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Volume 16, Number 14, Issue of July 15, 1996 pp. 4491-4500
Copyright ©1996 Society for Neuroscience

Profound Loss of Layer II Entorhinal Cortex Neurons Occurs in Very Mild Alzheimer's Disease

Received March 26, 1996; revised April 25, 1996; accepted May 1, 1996.

Teresa Gómez-Isla1, Joseph L. Price2, Daniel W. McKeel Jr.2, John C. Morris2, John H. Growdon1, and Bradley T. Hyman1

1 Neurology Service, Massachusetts General Hospital, Boston, Massachusetts 02114, and 2 Departments of Anatomy and Neurobiology, Pathology and Neurology, and the Alzheimer's Disease Research Center, Washington University, St. Louis, Missouri 63110

The entorhinal cortex (EC) plays a crucial role as a gateway connecting the neocortex and the hippocampal formation. Layer II of the EC gives rise to the perforant pathway, the major source of the excitatory input to the hippocampus, and layer IV receives a major hippocampal efferent projection. The EC is affected severely in Alzheimer disease (AD), likely contributing to memory impairment. We applied stereological principles of neuron counting to determine whether neuronal loss occurs in the EC in the very early stages of AD. We studied 20 individuals who at death had a Clinical Dementia Rating (CDR) score of 0 (cognitively normal), 0.5 (very mild), 1 (mild), or 3 (severe cognitive impairment). Lamina-specific neuronal counts were carried out on sections representing the entire EC. In the cognitively normal (CDR = 0) individuals, there were ~650,000 neurons in layer II, 1 million neurons in layer IV, and 7 million neurons in the entire EC. The number of neurons remained constant between 60 and 90 years of age. The group with the mildest clinically detectable dementia (CDR = 0.5), all of whom had sufficient neurofibrillary tangles (NFTs) and senile plaques for the neuropathological diagnosis of AD, had 32% fewer EC neurons than controls. Decreases in individual lamina were even more dramatic, with the number of neurons in layer II decreasing by 60% and in layer IV by 40% compared with controls. In the severe dementia cases (CDR = 3), the number of neurons in layer II decreased by ~90%, and the number of neurons in layer IV decreased by ~70% compared with controls. Neuronal number in AD was inversely proportional to NFT formation and neuritic plaques, but was not related significantly to diffuse plaques or to total plaques. These results support the conclusion that a marked decrement of layer II neurons distinguishes even very mild AD from nondemented aging.

Key words: entorhinal cortex; stereology; neuronal loss; perforant pathway; Alzheimer's disease; aging




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R. J. Killiany, B. T. Hyman, T. Gomez-Isla, M. B. Moss, R. Kikinis, F. Jolesz, R. Tanzi, K. Jones, and M. S. Albert
MRI measures of entorhinal cortex vs hippocampus in preclinical AD
Neurology, April 23, 2002; 58(8): 1188 - 1196.
[Abstract] [Full Text] [PDF]


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ScienceHome page
R. B. DeMattos, K. R. Bales, D. J. Cummins, S. M. Paul, and D. M. Holtzman
Brain to Plasma Amyloid-beta Efflux: a Measure of Brain Amyloid Burden in a Mouse Model of Alzheimer's Disease
Science, March 22, 2002; 295(5563): 2264 - 2267.
[Abstract] [Full Text] [PDF]


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Behav Cogn Neurosci RevHome page
D. S. Woodruff-Pak and T. J. Gould
Neuronal nicotinic acetylcholine receptors: involvement in Alzheimer's disease and schizophrenia.
Behav Cogn Neurosci Rev, March 1, 2002; 1(1): 5 - 20.
[Abstract] [PDF]


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Am. J. PsychiatryHome page
N. Okamura, H. Arai, M. Maruyama, M. Higuchi, T. Matsui, H. Tanji, T. Seki, H. Hirai, H. Chiba, M. Itoh, et al.
Combined Analysis of CSF Tau Levels and [123I]Iodoamphetamine SPECT in Mild Cognitive Impairment: Implications for a Novel Predictor of Alzheimer's Disease
Am J Psychiatry, March 1, 2002; 159(3): 474 - 476.
[Abstract] [Full Text] [PDF]


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JNMHome page
H. Matsuda, N. Kitayama, T. Ohnishi, T. Asada, S. Nakano, S. Sakamoto, E. Imabayashi, and A. Katoh
Longitudinal Evaluation of Both Morphologic and Functional Changes in the Same Individuals with Alzheimer's Disease
J. Nucl. Med., March 1, 2002; 43(3): 304 - 311.
[Abstract] [Full Text] [PDF]


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J. Neurosci.Home page
L. Bondolfi, M. Calhoun, F. Ermini, H. G. Kuhn, K.-H. Wiederhold, L. Walker, M. Staufenbiel, and M. Jucker
Amyloid-Associated Neuron Loss and Gliogenesis in the Neocortex of Amyloid Precursor Protein Transgenic Mice
J. Neurosci., January 15, 2002; 22(2): 515 - 522.
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Am. J. Neuroradiol.Home page
T. Ohnishi, H. Matsuda, T. Tabira, T. Asada, and M. Uno
Changes in Brain Morphology in Alzheimer Disease and Normal Aging: Is Alzheimer Disease an Exaggerated Aging Process?
AJNR Am. J. Neuroradiol., October 1, 2001; 22(9): 1680 - 1685.
[Abstract] [Full Text] [PDF]


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Arch NeurolHome page
J. L. Price, A. I. Ko, M. J. Wade, S. K. Tsou, D. W. McKeel, and J. C. Morris
Neuron Number in the Entorhinal Cortex and CA1 in Preclinical Alzheimer Disease
Arch Neurol, September 1, 2001; 58(9): 1395 - 1402.
[Abstract] [Full Text] [PDF]


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Arch NeurolHome page
D. H. Salat, J. A. Kaye, and J. S. Janowsky
Selective Preservation and Degeneration Within the Prefrontal Cortex in Aging and Alzheimer Disease
Arch Neurol, September 1, 2001; 58(9): 1403 - 1408.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
M. J. de Leon, A. Convit, O. T. Wolf, C. Y. Tarshish, S. DeSanti, H. Rusinek, W. Tsui, E. Kandil, A. J. Scherer, A. Roche, et al.
Prediction of cognitive decline in normal elderly subjects with 2-[18F]fluoro-2-deoxy-D-glucose/positron-emission tomography (FDG/PET)
PNAS, August 23, 2001; (2001) 191044198.
[Abstract] [Full Text] [PDF]


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J. Neurosci.Home page
A. Stephan, S. Laroche, and S. Davis
Generation of Aggregated {beta}-Amyloid in the Rat Hippocampus Impairs Synaptic Transmission and Plasticity and Causes Memory Deficits
J. Neurosci., August 1, 2001; 21(15): 5703 - 5714.
[Abstract] [Full Text] [PDF]


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NeurologyHome page
K.A. Johnson, F. Lopera, K. Jones, A. Becker, R. Sperling, J. Hilson, J. Londono, I. Siegert, M. Arcos, S. Moreno, et al.
Presenilin-1-associated abnormalities in regional cerebral perfusion
Neurology, June 12, 2001; 56(11): 1545 - 1551.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
J. M. Conner, M. A. Darracq, J. Roberts, and M. H. Tuszynski
Nontropic actions of neurotrophins: Subcortical nerve growth factor gene delivery reverses age-related degeneration of primate cortical cholinergic innervation
PNAS, February 13, 2001; 98(4): 1941 - 1946.
[Abstract] [Full Text] [PDF]


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NeurologyHome page
J. G. Csernansky, L. Wang, S. Joshi, J. P. Miller, M. Gado, D. Kido, D. McKeel, J. C. Morris, and M. I. Miller
Early DAT is distinguished from aging by high-dimensional mapping of the hippocampus
Neurology, December 12, 2000; 55(11): 1636 - 1643.
[Abstract] [Full Text] [PDF]


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J. Neurosci.Home page
Y. Zhang, C. Goodyer, and A. LeBlanc
Selective and Protracted Apoptosis in Human Primary Neurons Microinjected with Active Caspase-3, -6, -7, and -8
J. Neurosci., November 15, 2000; 20(22): 8384 - 8389.
[Abstract] [Full Text] [PDF]


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J. Neurosci.Home page
I. Greeve, I. Hermans-Borgmeyer, C. Brellinger, D. Kasper, T. Gomez-Isla, C. Behl, B. Levkau, and R. M. Nitsch
The Human DIMINUTO/DWARF1 Homolog Seladin-1 Confers Resistance to Alzheimer's Disease-Associated Neurodegeneration and Oxidative Stress
J. Neurosci., October 1, 2000; 20(19): 7345 - 7352.
[Abstract] [Full Text] [PDF]


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J. Neurosci.Home page
T. D. Smith, M. M. Adams, M. Gallagher, J. H. Morrison, and P. R. Rapp
Circuit-Specific Alterations in Hippocampal Synaptophysin Immunoreactivity Predict Spatial Learning Impairment in Aged Rats
J. Neurosci., September 1, 2000; 20(17): 6587 - 6593.
[Abstract] [Full Text] [PDF]


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Arch NeurolHome page
V. Haroutunian, M. Serby, D. P. Purohit, D. P. Perl, D. Marin, M. Lantz, R. C. Mohs, and K. L. Davis
Contribution of Lewy Body Inclusions to Dementia in Patients With and Without Alzheimer Disease Neuropathological Conditions
Arch Neurol, August 1, 2000; 57(8): 1145 - 1150.
[Abstract] [Full Text] [PDF]


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NeurologyHome page
M. S. Albert and D. A. Drachman
Alzheimer's disease: What is it, how many people have it, and why do we need to know?
Neurology, July 25, 2000; 55(2): 166 - 168.
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Am. J. Pathol.Home page
A. Takeuchi, M. C. Irizarry, K. Duff, T. C. Saido, K. Hsiao Ashe, M. Hasegawa, D. M. A. Mann, B. T. Hyman, and T. Iwatsubo
Age-Related Amyloid {beta} Deposition in Transgenic Mice Overexpressing Both Alzheimer Mutant Presenilin 1 and Amyloid {beta} Precursor Protein Swedish Mutant Is Not Associated with Global Neuronal Loss
Am. J. Pathol., July 1, 2000; 157(1): 331 - 339.
[Abstract] [Full Text] [PDF]


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Arch NeurolHome page
G. Binetti, J. J. Locascio, S. Corkin, J. P. Vonsattel, and J. H. Growdon
Differences Between Pick Disease and Alzheimer Disease in Clinical Appearance and Rate of Cognitive Decline
Arch Neurol, February 1, 2000; 57(2): 225 - 232.
[Abstract] [Full Text] [PDF]


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NeurologyHome page
T. Gomez-Isla, W. B. Growdon, M. McNamara, K. Newell, E. Gomez-Tortosa, E. T. Hedley-Whyte, and B. T. Hyman
Clinicopathologic correlates in temporal cortex in dementia with Lewy bodies
Neurology, December 1, 1999; 53(9): 2003 - 2003.
[Abstract] [Full Text] [PDF]


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J. Neurosci.Home page
D. M. Hartley, D. M. Walsh, C. P. Ye, T. Diehl, S. Vasquez, P. M. Vassilev, D. B. Teplow, and Dennis. J. Selkoe
Protofibrillar Intermediates of Amyloid beta -Protein Induce Acute Electrophysiological Changes and Progressive Neurotoxicity in Cortical Neurons
J. Neurosci., October 15, 1999; 19(20): 8876 - 8884.
[Abstract] [Full Text] [PDF]


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Arch NeurolHome page
J. K. Johnson, E. Head, R. Kim, A. Starr, and C. W. Cotman
Clinical and Pathological Evidence for a Frontal Variant of Alzheimer Disease
Arch Neurol, October 1, 1999; 56(10): 1233 - 1239.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
D. E. Smith, J. Roberts, F. H. Gage, and M. H. Tuszynski
Age-associated neuronal atrophy occurs in the primate brain and is reversible by growth factor gene therapy
PNAS, September 14, 1999; 96(19): 10893 - 10898.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
A. LeBlanc, H. Liu, C. Goodyer, C. Bergeron, and J. Hammond
Caspase-6 Role in Apoptosis of Human Neurons, Amyloidogenesis, and Alzheimer's Disease
J. Biol. Chem., August 13, 1999; 274(33): 23426 - 23436.
[Abstract] [Full Text] [PDF]


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BrainHome page
K. Meguro, X. Blaizot, Y. Kondoh, C. Le Mestric, J. C. Baron, and C. Chavoix
Neocortical and hippocampal glucose hypometabolism following neurotoxic lesions of the entorhinal and perirhinal cortices in the non-human primate as shown by PET: Implications for Alzheimer's disease
Brain, August 1, 1999; 122(8): 1519 - 1531.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
H. Funato, M. Enya, M. Yoshimura, M. Morishima-Kawashima, and Y. Ihara
Presence of Sodium Dodecyl Sulfate-Stable Amyloid {beta}-Protein Dimers in the Hippocampus CA1 Not Exhibiting Neurofibrillary Tangle Formation
Am. J. Pathol., July 1, 1999; 155(1): 23 - 28.
[Abstract] [Full Text] [PDF]


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Arch NeurolHome page
V. Haroutunian, D. P. Purohit, D. P. Perl, D. Marin, K. Khan, M. Lantz, K. L. Davis, and R. C. Mohs
Neurofibrillary Tangles in Nondemented Elderly Subjects and Mild Alzheimer Disease
Arch Neurol, June 1, 1999; 56(6): 713 - 718.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
J. Walter, A. Schindzielorz, J. Grunberg, and C. Haass
Phosphorylation of presenilin-2 regulates its cleavage by caspases and retards progression of apoptosis
PNAS, February 16, 1999; 96(4): 1391 - 1396.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
K. J. Ivins, J. K. Ivins, J. P. Sharp, and C. W. Cotman
Multiple Pathways of Apoptosis in PC12 Cells. CrmA INHIBITS APOPTOSIS INDUCED BY beta -AMYLOID
J. Biol. Chem., January 22, 1999; 274(4): 2107 - 2112.
[Abstract] [Full Text] [PDF]


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J. Neurol. Neurosurg. PsychiatryHome page
K Juottonen, M Lehtovirta, S Helisalmi, P J R. Sr, and H Soininen
Major decrease in the volume of the entorhinal cortex in patients with Alzheimer's disease carrying the apolipoprotein E epsilon 4 allele
J. Neurol. Neurosurg. Psychiatry, September 1, 1998; 65(3): 322 - 327.
[Abstract] [Full Text]


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Arch NeurolHome page
B. T. Hyman
New Neuropathological Criteria for Alzheimer Disease
Arch Neurol, September 1, 1998; 55(9): 1174 - 1176.
[Full Text] [PDF]


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Arch NeurolHome page
V. Haroutunian, D. P. Perl, D. P. Purohit, D. Marin, K. Khan, M. Lantz, K. L. Davis, and R. C. Mohs
Regional Distribution of Neuritic Plaques in the Nondemented Elderly and Subjects With Very Mild Alzheimer Disease
Arch Neurol, September 1, 1998; 55(9): 1185 - 1191.
[Abstract] [Full Text] [PDF]



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