Using a staining technique developed in 2004, we examined hippocampal tissue from autopsy-confirmed cases of Alzheimer's disease (AD) and controls. The stain disclosed aluminum in cells and subcellular structure. All pyramidal neurons in these aged specimens appeared to exhibit at least some degree of aluminum staining. Many displayed visible aluminum only in their nucleolus. At the other extreme were neurons that stained for aluminum throughout their nucleus and cytoplasm. The remainder exhibited intermediate degrees of staining. On the basis of their aluminum staining patterns, all pyramidal neurons could be classified into stages that indicated two distinct neuropathological processes, either (1) progressive increase of nuclear aluminum (often accompanied by granulovacuolar degeneration with granules that stain for aluminum) or (2) formation of neurofibrillary tangles (NFTs) in regions of aluminum-rich cytoplasm, especially in AD brain tissue. In the latter process, intraneuronal NFTs appeared to displace nuclei and then enucleate the affected neurons during the course of their transformation into extracellular NFTs. Given that the NFTs we observed in human neurons always developed in conjunction with cytoplasmic aluminum, we hypothesize that aluminum plays an important role in their formation and should therefore be reconsidered as a causative factor for AD.