Brain regions from patients with or without Alzheimer disease (AD) were obtained within 2 hr of death and examined for indices of presynaptic cholinergic function. Consistent with loss of cholinergic projections, cerebral cortical areas involved in AD exhibited decreased choline acetyltransferase (acetyl-CoA:choline O-acetyltransferase, EC 2.3.1.6) activity. However, remaining nerve terminals in these regions displayed marked up-regulation of synaptosomal high affinity [3Hlcholine uptake, a result indicative of relative cholinergic hyperactivity. As choline uptake is also rate-limiting in acetylcholine biosynthesis, these rmdings have implications for both therapy and identification of causes contributing to neuronal death in AD.Alzheimer disease (AD), the leading cause of dementia and currently the fourth leading cause of death in the United States (1), is characterized by the abnormal presence of senile plaques and neurofibrillary tangles in the central nervous system. Neurochemically, the loss of cholinergic projections to the cerebral cortex is the hallmark characteristic ofAD and has served as a focus for studies of its etiology and therapy (2-9). Dietary supplementation with neurotransmitter precursors represents a useful approach to the management of neurodegenerative diseases. The most prominent example is Parkinson disease, in which many ofthe symptoms ofdopaminergic deficiency can be offset with L-dopa (10). In contrast, choline supplementation has proven to be only marginally successful in treating AD (2-9), suggesting either that cholinergic presynaptic function may be affected over and above the loss of terminals or, alternatively, that the clinical dementia is not due solely to cholinergic dysfunction (11-13).Acetylcholine synthesis proceeds via the active, highaffinity uptake of choline by the nerve terminal and subsequent conversion to acetylcholine by the enzyme choline acetyltransferase (ChAT; acetyl-CoA:choline O-acetyltransferase, EC 2.3.1.6). The uptake step is particularly important in that it is both rate-limiting and subject to regulation by neuronal impulse activity (14-16). However, this step has not generally been evaluated in studies with human tissues because fresh material is required to isolate viable nerve terminal particles (synaptosomes) that will maintain their uptake characteristics; the up-regulation of choline uptake associated with neural stimulation decays particularly rapidly postmortem (17, 18). The current study measures ChAT activity and synaptosomal [3H]choline uptake obtained from brain regions of AD and non-AD patients less than 2 hr after death. Because choline uptake, but not ChAT, is responsive to nerve stimulation, we have also assessed the uptake/ ChAT ratio as an index of activity corrected for the relative loss of nerve terminals caused by AD.
EXPERIMENTAL PROCEDURESPatient Selection and Diagnostic Criteria. Thirty-one patients from the Rapid Autopsy Program were included in this study: 22 with AD (one with coexisting Parkinson disease and one with co...