Staging Neurodegenerative Disorders: Structural, Regional, Biomarker, and Functional Progressions

被引:15
作者
Archer, Trevor [1 ]
Kostrzewa, Richard M. [2 ]
Beninger, Richard J. [3 ,4 ]
Palomo, Tomas [5 ]
机构
[1] Univ Gothenburg, Dept Psychol, SE-40530 Gothenburg, Sweden
[2] E Tennessee State Univ, Quillen Coll Med, Dept Pharmacol, Johnson City, TN 37614 USA
[3] Queens Univ, Dept Psychol, Kingston, ON K7L 3N6, Canada
[4] Queens Univ, Dept Psychiat, Kingston, ON K7L 3N6, Canada
[5] Hosp Univ 12 Octobre, Serv Psiquiatria, Madrid 28041, Spain
关键词
Staging; Braak; AD; Viral infections-MCI; CBD; LBD; Imaging-PD; DARSS-intervention; MILD COGNITIVE IMPAIRMENT; ALPHA-SYNUCLEIN PATHOLOGY; MEDIAL TEMPORAL-LOBE; VOXEL-BASED MORPHOMETRY; LEWY BODY PATHOLOGY; GRAY-MATTER LOSS; DOPAMINE-RECEPTOR SUPERSENSITIVITY; EPISODIC MEMORY IMPAIRMENT; AMYLOID PRECURSOR PROTEIN; AUTONOMIC NERVOUS-SYSTEM;
D O I
10.1007/s12640-010-9190-2
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
The notion of staging in the neurodegenerative disorders is modulated by the constant and progressive loss of several aspects of brain structural integrity, circuitry, and neuronal processes. These destructive processes eventually remove individuals' abilities to perform at sufficient and necessary functional capacity at several levels of disease severity. The classification of (a) patients on the basis of diagnosis, risk prognosis, and intervention outcome, forms the basis of clinical staging, and (b) laboratory animals on the basis of animal model of brain disorder, extent of insult, and dysfunctional expression, provides the components for the clinical staging and preclinical staging, respectively, expressing associated epidemiological, biological, and genetic characteristics. The major focus of clinical staging in the present account stems from the fundamental notions of Braak staging as they describe the course and eventual prognosis for Alzheimer's disease, Lewy Body dementia, and Parkinson's disease. Mild cognitive impairment, which expresses the decline in episodic and semantic memory performance below the age-adjusted normal range without marked loss of global cognition or activities of daily living, and the applications of longitudinal magnetic resonance imaging, major instruments for the monitoring of either disease progression in dementia, present important challenges for staging concepts. Although Braak notions present the essential basis for further developments, current staging conceptualizations seem inadequate to comply with the massive influx of information dealing with neurodegenerative processes in brain, advanced both under clinical realities, and discoveries in the laboratory setting. The contributions of various biomarkers of disease progression, e.g., amyloid precursor protein, and neurotransmitter system imbalances, e.g., dopamine receptor supersensitivity and interactive propensities, await their incorporation into the existing staging models thereby underlining the ongoing, dynamic feature of the staging of brain disorders.
引用
收藏
页码:211 / 234
页数:24
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