摘要
目的 比较麻痹性痴呆（general paresis of insane,GPI）和阿尔茨海默病（Alzheimer＇s disease,AD）患者认知和精神行为症状的异同,为临床鉴别诊断提供线索.方法 本研究为病例对照研究.选取广州市脑科医院神经内科住院的GPI患者50例,AD患者61例,采用临床痴呆评估量表（CDR）对痴呆程度进行分级,采用简易精神状态检查（MMSE）、蒙特利尔认知评估量表（MoCA）、阿尔茨海默病评定量表认知部分（ADAS-cog）、神经精神问卷（NPI）对两组患者的认知功能和精神行为症状进行评估并比较两组差异.结果 （1）认知量表评分：GPI和AD患者的各认知量表总分在不同痴呆程度组间差异有统计学意义,且MMSE总分和MoCA总分均随痴呆程度递减,ADAS-cog总分随痴呆程度递增;GPI组和AD组比较：仅在轻度患者中,GPI组的MMSE总分显著高于AD组（分;GPI：20.63±5.87,AD：14.32±5.05,F=7.697,P=0.008）,ADAS-cog记忆因子分显著低于AD组[GPI：13.66 （8.33）,AD：23.00 （10.50）,Z=-3.205,P=0.001],其余各认知量表评分两组间差异无统计学意义.（2） NPI量表评分：GPI患者不同痴呆程度组间差异有统计学意义,轻度GPI组的NPI总分低于中、重度组患者,而AD患者的NPI总分在不同程度组间差异无统计学意义;GPI组和AD组比较：轻度GPI和AD患者的NPI总分及各因子分差异无统计学意义,中度GPl患者欣快、食欲两因子分显著高于AD患者,重度GPI患者NPI总分、幻觉、妄想、抑郁因子分显著高于AD患者.结论 GPI患者精神行为症状的改变模式与AD患者有明显差异,可为临床鉴别诊断GPI和AD提供重要线索.
Objective To compare the cognitive impairment and behavioral and psychological symptoms between patients with general paresis of insane （GPI） and those with Alzheimer＇s disease （AD）.Methods Fifty patients with GPI and sixty-one patients with AD from Guangzhou Brain Hospital were recruited in this case-control study.The severity of dementia was determined by the Clinical Dementia Rating Scale （CDR）.Cognitive functions and behavioral and psychological symptoms were evaluated by the MiniMental State Examination （MMSE）,Montreal Cognitive Assessment （MoCA）,Alzheimer＇s Disease Assessment Scale-cognitive subscale （ADAS-cog） and Neuropsychiatric Inventory （NPI）.Results （1）Cognitive assessments：There were statistically significant differences in different groups of patients classified by the CDR both in GPI and AD patients.In addition,with the increasing of the CDR degree,scores of MMSE and MoCA tended to drop down,but the scores of ADAS-cog tended to go up conversely.Comparing GPI with AD,the scores of MMSE in mild GPI groups were significantly higher than mild AD group （GPI：20.63 ±5.87,AD：14.32 ±5.05,F =7.697,P =0.008）,while the scores of ADAS-cog memory factor in mild GPI groups were significantly lower than mild AD group （GPI：13.66 （8.33）,AD：23.00 （10.50）,Z =-3.205,P =0.001）.（2） Assessments of behavioral and psychological symptoms：In GPI patients,the scores of NPI were increased with the degree of CDR; On the contrary,the scores stayed consistent relatively in patients with AD.In addition,comparing GPI with AD,patients with moderate degree were prominent in euphoria and eating disorders in GPI,rather than AD.What＇s more,severe GPI patients had significantly higher score in hallucination,delusion,depression and the total of NPI than severe AD patients.Conclusion Patients with GPI and AD show different characteristics in behavioral and psychological symptoms,which could help clinicians better understand GPI and AD.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2014年第12期841-846,共6页
Chinese Journal of Neurology
基金
广东省科技计划项目（2010B-060900095）
广州市医药卫生科技项目（20121A010010）
关键词
神经梅毒
阿尔茨海默病
认知障碍
神经行为学表现
诊断
鉴别
Neurosyphilis
Alzheimer disease
Cognition disorders
Neurobehavioral manifestations
Diagnosis, differential
