Neuropathological evaluation of mixed dementia
Neuropathological evaluation of mixed dementia
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DOI：
10.1016/j.jns.2007.01.045
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发表时间：
2007-06-15
影响因子：
4.4
通讯作者：
Attems, J.
中科院分区：
文献类型：
--
作者：
Jellinger, K. A.;Attems, J.
混合性痴呆（mixed dementia，MD）是指明确的阿尔茨海默病（Alzheimer disease，AD）和血管性脑病（vascular encephalopathy，VD）的结合，但两者的区别存在争议，目前的诊断标准是AD和脑血管病（cardiovascular disease，CVD）作为两个独立的实体，但血管性脑病变与痴呆之间的因果关系尚不清楚。我们建议将尸检证实的AD与多个血管或缺血性病变结合，其中约30 - 50 ml脑组织梗死/受损。基于人群的MD患病率未知。在回顾性和前瞻性尸检研究中，其范围为2 - 58%，合理平均值为6 - 12%。在奥地利维也纳对1500例老年痴呆患者进行的连续尸检中，其中830例临床上可能患有AD，41.5 - 52.0%显示"纯" AD，7%为非典型AD，16 - 20%为AD伴脑血管病变，9%为AD伴路易体病变;诊断为MD的分别为4.6和2.4%，“单纯”血管性痴呆（VaD）的分别为11和2.0%，而16.3/6。1%为其他痴呆症，1%无特异性病理。与MRC-CFAS和其他研究一样，这表明认知障碍患者中AD经常与多种脑血管病变共存。在AD和VaD血管病变经常涉及皮质下区域（基底节，丘脑，海马，和白色物质）或多发性微梗死，而在MD，大/半球梗死和多发性微梗死更频繁，提示不同的致病机制。在早期/轻度AD中，关键部位的小血管病变可能会诱导/促进认知功能下降，但在全面AD中，这些病变似乎不太重要。对AD、VaD和MD的主要致病因素的讨论表明，这些疾病之间存在协同关系。然而，目前可用的AD和VaD的形态学标准对MD的诊断价值有限，并且目前还没有普遍接受和验证的诊断VaD和MD的组织病理学标准。因此，更明确的和严格评估的临床病理标准是必要的。(c)2007 Elsevier B.V.保留所有权利。
Mixed dementia (MD) refers to a combination of definite Alzheimer disease (AD) and vascular encephalopathy, but the distinction between both disorders is controversial.For the diagnosis of MD the clinical/neuroimaging criteria of possible AD plus cerebrovascular disease (CVD) as separate entities are used, but causal relations between vascular brain lesions and dementia are unclear. We proposed the combination of autopsy-proven AD with multiple vascular or ischemic lesions with about 30-50 ml of infarcted/damaged brain tissue. The population-based prevalence of MD is unknown. In retrospective and prospective autopsy studies, it ranges from 2 to 58% with reasonable means of 6-12%. In a consecutive autopsy series of 1500 demented elderly subjects, 830 of which with clinically probable AD, in Vienna, Austria, 41.5 to 52.0% showed "pure" AD, 7% atypical AD, 16-20% AD plus cerebrovascular lesions, and 9% AD plus Lewy body pathology; MD was diagnosed in 4.6 and 2.4%, and "pure" vascular dementia (VaD) in 11 and 2.0%, respectively, while 16.3/6. 1 % were other dementing disorders, and 1% showed no specific pathology. Like the MRC-CFAS and other studies, this indicates frequent coexistence of AD with multiple cerebrovascular lesions, in cognitively impaired patients. In both AD and VaD vascular lesions frequently involved subcortical regions (basal ganglia, thalamus, hippocampus, and white matter) or were multiple microinfarcts, whereas in MD, large/hemispheral infarcts and multiple microinfarcts were more frequent, suggesting different pathogenic mechanisms. In early/mild AD, critically located small vascular lesions may induce/promote cognitive decline, but in full-blown AD they appear of minor importance. Discussion of the major pathogenic factors inducing AD, VaD and MD, suggests synergistic relations between these disorders. However, currently available morphological criteria for AD and VaD are of limited value for the diagnosis of MD and generally accepted and validated histopathological criteria for the diagnosis of VaD and MD are currently not available. Therefore, more distinct and critically evaluated clinico-pathological criteria are warranted. (c) 2007 Elsevier B.V. All rights reserved.