*Department of Neuropathology, John Radcliffe Hospital †Nuffield Department of Clinical Neurosciences ‡Nuffield Department of Medicine ∥Department of Pharmacology, Oxford University, Oxford §Department of Pathology, St George's Hospital, University of London, UK.
Alzheimer Dis Assoc Disord. 2014 Jan-Mar;28(1):30-5. doi: 10.1097/WAD.0b013e31829b72f1.
The understanding of how cerebrovascular disease (CVD) contributes to dementia is hampered by a lack of agreed and validated pathologic methods to accord weight to the contribution of different aspects of CVD to dementia. A previous study from the Oxford Project to Investigate Memory and Ageing (OPTIMA) validated a scheme for assessing the contribution of subcortical small vessel disease (SVD) toward dementia in the elderly by showing a significant inverse relationship between the severity of SVD and cognition in subjects without any other dementia pathology using this method. In the present paper, the method has been used to assess severity of SVD in 161 cases of neuropathologically confirmed Alzheimer disease. The results showed there was no relationship between the SVD score and cognitive scores acquired in the last 2 years of life. SVD scores were significantly related to age (P<0.0017) and were slightly but significantly higher in females than males (P<0.049). SVD scores were not related to blood pressure at entry to OPTIMA and were significantly lower when compared with the cohort of OPTIMA cases with only CVD (mean 5.06 ± 1.85 vs. 5.9 ± 2.67; P<0.0065). We conclude that when Alzheimer disease pathology is present in elderly subjects, it overwhelms the modest contribution that SVD makes to cognitive impairment.
由于缺乏公认和经过验证的病理方法来衡量脑血管疾病 (CVD) 对痴呆症的不同方面的贡献，因此对其导致痴呆症的机制的理解受到了阻碍。牛津探索记忆与衰老项目 (OPTIMA) 的一项先前研究通过显示在使用该方法的没有任何其他痴呆症病理的受试者中，SVD 的严重程度与认知能力之间存在显著的反比关系，从而验证了一种评估皮质下小血管疾病 (SVD) 对老年人痴呆症贡献的方案。在本文中，该方法用于评估 161 例经神经病理学证实的阿尔茨海默病患者的 SVD 严重程度。结果表明，SVD 评分与生命最后 2 年获得的认知评分之间没有关系。SVD 评分与年龄显著相关（P<0.0017），女性略高于男性（P<0.049）。SVD 评分与 OPTIMA 入组时的血压无关，与仅患有 CVD 的 OPTIMA 病例队列相比显著降低（平均 5.06 ± 1.85 比 5.9 ± 2.67；P<0.0065）。我们得出结论，当阿尔茨海默病病理存在于老年受试者中时，它会压倒 SVD 对认知障碍的适度贡献。
