Department of Pathology, University of Washington, Seattle, WA 98104, USA.
Brain Pathol. 2010 May;20(3):654-9. doi: 10.1111/j.1750-3639.2009.00371.x.
Cognitive impairment and dementia are more common in patients with Parkinson disease (PD) than age-matched controls and appear to become more frequent as PD progresses. However, estimates of dementia in patients with PD have varied widely, likely due in part to differences in case definition, case ascertainment and methodology. First, we review investigations of usual pathologic correlates of dementia in patients with brainstem (b) Lewy Body Disease (LBD) and report our findings from the initial 266 brain autopsies from a population-based study of brain aging and incident dementia. Our results showed that 2.6% of subjects were diagnosed with PD during life but that 20% had bLBD at autopsy. Seventy percent of individuals with bLBD had high level of one or more cerebral pathologic changes significantly associated with dementia: Alzheimer's disease (AD), cerebral (c) LBD or microvascular brain injury (microVBI); these were commonly co-morbid. Next we consider proposed contributors to cognitive impairment and dementia in the approximately 30% of patients with only bLBD, including regionally selective dendritic degeneration of neostriatal medium spiny neurons. Diseases contributing to cognitive impairment and dementia in patients with bLBD are heterogeneous, providing diagnostic challenges as well as multiple opportunities for successful intervention in patients with PD.
认知障碍和痴呆在帕金森病（PD）患者中比年龄匹配的对照组更为常见，并且随着 PD 的进展似乎变得更加频繁。然而，PD 患者痴呆的估计值差异很大，部分原因可能是病例定义、病例确定和方法的差异。首先，我们回顾了对脑干（b）路易体病（LBD）患者痴呆常见病理相关性的研究，并报告了我们从基于人群的大脑老化和新发痴呆研究中最初 266 例脑尸检中获得的发现。我们的结果表明，2.6%的受试者在生前被诊断为 PD，但 20%的人在尸检时患有 bLBD。70%的 bLBD 患者有一个或多个与痴呆显著相关的高级别脑病理改变：阿尔茨海默病（AD）、脑（c）LBD 或微血管脑损伤（microVBI）；这些通常是共病的。接下来，我们考虑了大约 30%仅有 bLBD 的患者认知障碍和痴呆的潜在原因，包括新纹状体中型多棘神经元的区域性选择性树突退化。导致 bLBD 患者认知障碍和痴呆的疾病具有异质性，为 PD 患者的诊断和治疗提供了多种机会。
