Rush Alzheimer Disease Center, Suite 1000, Rush University Medical Center, 1750 W Harrison Street, Chicago, IL, 60612, USA.
Department of Pathology (Neuropathology), Rush Alzheimer Disease Center and Rush University Medical Center, Chicago, IL, USA.
J Neurol. 2019 Dec;266(12):3108-3118. doi: 10.1007/s00415-019-09540-5. Epub 2019 Sep 18.
The association of Lewy bodies (LBs) with olfactory dysfunction was investigated in community-dwelling elders without clinical Parkinson's disease (PD) using the 12-item Brief Smell Identification Test (BSIT), a standard measure of odor identification.
280 participants in the Rush Memory and Aging Project completed the BSIT annually. Lewy bodies were detected in 13 brain regions by immunohistochemistry and were assigned to the Braak PD stages 1-6.
Of the 280 participants, 101 (36.1%) had LBs which were maximal in the olfactory bulb and tract (85.1%) and least in Heschl's cortex (21.8%). Due to the small number of cases in Braak PD stages 2, 3 and 5, the distribution of LBs in the 6 Braak PD stages was contracted into 3 main LB stages: (1) LBs in olfactory bulbs and dorsal motor nucleus of vagus, (2) further extension of LBs to limbic and other brainstem regions and (3) additional extension of LBs to neocortical areas. MMSE, global cognition and odor test scores were lower and frequency of dementia was higher at the time of the last valid BSIT, in cases with LBs as compared to those without LBs. Linear regression analyses showed that LBs were associated with impaired olfaction. However, on stratification of LBs into 3 stages, only the stage 3 cases were independently associated with impaired olfaction.
Although LB pathology was detected in olfactory bulbs in the early stage of LB progression (stage 1), the strongest association of LBs with olfactory dysfunction was observed in the late pathological stage (stage 3) when LBs extended to neocortical areas.
使用 12 项简短嗅觉识别测试（BSIT），一种标准的气味识别测量方法，研究了无临床帕金森病（PD）的社区居住老年人中 Lewy 体（LB）与嗅觉功能障碍的关联。
Rush 记忆与衰老项目的 280 名参与者每年完成 BSIT。通过免疫组织化学检测到 13 个脑区的 LB，并将其分配到 Braak PD 阶段 1-6。
在 280 名参与者中，有 101 名（36.1%）存在 LB，最大的位于嗅球和嗅束（85.1%），最小的位于海氏皮质（21.8%）。由于 Braak PD 阶段 2、3 和 5 的病例数量较少，因此将 6 个 Braak PD 阶段的 LB 分布收缩为 3 个主要的 LB 阶段：（1）LB 位于嗅球和迷走神经背核，（2）LB 进一步延伸至边缘和其他脑干区域，（3）LB 进一步延伸至新皮质区域。与无 LB 的病例相比，在最后一次有效 BSIT 时，有 LB 的病例的 MMSE、整体认知和嗅觉测试评分较低，痴呆频率较高。线性回归分析表明 LB 与嗅觉障碍有关。然而，在将 LB 分为 3 个阶段进行分层后，只有第 3 阶段的病例与嗅觉障碍独立相关。
尽管在 LB 进展的早期阶段（第 1 阶段）在嗅球中检测到 LB 病理学，但在 LB 延伸到新皮质区域的晚期病理阶段（第 3 阶段），LB 与嗅觉功能障碍的关联最强。
