Doubleday E K, Snowden J S, Varma A R, Neary D
Greater Manchester Neuroscience Centre, Hope Hospital, Salford, UK.
J Neurol Neurosurg Psychiatry. 2002 May;72(5):602-7. doi: 10.1136/jnnp.72.5.602.
To determine whether dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) can be differentiated on the basis of qualitative performance characteristics during neuropsychological evaluation.
Forty one patients with clinically defined DLB were matched with 26 patients with AD for age, illness duration, nature and severity of cognitive deficits, and regional blood flow distribution on SPECT. The presence or absence of a set of qualitative performance characteristics, observed and recorded during the patients' initial cognitive evaluation, was identified by retrospective analysis of patients' records and the groups compared.
Inattention, visual distractibility, impairments in establishing and shifting mental set, incoherence, confabulatory responses, perseveration, and intrusions were significantly more common in DLB than AD. Intrusions were particularly common in DLB, occurring in 78% of the group. They included externally cued intrusions arising from the visual environment, a feature never seen in AD. In a stepwise logistic regression analysis impaired mental set shifting, perseveration, and the presence of intrusions correctly classified 79% of patients.
It is possible to differentiate DLB and AD on the basis of qualitative features of performance. As many features are amenable to detection at clinical interview, they ought to contribute to clinicians' diagnostic armoury, leading to improved clinical recognition of DLB.
确定在神经心理学评估期间，能否基于定性表现特征区分路易体痴呆（DLB）和阿尔茨海默病（AD）。
41例临床确诊为DLB的患者与26例AD患者在年龄、病程、认知缺陷的性质和严重程度以及单光子发射计算机断层扫描（SPECT）上的局部血流分布方面进行匹配。通过对患者记录的回顾性分析，确定在患者初始认知评估期间观察和记录的一组定性表现特征的有无，并对两组进行比较。
注意力不集中、视觉易分散、建立和转换思维定势受损、语无伦次、虚构反应、持续动作和插入性思维在DLB中比在AD中更为常见。插入性思维在DLB中尤为常见，该组中78%的患者出现此症状。它们包括由视觉环境引发的外部线索性插入性思维，这是AD中从未见过的特征。在逐步逻辑回归分析中，思维定势转换受损、持续动作和插入性思维的存在正确分类了79%的患者。
可以根据表现的定性特征区分DLB和AD。由于许多特征在临床访谈中易于检测，它们应有助于临床医生的诊断手段，从而提高对DLB的临床识别。
