阿尔茨海默病与路易体痴呆患者临床表现对比分析

A comparative analysis of clinical manifestations of Alzheimer＇s disease patients and Lewy body dementia patients

目的比较阿尔茨海默病（AD）与路易体痴呆（DLB）患者的认知、精神行为症状等，为临床鉴别诊断提供证据。方法选取AD患者215例（AD组），DLB患者66例（DLB组），对两组患者的一般资料及家族史，疾病史进行回顾性分析，应用简易精神状态检查量表（MMSE）评定两组患者的认知能力，应用神经精神症状量表（NPI）评定两组患者常见痴呆精神行为症状。结果AD组合并高血压者多于DLB组；AD组113例（52.6%），DLB组24例（40%），P〈0.05。DLB组总体认知能力以及定向力、即刻回忆、延迟回忆方面优于AD组。DLB组波动性认知障碍、帕金森样症状较AD组突出。波动性认知障碍AD组2例（0.9%），DLB组19例（28.8%）（χ^2＝8.580，P＝0.003），帕金森样症状AD组26例（12.1%），DLB组25例（37.9%）（χ^2＝22.602，P＝0.000）。精神行为症状分析，NPI总分比较、幻觉及睡眠夜间行为异常DLB组较AD组常见。AD组幻觉32例（14.9%），夜间行为异常64例（29.8%），DLB组幻觉30例（46.2%），夜间行为异常30例（46.2%），P〈0.05。结论AD患者多合并高血压。DLB患者波动性认知障碍、帕金森样症状、幻觉、睡眠夜间行为异常为其常见突出表现。

ObjectiveTo compare cognitive, behavioral, and psychological symptoms observed in Alzheimer′s disease（AD）and dementia with Lewy body（DLB）in order to provide helpful information for differential diagnosis.MethodsWe selected 215 patients with AD（AD group）and 66 patients with DLB（DLB group）to retrospectively analyzed their general information, family history, and disease history.The Mini-Mental State Examination（MMSE scale）was used to evaluate cognitive abilities and Neuropsychiatric Inventory（NPI scale）was used for analysis of behavioral and psychological symptoms of dementia in both groups.ResultsThe prevalence of hypertension was higher in the AD group（52.6%, n=113）than in the DLB group（40%, n=24）（P〈0.05）. The DLB group showed better general cognitive scores, disorientation scores, immediate recall scores, and delayed recall scores than the AD group.Fluctuating cognitive deficiencies and Parkinson′s symptoms were more prevalent in the DLB group than in the AD group with 2 patients（0.9%）showing fluctuating cognitive deficiencies in the AD group, and 19（28.8%）in the DLB group（χ^2=8.580, P=0.003）; with 26 patients（12.1%）showing Parkinson′s symptoms in the AD group and 25（37.9%）in the DLB group（χ^2=22.602, P=0.000）. As to behavioral and psychological symptoms, the DLB group had higher scores in total NPI, hallucinations and nighttime abnormal behaviors with 32 patients（14.9%）showing hallucinations and 64（29.8%）showing nighttime abnormal behaviors in the AD group; 30（46.2%）showing hallucinations and 30（46.2%）showing nighttime abnormal behaviors in the DLB group（all P〈0.05）.ConclusionsHypertension is more prevalent in AD patients.Fluctuating cognitive deficiencies, Parkinson′s symptoms, hallucinations, and nighttime abnormal behaviors are prominent manifestations in DLB patients.