A population-based study of the incidence of delusional infestation in Olmsted County, Minnesota, 1976-2010.

BACKGROUND: Delusional infestation (DI) is a well-recognized clinical entity but there is a paucity of reliable data concerning its epidemiology. Knowledge of the epidemiology is fundamental to an understanding of any disease and its implications. Epidemiology is most accurately assessed using population-based studies, which are most generalizable to the wider population in the U.S. and worldwide. To our knowledge, no population-based study of the epidemiology (particularly incidence) of DI has been reported to date. OBJECTIVES: To determine the incidence of delusional infestation (DI) using a population-based study. METHODS: Medical records of Olmsted County residents were reviewed using the resources of the Rochester Epidemiology Project to confirm the patient's status as a true incident case of DI and to gather demographic information. Patients with a first-time diagnosis of DI or synonymous conditions between 1 January 1976 and 31 December 2010 were considered incident cases. RESULTS: Of 470 identified possible diagnoses, 64 were true incident cases of DI in this population-based study. The age- and sex-adjusted incidence was 1·9 [95% confidence interval (CI) 1·5-2·4] per 100 000 person-years. Mean age at diagnosis was 61·4 years (range 9-92 years). The incidence of DI increased over the four decades from 1·6 (95% CI 0·6-2·6) per 100 000 person-years in 1976-1985 to 2·6 (95% CI 1·4-3·8) per 100 000 person-years in 2006-2010. CONCLUSIONS: Our data indicate that DI is a rare disease, with incidence increasing across the life span, especially after the age of 40 years.

Morphological basis of long-term habituation and sensitization in Aplysia.

The morphological basis of the persistent synaptic plasticity that underlies long-term habituation and sensitization of the gill withdrawal reflex in Aplysia californica was explored by examining the fine structure of sensory neuron presynaptic terminals (the critical site of plasticity for the short-term forms of both types of learning) in control animals and in animals whose behavior had been modified by training. The number, size, and vesicle complement of sensory neuron active zones were larger in animals showing long-term sensitization than in control animals and smaller in animals showing long-term habituation. These changes are likely to represent an anatomical substrate for the memory consolidation of these tasks.

Serotonin-mediated endocytosis of apCAM: an early step of learning-related synaptic growth in Aplysia.

The long-term facilitation of synaptic efficacy that is induced by serotonin in dissociated cell cultures of sensory and motor neurons of Aplysia is accompanied by the growth of new synaptic connections. This growth is associated with a down-regulation in the sensory neuron of Aplysia cell adhesion molecules (apCAMs). To examine the mechanisms of this down-regulation, thin-section electron microscopy was combined with immunolabeling by gold-conjugated monoclonal antibodies specific to apCAM. Within 1 hour, serotonin led to a 50% decrease in the density of gold-labeled complexes at the surface membrane of the sensory neuron. This down-regulation was achieved by a heterologous, protein synthesis-dependent activation of the endosomal pathway, which leads to internalization and apparent degradation of apCAM. The internalization is particularly prominent at sites where the processes of the sensory neurons contact one another and may act there to destabilize process-to-process contacts that normally inhibit growth. In turn, the endocytic activation may lead to a redistribution of membrane components to sites where new synapses form.

Inhibitors of protein and RNA synthesis block structural changes that accompany long-term heterosynaptic plasticity in Aplysia.

Synaptic connections between the sensory and motor neurons of Aplysia in culture undergo long-term facilitation in response to serotonin (5-HT) and long-term depression in response to FMRFamide. These long-term functional changes are dependent on the synthesis of macromolecules during the period in which the transmitter is applied and are accompanied by structural changes. There is an increase and a decrease, respectively, in the number of sensory neuron varicosities in response to 5-HT and FMRFamide. To determine whether macromolecular synthesis is also required for the structural changes, we examined in parallel the effects of inhibitors of protein (anisomycin) or RNA (actinomycin D) synthesis on the structural and functional changes. We have found that anisomycin and actinomycin D block both the enduring alterations in varicosity number and the long-lasting changes in synaptic potential. These results indicate that macromolecular synthesis is required for expression of the long-lasting structural changes in the sensory cells and that this synthesis is correlated with the long-term functional modulation of sensorimotor synapses.

5-HT and cAMP induce the formation of coated pits and vesicles and increase the expression of clathrin light chain in sensory neurons of aplysia.

In the course of studying proteins involved in long-term facilitation in Aplysia, we found that 5-HT and cAMP, a second messenger activated by 5-HT, lead to the removal of a set of N-CAM-related cell adhesion molecules (apCAMs) from the surface membrane of sensory neurons by means of receptor-mediated endocytosis. Here we describe that, as part of this coordinated program for endocytosis, 5-HT and cAMP also induce in the sensory neurons an increase in the density of coated pits and coated vesicles and an increase in the expression of the light chain of Aplysia clathrin (apClathrin). The clathrin-related endocytosis seems designed to internalize and redistribute apCAMs and other surface membrane proteins in the sensory neurons, and thus it appears to constitute one of the initial steps in the growth of new synaptic connections that accompanies long-term facilitation.

Mutation in the phosphorylation sites of MAP kinase blocks learning-related internalization of apCAM in Aplysia sensory neurons.

The synaptic growth that accompanies 5-HT-induced long-term facilitation of the sensory to motor neuron connection in Aplysia is associated with the internalization of apCAM at the surface membrane of the sensory neuron. We have now used epitope tags to examine the fate of each of the two apCAM isoforms (membrane bound and GPI-linked) and find that only the transmembrane form is internalized. This internalization can be blocked by overexpression of transmembrane constructs with a single point mutation in the two MAPK consensus sites, as well as by injection of a specific MAPK antagonist into sensory neurons. These data suggest MAPK phosphorylation at the membrane is important for the internalization of apCAMs and, thus, may represent an early regulatory step in the growth of new synaptic connections that accompanies long-term facilitation.

Tissue plasminogen activator contributes to the late phase of LTP and to synaptic growth in the hippocampal mossy fiber pathway.

The expression of tissue plasminogen activator (tPA) is increased during activity-dependent forms of synaptic plasticity. We have found that inhibitors of tPA inhibit the late phase of long-term potentiation (L-LTP) induced by either forskolin or tetanic stimulation in the hippocampal mossy fiber and Schaffer collateral pathways. Moreover, application of tPA enhances L-LTP induced by a single tetanus. Exposure of granule cells in culture to forskolin results in secretion of tPA, elongation of mossy fiber axons, and formation of new, active presynaptic varicosities contiguous to dendritic clusters of the glutamate receptor R1. These structural changes are blocked by tPA inhibitors and induced by application of tPA. Thus, tPA may be critically involved in the production of L-LTP and specifically in synaptic growth.

Association of neuroactive peptides with the protein secretory pathway in identified neurons of Aplysia californica: immunolocalization of SCPA and SCPB to the contents of dense-core vesicles and the trans face of the Golgi apparatus.

The subcellular distribution of two molluscan neuropeptides, the small cardioactive peptides A and B (SCPA and SCPB), has been determined in two identified Aplysia buccal ganglion neurons, B1 and B2. These neurons were previously shown to synthesize and release these neuropeptides. B1 and B2, identified by their size and location within the ganglion, were labeled by intrasomatic injection of an electron-dense particulate marker (ferritin or Imposil) permitting the unequivocal identification of their somata and proximal processes in thin sections. The somatic cytoplasm of both neurons had a conspicuous population of large dense-core vesicles along with a smaller number of compound vesicles and small lucent vesicles. All three vesicle types are found in the neurites within the neuropil and proximal axon in the esophageal nerve. Immunoreactivity was localized on the surface of thin sections by the indirect immunogold method. The primary antiserum was shown to recognize both SCPA and SCPB after the neuropeptides had been immobilized on protein-coated nitrocellulose membranes by means of glutaraldehyde, the primary fixative used to immobilize SCPA and SCPB in situ. SCP immunoreactivity was present in the lumens of the dense-core vesicles distributed throughout the cytoplasm of B1 and B2 and in dense-core regions of the Golgi apparatus in the somatic cytoplasm. Taken together with biochemical evidence that B1 and B2 synthesize and release SCPs, these data suggest that the neuropeptides are sequestered into the protein secretory pathway of B1 and B2, a distribution that supports the notion that the SCPs function physiologically as neurotransmitters or neuromodulators.

Morphological aspects of synaptic plasticity in Aplysia. An anatomical substrate for long-term memory.

The morphological basis of long-term sensitization of the gill-and-siphon withdrawal reflex in Aplysia was explored by examining the structure of identified sensory neuron synapses in control and behaviorally modified animals. Following long-term training, sensitized animals displayed an increase in the number of sensory neuron synapses compared to control animals. The relative permanence of these structural changes and their similarity in time course to the behavioral duration of sensitization suggest a role for synapse number changes during long-term memory.

Two different and compatible intraneuronal labels for ultrastructural study of synaptically related cells.

To examine the structural interactions between synaptically connected neurons in Aplysia, we have developed a method for simultaneously labeling two identified cell with different and compatible intraneuronal marking agents (horseradish peroxidase and [3H]N-acetyl-D-galactosamine) visible in both the light and electron microscopes. Combining these two agents within a single cell yields a third label.

Indented synapses in Aplysia.

A new type of synaptic contact has been found in Aplysia californica, in which a post-synaptic spine extensively invaginates the pre-synaptic element. The post-synaptic spine, usually less than 0.25 micrometer in diameter, may protrude up to 2 micrometer into the pre-synaptic element. In some instances a larger post-synaptic element indents and forms multiple thin projections into the pre-synaptic varicosity. Along or at the end of these projections a zone occurs at which the surface membranes of the two apposed synaptic elements are rigidly parallel, and the extracellular gap is approximately 60% greater than normal and contains a small amount of electron-dense material. Synaptic vesicles are concentrated against the pre-synaptic membrane in these regions. There are twice as many vesicles per unit area positioned against the membrane at these zones than at similar active zones occurring in the alternative type of synapse, which has a flat, rather than indented, geometry. Single pre-synaptic varicosities have been found to form both flat and indented synapses. These findings raise the possibility that these two forms of synapse may be dynamic transformations of each other, having differing synaptic effectiveness.

Uptake of [3H]serotonin in the abdominal ganglion of Aplysia californica. Further studies on the morphological and biochemical basis of presynaptic facilitation.

Sensitization of the gill-withdrawal reflex in Aplysia california is mediated, in part, by a group of identified neurons, the L29 cells, which produce presynaptic facilitation of transmitter release from siphon sensory neurons. Physiological and pharmacological studies have provided indirect evidence that the L29 cells are serotonergic. In the present study we have used the specific uptake [3H]serotonin ([3H]5-HT) and electron-microscopic autoradiography in combination with horseradish peroxidase-labeling of identified neurons to characterize the fine structure of Aplysia serotonergic terminals and to examine more directly the transmitter biochemistry of the L29 neurons. Abdominal ganglia were incubated for 2 h in 10(-6) M [3H]5-HT and thick and thin plastic sections examined with the light and electron microscope. L29 varicosities, identified by labeling with HRP, were found to accumulate [3H]5-HT. In addition, [3H]-5-HT was localized to unidentified varicosities within the neuropil as well as to vesicle-filled terminals that formed axosomatic contacts in the cortical regions of the ganglion. The processes that accumulated [3H]5-HT contained conspicuous dense core vesicles identical in morphology to those previously described for L29. Some processes were found to make contact with HRP-labeled varicosities of sensory neurons. Comparison with results obtained from ganglia exposed to [3H]5-HT in the presence of either non-radioactive 5-HT or non-radioactive dopamine indicate that the uptake process is transmitter-specific. These studies provide additional evidence that the L29 cells are serotonergic and are consistent with the notion that aminergic neurons may be preferentially involved in modulatory synaptic actions.

Ultrastructure of a histaminergic synapses in Aplysia.

The ultrastructure of histaminergic synaptic terminals was studied by the means of intrasomatic injection of horseradish peroxidase into the identified histaminergic neuron C2 of Aplysia. The axonal tree of C2 was found to consist, in part, of varicosities that display putative release sites similar in morphology to those described in other neurons in Aplysia. The varicosities contain at least two populations of vesicles: a conspicuous class of of large vesicles with an electron-dense core that almost fills the entire vesicle and a heterogeneous class of large and small electron-lucent vesicles. The small lucent vesicles preferentially cluster near active zones.

Structural changes and the storage of long-term memory in Aplysia.

Long-term memory for sensitization of the gill-withdrawal reflex in Aplysia is associated with the growth of new synaptic connections between sensory and motor neurons. The duration of this structural change parallels the behavioral retention of the memory. Such changes can be reconstituted in dissociated cell culture by repeated presentations of the modulatory neurotransmitter serotonin (5HT) and are associated with an activity-dependent downregulation of NCAM-related cell adhesion molecules thought to contribute to cell recognition and axonal outgrowth during development. Thus, aspects of the mechanisms utilized for learning-related synaptic growth initiated by experience in the adult may eventually be understood in the context of the molecular logic that shapes synaptic circuitry during the later stages of neuronal development.

Long-term memory in Aplysia modulates the total number of varicosities of single identified sensory neurons.

The morphological consequences of long-term habituation and sensitization of the gill withdrawal reflex in Aplysia california were explored by examining the total number of presynaptic varicosities of single identified sensory neurons (a critical site of plasticity for the biochemical and biophysical changes that underlie both types of learning) in control and behaviorally trained animals. Sensory neurons from habituated animals had 35% fewer synaptic varicosities than did sensory neurons from control animals. In contrast, sensory neurons from sensitized animals had twice as many varicosities per sensory neuron compared to controls, as well as enlarged neuropil arbors. These changes suggest that modulation of synapse number may play a role in the maintenance of long-term memory.

Morphological basis of short-term habituation in Aplysia.

We have explored the morphological basis of the synaptic depression that underlies short-term habituation of the gill-withdrawal reflex in Aplysia by examining the fine structure of the presynaptic terminals of identified sensory neurons--a critical site of plasticity for the biochemical and biophysical changes that underlie this elementary form of learning. The structure of sensory neuron synapses from control (unstimulated) cells was compared with that of sensory neuron synapses from cells in which synaptic transmission had been depressed by repeated activation. We focused our analysis, as we had in an earlier study of long-term memory (Bailey and Chen, 1983), on the morphology of active zones at sensory neuron synapses. We found that both the incidence and size of serially reconstructed active zones were not changed in cells exposed to short-term habituation. This contrasts sharply with the reduction in both the frequency and surface area of sensory neuron active zones that accompanies long-term habituation, and suggests that modulation of active zone number and size may be an anatomical correlate that lies in the long-term domain. A quantitative analysis of the relationship between the active zone and nearby vesicle populations revealed a possible morphological substrate for the homosynaptic depression that underlies short-term habituation. Habituation leads to a depletion of synaptic vesicles immediately adjacent to the active zone. The ratio of this readily releasable pool of vesicles to the total population of vesicles associated with the active zone is 28% for control terminals, but only 11.5% for habituated terminals.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term sensitization in Aplysia increases the number of presynaptic contacts onto the identified gill motor neuron L7.

We have used the gill and siphon withdrawal reflex of Aplysia to study the morphological basis of the persistent synaptic plasticity that underlies long-term sensitization. One critical locus for storage of the memory for sensitization is the set of monosynaptic connections between identified siphon sensory neurons and gill and siphon motor neurons. To complement previous morphological studies of the presynaptic terminals of identified sensory neurons, we examined the effects of long-term sensitization on the structure of an identified postsynaptic target--the gill motor neuron L7. We found an increase in the frequency, size, and vesicle complement of presynaptic contacts onto L7 processes in sensitized compared to control animals. Combined, these data indicate a striking increase in the percentage of the surface area of L7 that is occupied by synaptic contacts after long-term training. These results are consistent with our observations that sensitization produces an increase in the synapses that the sensory neurons make on their target cells and provide additional support for the hypothesis that changes in synapse number may represent a mechanism underlying long-term memory.

Structural plasticity at identified synapses during long-term memory in Aplysia.

We have used the gill- and siphon-withdrawal reflex of Aplysia californica to determine the morphological basis of the prolonged changes in synaptic effectiveness that underlie long-term habituation and sensitization. We have found that clear structural changes accompany behavioral modification and have demonstrated that these can be detected at the level of identified sensory neuron synapses, a critical site of plasticity for the short-term forms of both types of learning. These alterations occur at two different levels of synaptic organization and include (1) changes in focal regions of synaptic membrane specialization--the number, size and vesicle complement of sensory neuron active zones are larger in sensitized animals and smaller in habituated animals compared with controls--and (2) a parallel but more dramatic and global trend involving modulation of the total number of presynaptic varicosities per sensory neuron. Quantitative analysis of the time course over which these structural alterations occur during sensitization has further demonstrated that changes in the number of varicosities and active zones persist in parallel with the behavioral retention of the memory. This increase in the number of sensory neuron synapses during long-term sensitization in Aplysia is similar to changes in the number of synapses in the mammalian brain following various forms of environmental manipulations and learning (Greenough, 1984). Therefore learning may involve a form of neuronal growth across a broad segment of the animal kingdom, thereby suggesting a role for structural synaptic plasticity during long-term behavioral modifications.

Time course of structural changes at identified sensory neuron synapses during long-term sensitization in Aplysia.

We have used the gill- and siphon-withdrawal reflex of Aplysia californica to explore the morphological basis of the synaptic plasticity that underlies long-term sensitization. In earlier studies (Bailey and Chen, 1983, 1988a), we described 2 classes of structural changes at identified sensory neuron synapses that occur following long-term sensitization: (1) increases in the number, size, and vesicle complement of active zones and (2) an overall increase in the total number of synaptic varicosities per sensory neuron. In the present study, we have begun to examine which of these anatomical changes might be necessary for the maintenance of long-term sensitization by exploring the time course over which they occur and, in particular, their duration relative to the persistence of the memory assessed behaviorally. Toward this end we have quantitated changes in both the total number of varicosities and their active zone morphology in single HRP-labeled sensory neurons taken from long-term sensitized and control animals at different intervals (1-2 d, 1 week, and 3 weeks) following training. We have found that long-term sensitized animals examined within 48 hr after the completion of training demonstrate an increase in the total number of varicosities per sensory neuron as well as an increase in the incidence, size, and vesicle complement of their synaptic active zones compared with control animals. The increase in the number of varicosities and active zones persists unchanged for at least 1 week, and the increase in active zone number is only partially reversed at the end of 3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Toward a molecular definition of long-term memory storage.

The storage of long-term memory is associated with a cellular program of gene expression, altered protein synthesis, and the growth of new synaptic connections. Recent studies of a variety of memory processes, ranging in complexity from those produced by simple forms of implicit learning in invertebrates to those produced by more complex forms of explicit learning in mammals, suggest that part of the molecular switch required for consolidation of long-term memory is the activation of a cAMP-inducible cascade of genes and the recruitment of cAMP response element binding protein-related transcription factors. This conservation of steps in the mechanisms for learning-related synaptic plasticity suggests the possibility of a molecular biology of cognition.