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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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MethodWhen the Amnestic Mild Cognitive Impairment Disappears
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BackgroundSpatial gene expression analysis of neuroanatomical differences in mouse models
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Feng, L., Watanabe, H., Molino, P. J., Wallace, G. G., Phung, S. L., Uchihashi, T., & Higgins, M. J. (2019) · Journal of Molecular Biology · doi:10.1016/j.jmb.2019.04.044 · Cited by 21
Patel, V. R., Liu, M., Worsham, C. M., & Jena, A. B. (2024) · BMJ · doi:10.1136/bmj-2024-082194 · Cited by 21
Vanherle, L., Lidington, D., Uhl, F. E., Steiner, S., Vassallo, S., Skoug, C., Duarte, J. M. N., Ramu, S., Uller, L., Desjardins, J., et al. (2022) · EBioMedicine · doi:10.1016/j.ebiom.2022.104384 · Cited by 20
Degeneration in Nucleus basalis of Meynert signals earliest stage of Alzheimer’s disease progression
Shafiee, N., Fonov, V., Dadar, M., Spreng, R. N., & Collins, D. L. (2024) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2024.03.003 · Cited by 21
“Widely accepted models suggest that Alzheimer ’ s degeneration starts in the entorhinal cortices and then spreads through the temporoparietal cortex (Braak, Braak, and Bohl, 1993).”
A note on testing hypotheses for stationary processes in the frequency domain
Holger Dette, A., & Hildebrandt, T. (2011) · Journal of Multivariate Analysis · doi:10.1016/j.jmva.2011.07.002 · Cited by 19
Functional Connectivity of the Hippocampus in Early- and vs. Late-Onset Alzheimer's Disease
Park, K. H., Noh, Y., Choi, E.-J., Kim, H., Chun, S., & Son, Y. (2017) · Journal of Clinical Neurology · doi:10.3988/jcn.2017.13.4.387 · Cited by 20
Molecular and Clinical Aspects of Protein Aggregation Assays in Neurodegenerative Diseases
Villar‐Piqué, A., Schmitz, M., Candelise, N., Ventura, S., Llorens, F., & Zerr, I. (2018) · Molecular Neurobiology · doi:10.1007/s12035-018-0926-y · Cited by 22
“orated the Braak’s hypothesis of disease staging, where the appearance of pathological lesions in the brain follows a diseasespecific temporal and regional pattern [8, 9].”
BackgroundThe Potential Roles of Ghrelin in Metabolic Syndrome and Secondary Symptoms of Alzheimer’s Disease
Kim, S., Nam, Y., Shin, S. J., Park, Y., Jeon, S. G., Kim, J.-I., Kim, M., & Moon, M. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.583097 · Cited by 20
Haubold, A., Peterson, B. S., & Bansal, R. (2012) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2012.02539.x · Cited by 20
Evidence for the involvement of TNF and NF-?B in hippocampal synaptic plasticity
Albensi, B. C., & Mattson, M. P. (2000) · Synapse · doi:10.1002/(sici)1098-2396(200002)35:2 · Cited by 527
Neuropathology of the Brainstem to Mechanistically Understand and to Treat Alzheimer’s Disease
Patthy, Á., Murai, J., Hanics, J., Pintér, A., Zahola, P., Hökfelt, T. G. M., Harkany, T., & Alpár, A. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10081555 · Cited by 17
“This said, pioneering studies found that cognitive loss parallels histopathological signs: the accumulation of β-amyloid (Aβ) (1–40) and (1–42) extracellularly [1] and neurofibrillary tangles (NFTs) composed of hyperphosphorylated tau intracellularly [2], allowing cortical staging of the pathological process [3].”
BackgroundAl‐Onaizi, M., Thériault, P., Lecordier, S., Préfontaine, P., Rivest, S., & ElAli, A. (2021) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2021.07.016 · Cited by 20
Modeling recall memory for emotional objects in Alzheimer's disease
Sundstrøm, M. (2011) · Aging Neuropsychology and Cognition · doi:10.1080/13825585.2011.567324 · Cited by 19
Pfeffer, A., Munder, T., Schreyer, S., Klein, C., Rasińska, J., Winter, Y., & Steiner, B. (2018) · Behavioural Brain Research · doi:10.1016/j.bbr.2018.03.030 · Cited by 20
Hubs of long‐distance co‐alteration characterize brain pathology
Cauda, F., Mancuso, L., Nani, A., Ficco, L., Premi, E., Manuello, J., Liloia, D., Gelmini, G., Duca, S., & Costa, T. (2020) · Human Brain Mapping · doi:10.1002/hbm.25093 · Cited by 17
“…the hippocampus may be the pathological epicenter, as well as with the observation that the left hemisphere is more affected than the right one (Braak, Braak, & Bohl, 1993; Buckner, 2005; Janke et al., 2001; Loewenstein et al., 1989; Manuello et al., 2018; Pievani, de Haan, Wu, Seeley, &…”
Stevenson, A. J., McCartney, D. L., Shireby, G. L., Hillary, R. F., King, D., Tzioras, M., Wrobel, N., McCafferty, S., Murphy, L., McColl, B. W., et al. (2022) · European Journal of Neuroscience · doi:10.1111/ejn.15661 · Cited by 20
“Age378 related decline in hippocampal volume is well established (38) and it is one of the earliest, and most 379 profoundly, affected regions in Alzheimer’s disease, suffering insidious synapse loss and neuronal 380 cell death culminating in a substantial atrophy as the disease progresses (39).”
BackgroundJiang, M. H., Vanan, S., Tu, H., Zhang, W., Zhang, Z.-W., Chia, S., Jang, S. E., Zeng, X., Yu, W., Xu, J., et al. (2020) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2020.07.031 · Cited by 19
Automated Measurement of Hippocampal Atrophy Using Fluid-Registered Serial MRI in AD and Controls
Barnes, J., Lewis, E. B., Scahill, R. I., Bartlett, J. W., Frost, C. D., Schott, J. M., Rossor, M. N., & Fox, N. C. (2007) · Journal of Computer Assisted Tomography · doi:10.1097/rct.0b013e31802f4139 · Cited by 19
Kelliny, S., Zhou, X., & Bobrovskaya, L. (2025) · Journal of Neuroscience Research · doi:10.1002/jnr.70046 · Cited by 27
“Alzheimer's disease (AD) is a severe neurodegenerative disorder characterized by gradual and progressive deficits in more than one domain of cognition, including learning and memory, attention, language, and deterioration of social skills (Braak et al. 1993).”
Immunogenomics Parameters for Patient Stratification in Alzheimer’s Disease
Huda, T. I., Diaz, M. J., Gozlan, E. C., Chobrutskiy, A., Chobrutskiy, B. I., & Blanck, G. (2022) · Journal of Alzheimer s Disease · doi:10.3233/jad-220119 · Cited by 18
“Thesestagesprogressfrom0,transentorhinal(I-II), limbic(III-IV),andendwithisocorticalstages(V-VI) [11].”
Amato, L. G., Vergani, A. A., Lassi, M., Fabbiani, C., Mazzeo, S., Burali, R., Nacmias, B., Sorbi, S., Mannella, R., Grippo, A., et al. (2024) · Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring · doi:10.1002/dad2.12526 · Cited by 17
Therapeutic Interventions Targeting Beta Amyloid Pathogenesis in an Aging Dog Model
Martin, S. B., Dowling, A. L. S., & Head, E. (2011) · Current Neuropharmacology · doi:10.2174/157015911798376217 · Cited by 19
“AD is characterized by the presence of senile plaques and neurofibrillary tangles (NFTs) in the brain [1-3].”
BackgroundMaurer, A. P., Burke, S. N., Diba, K., & Barnes, C. A. (2017) · Journal of Neuroscience · doi:10.1523/jneurosci.0531-17.2017 · Cited by 16
“Moreover, this structure is one of the first brain areas to undergo pathological alterations in preclinical Alzheimer’s disease (Braak and Braak, 1991; Braak et al., 1993; Khan et al., 2014; Hirni et al., 2016; Krumm et al., 2016).”
BackgroundLim, S., Tran, D. N., Zumkehr, J., Chen, C., Ghiaar, S., Kieu, Z., Villanueva, E., Gallup, V., Rodríguez‐Ortiz, C. J., & Kitazawa, M. (2018) · Glia · doi:10.1002/glia.23522 · Cited by 20
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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