Pearson R C, Esiri M M, Hiorns R W, Wilcock G K, Powell T P
Proc Natl Acad Sci U S A. 1985 Jul;82(13):4531-4. doi: 10.1073/pnas.82.13.4531.
The numbers and distribution of the neurofibrillary tangles and neuritic plaques have been determined in several areas of the neocortex in brains affected by various degrees of severity of Alzheimer disease. The homotypical cortex of the "association" areas of the temporal, parietal, and frontal lobes are severely involved, whereas the motor, somatic sensory, and primary visual areas are virtually unaffected. The neurofibrillary tangles are mainly in the supra- and infragranular layers, particularly in layers III and V. In all areas except area 18 in the occipital lobe, there are approximately twice as many tangles in layer V as in layer III. The tangles are arranged in definite clusters, and those in the supra- and infragranular layers are in register. The neuritic plaques occur in all layers but predominantly affect layers II and III and do not show clustering. These data on the severity of the pathological involvement in different areas of the neocortex and the laminar distribution and the clustering of the tangles support the suggestion that the pathological changes in Alzheimer disease affect regions that are interconnected by well-defined groups of connections and that the disease process may extend along the connecting fibers. The invariable and severe involvement of the olfactory areas of the brain in this disease is in striking contrast to the minimal changes in the somatic sensory and primary visual areas and raises the possibility that the olfactory pathway may be initially involved.
在受不同严重程度阿尔茨海默病影响的大脑中，已确定了新皮质几个区域中神经原纤维缠结和神经炎性斑块的数量及分布情况。颞叶、顶叶和额叶“联合”区域的同型皮质受累严重，而运动区、躯体感觉区和初级视觉区实际上未受影响。神经原纤维缠结主要位于颗粒上层和颗粒下层，尤其是第III层和第V层。在枕叶第18区以外的所有区域，第V层中的缠结数量大约是第III层的两倍。缠结排列成明确的簇状，颗粒上层和颗粒下层中的缠结相互对齐。神经炎性斑块出现在所有层中，但主要影响第II层和第III层，且不表现出簇状分布。这些关于新皮质不同区域病理受累严重程度、缠结的层状分布和簇状排列的数据支持了以下观点：阿尔茨海默病的病理变化影响由明确的连接组相互连接的区域，并且疾病过程可能沿着连接纤维扩展。该病中大脑嗅觉区域始终且严重受累，这与躯体感觉区和初级视觉区的微小变化形成鲜明对比，这增加了嗅觉通路可能最初就被累及的可能性。
