Honig Lawrence S, Kukull Walter, Mayeux Richard
Taub Institute for Research on Alzheimer's Disease and the Aging Brain, the Gertrude H. Sergievsky Center, and the Department of Neurology, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA.
Neurology. 2005 Feb 8;64(3):494-500. doi: 10.1212/01.WNL.0000150886.50187.30.
Epidemiologic studies have implicated cerebrovascular disease and its antecedents as risk factors for Alzheimer disease (AD). Cerebral atherosclerosis or strokes may increase the deposition of neuritic plaques or the formation of neurofibrillary tangles. Alternatively, they may simply hasten the age at onset of disease, or increase the severity of disease symptoms. This investigation examined the association between cerebrovascular disease and the pathologic manifestations of AD in an autopsy series.
This was a cross-sectional study using data from the United States National Alzheimer's Coordinating Center database. The primary analysis included 1,054 individuals with clinical information and semiquantitative neuropathologic measurements: 921 had AD as the primary neuropathologic diagnosis and 133 were considered neuropathologically normal.
Overall, 9% of the individuals had clinical history of stroke during life, but 33% had evidence of cerebral infarcts at postmortem. There was no association between neuritic plaques or neurofibrillary tangles, the primary neuropathologic manifestations of AD, with either clinical history of stroke or the presence of cerebral infarcts at postmortem. The authors did find a higher frequency of neuritic plaques and neurofibrillary tangles with increased amyloid angiopathy. Neither plaques nor tangles were associated with small vessel cerebrovascular disease, arteriosclerosis. However, the presence of large-vessel cerebrovascular disease, or atherosclerosis, was strongly associated with an increased frequency of neuritic plaques.
Atherosclerotic cerebrovascular disease may have a role in the pathogenesis of Alzheimer disease, because of a strong association with frequent neuritic plaques.
流行病学研究表明，脑血管疾病及其先兆是阿尔茨海默病（AD）的危险因素。脑动脉粥样硬化或中风可能会增加神经炎性斑块的沉积或神经原纤维缠结的形成。或者，它们可能只是加速疾病的发病年龄，或增加疾病症状的严重程度。本研究在一个尸检系列中调查了脑血管疾病与AD病理表现之间的关联。
这是一项横断面研究，使用来自美国国家阿尔茨海默病协调中心数据库的数据。主要分析包括1054名有临床信息和半定量神经病理学测量的个体：921例以AD作为主要神经病理学诊断，133例被认为神经病理学正常。
总体而言，9%的个体在生前有中风临床病史，但33%在死后有脑梗死证据。AD的主要神经病理学表现，即神经炎性斑块或神经原纤维缠结，与中风临床病史或死后脑梗死的存在之间没有关联。作者确实发现，随着淀粉样血管病的增加，神经炎性斑块和神经原纤维缠结的频率更高。斑块和缠结均与小血管脑血管疾病、动脉硬化无关。然而，大血管脑血管疾病或动脉粥样硬化的存在与神经炎性斑块频率增加密切相关。
动脉粥样硬化性脑血管疾病可能在阿尔茨海默病的发病机制中起作用，因为它与频繁出现的神经炎性斑块密切相关。
