误诊为阿尔茨海默病的麻痹性痴呆1例报告

General paresis of insane misdiagnosed as Alzheimer’s disease:a case report

目的探讨以痴呆、精神行为异常起病的麻痹性痴呆(GPI)与阿尔茨海默病的鉴别诊断。方法报告1例以痴呆、精神障碍起病的麻痹性痴呆患者的临床资料及诊疗过程,供临床诊疗参考。患者男,56岁,因认知功能下降,门诊完善认知测评、头颅MRI等检查,考虑阿尔茨海默病。结果因患者认知障碍症状加重,合并精神行为异常,住院行血液及脑脊液梅毒相关抗体检测提示阳性,诊断为麻痹性痴呆。本病例发病年龄晚,合并脑萎缩,易与AD混淆,完善脑脊液Aβ_(1-42)减低,Aβ_(1-42)/Aβ_(1-40)减低。结论门诊就诊的认知障碍患者需常规筛查梅毒血清抗体,Aβ_(1-42)可能与GPI存在密切关系。

Objective To explore the differential diagnosis of general paresis of insane(GPI)with dementia and psycho behavioral abnormalities from Alzheimer’s disease.Methods In this paper,we report the clinical data and diagnosis and treatment process in a case of general paresis of insane who with dementia and mental disorders and offer clinical for reference.The patient,a 56-year-old male who with cognitive impairment,completed cognitive assessment,head MRI and other examinations in the outpatient clinic to consider as Alzheimer’s disease.Results Due to worsening symptoms of cognitive impairment and psychobehavioral abnormalities,hospitalization with blood and cerebrospinal fluid syphilis-related antibody tests were positive,and the diagnosis was general paresis of insane.The onset age of this case was late,combined with cerebral atrophy,which was easy to be confused with AD,and the cerebrospinal fluid of Aβ_(1-42) and Aβ_(1-42)/Aβ_(1-40) was reduced.Conclusion Patients with cognitive impairment who present in outpatient clinics should be routinely screened for serum antibodies to syphilis,Aβ_(1-42) may be closely related to GPI.