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Dementia With Cerebral Lewy Bodies: A Mesocortical Dopaminergic Defect?

Dementia With Cerebral Lewy Bodies: A Mesocortical Dopaminergic Defect? Abstract • We describe a patient with dementia who at postmortem examination was found to have Lewylike bodies throughout the cerebral cortex associated with typical Lewy bodies in the pigmented brainstem nuclei. Moderate numbers of senile plaques but no neurofibrillary tangles were found in the neopallium or in the limbic areas. A positive correlation was found between the distribution of the cortical Lewylike bodies and the proposed distribution of dopamine terminals in the cerebral cortex. Cell loss in the ventral tegmental area and the basal nucleus of Meynert suggest abnormalities in the dopaminergic and cholinergic innervation of the cerebral cortex. The relative lack of senile changes of Alzheimer type make these two proposed abnormalities a more plausible explanation for the dementia in this patient. References 1. Den Hartog Jager WA, Bethlem J: The distribution of Lewy bodies in the central and autonomic nervous system in idiopathic paralysis agitans . J Neurol Neurosurg Psychiatry 1960;23:283-290.Crossref 2. Ikeda K, Yoshimura T, Kato H: A case of idiopathic parkinsonism with many Lewy bodies in the cerebral cortex . No To Shinkei 1975;27:733-742. 3. Ikeda K, Hori A, Bode G: Progressive dementia with 'diffuse Lewy-type inclusions' in cerebral cortex: A case report . Arch Psychiatrie Nervenkrankheiten 1980;228:243-248.Crossref 4. Itoh T, Momma Y, Ogasawara N: An electron microscopic study on atypical presenile dementia with numerous Lewy bodies in the cerebral cortex . Folia Psychiatr Neurol Jpn 1982;36:99-106. 5. Kosaka K, Oyanagi S, Matsushita M, et al: Presenile dementia with Alzheimer-, Pick-, and Lewy-body changes . Acta Neuropathol 1976;36:221-233.Crossref 6. Kosaka K: Lewy bodies in the cerebral cortex: Report of three cases . Acta Neuropathol 1978;42:127-134.Crossref 7. Kosaka K, Mehraein P: Dementia-parkin-sonism syndrome with numerous Lewy bodies and senile plaques in cerebral cortex . Arch Psychiatrie Nervenkrankheiten 1979;226:241-250.Crossref 8. Okazaki H, Lipkin LE, Aronson SM: Diffuse introcytoplasmic ganglionic inclusions (Lewy type) associated with progressive dementia and quadriparesis in flexion . J Neuropathol Exp Neurol 1961;20:237-244.Crossref 9. Yagashita S, Itoh Y, Amano N, et al: Atypical senile dementia with widespread Lewy type inclusion in the cerebral cortex . Acta Neuropathol 1980;49:187-191.Crossref 10. Yoshimura M: Cortical changes in the parkinsonian brain: A contribution to the delineation of 'diffuse Lewy body disease.' J Neurol 1983;229:17-32.Crossref 11. Defendini R, Markesbery WR, Mastri AR, et al: Hallervorden-Spatz disease and infantile neuroaxonal dystrophy: Ultrastructural observations, anatomical pathology and nosology . J Neurol Sci 1973;20:7-23.Crossref 12. Vuia O: Neuroaxonal dystrophy: A juvenile-adult form . Clin Neurol Neurosurg 1977;79:305-315. 13. Williamson K, Sima AAF, Curry B, et al: Neuroaxonal dystrophy in young adults: A clinicopathologic study of two unrelated cases . Ann Neurol 1982;11:335-343.Crossref 14. Forno LS: Concentric hyalin intraneuronal inclusions of Lewy type in the brains of elderly persons (50 incidental cases): Relationship to parkinsonism . J Am Geriatr Soc 1969;17:557-575. 15. Ikeda K, Ikeda S, Yoshimura T, et al: Idiopathic parkinsonism with Lewy-type inclusions in cerebral cortex: A case report . Acta Neuropathol 1978;41:165-168.Crossref 16. Lipkin LE: Cytoplasmic inclusions in ganglion cells associated with parkinsonian states: A neurocellular change studied in 53 cases and 206 controls . Am J Pathol 1959;35:1117-1133. 17. Tomlinson BE: The aging brain , in Smith W, Cavanagh JB (eds): Recent Advances in Neuropathology . Edinburgh, Churchill Livingstone, 1979, pp 129-159. 18. Blackwood W, Corsellis J: Greenfield's Neuropathology , ed 3. London, Edward Arnold Publishers Ltd, 1976. 19. Boller F, Mizutani T, Roessman V, et al: Parkinson disease, dementia and Alzheimer disease: Clinicopathological correlations . Ann Neurol 1980;7:329-335.Crossref 20. Hakim AM, Mathieson G: Dementia in Parkinson's disease: A neuropathological study . Neurology 1979;29:1209-1214.Crossref 21. Ohama E, Ikuta F: Parkinson's disease: Distribution of Lewy bodies and monoamine neuron system . Acta Neuropathol 1976;34:311-319.Crossref 22. Lindvall O, Björklund A, Moore RY, et al: Mesencephalic dopamine neurons projecting to neocortex . Brain Res 1974;81:325-331.Crossref 23. Lindvall O, Björklund A, Divac I: Organization of mesencephalic dopamine neurons projecting to neocortex and septum , in Costa E, Gessa GL (eds): Advances in Biochemical Psychopharmacology . New York, Raven Press, 1977, vol 16, pp 39-46. 24. Marsden CD: Neurotransmitters and CNS disease: Basal ganglia disease . Lancet 1982;2:1141-1146.Crossref 25. Scatton B, Rouquier L, Javoy-Agid F, et al: Dopamine deficiency in the cerebral cortex in Parkinson's disease . Neurology 1982;32:1039-1040.Crossref 26. Javoy-Agid F, Agid Y: Is the mesocortical dopaminergic system involved in Parkinson disease? Neurology 1980;30:1326-1330.Crossref 27. Uhl GR, Hedreen C, Price DL: Parkinson's disease: Loss of pigmented cells from the ventral tegmental area, abstracted . Neurology 1983;33( (suppl 2) ):A131.Crossref 28. Le Moal M, Galey F, Cardo B: Behavioural effects of local injection of 6-hydroxydopamine in the ventral tegmentum in the rat: Possible role of the mesolimbic dopaminergic system . Brain Res 1975;88:190-194.Crossref 29. Scarnati E, Forchetti C, Ruggieri S, et al: Dopamine and dementia: An animal model with destruction of the mesocortical dopaminergic pathway: A preliminary study , in Amaducci L, Davison AN, Antuono P (eds): Aging of the Brain and Dementia . New York, Raven Press, 1980, vol 13: Aging, pp 139-145. 30. Davies P: An update on the neurochemistry of Alzheimer disease . Adv Neurol 1983;38:25-86. 31. Bowen DM, Smith CB, White P, et al: Neurotransmitter-related enzymes and indices of hypoxia in senile dementia and other abiotrophies . Brain 1976;99:459-495.Crossref 32. Davies P, Maloney AJF: Selective loss of central cholinergic neurons in Alzheimer disease . Lancet 1976;2:1403.Crossref 33. Perry EK, Perry RH, Blessed G, et al: Necropsy evidence of central cholinergic deficits in senile dementia . Lancet 1977;1:189.Crossref 34. Sims NR, Bowen DM, Davison AN: (14C) Acetylcholine synthesis and (14C) carbon dioxide production from (U-14C) glucose by tissue prisms from human neocortex . Biochem J 1981;196:867-876. 35. Whitehouse PJ, Price DL, Clark AW, et al: Alzheimer's disease: Evidence for selective loss of cholinergic neurons in the nucleus basalis . Ann Neurol 1981;10:122-126.Crossref 36. Forno LS, Barbour PJ, Norville RL: Presenile dementia with Lewy bodies and neurofibrillary tangles . Arch Neurol 1978;35:818-822.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Dementia With Cerebral Lewy Bodies: A Mesocortical Dopaminergic Defect?

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1986.00520050094034
Publisher site
See Article on Publisher Site

Abstract

Abstract • We describe a patient with dementia who at postmortem examination was found to have Lewylike bodies throughout the cerebral cortex associated with typical Lewy bodies in the pigmented brainstem nuclei. Moderate numbers of senile plaques but no neurofibrillary tangles were found in the neopallium or in the limbic areas. A positive correlation was found between the distribution of the cortical Lewylike bodies and the proposed distribution of dopamine terminals in the cerebral cortex. Cell loss in the ventral tegmental area and the basal nucleus of Meynert suggest abnormalities in the dopaminergic and cholinergic innervation of the cerebral cortex. The relative lack of senile changes of Alzheimer type make these two proposed abnormalities a more plausible explanation for the dementia in this patient. References 1. Den Hartog Jager WA, Bethlem J: The distribution of Lewy bodies in the central and autonomic nervous system in idiopathic paralysis agitans . J Neurol Neurosurg Psychiatry 1960;23:283-290.Crossref 2. Ikeda K, Yoshimura T, Kato H: A case of idiopathic parkinsonism with many Lewy bodies in the cerebral cortex . No To Shinkei 1975;27:733-742. 3. Ikeda K, Hori A, Bode G: Progressive dementia with 'diffuse Lewy-type inclusions' in cerebral cortex: A case report . Arch Psychiatrie Nervenkrankheiten 1980;228:243-248.Crossref 4. Itoh T, Momma Y, Ogasawara N: An electron microscopic study on atypical presenile dementia with numerous Lewy bodies in the cerebral cortex . Folia Psychiatr Neurol Jpn 1982;36:99-106. 5. Kosaka K, Oyanagi S, Matsushita M, et al: Presenile dementia with Alzheimer-, Pick-, and Lewy-body changes . Acta Neuropathol 1976;36:221-233.Crossref 6. Kosaka K: Lewy bodies in the cerebral cortex: Report of three cases . Acta Neuropathol 1978;42:127-134.Crossref 7. Kosaka K, Mehraein P: Dementia-parkin-sonism syndrome with numerous Lewy bodies and senile plaques in cerebral cortex . Arch Psychiatrie Nervenkrankheiten 1979;226:241-250.Crossref 8. Okazaki H, Lipkin LE, Aronson SM: Diffuse introcytoplasmic ganglionic inclusions (Lewy type) associated with progressive dementia and quadriparesis in flexion . J Neuropathol Exp Neurol 1961;20:237-244.Crossref 9. Yagashita S, Itoh Y, Amano N, et al: Atypical senile dementia with widespread Lewy type inclusion in the cerebral cortex . Acta Neuropathol 1980;49:187-191.Crossref 10. Yoshimura M: Cortical changes in the parkinsonian brain: A contribution to the delineation of 'diffuse Lewy body disease.' J Neurol 1983;229:17-32.Crossref 11. Defendini R, Markesbery WR, Mastri AR, et al: Hallervorden-Spatz disease and infantile neuroaxonal dystrophy: Ultrastructural observations, anatomical pathology and nosology . J Neurol Sci 1973;20:7-23.Crossref 12. Vuia O: Neuroaxonal dystrophy: A juvenile-adult form . Clin Neurol Neurosurg 1977;79:305-315. 13. Williamson K, Sima AAF, Curry B, et al: Neuroaxonal dystrophy in young adults: A clinicopathologic study of two unrelated cases . Ann Neurol 1982;11:335-343.Crossref 14. Forno LS: Concentric hyalin intraneuronal inclusions of Lewy type in the brains of elderly persons (50 incidental cases): Relationship to parkinsonism . J Am Geriatr Soc 1969;17:557-575. 15. Ikeda K, Ikeda S, Yoshimura T, et al: Idiopathic parkinsonism with Lewy-type inclusions in cerebral cortex: A case report . Acta Neuropathol 1978;41:165-168.Crossref 16. Lipkin LE: Cytoplasmic inclusions in ganglion cells associated with parkinsonian states: A neurocellular change studied in 53 cases and 206 controls . Am J Pathol 1959;35:1117-1133. 17. Tomlinson BE: The aging brain , in Smith W, Cavanagh JB (eds): Recent Advances in Neuropathology . Edinburgh, Churchill Livingstone, 1979, pp 129-159. 18. Blackwood W, Corsellis J: Greenfield's Neuropathology , ed 3. London, Edward Arnold Publishers Ltd, 1976. 19. Boller F, Mizutani T, Roessman V, et al: Parkinson disease, dementia and Alzheimer disease: Clinicopathological correlations . Ann Neurol 1980;7:329-335.Crossref 20. Hakim AM, Mathieson G: Dementia in Parkinson's disease: A neuropathological study . Neurology 1979;29:1209-1214.Crossref 21. Ohama E, Ikuta F: Parkinson's disease: Distribution of Lewy bodies and monoamine neuron system . Acta Neuropathol 1976;34:311-319.Crossref 22. Lindvall O, Björklund A, Moore RY, et al: Mesencephalic dopamine neurons projecting to neocortex . Brain Res 1974;81:325-331.Crossref 23. Lindvall O, Björklund A, Divac I: Organization of mesencephalic dopamine neurons projecting to neocortex and septum , in Costa E, Gessa GL (eds): Advances in Biochemical Psychopharmacology . New York, Raven Press, 1977, vol 16, pp 39-46. 24. Marsden CD: Neurotransmitters and CNS disease: Basal ganglia disease . Lancet 1982;2:1141-1146.Crossref 25. Scatton B, Rouquier L, Javoy-Agid F, et al: Dopamine deficiency in the cerebral cortex in Parkinson's disease . Neurology 1982;32:1039-1040.Crossref 26. Javoy-Agid F, Agid Y: Is the mesocortical dopaminergic system involved in Parkinson disease? Neurology 1980;30:1326-1330.Crossref 27. Uhl GR, Hedreen C, Price DL: Parkinson's disease: Loss of pigmented cells from the ventral tegmental area, abstracted . Neurology 1983;33( (suppl 2) ):A131.Crossref 28. Le Moal M, Galey F, Cardo B: Behavioural effects of local injection of 6-hydroxydopamine in the ventral tegmentum in the rat: Possible role of the mesolimbic dopaminergic system . Brain Res 1975;88:190-194.Crossref 29. Scarnati E, Forchetti C, Ruggieri S, et al: Dopamine and dementia: An animal model with destruction of the mesocortical dopaminergic pathway: A preliminary study , in Amaducci L, Davison AN, Antuono P (eds): Aging of the Brain and Dementia . New York, Raven Press, 1980, vol 13: Aging, pp 139-145. 30. Davies P: An update on the neurochemistry of Alzheimer disease . Adv Neurol 1983;38:25-86. 31. Bowen DM, Smith CB, White P, et al: Neurotransmitter-related enzymes and indices of hypoxia in senile dementia and other abiotrophies . Brain 1976;99:459-495.Crossref 32. Davies P, Maloney AJF: Selective loss of central cholinergic neurons in Alzheimer disease . Lancet 1976;2:1403.Crossref 33. Perry EK, Perry RH, Blessed G, et al: Necropsy evidence of central cholinergic deficits in senile dementia . Lancet 1977;1:189.Crossref 34. Sims NR, Bowen DM, Davison AN: (14C) Acetylcholine synthesis and (14C) carbon dioxide production from (U-14C) glucose by tissue prisms from human neocortex . Biochem J 1981;196:867-876. 35. Whitehouse PJ, Price DL, Clark AW, et al: Alzheimer's disease: Evidence for selective loss of cholinergic neurons in the nucleus basalis . Ann Neurol 1981;10:122-126.Crossref 36. Forno LS, Barbour PJ, Norville RL: Presenile dementia with Lewy bodies and neurofibrillary tangles . Arch Neurol 1978;35:818-822.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: May 1, 1986

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