Chapter 29 Neuropathological changes in Alzheimer disease

Publisher Summary Alzheimer's disease (AD) is principally a disorder of the elderly, its pathology is additive to that of normal aging. Therefore, neuron loss is less in the old Alzheimer's patients than it is in the younger ones. Similarly, the concentration of plaques and tangles in the older AD patients is less than in the younger ones. One might infer from these findings that there is a threshold of brain damage which must be reached in order that the patient display significant cognitive loss. Older patients need less additional pathology to reach this threshold than do younger individuals. A greater reserve of neurons and synapses is probably protective. The classical, diagnostic lesions of AD—the plaque and tangle—do not account satisfactorily for the clinical symptoms of global dementia. Other recently found factors are clearly of great significance. The neuronal and synaptic loss may well be related to abnormalities of the plasma membrane, and thus gangliosides and phospholipids are strongly implicated.

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