Harding A J, Halliday G M
Prince of Wales Medical Research Institute, Prince of Wales Hospital, Randwick, NSW, Australia.
Neuropathol Appl Neurobiol. 1998 Jun;24(3):195-201. doi: 10.1046/j.1365-2990.1998.00115.x.
Pathological criteria have recently been developed to differentiate those cases where Lewy bodies contribute to the dementing process. We applied consensus criteria to 20 cases with a pathological diagnosis of Alzheimer's disease (all demented) and/or Parkinson's disease (three without dementia) and eight controls. In addition, we applied the criteria to the different cortical layers to determine whether the site of the semiquantification affected the diagnosis. In the parietal lobe, few Lewy bodies were observed, and this region could be excluded. Rare Lewy bodies present in the frontal association cortex in a number of Parkinson's disease cases resulted in their classification as limbic or transitional cases with Lewy bodies. Exclusion of this non-limbic association cortex resulted in many of these cases with rare cortical Lewy bodies being re-classified as having brain stem predominant Lewy bodies, thus improving the diagnostic accuracy of the criteria. Most of these cases were non-demented. No other case was re-classified by excluding these cortical regions from the analysis. Few Lewy bodies were present in cortical layers I and II, and these layers could be excluded from the semiquantitative procedure without change to the overall classification of cases. The occasional presence of possible Lewy bodies in cases with Alzheimer's disease and controls incorrectly classified these cases as having brain stem predominant Lewy body disease, although these cases had no brain stem Lewy bodies. These modifications to the consensus criteria for assessing Lewy body disease (i.e. exclude parietal and frontal lobe, cortical layers I and II, and cases without brain stem Lewy bodies), provide significant time and cost savings for neuropathologists and researchers using this criteria to diagnose and study dementia with Lewy bodies.
最近已制定出病理学标准，以区分路易小体导致痴呆过程的那些病例。我们将共识标准应用于20例经病理诊断为阿尔茨海默病（均为痴呆患者）和/或帕金森病（3例无痴呆）的病例以及8例对照。此外，我们将该标准应用于不同的皮质层，以确定半定量的部位是否会影响诊断。在顶叶，观察到的路易小体很少，该区域可被排除。在一些帕金森病病例的额叶联合皮质中存在罕见的路易小体，导致它们被归类为伴有路易小体的边缘型或过渡型病例。排除这个非边缘联合皮质后，许多这些伴有罕见皮质路易小体的病例被重新归类为脑干为主型路易小体病例，从而提高了标准的诊断准确性。这些病例大多数无痴呆。通过从分析中排除这些皮质区域，没有其他病例被重新归类。皮质I层和II层中存在的路易小体很少，这些层可从半定量程序中排除，而不会改变病例的总体分类。在阿尔茨海默病病例和对照中偶尔出现的可能的路易小体将这些病例错误地归类为脑干为主型路易小体病，尽管这些病例没有脑干路易小体。对评估路易小体病的共识标准进行的这些修改（即排除顶叶和额叶、皮质I层和II层以及无脑干路易小体的病例），为使用该标准诊断和研究路易体痴呆的神经病理学家和研究人员节省了大量时间和成本。
