Neurology:老年人认知和痴呆与阿兹海默病及其他疾病的神经病理变化的关系 

2022-08-03 Naomi MedSci原创

近日,一项发表在Neurology上的研究试图描述关键的神经病理病变及其与老年人死前认知的关联。这些结果强调了非 ADNC 神经病理合并症(主要是 LATE-NC)对老年人认知功能的重要性。

年龄是痴呆的最大危险因素。然而,痴呆症并不普遍,即使在最老的老年人群中也是如此。根据现代神经病理学指南,近日,一项发表在Neurology上的研究试图描述关键的神经病理病变及其与老年人死前认知的关联。

参与者是那些参加了“90 研究”的人,这是一项以人群为基础的纵向研究,对年龄最大的老年人进行老年痴呆症的研究,他们同意进行死后脑部检查。截至2020年12月的所有尸检大脑评估了阿尔茨海默病神经病理变化(ADNC)和非 ADNC 神经病理合并症的患病率。使用多项式 Logit模型和多项式线性回归评估神经病理损伤或总神经病理负担评分(个人评分总和)与认知之间的关系。单独的回归分析评估了边缘优势的年龄相关性 TDP-43脑病(late-NC)与海马硬化症(HS)或 ADNC/原发性年龄相关性脑病(PART)之间的关系。在存在或不存在非 ADNC 神经病理学特征的情况下,评估抵抗,或未能发展 ADNC/PART,以及从高于预期的认知功能推断的恢复能力。

  • 样本中最常见的神经病理学特征(n = 367)是 ADNC/PART 相关。
  • (OR = 1.5[95% CI 1.3.1.7] p < 0.0001) ,β 淀粉样蛋白(OR = 1.6[95% CI 1.2-2.0] p < 0.0001) ,神经原纤维缠结(OR = 2.6[95% CI 1.7-4.1] p < 0.0001)和 LATE-NC (OR = 2.3[95% CI 1.7-3.1] p < 0.0001) ,校正多重比较。
  • 与 LATE-NC 关联(OR = 6.1[95% CI 2.0-18.7] p = 0.002)和无(OR = 5.0[95% CI 2.6-9.7] p < 0.0001)合并 HS 的痴呆,并增加 ADNC 参与者痴呆的几率(OR = 5.0[95% CI 2.7-9.2] p < 0.0001)。
  • 对中度/重度 ADNC/PART 的耐药性很少(3%) ,但对 ADNC/PART 的耐药性则不是(55%)。非 ADNC 合并病变,尤其是 LATE-NC 的复原性较少。
  • 在中度/重度 ADNC/PART 患者中,痴呆几率随着每个非 ADNC 合并病变而增加(例如,1个病变: OR = 2.4[95% CI 1.3-4.5] p < 0.005; 2个病变: OR = 5.9[95% CI 2.8-12.3] p < 0.0001)。 

这些结果强调了非 ADNC 神经病理合并症(主要是 LATE-NC)对老年人认知功能的重要性。考虑到 非ADNC 合并神经病理学异常的累积效应,降低其发病率,特别是 LATENC,对于减少老年人痴呆负担的最终目标至关重要。

文献来源:Montine TJ, Corrada MM, Kawas C, et al. Association of Cognition and Dementia With Neuropathologic Changes of Alzheimer Disease and Other Conditions in the Oldest-Old [published online ahead of print, 2022 Jun 15]. Neurology. 2022;10.1212/WNL.0000000000200832. doi:10.1212/WNL.0000000000200832

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2001888, encodeId=ea1d2001888e1, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Oct 19 00:00:24 CST 2022, time=2022-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1735487, encodeId=e8971e35487a5, content=<a href='/topic/show?id=7f019e71750' target=_blank style='color:#2F92EE;'>#阿兹海默病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97717, encryptionId=7f019e71750, topicName=阿兹海默病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9ff833907849, createdName=xre2019, createdTime=Thu Mar 09 14:00:24 CST 2023, time=2023-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491446, encodeId=4b771491446df, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Tue Aug 02 02:00:24 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548080, encodeId=501015480809b, content=<a href='/topic/show?id=a9b8e439671' target=_blank style='color:#2F92EE;'>#神经病理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74396, encryptionId=a9b8e439671, topicName=神经病理)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=341e13990555, createdName=ms6279672939590805, createdTime=Tue Aug 02 02:00:24 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1247157, encodeId=e1a9124e1570c, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sun Jul 31 14:00:24 CST 2022, time=2022-07-31, status=1, ipAttribution=)]
    2022-10-19 yinhl1978
  2. [GetPortalCommentsPageByObjectIdResponse(id=2001888, encodeId=ea1d2001888e1, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Oct 19 00:00:24 CST 2022, time=2022-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1735487, encodeId=e8971e35487a5, content=<a href='/topic/show?id=7f019e71750' target=_blank style='color:#2F92EE;'>#阿兹海默病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97717, encryptionId=7f019e71750, topicName=阿兹海默病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9ff833907849, createdName=xre2019, createdTime=Thu Mar 09 14:00:24 CST 2023, time=2023-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491446, encodeId=4b771491446df, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Tue Aug 02 02:00:24 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548080, encodeId=501015480809b, content=<a href='/topic/show?id=a9b8e439671' target=_blank style='color:#2F92EE;'>#神经病理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74396, encryptionId=a9b8e439671, topicName=神经病理)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=341e13990555, createdName=ms6279672939590805, createdTime=Tue Aug 02 02:00:24 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1247157, encodeId=e1a9124e1570c, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sun Jul 31 14:00:24 CST 2022, time=2022-07-31, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=2001888, encodeId=ea1d2001888e1, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Oct 19 00:00:24 CST 2022, time=2022-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1735487, encodeId=e8971e35487a5, content=<a href='/topic/show?id=7f019e71750' target=_blank style='color:#2F92EE;'>#阿兹海默病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97717, encryptionId=7f019e71750, topicName=阿兹海默病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9ff833907849, createdName=xre2019, createdTime=Thu Mar 09 14:00:24 CST 2023, time=2023-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491446, encodeId=4b771491446df, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Tue Aug 02 02:00:24 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548080, encodeId=501015480809b, content=<a href='/topic/show?id=a9b8e439671' target=_blank style='color:#2F92EE;'>#神经病理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74396, encryptionId=a9b8e439671, topicName=神经病理)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=341e13990555, createdName=ms6279672939590805, createdTime=Tue Aug 02 02:00:24 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1247157, encodeId=e1a9124e1570c, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sun Jul 31 14:00:24 CST 2022, time=2022-07-31, status=1, ipAttribution=)]
    2022-08-02 axin012
  4. [GetPortalCommentsPageByObjectIdResponse(id=2001888, encodeId=ea1d2001888e1, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Oct 19 00:00:24 CST 2022, time=2022-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1735487, encodeId=e8971e35487a5, content=<a href='/topic/show?id=7f019e71750' target=_blank style='color:#2F92EE;'>#阿兹海默病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97717, encryptionId=7f019e71750, topicName=阿兹海默病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9ff833907849, createdName=xre2019, createdTime=Thu Mar 09 14:00:24 CST 2023, time=2023-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491446, encodeId=4b771491446df, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Tue Aug 02 02:00:24 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548080, encodeId=501015480809b, content=<a href='/topic/show?id=a9b8e439671' target=_blank style='color:#2F92EE;'>#神经病理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74396, encryptionId=a9b8e439671, topicName=神经病理)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=341e13990555, createdName=ms6279672939590805, createdTime=Tue Aug 02 02:00:24 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1247157, encodeId=e1a9124e1570c, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sun Jul 31 14:00:24 CST 2022, time=2022-07-31, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2001888, encodeId=ea1d2001888e1, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Wed Oct 19 00:00:24 CST 2022, time=2022-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1735487, encodeId=e8971e35487a5, content=<a href='/topic/show?id=7f019e71750' target=_blank style='color:#2F92EE;'>#阿兹海默病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97717, encryptionId=7f019e71750, topicName=阿兹海默病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9ff833907849, createdName=xre2019, createdTime=Thu Mar 09 14:00:24 CST 2023, time=2023-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491446, encodeId=4b771491446df, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Tue Aug 02 02:00:24 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548080, encodeId=501015480809b, content=<a href='/topic/show?id=a9b8e439671' target=_blank style='color:#2F92EE;'>#神经病理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74396, encryptionId=a9b8e439671, topicName=神经病理)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=341e13990555, createdName=ms6279672939590805, createdTime=Tue Aug 02 02:00:24 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1247157, encodeId=e1a9124e1570c, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sun Jul 31 14:00:24 CST 2022, time=2022-07-31, status=1, ipAttribution=)]
    2022-07-31 neuro.Dr

    老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!

    0

相关资讯

Neurology:协和医院:海马萎缩和血液中的A-beta如何受基因影响?

海马结构异常和β-淀粉样蛋白(Aβ)负担被认为是痴呆症进展的客观指标和阿尔茨海默病(AD)的有效内表型。一项欧洲人的全基因组关联研究(GWAS)发现,常见的遗传变异可以解释76%的

JNNP:谵妄与痴呆风险,一项对12949名患者的队列研究

谵妄和痴呆是老年人认知障碍的两个最常见原因,但对其相互关系了解甚少。痴呆的特征是不可逆转的渐进性认知下降。这与压力有关。在英国,痴呆症的社会负担为350亿英镑,其中三分之二由痴呆症患者及其家人承担。

梅斯专栏:神经新前沿——AD前沿

整合神经科诊疗资讯

北京大学发现:较高的脂肪肌肉质量比或可降低老年痴呆发病风险!

研究结果提示了定期监测体成分,特别是腿部肌肉与脂肪的构成,或许可应用于认知情况可能不佳的老年人群痴呆的预防策略中。

IBD患者会有更高痴呆症风险吗?| 来自丹麦41年的全国性队列研究

IBD患者与医疗系统的频繁接触可能会提升对痴呆症的检测水平,也可能表明疾病更严重或合并症更高,这可能在一定程度上解释为什么IBD的患者全因痴呆HR会略有增加。

痴呆及阿尔茨海默病进展要点简析

本文对痴呆及阿尔茨海默病的研究进展进行综述,旨在提升大众对痴呆的总体认识。

拓展阅读

Age Ageing:浙大学者发现脑淋巴系统在衰老有关的认知能力下降中的作用

脑淋巴功能在正常老龄化相关的认知功能衰退中发挥着保护作用

第52届IPA大会:抗胆碱能负荷——一项老年人群精神病学研究

在常规临床实践中,处方药物对认知和身体健康可能产生的不良影响可能未被充分认识。

BMJ子刊:我国学者揭示中国老龄人口午后小睡与认知功能的关系

本研究结果表明,在中国老龄人口中,下午的午睡与更好的认知功能有关。

JNNP:视力障碍比视网膜厚度更能预测帕金森病患者的痴呆情况

在这项深度表型的纵向队列中,视觉功能障碍预示着PD的痴呆和不良后果。

第75届美国神经病学协会年会|哥大研究:超声颈动脉动脉斑块与脑小血管疾病患者认知功能有关

该研究表明颅外颈动脉硬化的超声测量与脑小血管病的脑白质高信号有关,并与认知表现相关。

长期社会隔离引起认知功能损害:星形胶质细胞TRPA1-GABA通路抑制海马环路是关键介导机制

长期社会隔离引起认知功能损害:星形胶质细胞TRPA1-GABA通路抑制海马环路是关键介导机制