Wetterling T
Klinik für Psychiatrie, Medizinische Universität zu Lübeck.
Fortschr Neurol Psychiatr. 1989 Jan;57(1):1-13. doi: 10.1055/s-2007-1000740.
The enormous social problems and costs caused by patients suffering from dementia induce growing public interest and become a great challenge of medical science. This report attempts to give a review of recent investigations in neuropathology, genetics, neurotransmitter research, epidemiology, diagnostics and therapy of Alzheimer's dementia, the most common type of dementia. A lot of recent molecular genetic experiments and many neuropathological analogies of Alzheimer's dementia and Down's syndrome indicate a damage on the chromosome 21 as possible cause of Alzheimer's dementia. The neuropathological changes are not limited to the grey matter and cholinergic system, but the white matter and some neurotransmitter systems (noradrenaline, dopamine, serotonin and somatostatin) are affected too. Therapeutical trials to compensate these transmitter deficits show no or only poor clinical benefit. Metabolic studies show disturbances in glucose metabolism of Alzheimer brains suggesting an intraneural energy deficit may be the main damage in Alzheimer's dementia. In spite of extensive technical and psychopathometrical diagnostical attempts Alzheimer's dementia remains to be difficult to diagnose precisely clinically. Best information is given by PET.
痴呆症患者所引发的巨大社会问题及成本，引起了公众日益浓厚的兴趣，也成为医学领域的一大挑战。本报告旨在对近期有关阿尔茨海默病性痴呆（最常见的痴呆类型）的神经病理学、遗传学、神经递质研究、流行病学、诊断及治疗方面的调查进行综述。近期大量分子遗传学实验以及许多阿尔茨海默病性痴呆与唐氏综合征的神经病理学相似之处表明，21号染色体损伤可能是阿尔茨海默病性痴呆的病因。神经病理学变化不仅局限于灰质和胆碱能系统，白质及一些神经递质系统（去甲肾上腺素、多巴胺、5-羟色胺和生长抑素）也会受到影响。旨在弥补这些递质缺乏的治疗试验未显示出临床益处，或仅显示出有限的临床益处。代谢研究表明，阿尔茨海默病患者大脑的葡萄糖代谢存在紊乱，这表明神经内能量缺乏可能是阿尔茨海默病性痴呆的主要损伤。尽管进行了广泛的技术及心理测量诊断尝试，但阿尔茨海默病性痴呆在临床上仍难以准确诊断。正电子发射断层扫描（PET）能提供最佳信息。
