Braak H, Braak E
Zentrum der Morphologie, Frankfurt/Main, Federal Republic of Germany.
Acta Neuropathol. 1991;82(4):239-59. doi: 10.1007/BF00308809.
Eighty-three brains obtained at autopsy from nondemented and demented individuals were examined for extracellular amyloid deposits and intraneuronal neurofibrillary changes. The distribution pattern and packing density of amyloid deposits turned out to be of limited significance for differentiation of neuropathological stages. Neurofibrillary changes occurred in the form of neuritic plaques, neurofibrillary tangles and neuropil threads. The distribution of neuritic plaques varied widely not only within architectonic units but also from one individual to another. Neurofibrillary tangles and neuropil threads, in contrast, exhibited a characteristic distribution pattern permitting the differentiation of six stages. The first two stages were characterized by an either mild or severe alteration of the transentorhinal layer Pre-alpha (transentorhinal stages I-II). The two forms of limbic stages (stages III-IV) were marked by a conspicuous affection of layer Pre-alpha in both transentorhinal region and proper entorhinal cortex. In addition, there was mild involvement of the first Ammon's horn sector. The hallmark of the two isocortical stages (stages V-VI) was the destruction of virtually all isocortical association areas. The investigation showed that recognition of the six stages required qualitative evaluation of only a few key preparations.
对83个取自非痴呆和痴呆个体尸检的大脑进行了检查，以观察细胞外淀粉样沉积物和神经元内神经原纤维变化。结果表明，淀粉样沉积物的分布模式和堆积密度对神经病理阶段的区分意义有限。神经原纤维变化以神经炎斑、神经原纤维缠结和神经毡丝的形式出现。神经炎斑的分布不仅在结构单位内差异很大，而且在个体之间也有很大差异。相比之下，神经原纤维缠结和神经毡丝表现出一种特征性的分布模式，据此可以区分六个阶段。前两个阶段的特征是内嗅前层Pre-α轻度或重度改变（内嗅前阶段I-II）。两个边缘叶阶段（阶段III-IV）的特点是内嗅前区和内嗅皮质中Pre-α层明显受累。此外，海马体第一扇区有轻度受累。两个等皮质阶段（阶段V-VI）的标志是几乎所有等皮质联合区的破坏。研究表明，识别这六个阶段仅需对少数关键标本进行定性评估。
