背景:阿尔茨海默病和血管性痴呆是老年期痴呆的两个主要类型,两者的发病机制不同,治疗与预后也不相同.阿尔茨海默病到目前为止尚无有效的治疗方法,而血管性痴呆则可以通过积极有效的治疗达到改善患者生活质量的目的.目的:对比阿尔茨海默病和血管性痴呆临床特点、脑电地形图和脑诱发电位的差异.设计:以阿尔茨海默病和血管性痴呆患者为观察对象的回顾性分析.单位:哈尔滨医科大学第一临床医学院神经内科.对象:选择1996-12/2000-12哈尔滨医科大学第一临床医学院神经内科住院或出院后复诊患者,病史提供均为本人或与患者共同生活的亲属.共有9例阿尔茨海默病、14例血管性痴呆患者入选.入选患者均符合美国国立神经疾病和传播性疾病及卒中研究所、阿尔茨海默病和相关疾病协会和第四版精神疾病诊断和统计手册关于阿尔茨海默病与血管性痴呆的诊断标准,根据上述标准均诊断为轻、中度痴呆.方法:采用回顾性分析方法,对阿尔茨海默病和血管性痴呆患者采用以下分析指标:①临床特点:a.疾病进展过程.b.认知功能:远、近记忆力、计算力、理解力、抽象思维能力、定时及定向力等.c.情感反应:抑郁、焦虑、恐惧、欣快、强哭、强笑等.d.人格变化:淡漠、主动性减退.②脑电地形图:选择最能证明问题的异常段信号进行采样,计算得到1～30 Hz总功率的θ,δ,α和β4个频带功率值.③脑诱发电位:选择测定事件相关电位P300-靶N1,P2,N2,P3潜伏期和靶P2,P3波幅.采用计量资料两组比较采用t检验,率的比较采用χ2检验.主要观察指标:①阿尔茨海默病与血管性痴呆患者疾病发展过程、认知功能和非认知功能比较.②阿尔茨海默病和血管性痴呆患者脑电地形图特点比较.③阿尔茨海默病和血管性痴呆患者脑诱发电位特点比较.结果:共有9例阿尔茨海默病和14例血管性痴呆患者,15例正常老年人的资料均纳入结果分析.①阿尔茨海默病与血管性痴呆患者疾病发展过程、认知功能和非认知功能比较:阿尔茨海默病起病缓慢,血管性痴呆多数发病较急;阿尔茨海默病患者认知功能全面减退,包括记忆力减退和计算能力减退,抽象思维能力下降,定时及定向能力障碍;血管性痴呆患者认知功能以部分减退且呈间歇性阶梯状加重为特点,以记忆力减退和计算力减退为主要特征,但其他认知功能障碍不如阿尔茨海默病多见.阿尔茨海默病组患者的情感障碍以抑郁为多见;人格变化以主动性减退为多见;血管性痴呆组患者情感障碍以强哭、强笑多见,同一患者很少有2种以上情感障碍.②阿尔茨海默病和血管性痴呆患者脑电地形图特点比较:7例阿尔茨海默病患者脑电地形图表现为全头部θ频带功率增高,增高程度与痴呆的程度(简易智能状态检查评分)一致,同时α频带和β频带功率下降,后期δ功率增高;血管性痴呆组患者脑电地形图表现为病变部位δ和θ频带功率增高,增高程度与痴呆程度不相一致.③阿尔茨海默病和血管性痴呆患者脑诱发电位特点比较:两组患者脑诱发电位均表现为各波分化差,P300波幅降低,潜伏期明显延迟.阿尔茨海默病患者异常程度更为明显,而血管性痴呆患者则相对少见.结论:①阿尔茨海默病的认知功能为全方面减退,血管性痴呆以记忆力和计算力减退为主;阿尔茨海默病的非认知功能亦较多受累而血管性痴呆则受累较少.(②阿尔茨海默病和血管性痴呆患者脑电地形图变化前者为全头部、后者为病变部位θ频带功能增高,前者改变与痴呆严重程度一致,后者则不一致.③阿尔茨海默病和血管性痴呆患者脑诱发电位改变相似,但前者受累比后者多.%BACKGROUND: Alzheimer disease (AD) and vascular dementia (VD),the two major types of dementia in old age, differ from each other in pathological mechanism, treatment and prognosis. Up to now, no effective therapeutic method for AD is available, but VD can be treated effectively so that patients' quality of life can be improved.OBJECTIVE: To investigate the clinical features of brain electrical activity mapping (BEAM) and brain evoked potentials (BEP) between AD and VD patients.DESIGN: Retrospective analysis based on AD and VD patients.SETTING: Neurological Department, the First Clinical Medical College of Harbin Medical University.PARTICIPANTS: All inpatients and discharged patients were selected filiated to Harbin Medical University from December 1996 to December 2000. The history was provided by the patients themselves or their relatives who lived together with them. Nine cases of AD and fourteen cases of VD were diagnosed according to the diagnostic standard for AD and VD set by the National Institute of Neurological and Communicative Disorder and Stroke-the Alzheimer disease and Related Disorder Association, and Chinese Classification and Diagnostic Criteria of Mental Disease (4th edition). According to the clinical rating standard, the patients had mild or moderate degree of dementia.METHODS: AD and VD patients were analyzed with retrospective analynitive functions, including long-term and short-term memory, calculation,comprehension, abstract thinking, dyschronism and disorientation; c. emotional reaction, including depression, anxiety, fear, euphoria, compulsive laughing and crying; d personality alteration, including indifference,optimally were collected from the abnormal segment signals. After calculation, 4 frequency band powers of θ,δ, α and β of the total power of 1-30 N1, P2, N2 and P3 and the waves of P2 and P3 were measured. Comparison between the two groups and rate comparison were made with t-test and χ2 test, respectively.ease, cognitive functions and noncognitive functions between AD patients RESULTS: Data of 9 AD and 14 VD patients as well as 15 normal old cognitive functions and noncognitive functions between AD patients and VD patients: The onset of AD was slow, but that of VD was abrupt. Cognitive functions of AD patients were decreased, including memory decline,calculation decrement, abstract thinking disorder, dyschronism and disorientation. The cognitive functions of VD group were characterized by partial decrement and intermittent ladderlike aggravation. Memory decline and calculation ability decrease were the main characteristics, but other cognitive dysfunctions could not be observed as much as in AD. The patients of AD group often had depression as the most common emotional disorder.Personality alteration took initiative decrement as the most common one,whereas emotional disorder in the patients of VD group was presented by compulsive crying and laughing. One patient seldom had more than two and VD patients: BEAM of 7 AD patients was characterized by the power of θ frequency band of the whole head increased. The level of increase was consistent with the level of dementia (score of MMSE). At the same time,the power of α and β frequency bands declined, and the power of δ increased later, the left side (F3) was significantly higher than the right side AD and VD patients: The changes of BEP in the two group patients had poorly differentiated waves, with lower P300 wave and obviously delayed latent period. The abnormality degree of patients in AD group was more obvious than that in VD group.with memory decline and calculation ability decrease as the main characteristics in VD patients. The noncognitive functions of AD patients were more aftients were presented as the increased power of the whole head in the former ones and the increased power of θ frequency band in the latter ones. The changes were coincident with the severity of dementia in AD, but not in VD.effect of the former one was greater than that of the latter one.
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