路易体痴呆的诊断(附3例报告)

DIAGNOSIS OF DEMENTIA WITH LEWY BODIES(REPORT OF 3 PATIENTS)

为探讨路易体痴呆 (DementiawithLewyBodies ,DLB)临床诊断的正确性 ,分析了 3例临床上曾误诊为Alzheimer病 (AD)或AD合并Parkinson病 (PD) ,后经临床、脑影像学或病理检查诊断为DLB的病例。结果和AD相比 ,DLB有如下特点 :①缓慢进展性认知功能下降 ,尤其是波动性认知功能障碍 ;②反复发生的具体的生动的视幻觉 ;③四肢出现以僵硬为主的轻微对称性锥体外系症状 ;④脑萎缩相对比较轻。提出根据DLB的临床特点 ,在排除其他变性病的基础上 ,临床可考虑诊断为DLB。

To define the definite diagnosis of dementia with Lewy bodies(DLB). Three cases of DLB diagnosed by bedside examination,cerebral image or pathology were analysed. These patients had been diagnosed as Alzheimer disease(AD) or AD with Parkinson disease (PD). DLB consisted of the following features as compared with AD:①Slow progressive congnitive decline, especially fluctuating congnitive defect was prominent;② Recurrent visual hallucinations that were typically well formed and detailed;③The extrapyramidal symptoms usually included mild rigidity and bradykinesia, and they almost appeared simultaneously in the extremities; ④Cerebral atrophy was relatively mild. The clinical diagnosis of DLB might be possible on the detailed basis of their peculiar features, but other neurodegeration disorders should be ruled out.