Saito Yuko, Ruberu Nyoka N, Sawabe Motoji, Arai Tomio, Tanaka Noriko, Kakuta Yukio, Yamanouchi Hiroshi, Murayama Shigeo
Department of Neuropathology, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan.
J Neuropathol Exp Neurol. 2004 Sep;63(9):911-8. doi: 10.1093/jnen/63.9.911.
We have reported that the ambient gyrus is the site with the greatest accumulation of argyrophilic grains (AGs) and that the degeneration of the ambient gyrus is responsible for dementia with grains. Here we analyzed 1,405 serial autopsy cases from 2 hospitals and detected AGs only in cases older than 56 years of age. The distribution of AGs followed a stereotypic regional pattern. Thus, we propose the following staging paradigm: stage I: AGs restricted to the ambient gyrus and its vicinity; stage II: AGs more apparent in the anterior and posterior medial temporal lobe, including the temporal pole, as well as the subiculum and entorhinal cortex; and stage III: abundant AGs in the septum, insular cortex, and anterior cingulate gyrus, accompanying spongy degeneration of the ambient gyrus. Sixty-three of 65 (96.9%) argyrophilic grain stage III cases without other dementing pathology were classified as 0.5 or higher in the clinical dementia rating. Forty-seven of 50 dementia with grains cases (94%) were stage III and 3 were stage II. No association with apoE genotyping was detected. Our study further confirms that dementia with grains is an age-associated tauopathy with relatively uniform distribution and may independently contribute to cognitive decline in the elderly.
我们曾报道，环周回是嗜银颗粒（AGs）聚集最多的部位，且环周回的变性是导致颗粒性痴呆的原因。在此，我们分析了来自两家医院的1405例连续尸检病例，仅在年龄大于56岁的病例中检测到AGs。AGs的分布遵循一种刻板的区域模式。因此，我们提出以下分期范式：I期：AGs局限于环周回及其附近；II期：AGs在颞叶内侧前后部更明显，包括颞极，以及海马下脚和内嗅皮质；III期：隔区、岛叶皮质和前扣带回中有大量AGs，同时伴有环周回的海绵状变性。65例无其他痴呆病理改变的嗜银颗粒III期病例中有63例（96.9%）临床痴呆评定为0.5或更高。50例颗粒性痴呆病例中有47例（94%）为III期，3例为II期。未检测到与载脂蛋白E基因分型的关联。我们的研究进一步证实，颗粒性痴呆是一种与年龄相关的tau蛋白病，分布相对均匀，可能独立导致老年人认知功能下降。
