Locations of Remorse and Homelands of Resilience: Notes on Grief and Sense of Loss of Place of Latino and Irish-American Caregivers of Demented Elders

In this essay, based on qualitative research with Latino and Irish-American caregivers of demented elders, we argue that spatially and culturally constituted definitions of personhood, the moral life, and justice shape perceptions of normative aging, the agency of the demented persons and their place in the community, the appropriate care of the aged and demented, as well as partially determine the concrete resources which will be available to elders and their families. We review how ties to homelands and neighborhood institutions act as mediators and shapers of anticipatory grief, caregiver burdens, and caregiver resources, serving as a buffer against exhaustion and despair for some families (primarily the Irish-American sample), and as an additional site of loss or stress for others (primarily the Latino sample).     

Hippocampal tin,aluminum and zinc in Alzheimer's disease

The use of inductively coupled plasma source mass spectrometry (ICP-MS) for multi-element analysis has led to the observation, in two separate studies, of increased blood tin in Alzheimer's disease (AD). We have therefore applied the technique of ICP-MS to hippocampal tissues obtained post-mortem from patients with AD and from controls. There was no significant difference in tin concentrations in AD. There were increased concentrations of aluminum and silicon, and reduced concentrations of zinc and selenium. It is postulated that displacement of hippocampal zinc by heavy metals may be important in producing clinical memory disturbance. However, analysis of the CA1 region, rather than of the dentate gyrus, would have been preferable.     

The amyloid hypothesis for Alzheimer's disease: a critical reappraisal

The amyloid hypothesis has been the basis for most work on the pathogenesis of Alzheimer's disease. Recent clinical trials based on this hypothesis have been inconclusive. In this article I review the current status of the hypothesis and suggest that a major scientific need is to understand the normal function of amyloid-β precursor protein (APP) and think how this may relate to the cell death in the disease process.     

Cortical Substance P-Like Immunoreactivity in Cases of Alzheimer's Disease and Senile Dementia of the Alzheimer Type

Abstract: The concentration of substance P-like immunoreactive material (SPLI) and somatostatin-like immunoreactive material (SLI) and the activity of acetyl-CoA: choline- O -acetyltransferase (ChAT; EC 2.3.1.6.) were measured in eight brain regions of 13 normal patients and 12 patients with Alzheimer disease/senile dementia of the Alzheimer type (AD/SDAT). SPLI was significantly lower in five of eight regions in the patients with AD/SDAT. Younger patients with AD/SDAT had significantly lower SLI in the parietal cortex than older patients. ChAT activity and SPLI in the parietal cortex of the presenile patients with ADISDAT were not significantly different from values found in older patients.     

Transferrin and Iron in Normal, Alzheimer's Disease, and Parkinson's Disease Brain Regions

Abstract: Oxidant-mediated damage is suspected to be involved in the pathogenesis of several neurodegenerative disorders. Iron promotes conversion of hydrogen peroxide to hydroxyl radical and, thus, may contribute to oxidant stress. We measured iron and its transport protein transferrin in caudate, putamen, globus pallidus, substantia nigra, and frontal cortex of subjects with Alzheimer's disease (n = 14) and Parkinson's disease (n = 14), and in younger adult (n = 8) and elderly (n = 8) normal controls. Although there were no differences between control groups with regard to concentrations of iron and transferrin, iron was significantly increased ( p < 0.05) in Alzheimer's disease globus pallidus and frontal cortex and Parkinson's disease globus pallidus, and transferrin was significantly increased in Alzheimer's disease frontal cortex, compared with elderly controls. The transferrin/iron ratio, a measure of iron mobilization capacity, was decreased in globus pallidus and caudate in both disorders. Regional transferrin and iron concentrations were generally more highly correlated (Pearson's correlation coefficient) in elderly controls than in Alzheimer's and Parkinson's disease. The altered relationship between iron and transferrin provides further evidence that a disturbance in iron metabolism may be involved in both disorders.     

Immunological aspects of microglia: relevance to Alzheimer's disease

Alzheimer's disease (AD) is a progressive dementing neurologic illness, and the most frequent cause of dementia in the elderly. Neuritic plaques are one of the main neuropathological findings in AD, and the major protein component is the β-amyloid protein (Aβ). Another striking feature of neuritic plaques is the presence of activated microglia, cytokines, and complement components, suggestive of “inflammatory foci” within AD brain. In this review, we will examine the mechanisms by which microglia become activated in AD, emphasizing the role in the Aβ protein and proinflammatory cytokines. As well, pathways for suppression of microglial activation by immunosuppressive cytokines will be described. Inflammation mediated by activated microglia is an important component of AD pathophysiology, and strategies to control this response could provide new therapeutic approaches for the treatment of AD.     

Cadmium in blood in Alzheimer's disease and non-demented subjects: results from a population-based study

Blood cadmium concentrations were studied in Alzheimer's disease (AD) and non-demented subjects. The 29 individuals were randomized from the ongoing population survey on ageing and dementia in Stockholm, the Kungsholmen Project. Smokers had, as expected, higher cadmium levels than non-smokers. Cadmium concentrations in blood were related to diastolic blood pressure in non-smoking, non-demented individuals. In contrast to previous reports no differences in blood cadmium levels were found between AD sufferers and non-demented subjects. Furthermore, there were no correlations between cadmium levels in blood and age or cognitive functions. The importance of quality assurance in sample collection and analysis of cadmium as well as scrutinizing smoking habits is emphasized.     

Platelet MAO-B Activity and Serotonin Content in Patients with Dementia: Effect of Age,Medication, and Disease

This study aimed at determining the effect of drug therapy, age and type of dementia on biological markers. Both platelet monoamine oxidase type B (MAO-B) activity and serotonin content of 57 demented patients and 20 control subjects were determined. Platelet MAO-B activity was measured using [¹⁴C]tyramine as substrate. Serotonin content was determined by HPLC-EC method. Increased platelet serotonin content and platelet count was found in patients with dementia compared to controls. A positive correlation was experienced between platelet MAO-B activity, platelet serotonin content and age. Platelet MAO-B activity was higher in the haloperidol treated group, compared with patients treated with anxyolitics. The main original finding of the present study is that platelet serotonin content is increased in demented patients with delusions compared to dementia without complications (p = 0.006). It seems, that platelet MAO-B activity is influenced mainly by drug therapy, while serotonin content rather reflects clinical characteristics in dementia.     

Loss of glutaminase-positive cortical neurons in Alzheimer's disease

Phosphate activated glutaminase (PAG) was evaluated in the neocortex of Alzheimer and control cases. Consistent with previously reported results in rat cerebral cortex, pyramidal cells were stained immunohistochemically by a PAG specific polyclonal rabbit antibody, especially in layers II, III and V. An Alzheimer's case showed drastic depletion of PAG-positive pyramidal neurons, especially in layers II and III. Cortical PAG levels by biochemical assay were reduced to 18% of control in a small series of Alzheimer's cases (n=3), while choline acetyltransferase (ChAT) was reduced to 28% of control in the same tissue samples. PAG staining was also observed in large neurons of the rat neostriatum. Double immunostaining for PAG and ChAT established that these large neurons also contained both enzymes.Special issue dedicated to Dr. Elling Kvamme     

Characterisation, Density, and Distribution of Kainate Receptors in Normal and Alzheimer's Diseased Human Brain

The specific binding of [3H]kainic acid was investigated in membrane preparations from human parietal cortex obtained postmortem. Saturation studies revealed that binding occurred to a single population of sites with a KD of 15 nM and a Bmax of 110 fmol/mg of protein. The kinetically determined dissociation constant for these sites agreed well with that obtained from saturation analyses. Pharmacological characterisation of these sites gave a profile consistent with those reported for kainate receptor sites in animal brain. The integrity of kainate receptors was studied in several brain regions from six patients who had died of Alzheimer's disease and from six closely matched control subjects. No change in either the affinity or the number of kainate receptors was seen in any of the regions studied, despite the loss of neocortical and hippocampal glutamatergic terminals in the Alzheimer's diseased brains, as previously reported.     

Septal networks: relevance to theta rhythm, epilepsy and Alzheimer's disease

Information processing and storing by brain networks requires a highly coordinated operation of multiple neuronal groups. The function of septal neurons is to modulate the activity of archicortical (e.g. hippocampal) and neocortical circuits. This modulation is necessary for the development and normal occurrence of rhythmical cortical activities that control the processing of sensory information and memory functions. Damage or degeneration of septal neurons results in abnormal information processing in cortical circuits and consequent brain dysfunction. Septal neurons not only provide the optimal levels of excitatory background to cortical structures, but they may also inhibit the occurrence of abnormal excitability states.     

Brain Expression of Apolipoproteins E, J, and A-I in Alzheimer's Disease

Abstract: Inheritance of the ε4 allele of apolipoprotein (apo) E is associated with increased risk of Alzheimer's disease (AD) and with increased β-amyloid peptide (Aβ) deposition in the cortex. Apo E is a member of a family of exchangeable apos, characterized by the presence of amphipathic α-helical segments that allow these molecules to act as surfactants on the surface of lipoprotein particles. Two members of this family, apo E and apo J, have been shown to bind soluble Aβ, and both are associated with senile plaques in the AD cortex. We now have studied the pattern of brain apo expression and found that five members of this class are present: apo A-I, A-IV, D, E, and J. By contrast, apos A-II, B, and C-II were not detectable. Immunohistochemistry revealed that, in addition to apo E and apo J, apo A-I immunostained occasional senile plaques in AD cortex. Immunoblot analysis showed no difference in the relative amounts of any of these apos in tissue homogenates of frontal lobe from AD or control patients. Comparison by APO E genotype showed no differences in the amount of apo E in brain among APO E ε3/3, ε3/4, or ε4/4 individuals; however, a significant decrease in the amount of apo J was associated with the APO E ε4 allele. No differences in apo J levels were detected in CSF samples of AD subjects. We propose that several members of the exchangeable apo family may interact with Aβ deposits in senile plaques through common amphipathic α-helical domains. Competition among these molecules for binding of Aβ or Aβ aggregates may influence the deposition of Aβ in senile plaques.     

Role of ghrelin system in neuroprotection and cognitive functions: implications in Alzheimer's disease

Alzheimer's disease (AD) is a multifactorial progressive neurodegenerative disorder characterized by loss of memory and cognitive deficits, strongly influenced by the metabolic status, in which the impairment of neuropeptides/neurotransmitters systems has been previously observed. Ghrelin is a multifunctional hormone produced in a wide variety of tissues, which has been associated with the progression of obesity and metabolic syndrome, but has been also linked to neuromodulation, neuroprotection and memory and learning processes. In addition, ghrelin system also acts in an autocrine/paracrine fashion where the majority of its components [ghrelin variants (native ghrelin, In1-ghrelin), acylation enzyme (GOAT) and receptors (GHS-Rs)] are expressed in the different regions of central nervous system. In spite of all these pieces of information strongly suggesting a close association between ghrelin system and AD, which could be of pathophysiological relevance, few studies have been addressed to clarify this relationship. In this work, the role of ghrelin system in neuroprotection, memory consolidation and learning is reviewed, and its influence in AD, as well as the regulation of its expression in the brain of AD patients, is discussed.     

Role of the endocannabinoid system in Alzheimer's disease: new perspectives

The role of the endocannabinoid system in several diseases is currently under intense study. Among these, Alzheimer's disease may be a new promising area of research. We have recently reported the existence of profound changes in the location and density of several elements of this system in Alzheimer's disease tissue samples, indicating that a non-neuronal endocannabinoid system is up-regulated in activated glia. Additional data from other groups suggest that glial cells may be important elements in the regulation of endocannabinoid system activity, both in health as in disease. Some of these aspects are briefly discussed in the present review.     

Reduction of glyceraldehyde-3-phosphate dehydrogenase activity in Alzheimer's disease and in Huntington's disease fibroblasts

New functions have been identified for glyceraldehyde-3-phosphate dehydrogenase (GAPDH) including its role in neurodegenerative disease and in apoptosis. GAPDH binds specifically to proteins implicated in the pathogenesis of a variety of neurodegenerative disorders including the beta-amyloid precursor protein and the huntingtin protein. However, the pathophysiological significance of such interactions is unknown. In accordance with published data, our initial results indicated there was no measurable difference in GAPDH glycolytic activity in crude whole-cell sonicates of Alzheimer's and Huntington's disease fibroblasts. However, subcellular-specific GAPDH-protein interactions resulting in diminution of GAPDH glycolytic activity may be disrupted or masked in whole-cell preparations. For that reason, we examined GAPDH glycolytic activity as well as GAPDH-protein distribution as a function of its subcellular localization in 12 separate cell strains. We now report evidence of an impairment of GAPDH glycolytic function in Alzheimer's and Huntington's disease subcellular fractions despite unchanged gene expression. In the postnuclear fraction, GAPDH was 27% less glycolytically active in Alzheimer's cells as compared with age-matched controls. In the nuclear fraction, deficits of 27% and 33% in GAPDH function were observed in Alzheimer's and Huntington's disease, respectively. This evidence supports a functional role for GAPDH in neurodegenerative diseases. The possibility is considered that GAPDH:neuronal protein interaction may affect its functional diversity including energy production and as well as its role in apoptosis.     

Actigraphic sleep-wake patterns and urinary 6-sulfatoxymelatonin excretion in patients with Alzheimer's disease

Recent studies suggest melatonin, due to its antioxidant and free-radical- scavenging actions, may play a role in the neuroprotection against amyloid, which is implicated in the pathogenesis of Alzheimer's disease (AD). In this study, we determined urinary 6-sulfatoxymelatonin (aMT6s) excretion together with actigraphic sleep-wake patterns of untreated male patients with AD who lived at home. Results were compared with those obtained from normal age-matched elderly and normal young male subjects. Similar measurements were also performed in another group of patients with AD who were treated with a cholinesterase inhibitor (Donepezil, Aricept). Total 24h aMT6s values were significantly reduced in elderly controls (19.9h ± 5.2 μg/24h), in those with untreated AD (12.7 ± 4.4 μg/24h), and in patients treated for AD (12.4 ± 4.4 μ g/24h) compared with normal young men (32.8 ± 3.1 μ g/24h). A day-night difference in aMT6s was evident in all young controls, in 50% of elderly controls, in only 20% of patients with untreated AD, and in 67% of those with AD receiving Aricept. Sleep quality (expressed as sleep efficiency, wake time, and long undisturbed sleep duration) was better in young and elderly controls compared with the two groups of patients with AD. There was no significant correlation between aMT6s values or sleep patterns and the severity of cognitive impairment in patients with AD. Taken together, these data suggest that disrupted sleep, decreased melatonin production, and partial lack of day-night difference in melatonin secretion were observed equally in normal elderly and in patients with AD. Our results do not permit drawing any conclusion as to whether changes in urinary aMT6s excretion is correlated with disturbed sleep in patients with AD. (Chronobiology International, 18(3), 513-524, 2001)     

Membrane Instability, Plasmalogen Content, and Alzheimer's Disease

Abstract: The normal stability of the cell membrane bilayer depends on its lipid composition being appropriate to the ambient (physiological) temperature, T_p. Membrane lipid composition may be altered by disease such that the bilayer is only stable at a new critical temperature, T^⋆, which may differ from T_p. In Alzheimer's disease (AD) temporal cortex, a defect of lipid composition has previously been identified, namely, a decrease in the ratio of plasmalogen to nonplasmalogen ethanolamine glycerophospholipids. Furthermore, for AD temporal cortex neural membranes, T^⋆≪ T_p, a finding confirmed in the present study in a larger series than previously, using a new method for obtaining T^⋆. This inequality between T^⋆ and T_p has been proposed as a putative contributory pathogenetic mechanism leading to membrane destabilisation in AD brain. The plasmalogen deficiency could account for the change in T^⋆ in AD, as shown by experiments where T^⋆ was measured for artificial lipid mixtures simulating brain membranes with varying plasmalogen/nonplasmalogen ratios. The critical temperature was found to be very sensitive to small alterations in plasmalogen content.     

乙酰胆碱酯酶的非经典功能及其与A1zheimer's疾病的关系

乙酰胆碱酯酶（acetylcholinesterase,AChE)是主要存在于神经系统的一种水解酶,其经典功能是水解神经递质乙酰胆碱,从而终止神经冲动的传递。但是近年来,研究者发现许多证据表明它具有“非经典”的新功能,引起了人们的关注。除了水解神经递质乙酰胆碱的经典功能外,AChE对神经细胞的分化、迁移,突触的形成,造血系细胞和肿瘤细胞的增殖与分化调控也有作用。最近的研究结果显示：AChE可能在细胞凋亡过程中起重要作用,这对于认识Alzheimer‘s疾病（AD）的发病机理又有新的进步。     

Antibody-based approaches in Alzheimer's research: safety, pharmacokinetics, metabolism, and analytical tools

High morbidity, enormous socioeconomic costs, and lack of specific treatments emphasize the importance of research on protective therapies against Alzheimer's disease. The efficacy of anti-amyloid immunization strategies has been demonstrated preclinically, prompting the design of clinical studies. However, the detailed mechanisms of action of therapeutic antibodies, especially their influence on the complex amyloid β peptide (Aβ) metabolism and various Aβ-equilibria present both within and outside the CNS, are far from being clear. Furthermore, physiological Aβ metabolism is poorly understood and the analytical tools to characterize and quantify treatment effects on Aβ metabolism are suboptimal. Thus, the design of immunization strategies with optimized benefit-to-risk ratios for patients is subjected to significant obstacles. Indeed, an active immunization trial with Aβ was discontinued because of severe adverse effects. Anti-Aβ immunization protocols designed to attain high blood levels of antibodies bear the potential to induce brain inflammation and/or hemorrhage, thus directing the biomedical research towards development of more predictable therapies for minimizing the risk of adverse effects. The focus of this review is to summarize current knowledge of Aβ metabolism under physiological and antibody-based therapeutic conditions and to introduce a promising approach, namely the passive immunization using antibody fragments, which are characterized by entirely different pharmacokinetic and pharmacodynamic properties compared with conventional monoclonal antibodies.