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Pathologic Heterogeneity of Alzheimer's Disease-Reply

William Bondareff, MD, PhD; Christopher Mountjoy, FRCPsych; Martin Roth, MD, ScD, FRCP, FRCPsych; Martin N. Rossor, MD, MRCP; Leslie L. Iversen, MA, PhD, FRS; Gavin P. Reynolds, PhD
Arch Gen Psychiatry. 1988;45(10):963. doi:10.1001/archpsyc.1988.01800340091015.
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Reply.—  Mann and colleagues counted nLC neurons in 46 patients with AD (mean age, 77.73 ±9.42 years). They found two groups: one with a mean neuronal loss of 70% and the other with a mean neuronal loss of 28%. This compares well with our description of AD-1 (with a 20% loss of nLC neurons) and AD-2 (with an 80% loss). While these findings suggest the subdivision of AD into two subtypes, our case for subdivision rests on more evidence; in particular, on differences in neocortical norepinephrine concentration, choline acetyltransferase activity, plaques, and tangles.Like Mann and associates, we found that although there were some dips in the distribution curve of nLC neuronal counts, clear modes could not be discerned. Discriminant function analyses, however, showed the existence of two groups, which were better differentiated by age at death than by loss of nLC neurons.Although it is not known with certainty


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