阿尔茨海默病与血管性痴呆患者临床特征和影像学比较

Comparison of clinical and imaging features in patients with Alzheimer＇s disease and vascular dementia

目的探讨阿尔茨海默病（AD）和血管性痴呆（VaD）患者的临床特征和影像学改变，以期寻找鉴别诊断的方法。方法收集武警广东医院老年病科自2006年8月至2011年6月收治的162例和同期本地区痴呆症状调查发现的42例痴呆患者的临床资料，采用简易精神状况检查（MMSE）量表进行筛选．其中AD患者114例、VaD患者90例，分析并比较AD、VaD患者的认知能力、行为症状和影像学资料。结果与VaD患者比较，AD患者女性较多，文化程度普遍较高，病程更长，差异有统计学意义（P〈0．05）；VaD患者注意和计算分项评分低于AD患者，AD患者短程记忆、语言复述和阅读理解分项评分低于VaD患者，差异有统计学意义（P〈0．05）；AD患者重复收敛行为的发生高于VaD患者，差异有统计学意义（P〈0．05）；AD患者海马萎缩的比例高于VaD患者，VaD患者脑区域发生血管病变的发生率明显高于AD患者，差异均有统计学意义（P〈0．05）。结论AD和VaD患者具有不同的临床特征和影像学改变，是由各自的病变本质、病变部位和病理机制所共同导致的。

Objective To investigate the clinical and imaging features of patients with Alzheimer＇ s disease （AD） and vascular dementia （VaD） and find an effective method to make differential diagnosis between the 2 entities. Methods One hundred and sixty-two patients with dementia, admitted to our hospital from August 2006 to June 2011, and 42 patients with dementia found from community epidemiological survey were chosen in our study; their clinical data were retrospectively collected and analyzed; in these patients, 114 patients were with AD and 90 patients were with VaD. Mini Mental State Examination （MMSE） was performed on these patients and the cognitive competence, behavioral symptoms and imaging data of these patients were analyzed and compared. Results More female, higher education level and longer course of disease in patients with AD were noted as compared with those in patients with VaD （P〈0.05）; the scores of attention and calculation in patients with VaD were obviously lower than those in patients with AD （P〈0.05）; the scores of short-term memory, retelling and reading comprehension in patients with VaD were obviously higher than those in patients with AD （P〈0.05）; the happening of repeated convergence behavior in patients with AD was much more often than that in patients with VaD （P〈0.05）; patients with AD had higher ratio of shrinking hippocampus than patients with VaD, and the incidence of vascular disease in the brain of patients with VaD was significantly higher than that of patients with AD （P〈0.05）. Conclusion Substantial differences on clinical and imaging features exist in AD and VaD patients, which can be attributed to the differences of lesion nature and distribution, as well as the underlying pathophysiological procedures of each disease.