摘要
目的 研究阿尔茨海默病 (AD)和血管性痴呆 (VD)的临床特征 ,寻找鉴别诊断的有效方法。方法 共 12 5例AD患者和 97例VD患者 ,包括北京协和医院的门诊痴呆患者 171例和流行病学调查中受访的痴呆患者 5 1例 ,AD患者均有头颅MRI资料 ,VD患者都有头颅MRI或CT资料。按照美国精神医学会的《精神障碍诊断和统计手册》第四版 (DSM Ⅳ )标准诊断痴呆 ,很可能AD采用美国神经病学、语言障碍和卒中 老年性痴呆和相关疾病学会 (NINCDS ADRDA)标准 ,很可能VD采用美国国立神经病与卒中研究所 /瑞士神经科学国际协会 (NINDS AIREN)标准。比较AD和VD患者在认知功能、行为症状、日常活动能力和影像学方面的差异 ,采用Logistic二元多重回归模型确定鉴别诊断的有效指标。结果 不同痴呆阶段的AD和VD患者具有不同的临床特征 ,两者间的鉴别指标随痴呆进展而变化 :轻度AD患者学习能力较VD患者减退明显 (Fuld物体记忆储存分分别为 6 3± 2 4、8 0± 1 7,P =0 0 4 0 ) ,鉴别中度AD和VD患者的有效指标是注意力 (数字广度测验倒背分分别为 2 2± 1 4、1 0± 1 2 ,P =0 0 0 4 )和综合语言能力 (简易智能状态检查法综合语言能力分分别为 6 3± 1 1、5 3± 1 7,P =0 0 0 1) ,重度AD患者以短时记忆减退 (Fuld物体记忆总分分别?
Objectives To investigate the clinical features of Alzheimer’s disease (AD) and vascular dementia (VD) so as to finding out an effective method for differential diagnosis between these two entities. Methods There were 125 AD and 97 VD patients enrolled in this study,including patients from the memory clinics of PUMCH and from the community population visited by the Beijing epidemiological survey group during 1996-2000. Dementia, probable AD and probable VD were diagnosed according to the standards of DSM-IV, NINCDS-ADRDA, NINCDS-AIREN, respectively. Results of specific neuroimaging examination were used to compare the diagnoses and the final diagnosis of each patient was determined according to the discussion between clinical experts and radiological professionals. Analysis on clinical (cognition, behavior, and ability of daily life) and neuroimaging data was performed, aiming at finding differential points between the two dementia-subtypes. A Logistic binary multiple regression analysis was employed to detenmine the significant features for the differential diagnosis at last. Results AD and VD patients showed different clinical features in various demented stages, hence the indexes that differentiate the two dementia subtypes were changed accordingly. The predominant characters of mild AD appeared to be deficits in the prolonged memory and learning ability(score of overall storage in Fuld Objective Memory test: 6.3±2.4 vs 8.0±1.7,P=0.040). With the progress of dementia, attention (score of inverse digital span test: AD 2.2±1.4 vs VD 1.0±1.2,P=0.004) and compound language capability (score of multiple language tests in MMSE: AD 6.3±1.1 vs VD 5.3±1.7,P=0.001) turned to be the effective indexes for differentiating diagnosis. And severe AD patients went worse in short memory than VD (total score of Fuld Objective Memory test: 3.1±1.7 vs 6.0±4.3,P=0.046). In the mild and moderate demented stage, AD patients were inferior to VD patients in dealing with financial affairs and making phone calls, while the
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2004年第2期109-113,共5页
Chinese Journal of Neurology
基金
美国中华医学基金资助项目 ( 99 699)
关键词
影像学
阿尔茨海默病
AD
血管性痴呆
VD
精神障碍
Alzheimer disease
Dementia, vascular
Diagnostic imaging
Diagnosis, differential
