Douglas A. Price

Hippocampal synaptic loss in early Alzheimer's disease and mild cognitive impairment

One of the major neuropathological findings in the brains of individuals with Alzheimers disease (AD) is a loss of synaptic contacts in both the neocortex and hippocampus. Here we report, for the first time, an estimate of the total number of synapses in the outer molecular layer (OML) of the human dentate gyrus, in individuals with early Alzheimers disease (eAD), mild cognitive impairment (MCI), or no cognitive impairment (NCI). An unbiased stereologic sampling scheme coupled with transmission electron microscopy to directly visualize synaptic contacts, was used to estimate the total number of synapses in short postmortem autopsy tissue. Individuals with eAD had significantly fewer synapses than the other two diagnostic groups. Seventy-five percent of the individuals with MCI had synaptic values that were lower than the NCI group mean. The number of synapses showed a significant correlation with the subjects Mini-Mental State score and with cognitive tests involving delayed recall. Synaptic loss showed no relationship to Braak stage or to apoE genotype. The volume of the OML was significantly reduced in eAD compared to the other two diagnositic groups that were not different from each other. These data suggest that a loss of afferents from the entorhinal cortex underlie the synapse loss seen in eAD. This study supports the concept that synapse loss is an early event in the disease process and suggests that MCI may be a transition stage between eAD and NCI with synaptic loss a structural correlate involved in cognitive decline.

Quantitative assessment of cortical synaptic density in Alzheimer's disease

Significant progress has been made over the last decade in delineating the neuropathological and neurochemical changes in the brains of patients with Alzheimers disease (AD). Less well studied are the actual synaptic connections of affected areas of the brain, such as the cerebral cortex. Because the final common pathway for neurotransmission involves synaptic integrity, we quantitatively assessed synaptic number and synapse size in lamina III and V of human frontal cortex (Brodmann area 9) in patients with AD and age-matched controls. Samples were also matched for postmortem interval, and artifacts associated with postmortem change were eliminated. We found a significant decrease in synaptic number per unit volume in both lamina, more marked in lamina III (-42%) than V (-29%). In both normal controls and AD brains, there was a negative correlation between synapse number and synapse size as indexed by the length of the postsynaptic density (PSD); cortical samples with fewer synapses had larger synapse size. This appeared to be a compensatory response, rather than a selective loss of small synapses, since the total amount of synaptic contact area per unit volume did not decline in lamina V (despite a 29% loss of synapses); in lamina III it was reduced 11% despite a 42% loss of synapses. The loss of synapses in AD is widespread and significant in frontal cortex; there is observable compensation by enlargement of synaptic size. This compensatory effort is overcome by the continuing loss of synapses in areas most affected by the degeneration.

Synaptic pathology in Alzheimer’s disease: a review of ultrastructural studies

Morphologic studies of the neuropathology in Alzheimers disease (AD) have demonstrated significant loss of synaptic connectivity in many regions of the neocortex and hippocampus. The strongest correlation with cognitive decline in AD is with the synaptic density. This article discusses the ultrastructural studies that have documented changes in synaptic numbers in many areas of association cortex and in the hippocampal dentate gyrus molecular layer. Changes in the synaptic complex are discussed as a possible compensatory mechanism in response to synapse loss and a model is proposed to help relate the significance of these synaptic changes. Comparisons are made between results observed with ultrastructural technique and those utilizing immunohistochemistry to assess changes in synaptic pathology. Possible reasons underlying the synaptic neuropathology are discussed.

Alzheimer's disease-related alterations in synaptic density: Neocortex and hippocampus

Alzheimers disease (AD) is a progressive disorder that is characterized by the accumulation of neuropathologic lesions and neurochemical alterations. Ultrastructural investigations in many association regions of the neocortex and the hippocampal dentate gyrus have demonstrated a disease-related decline in numerical synaptic density. This decline in brain connectivity occurs early in the disease process and strongly correlates with the cognitive decline observed in AD. The synapse loss does not appear to be an inevitable consequence of the aging process. This article reviews the ultrastructural studies assessing AD-related synaptic loss and the possible compensatory changes in the synaptic complex that occur as a result of the loss in brain connectivity.

Synaptic loss in the inferior temporal gyrus in mild cognitive impairment and Alzheimer's disease.

Alzheimers disease (AD) is a slowly progressing form of dementia characterized in its earliest stages as a loss of memory. Individuals with amnestic mild cognitive impairment (aMCI) may be in the earliest stages of the disease and represent an opportunity to identify pathological changes related to the progression of AD. Synaptic loss is one of the hallmarks of AD and associated with cognitive impairment. The inferior temporal gyrus plays an important role in verbal fluency, a cognitive function affected early in the onset of AD. Unbiased stereology coupled with electron microscopy was used to quantify total synaptic numbers in lamina 3 of the inferior temporal gyrus from short postmortem autopsy tissue harvested from subjects who died at different cognitive stages during the progression of AD. Individuals with aMCI had significantly fewer synapses (36%) compared to individuals with no cognitive impairment. Individuals with AD showed a loss of synapses very similar to the aMCI cohort. Synaptic numbers correlated highly with Mini Mental State Examination scores and a test of category verbal fluency. These results demonstrate that the inferior temporal gyrus is affected during the prodromal stage of the disease and may underlie some of the early AD-related clinical dysfunctions.

Synaptic Density in the Inner Molecular Layer of the Hippocampal Dentate Gyrus in Alzheimer Disease

We examined the inner molecular layer (IML) of the hippocampal dentate gyrus for possible changes in synaptic density. Material was obtained from 9 individuals with Alzheimer disease (AD) and compared to samples obtained from 10 age-matched, postmortem-matched neurologically normal controls, employing standard ultrastructural techniques. Statistical analyses demonstrated a significant decline in synaptic numbers between controls and AD subjects. This decline was accompanied by a significant increase in apposition length and resulted in a significant correlation with the synaptic density. As the number of synapses declined, the apposition length increased. Assessment was also made of the granule cells density and the analyses showed a significant decline in the synapse to granule cell ratio in the AD group. This decline in the density of synaptic contacts in the IML reflects a more widespread decline in plasticity in AD and may be related to the memory problems associated with the disease.

Quantitative assessment of possible age-related change in synaptic numbers in the human frontal cortex

To investigate possible age-associated changes in human synaptic connectivity, superior-middle frontal cortex (Brodmann area 9) was evaluated with ultrastructural techniques. Short post mortem autopsy tissue was obtained from 37 cognitive normal individuals ranging in age from 20 to 89 years. A minimum of five subjects represented each decade of life. Synaptic volume density (Nv) was quantified in lamina III and V of the superior-middle frontal cortex employing the physical disector. The stereological assessment demonstrated maintenance of Nv in both lamina III and V of the frontal cortex. The lack of synaptic decline in the frontal cortex in neurologically normal individuals older than 65 years lends support to the idea that many stereotypic views of age-related changes in the CNS do not apply to all brain regions. It also suggests that synaptic loss observed in pathological conditions such as Alzheimers disease, may be the result of the disease process and not a consequence of normal aging.

Alzheimer's disease-related synapse loss in the cingulate cortex

Synapse loss is considered a profound neuropathology associated with Alzheimers disease (AD). This AD-related change in connectivity can be demonstrated in many regions of the neocortex. The posterior cingulate cortex has been identified as an area involved early in the disease process but has not been well studied. The anterior cingulate cortex, which is morphologically distinct from the posterior cingulate, is also involved in AD. The present study employed ultrastructural techniques to assess synaptic numbers in these two regions of association cortex. Both cingulate areas demonstrated a significant loss in lamina III in AD, while only the posterior cingulate manifested a loss in lamina V. The failure to find a significant change in lamina V of the anterior cingulate may be related to its connectivity with the motor system. The heterogeneity of synaptic change in this cortical region may reflect important information concerning corticocortico connectivity changes in AD.

Synaptic Change in the Posterior Cingulate Gyrus in the Progression of Alzheimer's Disease

Mild cognitive impairment (MCI) is considered to be an early stage in the progression of Alzheimers disease (AD) providing an opportunity to investigate brain pathogenesis prior to the onset of dementia. Neuroimaging studies have identified the posterior cingulate gyrus (PostC) as a cortical region affected early in the onset of AD. This association cortex is involved in a variety of different cognitive tasks and is intimately connected with the hippocampal/entorhinal cortex region, a component of the medial temporal memory circuit that displays early AD pathology. We quantified the total number of synapses in lamina 3 of the PostC using unbiased stereology coupled with electron microscopy from short postmortem autopsy tissue harvested from cases at different stage of AD progression. Individuals in the early stages of AD showed a significant decline in synaptic numbers compared to individuals with no cognitive impairment (NCI). Subjects with MCI exhibited synaptic numbers that were between the AD and NCI cohorts. Adjacent tissue was evaluated for changes in both pre and postsynaptic proteins levels. Individuals with MCI demonstrated a significant loss in presynaptic markers synapsin-1 and synaptophysin and postsynaptic markers PSD-95 and SAP-97. Levels of [3H]PiB binding was significantly increased in MCI and AD and correlated strongly with levels of synaptic proteins. All synaptic markers showed a significant association with Mini-Mental Status Examination scores. These results support the idea that the PostC synaptic function is affected during the prodromal stage of the disease and may underlie some of the early clinical sequelae associated with AD.

Synapse Stability in the Precuneus Early in the Progression of Alzheimer's Disease

Amnestic mild cognitive impairment (aMCI) is considered to be one of the early stages in the progression from no cognitive impairment (NCI) to Alzheimers disease (AD). Individuals with aMCI have increased levels of AD-type neuropathology in multiple regions of the neocortex and hippocampus and demonstrate a loss of synaptic connectivity. Recent neuroimaging studies have reported increased levels of 11C-PiB (Pittsburgh, compound B) in regions of the neocortex including the precuneus region of the medial parietal lobe. This cortical region has been implicated in episodic memory, which is disrupted early in the progression of AD. In this study, unbiased stereology coupled with electron microscopy was used to quantify total synaptic numbers in lamina 3 of the precuneus from short postmortem autopsy tissue harvested from subjects who died at different cognitive stages during the progression of AD. Individuals with aMCI did not reveal a statistically significant decline in total synapses compared to the NCI cohort while the AD group did show a modest but significant decline. Synaptic numbers failed to correlate with several different cognitive tasks including the Mini-Mental State Examination scores and episodic memory scores. Although levels of [3H]PiB binding were elevated in both the aMCI and AD groups, it did not strongly correlate with synaptic counts. These results support the idea that despite increased amyloid load, the precuneus region does not show early changes in synaptic decline during the progression of AD.