Neuropathologic alterations in mild cognitive impairment: a review.
Neuropathologic alterations in mild cognitive impairment: a review.
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DOI：
10.3233/jad-2010-1220
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Markesbery WR
中科院分区：
文献类型：
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作者：
Markesbery WR
轻度认知障碍 (MCI) 是痴呆症和阿尔茨海默病 (AD) 发展轨迹中最早的临床可检测阶段，它激发了人们对更早检测和预防 AD 的渴望。尽管这是一种临床诊断，但其潜在的神经病理学发现才刚刚被定义。 MCI 最好是在有痴呆症治疗经验的中心对患者进行纵向随访。在对纵向随访患者的少数主要临床病理报告的回顾中，大多数尸检遗忘性 MCI (aMCI) 患者似乎正在走向 AD。内嗅皮层、海马体和杏仁核中的神经原纤维病理（而不是淀粉样斑块）是 aMCI 和记忆力下降的主要基础。此外，许多 MCI 患者还伴有其他病理改变，其中最常见的是中风，但也包括嗜银颗粒和路易体。这些发现并不令人惊讶，因为大多数 MCI 尸检病例都处于年龄较大（80 至 90 岁）的范围内，这些发现在该范围内很常见。在 AD 早期，即 MCI 之后的阶段，显着的变化是新皮质中神经原纤维缠结的增加，这与 Braak 评分的增加和观察到的临床进展相关。
Mild cognitive impairment (MCI), the earliest clinically detectable phase of the trajectory toward dementia and Alzheimer’s disease (AD), catalyzed the desire for even earlier detection and prevention of AD. Although it is a clinical diagnosis, its underlying neuropathological findings are just being defined. MCI is best studied in longitudinally followed patients in centers that are experienced in dementing disorders. In this review of the few major clinical-pathological reports of longitudinally followed patients, it appears that most autopsied amnestic MCI (aMCI) patients are on a pathway toward AD. Neurofibrillary pathology in entorhinal cortex, hippocampus, and amygdala – not amyloid plaques – is the major substrate for aMCI and for memory decline. In addition, many MCI patients have other concomitant pathological alterations, the most common of which are strokes, but also include argyrophilic grains and Lewy bodies. These findings are not surprising because most MCI autopsied cases have been in the older (80 to 90 year) range where these findings are common. In early AD, the phase following MCI, the significant change is an increase in neurofibrillary tangles in the neocortex that correlates with an increase in Braak score and the observed clinical progression.