlying the wellestablished Braak & Braak staging of AD (Braak & Braak, 1991; Braak et al., 1993), and is consistent with the identification of two factors accounting for neurofibrillary tangles in this study.”
Daulatzai, M. A. (2013) · Neurotoxicity Research · doi:10.1007/s12640-013-9407-2 · Cited by 56
“The memory impairment in AD is consistent with an early damage to the hippocampus (Braak et al. 1993).”
BackgroundIn vivo proton magnetic resonance spectroscopy of the temporal lobe in Alzheimer's disease
Frederick, B. B., Lyoo, I. K., Satlin, A., Ahn, K. H., Kim, M. J., Yurgelun-Todd, D. A., Cohen, B. M., & Renshaw, P. F. (2004) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2004.08.013 · Cited by 56
Learning and memory as a function of age in Down syndrome: A study using animal-based tasks
Nelson, L. D., Johnson, J. K., Freedman, M., Lott, I. T., Groot, J., Chang, M., Milgram, N. W., & Head, E. (2005) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2004.12.009 · Cited by 56
Scopa, C., Barnada, S. M., Cicardi, M. E., Singer, M., Trotti, D., & Trizzino, M. (2023) · Nature Communications · doi:10.1038/s41467-023-43728-8 · Cited by 64
Michalski, B., Corrada, M. M., Kawas, C. H., & Fahnestock, M. L. (2015) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2015.08.022 · Cited by 57
“Despite a relatively well-documented association between the amount of AD-type neuropathology and the severity of cognitive impairment (Arriagada et al., 1992; Bennett et al., 2004; Berg et al., 1998; Braak et al., 1993; Gold et al., 2000; Nagy et al., 1995), there is a lack of agreement regarding the contribution of…”
BackgroundMiklossy, J., Taddei, K., Suvà, D., Verdile, G., Fonte, J., Fisher, C., Gnjec, A., Ghika, J. A., Suard, F., Mehta, P. D., et al. (2003) · Neurobiology of Aging · doi:10.1016/s0197-4580(02)00192-6 · Cited by 56
Armstrong, R. A., Ellis, W. G., Hamilton, R. L., Mackenzie, I. R., Hedreen, J. C., Gearing, M., Montine, T. J., Vonsattel, J., Head, E., Lieberman, A. P., et al. (2009) · Journal of Neural Transmission · doi:10.1007/s00702-009-0350-6 · Cited by 55
“Braak stage of the cases was based on the density and distribution of NFT (Braak et al. 1993).”
Linking Hippocampal Structure and Function to Memory Performance in an Aging Population
Reitz, C., Brickman, A. M., Brown, T. R., Manly, J. J., DeCarli, C. S., Small, S. A., & Mayeux, R. P. (2009) · Archives of Neurology · doi:10.1001/archneurol.2009.214 · Cited by 55
“Pathologic studies of brains from patients with AD show the earliest and greatest neurodegenerative changes in the entorhinal cortex,(8,9) which then spread to the hippocampus.(10) In accord with these findings, structural magnetic resonance imaging (MRI) studies have consistently shown atrophy of the hippocampal form…”
Johnson, S. A., Turner, S. M., Santacroce, L. A., Carty, K. N., Shafiq, L., Bizon, J. L., Maurer, A. P., & Burke, S. N. (2017) · Hippocampus · doi:10.1002/hipo.22729 · Cited by 49
Role of Liver X Receptor in AD Pathophysiology
Sandoval-Hernández, A. G., Buitrago, L., Moreno, H., Cardona‐Gómez, G. P., & Arboleda, G. (2015) · PLoS ONE · doi:10.1371/journal.pone.0145467 · Cited by 57
“The hippocampal formation, one of the brain areas involved in learning and memory, is the earliest affected structure in AD [3].”
BackgroundLi, A., & King, J. A. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.05.005 · Cited by 62
Kjelvik, G., Sando, S. B., Aasly, J. O., Engedal, K., & White, L. R. (2007) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1783 · Cited by 53
“It is suggested that the degenerative process in AD characterised by plaque and neurofibrillary tangles starts in the entorhinal cortex, and then proceeds to other temporal lobe structures, including hippocampus (Braak et al., 1993; Pearson, 1996; Attems et al., 2005).”
Mesial temporal lobe measurements on magnetic resonance imaging scans
Honeycutt, N. A., Smith, P. D., Aylward, E., Li, Q., Chan, M. D., Barta, P. E., & Pearlson, G. D. (1998) · Psychiatry Research Neuroimaging · doi:10.1016/s0925-4927(98)00035-3 · Cited by 54
Thompson, T. A. C., Wilson, P. H., Snyder, P. J., Pietrzak, R. H., Darby, D., Maruff, P. T., & Herman Buschke, L. (2011) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acr039 · Cited by 55
Crary, J. F. (2016) · Journal of Neurology and Neuromedicine · doi:10.29245/2572.942x/2016/6.1059 · Cited by 55
Zinc Transporter mRNA Levels in Alzheimer's Disease Postmortem Brain
Beyer, N., Coulson, D. T. R., Heggarty, S., Ravid, R., Hellemans, J., Irvine, G. B., & Johnston, J. A. (2012) · Journal of Alzheimer s Disease · doi:10.3233/jad-2012-112105 · Cited by 55
“staged [49] postmortem brain tissue from individuals”
Metadata
- Authors
- Braak, H., Braak, E., & Bohl, J.
- Affiliations
- Goethe University Frankfurt (DE)
- ORCID
- Braak, Heiko
- Venue
- European Neurology
- Publisher
- S. Karger AG
- Published
- 2008-02-12
- Volume
- 33
- Issue
- 6
- Pages
- 403-408
- ISSN
- 0014-3022 (ISSN-L)
- 1421-9913
- OpenAlex
- W2095422335
- Cited by
- 836
- References
- 0
- Citations by year
- 2026: 15 · 2025: 27 · 2024: 29 · 2023: 34 · 2022: 38 · 2021: 32 · 2020: 35 · 2019: 33 · 2018: 30 · 2017: 40 · 2016: 35 · 2015: 47 · 2014: 36 · 2013: 39 · 2012: 35
- FWCI
- 29.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Neurology (publishedVersion)
- PubMed (publishedVersion)
- 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, cortical destruction, neurofibrillary tangles, tau protein, neuropil threads, entorhinal cortex, hippocampal formation, neocortex, disease staging, cortical pyramidal neurons, Parkinson's disease, progressive supranuclear palsy, neuropathology
- MeSH terms
- Aged, Alzheimer Disease, Brain Mapping, Cerebral Cortex, Dementia, Diagnosis, Differential, Hippocampus, Humans, Limbic System, Parkinson Disease, Supranuclear Palsy, Progressive, Neurites, Neurofibrillary Tangles
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