Neuropathology and general autopsy findings in nondemented aged subjects
Neuropathology and general autopsy findings in nondemented aged subjects
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DOI：
10.5414/np300418
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发表时间：
2012-03-01
影响因子：
1.1
通讯作者：
Attems, Johannes
中科院分区：
文献类型：
--
作者：
Jellinger, Kurt A.;Attems, Johannes
采用半定量方法，对100例年龄≥ 65岁（平均81.23 ± 5.47岁）的非痴呆患者的基本一般病理学和神经病理学特征进行了回顾性研究。91%的患者有高血压史，31%有恶性肿瘤史，24%有COPD史，18%有心肌梗死史，4%有卒中史。主要死亡原因是心血管失代偿、肺炎、急性心肌梗死和恶性肿瘤。一般尸检发现严重的全身和冠状动脉粥样硬化分别为86%和90%，肾血管血管硬化82%，急性或复发性心肌梗死65%，和其他疾病。神经病理学显示平均脑重量为1，163 ± 113 g，轻度至中度脑萎缩，46%的大脑动脉无至轻度动脉粥样硬化，轻度、中度和重度动脉粥样硬化分别为31%、17%和6%。全身性/主动脉粥样硬化和颅内动脉粥样硬化之间的严重程度存在相当大的差异，只有不到三分之一具有可比性。Khachaturian标准阴性和CERAD 0期分别为83%和86%，CERAD A期仅为13%，B期为1%。Braak神经炎分期范围为0 - 11（53%），II-III（29%）至III-IV（18%），无评分为V级或VI级。Braak的平均评分为2.3 +/- 0.8。血管病变很常见; 61%的患者没有CAA，36%为轻度或中度，3%为重度。73%的病例可见基底节区和/或白色物质的轻度至重度腔隙样改变，3例可见海马硬化，9%的病例无脑血管病变。5例累及黑质的脑内可见Lewy小体。大脑皮质和延髓各1例，1例为偶发性路易体病。脑干tau蛋白病变60例（60%）。6例病例（平均年龄89.6岁）观察到混合性脑部病理（脑血管病变和中度神经炎Braak分期）。混合病理在非痴呆老年人中的重要性，比其他研究中更少发生，仍有待阐明。
A retrospective study of the essential general pathology and neuropathological features in 100 nondemented individuals aged 65 years or older (mean 81.23 +/- 5.47 y) was performed using semiquantitative methods. 91% of the patients had a history of hypertension, 31% malignancies, 24%) COPD, 18% myocardial infarction, and 4% stroke. Major causes of death were cardiovascular decompensation, pneumonia, acute myocardial infarction, and malignancies. General autopsy revealed severe systemic and coronary atherosclerosis in 86 and 90%, respectively, renal angioangiolosclerosis in 82%, acute or recurrent myocardial infarction in 65%, and other diseases. Neuropathology showed average brain weight of 1,163 +/- 113 g, mild to moderate brain atrophy, absent to mild atherosclerosis of large cerebral arteries in 46%, mild, moderate and severe one in 31, 17, and 6%, respectively. There were considerable discrepancies in the severity between generalized/aortic and intracranial atherosclerosis, only less than one-third being comparable. Negative Khachaturian criteria and CERAD Stage 0 were observed in 83 and 86%, respectively, only 13% with CERAD Stage A, and 1% Stage B. Braak neuritic stages ranged from 0 to 11 (53%), II - III (29%) to III - IV (18%), none scoring Grade V or VI. The average Braak score was 2.3 +/- 0.8. Vascular pathologies were common; CAA was absent in 61%, mild or moderate in 36% and severe in 3%. Mild to severe lacunar state in basal ganglia and/or white matter was seen in 73%, hippocampal sclerosis in 3 cases, while only 9% were free of cerebrovascular lesions. Lewy bodies were observed in 5 brains involving substantia nigra.(n = 3), cerebral cortex (n = 1) and medulla oblongata (n = 1), 1 case representing incidental Lewy body disease. tau pathology in brainstem was observed in 60 cases (60%). Mixed cerebral pathologies (cerebrovascular lesions and moderate neuritic Braak stages) were observed in 6 cases (mean age 89.6 y). The importance of mixed pathologies in nondemented elderly, being less frequent than in other studies, remains to be elucidated.