Takao Masaki
Department of Neuropathology (The Brain Bank for Aging Research), Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology.
Rinsho Shinkeigaku. 2012;52(11):851-4. doi: 10.5692/clinicalneurol.52.851.
The concept of mild cognitive impairment (MCI) is clinical condition between normal cognition and dementia. Annual rate of conversion from MCI to dementia is estimated as 10-15%. It must be emphasized that all MCI will not be potential patients of dementing illness. Most studies have been focused on amnestic-MCI as preclinical condition of Alzheimer's disease (AD). Along with the increase number of analyses, MCI is divided in four categories according to clinical presentation such as amnestic-MCI, amnestic-MCI with multiple domains, non amnestic-MCI with single domain and non amnestic-MCI with multiple domains. In general, the underlying disease of amnestic-MCI with multiple domains may be AD, cerebrovascular disorders (CVDs), metabolic disease or depression. Non amnestic-MCI may be frontotemporal dementia, dementia with Lewy body, CVDs and metabolic disorders. In fact, neuropathologic evidence of MCI revealed the presence of various types of pathologic change. Those pathologic changes include an accumulation of tau, amyloid beta, α-synuclein, TDP-43 and FUS protein with various degrees. It is not unusual condition that several different types of pathology are observed in a single individual. Besides neurodegenerative pathology, CVDs and hippocampus sclerosis significantly contribute the cognitive condition of MCI. To realize the complexity of neuropathologic alterations of MCI is important for early intervention of dementia indivisuals.
轻度认知障碍(MCI)的概念是介于正常认知和痴呆之间的临床状态。MCI每年转化为痴呆的发生率估计为10% - 15%。必须强调的是,并非所有MCI患者都会发展为痴呆。大多数研究聚焦于遗忘型MCI,将其视为阿尔茨海默病(AD)的临床前期状态。随着分析数量的增加,MCI根据临床表现被分为四类,即遗忘型MCI、多领域遗忘型MCI、单领域非遗忘型MCI和多领域非遗忘型MCI。一般来说,多领域遗忘型MCI的潜在病因可能是AD、脑血管疾病(CVD)、代谢性疾病或抑郁症。非遗忘型MCI可能是额颞叶痴呆、路易体痴呆、CVD和代谢紊乱。事实上,MCI的神经病理学证据显示存在各种类型的病理变化。这些病理变化包括不同程度的tau蛋白、淀粉样β蛋白、α - 突触核蛋白、TDP-43和FUS蛋白的积累。在一个个体中观察到几种不同类型的病理情况并不罕见。除了神经退行性病变外,CVD和海马硬化也显著影响MCI的认知状况。认识到MCI神经病理改变的复杂性对于痴呆患者的早期干预很重要。