经颅磁刺激联合言语康复治疗阿尔茨海默病Logopenic型进行性失语一例

Repetitive transcranial magnetic stimulation combined with speech and language therapy in the treatment of Logopenic progressive aphasia of Alzheimer's disease:a case report

Logopenic型进行性失语(Logopenic progressive aphasia,LPA)是罕见的阿尔茨海默病特殊类型,临床容易误诊,治疗方法有待探索。本例59岁女性患者,主要症状为言语不利、认知功能下降。言语不利表现为语速慢,流畅性差,有频繁找词停顿,命名性失语,语量少,语音、语调正常,句法简单,无语法错误;对句子的理解和复述障碍,对单词的理解和复述保留。完善血液和脑脊液、脑电图、磁共振成像、18氟-氟代脱氧葡萄糖-正电子发射计算机断层显像,结合临床表现诊断为LPA。给予重复经颅磁刺激治疗和言语康复训练10次,联合多奈哌齐等综合治疗后,患者语言流利程度及认知功能较前改善,但仍存在取词困难。通过病例分析与文献复习,思考诊断与治疗得失,为临床医生诊治LPA提供新的思路。

Logopenic progressive aphasia(LPA)is a special type of atypical Alzheimer's disease(AD)which is easy to be misdiagnosed and its treatment remains to be explored.This paper reports a 59-year-old female with the main symptoms of speech impairment and cognitive decline.Her speech impairment is characterized by slow speech speed,poor fluency,frequent pause in finding words,nominative aphasia,low speech volume,normal pronunciation and intonation,simple syntax,no grammatical errors,obstacles to understand and retell sentences,and the reserved understanding and retelling of words.Together with the blood and cerebrospinal fluid test,electroencephalogram,magnetic resonance imaging,18F-flurodeoxyglucose positron emission computed tomography,and clinical manifestations,the case was diagnosed with LPA.After being treated with repetitive transcranial magnetic stimulation and speech and language therapy training for 10 times combined with Donepezil treatment,the patient had improvement over her speech and cognitive function but sometimes still had difficulty in acquiring words.Through case analysis and literature review,this article discusses the gains and losses in the diagnosis and treatments of this case,which may provide new ideas for the diagnosis and treatments of LPA to clinicians.