阿尔茨海默病和血管性痴呆患者的认知功能和精神行为症状

Cognitive functions and behavioral and psychological symptoms in patients with Alzheimer' s disease and patients with vascular dementia

目的:比较轻中度阿尔茨海默病(Alzheimer's disease,AD)和血管性痴呆(vascular de-mentia,VD)患者的认知功能损害和精神行为症状的特点。方法:本研究为病例对照研究。选取神经内科老年记忆障碍门诊中就诊的轻中度老年期痴呆患者共115例,均符合美国精神病学会精神障碍诊断和统计手册第四版(Diagnostic and Statistical Manual of Mental disorders,Fourth Edition,DSM-Ⅳ)的痴呆诊断标准。AD组61例,符合NINCDS-ADRDA可能或很可能AD诊断标准;VD组54例,符合NINDS-AIREN可能或很可能VD诊断标准中的皮质下缺血性血管性痴呆。采用简易精神状态评定表(Mini-Mental StateExamination,MMSE),世界卫生组织-加利福尼亚洛杉矶大学听觉词语学习测验(World Health Organiza-tion-University of California,Los Angeles,auditory verbal learning test,WHO-UCLA AVLT),画钟测验(Clock Drawing Test,CDT),神经精神问卷(Neuropsychiatric Inventory,NPI)对两组患者从记忆力、语言、注意力等方面以及妄想、幻觉、激越、抑郁、淡漠、易激惹、异常的运动行为等方面进行评估。结果:AD患者较VD患者MMSE量表中的语言能力,WHO-UCLA AVLT测评中的延迟回忆和长时延迟再认减退明显(均P<0.05),VD患者较AD患者MMSE中的注意力减退明显(P<0.05);NPI量表中,AD患者淡漠、激越、易激惹、异常运动行为明显多于VD患者(P<0.05),抑郁少于VD患者(P<0.05)。结论:AD和VD患者在认知功能损害和精神行为症状方面存在差异,AD患者的语言能力、记忆力较差,而VD患者的注意力较差;AD淡漠、激越、易激惹、异常运动行为多见,VD抑郁多见。临床工作中对痴呆患者的认知功能和精神行为症状测评有助于AD和VD的鉴别。

Objective： To compare the cognitive impairment and behavioral and psychological symptoms between with mild to moderate Alzheimer＇s disease （AD） and vascular dementia （VD）. Methods： Totally 115 outpatients with mild-to-moderate dementia who met the Diagnostic and Statistical Manual of Mental disorders; Fourth Edition （DSM-IV） dementia diagnosis criteria, were recruited in this case-controlled study. The cognitive function, ineluding memory, language, attention, etc, and the behavioral and psychological symptoms, including delusions, illu- sions, agitation, depression, apathy irritability, aberrant motor behavior, etc, were evaluated with the Mini-Mental State Examination （MMSE）, World Health Organization-University of California, Los Angeles, auditory verbal learning test （WHO-UCLA AVLT）, Clock Drawing Test （CDT）, Neuropsychiatric Inventory （NPI） in 61 patients with AD according to NINCDS-ADRDA criteria and 54 patients with VD according to NINDS-AIREN criteria. Results： AD patients had lower scores in languages of MMSE scale and delayed recall of objects and prolonged memory recognition in the WHO-UCLA AVLT, while VD patients had lower scores in attention of the MMSE scale [（5.6±1.9） vs.（6.7±1.5）,（1.3±1.9） vs. （2.8±3.2）,（2.9±3.3） vs. （5.9±3.8）,（1.0±1.2） vs. （ 1.7±1.9） ; Ps 〈 0. 05]. The rate of apathy, agitation, irritability, aberrant motor behavior in AD group was significantly higher than that in VD group in the test of the NPI scale, while the rate of depression symptoms were more common in VD group than in AD group （P 〈0.05）. Conclusion： The cognitive impairment and behavioral and psychological symptoms between AD and VD patients are different. AD patients are worse in language ability and memory, while VD patients perform worse in attention. AD patients are more likely to have apathy, agitation, irritability, aberrant motor behavior, and VD patients are more likely to have depression. It is help to distinguish AD and VD patients by evaluating the cognitive function and behavioral and psychological symptoms.