Kovacs Gabor G, Gelpi Ellen
Institute of Neurology, Medical University of Vienna, Vienna, Austria.
Clin Neuropathol. 2012 May-Jun;31(3):116-8. doi: 10.5414/np300512.
The two major approaches for the neuropathological assessment of Alzheimer's disease (AD) related pathology have been based on the assessment of neuritic plaques (CERAD) and neurofibrillary pathology (Braak and Braak). In 1997 these two approaches were integrated in the criteria and recommendations of the National Institute on Aging and the Reagan Institute Working group. Recently a new guideline has been published by the National Institute on Aging-Alzheimer's Association. This new guideline recognizes the existence of a pre-clinical stage of AD as part of continuous neuropathological changes in the background of the disease process, and it fosters the assessment of amyloid-beta phases in addition to neurofibrillary degeneration and neuritic plaques following an "ABC" score. Further, it suggests protocols for the neuropathological assessment of additional/concomitant neurodegenerative and vascular pathologies. Altogether, the new guideline responds to the need for an update of the existing "1997 criteria" for AD. Continued studies will have to assess the added value of the new approach and the influence of interlaboratory and/or methodological differences on the implementation of these new recommendations.
阿尔茨海默病（AD）相关病理学的神经病理学评估主要有两种方法，分别基于神经炎性斑块评估（CERAD）和神经原纤维病理学（Braak分级）。1997年，这两种方法被纳入美国国立衰老研究所和里根研究所工作组的标准与建议中。最近，美国国立衰老研究所-阿尔茨海默病协会发布了一项新指南。该新指南认识到AD临床前期的存在，将其视为疾病进程背景下持续神经病理学变化的一部分，并且除了按照“ABC”评分对神经原纤维变性和神经炎性斑块进行评估外，还倡导对β淀粉样蛋白阶段进行评估。此外，它还提出了针对其他/伴随的神经退行性和血管性病理学进行神经病理学评估的方案。总体而言，新指南回应了更新现有AD“1997标准”的需求。后续研究将必须评估新方法的附加价值以及实验室间和/或方法学差异对这些新建议实施的影响。
