阿尔茨海默病与脑血管性痴呆临床特征比较

目的：比较阿尔茨海默病（AD）与脑血管性痴呆（VD）的临床特征。方法：按ICD-10诊断标准收集68例AD患者和89例VD患者，使用问卷调查，痴呆精神行为症状（BPSD）及认知功能筛查量表（CASIC-2.0)评定。结果：AD在性别，受教育程度，认知功能，BPSD等方面与VD有显著差异。结论：阿尔茨海默病与血管性痴呆的临床特征有各种差异。     

Alzheimer病与血管性痴呆临床特点的对照研究

目的 比较Alzheimer病(AD)与血管性痴呆(VD)的临床特点。方法 通过详细收集临床资料，并用痴呆严重程度临床评定量表(CDR)、简易精神状态检查量表(MMSE)、日常生活能力量表(ADL)评定，对38例AD与30例VD患者的发病情况、行为、精神症状特点、认知功能、日常生活能力等进行比较。结果 VD患者多急性发病、呈阶梯性病程、伴有高血压和卒中史；AD患者脑电图改变主要是双额叶及双枕叶的节律改变，以θ波及δ波为主要活动，而VD患者以不对称为主要表现；抑郁、焦虑、欣快的发生率VD患者明显高于AD患者，而幻觉、妄想、饮食障碍则明显低于AD患者；时间定向、地点定向、物体命名评分AD患者明显低于VD患者，而图形描述评分高于VD患者；AD和VD患者存在着躯体生活、工具使用能力下降的不平衡，VD患者躯体生活能力下降更明显。结论 AD与VD患者的临床特点不同，发病基础、行为、精神症状、认知功能、智能障碍、日常生活能力的评价及CT和脑电图的检查等对痴呆的诊断与鉴别诊断均具有重要价值。     

阿尔茨海默病与血管性痴呆患者精神行为症状和认知功能损害的比较

目的:探讨阿尔茨海默病(AD)和血管性痴呆(VD)患者精神行为症状和认知功能损害特点。方法:分析53例AD患者(AD组)及49例VD患者(VD组)近1个月精神行为症状及发生率;采用简明精神状态检查(MMSE)、世界卫生组织-加利福尼亚大学听觉词语学习测验(WHO-UCLA AVLT)和画钟测验(CDT)评估两组患者的认知功能。结果:AD组攻击行为、行为紊乱发生率明显高于VD组,抑郁发生率明显低于VD组(P均0.05);AD组MMSE中记忆、言语能力评分显著低于VD组,注意力评分显著高于VD组(P均0.05);AD组WHO-UCLA AVLT中延时记忆、长时记忆评分显著低于VD组(P均0.05);两组间CDT评分差异无统计学意义。结论:AD患者较VD患者有更多的攻击行为及行为紊乱,认知功能损害以记忆、言语能力下降更重;VD患者较多出现抑郁症状,注意力损害更明显。     

阿尔茨海默病和血管性痴呆患者行为障碍的比较

目的：比较阿尔茨海默病(AD)和血管性痴呆(VD)行为障碍。方法：用痴呆行为障碍量表(DBD)对AD患者47例与VD患者31例行为进行评定。结果：两组认知功能损害差异无显著性。除少数条目外，多数条目的平均评分及发生率差异均无显著性。结论：AD与VD两组病人的行为障碍基本类似。     

老年痴呆患者徘徊行为临床研究

目的：探讨老年痴呆徘徊行为的发生及相关因素。方法：符合美国精神障碍诊断与统计手册第4版阿尔茨海默病(AD)与血管性痴呆(VD)诊断标准的痴呆患者68例，采用Algase徘徊量表(RAWS)评定徘徊行为的表现及严重程度。结果：老年痴呆者徘徊行为发生率为50．0％，RAWS各因子分中以空间定向障碍为主要表现形式，不同痴呆严重程度之间徘徊行为的发生率及RAWS评分差异显著，不同痴呆类型其徘徊行为的发生率也有明显差异；RAWS评分与简易精神状态检查量表(MMSE)总分存在显著负相关。结论：徘徊行为在老年痴呆患者中普遍存在，与认知功能障碍和痴呆的严重程度有明显关系，对于医疗、护理及社区照顾，防止患者走失、摔倒受伤具有重要现实意义。     

Alzheimer病与血管性痴呆的认知及生活功能变化的随访研究

目的　探讨Alzheimer病(AD)与血管性痴呆(VD)的认知功能和生活功能的衰退模式。方法　入组时、1年后,采用痴呆严重程度临床评定量表(CDR)、简易智能状态检查量表(MMSE)、生活功能量表(ADL)对住院的Alzheimer病与血管性痴呆患者进行检查。患者出院1 年后对原有样本进行面检随访研究,并同时进行上述量表的测查,并分析对认知功能及生活功能的影响因素。结果　1年后AD病死率为3.45%(2/58)、VD病死率为12.12%(4/33)。入组时AD与VD组比较,各痴呆严重程度之间、MMSE总分差异无显著意义(均P>0.05),两者均以记忆力的减退最为明显, 1年后AD组MMSE总分及地点定向、图形描述因子分下降较为显著(P<0.05),而VD组MMSE总分及个因子分下降不明显(均P>0.05),AD组ADL总分及躯体生活功能、工具性生活功能因子分均有不同程度的升高(P<0.05),而VD组ADL总分及躯体生活功能、工具性生活功能因子分没有明显的变化(均P>0.05)。MMSE分与年龄、病程、GDS评级正相关,与ADL总分负相关,ADL总分与年龄、病程、GDS评级正相关,与MMSE分负相关。反映VD患者的空间感知能力损害较AD患者更为明显。结论　AD与VD患者的认知功能和日常生活能力减退各具其特点,这些特点有助于AD和VD的诊断和治疗。     

阿尔茨海默病不同阶段的临床神经心理学研究

目的　探讨阿尔茨海默病 (AD)患者不同严重程度时的临床神经心理功能的阶段性特征 ,为AD的早期诊断及鉴别诊断提供依据。方法　采用认知功能测试量表MMSE、HDS和ADL对AD组、VD组及对照组进行测试。结果　痴呆各组随着病程的延长痴呆的严重程度加重 ;ADL得分越高 ,痴呆越重 ;轻、中度AD患者主要表现为定向、计算和记忆三方面智能亚项的下降 ,而重度AD患者则显示MMSE测试各亚项的普遍下降 ;中、重度AD患者的计算、图形描绘及智能亚项明显低于血管性痴呆 (VD)患者 ;HDS测试痴呆两组各亚项得分均明显下降 ,且与MMSE测试结果具有很好的一致性。结论　MMSE、HDS和ADL等认知工具不仅可用于痴呆的检测 ,还可用于AD的早期诊断、AD与VD的鉴别诊断 ,并帮助判断痴呆的严重程度和日常生活能力。     

阿尔茨海默病和血管性痴呆的精神行为症状

目的 探讨阿尔茨海默病(Alzheimer’s disease，AD)和血管性痴呆(vascular dementia，VD)患者的精神行为症状特点及对早期诊断的价值。方法 对80例AD和72例VD的精神行为症状进行分类、比较和分析。结果 VD患者焦虑(P＝0．0024)和抑郁(P＝0．0059)的发生率显著高于AD患者，AD患者则以无目的闲逛(P＝0．0018)明显多见；而情感失控和情绪不稳的发生率在两组痴呆患者中无明显差异。结论 AD和VD患者的精神行为改变各有其不同特点，这对二者的早期诊断和鉴别诊断有一定帮助。     

高同型半胱氨酸血症与Alzheimer病的关系

目的 探讨高同型半胱氨酸血症与Alzheimer病(AD)的关系。方法 对38例AD患者及30例对照组老年人进行血浆同型半胱氨酸(Hcy)测定，并分析Hcy与认知功能障碍、痴呆严重程度、痴呆病程及精神症状的关系。结果 AD组血浆Hcy显著高于对照组IHcy水平与认知功能障碍、痴呆严重度密切相关，与痴呆病程和精神症状无关。结论 高同型半胱氨酸血症可能参与AD发病机制。     

痴呆患者心理和行为症状特征以及利培酮疗效的研究

目的　比较痴呆各亚型心理和行为症状 (BPSD)的特征 ,评价利培酮治疗BPSD疗效与安全性 ,探讨血浆同型半胱氨酸(Hcy)水平与BPSD的关系。方法　采用Alzheimer病行为症状评定量表 (BEHAVE AD)、Cohen Masfield激惹性问卷 (CMAI)评定阿尔茨海默病 (AD)、阿尔茨海默病混合型 (MD)、血管性痴呆 (VD)各 3 0例和正常对照组 3 0名的BPSD。 66例痴呆患者应用利培酮 (1 5mg/d)治疗 6周。采用副反应量表 (TESS)评价副反应。采用高压毛细管电泳紫外检测法测定经 2 ,4一二硝基氟苯 (DNFB)衍生后的血浆Hcy水平。结果　AD患者激惹、焦虑与恐惧发生率较高 ,VD患者无目的游荡发生率和严重程度均较低 ,MD患者BPSD症状无特异性。利培酮能明显改善痴呆患者BPSD ,且不损害认知功能 ,副反应主要为轻度嗜睡 ,肌强直 ,震颤。AD、MD和VD患者血浆Hcy浓度均显著高于正常对照组 ,血浆高Hcy水平的痴呆患者BEHAVE AD总分较高。结论　AD、VD患者BPSD症状有特异性 ,MD患者BPSD表现无特异性。利培酮能有效改善痴呆患者BPSD且安全。血浆高Hcy水平在痴患者BPSD的发病机制中可能起重要作用。     

阿尔茨海默氏病与血管性痴呆临床特点的对照研究

目的比较阿尔茨海默氏病（AD）与血管性痴呆（VD）的临床特点。方法对39例AD和38例VD患者的精神行为症状特点、伴随的躯体疾病、头颅CT检查以及脑电图检查进行比较。结果AD组与VD组在幻觉、妄想等精神病性症状方面无明显差异,在抑郁、焦虑等情绪障碍以及行为脱抑制方面有显著差异;AD组伴随的躯体疾病无明显特异性,VD组多伴发高血压、冠心病;AD组头颅CT多表现为脑萎缩,VD组多表现为脑梗塞;脑电图检查AD组无明显特异性,VD组界限脑电图居多。结论AD与VD患者的BPSD及所伴随的躯体疾病可有不同特点,CT和脑电图的检查等对痴呆的诊断与鉴别诊断均具有重要价值。     

Medical outcome of psychosocial intervention in demented patients: One-year clinical follow-up after relocation into group living units

Care of demented elderly in group living units is developing rapidly in Sweden. Group living (GL) offers a secure, small-size, homelike physical setting and an individualized, psychosocial and integrity-promoting therapy. Twentyeight patients suffering from dementia of Alzheimer type (DAT) or/and vascular dementias (VD) were evaluated before relocation from traditional long-term care institutions (TI) into GL units and followed up 6 and 12 months later by psychogeriatric ratings, regional cerebral blood flow measurements, somatic investigations and registration of pharmacological treatment. The patients relocated into GL were compared to a matched sample of 28 patients permanently cared for in TI. GL patients showed less dyspraxia, dysphasia and less prominent symptoms of depression and anxiety after both 6 and 12 months compared to the control group. Restlessness diminished among GL patients while the patient group in TI got more restless. Neuroleptic treatment was found to be used significantly more often among the TI patients during the whole study and anxiolytic-hypnotic treatment after 6 months. No difference was observed in antidepressive treatment. The results show that psychosocial stimulation and therapy offered in GL care has positive effects on emotional symptoms and performance compared to care in TI. These clinical changes abate later in the study as a consequence of the underlying organic disease. The major benefit of GL was slightly different between the diagnostic groups: for VD patients improvement of practical abilities, for AD patients abated agitation and restlessness.     

Vascular risk factors in demented elderly: analysis of Alzheimer Clinic materials]

In recent years evidence is increasing that vascular disease is associated with cognitive impairment and dementia. Moreover, presence of cerebrovascular disease may intensify the clinical symptoms of Alzheimer's disease (AD). The aim of the study was to determine the prevalence of vascular risk factors in age and sex matched patients with dementia. We studied 109 patients with AD and 37 patients vascular dementia (VD). DSM-III-R test for dementia, NINCDS-ADRDA guidelines for AD and NINDS-ARIEN for VD were applied. RESULTS: Mean age of dementia onset in AD and VD was 65.8 SD 7.8 and 67.4 SD 7.0 years (p > 0.05), the duration of dementia, MMS and GDS for patients with AD and VD was not significantly different. Arterial hypertension was associated in 51.3% VD and 30.3% AD (p < 0.05), hypotension in 11.1 and 23.6% respectively (p > 0.05), atrial fibrillation was similar in AD and VD, coronary artery disease was presents 64.8% AD and 46.8 VD (p > 0.05) and type 2 diabetes in 21.6% and 10.1% (p > 0.05) respectively. No significant differences in serum lipid profile were found in both groups, except two times higher incidence of normal HDL-cholesterol concentration in AD compare to VD. The relation between alcohol consumption, cigarette smoking and head trauma was similar in both types of dementia. CONCLUSION: Vascular disease and AD have to some extent a shared aetiology, and risk factors that they have in common increase the risk of both disorders independently and vascular disease is perhaps involved in the aetiology of AD.     

Prevalence, resource utilization and costs of vascular dementia compared to Alzheimer's dementia in a population setting

OBJECTIVES: To determine the prevalence of dementia and to measure the monetary impact and health resources utilization of vascular dementia (VD) compared to Alzheimer's dementia (AD) in persons aged over 64 years in a population setting. METHODS: Retrospective, cross-sectional study. In the initial phase, information was obtained on specific clinical characteristics from the subjects with an active diagnosis of dementia. The second phase consisted of a clinical evaluation and validation of the cases. Mini-Mental State Examination was used to assess cognitive impairment. Dementia and its subtypes were determined using established diagnostic criteria. Information was obtained on the use of health care resources (direct costs) and the number of hours devoted by the primary caregiver (indirect costs) for patients with a documented diagnosis of AD or VD within the last 6 months prior to the interview. A multiple logistic regression analysis was performed to correct the model. RESULTS: A total of 6,004 subjects were analyzed, 258 with diagnosis of dementia (overall prevalence: 4.3%). An evaluation was made of 224 patients, and gross prevalence of AD and VD was 2.4 and 1.0%, respectively. Cost per patient per semester was EUR 8,086 for AD and EUR 11,039 for VD (p = 0.016). 85.5% of the cost was attributable to primary caregiver time in AD and 84.4% in VD. CONCLUSIONS: The prevalence of AD and VD increases with age. No sociodemographic differences were seen between AD and VD. Costs associated with health care resource and primary caregiver utilization were high, being higher in VD than in AD.     

87例老年期痴呆住院患者死亡分析

目的:探讨住院老年期痴呆的生存时间和死亡原因.方法:收集1994年4月～2002年4月间住院死亡的阿尔茨海默病(AD)和血管性痴呆(VD)病例共87例.了解其发病年龄,病程,住院天数和死亡原因.结果:AD组发病年龄和死亡年龄均显著高于VD组.两组生存时间差异无显著性.但AD组中男性生存时间显著短于女性.两组住院天数差异无显著性.两组死亡原因主要均为感染和全身衰竭.结论:我国住院的AD患者发病年龄和死亡年龄均晚于VD患者.女性AD患者生存时间长于男性患者.感染和全身衰竭是老年期痴呆的主要死亡原因.     

Seizures in patients with Alzheimer’s disease or vascular dementia: A population‐based nested case–control analysis

Purpose: Patients with Alzheimer’s disease (AD) have an increased risk of developing seizures or epilepsy. Little is known about the role of risk factors and about the risk of developing seizures/epilepsy in patients with vascular dementia (VD). The aim of this study was to assess incidence rates (IRs) of seizures/epilepsy in patients with AD, VD, or without dementia, and to identify potential risk factors of seizures or epilepsy. Methods: We conducted a follow‐up study with a nested case–control analysis using the United Kingdom–based General Practice Research Database (GPRD). We identified patients aged ≥65 years with an incident diagnosis of AD or VD between 1998 and 2008 and a matched comparison group of dementia‐free patients. Conditional logistic regression was used to estimate the odds ratio (OR) with a 95% confidence interval (CI) of developing seizures/epilepsy in patients with AD or VD, stratified by age at onset and duration of dementia as well as by use of antidementia drugs. Key Findings: Among 7,086 cases with AD, 4,438 with VD, and 11,524 matched dementia‐free patients, we identified 180 cases with an incident diagnosis of seizures/epilepsy. The IRs of epilepsy/seizures for patients with AD or VD were 5.6/1,000 person‐years (py) (95% CI 4.6–6.9) and 7.5/1,000 py (95% CI 5.7–9.7), respectively, and 0.8/1,000 py (95% CI 0.6–1.1) in the dementia‐free group. In the nested case–control analysis, patients with longer standing (≥3 years) AD had a slightly higher risk of developing seizures or epilepsy than those with a shorter disease duration, whereas in patients with VD the contrary was observed. Significance: Seizures or epilepsy were substantially more common in patients with AD and VD than in dementia‐free patients. The role of disease duration as a risk factor for seizures/epilepsy seems to differ between AD and VD.     

Differentiating Alzheimer’s disease from subcortical vascular dementia with the FAB test

Background The frontal assessment battery (FAB) test is a composite tool for assessing executive functions related to the frontal lobe. Neuropsychological and blood-flow studies indicate distinct patterns of deterioration of anterior and posterior cortical function in Alzheimer’s disease (AD) and subcortical vascular dementia (VD) patients. We predict that the FAB score may be useful for discriminating VD from AD. Objective To evaluate the clinical usefulness of the FAB test for differential diagnosis of AD and VD. Methods We compared FAB scores in 25 patients with AD, 27 patients with VD, and 80 age-matched normal control subjects. The AD group was matched for age, education and MMSE score with the VD group. The subtest scores in FAB were also compared among the three groups. Results The FAB scores were significantly decreased in both the AD and VD groups compared to the control group, and the reduction were greater in the VD group. Among the FAB subtests, mental flexibility (phonological verbal fluency) was the only subtest that significantly discriminated VD from the other two groups. Conclusions The FAB test can provide useful information for differentiating AD and VD at the bedside. Received in revised form: 20 January 2006     

Ultrasonographic measurement of cerebral blood flow,cerebral circulation time and cerebral blood volume in vascular and Alzheimer’s dementia

Vascular dementia (VD) and Alzheimer’s dementia (AD) are the most common differential diagnoses in patients with cognitive impairment. Although of different etiology, small vessel disease is postulated to be present in both conditions. We investigated global cerebral blood flow (CBF), global cerebral circulation time (CCT) and global cerebral blood volume (CBV) in VD and AD patients using a multimodal ultrasound (US) approach. 20 VD and 20 AD patients were included and compared with 12 age–matched controls. Duplex US of both internal carotid and vertebral arteries was performed to measure CBF. CCT was defined as the time delay of an echo–contrast bolus arrival between the internal carotid artery and internal jugular vein using extracranial Doppler. CBV was calculated as the product of CBF and CCT. CBF was significantly lower (VD: 570 ± 61; AD: 578 ± 77; controls: 733 ± 54ml/min) and CCT significantly longer (8.8 ± 2.6; 8.2 ± 1.4; 6.4 ± 0.8 s) in both patient groups compared with controls (p < 0.003). No difference in CBF and CCT was found between the two patient groups. CBV was similar in all three groups (82 ± 20; 79 ± 19; 78 ± 9 ml). The equally reduced CBF and prolonged CCT in VD and AD support the hypothesis, that small vessel disease is a relevant factor in both types of dementia. The presented multimodal US approach helps to assess the extent of changes in the global cerebral hemodynamics in patients with dementia but does not allow a differentiation between VD and AD. Drs. Schreiber and Doepp contributed equally to their work.