Nägga Katarina, Rådberg Claes, Marcusson Jan
Department of Geriatric Medicine, Linköping University Hospital, Linköping, Sweden.
Dement Geriatr Cogn Disord. 2004;18(1):59-66. doi: 10.1159/000077737. Epub 2004 Apr 6.
Dementia has been found to display a more heterogeneous clinical picture than previously recognized. We investigated brain changes on computed tomography (CT) in a clinical dementia population consisting of 67 cases with Alzheimer's disease (AD), 13 with mixed dementia (AD and vascular dementia, VaD), 71 with VaD, and 12 cases that were not demented. Temporal cortical atrophy and atrophy around the temporal horns were more common in patients with mixed dementia compared to patients with VaD and the non-demented, respectively. Frontal white matter changes were present in 64% of AD, in 85% of mixed dementia and in 79% of VaD cases, but there were no differences between the dementia groups. Lacunes were present in almost 40% of AD cases and in 80 and 85% of VaD and mixed dementia cases, respectively. Only 14% of the VaD cases had large infarcts on the CT. We conclude that large infarcts were rare, even in VaD cases. The increased incidence of white matter changes and lacunes in AD patients strongly indicates an underestimation of the mixed dementia diagnosis. More distinct criteria for this diagnostic category are warranted.
现已发现，痴呆症的临床表现比之前所认识到的更为多样。我们对一组临床痴呆症患者的脑部计算机断层扫描（CT）变化进行了研究，该组患者包括67例阿尔茨海默病（AD）患者、13例混合性痴呆（AD与血管性痴呆，VaD）患者、71例VaD患者以及12例非痴呆患者。与VaD患者和非痴呆患者相比，混合性痴呆患者的颞叶皮质萎缩以及颞角周围萎缩更为常见。额叶白质改变在64%的AD患者、85%的混合性痴呆患者以及79%的VaD患者中出现，但各痴呆症组之间并无差异。腔隙性梗死在近40%的AD患者中出现，在80%的VaD患者和85%的混合性痴呆患者中出现。CT显示，仅14%的VaD患者有大面积梗死灶。我们得出结论，即使在VaD患者中，大面积梗死灶也很罕见。AD患者白质改变和腔隙性梗死发生率的增加强烈表明，混合性痴呆的诊断被低估了。对此诊断类别需要更明确的标准。
