阿尔茨海默病与血管性痴呆的临床、神经心理、影像学对比

目的研究阿尔茨海默病(Alzheimerdisease,AD)和血管性痴呆(vasculardementia,VD)在临床表现、认知功能、脑CT/MRI及单光子发射断层扫描(SPECT)的不同表现及特点。方法从临床表现、脑CT/MRI、神经心理测验、脑SPECT扫描对27例AD、26例VD及25例健康对照进行研究。结果(1)AD的精神症状频率显著高于VD。(2)脑CT/MRI上VD以皮质下双侧多发病灶为主;AD以脑萎缩为著;两者差异显著。(3)AD及VD的认知功能显著降低。(4)VD的脑血流低灌注/缺损灶分布广泛;皮层的病灶以不对称性分布为主。而AD的病灶位于皮层,呈对称分布为主。(5)AD与血管性痴呆神经心理测验结果与脑血流灌注的改变相关。结论临床表现、神经心理测验、脑CT/MRI及SPECT扫描对诊断及鉴别诊断AD与VD有一定价值。

Clinical,neuropsychological,and radiological findings in Alzheimer disease and vascular dementia

Aim To study the differences of clinical manifestations,cognitive changes,brain CT /MRI and single photon emission computed to-mography(SPECT)images between Alzheimer disease(AD)and vascular dementia(VD).Methods 27patients with AD,26patients with VD and 25controls were studied with clinical manifestation,brain CT /MRI,neu-ro-psychological testing and SPECT scanning.Results(1)AD had higher frequency of psychiatric symptoms t han VD.(2)Multi-bilateral sub-cortical deficits were found in CT /MRI images of patients with VD,while atrophy were found in most of patients with AD.There is great statistic difference between them.(3)Neuro-psychological testing score s were significantly low in AD and VD when compared to normal on es.(4)VD' s cerebral hy-po-perfusion lesions were detected widely in cortical and sub-cortical struc-tures.Most cortical hypo-perfusio n lesions were scattered and unsymme tri-cal.While hypo-perfusion lesions o f AD were found only in cortical struc-ture,most were found symmetrically.(5)Neuro-psychological testing score s of AD and VD showed correlation with t he changes of cerebral blood perfu-sion.Conclusion Clinical manifestations,neuro-psychological testing,brain CT /MRI and SPECT scanning cont ribute to the work-up of patients with AD and VD,combing all these meth ods it can be more useful.