Fischer P, Lassmann H, Jellinger K, Simanyi M, Bancher C, Travniczek-Marterer A, Gatterer G, Danielczyk W
Psychiatrischen Klinik, Universität Wien.
Wien Med Wochenschr. 1991;141(20):455-62.
Alzheimer's disease causes about 80% of dementias in old age. The pathological hallmarks of Alzheimer's disease are senile plaques (SP) and neurofibrillary tangles (NFT), which to a lesser degree can also be found in the brains of mentally intact elderly. The question whether SP or NFT or any other process are primarily correlated to severity of dementia can only be answered in prospective longitudinal clinical and neuropsychological studies with quantitative neuropathological investigation. We report the correlations between mini-mental-state scores and lesion counts in 3 isocortical and 3 hippocampal areas in a consecutive series of 19 Alzheimer's patients studied prospectively in the Vienna Longitudinal Study on Dementia. Lesion counts increased at very late stages of dementia and were rather low in mild to moderate severity of dementia. Mildly demented patients with very slow progression of dementia also had rather high lesion counts. Neurofibrillary changes in NFT and neuritic plaques were correlated with severity of dementia, but diffuse plaques, i.e. SP without neuritic degeneration, were not at all correlated with severity of dementia. We speculate that NFT and SP do not represent the primary process which leads to dementia.
阿尔茨海默病导致约80%的老年痴呆症。阿尔茨海默病的病理特征是老年斑（SP）和神经原纤维缠结（NFT），在精神正常的老年人脑中也能在较小程度上发现这些特征。SP或NFT或任何其他过程是否与痴呆症严重程度主要相关的问题，只能在前瞻性纵向临床和神经心理学研究以及定量神经病理学调查中得到解答。我们报告了在维也纳痴呆纵向研究中对19例阿尔茨海默病患者进行前瞻性研究时，3个等皮质区和3个海马区的简易精神状态评分与病变计数之间的相关性。病变计数在痴呆症的极晚期增加，在轻度至中度痴呆严重程度时相当低。痴呆进展非常缓慢的轻度痴呆患者的病变计数也相当高。NFT中的神经原纤维变化和神经炎性斑块与痴呆症严重程度相关，但弥漫性斑块，即无神经炎性变性的SP，与痴呆症严重程度完全不相关。我们推测NFT和SP并不代表导致痴呆症的主要过程。
