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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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Bathini, P., Mottas, A., Jaquet, M., Brai, E., & Alberi, L. A. (2018) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2018.12.006 · Cited by 52
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“Neuropathological studies have shown the hippocampus to be one of the first brain regions affected in AD (13), and there is extensive evidence that the hippocampus is critically involved in spatial memory, with the demonstration in rodents of spatially related firing activity of hippocampal neurons “place cells” (14)…”
BackgroundCytoskeletal mechanisms of neuronal degeneration
Brandt, R. (2001) · Cell and Tissue Research · doi:10.1007/s004410000334 · Cited by 52
Neuroimaging in aging and neurologic diseases
Risacher, S. L., & Saykin, A. J. (2019) · Handbook of clinical neurology · doi:10.1016/b978-0-12-804766-8.00012-1 · Cited by 56
“similar to the pattern reported by Braak and Braak (Braak et al., 1993).”
BackgroundResultInfluentialAdult neurogenesis in Alzheimer's disease
Choi, S. H., & Tanzi, R. E. (2023) · Hippocampus · doi:10.1002/hipo.23504 · Cited by 54
“Adult hippocampal neurogenesis (AHN) is a process of generating new neurons from adult neural progenitor cells (NPCs) in the dentate gyrus of the hippocampus, which is one of the first brain regions to be affected in AD patients (Braak et al., 1993), throughout life.”
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“We also examined some biomarkers of AD in the hippocampus of APP/PS1 Tg mice, which is a neurogenesis area in the mammalian brain (Braak et al., 1993).”
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Cortical and Subcortical Atrophy in Alzheimer Disease
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“Importantly, the lateral portion of the origin of the perforant path in the entorhinal cortex is among the earliest sites of dysfunction in Alzheimer’s disease with neurofibrillary tangles forming in that region prior to hippocampus and other cortical areas (Braak et al., 1993, 2006).”
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Olfactory impairment increases as a function of age in persons with Down syndrome
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From Cognitive Science to Dementia Assessment
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BackgroundChronic Traumatic Encephalopathy Within an Amyotrophic Lateral Sclerosis Brain Bank Cohort
Walt, G. S., Burris, H. M., Brady, C. B., Spencer, K. R., Alvarez, V. E., Huber, B. R., Guilderson, L., Abdul Rauf, N., Collins, D., Singh, T., et al. (2018) · Journal of Neuropathology & Experimental Neurology · doi:10.1093/jnen/nly092 · Cited by 45
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Mechanistic roles for altered O-GlcNAcylation in neurodegenerative disorders
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“Braak and Braak neurofibrillary tangle and senile plaque staging was provided as part of the standard neuropathology process [5–7].”
MethodCallosal Atrophy Correlates with Temporal Lobe Volume and Mental Status in Alzheimer's Disease
Black, S. E., Moffat, S. D., Yu, D. C., Parker, J. L., Stanchev, P. L., & Bronskill, M. J. (2000) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/s0317167100000846 · Cited by 44
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Neurobiological Models of Aging in the Dog and Other Vertebrate Species
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Lilja, A. M., Röjdner, J., Mustafiz, T., Thomé, C. M., Storelli, E., Gonzalez, D., Lithner, C. U., Greig, N. H., Nordberg, A. K., & Marutle, A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0058752 · Cited by 44
“The majority of these studies report compromised neurogenesis [60], [61], [62], but others have described increased neurogenesis [63], [64].”
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Regional Pattern of Dementia and Prevalence of Hearing Impairment in Germany
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Norditerpenoid alkaloids of Delphinium denudatum as cholinesterase inhibitors
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A platelet protein biochip rapidly detects an Alzheimer’s disease-specific phenotype
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“Classic neuropathological characteristics of AD are accumulations of beta-amyloid (Aβ) plaques and neurofibrillary tangles in cortical brain regions [8, 11].”
BackgroundMeta-analysis of expression and function of neprilysin in Alzheimer’s disease
Zhang, H., Liu, D., Wang, Y., Huang, H., Zhao, Y., & Zhou, H. (2017) · Neuroscience Letters · doi:10.1016/j.neulet.2017.07.060 · Cited by 41
Temperature and toxic Tau in Alzheimer's disease: new insights
Carrettiero, D. C., Santiago, F. E., Motzko-Soares, A. C. P., & Almeida, M. C. (2015) · Temperature · doi:10.1080/23328940.2015.1096438 · Cited by 41
Sokolow, S., Luu, S. H., Headley, A. J., Hanson, A. Y., Kim, T., Miller, C. A., Vinters, H. V., & Gylys, K. H. (2011) · Cell Calcium · doi:10.1016/j.ceca.2010.12.008 · Cited by 41
“Histopathological staging of AD was performed according to Braak’s classification [32].”
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“The main aim for most of the existing therapeutic strategies is to enhance the function of deficient cholinergic system either by using cholinergic agonists or by employing inhibitors of acetylcholinesterase (AChE) [1,3–10].”
BackgroundInfluentialHippocampal Subregions are Differentially Affected in the Progression to Alzheimer's Disease
Greene, S. J., Killiany, R., & Initiative, T. A. D. N. (2011) · The Anatomical Record · doi:10.1002/ar.21493 · Cited by 40
“The hippocampus is one of the earliest regions in the brain for neurofibrillary tangle (NT) development in AD (Braak and Braak, 1991; Braak et al., 1993), and such pathology has also been found in non-demented individuals at the time of death, (Ulrich, 1985; Price et al., 1991; Bouras et al., 1993,…”
BackgroundDysregulation and Diagnostic Potential of microRNA in Alzheimer’s Disease
Pan, Y., Liu, R., Terpstra, E., Wang, Y., Qiao, F., Wang, J., Tong, Y., & Pan, B. (2015) · Journal of Alzheimer's Disease · doi:10.3233/jad-150451 · Cited by 29
Improved Learning and Memory in Aged Mice Deficient in Amyloid β-Degrading Neutral Endopeptidase
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“Temporal cortices from a 75-year-old female Alzheimer patient (stage VI/C according to Braakk and Braak [48] and from a male 31-year-old patient (stage I-0-0) were used in this study.”
MethodDie Alzheimer‐Demenz: von der Pathologie zu therapeutischen Ansätzen
Jakob‐Roetne, R., & Jacobsen, H. (2009) · Angewandte Chemie · doi:10.1002/ange.200802808 · Cited by 41
APOE is a correlate of phenotypic heterogeneity in Alzheimer disease in a national cohort
Weıntraub, S., Teylan, M., Rader, B. M., Chan, K. C. G., Bollenbeck, M., Kukull, W. A., Coventry, C., Rogalski, E. J., Bigio, E. H., & Mesulam, M. M. (2019) · Neurology · doi:10.1212/wnl.0000000000008666 · Cited by 40
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“The neuropathological alterations that take place in the patients with AD selectively affect vital regions, which involved in the medial pain pathway, particularly the medial nuclei of the hypothalamus, cingulate, insula, and thalamus, while the brain regions involved in the lateral pain pathway are comparatively well…”
BackgroundSteroid Sulfation in Neurodegenerative Diseases
Vítků, J., Hill, M., Kolátorová, L., Havrdová, E., & Kancheva, R. L. (2022) · Frontiers in Molecular Biosciences · doi:10.3389/fmolb.2022.839887 · Cited by 42
“Therefore, steroid sulfation may influence processes in the hippocampus (one of the earliest sites affected in AD (Braak et al., 1993; Mu and Gage, 2011)) by multiple mechanisms, including an alteration of the cholinergic and serotoninergic signaling (Trent et al.”
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“As mentioned previously, Ab typically is deposited early in the prefrontal cortex of both dogs (Head et al. 2000) and humans (Braak and Braak 1997).”
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“The hallmarks of AD include cognitive deficits, amyloid plaques, neurofibrillary tangles, and neuronal loss (Braak et al., 1993).”
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“Canines and humans display beta-amyloid (Aβ)-containing lesions with identical amino acid sequence [8, 9] and similar region specific progression of Aβ accumulation [1, 2, 8, 10–16].”
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“Thus, in typical AD, neurofibrillary tangle pathology starts from the enthorinal/perirhinal cortices and then reaches field 1 of the CA (CA1), subicular region, second and third CA fields (CA2, 3) and finally the neocortex [4].”
Decline in verbal memory in non-demented older adults
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“One of the earliest sites of neurofibrillary tangle deposition is the entorhinal cortex, adjacent to the anterior hippocampus [Braak et al., 1993; Frank o and Joly, 2013].”
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“EC plays an essential role in cognition and memory and it is among the earliest brain regions affected by AD-related pathology (Braak et al., 1993).”
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Can insulin signaling pathways be targeted to transport Aβ out of the brain?
Vandal, M., Bourassa, P., & Calon, F. (2015) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2015.00114 · Cited by 37
“Deposition of Aβ peptides into neuritic plaques is still instrumental in the neuropathological diagnosis of AD (Braak et al., 1993; Selkoe, 2001; Cummings, 2004), but whether it plays a causal role in the progressive dementia, which characterizes AD clinically, remains uncertain (Karran et al.”
Walsh, C., Drinkenburg, W. H. I. M., & Ahnaou, A. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.12.020 · Cited by 37
“…seems to originate from a single focal area in the brain and progress in a relatively stereotypical manner to anatomically connected areas (Braak and Del Tredici, 2011), amyloid pathology first develops diffusely in the basal temporal neocortex and spreads throughout the adjacent cortical…”
InfluentialSone, D., Imabayashi, E., Maikusa, N., Okamura, N., Furumoto, S., Kudo, Y., Ogawa, M., Takano, H., Yokoi, Y., Sakata, M., et al. (2017) · Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring · doi:10.1016/j.dadm.2017.07.001 · Cited by 38
“According to the hallmark AD pathologic theory [14,15], NFTs, which consist of intraneuronal aggregates of tau, first target the ERC and PRC, damaging the perforant pathway to the hippocampus.”
BackgroundMueller, K. D., Koscik, R. L., Du, L., Bruno, D., Jonaitis, E. M., Koscik, A. Z., Christian, B. T., Betthauser, T. J., Chin, N. A., Hermann, B. P., et al. (2020) · Cortex · doi:10.1016/j.cortex.2020.07.008 · Cited by 38
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“Neurons of the hippocampus are particularly vulnerable to amyloid deposition during the early course of AD (Braak et al., 1993, Gomez-Isla et al., 1996, West et al., 1994).”
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The Role of Insulin Signaling in Hippocampal-Related Diseases: A Focus on Alzheimer’s Disease
Liu, Q., Wang, Z., Cao, J., Dong, Y., & Chen, Y. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms232214417 · Cited by 42
Age-related changes in tau and autophagy in human brain in the absence of neurodegeneration
Chatterjee, S., Sealey, M. A., Ruiz, E., Pegasiou, C. M., Brookes, K. J., Green, S., Crisford, A., Duque-Vasquez, M., Luckett, E. S., Robertson, R., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0262792 · Cited by 37
MR spectroscopy in Alzheimer’s disease: gender differences in probabilistic learning capacity
Colla, M., Ende, G., Bohrer, M., Deuschle, M., Kronenberg, G., Henn, F. A., & Heuser, I. (2003) · Neurobiology of Aging · doi:10.1016/s0197-4580(02)00189-6 · Cited by 35
“The degeneration of specific brain regions within the medial temporal lobe memory system and profound declarative memory impairment is a defining feature of AD [1,7,8].”
BackgroundMemory functions and rCBF 99mTc-HMPAO SPET: developing diagnostics in Alzheimer's disease
Elgh, E., Sundström, T., Näsman, B., Åhlström, K., & Nyberg, L. H. (2002) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-002-0829-y · Cited by 35
“The primary and association visual regions are affected relatively late in AD [40, 41 , 42, 43] and therefore BA 17 in the occipital lobe was chosen as a control region where no rCBF changes were expected in the mildly affected AD patients.”
BackgroundApolipoprotein E and Alzheimer's disease: a genetic, molecular and neuroimaging review.
Swartz, R. H., Black, S. E., & George‐Hyslop, P. S. (1999) · PubMed · Cited by 35
Shastri, D., Raj, V., & Lee, S.-K. (2024) · Ageing Research Reviews · doi:10.1016/j.arr.2024.102379 · Cited by 34
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“Previous work pointed out that HP plays essential roles in episodic memory formation [40, 41], and it is susceptible to the AD-related pathologies, especially the NFTs [9, 42–44].”
Asymmetry of Hippocampal Tau Pathology in Primary Age-Related Tauopathy and Alzheimer Disease
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The influence of sex on limbic volume and perfusion in AD
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“Lack of estrogen has been found to decrease synaptogenesis following damage to the entorhinal cortex [16,47], which is one of the first brain regions damaged in AD [5].”
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“The hippocampus is involved in learning and memory and is the earliest affected site in AD (Braak et al. 1993).”
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PKA Phosphorylations on Tau: Developmental Studies in the Mouse
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Neuronal activity drives IGF2 expression from pericytes to form long-term memory
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Neocortex and Allocortex Respond Differentially to Cellular Stress In Vitro and Aging In Vivo
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“By the time of diagnosis of the late-stage syndromal AD dementia, statistically significant atrophy is usually found throughout wide neocortical and subcortical regions with a relative sparing of primary sensory and motor cortices [4].”
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“particularly affected and this is associated with deficits in cognition/memory (Braak et al., 1993).”
Smith, M., Esiri, M. M., Barnetson, L. P. D., King, E., & Nagy, Z. (2001) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000051270 · Cited by 33
Spatial patterns of the tau pathology in progressive supranuclear palsy
Armstrong, R. A., & Cairns, N. J. (2012) · Neurological Sciences · doi:10.1007/s10072-012-1006-0 · Cited by 33
“In addition, with two exceptions (Cases C and F), cases represented Braak tangle stages I or II [30].”
Background
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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