Clinical and pathological aspects of parkinsonism in Alzheimer's disease. A role for extranigral factors?
Clinical and pathological aspects of parkinsonism in Alzheimer's disease. A role for extranigral factors?
复制标题
阿尔茨海默病帕金森病的临床和病理学方面。
作者：
J. C. Morris;Mark H. Drazner;K. Fulling;E. Grant;James Goldring
为了研究阿尔茨海默病中帕金森综合征的自然史和发病机制，在66个月的时间内研究了44例明确确定为阿尔茨海默型老年痴呆的受试者。16例受试者（36%）发生了特发性帕金森综合征，12例受试者（27%）发生了药物诱导的帕金森综合征;两种类型的主要临床特征均为运动迟缓和强直，但不包括静息性震颤。帕金森综合征的存在与整体（而不是选择性）认知障碍有关，这是由心理测量测试确定的，并且与更快地进展到痴呆的晚期阶段有关。临床帕金森综合征的病理相关性是异质性的10例阿尔茨海默氏病的受试者进行了尸检。共存的帕金森氏病，观察到在另外三个非特异性黑质退行性病变，但是，两个病例既没有组织学变化，也没有减少黑质神经元密度。这两个病例表明，脑黑质病变，可能涉及中皮质多巴胺能通路，可能有助于帕金森病的发展与阿尔茨海默病的主题。
To examine the natural history and pathogenesis of parkinsonism in Alzheimer's disease, 44 subjects with clearly established senile dementia of the Alzheimer type were studied during a 66-month period. Sixteen subjects (36%) developed idiopathic parkinsonism, and 12 subjects (27%) developed drug-induced parkinsonism; the chief clinical features of both types were bradykinesia and rigidity, but not resting tremor. The presence of parkinsonism was associated with global (rather than selective) cognitive impairment, as determined by psychometric testing, and with more rapid progression to advanced stages of dementia. The pathological correlates of clinical parkinsonism were heterogeneous in 10 subjects with Alzheimer's disease who were examined post mortem. Coexistent Parkinson's disease was observed in five cases and nonspecific nigral degenerative lesions were present in another three; however, two cases had neither histological changes nor reduced neuronal densities in the substantia nigra. These two cases suggested that extranigral lesions, possibly involving mesocortical dopaminergic pathways, may contribute to the development of parkinsonism in subjects with Alzheimer's disease.