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阿尔茨海默病(Alzheimer disease,AD)是最常见的老年性痴呆,占所有老年性痴呆患者的50%~70%,是以渐进性记忆障碍、认知功能障碍、人格改变及语言障碍等神经精神症状为特征的慢性、进行性、中枢神经系统变性疾病。AD影响着约5%的65岁以上人群,85岁以上人群其发病率超过50%。患病人数20年后将会翻一倍,全球痴呆患者人数有明显递增趋势,以发展中国家增长速度最快。2010年全球用于痴呆的治疗费用达6040亿,国际AD研究中心预测,到2030年该项开支会增加85%[1]。鉴于我国老龄化人口在未来大幅增长,2050年60岁以上人口数将翻一番。目前我国AD患病人数已超过600万人,若无有效地诊治手段,AD将会给社会、家庭带来沉重的精神和经济负担[2]。
这种无法治愈的、神经退行性疾病是由德国精神病学及神经病理学医生Alois Alzheimer发现并以他的名字命名的,在通过对AD患者脑组织的病理研究中,Alzheimer指出AD的病理基础为老年斑(senile plaque)和神经纤维缠结(neurofibrillary tangle)[3]。老年斑和神经纤维缠结的物质基础均由异常蛋白的沉积而形成,组成老年斑的β淀粉样蛋白(amyloid β-peptide,Aβ),组成神经纤维缠结的蛋白称为tau蛋白,这两种物质结合而形成不相溶的神经纤维缠结和老年斑且破坏神经元,从而影响脑部功能性质的改变。同时,AD患者脑内神经递质活性下降,脑胆碱能神经元的退变以及皮质和海马乙酰胆碱的减少是AD的突出特征。在实际临床诊断中,AD诊断主要依赖临床检查和神经心理学测试,由于缺乏客观的生物学标志,其诊断准确率仅为74%~86%[4],因此有必要寻找可靠的神经影像学指标以对AD甚至对早期AD做出正确诊断。
神经影像学技术PET、MRI等的飞速发展,使人类实现了在无创条件下对脑进行结构描述和功能定位,为人类研究认知功能、认知障碍及其神经机制提供了必要的技术手段,也使得这类研究的多层次、跨学科结合成为可能。近年来,在AD的临床诊断上,科学家们深刻认识到仅凭行为检测标准不能满足对AD患者的早期预测和干预治疗,于是提出了借助MRI、PET等分子影像学技术建立新的AD临床诊断标准。在此背景下,AD的神经影像学研究得到广泛关注,其目的在于实现对AD的早期预测、药物开发与干预。
阿尔茨海默病的影像学诊断进展
The advancement in Alzheimer disease of imaging diagnosis
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摘要: 阿尔茨海默病(AD)已经成为我国和发达国家严重影响老年人生活质量的神经系统疾病,如何防治是目前脑科学领域研究的重点。神经影像学技术(如PET、MRI等)的飞速发展,使人类实现了无创条件下对脑进行结构描述和功能定位,为人类研究认知功能、认知障碍及其发病机制提供了必要的技术手段,也使得这类研究的多层次、跨学科结合成为可能。该文就神经影像学技术对AD的诊断进展进行简要概述。
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关键词:
- 阿尔茨海默病 /
- 正电子发射断层显像术 /
- 磁共振成像
Abstract: Alzheimer disease (AD) is one of the neurodegenerative disorders that deteriorate the life quality of the elderly in China and developed countries. Prevention and treatment of AD are the focal point in the study of brain science. In recent years, the rapid development of medical imaging technology enables us to get functional orientation and structure descrrption of brain noninvasively and provides a substantial basis for studies of cognition, cognitive impairment, and pathogenesis. It also makes such multi-tiered research and trans-subject combination possible. The progress in AD of imaging technology is briefly reviewed in this article. -
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