Mizutani T
Department of Neuropathology, Tokyo Metropolitan Institute of Gerontology, Japan.
Pathol Int. 1996 Nov;46(11):842-54. doi: 10.1111/j.1440-1827.1996.tb03557.x.
The pathological diagnosis of Alzheimer-type dementia (ATD) is reviewed. The problems with the quantitative diagnosis are three-fold: the number of the senile plaques (SP) is not always related to the presence or the absence of dementia; recent research indicates that the SP and the neurofibrillary tangles (NFT) could represent a different level in the pathogenesis of ATD, and finally it has not been seriously discussed whether ATD is the final stage of physiological aging or if ATD is a definitive disease. For these reasons, new diagnostic criteria are proposed in order to differentiate ATD from physiological aging. The new criteria are suitable even in the old-old and oldest-old patients. It is stressed that ATD is heterogeneous in the pathogenetic aspect, consisting of Alzheimer's disease with onset before the age of 70 years (the neocortical type of ATD) and senile dementia of the Alzheimer type (the limbic type of ATD) with the onset after the age of 70. Even in cases with the latter type, there are several atypical ATD and non-ATD forms. "Primary senile dementia' is proposed as a comprehensive term to include various types of senile dementia of unknown etiology.
本文综述了阿尔茨海默型痴呆（ATD）的病理诊断。定量诊断存在三方面问题：老年斑（SP）的数量并不总是与痴呆的有无相关；近期研究表明，SP和神经原纤维缠结（NFT）可能代表了ATD发病机制中的不同层面，最后，ATD究竟是生理衰老的终末阶段还是一种明确的疾病，尚未得到认真讨论。基于这些原因，提出了新的诊断标准，以便将ATD与生理衰老区分开来。新的标准甚至适用于高龄和超高龄患者。需要强调的是，ATD在发病机制方面具有异质性，包括70岁之前起病的阿尔茨海默病（新皮质型ATD）和70岁之后起病的阿尔茨海默型老年痴呆（边缘型ATD）。即使是后一种类型的病例，也存在几种非典型的ATD和非ATD形式。“原发性老年痴呆”被提议作为一个综合术语，以涵盖各种病因不明的老年痴呆类型。
