engleski

Alzheimer's disease associated with monoclonal gammapathy

Alzheimer's disease (AD) and monoclonal gammapathy (MG) are amyloidoses with with unknown joint incidence and pathogenesis. Beta-amyloid is non-immunoglobulin protein derived from amyloid precursor protein (APP). Amyloid light chain is product of circulating immunoglobulin precursor produced by plasma cells. Amyloid pathogenesis and variable amyloid vessel and tissue tropism is not clear. Two patients with joint involvement of AD and MG are described. The investigation included mini-mental-state-examination (MMSE), CT, MRI, SPECT, tau-231 in CSF, electrophoresis, immunoelectrophoresis and sternal biopsy. Joint involvement of AD and MG was noted simultaneously. The diagnosis of AD is based upon MMSE, CT, MRI, SPECT, tau-231 protein in CSF. Pathognomonic narrow banded electrophoretic peaks of monoclonal IgG and free light chains of the same kappa type in serum of both patients confirmed MG. Sternal biopsy showed plasma cell dyscrasia as multiple myeloma in the first patient who had also rheumatoid arthritis. The monoclonal gammapathy of undetermined significance was verified in the second patient who had also serious aortal stenosis. Monoclonal gammapathy in both patients was coincident finding, but occurrence of paraproteinaemia in AD is probably more than chance association and it should be searched for in patients presenting with AD and/or in mild cognitive impairment (MCI) patients. These findings could actuate more experiments on circulating monoclonal protein and APP based upon hypothesis that AD is not solely localized amyloidosis but could also be involved in systemic immunological disease.

Alzheimer's disease; monoclonal gammapathy

Abstracts of the XVIIIth World Congress of Neurology