Ishijima M, Imazu O, Kitamura S, Terashi A
Second Department of Internal Medicine, Nippon Medical School.
Nihon Ronen Igakkai Zasshi. 1996 Oct;33(10):744-53. doi: 10.3143/geriatrics.33.744.
Patients with multi-infarct dementia often have periventricular low density lesions on computed tomography and periventricular hyper-intensity lesions on computed tomography and periventricular hyper-intensity lesions on magnetic resonance imaging. Hachinski called this condition leukoaraiosis and results of previous studies that in multi-infarct dementia leukoaraiosis correlates with cerebral hypoperfusion. Periventricular low-density lesions in the white matter also occur, but their origin and clinical significance insuch patients is unknown. We studied when these lesions develop in patients with Alzheimer's dementia, and whether their presence correlates with clinical findings and cerebral blood flow. The subjects were 37 patients with a probable diagnosis of Alzheimer's dementia, as based on the Neuroepidermilogy Branch of the National Institute of Neurological Disorders and Stroke and the Alzheimer's disease and Related Disorders Association system. Autopsy findings were also available for 2 patients. Patients at higher Functional Assessment Staging of Senile Dementia of Alzheimer Type stages had more extensive periventricular low-density lesions. Patients with the lesions were more likely to have grasp reflex and sucking relex. Blood flow to the frontal and parietal cortices was significantly less in patients with the lesions than in those without the lesions. Neither of the 2 autopsies cases yielded evidence of arteriolosclerosis. Periventricular low-density lesions in Alzheimer's dementia may be closely associated with a degenerative process different from that seen in multi-infarct dementia.
多梗死性痴呆患者在计算机断层扫描上常出现脑室周围低密度病变，在磁共振成像上则出现脑室周围高强度病变。哈钦斯基将这种情况称为脑白质疏松症，先前的研究结果表明，在多梗死性痴呆中，脑白质疏松症与脑灌注不足相关。白质中的脑室周围低密度病变也会出现，但其在这类患者中的起源和临床意义尚不清楚。我们研究了这些病变在阿尔茨海默病痴呆患者中何时出现，以及它们的存在是否与临床发现和脑血流量相关。研究对象为37例根据美国国立神经疾病与中风研究所神经流行病学分支以及阿尔茨海默病及相关疾病协会系统可能诊断为阿尔茨海默病痴呆的患者。其中2例患者也有尸检结果。阿尔茨海默病型老年痴呆功能评估分期较高阶段的患者脑室周围低密度病变更广泛。有这些病变的患者更有可能出现抓握反射和吸吮反射。有病变的患者额叶和顶叶皮质的血流量明显低于无病变的患者。2例尸检病例均未发现小动脉硬化的证据。阿尔茨海默病痴呆中的脑室周围低密度病变可能与一种不同于多梗死性痴呆所见的退行性过程密切相关。
