Brain Lesions at Autopsy in Older Japanese-American Men as Related to Cognitive Impairment and Dementia in the Final Years of Life: A Summary Report from the Honolulu-Asia Aging Study
Brain Lesions at Autopsy in Older Japanese-American Men as Related to Cognitive Impairment and Dementia in the Final Years of Life: A Summary Report from the Honolulu-Asia Aging Study
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DOI：
10.3233/jad-2009-1178
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发表时间：
2009-01-01
影响因子：
4
通讯作者：
White, Lon
中科院分区：
文献类型：
--
作者：
White, Lon
这份报告总结了从1991年到2003年，对443名日裔美国男性进行尸检的结果，这些男性都是檀香山-亚洲老龄化研究的积极参与者。研究发现，五种不同的神经病变类型与生命最后几年的认知障碍和/或痴呆有很强的、部分的或完全独立的关联。它们是：阿尔茨海默病（新皮质神经原纤维缠结和神经性斑块）、微血管梗死（微梗死和腔隙性梗死）、新皮质路易小体、海马硬化和全身性脑萎缩。萎缩与阿尔茨海默病和微血管梗死密切相关，但在这些和其他病变水平可忽略的死者中也观察到。大约一半的海马硬化病例似乎与阿尔茨海默病有关。海马硬化与微血管梗死也有微弱的关联。为五种病变类型中的每一种定义了可比较的3级指数，以方便与认知障碍和痴呆的关联进行比较。观察到五种病变类型的多重组合。老年痴呆的发展与它们的总数和严重程度的关系比与特定病变类型的关系更密切。在这个尸检小组中，在33.8%的痴呆或明确受损的死者中，微血管梗死被确定为唯一或显性病变，而阿尔茨海默病的发生率为18.6%，共同显性病变（最常见的是阿尔茨海默病和微血管）的发生率为14.2%。这些或一种或多种其他病变类型在87.9%的痴呆或绝对受损的死者中观察到。
This report summarizes findings from 443 autopsies on Japanese-American men followed as active participants in the Honolulu-Asia Aging Study from 1991 through 2003. Five distinct neuropathological lesion types were found to have strong, partially, or completely independent associations with cognitive impairment and/or dementia in the final years of life. They were: Alzheimer lesions (neocortical neurofibrillary tangles and neuritic plaques), microvascular infarcts (microinfarcts and lacunar infarcts), neocortical Lewy bodies, hippocampal sclerosis, and generalized brain atrophy. Atrophy was strongly associated with both Alzheimer lesions and microvascular infarcts, but was also observed in decedents with negligible levels of these and the other lesions. About half of the hippocampal sclerosis cases appeared to be linked to Alzheimer lesions. A weak association of hippocampal sclerosis with microvascular infarcts was also noted. Comparable 3-level indices were defined for each of the five lesion types to facilitate comparisons of associations with cognitive impairment and dementia. Multiple combinations of the five lesion types were observed. The development of dementia in the final years of life was more closely correlated with their combined numbers and severities than with specific lesion types. In this autopsy panel, microvascular infarcts were identified as the sole or dominant lesion in 33.8% of the demented or definitely impaired decedents, compared with Alzheimer lesions in 18.6% and co-dominant lesions (most often Alzheimer and microvascular) in 14.2%. These or one or more of the other lesion types were observed in 87.9% of the demented or definitely impaired decedents.