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Published in: Acta Neuropathologica 6/2020

Open Access 01-12-2020 | Alzheimer's Disease | Review

Cerebral blood flow decrease as an early pathological mechanism in Alzheimer's disease

Authors: Nils Korte, Ross Nortley, David Attwell

Published in: Acta Neuropathologica | Issue 6/2020

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Abstract

Therapies targeting late events in Alzheimer’s disease (AD), including aggregation of amyloid beta (Aβ) and hyperphosphorylated tau, have largely failed, probably because they are given after significant neuronal damage has occurred. Biomarkers suggest that the earliest event in AD is a decrease of cerebral blood flow (CBF). This is caused by constriction of capillaries by contractile pericytes, probably evoked by oligomeric Aβ. CBF is also reduced by neutrophil trapping in capillaries and clot formation, perhaps secondary to the capillary constriction. The fall in CBF potentiates neurodegeneration by upregulating the BACE1 enzyme that makes Aβ and by promoting tau hyperphosphorylation. Surprisingly, therefore, CBF reduction may play a crucial role in driving cognitive decline by initiating the amyloid cascade itself, or being caused by and amplifying Aβ production. Here, we review developments in this area that are neglected in current approaches to AD, with the aim of promoting novel mechanism-based therapeutic approaches.
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Metadata
Title
Cerebral blood flow decrease as an early pathological mechanism in Alzheimer's disease
Authors
Nils Korte
Ross Nortley
David Attwell
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Acta Neuropathologica / Issue 6/2020
Print ISSN: 0001-6322
Electronic ISSN: 1432-0533
DOI
https://doi.org/10.1007/s00401-020-02215-w

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