The Progression of Alzheimer’s Disease from Limbic Regions to the Neocortex: Clinical, Radiological and Pathological Relationships

• Published in: Dementia and geriatric cognitive disorders Vol. 10; no. 2; pp. 115 - 120
• Main Authors: Nagy, Zs, Hindley, N.J., Braak, H., Braak, E., Yilmazer-Hanke, D.M., Schultz, C., Barnetson, L., King, E.M.-F., Jobst, K.A., Smith, A.D.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.03.1999; S. Karger AG
• Subjects: Aged; Alzheimer Disease - diagnostic imaging; Alzheimer Disease - pathology; Alzheimer Disease - psychology; Biological and medical sciences; Cognition; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disease Progression; Female; Humans; Limbic System - diagnostic imaging; Limbic System - pathology; Male; Medical sciences; Memory; Neocortex - diagnostic imaging; Neocortex - pathology; Neurofibrillary Tangles - pathology; Neurology; Neuropsychological Tests; Original Research Article; Prospective Studies; Severity of Illness Index; Temporal Lobe - pathology; Tomography, X-Ray Computed; CT; CAMDEX; Pathological stages; Alzheimer's disease; Medial temporal lobe; Human; Temporal lobe; Nervous system diseases; Radiodiagnosis; Alzheimer disease; Cognition; Limbic system; Cerebral disorder; Clinical stage; Central nervous system disease; Medical imagery; Evolution; Degenerative disease; Computerized axial tomography
• ISSN: 1420-8008; 1421-9824
• DOI: 10.1159/000017111

Alzheimer’s disease (AD) is characterised by the gradual accumulation of neurofibrillary pathology in selected regions of the brain. Earlier studies indicate that the accumulation of neurofibrillary tangles is associated both with decline in patient’s cognitive performance as well as with medial temporal lobe atrophy on CT scans. There are also indications that progression through the pathological stages of AD is associated with decline in cognitive functions. The results of this study indicate that progression of disease, especially beyond the boundaries of the limbic regions, is associated with marked decline in the cognitive performance of patients suffering from AD. However the clinical manifestations of early pathological stages are not so well defined. We also found that the atrophy of the medial temporal lobe on CT scans is related to the progression of pathology. Atrophy is most apparent when the disease reaches its isocortical stages and is not marked in the limbic stages of the disease. The additive effect of pathologies co-existing with AD is apparent in reduced cognitive scores, while the atrophy of limbic structures, as measured on CT scans, seems to be mainly attributable to AD-related pathology.