Casserly Ivan, Topol Eric
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Lancet. 2004 Apr 3;363(9415):1139-46. doi: 10.1016/S0140-6736(04)15900-X.
Late-onset sporadic Alzheimer's disease is a heterogeneous disorder. In elderly patients, increasing evidence suggests a link between this neurodegenerative disease, and vascular risk factors and atherosclerosis. The nature of this link remains speculative. Some investigators have suggested that the disease arises as a secondary event related to atherosclerosis of extracranial or intracranial vessels. A toxic effect of vascular factors on the microvasculature of susceptible brain regions has also been argued. An alternative explanation is that atherosclerosis and Alzheimer's disease are independent but convergent disease processes. This hypothesis is lent support by observations of shared epidemiology, pathophysiological elements, and response to treatment in both disorders. It provides a potential framework for an improved understanding of the pathogenesis of Alzheimer's disease, especially in elderly patients with vascular risk factors, and offers some promise toward the search for preventive and therapeutic treatments.
迟发性散发性阿尔茨海默病是一种异质性疾病。在老年患者中，越来越多的证据表明这种神经退行性疾病与血管危险因素和动脉粥样硬化之间存在联系。这种联系的本质仍具有推测性。一些研究人员认为，该疾病是作为与颅外或颅内血管动脉粥样硬化相关的继发性事件出现的。也有人认为血管因素对易感脑区的微血管有有毒作用。另一种解释是动脉粥样硬化和阿尔茨海默病是独立但趋同的疾病过程。两种疾病在流行病学、病理生理因素及对治疗的反应方面具有共性，这些观察结果支持了这一假说。它为更好地理解阿尔茨海默病的发病机制提供了一个潜在框架，尤其是在有血管危险因素的老年患者中，并且为寻找预防和治疗方法带来了一些希望。
