基于人群的神经病理学研究对痴呆病理基础的认识。

Insights into the pathological basis of dementia from population-based neuropathology studies.

机构信息

Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.

Population Health Sciences Institute, Newcastle University, Sheffield, UK.

出版信息

Neuropathol Appl Neurobiol. 2023 Aug;49(4):e12923. doi: 10.1111/nan.12923.

Abstract

The epidemiological neuropathology perspective of population and community-based studies allows unbiased assessment of the prevalence of various pathologies and their relationships to late-life dementia. In addition, this approach provides complementary insights to conventional case-control studies, which tend to be more representative of a younger clinical cohort. The Cognitive Function and Ageing Study (CFAS) is a longitudinal study of cognitive impairment and frailty in the general United Kingdom population. In this review, we provide an overview of the major findings from CFAS, alongside other studies, which have demonstrated a high prevalence of pathology in the ageing brain, particularly Alzheimer's disease neuropathological change and vascular pathology. Increasing burdens of these pathologies are the major correlates of dementia, especially neurofibrillary tangles, but there is substantial overlap in pathology between those with and without dementia, particularly at intermediate burdens of pathology and also at the oldest ages. Furthermore, additional pathologies such as limbic-predominant age-related TDP-43 encephalopathy, ageing-related tau astrogliopathy and primary age-related tauopathies contribute to late-life dementia. Findings from ageing population-representative studies have implications for the understanding of dementia pathology in the community. The high prevalence of pathology and variable relationship to dementia status has implications for disease definition and indicate a role for modulating factors on cognitive outcome. The complexity of late-life dementia, with mixed pathologies, indicates a need for a better understanding of these processes across the life-course to direct the best research for reducing risk in later life of avoidable clinical dementia syndromes.

摘要

从人群和社区为基础的研究的流行病学神经病理学角度来看,可以公正地评估各种病理学的流行程度及其与老年痴呆症的关系。此外,这种方法为传统的病例对照研究提供了互补的见解,后者往往更能代表较年轻的临床队列。认知功能与衰老研究(CFAS)是一项针对英国普通人群认知障碍和虚弱的纵向研究。在这篇综述中,我们概述了 CFAS 以及其他研究的主要发现,这些研究表明,衰老大脑中的病理学非常普遍,特别是阿尔茨海默病神经病理学变化和血管病理学。这些病理学负担的增加是痴呆症的主要相关因素,特别是神经纤维缠结,但在有和没有痴呆症的人群之间,病理学存在大量重叠,尤其是在病理学的中间负担和最年长的年龄。此外,其他病理学,如边缘优势与年龄相关的 TDP-43 脑炎、与年龄相关的 tau 星形胶质病和原发性与年龄相关的 tau 病,也会导致老年痴呆症。代表性老龄化人群研究的结果对理解社区痴呆症的病理学具有重要意义。病理学的高流行率和与痴呆症状态的可变关系对疾病的定义具有重要意义,并表明调节因素对认知结果具有一定的作用。老年痴呆症的复杂性,伴有混合病理学,表明需要更好地了解这些过程在整个生命周期中的作用,以指导为减少晚年可避免的临床痴呆综合征的风险而进行的最佳研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c5f4/10946587/c9c5de200c63/NAN-49-0-g005.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索