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 clinical characteristics 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 Most of patients with VD had acute onset,stepwise progressive course and a history of hypertension and stroke;In AD patients, the EEG abnormalities demonstrated that bilateral dysrhythmia of theta wave and delta wave in frontal lobe and occipital lobe. Compared with AD and VD patients were associaetd 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;In MMSE result the AD patient's scores of time orientation, place orientation .object named were lower significatly than that of VD,but the score of describe graph was higher than that of VD;There was a imbalance on declined scores of physical selfmaintenance scale and instrumental activities of daily living scale between AD and VD patients, VD patients had lower physical self-maintenance. Conclusion There are differences in the clinical manifestations between AD and VD patients. Besides of onset,behavioral and psychic disturbance,cognitive function,intelligence disorder,activity of daily life and CT,EEC examinations are vital in the diagnosis of AD and VD in clinical practice.