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Pier Luigi Di Patre, MD; Stephen L. Read, MD; Jeffrey L. Cummings, MD; Uwamie Tomiyasu, MD; Luiza M. Vartavarian, MS; Diana L. Secor, MS; Harry V. Vinters, MD

Arch Neurol. 1999;56:1254-1261.

Objectives  To quantify the progression of senile plaques, neurofibrillary tangles, cerebral amyloid angiopathy, and microglial activation in the cortex and white matter of patients with Alzheimer disease evaluated at both biopsy and subsequent autopsy and correlate these changes with the progression of neurologic impairment.

Setting  Academic referral center for patient with Alzheimer disease.

Patients  Four patients meeting the clinical criteria for Alzheimer disease, enrolled in a pilot study for the evaluation of response to intracerebroventricular administration of bethanechol chloride. The patients were followed up until death occurred and autopsy was performed.

Results  All 4 patients had progressive deterioration from the time of biopsy to autopsy (9-11 years). Pathological investigations showed a striking increase in the density of senile plaques and neurofibrillary tangles in 2 of 4 patients from biopsy to autopsy, and a significant increase in microglial activation in 1 of 4 cases. Severity of cerebral amyloid angiopathy varied significantly among patients, 1 of whom displayed striking amyloid deposition with associated subcortical white matter atrophy.

Conclusions  These unique data demonstrate that the progressive neurologic impairment in Alzheimer disease is accompanied by a significant increase in senile plaque and neurofibrillary tangle counts in the frontal cortex and, possibly in some patients, by increased microglial cell activation. Cerebral amyloid angiopathy was associated with significant white matter disease.

From the Departments of Pathology and Laboratory Medicine, Neuropathology, (Drs Di Patre and Vinters and Mss Vartavarian and Secor) and Psychiatry and Biobehavioral Sciences (Drs Read and Cummings), University of California, Los Angeles, Medical Center, and the Departments of Psychiatry (Dr Read) and Pathology (Dr Tomiyasu), West Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif.

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