Selective Vulnerability of the Nucleus Basalis of Meynert Among Neuropathologic Subtypes of Alzheimer Disease

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Abstract

Key Points Question Does the objective classification of neuropathologic subtypes of Alzheimer disease underlie variability in the accumulation of neurofibrillary tangles and loss of neurons in the nucleus basalis of Meynert? Findings This cross-sectional study of 1464 human brains found the fewest neurons in the nucleus basalis of Meynert in hippocampal sparing Alzheimer disease and greater accumulation of neurofibrillary tangle pathology, twice that observed in limbic predominant Alzheimer disease. Younger age at onset of cognitive symptoms was associated with greater accumulation of neurofibrillary tangles in hippocampal sparing and typical but not limbic predominant Alzheimer disease. Meaning These results help to characterize differential involvement of the nucleus basalis of Meynert among neuropathologic Alzheimer disease subtypes, which may contribute to the differential benefit of acetylcholinesterase inhibitor treatment, especially in patients with young-onset Alzheimer disease.

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National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease: a practical approach.

Thomas J Montine, Creighton H Phelps, Thomas G Beach … (2012)

We present a practical guide for the implementation of recently revised National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease (AD). Major revisions from previous consensus criteria are: (1) recognition that AD neuropathologic changes may occur in the apparent absence of cognitive impairment, (2) an "ABC" score for AD neuropathologic change that incorporates histopathologic assessments of amyloid β deposits (A), staging of neurofibrillary tangles (B), and scoring of neuritic plaques (C), and (3) more detailed approaches for assessing commonly co-morbid conditions such as Lewy body disease, vascular brain injury, hippocampal sclerosis, and TAR DNA binding protein (TDP)-43 immunoreactive inclusions. Recommendations also are made for the minimum sampling of brain, preferred staining methods with acceptable alternatives, reporting of results, and clinico-pathologic correlations.