Early-onset familial Alzheimer's disease is the most aggressive form of Alzheimer's, striking patients as early as their 30s; those patients typically carry mutations in presenilin-1 and presenilin-2. To investigate the coordinated functions of presenilin in the adult brain, we generated double knockout mice, in which both presenilins were deleted in the forebrain. We found that concurrent loss of presenilins in adulthood resulted in massive cortical shrinkage, atrophy of hippocampal molecular layers and corpus callosum, and enlargement of the lateral and third ventricles. We further revealed that deficiency of presenilins caused a series of biochemical alterations, including neuronal atrophy, astrogliosis, caspase-3-mediated apoptosis, and tau hyperphosphorylation. Thus, our study demonstrates that presenilins are essential for the ongoing maintenance of cortical structures and function.A lzheimer's disease (AD) is a degenerative disease of the CNS (1), currently affecting Ͼ25 million people worldwide. Among various subtypes of AD, early-onset familial AD is known to be the most aggressive form, striking patients as early as their 20s or 30s (2, 3). The clinical symptoms of these patients include accelerated onset of memory loss and dementia and progressive impairment in problem solving, language, and other cognitive abilities. In late stages, patients exhibit greatly reduced physical function and are often incontinent, mute, and incapable of caring for themselves. The terminal brains of AD patients are usually hallmarked by accumulations of senile plaques and neurofibrillary tangles, selective shrinkage of cortical and hippocampal tissues, and enlargement of lateral and third ventricle volume (4-6).Discovery of mutations in the presenilin-1 (PS1) and presenilin-2 (PS2) genes in patients with early-onset AD pathogenesis in the mid1990s marked the beginning of the molecular analysis of this devastating subform of the disease (3, 7-10). The PS1 gene encodes a transmembrane protein with ␥-secretase activity important for the proteolytic processing of Notch, amyloid precursor protein, and several other proteins (11,12). In addition, it interacts directly with proteins involved in apoptosis (13,14), tau hyperphosphorylation (15), and neuronal cell adhesion (16). Genetic linkage analysis also revealed a second presenilin gene, PS2, located on chromosome 1 (17, 18). PS1 and PS2 share Ϸ60% homology in amino acid sequence and are expressed ubiquitously in a variety of tissues, including in the brain. In general, PS1 is expressed at a relatively higher level than PS2.Currently, little information is available regarding the functional relationship and in vivo coordination between these two presenilin genes in the adult brain; it is also not clear whether those mutations exert deleterious effects through a gain-offunction or loss-of-function mechanism. Genetic manipulations of Alzheimer's genes represent a valuable approach to the study of the molecular basis underlying the disease process (19-21). Because the conventional...