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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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