Hyman B T
Department of Neurology, Massachusetts General Hospital, Charlestown 02129, USA.
Neurobiol Aging. 1997 Jul-Aug;18(4 Suppl):S27-32. doi: 10.1016/s0197-4580(97)00066-3.
The neuropathological diagnosis of Alzheimer's disease currently relies on quantitative or semiquantitative criteria of senile or neuritic plaques that are adjusted for age and for the presence or absence of a clinical history of dementia. Based on clinical-pathological correlation studies, I will argue that neuropathological assessment should stand independently of clinical history and instead should describe brain lesions in the context of the topography and natural history of the disease. Only probabilistic estimates about the presence or absence of dementia can be made from a neuropathological examination, especially in the setting of Alzheimer disease lesions plus other pathological alterations such as Lewy bodies or infarcts. Moreover, I will argue that any neurofibrillary tangles or senile plaques are inherently pathological entities, even if clinically silent and so "incidental" neuropathological findings. Because the intensity and location of neurofibrillary tangles, rather than senile plaques, appears to correlate most closely with clinical symptoms, I suggest using a staging system that highlights this information rather than using absolute numerical cut-offs for diagnostic purposes.
目前，阿尔茨海默病的神经病理学诊断依赖于根据年龄以及有无痴呆临床病史进行调整的老年斑或神经炎性斑块的定量或半定量标准。基于临床病理相关性研究，我认为神经病理学评估应独立于临床病史，而应在疾病的拓扑结构和自然史背景下描述脑损伤情况。仅通过神经病理学检查只能对痴呆的存在与否做出概率性估计，尤其是在存在阿尔茨海默病病变以及其他病理改变（如路易体或梗死）的情况下。此外，我认为任何神经原纤维缠结或老年斑本质上都是病理实体，即使临床上无症状，因此是“偶然的”神经病理学发现。由于神经原纤维缠结的强度和位置，而非老年斑，似乎与临床症状最密切相关，我建议使用一个突出此信息的分期系统，而不是使用绝对数值界限进行诊断。
