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William Samuel, MD, PhD; Robert D. Terry, MD; Richard DeTeresa; Nelson Butters, PhD; Eliezer Masliah, MD

Arch Neurol. 1994;51(8):772-778.

Abstract
Objective
We correlated severity of dementia in Alzheimer's disease with the degree of neuropathology in cortical and subcortical brain regions.

Methods
In 13 patients with Alzheimer's disease who underwent neuropsychological testing before death, we assessed neurofibrillary tangles, senile plaques, and neuronal and synaptic density in the midfrontal cortex and the nucleus basalis of Meynert.

Results
In the midfrontal cortex, synapse density was the strongest correlate of dementia severity, followed by neurofibrillary tangles. In the nucleus basalis, by contrast, neurofibrillary tangles were the strongest correlate, followed by synapse density. Stepwise regression analyses showed midfrontal synapse density to be the strongest predictor of tests emphasizing higher cortical functions, but neurofibrillary tangles in the nucleus basalis were the strongest predictor on memory-oriented tests.

Conclusions
The specificity of pathology in cortical vs subcortical locations for predicting a particular quality of neuropsychological deficit probably reflects disruption of corticocortical connections vs derangement of the basal forebrain cholinergic system.

Author Affiliations
From the Departments of Neurosciences (Drs Samuel, Terry, and Masliah and Mr DeTeresa) and Psychiatry (Dr Butters), University of California—San Diego.

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