Neurologie, Universitätsklinikum Ulm, Ulm, Germany.
J Neural Transm (Vienna). 2010 Mar;117(3):353-67. doi: 10.1007/s00702-010-0370-2. Epub 2010 Jan 30.
Older adults suffering from Parkinson's disease (PD) frequently present with an additional form of severe neurodegenerative and/or vascular pathology. Findings of differential clinical manifestations of cognitive impairment, depending on presence and nature of such coexisting brain pathology, raise the question for neuropsychological procedures that are capable not only of distinguishing between non-demented PD patients and patients with Parkinson-associated dementia (PDD), but also of detecting other types of cognitive decline, most likely Alzheimer's disease (AD) or vascular dementia (VD), superimposing PD. The aim of this article is to review the literature on neuropsychological processes at risk in developing PDD, to introduce comorbid causes of cognitive decline in the presence of PD, to discuss the scope of the "cortical versus subcortical dementia"-concept in view of its capability of differentiating dementias, and to scrutinize existing diagnostic criteria concerning the toleration of comorbidity. Additionally, we derive an evidence-based neuropsychological diagnostic procedure for assessing PDD under special consideration of these comorbid aspects.
患有帕金森病 (PD) 的老年人经常出现另一种严重的神经退行性和/或血管病理学形式。根据这种共存的脑病理学的存在和性质，认知障碍的临床表现存在差异的发现提出了神经心理学程序的问题，这些程序不仅能够区分非痴呆型 PD 患者和与帕金森病相关的痴呆症 (PDD) 患者，而且还能够检测其他类型的认知能力下降，很可能是阿尔茨海默病 (AD) 或血管性痴呆症 (VD)，叠加 PD。本文的目的是回顾有关发展为 PDD 的神经心理过程的文献，介绍 PD 存在时认知能力下降的合并症原因，讨论“皮质与皮质下痴呆”概念的范围，鉴于其区分痴呆症的能力，并仔细审查关于合并症耐受性的现有诊断标准。此外，我们根据这些合并症方面的特殊考虑，制定了一种基于证据的神经心理学诊断程序来评估 PDD。
