Geddes J W, Tekirian T L, Soultanian N S, Ashford J W, Davis D G, Markesbery W R
Sanders-Brown Center on Aging, University of Kentucky, Lexington 40536-0230, USA.
Neurobiol Aging. 1997 Jul-Aug;18(4 Suppl):S99-105. doi: 10.1016/s0197-4580(97)00063-8.
The National Institute on Aging and Reagan Institute (NIA-RI) criteria, and other neuropathologic criteria for Alzheimer's disease (AD), were compared with the clinical diagnosis of dementia in a well defined population of Catholic sisters. The 47-participant subset examined in this study were college educated and lacked complicating conditions such as brain infarcts or diffuse Lewy body disease. Sixteen participants had a clinical diagnosis of dementia. The NIA-RI criteria imply a perfect correlation between neuritic plaque (NP) density and neurofibrillary tangle distribution. However, NP density often did not coincide with tangle distribution. As a result, it was not possible to categorize many of the participants using the NIA-RI guidelines. The 'high likelihood' category of the NIA-RI criteria for AD research settings (neocortical Braak stage and frequent neocortical NP) had relatively high specificity (90% of nondemented participants did not meet this criteria). However, only half of the demented participants were in this category. Neuropathologic criteria requiring the presence of neocortical tangles (rather than neocortical Braak stage) had relatively high sensitivity, accounting for 87-94% of participants with dementia, but also included 32-35% of nondemented participants. Criteria based on neocortical NP or senile plaques had 100% sensitivity, but a majority of nondemented participants also met these criteria. The results support consideration of both tangles and NP for the neuropathologic diagnosis of AD, but indicate that refinement of the NIA-RI criteria is necessary. A possible refinement is suggested for further consideration.
在一群明确界定的天主教修女群体中，对美国国立衰老研究所和里根研究所（NIA-RI）的标准以及其他阿尔茨海默病（AD）的神经病理学标准与痴呆症的临床诊断进行了比较。本研究中所检查的47名参与者均受过大学教育，且不存在脑梗死或弥漫性路易体病等复杂情况。16名参与者有痴呆症的临床诊断。NIA-RI标准意味着神经炎性斑块（NP）密度与神经原纤维缠结分布之间存在完美的相关性。然而，NP密度往往与缠结分布不一致。因此，按照NIA-RI指南对许多参与者进行分类是不可能的。NIA-RI标准中用于AD研究环境的“高可能性”类别（新皮质Braak分期和频繁的新皮质NP）具有相对较高的特异性（90%的非痴呆参与者不符合此标准）。然而，只有一半的痴呆参与者属于这一类别。需要存在新皮质缠结（而非新皮质Braak分期）的神经病理学标准具有相对较高的敏感性，占痴呆参与者的87 - 94%，但也包括32 - 35%的非痴呆参与者。基于新皮质NP或老年斑的标准具有100%的敏感性，但大多数非痴呆参与者也符合这些标准。结果支持在AD的神经病理学诊断中同时考虑缠结和NP，但表明有必要完善NIA-RI标准。建议进行一项可能的完善以供进一步考虑。
