Abstract
The neuropathological staging model proposed by Braak and Braak (1991) implies that the evolution of neurofibrillary pathology follows a predictable sequence and can be ordered in a regular regional hierarchy. A total of 42 cases of an elderly population sample, which had been prospectively clinically assessed, were examined. Clinical diagnosis was made according to the CAMDEX criteria, and the sample reported here did not include cases were vascular dementia according to the criteria proposed by Chui et al. (1991). The neuropathological staging procedure was applied as originally proposed by Braak and Braak (1991). In addition, in all cortical laminae and regions which are essential for the staging model neurofibrillary tangles were quantified. Demented cases had significantly more areas involved and more advanced neuropathological stages. Cases with stages 1–3 tended to be non-demented, and cases with stages 4–6 tended to be demented. However, there was a considerable degree of overlap and no clear-cut threshold could be established. This brings into question the diagnostic value of the staging model.
Similar content being viewed by others
References
Alzheimer A (1907) Über eine eigenartige Erkrankung der Hirnrinde. Allgem Zeit Psychiatr Psychol-Gerich Med 64:146–148
American Psychiatrie Association (1987) Diagnostic and statistical manual of mental disorders (DSM-III-R), 3rd edn, revised. American Psychiatrie Press, Washington, DC
Ball MJ (1976) Neurofibrillary tangles and the pathogenesis of dementia: a quantitative study. Neuropathol Appl Neurobiol 2:395–410
Braak H, Braak E (1991) Neuropathological staging of Alzheimer-related changes. Acta Neuropathol 82:239–259
Brayne C (1993) Research and Alzheimer's disease: an epidermiological perspective. Psychol Med 23:287–296
Campbell SK, Switzer RC, Martin TL (1987) Alzheimer's plaques and tangles: a controlled and enhanced silver-staining method. Soc Neurosci (abstract) 3:687
Chui HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R (1992) Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's disease diagnostic and treatment centers. Neurology 42:473–480
Esiri MM, Pearson RCA, Powell TPS (1986) The cortex of the primary auditory area in Alzheimer's disease. Brain Res 366:385–387
Gellerstedt N (1933) Zur Kenntnis der Hirnveränderungen bei der normalen Altersinvolution Uppsala Lak Förh N.F. 38:193–408
Gertz H-J, Xuereb J, Huppert F, Brayne C, Krüger H, McGee MA, Paykel E, Harrington C, Mukaetova-Ladinska E, O'Connor DW, Wischik C (1996) The validity of the neuropathological staging (Braak) and its relation to clinical dementia (in press)
Hirano A, Zimmermann HM (1962) Alzheimer's neurofibrillary changes: a topographic study. Arch Neurol 7:227–242
Hyman BT, Damasio AR, Van Hoesen GW, Barnes CL (1984) Alzheimer's disease: cell specific pathology isolates the hippocampal formation. Science 225:1168–1170
Matsuyama H (1983) Incidence of neurofibrillary change, senile plaques, and granulovacuolar degeneration in aged individuals. In: Reisberg B (ed) Alzheimer's disease. The standard reference. The Free Press, New York, pp 149–154
Matsuyama H, Nakamura S (1978) Senile changes in the Japanese: incidence of Alzheimer's neurofibrillary change and senile plaques. Aging 7:287–297
Mukaetova-Ladinska EB, Harrington CR, Roth M, Wischik C (1993) Biochemical and anatomical redistribution of tau protein in Alzheimer's disease. Am J Pathol 143:565–578
O'Connor DW, Pollitt PA, Hyde JB, Fellows JL, Miller ND, Brook CPB, Reiss BB, Roth M (1989) The prevalence of dementia as measured by the Cambridge Mental Disorders of the Elderly Examination. Acta Psychiatry Scand 79:190–198
Paykel ES, Brayne C, Huppert FA, Gill C, Barkley C, Gehlhaar E, Beardsall L, Girling DM, Pollitt P, O'Connor D (1994) Incidence of dementia in an population older than 75 years in the United Kingdom. Arch Gen Psychiatry 5:325–332
Robakis NK (1994) β-amyloid and amyloid precursor protein. In: Terry RD, Katzman R, Bick KL (eds) Alzheimer disease. Raven Press, New York, pp 317–326
Roth M, Huppert FA, Tym E, Mountjoy CQ (1988) The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). Cambridge University Press, Cambridge
Simchowicz T (1911) Histologische Studien über die senile Demenz. In: Nissl F, Alzheimer A (eds) Histologische und histopathologische Arbeiten über die Grosshirnrinde mit besonderer Berücksichtigung der pathologischen Anatomie der Geisteskrankheiten, vol. 4. Fischer, Jena, pp 267–444
St. George-Hyslop PH (1994) The molecular genetics of Alzheimer's disease. In: Terry RD, Katzman R, Bick KL (eds) Alzheimer disease. Raven Press, New York, pp 345–352
Tomlinson BE, Henderson G (1976) Some quantitative cerebral findings in normal and demented old people. In: Terry RD, Gershon S (eds) Neurobiology and aging, vol 3. Raven Press, New York, pp 183–204
Tomlinson BE, Blessed G, Roth M (1968) Observations on the brains of non-demented old people. J Neurol Sci 7:331–356
Treves A, Rolls ET (1994) A computational analysis of the role of the hippocampus in memory. Hippocampus 4:374–391
Van Hoesen GW (1982) The parahippocampal gyrus. New observations regarding its cortical connections in the monkey. Trends Neurosci 5:345–350
Wilcock GK, Esiri MM (1982) Plaques, tangles and dementia —a quantitative study. J Neurol Sci 56:343–356
Wischik CM, Lai RYK, Harrington CR, Mukaetova-Ladinska EB, Xuereb JH, Mena R, Edwards PC, Roth M (1995) Structure, biochemistry, and molecular pathogenesis of paired helical filaments in Alzheimer's disease. In: Goate A, Ashall F (eds) Pathobiology of Alzheimer's disease. Neuroscience perspectives. Academic Press, London, pp 9–39
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gertz, H.J., Krüger, H., Xuereb, J.H. et al. The relationship between clinical dementia and neuropathological staging (Braak) in a very elderly community sample. Eur Arch Psychiatry Clin Nuerosci 246, 132–136 (1996). https://doi.org/10.1007/BF02189114
Issue Date:
DOI: https://doi.org/10.1007/BF02189114