Prospective and retrospective studies of mild cognitive impairment : Alzheimer disease and senile tauopathy

轻度认知障碍(MCI)被定义为介于正常认知和痴呆之间的中间状态，并被强调为老年人认知衰退预防方案的主要目标。我们筛选了东京大都会脑库老龄化研究中心近五年来1120例连续尸检病例的临床记录。由两位专业神经科医师按以下标准分别回顾筛选出相当于MCI的病例：1.记忆障碍的医疗描述；2.无明确的痴呆描述；3.临床痴呆评分0.5。这些病例的背景病理包括25例主要表现为阿尔茨海默病(AD)型病理，23例老年性痴呆，包括颗粒状或中性粒细胞缠结为主的痴呆型改变以及其他类型的痴呆。根据这一结果，我们建立了CRIT…对于MCI来说，这是一条更具代表性的道路。初步筛查包括神经学检查、简易精神状态检查和CT扫描。二次筛查包括体积MRI、统计学SPECT、Rivermead行为记忆测验(RBMT)和脑电(EEG)。符合MCI标准的患者在知情同意的情况下被招募到前瞻性研究中。高级检查包括脑脊液生物标志物(tau、磷酸化tau和Abeta)、apoE表型、WAIS-R、WMS-R和PET扫描。可能患有早期阿尔茨海默病或老年肌萎缩症的MCI患者被纳入使用乙酰胆碱酯酶抑制剂的医学对照。我们今年已经运行了这一关键路径。初步总结如下：1.除AD外，MCI还包括许多病例。2.适当的医疗干预可以防止，在某些情况下，还可以逆转认知衰退的进程。3.及早介入对维持生活质素十分有用。有关个案现正进一步累积。较少

Mild cognitive impairment (MCI) is defined as the intermediate state between normal cognition and dementia and highlighted as the main target for preventive scheme against cognitive decline in the elderly.We screened clinical records of 1,120 serial autopsy cases from Tokyo Metropolitan Brain Bank for Aging Research in these five years. The cases equivalent to MCI were retrospectively selected by two professional neurologists independently, on the following criteria: 1.the description of memory impairment incurring problems for medical care,2.no definite description of dementia, and 3.Clinical Dementia Rating 0.5.One hundred and seventy one cases were pulled out as MCI equivalents. The background pathology of these cases consisted of 25 cases mainly presenting with Alzheimer disease (AD)-type pathology,23 cases of senile tauopathy, comprising dementia with grain or neuforibrillary tangle-predominant form of dementia-type changes and others.With this result, we have established the crit … More ical path for MCI. The initial screening consists of neurological examination, Mini-Mental State Examination and CTscan. The secondary screening includes volumetric MRI, statistical SPECT, the Rivermead Behavioral Memory Test (RBMT) and electroencephalography (EEG). Those patients who fulfill the criteria of MCI are recruited to the prospective study with informed consent. The advanced examination includes biological marker of cerebrospinal fluid (tau, phosphorylated tau and Abeta), apoE phenotyping, WAIS-R, WMS-R and PET scans. MCI cases with possible early AD or senile tauopathy are recruited to medical control by acetylcholine esterase inhibitor.We have run this critical path this year. Tentative summaries are as follows: 1.MCI includes many cases in addition to AD. 2.Appropriate medical intervention could prevent and, in some cases, reverse the progression of cognitive decline. 3.Early intervention is quite useful for the preservation of the quality of life.Further accumulation of the cases are now on going. Less