White matter hypoperfusion and damage in dementia: post-mortem assessment.
White matter hypoperfusion and damage in dementia: post-mortem assessment.
复制标题
痴呆症中的白质灌注不足和损伤：尸检评估。
DOI：
10.1111/bpa.12223
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Love S
中科院分区：
文献类型：
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作者：
Love S
神经影像学已经揭示了痴呆症中常见的一系列白色异常，其中一些可以预测认知能力的下降。这些异常可能由脑血管结构性疾病引起，如小动脉硬化和淀粉样血管病，但也可能由非结构性血管异常（如血管收缩性或渗透性）、神经血管不稳定或颅外心脏或血管疾病引起。传统的白色物质的组织病理学评估往往将形态学血管异常与反映间质流体动力学改变或白色物质缺血性损伤的变化混为一谈，即使后者可能是颅外或非结构性病因。然而，组织病理学正在通过生物化学方法进行补充，包括测量参与脑缺血分子反应的蛋白质、对缺血性损伤差异敏感的髓鞘蛋白、允许快速测量微血管密度的血管相关蛋白、血脑屏障功能障碍和轴突损伤的标志物以及白色物质损伤的介质。通过将神经影像学与组织病理学和生化分析相结合，我们可以提供有关白色物质损伤严重程度的可重复的定量数据，以及有关其病因和发病机制的信息。这些都有可能提供信息和改善治疗，特别是在白色物质灌注不足的痴呆症中。
Neuroimaging has revealed a range of white matter abnormalities that are common in dementia, some that predict cognitive decline. The abnormalities may result from structural diseases of the cerebral vasculature, such as arteriolosclerosis and amyloid angiopathy, but can also be caused by nonstructural vascular abnormalities (eg, of vascular contractility or permeability), neurovascular instability or extracranial cardiac or vascular disease. Conventional histopathological assessment of the white matter has tended to conflate morphological vascular abnormalities with changes that reflect altered interstitial fluid dynamics or white matter ischemic damage, even though the latter may be of extracranial or nonstructural etiology. However, histopathology is being supplemented by biochemical approaches, including the measurement of proteins involved in the molecular responses to brain ischemia, myelin proteins differentially susceptible to ischemic damage, vessel‐associated proteins that allow rapid measurement of microvessel density, markers of blood–brain barrier dysfunction and axonal injury, and mediators of white matter damage. By combining neuroimaging with histopathology and biochemical analysis, we can provide reproducible, quantitative data on the severity of white matter damage, and information on its etiology and pathogenesis. Together these have the potential to inform and improve treatment, particularly in forms of dementia to which white matter hypoperfusion makes a significant contribution.