Pfitzenmeyer Pierre, Martin-Hunyadi Catherine, Mourey France, d'Athis Philippe, Baudouin Nathalie, Mischis-Troussard Christelle
Service de Médecine Gériatrique, Centre Hospitalier Régional et Université de Dijon, France.
Aging Clin Exp Res. 2002 Apr;14(2):100-7. doi: 10.1007/BF03324423.
In previous studies, we described a clinical picture typically observed in frail old people, called "Psychomotor Disadaptation Syndrome" (PDS), but we have never studied etiopathogenic data. The aim of this study was to complete the clinical picture, record cardiovascular risk factors and provide cerebral CT scan findings in patients with PDS.
73 patients with PDS were recruited in the Geriatric Medicine departments of the University Hospitals of Dijon (Burgundy, France) and Strasbourg (Alsace, France); this group included prospectively all hospitalized patients showing postural and gait abnormalities according to the following criteria: trend towards backward falling and gait pattern alteration characterized by hesitancy in initiation, small steps, and increase in the double support durations. General characteristics, neurological and cardiovascular information were collected for each patient. For the detection of white matter changes (WMC), we used a third-generation CT scanner (GE CT HSA) evaluating a section of 7 mm at each interval of 8 mm.
Neurological examination showed that "reactional hypertonia" was observed in more than 90% of the patients, and that no patient showed normal reactive postural responses. Prior history of hypertension was noted in 49% of the patients, while a current antihypertensive treatment was taken by 13% of the patients. Orthostatic hypotension was observed in 44% of patients. Severe or moderate periventricular lucencies on CT scan were found in 67% of the patients, and severe ventricular enlargement in 50.5% of the patients.
We advance that PDS might be associated with WMC, and that hypotension might be an important etiologic factor of WMC in causing reduction of the cerebral blood flow in subcortical areas.
在之前的研究中，我们描述了一种在体弱老年人中典型观察到的临床症状，称为“精神运动适应不良综合征”（PDS），但我们从未研究过其病因数据。本研究的目的是完善该临床症状，记录心血管危险因素，并提供PDS患者的脑部CT扫描结果。
在第戎大学医院（法国勃艮第）和斯特拉斯堡大学医院（法国阿尔萨斯）的老年医学科招募了73例PDS患者；该组前瞻性纳入了所有根据以下标准表现出姿势和步态异常的住院患者：有向后跌倒的倾向以及以起步犹豫、步幅小和双支撑持续时间增加为特征的步态模式改变。收集了每位患者的一般特征、神经和心血管信息。为了检测白质变化（WMC），我们使用了第三代CT扫描仪（GE CT HSA），每隔8mm评估7mm的切片。
神经检查显示，超过90%的患者存在“反应性肌张力亢进”，且没有患者表现出正常的反应性姿势反应。49%的患者有高血压病史，而13%的患者正在接受抗高血压治疗。44%的患者观察到体位性低血压。CT扫描发现67%的患者有重度或中度脑室周围透亮区，50.5%的患者有重度脑室扩大。
我们提出PDS可能与WMC有关，低血压可能是WMC的一个重要病因，导致皮质下区域脑血流量减少。
