The synaptic organization of the neocortex in Alzheimer's disease

Alzheimer's disease (AD) is characterized by a progressive deterioration of cognitive functions. Recent studies have shown that, in addition to the classically described lesions (plaques and tangles) found in AD, this neurodegenerative disorder is characterized by neuronal and synaptic loss and by synapto-axonal pathology. Stepwise regression analysis has shown that the major correlate of cognitive deficiency is the synapse loss in the prefrontal cortex, contributing about 70% of the strength of the correlation with global psychometric tests. We review evidence that supports the theory that most of the synaptic loss in the neocortex is derived from loss of cortico-cortical associational input into the modules. This hypothesis also predicts that neuritic plaque formation in the neocortical modules could represent an aberrant sprouting reaction of associational fibers responding to abnormal growth stimuli or to local damage. On these bases, it is also proposed that the cellular substrate of AD pathology is synapto-axonal, while in certain other forms of dementia such as Creutzfeldt-Jacob disease (CJD) and HIV encephalitis (HIVE) it is primarily dendritic.