阿尔茨海默病与血管性痴呆的临床特点

The study of characteristic clinical features of Alzheimers disease and vascular dementia.

目的 观察比较阿尔茨海默氏病（ＡＤ） 与血管性痴呆（ＶＤ） 的临床特点，为临床上对老年期痴呆的诊断和鉴别诊断提供帮助。方法 根据ＤＳＭⅣ诊断标准，对２１ 例ＡＤ 患者、２５ 例ＶＤ 患者的临床特点进行对比研究，包括：疾病发展过程、认知功能、情感反应、行为变化和知觉异常。所有病人均为轻中度痴呆患者。结果 ①ＡＤ 为缓慢起病；ＶＤ 多数起病较急。②ＡＤ 的认知功能减退常常累及多个方面；ＶＤ 以记忆力减退和计算力减退为主。③ＡＤ 的非认知功能常常受影响；ＶＤ的非认知功能较少受累。结论 ＡＤ 与ＶＤ 的临床特点不同，与两种疾病的病理机制不同有关。根据其不同的临床表现，有助于对这两种常见的老年期痴呆作出诊断及鉴别诊断。

Objective To compare the clinical manifestations between Alzheimers disease (AD) and vascular dementia (VD) and in order to assist the work up of patients with dementia. Methods All of the patients came from the special ward for dementia in a department of neurology.Twenty one patients with AD and 25 patients with VD were diagnosed according to the DSM IV classification. The severity of dementia was mild to moderate. Clinical symptoms were compared between the two groups including the clinical course of the disease, cognitive function, affective symptoms, behavior disorder, personality alteration and disturbance of perception. Results ① The course of AD was gradual decline. The course of VD was stepwise progression.② The decline of intelligence in Alzheimers disease was not only in cognitive functioin, which was global decline, but also in non cognitive functions such as affective symptoms, behavior disorder, personality alteration and disturbance of perception. Controversially,only parts of cognitive function in VD declined. Conclusions There are differences in the clinical manifestations between the AD and VD patients who have mild to moderoate degree of dementia. The differences in clinical manifestation are related to the different pathological mechanisms. The different clinical manifestations help to differentiate the diagnosis of AD and VD in clinical practice.