老年人痴呆108例临床研究

CLINICAL STUDY OF SENILE DEMENTIA:A REPORT OF 108 CASES

目的 :研究老年人痴呆的病种分类 ,临床症状 ,影像特点和诊断、鉴别诊断方法。方法 :采用综合分析方法对 1 0 8例老年人 (6 0岁以上 )痴呆患者进行临床症状观察 ,神经心理、MRI检查 ,总结各种痴呆的特点及诊断要点。 结果 :1 0 8例老年人痴呆中血管性痴呆 (vasculardementia ,VD ) 5 0例 ,阿尔茨海默病(Alzheimer’sdisease ,AD) 4 0例 ,混合性痴呆 (mixeddementia ,MD) 1 8例 ;卒中病史在AD组中无 ,在VD和MD组中分别为 4 5例和 8例 ;神经系统局灶征在AD组中无 ,VD和MD组分别为 4 8例和 5例 ;影像学变化VD组多发性脑梗死 4 5例 ,AD组全部有脑萎缩 ,MD组全部有脑萎缩和腔隙性脑梗死 ;3种痴呆均存在记忆力障碍。结论 :①老年人痴呆以VD最多见 ,AD次之 ;②老年人痴呆各有不同的临床特点和影像学变化 ;③老年人痴呆的诊断要符合痴呆的诊断标准 ,再根据VD、AD。

Objective:To study features of senile dementia including the classification,clinical symptoms,neuroimaging characteristics and diagnostic methods.Methods:We analyzed the clinical symptoms,neuropsychology and results of MRI in 108 senior cases (above the age of 60) with senile dementia and got the characteristics and diagnostic essentials of different kinds of senile dementia.Results:In all of the 108 cases,there were 50 cases of vascular dementia (VD),40 cases of Alzheimer's disease (AD) and 18 cases of mixed dementia (MD). No one had stroke history in the AD group,but 45 cases in the VD group and 8 cases in the MD group respectively.No one had focal neurological symptom in the AD group,however 48 cases in the VD group and 5 cases in the MD group.Neuroimaging showed that there were 45 cases of cerebral infarction in the VD group,all of the cases in the AD group had encephalatrophy and all of the cases in the MD group had both encephalatrophy and infarction.The memory handicap existed in all the three groups.Conclusions:①Senile dementia are most common in the VD group,and second in the AD group.②Different types of senile dementia have their own clinical characteristics and neuroimaging features.③For the diagnosis of different types of senile dementia,we should first diagnose the dementia and then type it according to AD,VD and MD standards.