早发型阿尔茨海默病一例报告

A case of early-onset Alzheimer's disease with early psycho-behavioral symptoms and no obvious cortical atrophy

目的:早发型阿尔茨海默病(early-onset Alzheimer Disease,EOAD)为阿尔茨海默病较为少见的类型。因其临床表现多变,早期不易诊断。探索EOAD特征,提高医务人员对其诊断及鉴别能力尤为重要。方法:报道1例早期伴精神行为症状,无明显皮质萎缩的EOAD患者,并进行文献复习。结果:患者中年女性,以记忆力减退、认知功能障碍伴精神行为异常为主要特征,曾被误诊为精神类疾患,服用奥氮平后存运动症状,停药后症状改善。辅助检查提示存淀粉样蛋白异常沉积及tau蛋白纤维异常缠结,考虑EOAD。结论:EOAD早期易被误诊,需结合病史、影像、脑脊液检查等辅助诊断予以鉴别。

Object:Early-onset Alzheimer Disease(EOAD)is a relatively rare type of Alzheimer's disease.Due to the variable manifestations of EOAD,early diagnosis is difficult.Exploring the characteristics of EOAD is particularly important to improve the ability of physicians to diagnose and distinguish this disease.Methods:An EOAD patient appearing early psychiatric-behavioral symptoms without significant cortical atrophy was reported here.In addition,the literature on EOAD was reviewed.Results:The patient,a middle-aged female,was characterized as cognitive dysfunction with psychotic behavior abnormalities.She had been misdiagnosed with a psychiatric disorder.Motor symptoms developed after receiving olanzapine treatment and improved after stopping the drug.Auxiliary examinations showed abnormal deposits of amyloid and abnormal tangles of tau protein fibers,indicating EOAD.Conclusion:EOAD is easily misdiagnosed in its early stages.It needs to be differentiated with history taking,imaging,cerebrospinal fluid examination,and other supporting diagnoses.