Shimohata Takayoshi, Aiba Ikuko, Nishizawa Masatoyo
Department of Neurology, Brain Research Institute, Niigata University.
Rinsho Shinkeigaku. 2016;56(3):149-57. doi: 10.5692/clinicalneurol.cn-000841. Epub 2016 Mar 13.
Experts use the term corticobasal syndrome (CBS) for patients with a clinical diagnosis of corticobasal degeneration (CBD), and reserve CBD for those whose conditions have been diagnosed on the basis of neuropathological analyses. Several studies demonstrated that patients with CBD may also present with progressive supranuclear syndrome (PSPS), aphasia, Alzheimer disease-like dementia or behavioral change, suggesting that CBS is merely one of the presenting phenotypes of CBD. Although previous CBD diagnostic criteria reflected only CBS, the international consortium proposed new diagnostic criteria for CBD in 2013 (Armstrong's criteria). The new criteria include 4 CBD subtypes; CBS, frontal behavioral-spatial syndrome (FBS), nonfluent/agrammatic variant of primary progressive aphasia (naPPA),and PSPS. These subtypes were combined to create 2 sets of criteria: more specific clinical research criteria for probable CBD (cr-CBD) and broader criteria for possible CBD that are more inclusive but have a higher chance to detect other tau-based pathologies (p-CBD). Two studies have already revealed that the sensitivity and specificity of the criteria were not high. Because therapeutic interventions that target abnormally-phosphorylated tau have started, further refinement of the criteria is needed via biomarker researches with prospective study designs.
专家们将临床诊断为皮质基底节变性(CBD)的患者称为皮质基底节综合征(CBS),而将基于神经病理学分析确诊的患者称为CBD。多项研究表明,CBD患者也可能出现进行性核上性综合征(PSPS)、失语症、阿尔茨海默病样痴呆或行为改变,这表明CBS仅仅是CBD的一种表现型。尽管此前的CBD诊断标准仅反映了CBS,但国际联盟在2013年提出了新的CBD诊断标准(阿姆斯特朗标准)。新标准包括4种CBD亚型:CBS、额叶行为空间综合征(FBS)、原发性进行性失语的非流利/语法缺失型(naPPA)和PSPS。这些亚型被合并以创建2套标准:针对可能的CBD的更具体的临床研究标准(cr-CBD)和针对可能的CBD的更宽泛标准,该标准包容性更强,但检测其他基于tau蛋白的病变的可能性更高(p-CBD)。两项研究已经表明这些标准的敏感性和特异性不高。由于针对异常磷酸化tau蛋白的治疗干预已经开始,需要通过具有前瞻性研究设计的生物标志物研究进一步完善这些标准。