McKeith I G, Perry R H, Fairbairn A F, Jabeen S, Perry E K
University Department of Old Age Psychiatry, Brighton Clinic, Newcastle General Hospital, Newcastle-upon-Tyne.
Psychol Med. 1992 Nov;22(4):911-22. doi: 10.1017/s0033291700038484.
Recent reports have suggested that brain stem and cortical Lewy body formation may identify a neurodegenerative disorder in elderly demented individuals which accounts for up to 20% of cases of senile dementia coming to autopsy. Retrospective analysis of case notes of 21 autopsy patients with neuropathologically proven senile dementia of Lewy body type (SDLT) and 37 cases with neuropathologically proven Alzheimer's disease (AD) identified a characteristic clinical syndrome in SDLT. Fluctuating cognitive impairment; psychotic features including visual and auditory hallucinations, and paranoid delusions; depressive symptoms; falling and unexplained losses of consciousness were all seen significantly more often than in AD. Over half of the SDLT patients in this series who were given neuroleptics in standard dose showed acute and often irreversible adverse reactions indicative of a neuroleptic sensitivity syndrome. The survival time of drug treated patients was reduced by 50%. Operational criteria to aid in the clinical distinction between SDLT and AD patients are proposed and hypotheses regarding possible aetiology and treatment discussed.
最近的报告表明，脑干和皮质路易体的形成可能确定了老年痴呆患者中的一种神经退行性疾病，在接受尸检的老年痴呆病例中，这种疾病占比高达20%。对21例经神经病理学证实为路易体型老年痴呆（SDLT）的尸检患者以及37例经神经病理学证实为阿尔茨海默病（AD）的病例记录进行回顾性分析，确定了SDLT的一种特征性临床综合征。与AD相比，认知功能波动障碍、包括视幻觉和听幻觉以及偏执妄想在内的精神病性特征、抑郁症状、跌倒和不明原因的意识丧失在SDLT中出现的频率明显更高。在该系列中，超过一半接受标准剂量抗精神病药物治疗的SDLT患者出现了急性且往往不可逆的不良反应，提示存在抗精神病药物敏感综合征。药物治疗患者的生存时间缩短了50%。本文提出了有助于临床区分SDLT和AD患者的操作标准，并讨论了关于可能病因和治疗的假设。
