アルツハイマー型痴呆患者にみられる脳室周囲白質病変についての臨床的および病理学的検討
X線CTでの脳室周囲低吸収域 (PVL) は脳血管性痴呆 (VD) にしばしば観察され, 臨床的検討の多くはVDにおけるPVLの虚血との関係を示唆している. 今回の検討では, アルツハイマー型老年痴呆患者 (DAT) にみられる脳室周囲白質病変について臨床的意義を明らかにするため, その出現時期, 前頭葉徴候, 脳血流量 (CBF) との関係を retrospective に検討した. 対象はNINCDS-ADARDA による Probable AD 37例である. また, DAT 2例については, 剖検し病理所見を得ることができた. 今回の結果では, DATのPVLは病期の進行した例に多く認...
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| Published in | 日本老年医学会雑誌 Vol. 33; no. 10; pp. 744 - 753 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本老年医学会
25.10.1996
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0300-9173 |
| DOI | 10.3143/geriatrics.33.744 |
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| Abstract | X線CTでの脳室周囲低吸収域 (PVL) は脳血管性痴呆 (VD) にしばしば観察され, 臨床的検討の多くはVDにおけるPVLの虚血との関係を示唆している. 今回の検討では, アルツハイマー型老年痴呆患者 (DAT) にみられる脳室周囲白質病変について臨床的意義を明らかにするため, その出現時期, 前頭葉徴候, 脳血流量 (CBF) との関係を retrospective に検討した. 対象はNINCDS-ADARDA による Probable AD 37例である. また, DAT 2例については, 剖検し病理所見を得ることができた. 今回の結果では, DATのPVLは病期の進行した例に多く認められ, PVL (+) 群に有意に前頭葉徴候の陽性率が高かった. 皮質平均, 前頭葉, 側頭葉でPVL (+) 群のCBFが有意に低下していたが, 病理学的には虚血性の変化に乏しくDATのPVLはVDのPVLとは異なりDATの脳の変性を主体とする病態と密接な関係をもっていると考えられた. |
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| AbstractList | X線CTでの脳室周囲低吸収域 (PVL) は脳血管性痴呆 (VD) にしばしば観察され, 臨床的検討の多くはVDにおけるPVLの虚血との関係を示唆している. 今回の検討では, アルツハイマー型老年痴呆患者 (DAT) にみられる脳室周囲白質病変について臨床的意義を明らかにするため, その出現時期, 前頭葉徴候, 脳血流量 (CBF) との関係を retrospective に検討した. 対象はNINCDS-ADARDA による Probable AD 37例である. また, DAT 2例については, 剖検し病理所見を得ることができた. 今回の結果では, DATのPVLは病期の進行した例に多く認められ, PVL (+) 群に有意に前頭葉徴候の陽性率が高かった. 皮質平均, 前頭葉, 側頭葉でPVL (+) 群のCBFが有意に低下していたが, 病理学的には虚血性の変化に乏しくDATのPVLはVDのPVLとは異なりDATの脳の変性を主体とする病態と密接な関係をもっていると考えられた. |
| Author | 北村, 伸 今津, 修 赫, 彰郎 石島, 路子 |
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| References | 16) 赫彰郎, 小宮山佐, 駒場佑一, 酒寄修, 荒木俊彦, 北村伸: 多発性脳梗塞の痴呆の有無と白質, 脳循環代謝の検討. 厚生省長寿科学総合研究, 平成5年度研究報告 1993; 5: 195-199. 9) 海江田亮: MRIにおける脳室周囲高信号領域の臨床的意義に関する研究 (特に痴呆患者について). 日本医科大学雑誌 1991; 58: 209-218. 15) 酒寄修, 小宮山佐, 北村伸, 赫彰郎: 脳室周囲高信号領域 (PVH) の存在と虚血および痴呆との関係について-多発性脳梗塞例における脳循環代謝面からの検討-. 脳卒中 1993; 15: 176-188. 18) Wakita H, Tomimoto H, Akiguchi I, Kimura J: Clial activation and white matter changes in the rat brain induced by chronic cerebral hypoperfusion: An immunohistochemical study. Acta Neuropathol 1994; 87: 484-492. 13) Burns A, Jacoby R, Levy R: Neurological signs in Alzheimer's disease. Age Ageing 1991; 20: 45-51. 21) Scheltens P, Barkhof F, Leys D, Wolters EC, Ravid R, Kamphorst W: Histopathologic correlates of white matter changes on MRI in Alzheimer's disease and normal aging. Neurology 1995; 45: 883-888. 11) Corbett AJ, Bennett H, Kos S: Frontal signs following subcortical infarction. Clin Exp Neurol 1992; 29: 161-171. 10) Wolfe N, Babikian VL, Linn RT, Knoefel JE, D' Esposito M, Albert ML: Are multiple cerebral infarcts synergistic? Arch Neurol 1994; 51: 211-215. 8) Bennett DA, Gilley DW, Lee S, Cochran EJ: White matter changes: Bennett DA, Gilley DW, Lee S, Cochran EJ: White matter changes: Neurobehavioral manifestations of Binswanger's disease and clinical correlates in Alzheimer's disease. Dementia 1994; 5: 148-152. 2) Awad IA, Spetzler RF, Hodak JA, Awad CA, Carey R: Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. Stroke 1986; 17: 1084-1089. 12) Franssen EH, Reisberg B, Kluger A, Sinaiko E, Boja C: Cognition-independent neurologic symptoms in normal aging and probable Alzheimer's disease. Arch Neurol 1991; 48: 148-154. 7) Kertesz A, Black SE, Tokar G, Benke T, Carr T, Nicholson L: Periventricular and subcortical hyperintensities on magnetic resonance imaging. Rims, caps, and unidentified bright objects. Arch Neurol 1988; 45: 404-408. 17) Frackowiak RS, Lenzi GL, Jones T, Heather JD: Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 150 and positron emission tomography: Theory, procedure, and normal values. J Comput Assist Tomogr 1980; 4: 727-736. 5) Reisberg B, Feriess SH, de Leon MJ: Senile dementia of the Alzheimer type: Diagnostic and differential diagnostic features with special reference to functional assessment staging, Springer-Verlag, Berlin, 1985, p18-37. 20) 松下正明: Alzheimer 病の形態的特徴. 臨床神経学1986; 26: 1283-1286. 3) McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984; 34: 939-944. 4) Gerard G, Weisberg LA: MRI periventricular lesions in adults. Neurology 1986; 36: 998-1001. 19) Suenaga T, Ohnishi K, Nishimura M, Nakamura S, Akiguchi I, Kimura J: Bundles of amyloid precursor protein-immunoreactive axons in human cerebrovascular white matter lesions. Acta Neuropathol 1994; 87: 450-455. 14) Fazekas F, Niederkorn K, Schmidt R, Offenbacher H, Horner 5, Bertha G, et al: White matter signal abnormalities in normal individuals: Correlation with carotid ultrasonography, cerebral blood flow measurements and cerebrovascular risk factors. Stroke 1988; 1988; 19: 1285-1288. 6) Iida H, Itoh H, Nakazawa M, Hatazawa J, Nishimura H, Onishi Y, et al: Quantitative mapping of regional cerebral blood flow using iodine-123-IMP and SPECT. J Nucl Med 1994; 35: 2019-2030. 1) Hachinski VC, Potter P, Merskey H: Leukoaraiosis. An ancient term for a new problem. Can J Neurol Sci 1986; 13: 533-534. |
| References_xml | – reference: 7) Kertesz A, Black SE, Tokar G, Benke T, Carr T, Nicholson L: Periventricular and subcortical hyperintensities on magnetic resonance imaging. Rims, caps, and unidentified bright objects. Arch Neurol 1988; 45: 404-408. – reference: 5) Reisberg B, Feriess SH, de Leon MJ: Senile dementia of the Alzheimer type: Diagnostic and differential diagnostic features with special reference to functional assessment staging, Springer-Verlag, Berlin, 1985, p18-37. – reference: 15) 酒寄修, 小宮山佐, 北村伸, 赫彰郎: 脳室周囲高信号領域 (PVH) の存在と虚血および痴呆との関係について-多発性脳梗塞例における脳循環代謝面からの検討-. 脳卒中 1993; 15: 176-188. – reference: 16) 赫彰郎, 小宮山佐, 駒場佑一, 酒寄修, 荒木俊彦, 北村伸: 多発性脳梗塞の痴呆の有無と白質, 脳循環代謝の検討. 厚生省長寿科学総合研究, 平成5年度研究報告 1993; 5: 195-199. – reference: 19) Suenaga T, Ohnishi K, Nishimura M, Nakamura S, Akiguchi I, Kimura J: Bundles of amyloid precursor protein-immunoreactive axons in human cerebrovascular white matter lesions. Acta Neuropathol 1994; 87: 450-455. – reference: 10) Wolfe N, Babikian VL, Linn RT, Knoefel JE, D' Esposito M, Albert ML: Are multiple cerebral infarcts synergistic? Arch Neurol 1994; 51: 211-215. – reference: 11) Corbett AJ, Bennett H, Kos S: Frontal signs following subcortical infarction. Clin Exp Neurol 1992; 29: 161-171. – reference: 4) Gerard G, Weisberg LA: MRI periventricular lesions in adults. Neurology 1986; 36: 998-1001. – reference: 6) Iida H, Itoh H, Nakazawa M, Hatazawa J, Nishimura H, Onishi Y, et al: Quantitative mapping of regional cerebral blood flow using iodine-123-IMP and SPECT. J Nucl Med 1994; 35: 2019-2030. – reference: 9) 海江田亮: MRIにおける脳室周囲高信号領域の臨床的意義に関する研究 (特に痴呆患者について). 日本医科大学雑誌 1991; 58: 209-218. – reference: 17) Frackowiak RS, Lenzi GL, Jones T, Heather JD: Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 150 and positron emission tomography: Theory, procedure, and normal values. J Comput Assist Tomogr 1980; 4: 727-736. – reference: 13) Burns A, Jacoby R, Levy R: Neurological signs in Alzheimer's disease. Age Ageing 1991; 20: 45-51. – reference: 20) 松下正明: Alzheimer 病の形態的特徴. 臨床神経学1986; 26: 1283-1286. – reference: 21) Scheltens P, Barkhof F, Leys D, Wolters EC, Ravid R, Kamphorst W: Histopathologic correlates of white matter changes on MRI in Alzheimer's disease and normal aging. Neurology 1995; 45: 883-888. – reference: 8) Bennett DA, Gilley DW, Lee S, Cochran EJ: White matter changes: Bennett DA, Gilley DW, Lee S, Cochran EJ: White matter changes: Neurobehavioral manifestations of Binswanger's disease and clinical correlates in Alzheimer's disease. Dementia 1994; 5: 148-152. – reference: 14) Fazekas F, Niederkorn K, Schmidt R, Offenbacher H, Horner 5, Bertha G, et al: White matter signal abnormalities in normal individuals: Correlation with carotid ultrasonography, cerebral blood flow measurements and cerebrovascular risk factors. Stroke 1988; 1988; 19: 1285-1288. – reference: 12) Franssen EH, Reisberg B, Kluger A, Sinaiko E, Boja C: Cognition-independent neurologic symptoms in normal aging and probable Alzheimer's disease. Arch Neurol 1991; 48: 148-154. – reference: 18) Wakita H, Tomimoto H, Akiguchi I, Kimura J: Clial activation and white matter changes in the rat brain induced by chronic cerebral hypoperfusion: An immunohistochemical study. Acta Neuropathol 1994; 87: 484-492. – reference: 2) Awad IA, Spetzler RF, Hodak JA, Awad CA, Carey R: Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. Stroke 1986; 17: 1084-1089. – reference: 3) McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984; 34: 939-944. – reference: 1) Hachinski VC, Potter P, Merskey H: Leukoaraiosis. An ancient term for a new problem. Can J Neurol Sci 1986; 13: 533-534. |
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| Snippet | X線CTでの脳室周囲低吸収域 (PVL) は脳血管性痴呆 (VD) にしばしば観察され, 臨床的検討の多くはVDにおけるPVLの虚血との関係を示唆している. 今回の検討では,... |
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| SubjectTerms | アルツハイマー型老年痴呆 前頭葉徴候 局所脳血流量 病理 脳室周囲白質病変 |
| Title | アルツハイマー型痴呆患者にみられる脳室周囲白質病変についての臨床的および病理学的検討 |
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