老年慢性精神分裂症的形态学基础:一项临床病理研究。

Q3 Medicine
Free neuropathology Pub Date : 2025-03-13 eCollection Date: 2025-01-01 DOI:10.17879/freeneuropathology-2025-6135
Kurt A Jellinger
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引用次数: 0

摘要

目的:精神分裂症患者发生痴呆的风险较高,但认知障碍的基础仍在讨论中。关于精神分裂症与阿尔茨海默病(AD)关联的相互矛盾的结果可能部分归因于非AD病变的纳入,很少有临床病理研究考虑到这一点。因此,对先前发表的老年精神分裂症尸检队列进行了重新评估。材料与方法:在符合DSM-5和ICD.10精神分裂症诊断标准的99例连续尸检患者中(平均年龄69.5±8.25岁),56例表现为中重度痴呆。使用AD的现行标准对所有大脑进行盲检,寻找伴随病变。结果:4例表现出明确的AD特征,5例可能为AD, 3例年龄在82-89岁之间被归类为原发性年龄相关性牛头病(PART)。皮质型伴路易体痴呆2例,脑干型路易体病1例;6例为海马硬化,14例为嗜银颗粒病(AGD), 1例为进行性核上性麻痹(PSP)。其他共病包括基底节区常见的凹窝、中度脑淀粉样血管病、内嗅皮质轻度发育异常、Fahr病、转移性肿瘤和急性或陈旧性脑梗死(各4例)。在年龄匹配的痴呆对照组中,明确的AD见于48% %。结论:在这组老年精神分裂症患者中,只有7.6 %符合明确或可能AD的神经病理学标准,3.6% %符合PART,而文献中典型和非典型AD的神经病理学标准为6 %至13.7 %,而相当多的病例显示非AD共病。这与其他研究一致,表明老年精神分裂症患者患AD的频率可能等于或低于年龄匹配的对照组。需要进一步的研究来阐明精神分裂症患者认知能力下降的机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Morphological substrate of chronic schizophrenia in elderly patients: a clinicopathological study.

Objective: Patients with schizophrenia are at a higher risk of developing dementia, but the basis of cognitive impairment is a matter of discussion. Conflicting results regarding the association of schizophrenia with Alzheimer disease (AD) may partly be attributable to the inclusion of non-AD lesions, which few clinicopathological studies have considered. Therefore, a re-evaluation of an autopsy cohort of elderly schizophrenics published previously [1] was performed. Material & methods: Among 99 consecutive autopsy cases of patients who met the DSM-5 and ICD.10 criteria for schizophrenia (mean age 69.5 ± 8.25 years), 56 showed moderate to severe dementia. All brains were blindly examined using the current criteria for AD and looking for concomitant lesions. They were compared with the frequency of AD in an autopsy series of 1.750 aged demented individuals Results: Four cases revealed the features of definite AD, five probable AD, and three aged 82-89 years were classified as primary age-related tauopathy (PART). Two cases were a cortical type of dementia with Lewy bodies (DLB), one Lewy body disease of brainstem type; six showed hippocampal sclerosis, 14 argyrophilic grain disease (AGD), and one progressive supranuclear palsy (PSP). Other co-pathologies were frequent lacunes in basal ganglia, moderate cerebral amyloid angiopathy, minor development anomalies in the entorhinal cortex, Fahr's disease, metastatic tumors, and acute or old cerebral infarctions (n = 4 each). Definite AD was seen in 48 % of the age-matched demented control group. Conclusions: In this cohort of elderly schizophrenic patients, only 7.6 % fulfilled the neuropathological criteria of definite or probable AD and 3.6 % of PART compared to 6 % to 13.7 % typical and atypical AD in the literature, whereas a considerable number of cases showed non-AD co-pathologies. This is in line with other studies showing that the frequency of AD in elderly schizophrenics may be equal to or less than in age-matched controls. Further studies are needed to elucidate the mechanisms of cognitive decline in schizophrenia.

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