Overlap between pathology of Alzheimer disease and vascular dementia
Overlap between pathology of Alzheimer disease and vascular dementia
复制标题
DOI：
10.1097/00002093-199912003-00017
复制
发表时间：
1999-12-01
影响因子：
2.1
通讯作者：
Ballard, C
中科院分区：
文献类型：
--
作者：
Kalaria, RN;Ballard, C
有压倒性的证据表明，阿尔茨海默病（AD）的神经病理学超越淀粉样斑块和神经原纤维缠结。对各种联合体资料的回顾显示，超过30%的阿尔茨海默病病例表现为脑血管病变。然而，某些血管病变，如脑淀粉样血管病、微血管变性和心室周围白质病变，在几乎所有AD病例中都是明显的。这些血管病变在阿尔茨海默病的发病过程中是巧合还是因果关系尚不清楚。尽管高血压、冠状动脉疾病和其他心血管疾病等系统性血管影响可能导致AD的这种病理，但同样有趣的是，大约三分之一被诊断为血管性痴呆（VaD）的患者在尸检时也会出现AD型病理。此外，先前的研究表明，与基底前脑神经元相关的胆碱能指数的缺陷在多发梗死性痴呆中是明显的。在这篇简短的综述中，我们根据涉及痴呆发病机制的周围血管病理生理来评估AD的脑血管病理。我们还考虑了与遗传影响相关的病理结果，如载脂蛋白E，这可能揭示AD和VaD之间的联系。鉴于这些共性，对AD和VaD考虑相同的治疗策略是合理的。
There is overwhelming evidence to suggest that the neuropathology of Alzheimer disease (AD) extends beyond amyloid plaques and neurofibrillary tangles. Review of various consortium data shows that more than 30% of AD cases exhibit cerebrovascular pathology. However, certain vascular lesions such as cerebral amyloid angiopathy, microvascular degeneration, and periventricular white matter lesions are evident in almost all cases of AD. Whether these vascular lesions are coincidental or causal in the pathogenetic processes of AD remains to be defined. Although systemic vascular influences such as hypertension, coronary artery disease, and other cardiovascular disturbances may be responsible for such pathology in AD, it is equally intriguing that about one third of patients diagnosed with vascular dementia (VaD) will have AD-type pathology at autopsy. Moreover, previous studies have revealed that deficits in cholinergic indices related to the basal forebrain neurones are apparent in multi-infarct dementia. In this short review we evaluate cerebrovascular pathology of AD in light of peripheral vascular pathophysiology implicated in the etiopathogenesis of the dementia. We also consider pathological findings in relation to genetic influences such as apolipoprotein E that may shed light on the link between AD and VaD. In view of these commonalties, it is reasonable to consider the same treatment strategies for both AD and VaD.