Dendritic spines are key players in information processing in the brain. Changes in spine shape and wholesale spine turnover provide mechanisms for modifying existing synaptic connections and altering neuronal connectivity. Although neuronal cell death in acute and chronic neurodegenerative diseases is clearly an important factor in decline of cognitive or motor function, loss of dendritic spines, in the absence of cell death, may also contribute to impaired brain function in these diseases, as well as in psychiatric disorders and aging. Because spines can function in neuroprotection in vitro, advances toward a molecular understanding of spine maintenance might one day aid in the design of therapies to minimize neurological damage following excitotoxic injury. In addition, progress in defining the biochemical basis of spine development and stabilization may yield insights into mental retardation and psychiatric disorders.