Current Alzheimer Research - Volume 10, Issue 6, 2013

Parkinson disease (PD) is the second most prevalent neurodegenerative disorder after Alzheimer’s disease (AD). The formation of the cytoplasmic inclusions named “Lewy bodies” in the brain, considered to be a marker for neuronal degeneration in PD and dementia with Lewy bodies. However, Lewy bodies (LBs) are also observed in approximately 60 percent of both sporadic and familial cases with AD. LBs consist of fibrils mainly formed by post-translational modified α-synuclein (α-syn) protein. The modifications can be truncation, phosphorylation, nitration and mono-, di-, or tri-ubiquitination. Development of disease seems to be linked to events that increase the concentration of α-syn or cause its chemical modification, either of which can accelerate α-syn aggregation. Examples of such events include increased copy number of genes, decreased rate of degradation via the proteasome or other proteases, or modified forms of α-syn. As the aggregation of α-syn in the brain has been strongly implicated as a critical step in the development of several neurodegenerative diseases, the current search for disease-modifying drugs is focused on modification of the process of α-syn deposition in the brain. Recently researchers have screened and designed various molecules that are selectively focused on inhibiting or preventing α-syn aggregation and toxicity. Another strategy that has emerged is to target α-syn expression as a potential therapy for neurodegenerative diseases associated with LBs.

Age associated neurodegenerative diseases are characterized by intra- and extracellular aggregation and deposition of misfolded proteins. The neuropathological classification of neurodegenerative diseases is based on the semiquantitative assessment of these misfolded proteins, that constitute the neuropathological hallmark lesion for the respective disease: e.g. Alzheimer's disease (AD), amyloid-β (Aβ) hyperphosphorylated tau (tau); Lewy body diseases, α- synuclein (α-syn); frontotemporal lobar degeneration, tau, TDP-43, ubiquitin or FUS. In addition, cerebovascular lesions are assessed for the diagnosis of vascular dementia. However, in brains of elderly patients suffering from neurodegenerative diseases multiple pathologies are usually present and even in clinically characterized prospective cohorts additional pathologies are frequently found at post mortem examination. On the other hand, various amounts of AD pathology are frequently seen in brains of non-demented elderly and the threshold to cause clinical overt dementia is ill defined as additional co-morbidities (e.g., cerebrovascular lesions) might lower the threshold for clinical dementia in some cases. It becomes increasingly clear that the clinical picture of dementia in most aged patients results from a multimorbid condition in the CNS rather than from one single disease and data from animal studies suggest that Aβ, tau, and α-syn interact in vivo to promote the aggregation and accumulation of each other. We suggest that clinico-pathologocal correlative studies using a more quantitative approach in the assessment of neuropathological lesions are warranted to elucidate cerebral multimorbidity and to identify suitable targets for targeted therapeutic strategies against age associated neurodegeneration.

Although the brain’s ability to change constantly in response to external and internal inputs is now well recognized the mechanisms behind it in normal aging and neurodegeneration are less well understood. To gain a better understanding, transcranial magnetic stimulation (TMS) has been used extensively to characterize non-invasively the cortical neurophysiology of the aging and degenerating brain. Furthermore, there has been a surge of studies examining whether repetitive TMS (rTMS) can be used to improve functional deficits in various conditions including normal aging, Alzheimer’s and Parkinson’s disease. The results of these studies in normal aging and neurodegeneration have emerged reasonably coherent in delineating the main pathology in spite of considerable technical limitations, omnipresent methodological variability, and extraordinary patient heterogeneity. Nevertheless, comparing and integrating what is known about TMS measurements of cortical excitability and plasticity in disorders that predominantly affect cortical brain structures with disorders that predominantly affect subcortical brain structures may provide better understanding of normal and abnormal brain aging fostering new. The present review provides a TMS perspective of changes in cortical neurophysiology and neurochemistry in normal aging and neurodegeneration by integrating what is revealed in individual TMS measurements of cortical excitability and plasticity in physiological aging, Alzheimer’s, Parkinson’s, and Huntington’s, disease. The paper also reflects on current developments in utilizing TMS as a physiologic biomarker to discriminate physiologic aging from neurodegeneration and its potential as a method of therapeutic intervention.

Body function rhythmicity has a key function for the regulation of internal timing and adaptation to the environment. A wealth of recent data has implicated endogenous biological rhythm generation and regulation in susceptibility to disease, longevity, cognitive performance. Concerning brain diseases, it has been established that many molecular pathways implicated in neurodegeneration are under circadian regulation. At the molecular level, this regulation relies on clock genes forming interconnected, self-sustained transcriptional/translational feedback loops. Cells of the master circadian pacemaker, the hypothalamic suprachiasmatic nucleus, are endowed with this molecular clockwork. Brain cells in many other regions, including those which play a key role in learning and memory, as well as peripheral cells show a circadian oscillatory behavior regulated by the same molecular clockwork. We here address the question as to whether intracellular clockwork signaling and/or the intercellular dialogue between “brain clocks” are disrupted in aging-dependent neurodegenerative diseases, such as Parkinson’s disease and Alzheimer’s disease. The potential implications of clock genes in cognitive functions in normal conditions, clinical disturbances of circadian rhythms, and especially the sleepwake cycle, in aging-dependent neurodegenerative diseases and data in animal models are reviewed. The currently limited knowledge in this field is discussed in the context of the more extensive body of data available on cell clocks and molecular clockwork during normal aging. Hypotheses on implications of the synchronization between brain oscillators in information processing in neural networks lay ground for future studies on brain health and disease.

The prevalence of diabetes mellitus (DM) continues to increase because of sedentary life style and inappropriate diet. DM is one of the most common metabolic diseases, affecting more than 240 million people worldwide. It is projected that the number of people with DM will continue to increase in the next decade. Alzheimer disease (AD) is the most common cause of dementia, and affects over 24 million people globally, mostly senior citizens. The worldwide prevalence of AD is estimated to double in the next 20 years. How are these two chronic and debilitating diseases similar? Do they have common denominators? AD is similar to DM in many ways, in that both are associated with defective insulin release and/or signalling, impaired glucose uptake, amyloidosis, increased oxidative stress, stimulation of the apoptotic pathway, angiopathy, abnormal lipid peroxidation, ageing (in type 2 DM), brain atrophy, increased formation of advanced glycation end products and tau phosphorylation, impaired lipid metabolism and mitochondrial pathology. The pathogenesis of both AD and DM has genetic as well as environmental components. Both can also cause impaired cognition and dementia. All of these common denominators indicate that AD and DM share a lot of factors in terms of pathophysiology, histopathology and clinical outcome. These similarities can be used in the search for and design of effective pharmacotherapy for AD, since potent therapeutic agents such as insulin, incretins, oral hypoglycaemic agents and antioxidants used in the management of DM may play a key role in the treatment of patients with AD.

Deterioration of the cortical cholinergic system is a leading neurochemical feature of Alzheimer’s Disease (AD). This review summarizes evidence that the homomeric α7- nicotinic acetylcholine receptor (nAChR) plays a crucial role in the pathogenesis of this disease, which is characterized by amyloid-β (Aβ) accumulations and neurofibrillary tangles originating from of hyperphosphorylated tau protein. Aβ binds to α7-nAChRs with a high affinity, either activating or inhibiting this receptor in a concentration-dependent manner. There is strong evidence that α7-nAChRs are neuroprotective, reducing Aβ-induced toxicity; but co-localization of α7- nAChRs, Aβ and amyloid plaques also points to neurodegenerative actions. Aβ induces tau phosphorylation via α7-nAChR activation. Aβ influences hippocampus-dependent memory and long-term potentiation in a dose-dependent way: there is evidence that enhancement by picomolar Aβ concentrations is mediated by α7-nAChRs, whereas inhibition by nanomolar concentrations is independent of nAChRs and probably mediated by small Aβ42 oligomers. α7-nAChRs located on vascular smooth muscle cells and astrocytes are also involved in the pathogenesis of AD. Although these data strongly point to an important role of α7-nAChRs in the development of AD, dose-dependence of the effects, rapid desensitization of the receptor and dependence of the effects on Aβ aggregation (monomers, oligomers, fibrils) make it difficult to develop simple therapeutic strategies acting upon this receptor.

The mature neuromuscular junction (NMJ) is the best characterized cholinergic synapse. The maintenance of a high number and density of nicotinic acetylcholine receptors (nAChRs) at the postsynaptic membrane adjacent to the nerve terminal are crucial for NMJ function. This density is maintained by several factors, ranging from synaptic activity to postsynaptic scaffold proteins. Decreases in postsynaptic nAChR density are related to myasthenic syndromes in the peripheral NMJ, but are also associated in central synapses with neurodegenerative diseases such as Alzheimer’s. In this review, we focus particularly on our increasing knowledge about the molecular dynamics of nAChR at the peripheral cholinergic NMJ and their regulation by the postsynaptic proteins of the dystrophin glycoprotein complex (DGC).

Age is the strongest risk factor for brain degeneration whether it results from vascular or neurodegenerative mechanisms or both. To evaluate the current views on the impact of vascular disease on the most common causes of dementia, most relevant articles to the selected subject headings were reviewed until November 2011 from the popularly used databases including Pubmed, Cochrane Database and Biological Abstracts. Within the past decade, there has been four-fold increased interest in the vascular basis of neurodegeneration and dementia. Vascular ageing involving arterial stiffness, endothelial changes and blood-brain barrier dysfunction affects neuronal survival by impairing several intracellular protective mechanisms leading to chronic hypoperfusion. Modifiable risk factors such as hypertension, diabetes, dyslipidaemia and adiposity linked to Alzheimer’s disease and vascular dementia promote the degeneration and reduce the regenerative capacity of the vascular system. These in tandem with accumulation of abnormal proteins such as amyloid β likely disrupt cerebral autoregulation, neurovascular coupling and perfusion of the deeper structures to variable degrees to produce white matter changes and selective brain atrophy. Brain pathological changes may be further modified by genetic factors such as the apoliopoprotein E ε4 allele. Lifestyle measures that maintain or improve vascular health including consumption of healthy diets, moderate use of alcohol and implementing regular physical exercise in general appear effective for reducing dementia risk. Interventions that improve vascular function are important to sustain cognitive status even during ageing whereas preventative measures that reduce risk of vascular disease are predicted to lessen the burden of dementia in the long-term.

Background: Past studies investigating the association between Alzheimer’s disease (AD) pathology and diabetes mellitus type 2 (DM2) have provided conflicting results. While several studies indicate that subjects with comorbid AD and DM2 have less AD pathology, others have found no significant differences in AD pathology between the two groups. Other studies have indicated that individuals with AD and DM2 have significantly greater neuropathology than AD individuals who do not have DM2. Additional research has demonstrated that ApoE ε4 carriers with AD and DM2 have significantly greater pathology than ApoE ε4 non-carriers. Methods: Data on clinically and pathologically diagnosed Alzheimer’s disease cases (NINDS-ADRDA clinically and NIA Reagan intermediate or high pathologically) with DM2 (n= 40) and those without DM2 (n= 322) from the Banner Sun Health Research Institute Brain and Body Donation Program were obtained for this study. Plaque and tangle scores from the frontal, parietal, temporal, entorhinal and hippocampal regions were compared between the DM2+ and DM2 – groups. In addition, total plaque count, total tangle count, and Braak scores were also compared between groups. Similar analyses were conducted to determine the effect of ApoE ε4 carrier status on the neuropathological variables while also accounting for and DM2 status. Results: The DM2+ and DM2 – groups showed no significant differences on plaque and tangle pathology. Logistic regression analyses, which accounted for the effects of ApoE ε4 carrier status and age at death, found no association between total plaque [OR 1.05 (0.87, 1.27), p = 0.60] or total tangle [OR 0.97 (0.89, 1.07) p = 0.58] counts and DM2 status. ApoE ε4 carrier status was not significantly associated with DM2 status [χ2 = 0.30 (df = 1), p = 0.58]. Within the DM2+ group, significantly greater plaque and tangle pathology was found for ApoE ε4 carriers in relation to DM2+ ApoE ε4 non-carriers. Conclusion: Overall, the presence of DM2 does not affect plaque and tangle burden in a sample of clinically and pathologically confirmed AD cases. Among AD individuals with DM2, those who are ApoE ε4 carriers had significantly greater neuropathology than those who do not carry an ApoE ε4 allele. Positive DM2 status appears to exacerbate AD neuropathology in the presence of ApoE ε4.

We have shown previously, that mice lacking tumor necrosis factor-α (TNF-α) receptor 1 (TNFR1) exhibit greater hippocampal neurodegeneration, suggesting that TNFR1 may be protective in kainic acid (KA)-induced neurotoxicity. Here, we aim to clarify the role of TNF-α in neurodegenerative disorders and to elucidate its potential signaling pathways. TNF-α knockout (KO) mice and wild-type (WT) mice were treated with KA intranasally and, seizure severity measures obtained, Behavioral tests, including Elevated Plus-Maze™, open-field, Y-maze were also performed. Five days following KA treatment, immunohistochemical methods were used to assess neuronal degeneration and glial activation. The production of nitric oxide (NO) and the expression of nuclear factor kappaB (NF-αB) and AKT in the hippocampus were also measured. Compared with WT mice, TNF-α KO mice were more susceptibile to KA-induced neurotoxicity, as demonstrated by more severe seizures, measurable behavior changes, greater neuronal degeneration in hippocampus, elevated glial activation and NO production. Additionally, KA-treatment up-regulated the expression of NFκB in TNF-α KO mice to a greater degree than in KA-treated WT mice. We conclude that TNF-α deficiency adversely influences KAinduced neurotoxicity and that TNF-α may play a protective role in KA-induced neurotoxicity via the down-regulation of NFκB signaling pathway.