路易体痴呆与帕金森病痴呆认知及精神行为比较

摘要

Objective To investigate the characteristics of cognitive function and mental behavior symp-toms in patients with Parkinson′s disease dementia(PDD)and dementia with lewy body(DLB).Methods Forty-eight patients with DLB and 38 with PDD were collected in Tianjin Huanhu Hospital and Tianjin Jianhua Hospital. All patients were assessed on cognitive function and mental behavior symptoms using Montreal Cognitive Assess-ment Scale,Mini-Mental State Examination,Hamilton Depression Scale,Hamilton Anxiety Scale and The Neuro-psychiatric Inventory Questionnaire.The Unified Parkinson Disease Rating Scale-Part 3(UPDRSⅢ)and modified Hoehn Yahr staging were used to assess the severity of motor symptoms in patients. Results Scores of UPDRSⅢ,posture and gait disorder were higher in DLB group than those in PDD group but the score of tremor was lower in DLB group than that in PDD group. The proportions of non tremor onset and bilateral onset were also lower in DLB group than those in PDD group,and the differences were statistically significant(P<0.05).Cognitive func-tion impairment was more serious in DLB group than that in PDD group in all cognitive fields including execution, attention,visual space,orientation and the difference was statistically significant(P < 0.05). Hallucinations (81.3%)and irritability/emotional instability(62.5%)were more common in DLB group but apathy(76.9%),de-pression(73.7%)and anxiety(73.7%)were more common in PDD group. Conclusions Cognitive impairment is more progressive in DLB patients than that in PDD patients.Hallucinations and irritability/emotional instability are more common in DLB group but apathy,depression and anxiety are more common in PDD group.%目的 探讨路易体痴呆(DLB)和帕金森病痴呆(PDD)认知及精神行为特点.方法 对48例DLB患者和38例PDD患者进行运动症状评估、认知评估及精神行为症状评估.结果 DLB组首发症状单侧起病和震颤起病较PDD患者少,震颤评分较PDD患者低,但姿势步态障碍评分较PDD患者高.DLB组认知评分明显低于PDD组,DLB组在视空间和执行、注意力及定向力方面评分低于PDD组.幻觉是DLB最常见的精神症状,81.3%的DLB患者有幻觉,易激惹、情绪不稳也是DLB常见的精神症状(62.5%).PDD患者中淡漠、抑郁和焦虑较DLB患者更常见.结论 DLB患者认知障碍较PDD进展快,存在明显幻觉及易激惹、情绪不稳,而PDD患者存在明显的淡漠、抑郁和焦虑.