de la Monte S M
Massachusetts Alzheimer's Disease Research Center, Boston.
Ann Neurol. 1989 May;25(5):450-9. doi: 10.1002/ana.410250506.
Morphometric analysis of standardized gross cerebral slices from 16 patients with end-stage Alzheimer's disease (AD), 14 controls without neuropathological lesions or neurological disease, and 4 neurologically intact nondemented patients with histopathological lesions of AD was used to measure cross-sectional areas of cerebral cortex, white matter, subcortical nuclei, and the ventricular system. In AD, there was global cerebral atrophy of both cortex and white matter, selective atrophy of the amygdala and hippocampus, and ex vacuo hydrocephalus. In addition, in half the cases of AD, white matter atrophy was associated with overt histopathological evidence of patchy rarefaction of fibers and gliosis. Patients with preclinical AD had prominent and selective shrinkage of white matter comparable to that observed in AD, yet their cortical areas were normal. These observations suggest that white matter degeneration is an intrinsic component of AD. Moreover, its presence in preclinical AD where cortical atrophy is not evident indicates that cytoskeletal abnormalities associated with axonal degeneration may precede and perhaps cause the cortical atrophy observed in clinically manifested AD.
对16例晚期阿尔茨海默病（AD）患者、14例无神经病理损伤或神经系统疾病的对照者以及4例有AD组织病理学损伤但神经功能完好的非痴呆患者的标准化大脑大体切片进行形态计量分析，以测量大脑皮质、白质、皮质下核团和脑室系统的横截面积。在AD患者中，存在皮质和白质的全脑萎缩、杏仁核和海马体的选择性萎缩以及代偿性脑积水。此外，在半数AD病例中，白质萎缩与纤维稀疏和胶质增生的明显组织病理学证据相关。临床前期AD患者的白质有明显的选择性萎缩，与AD患者中观察到的情况相当，但他们的皮质面积正常。这些观察结果表明，白质变性是AD的一个内在组成部分。此外，在临床前期AD中白质变性的存在，而此时皮质萎缩并不明显，这表明与轴突变性相关的细胞骨架异常可能先于并可能导致临床显性AD中观察到的皮质萎缩。
