The neuropathological diagnosis of Alzheimer's disease: Clinical-pathological studies
The neuropathological diagnosis of Alzheimer's disease: Clinical-pathological studies
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DOI：
10.1016/s0197-4580(97)00066-3
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发表时间：
1997-07-01
影响因子：
4.2
通讯作者：
Hyman, BT
中科院分区：
文献类型：
--
作者：
Hyman, BT
阿尔茨海默病的神经病理学诊断目前依赖于老年斑或神经炎斑的定量或半定量标准，这些标准根据年龄和是否存在痴呆临床病史进行调整。基于临床病理相关性研究，我认为神经病理学评估应该独立于临床病史，而应该在疾病的地形图和自然病史的背景下描述脑病变。从神经病理学检查中只能对痴呆的存在或不存在进行概率估计，特别是在阿尔茨海默病病变加上其他病理学改变（如路易体或梗死）的情况下。此外，我认为，任何神经系统缠结或微笑斑块都是固有的病理实体：即使临床上没有症状，所以“偶然”的神经病理学发现。因为神经纤维缠结的强度和位置，而不是老年斑，似乎与临床症状最密切相关，我建议使用一个分期系统，突出这一信息，而不是使用绝对的数字截止值为诊断目的。(C)1997年爱思唯尔科学公司
The neuropathological diagnosis of Alzheimer's disease currently relies on quantitative or semiquantitative criteria of senile or neuritic plaques that are adjusted for age and for the presence absence of a clinical history of dementia. Based on clinical-pathological correlation studies, I will argue that neuropathological assessment should stand independently of clinical history and instead should describe brain lesions in the context of the topography and natural history of the disease. Only probabalistic estimates about the presence or absence of dementia can be made from a neuropathological examination, especially in the setting of Alzheimer disease lesions plus other pathological alterations such as Lewy bodies or infarcts. Moreover, I will argue that any neurofibrillary tangles or smile plaques are inherently pathological entities: even if clinically silent and so ''incidental'' neuropathological findings. Because the intensity and location of neurofibrillary tangles, rather than senile plaques, appears to correlate most closely with clinical symptoms, I suggest using a staging system that highlights this information rather than using absolute numerical cut-offs for diagnostic purposes. (C) 1997 Elsevier Science Inc.