Abstract
Amyloid imaging has identified cognitively normal older people with plaques as a group possibly at increased risk for developing Alzheimer’s disease-related dementia. It is important to begin to thoroughly characterize this group so that preventative therapies might be tested. Existing cholinotropic agents are a logical choice for preventative therapy as experimental evidence suggests that they are anti-amyloidogenic and clinical trials have shown that they delay progression of mild cognitive impairment to dementia. A detailed understanding of the status of the cortical cholinergic system in preclinical AD is still lacking, however. For more than 30 years, depletion of the cortical cholinergic system has been known to be one of the characteristic features of AD. Reports to date have suggested that some cholinergic markers are altered prior to cognitive impairment while others may show changes only at later stages of dementia. These studies have generally been limited by relatively small sample sizes, long postmortem intervals and insufficient definition of control and AD subjects by the defining histopathology. We, therefore, examined pre- and post-synaptic elements of the cortical cholinergic system in frontal and parietal cortex in 87 deceased subjects, including non-demented elderly with and without amyloid plaques as well as demented persons with neuropathologically confirmed AD. Choline acetyltransferase (ChAT) activity was used as a presynaptic marker while displacement of 3H-pirenzepine binding by oxotremorine-M in the presence and absence of GppNHp was used to assess postsynaptic M1 receptor coupling. The results indicate that cortical ChAT activity as well as M1 receptor coupling are both significantly decreased in non-demented elderly subjects with amyloid plaques and are more pronounced in subjects with AD and dementia. These findings confirm that cortical cholinergic dysfunction in AD begins at the preclinical stage of disease and suggest that cholinotropic agents currently used for AD treatment are a logical choice for preventative therapy.
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References
Consensus recommendations for the postmortem diagnosis of Alzheimer’s disease. The National Institute on Aging, and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer’s Disease (1997) Neurobiol Aging 18:S1–S2
Basun H, Nilsberth C, Eckman C, Lannfelt L, Younkin S (2002) Plasma levels of Abeta42 and Abeta40 in Alzheimer patients during treatment with the acetylcholinesterase inhibitor tacrine. Dement Geriatr Cogn Disord 14:156–160
Beach TG, Honer WG, Hughes LH (1997) Cholinergic fibre loss associated with diffuse plaques in the non-demented elderly: the preclinical stage of Alzheimer’s disease? Acta Neuropathol (Berl) 93:146–153
Beach TG, Kuo YM, Spiegel K, Emmerling MR, Sue LI, Kokjohn K, Roher AE (2000) The cholinergic deficit coincides with Abeta deposition at the earliest histopathologic stages of Alzheimer disease. J Neuropathol Exp Neurol 59:308–313
Beach TG, Potter PE, Kuo YM, Emmerling MR, Durham RA, Webster SD, Walker DG, Sue LI, Scott S, Layne KJ, Roher AE (2000) Cholinergic deafferentation of the rabbit cortex: a new animal model of Abeta deposition. Neurosci Lett 283:9–12
Beach TG, Sue LI, Scott S, Sparks DL (1998) Neurofibrillary tangles are constant in aging human nucleus basalis. Alzheimer’s Rep 1:375–380
Beach TG, Sue LI, Walker DG, Roher AE, Lue L, Vedders L, Connor DJ, Sabbagh MN, Rogers J (2008) The Sun Health Research Institute Brain Donation Program: description and experience, 1987–2007. Cell Tissue Bank 9:229–245
Beach TG, Walker D, Sue L, Scott S, Layne K, Newell A, Potter P, Durham RA, Emmerling M, Webster SD, Honer W, Fisher A, Roher A (2003) Immunotoxin lesion of the cholinergic nucleus basalis causes Aβ deposition: towards a physiologic animal model of Alzheimer’s disease. Curr Med Chem 3:57–75
Beach TG, Walker DG, Potter PE, Sue LI, Fisher A (2001) Reduction of cerebrospinal fluid amyloid beta after systemic administration of M1 muscarinic agonists. Brain Res 905:220–223
Berg L, McKeel DW Jr, Miller JP, Baty J, Morris JC (1993) Neuropathological indexes of Alzheimer’s disease in demented and nondemented persons aged 80 years and older. Arch Neurol 50:349–358
Birks J, Grimley EJ, Iakovidou V, Tsolaki M, Holt FE (2009) Rivastigmine for Alzheimer’s disease. Cochrane Database Syst Rev CD001191
Bowen DM, Benton JS, Spillane JA, Smith CC, Allen SJ (1982) Choline acetyltransferase activity and histopathology of frontal neocortex from biopsies of demented patients. J Neurol Sci 57:191–202
Braak H, Braak E (1991) Neuropathological staging of Alzheimer-related changes. Acta Neuropathol (Berl) 82:239–259
Bruno MA, Mufson EJ, Wuu J, Cuello AC (2009) Increased matrix metalloproteinase 9 activity in mild cognitive impairment. J Neuropathol Exp Neurol 68:1309–1318
Bullock R, Dengiz A (2005) Cognitive performance in patients with Alzheimer’s disease receiving cholinesterase inhibitors for up to 5 years. Int J Clin Pract 59:817–822
Buxbaum JD, Oishi M, Chen HI, Pinkas-Kramarski R, Jaffe EA, Gandy SE, Greengard P (1992) Cholinergic agonists and interleukin 1 regulate processing and secretion of the Alzheimer beta/A4 amyloid protein precursor. Proc Natl Acad Sci USA 89:10075–10078
Bymaster FP, Carter PA, Peters SC, Zhang W, Ward JS, Mitch CH, Calligaro DO, Whitesitt CA, DeLapp N, Shannon HE, Rimvall K, Jeppesen L, Sheardown MJ, Fink-Jensen A, Sauerberg P (1998) Xanomeline compared to other muscarinic agents on stimulation of phosphoinositide hydrolysis in vivo and other cholinomimetic effects. Brain Res 795:179–190
Cohen AD, Price JC, Weissfeld LA, James J, Rosario BL, Bi W, Nebes RD, Saxton JA, Snitz BE, Aizenstein HA, Wolk DA, DeKosky ST, Mathis CA, Klunk WE (2009) Basal cerebral metabolism may modulate the cognitive effects of Abeta in mild cognitive impairment: an example of brain reserve. J Neurosci 29:14770–14778
Crystal H, Dickson D, Fuld P, Masur D, Scott R, Mehler M, Masdeu J, Kawas C, Aronson M, Wolfson L (1988) Clinico-pathologic studies in dementia: nondemented subjects with pathologically confirmed Alzheimer’s disease. Neurology 38:1682–1687
Davies L, Wolska B, Hilbich C, Multhaup G, Martins R, Simms G, Beyreuther K, Masters CL (1988) A4 amyloid protein deposition and the diagnosis of Alzheimer’s disease: prevalence in aged brains determined by immunocytochemistry compared with conventional neuropathologic techniques. Neurology 38:1688–1693
Davis AA, Fritz JJ, Wess J, Lah JJ, Levey AI (2010) Deletion of M1 muscarinic acetylcholine receptors increases amyloid pathology in vitro and in vivo. J Neurosci 30:4190–4196
Davis KL, Mohs RC, Marin D, Purohit DP, Perl DP, Lantz M, Austin G, Haroutunian V (1999) Cholinergic markers in elderly patients with early signs of Alzheimer disease. JAMA 281:1401–1406
DeKosky ST, Ikonomovic MD, Styren SD, Beckett L, Wisniewski S, Bennett DA, Cochran EJ, Kordower JH, Mufson EJ (2002) Upregulation of choline acetyltransferase activity in hippocampus and frontal cortex of elderly subjects with mild cognitive impairment. Ann Neurol 51:145–155
Dickson DW, Crystal HA, Mattiace LA, Masur DM, Blau AD, Davies P, Yen SH, Aronson MK (1992) Identification of normal and pathological aging in prospectively studied nondemented elderly humans. Neurobiol Aging 13:179–189
Farber SA, Nitsch RM, Schulz JG, Wurtman RJ (1995) Regulated secretion of beta-amyloid precursor protein in rat brain. J Neurosci 15:7442–7451
Ferrari-DiLeo G, Mash DC, Flynn DD (1995) Attenuation of muscarinic receptor–G-protein interaction in Alzheimer disease. Mol Chem Neuropathol 24:69–91
Fisher A (2008) Cholinergic treatments with emphasis on m1 muscarinic agonists as potential disease-modifying agents for Alzheimer’s disease. Neurotherapeutics 5:433–442
Fonnum F (1969) Radiochemical micro assays for the determination of choline acetyltransferase and acetylcholinesterase activities. Biochem J 115:465–472
Funato H, Yoshimura M, Kusui K, Tamaoka A, Ishikawa K, Ohkoshi N, Namekata K, Okeda R, Ihara Y (1998) Quantitation of amyloid beta-protein (A beta) in the cortex during aging and in Alzheimer’s disease. Am J Pathol 152:1633–1640
Gau JT, Steinhilb ML, Kao TC, D’Amato CJ, Gaut JR, Frey KA, Turner RS (2002) Stable beta-secretase activity and presynaptic cholinergic markers during progressive central nervous system amyloidogenesis in Tg2576 mice. Am J Pathol 160:731–738
Geula C, Mesulam MM (1989) Cortical cholinergic fibers in aging and Alzheimer’s disease: a morphometric study. Neuroscience 33:469–481
Geula C, Nagykery N, Wu CK, Bu J (2003) Loss of calbindin-D28K from aging human cholinergic basal forebrain: relation to plaques and tangles. J Neuropathol Exp Neurol 62:605–616
Gilmor ML, Erickson JD, Varoqui H, Hersh LB, Bennett DA, Cochran EJ, Mufson EJ, Levey AI (1999) Preservation of nucleus basalis neurons containing choline acetyltransferase and the vesicular acetylcholine transporter in the elderly with mild cognitive impairment and early Alzheimer’s disease. J Comp Neurol 411:693–704
Greenwood AF, Powers RE, Jope RS (1995) Phosphoinositide hydrolysis, G alpha q, phospholipase C, and protein kinase C in post mortem human brain: effects of post mortem interval, subject age, and Alzheimer’s disease. Neuroscience 69:125–138
Hernandez D, Sugaya K, Qu T, McGowan E, Duff K, McKinney M (2001) Survival and plasticity of basal forebrain cholinergic systems in mice transgenic for presenilin-1 and amyloid precursor protein mutant genes. Neuroreport 12:1377–1384
Hixson JE, Vernier DT (1990) Restriction isotyping of human apolipoprotein E by gene amplification and cleavage with HhaI. J Lipid Res 31:545–548
Hock C, Maddalena A, Heuser I, Naber D, Oertel W, von der KH, Wienrich M, Raschig A, Deng M, Growdon JH, Nitsch RM (2000) Treatment with the selective muscarinic agonist talsaclidine decreases cerebrospinal fluid levels of total amyloid beta-peptide in patients with Alzheimer’s disease. Ann NY Acad Sci 920:285–291
Ikonomovic MD, Abrahamson EE, Isanski BA, Wuu J, Mufson EJ, DeKosky ST (2007) Superior frontal cortex cholinergic axon density in mild cognitive impairment and early Alzheimer disease. Arch Neurol 64:1312–1317
Ikonomovic MD, Wecker L, Abrahamson EE, Wuu J, Counts SE, Ginsberg SD, Mufson EJ, DeKosky ST (2009) Cortical alpha7 nicotinic acetylcholine receptor and beta-amyloid levels in early Alzheimer disease. Arch Neurol 66:646–651
Jack CR Jr, Petersen RC, Grundman M, Jin S, Gamst A, Ward CP, Sencakova D, Doody RS, Thal LJ (2008) Longitudinal MRI findings from the vitamin E and donepezil treatment study for MCI. Neurobiol Aging 29:1285–1295
Jicha GA, Parisi JE, Dickson DW, Johnson K, Cha R, Ivnik RJ, Tangalos EG, Boeve BF, Knopman DS, Braak H, Petersen RC (2006) Neuropathologic outcome of mild cognitive impairment following progression to clinical dementia. Arch Neurol 63:674–681
Katsumi Y, Hanakawa T, Fukuyama H, Hayashi T, Nagahama Y, Yamauchi H, Ouchi Y, Tsukada H, Shibasaki H (1999) The effect of sequential lesioning in the basal forebrain on cerebral cortical glucose metabolism in rats. An animal positron emission tomography study. Brain Res 837:75–82
Katzman R, Terry R, DeTeresa R, Brown T, Davies P, Fuld P, Renbing X, Peck A (1988) Clinical, pathological, and neurochemical changes in dementia: a subgroup with preserved mental status and numerous neocortical plaques. Ann Neurol 23:138–144
Kelly JF, Storie K, Skamra C, Bienias J, Beck T, Bennett DA (2005) Relationship between Alzheimer’s disease clinical stage and Gq/11 in subcellular fractions of frontal cortex. J Neural Transm 112:1049–1056
Kemp PM, Holmes C, Hoffmann S, Wilkinson S, Zivanovic M, Thom J, Bolt L, Fleming J, Wilkinson DG (2003) A randomised placebo controlled study to assess the effects of cholinergic treatment on muscarinic receptors in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 74:1567–1570
Krishnan KR, Charles HC, Doraiswamy PM, Mintzer J, Weisler R, Yu X, Perdomo C, Ieni JR, Rogers S (2003) Randomized, placebo-controlled trial of the effects of donepezil on neuronal markers and hippocampal volumes in Alzheimer’s disease. Am J Psychiatry 160:2003–2011
Le MC, Chavoix C, Chapon F, Mezenge F, Epelbaum J, Baron JC (1998) Effects of damage to the basal forebrain on brain glucose utilization: a reevaluation using positron emission tomography in baboons with extensive unilateral excitotoxic lesion. J Cereb Blood Flow Metab 18:476–490
Lin L, Georgievska B, Mattsson A, Isacson O (1999) Cognitive changes and modified processing of amyloid precursor protein in the cortical and hippocampal system after cholinergic synapse loss and muscarinic receptor activation. Proc Natl Acad Sci USA 96:12108–12113
Lu PH, Teng E, Tingus K, Petersen RC, Cummings JL (2009) Donepezil delays progression to AD in MCI subjects with depressive symptoms. Neurology 72:2115–2121
Mazere J, Prunier C, Barret O, Guyot M, Hommet C, Guilloteau D, Dartigues JF, Auriacombe S, Fabrigoule C, Allard M (2008) In vivo SPECT imaging of vesicular acetylcholine transporter using [(123)I]-IBVM in early Alzheimer’s disease. Neuroimage 40:280–288
McGeer PL, McGeer EG, Suzuki J, Dolman CE, Nagai T (1984) Aging, Alzheimer’s disease, and the cholinergic system of the basal forebrain. Neurology 34:741–745
Minger SL, Davies P (1992) Persistent innervation of the rat neocortex by basal forebrain cholinergic neurons despite the massive reduction of cortical target neurons. I. Morphometric analysis. Exp Neurol 117:124–138
Mintun MA, Larossa GN, Sheline YI, Dence CS, Lee SY, Mach RH, Klunk WE, Mathis CA, DeKosky ST, Morris JC (2006) [11C]PIB in a nondemented population: potential antecedent marker of Alzheimer disease. Neurology 67:446–452
Mirra SS, Heyman A, McKeel D, Sumi SM, Crain BJ, Brownlee LM, Vogel FS, Hughes JP, van Belle G, Berg L (1991) The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer’s disease. Neurology 41:479–486
Mori E, Hashimoto M, Krishnan KR, Doraiswamy PM (2006) What constitutes clinical evidence for neuroprotection in Alzheimer disease: support for the cholinesterase inhibitors? Alzheimer Dis Assoc Disord 20:S19–S26
Mormino EC, Kluth JT, Madison CM, Rabinovici GD, Baker SL, Miller BL, Koeppe RA, Mathis CA, Weiner MW, Jagust WJ (2009) Episodic memory loss is related to hippocampal-mediated beta-amyloid deposition in elderly subjects. Brain 132:1310–1323
Mufson EJ, Ma SY, Cochran EJ, Bennett DA, Beckett LA, Jaffar S, Saragovi HU, Kordower JH (2000) Loss of nucleus basalis neurons containing trkA immunoreactivity in individuals with mild cognitive impairment and early Alzheimer’s disease. J Comp Neurol 427:19–30
Mufson EJ, Ma SY, Dills J, Cochran EJ, Leurgans S, Wuu J, Bennett DA, Jaffar S, Gilmor ML, Levey AI, Kordower JH (2002) Loss of basal forebrain P75(NTR) immunoreactivity in subjects with mild cognitive impairment and Alzheimer’s disease. J Comp Neurol 443:136–153
Muma NA, Mariyappa R, Williams K, Lee JM (2003) Differences in regional and subcellular localization of G(q/11) and RGS4 protein levels in Alzheimer’s disease: correlation with muscarinic M1 receptor binding parameters. Synapse 47:58–65
Muth K, Schonmeyer R, Matura S, Haenschel C, Schroder J, Pantel J (2010) Mild cognitive impairment in the elderly is associated with volume loss of the cholinergic basal forebrain region. Biol Psychiatry 67:588–591
Nitsch RM, Deng M, Tennis M, Schoenfeld D, Growdon JH (2000) The selective muscarinic M1 agonist AF102B decreases levels of total Abeta in cerebrospinal fluid of patients with Alzheimer’s disease. Ann Neurol 48:913–918
Nitsch RM, Wurtman RJ, Growdon JH (1996) Regulation of APP processing. Potential for the therapeutical reduction of brain amyloid burden. Ann NY Acad Sci 777:175–182
Nordberg A (1999) PET studies and cholinergic therapy in Alzheimer’s disease. Rev Neurol (Paris) 155(Suppl 4):S53–S63
Nordberg A, Winblad B (1986) Reduced number of [3H]nicotine and [3H]acetylcholine binding sites in the frontal cortex of Alzheimer brains. Neurosci Lett 72:115–119
Overk CR, Felder CC, Tu Y, Schober DA, Bales KR, Wuu J, Mufson EJ (2010) Cortical M1 receptor concentration increases without a concomitant change in function in Alzheimer’s disease. J Chem Neuroanat 40:63–70
Palmer AM (1996) Neurochemical studies of Alzheimer’s disease. Neurodegeneration 5:381–391
Pearson RC, Powell TP (1987) Anterograde vs. retrograde degeneration of the nucleus basalis medialis in Alzheimer’s disease. J Neural Transm Suppl 24:139–146
Perry EK, Blessed G, Tomlinson BE, Perry RH, Crow TJ, Cross AJ, Dockray GJ, Dimaline R, Arregui A (1981) Neurochemical activities in human temporal lobe related to aging and Alzheimer-type changes. Neurobiol Aging 2:251–256
Perry EK, Johnson M, Kerwin JM, Piggott MA, Court JA, Shaw PJ, Ince PG, Brown A, Perry RH (1992) Convergent cholinergic activities in aging and Alzheimer’s disease. Neurobiol Aging 13:393–400
Perry EK, Perry RH, Smith CJ, Dick DJ, Candy JM, Edwardson JA, Fairbairn A, Blessed G (1987) Nicotinic receptor abnormalities in Alzheimer’s and Parkinson’s diseases. J Neurol Neurosurg Psychiatry 50:806–809
Petersen RC, Parisi JE, Dickson DW, Johnson KA, Knopman DS, Boeve BF, Jicha GA, Ivnik RJ, Smith GE, Tangalos EG, Braak H, Kokmen E (2006) Neuropathologic features of amnestic mild cognitive impairment. Arch Neurol 63:665–672
Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, Galasko D, Jin S, Kaye J, Levey A, Pfeiffer E, Sano M, van Dyck CH, Thal LJ (2005) Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med 352:2379–2388
Pike KE, Savage G, Villemagne VL, Ng S, Moss SA, Maruff P, Mathis CA, Klunk WE, Masters CL, Rowe CC (2007) Beta-amyloid imaging and memory in non-demented individuals: evidence for preclinical Alzheimer’s disease. Brain 130:2837–2844
Potter PE, Tedford CE, Kindel G, Hanin I (1989) Inhibition of high affinity choline transport attenuates both cholinergic and non-cholinergic effects of ethylcholine aziridinium (AF64A). Brain Res 487:238–244
Reiman EM, Chen K, Liu X, Bandy D, Yu M, Lee W, Ayutyanont N, Keppler J, Reeder SA, Langbaum JB, Alexander GE, Klunk WE, Mathis CA, Price JC, Aizenstein HJ, DeKosky ST, Caselli RJ (2009) Fibrillar amyloid-beta burden in cognitively normal people at 3 levels of genetic risk for Alzheimer’s disease. Proc Natl Acad Sci USA 106:6820–6825
Sabbagh MN, Shah F, Reid RT, Sue L, Connor DJ, Peterson LK, Beach TG (2006) Pathologic and nicotinic receptor binding differences between mild cognitive impairment, Alzheimer disease, and normal aging. Arch Neurol 63:1771–1776
Sabri O, Kendziorra K, Wolf H, Gertz HJ, Brust P (2008) Acetylcholine receptors in dementia and mild cognitive impairment. Eur J Nucl Med Mol Imaging 35(Suppl 1):S30–S45
Sassin I, Schultz C, Thal DR, Rub U, Arai K, Braak E, Braak H (2000) Evolution of Alzheimer’s disease-related cytoskeletal changes in the basal nucleus of Meynert. Acta Neuropathol (Berl) 100:259–269
Seo H, Ferree AW, Isacson O (2002) Cortico-hippocampal APP and NGF levels are dynamically altered by cholinergic muscarinic antagonist or M1 agonist treatment in normal mice. Eur J Neurosci 15:498–506
Shimohama S, Fujimoto S, Matsushima H, Takenawa T, Taniguchi T, Perry G, Whitehouse PJ, Kimura J (1995) Alteration of phospholipase C-delta protein level and specific activity in Alzheimer’s disease. J Neurochem 64:2629–2634
Shiozaki K, Iseki E (2004) Decrease in GTP-sensitive high affinity agonist binding of muscarinic acetylcholine receptors in autopsied brains of dementia with Lewy bodies and Alzheimer’s disease. J Neurol Sci 223:145–148
Thorne B, Wonnacott S, Dunkley PR (1991) Isolation of hippocampal synaptosomes on Percoll gradients: cholinergic markers and ligand binding sites. J Neurochem 56:479–484
Tiraboschi P, Hansen LA, Alford M, Masliah E, Thal LJ, Corey-Bloom J (2000) The decline in synapses and cholinergic activity is asynchronous in Alzheimer’s disease. Neurology 55:1278–1283
Tsang SW, Lai MK, Kirvell S, Francis PT, Esiri MM, Hope T, Chen CP, Wong PT (2006) Impaired coupling of muscarinic M1 receptors to G-proteins in the neocortex is associated with severity of dementia in Alzheimer’s disease. Neurobiol Aging 27:1216–1223
Tsang SW, Pomakian J, Marshall GA, Vinters HV, Cummings JL, Chen CP, Wong PT, Lai MK (2007) Disrupted muscarinic M1 receptor signaling correlates with loss of protein kinase C activity and glutamatergic deficit in Alzheimer’s disease. Neurobiol Aging 28:1381–1387
Wong TP, Debeir T, Duff K, Cuello AC (1999) Reorganization of cholinergic terminals in the cerebral cortex and hippocampus in transgenic mice carrying mutated presenilin-1 and amyloid precursor protein transgenes. J Neurosci 19:2706–2716
Acknowledgments
The Banner Sun Health Research Institute Brain Donation Program is supported by the National Institute on Aging (P30 AG19610 Arizona Alzheimer’s Disease Core Center), the Arizona Department of Health Services (contract 211002, Arizona Alzheimer’s Research Center), the Arizona Biomedical Research Commission (contracts 4001, 0011, 05-901 and 1001 to the Arizona Parkinson’s Disease Consortium) and the Michael J. Fox Foundation for Parkinson’s Research.
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Potter, P.E., Rauschkolb, P.K., Pandya, Y. et al. Pre- and post-synaptic cortical cholinergic deficits are proportional to amyloid plaque presence and density at preclinical stages of Alzheimer’s disease. Acta Neuropathol 122, 49–60 (2011). https://doi.org/10.1007/s00401-011-0831-1
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DOI: https://doi.org/10.1007/s00401-011-0831-1