Del Ser T, McKeith I, Anand R, Cicin-Sain A, Ferrara R, Spiegel R
Hospital Severo Ochoa, Madrid, Spain.
Int J Geriatr Psychiatry. 2000 Nov;15(11):1034-45. doi: 10.1002/1099-1166(200011)15:11<1034::aid-gps231>3.0.co;2-5.
To describe the baseline demographic, neuropsychiatric and neurological data of a large selected clinical sample of patients with dementia with Lewy Bodies (DLB) from an international multicentre trial with rivastigmine. To examine the usefulness of the Consensus Criteria for the diagnosis of DLB in different countries.
Seventeen centres from Spain, the UK and Italy recruited patients diagnosed clinically as probable DLB according to recent Consensus Criteria (McKeith et al., 1996). A standard clinical protocol including inclusion/exclusion criteria, collection of demographic and medical data, cognitive (Mini Mental State Examination: MMSE), motor (Unified Parkinson's Disease Rating Scale: UPDRS) and neuropsychiatric (Neuropsychiatric Inventory: NPI) examinations, was applied after obtaining informed consent. Data were summarised and compared across countries with uni- and multivariate analyses.
One hundred and twenty patients were recruited: 56.7% males, mean (SD) age 73.9 (6.4) years, range 57 - 87 years. Sixty percent fulfilled all three core diagnostic features of DLB, and 40% only two ('parkinsonism' 92.4%, 'cognitive fluctuations' 89.1%, 'visual hallucinations' 77.3%). 'Systematised delusions' (46%) and 'repeated falls' (42%) were the most frequent supportive diagnostic features. There were no differences across countries in demographic, diagnostic or clinical features. Patients showed a wide range of psychopathology which was weakly correlated with cognitive impairment. Some mild extrapyramidal signs (EPS) were observed in most patients.
The Consensus Criteria for DLB can be consistently applied across many different sites for multicentre studies. 'Parkinsonism' and 'cognitive fluctuations' as core features and 'systematised delusions' and 'repeated falls' as supportive features are the most frequent diagnostic clues. Neuropsychiatric disturbances, in particular apathy, delusions, hallucinations and anxiety, and mild symmetric EPS are frequent in DLB and are only related weakly to cognitive impairment.
描述来自一项关于卡巴拉汀的国际多中心试验中，大量经过挑选的路易体痴呆（DLB）患者临床样本的基线人口统计学、神经精神和神经学数据。研究不同国家中DLB诊断共识标准的实用性。
来自西班牙、英国和意大利的17个中心招募了根据最新共识标准（McKeith等人，1996年）临床诊断为可能患有DLB的患者。在获得知情同意后，应用了一个标准临床方案，包括纳入/排除标准、人口统计学和医学数据收集、认知（简易精神状态检查表：MMSE）、运动（统一帕金森病评定量表：UPDRS）和神经精神（神经精神科问卷：NPI）检查。通过单变量和多变量分析对各国数据进行汇总和比较。
招募了120名患者：男性占56.7%，平均（标准差）年龄73.9（6.4）岁，年龄范围为57 - 87岁。60%的患者符合DLB的所有三个核心诊断特征，40%的患者仅符合两个特征（“帕金森综合征”92.4%，“认知波动”89.1%，“视幻觉”77.3%）。“系统性妄想”（46%）和“反复跌倒”（42%）是最常见的支持性诊断特征。各国在人口统计学、诊断或临床特征方面没有差异。患者表现出广泛的精神病理学症状，且与认知障碍呈弱相关。大多数患者观察到一些轻度锥体外系体征（EPS）。
DLB的共识标准可在许多不同地点一致地应用于多中心研究。“帕金森综合征”和“认知波动”作为核心特征，“系统性妄想”和“反复跌倒”作为支持性特征是最常见的诊断线索。神经精神障碍，特别是淡漠、妄想、幻觉和焦虑，以及轻度对称性EPS在DLB中很常见，且仅与认知障碍呈弱相关。
