Piguet Olivier, Halliday Glenda M, Creasey Helen, Broe G Anthony, Kril Jillian J
Prince of Wales Medical Research Institute and University of New South Wales, Sydney, Australia.
Int Psychogeriatr. 2009 Aug;21(4):688-95. doi: 10.1017/S1041610209009454. Epub 2009 Jun 4.
The clinical presentations in dementia with Lewy bodies (DLB) and frontotemporal dementia (FTD) overlap considerably with that of Alzheimer's disease (AD) despite different pathological processes. Autopsy studies have also shown that multiple brain pathology occurs frequently, even in cases with a single clinical diagnosis. We aimed to determine the frequency of clinical diagnosis of FTD and DLB and the underlying pathology in a well-characterized cohort of patients with a clinical diagnosis of probable or possible AD.
We conducted a retrospective analysis of 170 AD patients (probable AD = 83; possible AD = 87) originally enrolled in a case-control study, 27 with postmortem examination, to establish the number of cases meeting probable diagnosis for FTD and DLB, using a checklist of features compiled from their consensus criteria.
23/83 probable AD cases and 32/87 possible AD cases met probable criteria for another dementia, more commonly DLB than FTD. AD pathology was present in 8/15 probable AD and 8/12 possible AD cases coming to autopsy. DLB pathology was seen in four cases and FTD pathology in eight cases. In the AD cases reaching clinical diagnosis for a second dementia syndrome and coming to autopsy, a minority showed non-AD pathology only.
Presence of core clinical features of non-AD dementia syndromes is common in AD. Concordance between clinical and pathological diagnoses of dementia remains variable. We propose that repeat clinical examinations and structural neuroimaging will improve diagnostic accuracy. In addition, clinical diagnostic criteria for the main dementia syndromes require refinement.
尽管路易体痴呆（DLB）和额颞叶痴呆（FTD）的病理过程不同，但其临床表现与阿尔茨海默病（AD）有相当大的重叠。尸检研究还表明，即使在临床诊断为单一疾病的病例中，多种脑病理改变也经常出现。我们旨在确定在一组临床诊断为可能或疑似AD的特征明确的患者队列中，FTD和DLB的临床诊断频率及其潜在病理情况。
我们对最初纳入一项病例对照研究的170例AD患者（可能AD = 83例；疑似AD = 87例）进行了回顾性分析，其中27例进行了尸检，使用根据其共识标准编制的特征清单来确定符合FTD和DLB可能诊断标准的病例数。
23/83例可能AD病例和32/87例疑似AD病例符合另一种痴呆的可能标准，更常见的是DLB而非FTD。在进行尸检的8/15例可能AD和8/12例疑似AD病例中存在AD病理改变。在4例中发现了DLB病理改变，8例中发现了FTD病理改变。在临床诊断为第二种痴呆综合征并进行尸检的AD病例中，少数病例仅显示非AD病理改变。
非AD痴呆综合征的核心临床特征在AD中很常见。痴呆的临床诊断与病理诊断之间的一致性仍然存在差异。我们建议重复临床检查和结构神经影像学检查将提高诊断准确性。此外，主要痴呆综合征的临床诊断标准需要完善。
