Londos E, Passant U, Brun A, Gustafson L
Department of Psychogeriatrics, University Hospital, Lund, Sweden.
Int J Geriatr Psychiatry. 2000 Jan;15(1):40-9. doi: 10.1002/(sici)1099-1166(200001)15:1<40::aid-gps74>3.0.co;2-s.
To study the prevalence of patients fulfilling the clinical consensus criteria for dementia with Lewy bodies (DLB) in a dementia population followed up with postmortem examination. To compare the clinical and neuropathological findings in the clinical Lewy body dementia (LBD) group with findings in a clinically defined group with Alzheimer's disease (AD).
Medical records from 200 patients were studied retrospectively. Clinical consensus criteria for DLB and clinical criteria for other dementias were applied.
The majority of the cases were examined and cared for in psychogeriatric and psychiatric departments.
The patients, who died between 1985 and 1994, were part of a longitudinal dementia project. Each case was neuropathologically examined. Main outcome measures Prevalence of clinical signs and neuropathology was compared between the clinical groups.
Forty-eight (24%) patients fulfilled the clinical criteria for DLB while 45 (22%) fulfilled the clinical criteria for Alzheimer's disease. The clinical LBD group had a higher Hachinski score compared to the clinical AD group. They also showed a tendency towards a 'frontal profile' with disinhibition, confusion, personality change and vocally disruptive behaviour. More than 80% of the AD and LBD groups respectively exhibited Alzheimer pathology. The LBD group had frontal white matter pathology and degeneration of the substantia nigra more often than the clinical AD group. Both LBD and AD groups showed a progressive and marked increase in severity of dementia and decrease in ADL capacity according to an evaluation based on the Berger scale and Katz index. The condition of the LBD group was significantly worse earlier in dementia.
The results of this study indicate that patients fulfilling the clinical criteria for DLB also exhibit clinical features of possible vascular origin and a frontal profile. Subcortical vascular pathology, nigral degeneration and AD pathology in this group could partly explain the clinical features used to define DLB.
研究在进行尸检随访的痴呆症人群中，符合路易体痴呆（DLB）临床共识标准的患者的患病率。比较临床路易体痴呆（LBD）组与临床定义的阿尔茨海默病（AD）组的临床和神经病理学发现。
对200例患者的病历进行回顾性研究。应用DLB的临床共识标准和其他痴呆症的临床标准。
大多数病例在老年精神科和精神科进行检查和护理。
这些患者于1985年至1994年间死亡，是一项纵向痴呆症项目的一部分。对每个病例进行神经病理学检查。主要结局指标比较各临床组之间临床体征和神经病理学的患病率。
48例（24%）患者符合DLB的临床标准，45例（22%）符合阿尔茨海默病的临床标准。临床LBD组的哈金斯基评分高于临床AD组。他们还表现出一种“额叶特征”的倾向，即抑制解除、意识混乱、人格改变和言语干扰行为。AD组和LBD组分别有超过80%表现出阿尔茨海默病病理学特征。LBD组比临床AD组更常出现额叶白质病变和黑质变性。根据基于伯杰量表和卡茨指数的评估，LBD组和AD组的痴呆严重程度均呈进行性显著增加，日常生活活动能力下降。LBD组在痴呆早期病情明显更差。
本研究结果表明，符合DLB临床标准的患者还表现出可能源于血管病变的临床特征和额叶特征。该组的皮质下血管病变、黑质变性和AD病理学特征可能部分解释了用于定义DLB的临床特征。
