Ballard C G, Aarsland D, McKeith I, O'Brien J, Gray A, Cormack F, Burn D, Cassidy T, Starfeldt R, Larsen J-P, Brown R, Tovee M
Institute for Ageing and Health, University of Newcastle, UK.
Neurology. 2002 Dec 10;59(11):1714-20. doi: 10.1212/01.wnl.0000036908.39696.fd.
Marked impairments in and fluctuation of attention are characteristic of dementia with Lewy bodies (DLB). The comparative impairment of these cognitive domains in PD and PD dementia (PD dementia) has not been studied, and is important to the conceptual understanding of parkinsonian dementias.
Detailed evaluations of attention and fluctuating attention (Cognitive Drug Research computerized battery) were undertaken in 278 subjects (50 DLB, 48 PD dementia, 50 PD, 80 AD, 50 elderly controls) from the Newcastle dementia register and the Stavanger PD register (controls, PD, and PD dementia patients were recruited from both centers). DLB, AD, PD, and PD dementia were diagnosed using operationalized criteria.
Impairments in reaction time, vigilance, and fluctuating attention were comparable in patients with DLB and PD dementia, but were less substantially impaired in patients with DLB without parkinsonism. Patients with PD had significantly greater impairment of cognitive reaction time than elderly controls, and comparable impairments of cognitive reaction time to patients with AD. Patients with PD, however, did not exhibit fluctuation of attention.
The profile of attentional impairments and fluctuating attention is similar in PD dementia and DLB with parkinsonism. The current findings do not support the current arbitrary distinctions between these patient groups. Importantly, patients with PD do not experience fluctuating attention.
注意力显著受损及波动是路易体痴呆（DLB）的特征。帕金森病（PD）及帕金森病痴呆（PDD）在这些认知领域的相对损害尚未得到研究，而这对于帕金森病痴呆的概念理解很重要。
对来自纽卡斯尔痴呆登记册和斯塔万格PD登记册的278名受试者（50名DLB、48名PDD、50名PD、80名阿尔茨海默病（AD）、50名老年对照）进行了注意力和注意力波动（认知药物研究计算机化测试组）的详细评估（对照、PD和PDD患者从两个中心招募）。使用操作性标准对DLB、AD、PD和PDD进行诊断。
DLB和PDD患者在反应时间、警觉性和注意力波动方面的损害相当，但无帕金森综合征的DLB患者的损害程度较轻。PD患者的认知反应时间损害明显大于老年对照，且与AD患者的认知反应时间损害相当。然而，PD患者没有表现出注意力波动。
PDD和伴有帕金森综合征的DLB在注意力损害和注意力波动方面的表现相似。目前的研究结果不支持目前这些患者群体之间的任意区分。重要的是，PD患者不会出现注意力波动。
