Cognitive status correlates with neuropathologic stage in Parkinson disease
Cognitive status correlates with neuropathologic stage in Parkinson disease
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DOI：
10.1212/01.wnl.0000158422.41380.82
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发表时间：
2005-04-26
期刊：
影响因子：
9.9
通讯作者：
de Vos, RAI
中科院分区：
文献类型：
--
作者：
Braak, H;Rüb, U;de Vos, RAI
目的：研究认知状态与已发表的散发性帕金森病 (PD) 神经病理学分期程序的分期之间的关系，该队列由来自单个神经科的 88 名 PD 患者组成。没有人接受路易体痴呆（DLB）的临床诊断。方法：作者半定量评估了 18 个脑区切片中对 α-突触核蛋白具有免疫反应性的路易神经突/体 (LN/LB)。在银染切片和 tau 蛋白和 β-淀粉样蛋白免疫染色切片中，作者半定量评估了可能导致认知能力下降的合并症，例如。例如，阿尔茨海默病（AD）、嗜银颗粒病（AGD）和脑血管疾病。作者使用非参数检验分析了从认知轻微受损到严重痴呆的四个简易精神状态检查 (MMSE) 亚组。结果：可以将所有患者分配到其中一个 PD 阶段。 MMSE 评分与神经病理学分期相关 (p < 0.005)，并且这种关联呈线性趋势 (p < 0.025)。女性 MMSE 测试分数中位数低于男性。与认知未受损的人相比，认知受损的个体表现出更高阶段的 AD 相关神经原纤维病理学 (p < 0.05) 和 β-淀粉样蛋白沉积 (p < 0.05)。 MMSE 评分与 AGD、疾病持续时间、发病年龄或死亡年龄没有显着相关性。然而，Hoehn 和 Yahr 评分与 PD 分期 (p < 0.0005) 和 MMSE 评分 (p < 0.0005) 相关。结论：PD 3 至 6 期之间简易精神状态检查中位数分数的下降表明，随着疾病进展，患痴呆症的风险增加。然而，在某些个体中，在存在与帕金森病相关的轻度皮质病变的情况下，可能会出现认知能力下降，相反，广泛的皮质病变并不一定会导致认知能力下降。
Objective: To study the association of cognitive status with the stages of a published neuropathologic staging procedure for sporadic Parkinson disease (PD) in a cohort of 88 patients with PD from a single neurologic unit. None had received the clinical diagnosis of dementia with Lewy bodies (DLB). Methods: The authors assessed Lewy neurites/bodies (LNs/LBs) immunoreactive for alpha-synuclein semiquantitatively in sections from 18 brain regions. In silver-stained sections and sections immunostained for tau and beta-amyloid protein, the authors semiquantitatively evaluated comorbidities potentially contributing to cognitive decline, e. g., Alzheimer disease (AD), argyrophilic grain disease (AGD), and cerebral vascular disease. The authors analyzed four Mini-Mental State Examination (MMSE) subgroups ranging from marginally impaired cognition to severe dementia using nonparametric tests. Results: It was possible to assign all patients to one of the PD stages. MMSE scores correlated with neuropathologic stages (p < 0.005) and this association showed a linear trend (p < 0.025). Median MMSE test scores for women were lower than those for men. Cognitively impaired individuals displayed higher stages of AD-related neurofibrillary pathology (p < 0.05) and beta-amyloid deposition (p < 0.05) than cognitively unimpaired persons. MMSE scores did not correlate significantly with AGD, disease duration, age at disease onset, or age at death. Hoehn and Yahr scores, however, correlated with PD stages (p < 0.0005) and MMSE scores (p < 0.0005). Conclusions: The decrease in median Mini-Mental State Examination scores between PD stages 3 to 6 indicates that the risk of developing dementia increases with disease progression. In some individuals, however, cognitive decline can develop in the presence of mild Parkinson disease-related cortical pathology and, conversely, widespread cortical lesions do not necessarily lead to cognitive decline.