Yamamoto Ryoko, Iseki Eizo, Murayama Norio, Minegishi Michiko, Marui Wami, Togo Takashi, Katsuse Omi, Kato Masanori, Iwatsubo Takeshi, Kosaka Kenji, Arai Heii
Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, 3-3-20 Shinsuna, Koto-ku, Tokyo 136-0075, Japan.
J Neurol Sci. 2006 Jul 15;246(1-2):95-101. doi: 10.1016/j.jns.2006.02.016. Epub 2006 Apr 19.
We examined 19 autopsied cases of dementia with Lewy bodies (DLB) using pathological and alpha-synuclein-immunohistochemical methods, and investigated Lewy pathology in the primary visual pathway (lateral geniculate body and Brodmann's area 17), secondary visual pathway (pulvinar, Brodmann's areas 18 and 19, and inferior temporal cortex), amygdala and substantia nigra, to clarify the relationship between visual misidentification and Lewy pathology in the visual pathway. Consequently, the secondary visual pathway revealed significantly severer Lewy pathology than the primary visual pathway, suggesting that the degeneration of the secondary visual pathway induces dysfunction in the recognition of objects shape and color. In addition, the amygdala revealed significantly severer Lewy pathology and neuronal loss than the primary and secondary visual pathways, suggesting that the degeneration of the amygdala, which receives the afferent connections from the substantia nigra, fails to modulate the visual processing according to cognition and emotion. These findings suggest that Lewy pathologies in the secondary visual pathway and amygdala may cause the dysfunction of the visuo-amygdaloid pathway and participate in visual misidentification in DLB patients. In addition, we compared Lewy pathology between cases with and without visual hallucinations, and showed no significant differences between the two groups.
我们使用病理学和α-突触核蛋白免疫组织化学方法检查了19例路易体痴呆（DLB）尸检病例，并研究了初级视觉通路（外侧膝状体和布罗德曼17区）、次级视觉通路（丘脑枕、布罗德曼18区和19区以及颞下回皮质）、杏仁核和黑质中的路易体病理，以阐明视觉识别错误与视觉通路中路易体病理之间的关系。结果发现，次级视觉通路的路易体病理比初级视觉通路严重得多，这表明次级视觉通路的退化会导致物体形状和颜色识别功能障碍。此外，杏仁核的路易体病理和神经元丢失比初级和次级视觉通路严重得多，这表明接受来自黑质传入连接的杏仁核退化，无法根据认知和情感调节视觉处理。这些发现表明，次级视觉通路和杏仁核中的路易体病理可能导致视觉-杏仁核通路功能障碍，并参与DLB患者的视觉识别错误。此外，我们比较了有和没有视幻觉的病例之间的路易体病理，结果显示两组之间没有显著差异。
