老年脑血管病病理学与帕金森症征象。
Cerebrovascular disease pathology and parkinsonian signs in old age.
机构信息
Rush Alzheimer's Disease Center, Rush University Medical Center, Armour Academic Facility, Suite 1022, 600 South Paulina Street, Chicago, IL 60612, USA.
出版信息
Stroke. 2011 Nov;42(11):3183-9. doi: 10.1161/STROKEAHA.111.623462. Epub 2011 Sep 1.
BACKGROUND AND PURPOSE
Mild motor symptoms including parkinsonian signs are common in old age, but their underlying neuropathology is unclear. We tested the hypothesis that cerebrovascular pathologies are related to parkinsonian signs.
METHODS
We studied brain autopsies from 418 deceased participants from the Religious Order Study, who underwent evaluation of parkinsonian signs with a modified version of the motor section of the Unified Parkinson's Disease Rating Scale. Brains were evaluated for macroscopic and microinfarcts and the severity of arteriolosclerosis. Regression analyses were used to examine the association of cerebrovascular pathologies with parkinsonian signs.
RESULTS
More than 35% of cases (N=149) showed macroscopic infarcts. Almost 30% of cases without macroscopic infarcts showed pathologies not detected by conventional brain imaging: microinfarcts (N=33 [7.9%]), arteriolosclerosis (N=62 [14.8%]), or both (N=24 [5.7%]). Macroscopic infarcts, specifically multiple cortical and ≥1 subcortical macroscopic infarcts, were related to higher global parkinsonian scores. The presence of multiple and cortical microinfarcts was associated with global parkinsonian score. Arteriolosclerosis was associated with global parkinsonian score, but this effect was attenuated and no longer significant after accounting for infarcts. Each of the 3 pathologies was separately associated with parkinsonian gait (macroscopic infarcts [estimate, 0.552; SE, 0.210; P=0.009]; microinfarcts [estimate, 0.424; SE, 0.213; P=0.047]; arteriolosclerosis [estimate, 0.191; SE, 0.056; P<0.001]). Further analyses showed that subcortical macroscopic and microinfarcts were specifically associated with the severity of parkinsonian gait.
CONCLUSIONS
Cerebrovascular pathologies, including macroscopic infarcts, microinfarcts, and arteriolosclerosis, are common in older persons and may be unrecognized common etiologies of mild parkinsonian signs, especially parkinsonian gait, in old age.
背景与目的
包括帕金森病征在内的轻度运动症状在老年中很常见，但它们的潜在神经病理学尚不清楚。我们检验了这样一个假设，即脑血管病与帕金森病征有关。
方法
我们研究了来自宗教秩序研究的 418 名已故参与者的脑尸检，他们接受了改良的帕金森病统一评定量表的运动部分评估帕金森病征。大脑评估了宏观和微观梗死以及小动脉硬化的严重程度。回归分析用于检查脑血管病与帕金森病征之间的关联。
结果
超过 35%的病例（N=149）有宏观梗死。近 30%没有宏观梗死的病例显示出常规脑成像无法检测到的病理变化：微梗死（N=33[7.9%]）、小动脉硬化（N=62[14.8%]）或两者兼而有之（N=24[5.7%]）。宏观梗死，特别是多发性皮质和≥1 个皮质下宏观梗死，与更高的整体帕金森病评分有关。多发性和皮质微梗死的存在与整体帕金森病评分有关。小动脉硬化与整体帕金森病评分有关，但在考虑到梗死后，这种影响减弱且不再显著。3 种病理变化中的每一种都与帕金森步态（宏观梗死[估计值，0.552；SE，0.210；P=0.009]；微梗死[估计值，0.424；SE，0.213；P=0.047]；小动脉硬化[估计值，0.191；SE，0.056；P<0.001]）分别相关。进一步的分析表明，皮质下宏观和微梗死与帕金森步态的严重程度特别相关。
结论
脑血管病，包括宏观梗死、微梗死和小动脉硬化，在老年人中很常见，可能是老年轻度帕金森病征（尤其是帕金森步态）的未被识别的常见病因。
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