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。

The comparative study of characteristic clinical features of Alzheimer''''s disease and vascular dementia

Objective To compare the clinical manifestations between Alzheimer's disease (AD) and vascular dementia (VD) . Methods 38 patients with AD and 30 patients with VD were tested with CDR , MMSE, and ADL , clinical symptoms were compared between the two groups including pattern of onset , behavioral and psychic disturbance , cognitive function and activity of daily life . Results VD most had acute onset , stepwise progressive course and commonly accompanied with history of hypertension , stroke ; In AD patients , the EEG abnormalities demonstrated that bilateral dysrhythmia of theta wave and delta wave in frontal lobe and occipital lobe ,compared to AD , VD patients were associated with non synchronization ; The incidence of depression , anxiety and euphoria in VD was significantly higher than that of AD ,but the incidence of hallucination , delusion and eating disorder was lower than that of AD; MMSE result , the AD patient's scores of time orientation , place orientation ,object named were lower significantly than that of VD , but the score of describe graph was higher than that of VD ; There was imbalance on declined scores of physical self maintenance scale and instrumental activities of daily living scale between AD and VD patients , VD patients physical self maintenance declined significantly . Conclusions There are differences in the clinical manifestations between AD and VD patients, the different clinical manifestation of basis of onset , behavioral and psychic disturbance , cognitive function , intelligence disorder , activity of daily life and CT, EEG examinations , help to differentiate the diagnosis of AD and VD in clinical practice.