Yokota Osamu, Miki Tomoko, Ikeda Chikako, Nagao Shigeto, Takenoshita Shintaro, Ishizu Hideki, Haraguchi Takashi, Kuroda Shigetoshi, Terada Seishi, Yamada Norihito
Department of Psychiatry, Kinoko Espoir Hospital, Okayama, Japan.
Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Neuropathology. 2018 Feb;38(1):82-97. doi: 10.1111/neup.12429. Epub 2017 Sep 14.
Argyrophilic grain disease (AGD) is a common four-repeat tauopathy in elderly people. While dementia is a major clinical picture of AGD, recent studies support the possibility that AGD may be a pathological base in some patients with mild cognitive impairment, late-onset psychosis, bipolar disorder and depression. AGD often coexists with various other degenerative changes. The frequency of AGD in progressive supranuclear palsy (PSP) cases was reported to range from 18.8% to 80%. The frequency of AGD in corticobasal degeneration (CBD) cases tends to be higher than that in PSP cases, ranging from 41.2% to 100%. Conversely, in our previous study of the frequencies of mild PSP and CBD pathologies in AGD cases, five of 20 AGD cases (25%) had a few Gallyas-positive tufted astrocytes, six cases (30%) had a few granular/fuzzy astrocytes, and one case (5.0%) had a few Gallyas-positive astrocytic plaques in the putamen, caudate nucleus and/or superior frontal gyrus. Both Gallyas-positive tufted astrocytes and Gallyas-negative tau-positive granular/fuzzy astrocytes preferentially developed in the putamen, caudate nucleus and superior frontal cortex in AGD cases, being consistent with the predilection sites of Gallyas-positive tufted astrocytes in PSP cases. Further, in AGD cases, the quantities of Gallyas-positive tufted astrocytes, overall tau-positive astrocytes, and tau-positive neurons in the subcortical nuclei and superior frontal cortex were significantly correlated with Saito AGD stage, respectively. The frequency of AGD in AD cases was reported to reach up to 25% when using four-repeat tau immunohistochemistry. Pretangles are essential pathologies in AGD; however, the Braak stage of three-repeat tau-positive NFTs, which may indicate mild AD pathology or primary age-related tauopathy, was not correlated with Saito AGD stage. Clinicians should be aware of the possibility that coexisting AGD may impact clinical and radiological features in cases of other degenerative diseases.
嗜银颗粒病（AGD）是老年人中常见的四重复tau蛋白病。虽然痴呆是AGD的主要临床表现，但最近的研究支持AGD可能是一些轻度认知障碍、迟发性精神病、双相情感障碍和抑郁症患者的病理基础这一可能性。AGD常与各种其他退行性改变共存。据报道，进行性核上性麻痹（PSP）病例中AGD的发生率在18.8%至80%之间。皮质基底节变性（CBD）病例中AGD的发生率往往高于PSP病例，在41.2%至100%之间。相反，在我们之前关于AGD病例中轻度PSP和CBD病理发生率的研究中，20例AGD病例中有5例（25%）有一些Gallyas阳性簇状星形胶质细胞，6例（30%）有一些颗粒状/模糊星形胶质细胞，1例（5.0%）在壳核、尾状核和/或额上回有一些Gallyas阳性星形胶质细胞斑块。在AGD病例中，Gallyas阳性簇状星形胶质细胞和Gallyas阴性tau阳性颗粒状/模糊星形胶质细胞均优先在壳核、尾状核和额上皮质中出现，这与PSP病例中Gallyas阳性簇状星形胶质细胞的好发部位一致。此外，在AGD病例中，皮质下核和额上皮质中Gallyas阳性簇状星形胶质细胞、总tau阳性星形胶质细胞和tau阳性神经元的数量分别与斋藤AGD分期显著相关。据报道，使用四重复tau免疫组织化学时，AD病例中AGD的发生率高达25%。前缠结是AGD的基本病理；然而，三重复tau阳性神经原纤维缠结（NFTs）的Braak分期，这可能表明轻度AD病理或原发性年龄相关性tau蛋白病，与斋藤AGD分期无关。临床医生应意识到共存的AGD可能会影响其他退行性疾病病例的临床和放射学特征。
