路易体痴呆和帕金森病痴呆患者的临床症状对比研究

Comparison of clinical features between dementia with lewy bodies and Parkinson disease with dementia

目的 对比研究路易体痴呆和帕金森痴呆患者的临床症状,以期为临床诊断提供依据.方法 选择2015年3月至2017年12月于本院神经科门诊及住院的36例路易体痴呆（DLB）患者和24例帕金森痴呆（PDD）患者,将其分为DLB组与PDD组,比较两组患者的运动症状、认知水平以及精神行为症状.结果 DLB组患者病程（2.13±1.98）d明显短于PDD组（5.65±3.59）d;DLB组患者的UPDRS Ⅲ、震颤评分分别为（26.73±11.61）分、（2.59±1.83）分显著低于PDD组（37.16±13.73）分、（5.15±3.59）分,但姿势步态障碍评分（9.16±1.64）分高于PDD组（6.35±2.48）分,差异均有统计学意义（均P＜ 0.05）;DLB组患者MMSE、MoCA以及CDT评分显著低于PDD组,且DLB组患者在视空间和执行、注意力及定向力方面评分也显著低于PDD组,差异均有统计学意义（均P＜0.05）;DLB患者中幻觉、情绪不稳发生率明显高于PDD组;DLB患者中淡漠、抑郁、焦虑发生率低于PDD组,PDD患者睡眠障碍明显高于DLB患者,差异均有统计学意义（均P＜0.05）.结论 路易体痴呆和帕金森痴呆患者在认知和精神行为等临床症状方面存在显著差异,DLB患者认知障碍较PDD患者进展快,存在明显幻觉及易激惹,而PDD患者存在明显的抑郁焦虑以及睡眠障碍.

Objective To investigate the clinical features in patients with Parkinson disease with dementia （PDD） and dementia with lewy bodies （DLB）,in order to provide evidence for clinical diagnosis.Methods 36 patients with DLB and 24 patients with PDD were collected in department of neurology of our hospital from March 2015 to December 2017.The severity of motor symptoms,cognitive function,and mental behavior symptoms were compared between the two groups.Results The course of disease in DLB group was significantly shorter than that in PDD group [（2.13±1.98）d vs.（5.65±3.59）d].The scores of UPDRS Ⅲ and tremor in DLB group were lower than those in PDD group [（26.73±11.61） vs.（37.16±13.73）,（2.59±1.83） vs.（5.15±3.59）],but the score of posture and gait disorder in DLB group was higher than that in PDD group [（9.16±1.64）vs.（6.35±2.48）] （P〈0.05）.The scores of MMSE,MoCA,and CDT in DLB group were lower than those in PDD group （P〈0.05）.The rates of illusion and emotional instability in DLB group were higher than those in PDD group,the rates of apathy,depression,anxiety,and sleep disorders in DLB group were lower than those in PDD group （P〈0.05）.Conclusion Cognitive impairment is more progressive in DLB patients compared with PDD patients.Hallucinations and emotional instability are more common in DLB patients,but depression,anxiety,and sleep disorders are more common in PDD patients.