Fallet-Bianco C, Roudier M, Lamour Y, Davous P
Laboratoire d'Anatomie-Pathologique, Centre Hospitalier Sainte-Anne, Paris.
Rev Neurol (Paris). 1990;146(11):687-96.
Fifty brains from patients prospectively studied in a geriatric hospital (Charles Richet Study) were examined pathologically. The patients were senile (mean age: 85) and demented and had been clinically diagnosed as senile dementia of Alzheimer type (SDAT), vascular or multi-infarct dementia (VD), mixed dementia (MD). The whole brain was studied after formalin fixation and coronal sections. The senile changes were quantified in 6 neocortical areas, hippocampus and amygdala and subcortical structures after staining by thioflavine--S and Bodian's method. The other vascular and degenerative lesions were semiquantitatively studied. Three groups of patients were identified after microscopic examination: 1. SDAT (n = 27), 2. VD (n = 6), 3. MD (n = 15), 2 patients had no significant pathological correlate for dementia. Comparison of thioflavine S and Bodian's method in 30 cases showed the former to be more sensitive for the identification of senile plaques. In SDAT, 13/27 brains lacked neurofibrillary tangles in the neocortex. Amyloid angiopathy was observed in 78% of the brains but lacked in 5/6 cases affected by pure VD. Significant lesions of the substantia nigra were observed in 13 cases with typical features of Parkinson's disease in 2 cases. The locus coeruleus was affected mainly in SDAT cases (20/27) and in some cases of VD or MD (6/21). The raphe nuclei showed neuronal loss in 18% of the cases, mostly SDAT. In this series of cases, neocortical neurofibrillary tangles could be lacking in SDAT. Amyloid angiopathy was almost always present in SDAT and MD. Subcortical structures involved in cholinergic, noradrenergic and serotoninergic innervation of the cortex were more severely impaired in SDAT and MD than in VD. Mixed dementia was frequent in these very old demented patients. Clinical and pathological criteria are needed to identify this group of patients.
对一家老年医院（夏尔·里歇研究）前瞻性研究的50例患者的大脑进行了病理检查。患者均为老年人（平均年龄：85岁）且患有痴呆症，临床诊断为阿尔茨海默型老年痴呆（SDAT）、血管性或多发性梗死性痴呆（VD）、混合性痴呆（MD）。全脑经福尔马林固定后制作冠状切片进行研究。采用硫黄素-S和博迪安氏法染色后，对6个新皮质区域、海马体、杏仁核及皮质下结构的老年变化进行定量分析。对其他血管性和退行性病变进行半定量研究。显微镜检查后确定了三组患者：1. SDAT（n = 27），2. VD（n = 6），3. MD（n = 15），2例患者的痴呆无明显病理相关因素。对30例病例中硫黄素S和博迪安氏法的比较显示，前者在识别老年斑方面更敏感。在SDAT中，27例大脑中有13例新皮质缺乏神经原纤维缠结。78%的大脑观察到淀粉样血管病，但6例纯VD患者中有5例未出现。13例观察到黑质有明显病变，其中2例具有帕金森病的典型特征。蓝斑主要在SDAT病例（20/27）以及部分VD或MD病例（6/21）中受到影响。缝核在18%的病例中显示神经元丢失，大多为SDAT。在这一系列病例中，SDAT可能缺乏新皮质神经原纤维缠结。淀粉样血管病几乎总是存在于SDAT和MD中。与VD相比，SDAT和MD中参与皮质胆碱能、去甲肾上腺素能和5-羟色胺能神经支配的皮质下结构受损更严重。在这些高龄痴呆患者中，混合性痴呆很常见。需要临床和病理标准来识别这组患者。
