Bierer L M, Hof P R, Purohit D P, Carlin L, Schmeidler J, Davis K L, Perl D P
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY.
Arch Neurol. 1995 Jan;52(1):81-8. doi: 10.1001/archneur.1995.00540250089017.
To determine the relationships between dementia severity and the extent of histopathologic lesions in a variety of brain regions. Neocortical and hippocampal ratings for neurofibrillary tangles (NFTs) and senile plaques (SPs) were compared in 70 cases of clinically and neuropathologically confirmed Alzheimer's disease.
Neuropathologic case series. Dementia severity was assessed by postmortem chart review with use of the extended Clinical Dementia Rating Scale (CDR). Linear association between CDR scores and NFT and SP scores were assessed by partial correlation, controlling for age at death.
Studies were conducted at the Alzheimer's Disease Research Center of the Mount Sinai Medical Center, New York, NY.
Association between CDR scores and neuropathologic changes assessed with the Consortium to Establish a Registry for Alzheimer's Disease semiquantitative scale.
Among these lesion scores, only NFTs showed a significant association with CDR score, and only for neocortical regions. In particular, NFT densities in the superior temporal cortex were most strongly correlated with dementia severity, followed by those in the inferior parietal and midfrontal cortex. No such correlations were apparent for the amygdala, hippocampus, or entorhinal cortex. Medial temporal lobe structures displayed high NFT scores, even in cases of mild dementia. Senile plaques did not correlate significantly with CDR score in any region.
These data support the notion that neocortical neuronal degeneration, as indicated by NFT formation, is a critical determinant of the clinical progression of Alzheimer's disease and suggest that medial temporal lobe structures may represent the initial site of NFT formation. While SP density correlates with age at death, there is no correlation between SP counts and dementia severity. These results further suggest that the clinical presentation of dementia may be closely related to neurodegeneration in neocortical regions within the temporal lobe.
确定痴呆严重程度与多个脑区组织病理学病变程度之间的关系。对70例临床和神经病理学确诊的阿尔茨海默病患者的新皮质和海马体神经原纤维缠结（NFTs）及老年斑（SPs）进行评分并比较。
神经病理学病例系列研究。通过尸检图表回顾，使用扩展临床痴呆评定量表（CDR）评估痴呆严重程度。通过偏相关分析评估CDR评分与NFT和SP评分之间的线性关联，并控制死亡年龄。
研究在纽约州纽约市西奈山医学中心的阿尔茨海默病研究中心进行。
CDR评分与使用阿尔茨海默病注册协会半定量量表评估的神经病理学变化之间的关联。
在这些病变评分中，只有NFTs与CDR评分显示出显著关联，且仅在新皮质区域。特别是，颞上皮质的NFT密度与痴呆严重程度的相关性最强，其次是顶下皮质和额中皮质。杏仁核、海马体或内嗅皮质未显示出此类相关性。即使在轻度痴呆病例中，内侧颞叶结构的NFT评分也很高。老年斑在任何区域与CDR评分均无显著相关性。
这些数据支持以下观点，即NFT形成所表明的新皮质神经元变性是阿尔茨海默病临床进展的关键决定因素，并表明内侧颞叶结构可能是NFT形成的初始部位。虽然SP密度与死亡年龄相关，但SP计数与痴呆严重程度之间无相关性。这些结果进一步表明，痴呆的临床表现可能与颞叶内新皮质区域的神经变性密切相关。
