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Abstract
Objective To investigate the status of the basal forebrain cholinergic system in primary progressive aphasia (PPA) as justification for cholinergic therapy.
Methods A cohort of 36 brains from PPA participants with the neuropathology of Alzheimer disease (PPA-AD, n = 14) or frontotemporal lobar degeneration (PPA-tau, n = 12; PPA-TDP, n = 10) were used for semiquantitative rating of degeneration and gliosis of basal forebrain cholinergic neurons (BFCN). A subpopulation of 5 PPA-AD and 7 control brains underwent detailed analysis of BFCN pathology and cortical cholinergic axonal loss employing immunohistochemical and histochemical methods and stereologic analysis.
Results Semiquantitatively, 11 (∼80%) PPA-AD participants were rated as having moderate/severe BFCN loss and gliosis, whereas none of the PPA-tau and only 1 (10%) PPA-TDP participant received such a rating. Detailed analysis in the subpopulation of PPA-AD participants revealed substantial tangle formation, loss of BFCN, and degeneration of cortical cholinergic axons. Compared to controls, loss of p75 low affinity neurotrophin receptor-positive BFCN was detected in the PPA-AD participants (p < 0.01). Acetylcholinesterase-positive cholinergic axons in all cortical areas studied displayed loss in PPA-AD (p < 0.005–0.0001). The loss was more severe in the language-dominant left hemisphere and, within the left hemisphere, in language-affiliated cortical areas.
Conclusions Our results demonstrate prominent depletion of BFCN and cortical cholinergic axons in PPA-AD when compared with normal control or other neuropathologic variants of PPA. The demonstration of cholinergic denervation with an anatomy that fits the clinical picture suggests that cholinergic treatment is justified in patients with PPA who have positive AD biomarkers.
Glossary
- ACC=
- anterior cingulate cortex;
- AChE=
- acetylcholinesterase;
- AD=
- Alzheimer disease;
- AV-AD=
- amnestic variant of Alzheimer disease;
- BFCN=
- basal forebrain cholinergic neurons;
- BuChE=
- butyrylcholinesterase;
- ChEI=
- cholinesterase inhibitor;
- ENT=
- entorhinal cortex;
- FTLD=
- frontotemporal lobar degeneration;
- IFG=
- inferior frontal gyrus;
- IPL=
- inferior parietal lobule;
- MCI=
- mild cognitive impairment;
- nbM-Ch4=
- Ch4 neuronal group of the nucleus basalis of Meynert;
- PPA=
- primary progressive aphasia;
- PPA-AD=
- primary progressive aphasia with Alzheimer disease neuropathology;
- PPA-Tau=
- primary progressive aphasia with tauopathy;
- PPA-TDP=
- primary progressive aphasia with transactive response DNA binding protein-43;
- STG=
- superior temporal gyrus
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
- Received September 11, 2018.
- Accepted in final form November 28, 2018.
- © 2019 American Academy of Neurology
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