Article Text

Download PDFPDF
The basal ganglia cholinergic neurochemistry of progressive supranuclear palsy and other neurodegenerative diseases
  1. N M Warren1,
  2. M A Piggott1,
  3. A J Lees2,
  4. D J Burn1
  1. 1Institute for Ageing and Health, Newcastle University, New Castle upon Tyne, UK
  2. 2Sara Koe PSP Research Centre, London, UK
  1. Correspondence to:
 Dr N M Warren
 Specialist Registrar in Neurology, c/o Professor D J Burn, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK; naomiwarren{at}


Background: Progressive supranuclear palsy (PSP) is a progressive neurodegenerative disorder involving motor and cognitive dysfunction. Currently, there is no effective treatment either for symptomatic relief or disease modification. This relates, in part, to a lack of knowledge of the underlying neurochemical abnormalities, including cholinergic receptor status in the basal ganglia.

Aim: To measure muscarinic M2 and M4 receptors in the basal ganglia in PSP.

Methods: The muscarinic M2 (presynaptic) and M4 (postsynaptic) receptors in the striatum, pallidum and adjacent insular cortex were autoradiographically measured in pathologically confirmed cases of PSP (n = 18), and compared with cases of Lewy body dementias (LBDs; n = 45), Alzheimer’s disease (AD; n = 39) and controls (n = 50).

Results: In cases of PSP, there was a reduction in M2 and M4 receptors in the posterior caudate and putamen compared to controls, but no significant changes in the pallidum. Cases with AD showed lower M2 receptors in the posterior striatum. Groups with LBD and AD showed higher M2 binding in the insular cortex compared with controls.

Conclusions: The results suggest loss of posterior striatal cholinergic interneurones in PSP, and reduction in medium spiny projection neurones bearing M4 receptors. These results should be taken in the context of more widespread pathology in PSP, but may have implications for future trials of cholinergic treatments.

  • ACh, acetylcholine
  • AD, Alzheimer’s disease
  • DLB, dementia with Lewy bodies
  • GPe, external globus pallidus
  • GPi, internal globus pallidus
  • LBD, Lewy body dementia
  • PD, Parkinson’s disease
  • PDD, Parkinson’s disease with dementia
  • PM, post mortem
  • PSP, progressive supranuclear palsy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Published Online First 18 December 2006

  • Funding: NMW was sponsored by the PSP (Europe) Association.

  • Competing interests: None declared.