Harman Denham
Department of Medicine, University of Nebraska College of Medicine, 984635 Nebraska Medical Center, Omaha, 68198-4635, USA.
Ann N Y Acad Sci. 2006 May;1067:454-60. doi: 10.1196/annals.1354.065.
Alzheimer's disease (AD) is the chief cause of dementia, and age is its major risk factor. The majority of cases (90-95%) are sporadic (SAD), and the remainder are familial (FAD). AD is characterized by two brain lesions, intraneuronal fibrillary tangles and extracellular plaques. The lesions are identical in SAD and FAD as well as to those in persons with Down's syndrome (DS). The same lesions are also observed frequently in elderly non-demented individuals (E-ND). Both AD lesions may stem from the normal progressive increases in oxidative stress (OxS) throughout the body with age. Onset of dementia due to the accumulating lesions is around 40 years for DS, 40-60 years for FAD, over about 65 years for SAD, while that for E-ND is unknown. The lesions are made clinically manifest with time by the normal increase with age of OxS, "the dementia of old age," or by a process specific for each AD category, which enhances the normal OxS so as to lower the unknown onset age of dementia for E-ND individuals to that associated with the AD category. A plausible process can be advanced for each AD category. The hypothesis suggests convenient, effective measures to prevent and treat, for example, by decreasing brain OxS levels with oral antioxidants such as lipoic or dehydroascorbic acids that are capable of passing the blood-brain barrier.
阿尔茨海默病(AD)是痴呆症的主要病因,年龄是其主要风险因素。大多数病例(90 - 95%)为散发性(SAD),其余为家族性(FAD)。AD的特征是两种脑损伤,即神经元内的神经原纤维缠结和细胞外斑块。这些损伤在SAD和FAD中以及在唐氏综合征(DS)患者中是相同的。在老年非痴呆个体(E-ND)中也经常观察到同样的损伤。这两种AD损伤可能都源于随着年龄增长全身氧化应激(OxS)的正常渐进性增加。由于这些累积损伤导致的痴呆症发病年龄,DS约为40岁,FAD为40 - 60岁,SAD超过约65岁,而E-ND的发病年龄尚不清楚。随着年龄增长,OxS正常增加,即“老年痴呆症”,或者通过每种AD类型特有的过程,使这些损伤在临床上随时间显现出来,该过程增强了正常的OxS,从而将E-ND个体痴呆症未知的发病年龄降低到与相应AD类型相关的发病年龄。对于每种AD类型都可以提出一个合理的过程。该假说提出了方便、有效的预防和治疗措施,例如,通过口服能够穿过血脑屏障的抗氧化剂如硫辛酸或脱氢抗坏血酸来降低脑OxS水平。