Congo red birefringent structures in the hypothalamus in senile dementia of the Alzheimer type

Serial cryostat sections of hypothalamus from four cases of Alzheimer-type dementia and four controls were stained with Congo red and examined for birefringence. Green birefringence and dichroism was associated with (a) neurofibrillary tangles, which were most numerous at the level of the tuberomammillary nucleus where they were found in large acetylcholinesterase-positive neurons; (b) neuropil processes within tangle fields; (c) a few plaque cores in the mammillary body; (d) spicules at the ependyma of the third ventricle, and (e) blood vessels. Birefringence (e) had different properties from (a) to (d) and was considered to be due to collagen. The ependymal spicules did not react with an antibody which recognized the tangles and neuropil processes. Each Alzheimer case had many more tangles than the control cases. Birefringence in (b)-(d) tended to be greater in the Alzheimer than in the control cases. This study confirms previous reports of large numbers of tangles in circumscribed areas of caudal hypothalamus in Alzheimer-type dementia and demonstrates that Congo red staining reveals abnormalities in hypothalamic structures (neuropil processes and ependyma) not demonstrated by other staining techniques.