Focal pathology in the Edinger-Westphal nucleus explains pupillary hypersensitivity in Alzheimer's disease

Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02138, USA.
Acta Neuropathologica (Impact Factor: 10.76). 07/1999; 97(6):557-64. DOI: 10.1007/s004010051031
Source: PubMed


Patients who suffer from Alzheimer's disease (AD) and a sub-population of community-dwelling elders show an exaggerated pupillary reaction to dilute tropicamide, a cholinergic antagonist. This finding may serve as an early diagnostic marker of AD. Here we report a likely pathological basis for this hypersensitive pupillary response. Our observations indicate that the Edinger-Westphal nucleus (EW), a known center for the control of pupillary function, is a selective target of Alzheimer pathology early in the course of the disease. In all AD cases examined, the EW contained plaques and tangles. In contrast, the adjacent somatic portion of the oculomotor complex was virtually spared of pathology. Early pathology in the EW is likely to initiate a cascade of events that may give rise to pupillary hypersensitivity.

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    • "The nucleus of Edinger-Westphal is a selective target of Alzheimer pathology even in the early stages of the disease [28] [29]. Scinto et al. (1999) showed that the EW nucleus alone contained plaques and tangles in AD patients as well as a severe and selective neuronal loss, thus sparing the somatic portion of the third cranial nerve nucleus [29]. They addressed these findings congruent to the exaggerated pupillary reaction to Fig. 3. Three dimensional reconstructions from a fusiform small soma sized neuron (A) and a multipolar large soma sized (B) neuron of the Edinger-Westphal nucleus. "
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    ABSTRACT: Alzheimer’s disease (AD) is a heterogeneous neurodegenerative disorder, causing a progressive decline of intellectual faculties, impairment of behavior and social performance, and impairment of speech eloquence, associated with various neurological manifestations based on a variable neuropathological background. Edinger-Westphal nucleus is a selective target of Alzheimer pathology early in the course of the disease. We attempted to determine the morphological alterations of the dendrites and the dendritic spines in Edinger-Westphal nucleus of 7 cases that fulfilled the diagnostic criteria for Alzheimer’s disease. For the histological study, we applied (a) routine neuropathological techniques and (b) rapid Golgi method. We proceeded to 3D neuronal reconstruction for the estimation of dendritic and spinal changes in Alzheimer’s disease. The morphological and morphometric analysis revealed a substantial neuronal loss and synaptic alterations in Edinger-Westphal nucleus in all the cases of Alzheimer’s disease. Distal dendritic branches are prominently affected. The neuronal loss and alteration of the spines in Edinger-Westphal nucleus in Alzheimer’s disease may be related to the exaggerated pupillary reaction to cholinergic antagonists. Furthermore, the vulnerability of distal branches to Alzheimer’s disease might be related to neuroplasticity impairment.
    Folia Neuropathologica 08/2014; 52:(2):197-204. DOI:10.5114/fn.2014.43791 · 1.57 Impact Factor
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    • "In a histopathological observation in eight earlystage AD patients tangles and A␤-containing plaques were observed in the EW nucleus [3]. The EW nucleus represents the visceral portion of the oculomotor complex and in addition to its role in controlling pupillary constriction may mediate between the sympathetic and parasympathetic innervation of the iris musculature [3]. Moreover A␤ deposits were identified in the midbrain tectum and tegmentum area in AD, mixed AD, and Parkinson's disease patients [72]. "
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    ABSTRACT: It was investigated whether alterations of the pupil's light reflex might reflect Alzheimer's disease (AD) pathology. Changes in the pupil's system might be expected due to AD pathology present in the oculomotor system of the Edinger-Westphal nucleus, and a cholinergic deficit caused by degeneration of the nucleus basalis Meynert. A rather new method of repetitive light stimulation was applied assessing variations in pupil size, latency, and amplitude over time. We analyzed 44 healthy controls, 42 subjects with mild cognitive impairment (MCI), and 66 AD patients. AD and MCI showed a less pronounced pupil size decrease and amplitude increase over time than controls. A higher MMSE was associated with a higher increase of relative amplitude and greater decrease of latency in AD and MCI, and absolute amplitude increase in AD alone. Pupil size increase correlated with cerebrospinal fluid markers in AD. Summarized pupil light reflex is not stable under repetitive stimulation, but changes systematically and less pronounced in AD and MCI. Thus repetitive stimulation of the pupil's response potentially indicates AD pathology.
    Journal of Alzheimer's disease: JAD 07/2014; 42(4). DOI:10.3233/JAD-140969 · 4.15 Impact Factor
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    • "Some of the brain regions with significant QC/isoQC expression are known to be affected by pathogenic protein aggregation and neurodegeneration in AD. In particular, EWN and LC display profound neuronal loss (Bondareff et al., 1987; Rüb et al., 2001; Scinto et al., 1999, 2001). In humans, a substantial QC expression was demonstrated in EWN and in LC (Morawski et al., 2010). "
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    ABSTRACT: Glutaminyl cyclases (QCs) catalyze the formation of pyroglutamate (pGlu) from glutamine precursors at the N-terminus of a number of peptide hormones, neuropeptides and chemokines. This post-translational modification stabilizes these peptides, protects them from proteolytical degradation or is important for their biological activity. However, QC is also involved in a pathogenic pGlu modification of peptides accumulating in protein aggregation disorders such as Alzheimer's disease and familial Danish and familial British dementia. Its isoenzyme (isoQC) was shown to contribute to aspects of inflammation by pGlu-modifying and thereby stabilizing the monocyte chemoattractant protein CCL2. For the generation of respective animal models and for pharmacological treatment studies the characterization of the mouse strain and brain region-specific expression of QC and isoQC is indispensible. In order to address this issue, we used enzymatic activity assays and specific antibodies to detect both QC variants by immunohistochemistry in nine different mouse strains. Comparing different brain regions, the highest enzymatic QC/isoQC activity was detected in ventral brain, followed by cortex and hippocampus. Immunohistochemical stainings revealed that QC/isoQC activity in cortex mostly arises from isoQC expression. For most brain regions, the highest QC/isoQC activity was detected in C3H and FVB mice, whereas low QC/isoQC activity was present in CD1, SJL and C57 mice. Quantification of QC- and isoQC-immunoreactive cells by unbiased stereology revealed a higher abundance of isoQC- than of QC-immunoreactive neurons in Edinger-Westphal nucleus and in substantia nigra. In the locus coeruleus, however, there were comparable densities of QC- and of isoQC-immunoreactive neurons. These observations are of considerable importance with regard to the selection of appropriate mouse strains for the study of QC/isoQC relevance in mouse models of neurodegeneration and neuroinflammation and for the testing of therapeutical interventions in these models.
    International Journal of Developmental Neuroscience 05/2014; DOI:10.1016/j.ijdevneu.2014.05.008 · 2.58 Impact Factor
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