阿尔茨海默病与血管性痴呆的临床特征比较

Comparative Study on the Clinical Features of Alzheimer′s Disease and Vascular Dementia

目的 研究阿尔茨海默病 (Alzheim er's disease AD )和血管性痴呆 (vascular dementia VaD )的临床特征,寻找鉴别诊断的有效方法。方法 共纳入 112名 AD 患者和 92名 VaD 患者,包括在北京协和医院就诊的门诊痴呆患者和流行病学调查中的受访痴呆患者,AD 患者均接受过头颅 M RI 检查,VaD 患者都有头颅 M RI 或 CT 检查的资料。按照国际标准诊断痴呆、很可能 AD 和很可能 VaD 。比较 AD 和 VaD 患者在认知功能、行为症状、日常活动能力等方面的差异,确定临床鉴别诊断的有效指标。结果 不同痴呆阶段的 AD 和 VaD 患者有着不同的临床特征,二者之间的鉴别指标随痴呆的进展而变化:轻度 AD 患者延迟记忆明显减退;轻度 VaD 患者计算力障碍更突出。鉴别中度 AD 和 VaD 患者的有效指标是学习能力和注意力。轻中度 AD 在理财和打电话上逊于 VaD 患者,VaD 主要在与肢体活动有关的日常活动中表现退步。中重度 VaD 患者因智能和机体的双重衰退生活自理能力的急剧减退,其 ADL 总分明显高于同阶段 AD 患者 (P <0.05)。重复收敛行为始终是鉴别 AD 和 VaD 患者的有效指标。结论 AD 和 VaD 具有不同的临床特征,二者间的差别是由各自的病变性质、部位和病理生理机制所决定的。

Objective To investigate the clinical features of Alzheimer′s disease(AD)and vascular dementia(VaD), and to find effective methods for differential diagnosis between the two entities. Methods Totally 112 AD patients and 92 VaD patients were enrolled in this study,consisted of patients from the memory clinics and patients from the community population visited during the epidemiological survey from 1996 to 2000. Diagnosis of dementia, probable AD and probable VaD were made according to international criteria. Results of specific neuroimaging examination were referred to verify the diagnosis and the final diagnosis of each patient was determined from the discussion between clinical experts and radiological professionals. Analysis on clinical and neuroimaging data was performed, aiming at finding differential points between the two dementia-subtypes. A logistic binary multiple regression analysis was performed to pick out those statistically significant clinical features for differential diagnosis at last. Results AD and VaD patients have different clinical features in various demented stages, therefore the indexes that differentiate the two dementia subtypes change accordingly. The predominant features of mild AD appear to be deficits of prolonged memory and learning ability, while the major impairment of mild VaD patients is decline of calculating ability. With the progress of dementia, learning ability and attention turn to be the effective indexes for differential diagnosis. In the mild and moderate demented stage, AD patients are inferior to VaD patients in handling finacial affairs and making phone calls, while VaD patients often degenerate in daily activities concerning with both physical ability and intellectual level. Severe VaD patients appears more global degeneration of living ability compared to AD patients. The difference of ADL scores between the two subtypes is significant in moderate to severe demented patients(P < 0.05). Psychological behavior symptoms, such as repeatedly collecting useless things, are the characteristic manifestation to differentiate AD from VaD in all clinical stages. Conclusions The results of our study indicate that substantial differences exist between AD and VaD patients. Such differences can be attributed to the differences of lesion nature and distribution, as well as the underlying pathophysiological procedures of each disease.