Frequency of Alzheimer's disease pathology at autopsy in patients with clinical normal pressure hydrocephalus.
Frequency of Alzheimer's disease pathology at autopsy in patients with clinical normal pressure hydrocephalus.
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DOI：
10.1016/j.jalz.2010.12.008
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发表时间：
2011-09-01
期刊：
影响因子：
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通讯作者：
Sabbagh, Marwan N
中科院分区：
文献类型：
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作者：
Cabral, Danielle;Beach, Thomas G;Sabbagh, Marwan N
背景：正常压力脑积水（NPH）被认为可以通过放置脑脊液（CSF）分流器来治疗。然而，据报道该手术取得了不同程度的成功，特别是在改善 NPH 的认知障碍方面。神经系统合并症，特别是阿尔茨海默氏病（AD）的存在可能会导致分流反应。揭示 AD 和 NPH 共同发生的程度对于 NPH 的诊断和治疗具有重要意义。对 NPH 患者一生中的尸检研究将阐明此类合并症的发生频率。 方法：在 1997 年 1 月 1 日至 2009 年 4 月 1 日期间对太阳健康研究所大脑捐赠计划数据库进行了检索，以识别所有具有痴呆神经病理学证据的病例以及临床诊断的 NPH 病例。我们审查了每个 NPH 病例的病历和脑部检查结果。 结果：在研究期间对 761 例尸检的病例中，发现 563 例的神经病理学证据符合痴呆症的标准。在 563 例患者中，仅 313 例（56%）发现 AD，94 例继发诊断为痴呆。 761例中，9例临床诊断为NPH，属于尸检时神经病理学为痴呆症的563例中，占病例的1.6%（9/563）。在审查这 9 名患者的脑部尸检报告时，发现 8 名患者 (89%) 患有 AD，1 名患者 (11%) 患有进行性核上性麻痹。对 9 名 NPH 病例的医疗记录进行审查后发现，有以下临床合并症：5 名患有 AD，1 名患有帕金森病，1 名患有轻度认知障碍，1 名患有癫痫症。结论：鉴于本研究的结果，我们支持 AD-NPH 理论，并认为 AD 是 NPH 中常见的病理性合并症，可能妨碍分流术后认知改善。这可能会影响未来分流案例的选择。
BACKGROUND: Normal pressure hydrocephalus (NPH) is considered to be potentially treatable with the placement of a cerebrospinal fluid (CSF) shunt. However, the procedure has been reported to have variable success, particularly with respect to improving the cognitive impairment in NPH. The presence of neurologic comorbidities, particularly Alzheimer's disease (AD), may contribute to shunt responsiveness. Uncovering the extent to which AD and NPH co-occur has implications for diagnosis and treatment of NPH. Autopsy studies of patients with NPH during their lifetime would elucidate the frequency of such comorbidities.METHODS: A search of the Sun Health Research Institute Brain Donation Program database was conducted between January 1, 1997 and April 1, 2009 to identify all cases with neuropathologic evidence of dementia as well as those of clinically diagnosed NPH. We reviewed the medical records and brain findings of each NPH case.RESULTS: Of the 761 cases autopsied over the study interval, 563 were found to have neuropathologic evidence meeting criteria for a dementing illness. Of 563 cases, AD was found exclusively in 313 (56%), and 94 suffered from secondary diagnosis of dementia. Nine of 761 cases were identified with a clinical diagnosis of NPH, which were among the 563 cases with neuropathology of dementing illness at autopsy, representing 1.6% (9/563) of the cases. On review of brain autopsy reports of these nine patients, eight (89%) were found to have AD and one (11%) had progressive supranuclear palsy. Review of the medical records of the nine NPH cases revealed the following clinical comorbidities: five suffered from AD, one from Parkinson's Disease, one from mild cognitive impairment, and one from seizure disorder.CONCLUSIONS: Given the findings of the present study, we support the AD-NPH theory and posit that AD is a common pathologic comorbidity in the setting of NPH and may preclude cognitive improvement postshunt placement. This may influence the selection of cases for shunting in the future.