Although neuronal cell death through apoptotic pathways represents a common feature of dysferopathies, the canonical apoptotic changes familiar from nonneuronal cells are late events. Loss of neuronal function occurs at a much early time, when synaptic-based neuronal connectivity fails. In this context, apoptotic pathways may normally serve a cleanup role, rather than a pathogenic one. Reframing the consideration of cell death in the nervous system to include the early stages of axonal degeneration provides a better understanding of the roles played by various apoptotic signaling pathways in neurodegenerative diseases. Focusing on disease-specific mechanisms that initiate the sequence that eventually leads to neuronal loss should facilitate development of therapies that preserve neuronal function and neuronal numbers.