The olfactory bulb in Alzheimer disease: a morphologic study of neuron loss, tangles, and senile plaques in relation to olfaction.

Complete pairs of olfactory bulbs of six Alzheimer disease (AD) patients and of six age- and sex-matched controls were morphologically investigated using a random systematic sampling procedure. The total number of cells and the number of mitral cells were the same for controls and patients, but the volume of the bulb and the number of neurons in the anterior olfactory nucleus (AON) were decreased in AD patients. The loss of AON neurons was limited to the younger AD patients and was very severe (75%). Neurofibrillary tangles (NFT) and senile plaques (SP) were found in controls, but they were more frequent in AD, especially in the younger cases. A new finding was the occurrence of very large numbers of so-called diffuse or "very primitive plaques" with the methenamine-silver stain (MS-SP). NFT and SP were limited to the AON but MS-SP also occurred in other parts of the bulb. The data are discussed in relation to olfaction, and it was concluded that odor identification is processed in central rather than in peripheral olfactory structures.