Brain infarction and the clinical expression of Alzheimer disease - The nun study
Brain infarction and the clinical expression of Alzheimer disease - The nun study
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DOI：
10.1001/jama.1997.03540340047031
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发表时间：
1997-03-12
影响因子：
120.7
通讯作者：
Markesbery, WR
中科院分区：
文献类型：
--
作者：
Snowdon, DA;Greiner, LH;Markesbery, WR
客观。-确定脑梗死与阿尔茨海默病（AD）临床表现的关系。认知功能和痴呆症的患病率被确定为参加修女研究谁后来死亡。在尸检时，确定了腔隙性和较大的脑梗死，并对新皮质中的老年斑和神经元缠结进行了定量，将新皮质中具有丰富老年斑和一些神经元缠结的参与者归类为符合AD的神经病理学标准。美国中西部、东部和南部的修道院。共有102名年龄在76岁至100岁之间的受过大学教育的女性。通过标准测试评估认知功能，并通过临床和神经病理学标准评估痴呆和AD。在61名符合AD神经病理学标准的参与者中，脑梗死患者的认知功能较差，痴呆的患病率高于无梗死患者。基底节、丘脑或深部白色物质有腔隙性梗死的参与者与无梗死的参与者相比，痴呆的患病率特别高（痴呆的比值比[OR]为20.7，95%置信区间[95%CI]为1.5-288.0）。在基底节、丘脑或深部白色物质有腔隙性梗死的患者中，导致痴呆的AD神经病理学病变似乎比无梗死的患者少。相比之下，在41名不符合AD神经病理学标准的参与者中，脑梗死与认知功能差和痴呆仅存在微弱相关性。在所有102名参与者中，Willis环动脉粥样硬化与腔隙性和大面积脑梗死密切相关。这些结果表明，脑血管疾病可能在确定AD临床症状的存在和严重程度方面发挥重要作用。
Objective.-To determine the relationship of brain infarction to the clinical expression of Alzheimer disease (AD).Design.-Cognitive function and the prevalence of dementia were determined for participants in the Nun Study who later died. At autopsy, lacunar and larger brain infarcts were identified, and senile plaques and neurofibrillary tangles in the neocortex were quantitated, Participants with abundant senile plaques and some neurofibrillary tangles in the neocortex were classified as having met the neuropathologic criteria for AD.Setting.-Convents in the Midwestern, Eastern, and Southern United States.Participants.-A total of 102 college-educated women aged 76 to 100 years.Main Outcome Measures.-Cognitive function assessed by standard tests and dementia and AD assessed by clinical and neuropathologic criteria.Results.-Among 61 participants who met the neuropathologic criteria for AD, those with brain infarcts had poorer cognitive function and a higher prevalence of dementia than those without infarcts. Participants with lacunar infarcts in the basal ganglia, thalamus, or deep white matter had an especially high prevalence of dementia, compared with those without infarcts (the odds ratio [OR] for dementia was 20.7, 95% confidence interval [95% CI], 1.5-288.0). Fewer neuropathologic lesions of AD appeared to result in dementia in those with lacunar infarcts in the basal ganglia, thalamus, or deep white matter than in those without infarcts. In contrast, among 41 participants who did not meet the neuropathologic criteria for AD, brain infarcts were only weakly associated with poor cognitive function and dementia. Among all 102 participants, atherosclerosis df the circle of Willis was strongly associated with lacunar and large brain infarcts.Conclusion.-These findings suggest that cerebrovascular disease may play an important role in determining the presence and severity of the clinical symptoms of AD.