Department of Psychiatry, Hospital de São João, Oporto, Portugal.
Psychiatry Res. 2010 Jun 30;182(3):287-8. doi: 10.1016/j.pscychresns.2010.04.009. Epub 2010 May 21.
The diagnosis of Alzheimer disease (AD) at an early age of onset may be a challenging task. The diagnosis of such a type of dementia may be even more difficult when concomitant depressive symptoms occur. We report the case of a 51-year-old woman who was admitted at a Psychiatric Day Hospital presenting with depressive symptoms, visuospatial deficits, apraxia, and minor memory loss. The patient underwent long-term antidepressant therapy, but despite the improvement of depressive symptoms, there was progressive cognitive deterioration. Otherwise, the prior clinical history was unremarkable, and there was no family history of dementia. The clinical examination revealed cognitive deficits in several domains. The patient scored 12 in the Mini-Mental State Examination. Routine laboratory tests were normal. Magnetic resonance (MR) imaging showed global brain volume loss more pronounced than would be expected for someone of the patient's age, especially in the precuneus-a pattern of posterior cortical atrophy consistent with the diagnosis of early-onset AD. Images obtained with 99mTc-HMPAO single-photon emission computed tomography (SPECT) also revealed marked brain hypoperfusion involving the left parietal lobe, far beyond the regions of brain volume loss. This clinical case report illustrates the relative contribution of both MR imaging and SPECT for the diagnosis of dementia in a patient with concomitant depressive symptoms. Apart from contributing to the diagnosis of dementia beyond the traditional exclusionary approach, neuroimaging is increasingly being used to classify its particular subtypes. The role of neuroimaging role in AD is also supported by a recent proposal of revised diagnostic criteria, which take into account abnormal biomarkers of disease.
阿尔茨海默病（AD）的早期诊断可能是一项具有挑战性的任务。当同时出现抑郁症状时，这种类型的痴呆症的诊断可能更加困难。我们报告了一例 51 岁女性的病例，她因抑郁症状、视空间缺陷、失用症和轻微记忆丧失而被收入精神病日间医院。该患者接受了长期的抗抑郁治疗，但尽管抑郁症状有所改善，但认知功能仍逐渐恶化。此外，患者的既往临床病史无明显异常，也没有痴呆症家族史。临床检查显示患者在多个认知领域存在缺陷。她在简易精神状态检查中得分为 12 分。常规实验室检查正常。磁共振成像（MR）显示大脑总体积丢失，比患者年龄预期的更为明显，特别是在后扣带回，这是一种与早发性 AD 诊断相符的皮质后部萎缩模式。使用 99mTc-HMPAO 单光子发射计算机断层扫描（SPECT）获得的图像也显示了明显的大脑低灌注，涉及左侧顶叶，远远超出了大脑体积丢失的区域。本病例报告说明了 MR 成像和 SPECT 对伴有抑郁症状的痴呆患者的诊断的相对贡献。除了通过传统的排除方法有助于诊断痴呆症之外，神经影像学也越来越多地用于对其特定亚型进行分类。AD 的神经影像学作用也得到了最近提出的修订诊断标准的支持，该标准考虑了疾病的异常生物标志物。
