Davidson H A, Borrie M J, Crilly R G
Department of Psychology, Parkwood Hospital, London, Ontario.
J Am Geriatr Soc. 1991 May;39(5):467-71. doi: 10.1111/j.1532-5415.1991.tb02491.x.
The relationship between behavioral symptoms and cognitive impairment in Alzheimer's Disease (AD) is only poorly understood. The aim of the present study was to examine cognitive correlates of urinary incontinence in AD. Although incontinence is generally accepted as an accompaniment of AD, it was our clinical impression that it correlated poorly with global measures of cognitive impairment. A retrospective pilot study of 17 incontinent demented patients and 17 continent patients, matched for age, sex, and total score on the Folstein Mini-Mental Status Exam (MMSE), revealed a striking association between an inability to do a copy task and urinary incontinence. A prospective study confirmed this finding in a sample of 45 patients meeting DSMIII-R diagnostic criteria for dementia, probable Alzheimer's disease. The 17 incontinent patients did not differ from the 28 continent patients in age, sex distribution, or total score on the MMSE. However, the incontinent subjects scored significantly lower on a cube copying task. Qualitative analysis revealed that the drawings by incontinent patients showed features comparable with those observed in the drawings by patients with right-sided parietal lesions, in particular, poor representation of perspective and spatial orientation. Further investigation of the relationship between copying performance and incontinence may have implications for understanding the cortical mechanisms of urinary continence. The present results also underscore the limitations of the MMSE as a measure of dementia severity and suggest there are areas of cognitive ability which are inadequately assessed by MMSE but which may be of major important in understanding the loss of functional skills in the dementing patient.
阿尔茨海默病（AD）中行为症状与认知障碍之间的关系目前还了解甚少。本研究旨在探讨AD患者尿失禁的认知相关因素。虽然尿失禁通常被认为是AD的伴随症状，但我们的临床印象是，它与认知障碍的整体测量指标相关性较差。一项对17例失禁痴呆患者和17例非失禁患者的回顾性初步研究，这些患者在年龄、性别以及Folstein简易精神状态检查（MMSE）总分上相匹配，结果显示无法完成临摹任务与尿失禁之间存在显著关联。一项前瞻性研究在45例符合DSMIII-R痴呆诊断标准、可能为阿尔茨海默病的患者样本中证实了这一发现。17例失禁患者与28例非失禁患者在年龄、性别分布或MMSE总分上并无差异。然而，失禁受试者在立方体临摹任务中的得分显著更低。定性分析显示，失禁患者的绘图表现出与右侧顶叶病变患者绘图中观察到的特征相似，特别是在透视和空间定向方面表现不佳。对临摹表现与尿失禁之间关系的进一步研究可能有助于理解尿失禁的皮质机制。目前的结果还强调了MMSE作为痴呆严重程度测量指标的局限性，并表明存在一些认知能力领域，MMSE对其评估不足，但这些领域可能对理解痴呆患者功能技能丧失至关重要。
