路易体痴呆临床特点分析

Clinical analysis of dementia with lewy body

目的研究路易体痴呆(dementia with lewy body,DLB)的临床特点、诊断要点、治疗及预后,以期全面提高对本病的认识及诊治水平。方法研究我院收治临床诊断DLB患者13例,分析临床表现、专科查体、辅助检查、治疗以及预后。结果 13例患者均出现进行性痴呆,部分有波动,11例诊断为很可能DLB,2例诊断为可能DLB。所有患者中伴有波动性认知障碍8例(8/13)、帕金森综合征8例(8/13)、视幻觉8例(8/13)、记忆力减退13例(13/13)、肢体震颤4例(4/13)、谵妄状态5例(5/13)、睡眠增多3例(3/13)、缄默1例(1/13)、焦虑抑郁状态9例(9/13)、头晕1例(1/13)、快动眼睡眠期行为异常6例(6/13)、对地西泮异常敏感1例(1/13)。随访6个月~5年,患者认知功能波动,总体病情进展,其中2例死亡。结论路易体痴呆是不可逆进行性加重的神经变性疾病,早期全面的认识其临床特点,有利于避免本病延误诊治,进一步改善预后。

Objective To investigate the clinical features, diagnosis, treatment and prognosis of Dementia with Lewy Body （DLB） in order to improve doctors＇ understanding and experience. Methods Thirteen cases of clinical1 diagnosed DLB were analyzed. The clinical manifestations, neurological examination, laboratory tests, treatment and prognosis were analyzed. Results All of 13 patients had fluctuating dementia. Among them, 11 were diagnosed with probable DLB, and 2 were diagnosed with possible DLB. There were 8 cases （8/13） with volatility cognitive impairment, 8 cases （8/13） with Parkinson＇s syndrome, 8 casess （8/13） with visual hallucinations, 13 cases （13/13） with memory loss, 4 patients with limb tremor （4/13）, 5 cases with delirium （5/13）, 3 cases with increased sleep （3/ 13）, 1 case with silence （1/13）, 9 cases with anxiety and depression （9/13）, one case with dizziness （1/13）, 6 cases with abnormal dysplasia （6/13）, and one case with abnormal sensitive to diazepam （1/13）.The cognitive function fluctuated, the condition deteriorated and two patients died during the follow-up from 6 months and 5 years. Conclusions Lewy body dementia is an irreversible and progressive neurodegenerative disease. Comprehensive understanding of its clinical features is helpful for the early diagnosis and treatment, which may in turn improve the prognosis.