Iseki Eizo
Department of Psychiatry, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan.
Neuropathology. 2004 Mar;24(1):72-8. doi: 10.1111/j.1440-1789.2003.00530.x.
The present study is an attempt to reclassify the pathological subtypes of DLB based on both Lewy pathology and Alzheimer pathology, and to clarify the pathological boundary between DLB and Parkinson's disease (PD) or Alzheimer's disease (AD) in autopsied cases, using pathological and immunohistochemical methods. Dementia with Lewy bodies was classified into the limbic type and neocortical type according to the degree of Lewy pathology, including Lewy bodies (LB) and LB-related neurites, by our staging and was classified into the pure form, common form and AD form according to the degree of Alzheimer pathology including NFT and amyloid deposits by Braak staging. These combined subtypes were lined up on a spectrum not only with Lewy pathology but also with other DLB-related pathologies including Alzheimer pathology, neuronal loss in the substantia nigra, spongiform change in the transentorhinal cortex and LB-related neurites in the CA2-3 region. There were some similarities in both Lewy pathology and other DLB-related pathologies between PD and DLB, although Lewy pathology of PD was below the lowest stage of Lewy pathology. In contrast, AD did not meet the stages of Lewy pathology, and there were also no similarities in other DLB-related pathologies between AD and DLB. In addition, LB of AD showed the characteristics different from those of DLB on the coexistence of LB with NFT. These present findings suggest that DLB has pathological continuity with PD, but can be pathologically differentiated from AD. The present study clarified the pathological entity of DLB, compared with PD and AD.
本研究旨在基于路易体病理和阿尔茨海默病病理对路易体痴呆（DLB）的病理亚型进行重新分类，并使用病理和免疫组织化学方法，在尸检病例中阐明DLB与帕金森病（PD）或阿尔茨海默病（AD）之间的病理界限。根据路易体病理程度，包括路易体（LB）和与LB相关的神经突，通过我们的分期将路易体痴呆分为边缘型和新皮质型，并根据Braak分期中包括神经原纤维缠结（NFT）和淀粉样蛋白沉积的阿尔茨海默病病理程度分为纯合型、常见型和AD型。这些联合亚型不仅在路易体病理方面，而且在包括阿尔茨海默病病理、黑质神经元丢失、内嗅皮质海绵状改变以及CA2-3区与LB相关的神经突等其他与DLB相关的病理方面，都排列在一个连续谱上。PD和DLB在路易体病理以及其他与DLB相关的病理方面存在一些相似之处，尽管PD的路易体病理低于路易体病理的最低阶段。相比之下，AD不符合路易体病理阶段，并且AD与DLB在其他与DLB相关的病理方面也没有相似之处。此外，AD的LB在与NFT共存时表现出与DLB不同的特征。这些目前的发现表明，DLB与PD存在病理连续性，但在病理上可与AD区分开来。本研究阐明了与PD和AD相比，DLB的病理实体。
