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Authors: Jellinger, Kurt A.

Article Type: Letter

DOI: 10.3233/JAD-2003-5308

Citation: Journal of Alzheimer's Disease, vol. 5, no. 3, pp. 247-250, 2003

Authors: Jellinger, Kurt A.

Article Type: Research Article

Abstract: The prevalence, morphology and pathogenesis of vascular dementia (VaD), recently termed vascular cognitive disorder (VCD), are a matter of discussion.VaD is suggested in 8–15% of cognitively impaired aged subjects. Its prevalence in autopsy series ranges from 0.03 to 58% (mean 8–15% in Western series, 22–35% in Japan). Neuropathology shows multifocal and/or diffuse lesions, ranging from lacunes and microinfarcts, often involving subcortical and strategically important brain areas (thalamus, frontobasal, limbic system), white matter lesions and hippocampal sclerosis to multi-infarct encephalopathy and diffuse post-ischemic lesions. They result from systemic, cardiac and local large and small vessel disease. Pathogenesis is multifactorial and pathophysiology …affects neuronal networks involved in cognition, behavior, execution and memory. Vascular lesions often coexist with Alzheimer's disease (AD) and other pathologies. Minor vascular lesions hardly contribute to cognitive decline in full-blown AD, while both mild Alzheimer pathology and small vessel disease interact synergistically. AD pathology is less severe in the presence of vascular lesions. The lesion pattern in “pure” VaD/VCD) related to microangiopathies differs from that in “mixed dementia” (AD + vascular encephalopathy), often associated with large infarcts, suggesting different pathogenesis. Due to the heterogeneity of cerebrovascular pathology and its causative factors, no validated neuropathologic criteria for VaD are currently available, and a large variability across laboratories still exists in morphologic examination procedures and techniques. Further prospective clinico-pathologic studies are needed to validate diagnostic criteria for VaD and to clarify the impact of vascular lesions on cognitive impairment. Show more

Keywords: Cerebral infarcts, large and small vessel disease, neuropathology, pathogenic factors, subcortical vascular lesions, vascular cognitive impairment, vascular dementia

DOI: 10.3233/JAD-2008-14110

Citation: Journal of Alzheimer's Disease, vol. 14, no. 1, pp. 107-123, 2008

Authors: Jellinger, Kurt A.

Article Type: Letter

DOI: 10.3233/JPD-240174

Citation: Journal of Parkinson's Disease, vol. 14, no. 5, pp. 1071-1072, 2024

Authors: Jellinger, Kurt A.

Article Type: Research Article

Abstract: A retrospective clinico-pathological study of a consecutive autopsy series of 1050 elderly demented individuals (mean age 83.4 ± 6.0 years; MMSE < 20) was performed. Clinical diagnoses were probable or possible Alzheimer disease (62.9%), nonspecific degenerative dementia (10.4%), vascular dementia (10%), Parkinson disease with dementia (9.5%), 1.5% mixed dementia, and 5.7% other disorders. At autopsy, 86% revealed Alzheimer-related pathology, but only 42.8% showed "pure" Alzheimer disease, with additional cerebrovascular lesions in 22.6% and Lewy body pathology in 10.8%, while among 660 cases of clinically suspected Alzheimer disease, Alzheimer pathology was seen in 93%, only 44.7% in "pure" form, and additional …vascular lesions and Lewy bodies in 27.7 and 10%, respectively. The non-Alzheimer cases included Huntington and Creutzfeldt-Jakob disease, frontotemporal dementias, and others. These and other recent data indicate that in patients with the clinical diagnosis of Alzheimer disease its combination with cerebrovascular lesions and Lewy body pathologies is rather frequent. Comparison of clinical and postmortem diagnoses revealed postmortem confirmation of Alzheimer disease in 93%, of mixed and vascular dementia in 60 and 52.3%, respectively. 78% of clinically suspected degenerative dementias were pathologically definite Alzheimer disease, while in the clinical Parkinson + dementia group dementia with Lewy bodies accounted for 35%, Parkinson+Alzheimer disease, and "pure" Alzheimer disease for 29%, each. A sample of 207 prospectively studied elderly showed significant negative correlation between the preterminal psychostatus assessed by MMSE and the neuritic Braak stages, with a broad "gray" zone of Alzheimer lesions in mildly to moderately demented subjects. Similar relations between CDR and Braak stages were seen in very old subjects. The present study and the results of other recent series indicate increasing agreement between clinical and autopsy diagnoses in demented aged individuals with variable accuracy rates for different forms of dementia disorders. Show more

Keywords: Dementia disorders, Alzheimer disease, clinico-pathological correlations, diagnostic accuracy rates

DOI: 10.3233/JAD-2006-9S308

Citation: Journal of Alzheimer's Disease, vol. 9, no. s3, pp. 61-70, 2006

Authors: Jellinger, Kurt A.

Article Type: Review Article

Abstract: Multiple system atrophy (MSA) is an orphan, fatal, adult-onset neurodegenerative disorder of uncertain etiology that is clinically characterized by various combinations of parkinsonism, cerebellar, autonomic, and motor dysfunction. MSA is an α-synucleinopathy with specific glioneuronal degeneration involving striatonigral, olivopontocerebellar, and autonomic nervous systems but also other parts of the central and peripheral nervous systems. The major clinical variants correlate with the morphologic phenotypes of striatonigral degeneration (MSA-P) and olivopontocerebellar atrophy (MSA-C). While our knowledge of the molecular pathogenesis of this devastating disease is still incomplete, updated consensus criteria and combined fluid and imaging biomarkers have increased its diagnostic accuracy. The …neuropathologic hallmark of this unique proteinopathy is the deposition of aberrant α-synuclein in both glia (mainly oligodendroglia) and neurons forming glial and neuronal cytoplasmic inclusions that cause cell dysfunction and demise. In addition, there is widespread demyelination, the pathogenesis of which is not fully understood. The pathogenesis of MSA is characterized by propagation of misfolded α-synuclein from neurons to oligodendroglia and cell-to-cell spreading in a “prion-like” manner, oxidative stress, proteasomal and mitochondrial dysfunction, dysregulation of myelin lipids, decreased neurotrophic factors, neuroinflammation, and energy failure. The combination of these mechanisms finally results in a system-specific pattern of neurodegeneration and a multisystem involvement that are specific for MSA. Despite several pharmacological approaches in MSA models, addressing these pathogenic mechanisms, no effective neuroprotective nor disease-modifying therapeutic strategies are currently available. Multidisciplinary research to elucidate the genetic and molecular background of the deleterious cycle of noxious processes, to develop reliable biomarkers and targets for effective treatment of this hitherto incurable disorder is urgently needed. Show more

Keywords: α-synuclein, diagnostic criteria, glio-neuronal degeneration, multiple system atrophy, oligodendroglial proteinopathy, pathogenesis, prion-like seeding

DOI: 10.3233/JAD-170397

Citation: Journal of Alzheimer's Disease, vol. 62, no. 3, pp. 1141-1179, 2018

Authors: Jellinger, Kurt A. | Attems, Johannes

Article Type: Research Article

Abstract: The prevalence of both Alzheimer's disease (AD) and vascular dementia (VaD) increase with advancing age, but epidemiologic data above age 85 are imprecise and inconsistent. A retrospective hospital-based study of the prevalence and pathology of VaD was performed in 1700 consecutive autopsy cases of demented elderly in Vienna, Austria (mean age 84.3 ± 5.4 SD; 90% over age 70). It assessed clinical and general autopsy data and neuropathology including immunohistochemistry. Neuropathologic diagnosis followed current consensus criteria. Four age groups (7th to 10th decade) were evaluated. “Pure” VaD (due to cerebrovascular disease without other pathologies; neuritic Braak stages 1.2–1.6) was observed …in 12.3% of the total cohort, decreasing between age 60 and 90+ from 15.0 to 8.7%. Morphologic subtypes (subcortical arteriosclerotic encephalopathy, multi-infarct encephalopathy, and strategic infarct dementia) showed no age-related differences. By contrast, AD (without concomitant pathologies; 45.6% of total), mixed dementia (AD + cerebrovascular encephalopathy; 5.5%), and AD with minor cerebrovascular lesions (22.3%) increased with age. The relative prevalence of AD + Lewy pathology (9.3%) remained fairly stable, whereas other dementias (5.0%) decreased significantly over age 90. 85% of the patients with "pure" VaD had histories of diabetes, 75% of stroke(s), 95% morphologic signs of hypertension, 65% myocardial infarction (recent and old ones), 97% cerebral hypertonic-arteriosclerotic microangiopathy (associated with cerebral amyloid angiopathy in 23%) and 90% severe atherosclerosis of large cerebral arteries. Similar autopsy findings were seen in mixed dementia (MIX) and in AD + minor cerebrovascular lesions. Major vascular lesions differed between VaD and MIX, VaD showing more than 60% subcortical infarcts, MIX only 43% such lesions. This retrograde hospital-based study using strict morphologic diagnostic criteria confirmed the existence of “pure” VaD in old age, with a tendency to decline after age 90, while AD and AD + cerebrovascular pathologies showed considerable age-related increase, and "pure" AD slightly decreasing after age 90. Show more

Keywords: Autopsy study, cerebral amyloid angiopathy, mixed dementia, multi-infarct dementia, subcortical arteriosclerotic encephalopathy, vascular dementia

DOI: 10.3233/JAD-2010-100603

Citation: Journal of Alzheimer's Disease, vol. 21, no. 4, pp. 1283-1293, 2010

Authors: Jellinger, Kurt A. | Stadelmann, Christine

Article Type: Research Article

Abstract: Progressive cell loss in specific neuronal populations is a pathological hallmark of neurodegenerative diseases, but its mechanisms remain unresolved. Apoptosis or alternative pathways of neuronal death have been discussed in Alzheimer disease (AD) and other disorders. However, DNA fragmentation in human brain as a sign of neuronal injury is too frequent to account for the continuous loss in these slowly progressive diseases. In autopsy cases of AD, Parkinson's disease (PD), related disorders, and age-matched controls, DNA fragmentation using the TUNEL method and an array of apoptosis-related proteins (ARP), proto-oncogenes, and activated caspase 3, the key enzyme of late-stage apoptosis, were …examined. In AD, a considerable number of hippocampal neurons and glial cells showed DNA fragmentation with a 3- to 6-fold increase related to amyloid deposits and neurofibrillary tangles, but only one in 2.600 to 5.650 neurons displayed apoptotic morphology and cytoplasmic immunoreactivity for activated caspase~3, whereas no neurons were labeled in age-matched controls. Caspase~3 immunoreactivity was seen in granules of cells with granulovacuolar degeneration, in around 25% In progressive supranuclear palsy, only single neurons but oligodendrocytes in brainstem, around 25% TUNEL-positive and expressed both ARPs and activated caspase 3. In PD, dementia with Lewy bodies, and multisystem atrophy (MSA), TUNEL-positivity and expression of ARPs or activated caspase~3 were only seen in microglia and oligodendrocytes with cytoplasmic inclusions in MSA, but not in neurons. These data provide evidence for extremely rare apoptotic neuronal death in AD and PSP compatible with the progression of neuronal degeneration in these chronic diseases. Apoptosis mainly involves reactive microglia and oligodendroglia, the latter occasionally involved by deposits of insoluble fibrillary proteins, while alternative mechanisms of neuronal death may occur. Susceptible cell populations in a proapoptotic environment, particularly in AD, show increased vulnerability towards metabolic or other noxious factors, with autophagy as a possible protective mechanism in early stages of programmed cell death. The intracellular cascade leading to cell death still awaits elucidation. Show more

Keywords: Alzheimer's disease, Parkinson's disease, programmed cell death, apoptose-related proteins, activated caspase-3

DOI: 10.3233/JAD-2001-3106

Citation: Journal of Alzheimer's Disease, vol. 3, no. 1, pp. 31-40, 2001

Authors: Rösler, Norbert | Wichart, Ildiko | Jellinger, Kurt A.

Article Type: Letter

DOI: 10.3233/JAD-2001-3611

Citation: Journal of Alzheimer's Disease, vol. 3, no. 6, pp. 599-600, 2001

Authors: Attems, Johannes | Lintner, Felix | Jellinger, Kurt. A.

Article Type: Research Article

Abstract: Olfactory dysfunction and tau pathology in the olfactory bulb increase with the severity of Alzheimer's disease. We report data of a postmortem study in the aged. 130 autopsy cases (81 female, 49 male, aged 61–102, mean 82.48 ± 4.35 SD) years, underwent a standardized neuropathological assessment with immunohistochemical study of tau pathology in the olfactory bulb and nerve and of Alzheimer's disease using established criteria including Braak staging. All cases of definite Alzheimer's disease (Braak stages 5 and 6) (n = 40) showed large numbers of neuropil threads and neurofibrillary tangles, with amyloid deposits in 32.5% and neuritic plaques in …one single case in the olfactory system. Braak stage 4 (n = 27) was associated with mild to moderate tau pathology in 85.2%, and amyloid plaques in 1.1%, Braak stage 3 (n = 28) with olfactory tau lesions in 37.0% and amyloid deposits in one single case, Braak stages 3 and 4 with olfactory tau lesions in 61.1%. Braak stage 2 (n = 15) showed olfactory tau pathology in 31.2%, whereas Braak stages 0 and 1 (n = 15) were all negative. The olfactory system tau score showed highly significant correlations with neuritic Braak stages in the brain, while both scores showed significant but low correlations with age. These data confirm previous studies demonstrating abundant tau pathology in the olfactory system in all definite Alzheimer's disease cases, in two-thirds of limbic Alzheimer's disease, and in almost one-third of non-demented elderly persons with Braak stage 2. There are strong correlations between tau pathology in the olfactory and limbic systems, both with similar increase in severity. Clinical dementia correlated with both Braak and olfactory system tau scores. Since the involvement of both systems is associated with a high risk of cognitive decline, future studies should validate the sensitivity of olfactory mucosa biopsies in the diagnosis of Alzheimer's disease. Show more

Keywords: olfactory system, tau pathology, Alzheimer disease, dementia

DOI: 10.3233/JAD-2005-7208

Citation: Journal of Alzheimer's Disease, vol. 7, no. 2, pp. 149-157, 2005

Authors: Jellinger, Kurt A. | Seppi, Klaus | Wenning, Gregor K.

Article Type: Letter

DOI: 10.3233/JAD-2002-4408

Citation: Journal of Alzheimer's Disease, vol. 4, no. 4, pp. 327-328, 2002