The Jewish Home & Hospital LifeCare System, New York, NY 10025, USA.
Parkinsonism Relat Disord. 2009 Sep;15(8):572-5. doi: 10.1016/j.parkreldis.2009.02.003. Epub 2009 Apr 5.
The literature currently views Lewy bodies as central in the pathogenesis of Parkinson's disease dementia (PDD) when Alzheimer's disease (AD) or vascular pathology is not present. Because the neuropathology of PDD is not well understood, the pathological features of PDD were characterized in eighteen PD brain specimens using published criteria for AD, Diffuse Lewy Body Disease (DLBD), and Vascular Disease as a framework. Among the PD dementia (n=16) subjects, 3 (19%) did not have LBs outside of the brain stem, nor AD or vascular pathology. In two additional cases, one did have rare LBs in the neocortex and cingulate gyrus. However, these two cases did not meet the diagnostic criteria for DLBD. Beyond these 5 cases, the remaining PD dementia subjects fitted a classical pathological profile consistent with AD (38%), vascular disease (12.5%), DLBD (6%), or a combination of these pathologies (12.5%). The findings from this study do not support the hypothesis that LBs are the main substrate for dementia in PD. More research with a larger sample size is needed to determine whether the LB may be a secondary phenomenon and/or an "innocent-bystander". The entire role of the LB in PD dementia is again brought into question.
目前的文献认为路易体（Lewy bodies）在阿尔茨海默病（AD）或血管病变不存在时是帕金森病痴呆（PDD）发病机制的核心。由于 PDD 的神经病理学尚不清楚，因此使用 AD、弥漫性路易体病（DLBD）和血管疾病的发表标准作为框架，在 18 个 PD 脑标本中对 PDD 的病理特征进行了描述。在 PD 痴呆（n=16）患者中，3 名（19%）患者除了脑干外没有路易体，也没有 AD 或血管病变。在另外两例中，有一例在大脑皮层和扣带回有罕见的路易体。然而，这两例不符合 DLBD 的诊断标准。除了这 5 例病例外，其余 PD 痴呆患者的病理特征符合 AD（38%）、血管疾病（12.5%）、DLBD（6%）或这些病理学的组合（12.5%）。本研究的结果不支持路易体是 PD 痴呆的主要病变基础的假说。需要进行更大样本量的研究，以确定 LB 是否是一种次要现象和/或“无辜旁观者”。LB 在 PD 痴呆中的作用再次受到质疑。
