383例老年人尸检资料中痴呆的病因分析

目的分析经尸检证实的老年人痴呆原因,提高对老年期痴呆各种病因的认识。方法对383例≥60岁有脑病理检查的患者进行临床和病理资料回顾性分析。结果383例老年人尸检病例中,有临床病史和相关病理改变的痴呆患者78例,痴呆发生率为20．4％。其中血管性痴呆30例,占老年人痴呆病例的38．5％;变性病痴呆20例,占25．6％,其中阿尔茨海默病11例,路易体痴呆、皮质基底节变性、进行性核上性麻痹、皮克病、帕金森病合并痴呆等非阿尔茨海默病型痴呆共9例;各种内科疾病包括肝性脑病、肺性脑病、低血糖反复发作引起认知功能障碍共16例,占老年人痴呆的20．5％。另外还有脑肿瘤、正常颅压脑积水和慢性硬膜下血肿等疾患共12例占15．4％。结论老年期痴呆是多病因所至的临床综合征,应该重视临床病史和现有的辅助检查方法对痴呆病因诊断的作用。

An analysis of the causes of dementia in 383 elderly autopsied cases

OBJECTIVE: To survey the causes of dementia confirmed by autopsy in the elderly and to have a better understanding of various causes of senile dementia. METHODS: A retrospective study on clinical and pathological diagnosis in 383 cases aged 60 and over with autopsy performed was carried out clinical diagnosis of dementia was based on DSM-IVR, NINCDS-ADRDA and NINCDS-AIREN criteria. Gallyas-Braak staining, Tau and Ubiquitin Immunohistochemistry staining were adopted for diagnosing neurodegenerative dementia and distinguishing various degenerative diseases. RESULTS: Among the 383 aged cases with consecutive autopsy, 78 cases were found to have clinical features and brain pathologic change related to dementia. The incidence of dementia in the aged patients with autopsy was 20.4%. Of all the cases, vascular dementia accounted for 38.5% (30 cases), being the most frequently on countered. Next in order were degenerative dementias including Alzheimer's disease (11 cases) and non-Alzheimer's degenerative dementia (9 cases) including dementia with Lewy bodies, corticobasal degeneration, progressive supranuclear palsy, Pick's disease and idiopathic Parkinson'disease. Degenerative dementias accounted for 25.6% (20 cases). Various medical disorders including hepatic encephalopathy, pulmonary encephalopathy, hypoglycemia with cognitive impairment were also relatively common, they accounted for 20.5% (16 cases). The other less common causes included brain tumor, normal pressure hydrocephalus and subdural hematoma, 12 cases accounted 15.4%. The total accordance rate of clinical and pathologic diagnosis of senile dementia was 64.5%, the accordance rates of medical disorders such as hepatic encephalopathy, pulmonary encephalopathy and brain metastatic tumors were all 100%, the accordance rate of vascular dementia and degenerative dementia was 66.7% and 40% respectively. CONCLUSION: Senile dementia is a clinical syndrome caused by multiple factors. Physician should think of various possible causes of dementia, basing on their clinical history and laboratory results. Promoting autopsy and adopting new pathological techniques would increase the diagnostic accuracy of degenerative dementia.