McLachlan D R, Fraser P E, Dalton A J
Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada.
Ciba Found Symp. 1992;169:87-98; discussion 99-108. doi: 10.1002/9780470514306.ch6.
Known risk factors for Alzheimer's disease (AD) are few and insufficient knowledge is available to recommend steps to reduce AD in our ageing populations. Although not 'the cause', considerable evidence implicates human ingestion of aluminium as a possible risk factor for the expression of dementia of the Alzheimer type. A recent epidemiological study in Ontario relating the incidence of AD to aluminium in drinking water strongly supports this conclusion. To test further the hypothesis that aluminium may play a role in the pathogenesis of AD we conducted a clinical trial employing the trivalent metal ion binding compound, desferrioxamine. The design was a two-year randomized trial with behavioural assessments blinded to study assignment. Sixty-three patients with probable AD were selected who were living at home and were under 74 years. Forty-eight signed an informed consent and completed all initial testing. The main outcome measure was a video-recorded home-behavioural assessment of measures of skills of daily living. The principal outcome was that the mean slope for performance of the skills of daily living for the group without treatment was -1.72% maximum score/month, compared to -0.87% maximum score/month for the group treated with desferrioxamine (P = 0.038). Considerable evidence supports the hypothesis that aluminium has an active role in the pathogenesis of AD.
已知的阿尔茨海默病（AD）风险因素较少，且缺乏足够的知识来推荐在老龄化人群中降低AD发病率的措施。尽管铝并非“病因”，但大量证据表明，人体摄入铝可能是阿尔茨海默型痴呆症发病的一个风险因素。安大略省最近一项关于AD发病率与饮用水中铝含量关系的流行病学研究有力地支持了这一结论。为了进一步验证铝可能在AD发病机制中起作用的假设，我们进行了一项临床试验，使用三价金属离子结合化合物去铁胺。该设计为一项为期两年的随机试验，行为评估对研究分组设盲。选取了63名可能患有AD的患者，他们均在家中生活且年龄在74岁以下。48名患者签署了知情同意书并完成了所有初始测试。主要结局指标是对日常生活技能进行视频记录的家庭行为评估。主要结果是，未接受治疗组日常生活技能表现的平均斜率为每月最高得分的-1.72%，而去铁胺治疗组为每月最高得分的-0.87%（P = 0.038）。大量证据支持铝在AD发病机制中起积极作用这一假设。
