老年期痴呆129例的临床研究

A clinical study of senile dementia on 129 cases

目的 探讨老年期痴呆的病种分布、临床表现、影像特点和诊断方法。方法 采用综合分析方法对129例老年期痴呆患者进行临床症状、神经心理、MRI检查,并以112名老年健康体检者为对照,总结了各种痴呆的特点和诊断方法。结果 129例老年期痴呆中,阿尔茨海默病（Alzheimer’s disease,AD）55例,血管性痴呆（vas-cular dementia,VD）46例,混合性痴呆（mixed dementia,MD）18例。3种痴呆中记忆障碍均存在（100％）,卒中病史在AD组中无,在VD组和MD组中分别为39例（84％）和7例（39％）;神经系统局灶征在AD组中未能发现,在VD组和MD组中分别为44例（95％）和5例（27％）;影像变化AD组中全部有脑萎缩（100％）,VD组多发性脑梗死42例（93％）,MD组全部有脑萎缩（100％）和全部有腔梗（100％）,但腔梗数量不超过5个。结论（1）对各种痴呆的诊断步骤,应先符合痴呆的标准,再根据AD、VD和MD的标准进行分型。（2）老年期痴呆以AD为最多见,VD次之。（3）不同痴呆各有其不同的临床特点:AD起病慢,无神经系统局灶征,影像变化以脑萎缩为主,Hackinski缺血评分<4分;VD多有脑血管病病史,起病快,有神经局灶征,影像变化以脑梗死为主;MD多兼有AD和VD的特点,脑血管病史不甚明确,影像学上既有脑萎缩又有散在的腔梗,数量多在5个以上。

Objective To study types, clinical manifestations , neuroimaging features and diagnostic protocol of senile dementia. Methods The results of clinical symptoms, neuropsychology and MRI of 129 cases with senile dementia were analyzed and summarized, in contrast with 112 control, to get the diagnostic essentials of different types of senile dementia. Results In 129 cases of senile dementia, there were 55 Alzheimer's disease(AD) , 46 vas-cular dementia (VD) and 18 mixed dementia (MD). Memory impairments existed in all three groups (100%). There were no stroke history in AD group, but in 39 cases (84%) and 7 cases(39%)in VD and MD group respec-tively. Focal neurological findings were found in 44 cases (95%) in VD group,5 cases (27%) in MD group and no in AD group. Neuroimaging examinations showed encephalatrophy in all cases in AD group (100%)and MD group (100%), cerebral infarctions in 42 cases (93%) in VD and in all cases(100%) with no more than 5 infarctions in MD group. Conclusion (1) For the diagnosis of different types of senile dementia, dementia should be diagnosed first, and then classified into AD, VD and MD according to their criterias. (2) In senile dementia, the incidence of AD is higher than VD. (3) Different types of dementia have their own features: AD has a slow development, with a encephalatrophy and no focal neurological impairments, and with no more than 4 of Hackinski scales. VD usually has a history of cerebrovascular disease, a fast development and focal neurological impairments, with multi-cere-bral infarctions. MD usually has the features of AD and VD, with both encephalatrophy and lacunar infarction, and with an unclear history of cerebrovascular disease.