帕金森病痴呆与阿尔茨海默病的认知功能和精神行为症状比较

摘要

Objective To compare the cognitive functions and behavioral and psychological symptoms between Parkinson disease with dementia(PDD)and Alzheimer disease(AD). Methods Seventy-five cases with AD and 63 cases with PDD were recruited in this study. The mini mental state examination (MMSE), Montreal cognitive assessment (MoCA)and activities of daily living scale (ADL)were used to evaluate the cognitive impairment.The Chinese version of neuropsychiatric questionnaire(CNPI)was used to measure behavioral and psychological symptoms. Results ①Cognitive assessments:there were no statistically significant differences in total MMSE scores,total MoCA scores,total CNPI scores and ADL scores between AD patients and PDD patients (P>0.05).The sub-items of MoCA showed that memory loss was more severe in AD patients(2.17±0.65)than in PDD patients(2.44±0.50)(P<0.01).Visuospatial/executive dysfunction was more severe in PDD patients(3.73±0.70)than in AD patients(4.01±0.76)(P<0.05).②The items of CNPI showed that ADD patients had lower scores in the items of CNPI compared with the PDD patients (15.31±3.16 vs 19.41±3.52). The sub-items of CNPI showed that the most common mental symptoms in PDD patients were hallucination, depression, and agitation, which were 55.6%, 54%, and 52.4%, respectively Compared with the AD patients (P<0.05). On the contrary, compared with PDD patients, the most common mental symptoms were anxiety, apathy and irritability in AD patients, which were 53.3%, 52% and 49.3%, respectively (P<0.05). Conclusion Patients with AD and PDD exhibit different characteristics in cognitive functions and behavioral and psychological symptoms.Neuropsychological tests combined with clinical history can be helpful for differentiation between AD and PDD in dementia patients.%目的 比较阿尔茨海默病(Alzheimer disease, AD)与帕金森病痴呆(Parkinson disease with dementia, PDD)患者认知功能和精神行为损害特点.方法 采用简易精神状态检查 (MMSE)、蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)、中文版神经精神问卷(CNPI)评估75例AD与63例PDD患者的认知功能和精神行为症状,并比较两组差异.结果 ①认知量表评分:AD组与PDD组在MMSE总分、MoCA总分、CNPI总分及ADL总分差异无统计学意义(P>0.05),在MoCA亚项分析,AD组记忆力(2.17±0.65)比PDD组(2.44±0.50)患者减退更严重(P<0.01);而PDD组(3.73±0.70)视空间和执行功能比AD组(4.01±0.76)受损更严重(P<0.05).②CNPI量表分析:与PDD患者(19.41±3.52)相比,AD患者有更低的CNPI评分(15.31±3.16)(P<0.05).CNPI亚项分析:与AD组相比,PDD组最常见的精神症状为幻觉、抑郁、激越,分别为55.6%、54.0%、52.4%(P<0.05);与PDD组相比,AD组最常见的精神症状为焦虑、淡漠、易激惹,分别为53.3%、52.0%、49.3%(P<0.05).结论 AD及PDD在认知功能及精神行为症状方面均有差异,结合病史及神经心理学评估量表有助于AD与PDD的鉴别.