Bradshaw J, Saling M, Hopwood M, Anderson V, Brodtmann A
Austin Health, Heidelberg, Australia.
J Neurol Neurosurg Psychiatry. 2004 Mar;75(3):382-7. doi: 10.1136/jnnp.2002.002576.
To document and illustrate qualitative features of fluctuating cognition as described by care givers of patients with probable dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). To determine whether the quality of the fluctuations differs between DLB and AD. To examine the clinical utility of two recently developed rating scales.
Care givers of 13 patients with early probable DLB and 12 patients with early probable AD were interviewed using the Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale, both developed recently. Descriptions of fluctuating cognition were recorded verbatim, analysed, and rated.
Descriptions of fluctuating cognition in DLB had a spontaneous, periodic, transient quality, which appeared to reflect an interruption in the ongoing flow of awareness or attention that impacted on functional abilities. Descriptions of fluctuations in AD frequently highlighted episodes of memory failure, or a more enduring state shift in the form of "good" and "bad" days, typically occurring in response to the cognitive demands of the immediate environment. These qualitative differences could be detected reliably by independent raters, but were not always captured in standard severity scores.
Fluctuations occurring in DLB have particular characteristics that are distinguishable from fluctuations occurring in AD. Interpretation and application of the fluctuation criterion continues to limit the diagnostic sensitivity of the consensus criteria for DLB. Findings suggest that explicit documentation and a wider appreciation of these distinctions could improve the reliability with which less experienced clinicians identify this core diagnostic feature in the clinical setting.
记录并阐述路易体痴呆（DLB）和阿尔茨海默病（AD）可能患者的照护者所描述的认知波动的定性特征。确定DLB和AD中波动的性质是否存在差异。检验两种最近开发的评定量表的临床实用性。
使用最近开发的临床医生波动评估量表和一日波动评估量表，对13例早期可能患有DLB的患者和12例早期可能患有AD的患者的照护者进行访谈。逐字记录、分析并评定认知波动的描述。
DLB中认知波动的描述具有自发、周期性、短暂的性质，这似乎反映了持续的意识或注意力流的中断，从而影响功能能力。AD中波动的描述经常突出记忆丧失发作，或以“好”和“坏”天的形式出现的更持久的状态转变，通常是对即时环境认知需求的反应。这些定性差异可以由独立评定者可靠地检测到，但在标准严重程度评分中并不总是能体现出来。
DLB中出现的波动具有与AD中出现的波动不同的特定特征。波动标准的解释和应用继续限制了DLB共识标准的诊断敏感性。研究结果表明，明确记录并更广泛地认识这些差异，可以提高经验不足的临床医生在临床环境中识别这一核心诊断特征的可靠性。
