Szpak G M, Lewandowska E, Lechowicz W, Bertrand E, Wierzba-Bobrowicz T, Gwiazda E, Pasennik E, Kosno-Kruszewska E, Lipczyńska-Lojkowska W, Bochyńska A, Fiszer U
Department of Neuropathology, Institute of Psychiatry and Neurology, Warszawa, Poland.
Folia Neuropathol. 2001;39(2):63-71.
Immunohistochemistry (IHC) and ultrastructural study were performed on 19 demented autopsy cases of sporadic Alzheimer's disease (AD). Semiquantitative IHC assessment of the pathological changes, according to the criteria of the Consortium to Establish a Registry of Alzheimer's Disease (CERAD) and the Consortium on Dementia with Lewy Bodies, showed morphological hallmarks of AD in 18 demented patients. It was found that 11 of these cases fulfilled criteria for "pure" AD, whereas the remaining 7 cases, with mixed findings, Lewy bodies (LBs) and Lewy-related dystrophic neurites, neuritic plaques (NP) and sometimes neurofibrillary tangles (NFT), met the criteria for Lewy body variant of Alzheimer's disease (LBV). One case with brain stem and cortical LBs but without NP and NFT was finally diagnosed as a pure form of dementia with Lewy bodies (DLB). Regional distribution and semiquantitative assessment frequency of alpha-synuclein-immunoreactive LBs, tau-immunoreactive NFT and beta-amyloid immunoreactive senile plaques, were compared between LBVand AD. Ultrastructural examination confirmed the filamental structure of cortical LBs. In conclusion, IHC study including antibody to alpha-synuclein, the sensitive marker for Lewy bodies, revealed the coexistence of brain stem and cortical LBs and pathological features of AD in a great part of dementia cases. Patients with mixed, LBs, NP and sometimes NFT pathology, fulfilled neuropathological CERAD criteria for LBV. Semiquantitative comparative IHC study, according to LBs- and NFT-scores and CERAD NP-scores showed in the LBV group a significantly lower frequency of NFT coexisting with neocortical LBs than in the group with pure form of AD.
对19例散发性阿尔茨海默病（AD）痴呆尸检病例进行了免疫组织化学（IHC）和超微结构研究。根据阿尔茨海默病注册协会（CERAD）和路易体痴呆协会的标准，对病理变化进行半定量IHC评估，结果显示18例痴呆患者具有AD的形态学特征。发现其中11例符合“纯”AD标准，而其余7例有混合表现，存在路易体（LBs）和路易体相关的营养不良性神经突、神经炎性斑块（NP），有时还有神经原纤维缠结（NFT），符合阿尔茨海默病路易体变异型（LBV）标准。1例脑干和皮质有LBs但无NP和NFT的病例最终被诊断为纯路易体痴呆（DLB）。比较了LBV和AD之间α-突触核蛋白免疫反应性LBs、tau免疫反应性NFT和β-淀粉样蛋白免疫反应性老年斑的区域分布和半定量评估频率。超微结构检查证实了皮质LBs的丝状结构。总之，包括针对路易体敏感标志物α-突触核蛋白抗体的IHC研究显示，在大部分痴呆病例中存在脑干和皮质LBs以及AD的病理特征。具有LBs、NP且有时有NFT混合病理的患者符合LBV的神经病理学CERAD标准。根据LBs和NFT评分以及CERAD NP评分进行的半定量比较IHC研究显示，LBV组中与新皮质LBs共存的NFT频率明显低于纯AD组。
