Mild cognitive impairment is related to Alzheimer disease pathology and cerebral infarctions
Mild cognitive impairment is related to Alzheimer disease pathology and cerebral infarctions
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DOI：
10.1212/01.wnl.0000152982.47274.9e
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发表时间：
2005-03-08
期刊：
影响因子：
9.9
通讯作者：
Wilson, RS
中科院分区：
文献类型：
--
作者：
Bennett, DA;Schneider, JA;Wilson, RS
目的：研究轻度认知功能障碍患者中阿尔茨海默病（AD）病理学、脑梗死和路易体病的程度。方法：共有180名天主教神职人员参加了宗教秩序的研究进行了年度详细评估和脑尸检。石蜡包埋中额叶、上级颞叶、内侧颞叶、下顶叶、内嗅皮质、海马和黑质块，并在6 μ m处切片。用Bielschowsky银染色观察皮质神经炎斑块、弥漫性斑块和神经纤维缠结，并计数和总结以产生Braak分期、建立阿尔茨海默病登记协会（CERAD）诊断、国家老龄化研究所（NIA）-Reagan诊断和AD病理学的复合测量。作者记录了所有肉眼可见的慢性脑梗死的数量和位置。路易体与α-突触核蛋白的抗体进行了鉴定。多元回归分析被用来检查AD病理和脑梗死的临床诊断接近死亡，控制年龄，性别和教育的关系。结果：共有37人有轻度认知功能障碍，60人没有认知功能障碍，83人有接近死亡的痴呆症。几乎所有的人都至少有一些AD病理。脑梗死占35.2%，路易体病占15.6%。与其他两组相比，轻度认知障碍的人在Braak分期和CERAD和NIA-Reagan AD神经病理标准方面处于中间水平。在多元回归分析中，轻度认知功能障碍者的AD病理水平介于无认知功能障碍者和痴呆者之间（趋势检验，F = 45.2，p < 0.001）。此外，轻度认知障碍患者的认知与AD病理之间的关系与痴呆患者或无认知障碍患者的认知与AD病理之间的关系无显著差异。轻度认知障碍的人也有中等水平的脑梗死（趋势检验，p = 0.04）。轻度认知功能障碍者仅3例（8.1%）有路易体病。结论：轻度认知功能障碍可能是常见的年龄相关性神经系统疾病的最早临床表现。
Objectives: To examine the extent to which persons with mild cognitive impairment have intermediate levels of Alzheimer disease ( AD) pathology, cerebral infarcts, and Lewy body disease. Methods: A total of 180 Catholic clergy participating in the Religious Orders Study underwent annual detailed evaluation and brain autopsy. Blocks of midfrontal, superior temporal, medial temporal lobe, inferior parietal, entorhinal cortex, hippocampus, and substantia nigra were paraffin embedded, and sectioned at 6 mum. Cortical neuritic plaques, diffuse plaques, and neurofibrillary tangles were visualized with Bielschowsky silver stain, and counted and summarized to yield a Braak stage, Consortium to Establish a Registry for Alzheimer's Disease (CERAD) diagnosis, National Institute on Aging (NIA)-Reagan diagnosis, and composite measure of AD pathology. The authors recorded the number and location of all gross chronic cerebral infarctions. Lewy bodies were identified with antibodies to alpha-synuclein. Multiple regression analyses were used to examine the relation of AD pathology and cerebral infarctions to clinical diagnosis proximate to death, controlling for age, sex, and education. Results: A total of 37 had mild cognitive impairment, 60 did not have cognitive impairment, and 83 had dementia proximate to death. Nearly all persons had at least some AD pathology. Cerebral infarctions were present in 35.2%, and 15.6% had Lewy body disease. Persons with mild cognitive impairment were intermediate in terms of Braak stage and CERAD and NIA-Reagan neuropathologic criteria for AD compared to the other two groups. In multiple regression analyses, persons with mild cognitive impairment had intermediate levels of AD pathology from those without cognitive impairment and those with dementia (test for trend, F = 45.2, p < 0.001). Further, the relation between cognition and AD pathology in persons with mild cognitive impairment did not differ significantly from the relation between cognition and AD pathology in persons with dementia or those without cognitive impairment. Persons with mild cognitive impairment also had intermediate levels of cerebral infarctions (test for trend, p = 0.04). Only 3 (8.1%) persons with mild cognitive impairment had Lewy body disease. Conclusion: These data suggest that mild cognitive impairment may be the earliest clinical manifestation of common age-related neurologic diseases.