Calcium Hypothesis of Alzheimer's disease and brain aging: A framework for integrating new evidence into a comprehensive theory of pathogenesis

This article updates the Calcium Hypothesis of Alzheimer's disease and brain aging on the basis of emerging evidence since 1994 (The present article, with the subtitle “New evidence for a central role of Ca2+ in neurodegeneration,” includes three appendices that provide context and further explanations for the rationale for the revisions in the updated hypothesis—the three appendices are as follows: Appendix I “Emerging concepts on potential pathogenic roles of [Ca2+],” Appendix II “Future studies to validate the central role of dysregulated [Ca2+] in neurodegeneration,” and Appendix III “Epilogue: towards a comprehensive hypothesis.”) (Marx J. Fresh evidence points to an old suspect: calcium. Science 2007; 318:384–385). The aim is not only to re‐evaluate the original key claims of the hypothesis with a critical eye but also to identify gaps in knowledge required to validate relevant claims and delineate additional studies and/or data that are needed. Some of the key challenges for this effort included examination of questions regarding (1) the temporal and spatial relationships of molecular mechanisms that regulate neuronal calcium ion (Ca2+), (2) the role of changes in concentration of calcium ion [Ca2+] in various subcellular compartments of neurons, (3) how alterations in Ca2+ signaling affect the performance of neurons under various conditions, ranging from optimal functioning in a healthy state to conditions of decline and deterioration in performance during aging and in disease, and (4) new ideas about the contributions of aging, genetic, and environmental factors to the causal relationships between dysregulation of [Ca2+] and the functioning of neurons (see Appendices I and II). The updated Calcium Hypothesis also includes revised postulates that are intended to promote further crucial experiments to confirm or reject the various predictions of the hypothesis (see Appendix III).