Brain excitability and connectivity of neuronal assemblies in Alzheimer's disease: From animal models to human findings

The human brain contains about 100 billion neurons forming an intricate network of innumerable connections, which continuously adapt and rewire themselves following inputs from external and internal environments as well as the physiological synaptic, dendritic and axonal sculpture during brain maturation and throughout the life span.Growing evidence supports the idea that Alzheimer's disease (AD) targets selected and functionally connected neuronal networks and, specifically, their synaptic terminals, affecting brain connectivity well before producing neuronal loss and compartmental atrophy.The understanding of the molecular mechanisms underlying the dismantling of neuronal circuits and the implementation of ‘clinically oriented’ methods to map-out the dynamic interactions amongst neuronal assemblies will enhance early/pre-symptomatic diagnosis and monitoring of disease progression. More important, this will open the avenues to innovative treatments, bridging the gap between molecular mechanisms and the variety of symptoms forming disease phenotype.In the present review a set of evidence supports the idea that altered brain connectivity, exhausted neural plasticity and aberrant neuronal activity are facets of the same coin linked to age-related neurodegenerative dementia of Alzheimer type.Investigating their respective roles in AD pathophysiology will help in translating findings from basic research to clinical applications.

► Early synaptic loss and dysfunction preceding plaque, tangle formation and neuronal loss, are the probable basis of cognitive impairment in AD.
► The pathological accumulation of oligomeric Aβ induces synaptic dysfunction and it elicits aberrant patterns of neuronal circuit activity.
► AD as disconnection syndrome.
► Functional neuroimaging techniques as promising diagnostic tools in the detection of AD.