Inhomogeneous distribution of Alzheimer pathology along the isocortical relief. Are cortical convolutions an Achilles heel of evolution?

Alzheimer's disease (AD) is neuropathologically characterized by neuritic plaques and neurofibrillary tangles. Progression of both plaques and tangles throughout the brain follows a hierarchical distribution which is defined by intrinsic cytoarchitectonic features and extrinsic connectivity patterns. What has less well been studied is how cortical convolutions influence the distribution of AD pathology. Here, the distribution of both plaques and tangles within subsulcal gyral components (fundi) to components forming their top regions at the subarachnoidal brain surface (crowns) by stereological methods in seven different cortical areas was systematically compared. Further, principle differences in cytoarchitectonic organization of cortical crowns and fundi that might provide the background for regionally selective vulnerability were attempted to identify. It was shown that both plaques and tangles were more prominent in sulcal fundi than gyri crowns. The differential distribution of pathology along convolutions corresponds to subgyral differences in the vascular network, GFAP-positive astrocytes and intracortical and subcortical connectivity. While the precise mechanisms accounting for these differences remain open, the presence of systematic inhomogeneities in the distribution of AD pathology along cortical convolutions indicates that the phylogenetic shaping of the cortex is associated with features that render the human brain vulnerable to AD pathology.