Wakisaka Yoshinobu, Furuta Akiko, Tanizaki Yumihiro, Kiyohara Yutaka, Iida Mitsuo, Iwaki Toru
Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Acta Neuropathol. 2003 Oct;106(4):374-82. doi: 10.1007/s00401-003-0750-x. Epub 2003 Aug 2.
In dementia with Lewy bodies (DLB), the Lewy bodies (LBs) are an essential substrate. Although LB pathology has gained increasing attention as one of the major causes of dementia, little is known about the exact prevalence of LB pathology in the general population. In addition, the pathology of Alzheimer-type dementia (ATD) is frequently associated with DLB. To investigate the prevalence of LB pathology in a community-based population and to evaluate the relationship between LB and ATD pathology, we performed an analysis of 102 consecutive autopsy cases. The survey extended over 2.5 years and autopsy rate was 70.5%. LB pathology was detected using alpha-synuclein immunohistochemistry and was assessed based on consensus guidelines for DLB. ATD pathology was evaluated by both CERAD and NIA-RI criteria. Twenty-nine subjects were clinically demented. LB pathology was present in 23 (22.5%) of 102 cases, and in 12 (41.4%) of the demented subjects. The LB score was not significantly different between DLB cases and non-demented subjects with LB pathology (nd-LB), while the Braak stages were significantly different between the two groups. Prevalence of LB pathology constantly increased with age. DLB cases accompanying severe ATD pathology showed more rapid increase of LB scores than did DLB cases without severe ATD pathology. Moreover, DLB cases with severe ATD pathology had poorer prognoses than those without severe ATD pathology. Our results suggested that aging and severe ATD pathology have a strong effect on the evolution of LB pathology.
在路易体痴呆（DLB）中，路易体（LBs）是重要的病理基础。尽管路易体病理作为痴呆的主要病因之一已受到越来越多的关注，但关于其在普通人群中的确切患病率却知之甚少。此外，阿尔茨海默病型痴呆（ATD）的病理常与DLB相关。为了调查社区人群中路易体病理的患病率，并评估路易体与ATD病理之间的关系，我们对102例连续尸检病例进行了分析。调查持续了2.5年，尸检率为70.5%。采用α-突触核蛋白免疫组化检测路易体病理，并根据DLB的共识指南进行评估。通过CERAD和NIA-RI标准评估ATD病理。29名受试者临床上存在痴呆。102例中有23例（22.5%）存在路易体病理，痴呆受试者中有12例（41.4%）存在路易体病理。DLB病例与存在路易体病理的非痴呆受试者（nd-LB）之间的路易体评分无显著差异，而两组之间的Braak分期有显著差异。路易体病理的患病率随年龄不断增加。伴有严重ATD病理的DLB病例路易体评分的增加比不伴有严重ATD病理的DLB病例更快。此外，伴有严重ATD病理的DLB病例的预后比不伴有严重ATD病理的病例更差。我们的结果表明，衰老和严重的ATD病理对路易体病理的演变有强烈影响。
