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[ADA2011]糖尿病与认知损害
——Jose A. Luchsinger教授专访
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作者:J.A.Luchsinger 2011/6/17 17:56:00    加入收藏
内容概要:Jose A. Luchsinger 哥伦比亚大学医学中心心脏科教授,研究领域:心脏病风险因素与认知的关系,饮食与认知的关系。

 Jose A. Luchsinger   哥伦比亚大学医学中心心脏科教授,研究领域:心脏病风险因素与认知的关系,饮食与认知的关系。
     <International Diabetes>: Alzheimer’s disease seems to be a disease that doesn’t have a specific definition, in fact, if one tries to find a definition it seems that it is a large web of many different conditions. What is your opinion about that and do you have a definition of Alzheimer’s disease?

    《国际糖尿病》:阿尔兹海默病似乎不具有特定的定义,而是似乎代表了多种不同的临床情况。您对此有什么看法,您是怎么定义阿尔兹海默病的?
    Prof. Luchsinger: That is what researchers have tried to do for many years but we think Alzheimer’s disease is more complex than we originally thought. So what is Alzheimer’s disease clinically? There is a lot of confusion. What we call clinical Alzheimer’s disease is a disease characterized by memory loss of slow onset progressing over many years to a point where people cannot care for themselves anymore and at this stage we call it dementia. There is also Alzheimer’s disease that is the finding in the brain. So there is a lot of controversy and issues with semantics regarding this. The traditional thought was that the culprit was the production and deposition of the abnormal peptide amyloid in the brain but I think there is growing evidence that what we call Alzheimer’s disease clinically is much more heterogeneous and depends on many more factors such as: a person’s education; their upbringing; how healthy their brain is to begin with; how many synapses the brain has and therefore how resilient the brain is when facing various insults throughout life; and there is amyloid as well and things like stroke and vascular white matter hyperintensities; and certainly diabetes, obesity, high blood pressure and cardiovascular disease that we know it is linked to. It has become a very complex web, as you say, and I think it is going to be impossible to find one silver bullet or a single explanation. The only way to understand it is by addressing its complexity and by understanding all of the different connections rather than looking for the one thing that ties it all together because I don’t think that is going to happen.

    Luchsinger教授:研究人员们多年来一直试图给阿尔兹海默病下一个精确的定义,但这比我们最初想的要复杂得多。那么阿尔兹海默病的临床定义是什么呢?这其中存在很多模糊之处,临床上我们所说的阿尔兹海默病指缓慢起病,记忆力逐渐丧失,历经多年病情缓慢进展,直到发展成生活不能自理,这个阶段我们称之为痴呆。阿尔兹海默病患者的脑部也存在改变。因此这个词在语义方面还存在很多矛盾和争论。传统上认为导致阿尔兹海默病的罪魁祸首是异常的淀粉样多肽在脑部沉积,但越来越多的证据告诉我们,临床上遇到的阿尔兹海默病是一种异质性疾病,其发病与多种因素相关:如教育背景;成长背景;出生时脑健康程度;脑突触的数量以及由此导致的生活中遇到创伤事件时的情绪恢复速度;还有淀粉样物质沉积,脑卒中及血管白质病变;当然还有我们熟知的危险因素如糖尿病,肥胖,高血压以及心血管病等。正如你所说,这是一个非常复杂的病因网络,我想不太可能找到单一的病因解释。理解这个疾病的唯一方式就是我们深刻领会其复杂性,认识各种因素的关联性而不是去寻努力寻找与各种因素都相关的那个单一的共同危险因素,我想这个东西是不存在的。



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