Ota Kazumi, Iseki Eizo, Murayama Norio, Chiba Yuhei, Fujishiro Hiroshige, Kasanuki Koji, Manabe Yuta, Arai Heii, Sato Kiyoshi
PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan.
Psychogeriatrics. 2014 Mar;14(1):72-80. doi: 10.1111/psyg.12039. Epub 2014 Feb 16.
We report three presenile patients who were initially suspected of having Alzheimer's disease (AD) or being in the prodromal stage of AD, regardless of visuoperceptual dysfunctions in daily living, because they lacked the core features and prodromal non-motor symptoms of dementia with Lewy bodies. Subsequently, progression to dementia with Lewy bodies was suspected based on neuropsychological and neuroimaging findings; additionally, one of the three patients suffered from visual hallucinations. Neuropsychological examinations such as subjective contours, cube copying and block design in the Wechsler Adult Intelligence Scale-III revealed visuoperceptual dysfunction in all three patients even when other cognitive functions were rather preserved. Brain magnetic resonance imaging revealed no significant brain atrophy, including in the parieto-occipital area and the hippocampus, while brain (18)F-fluorodeoxyglucose positron emission tomography demonstrated right dominant metabolic reductions in the occipital lobe, including the primary visual cortex, in all three patients. We suggest the possibility of progression to dementia with Lewy bodies, but not AD or posterior cortical atrophy. Regardless of the presence of core features and prodromal non-motor symptoms, this progression is suggested when there are difficulties only in higher-level visual processing such as subjective contours and block design in the Wechsler Adult Intelligence Scale-III, no significant atrophy of the parieto-occipital area and hippocampus on brain magnetic resonance imaging, and hypometabolism in the occipital lobe including the primary visual cortex on brain (18)F-fluorodeoxyglucose positron emission tomography.
我们报告了三名早老患者，他们最初被怀疑患有阿尔茨海默病（AD）或处于AD的前驱期，尽管日常生活中存在视觉感知功能障碍，但由于他们缺乏路易体痴呆的核心特征和前驱非运动症状。随后，根据神经心理学和神经影像学检查结果，怀疑他们进展为路易体痴呆；此外，三名患者中有一名出现了视幻觉。韦氏成人智力量表第三版中的主观轮廓、立方体临摹和积木图案等神经心理学检查显示，即使其他认知功能相对保留，这三名患者均存在视觉感知功能障碍。脑磁共振成像显示，包括顶枕叶区域和海马体在内，脑实质无明显萎缩，而脑（18）F-氟脱氧葡萄糖正电子发射断层扫描显示，所有三名患者枕叶（包括初级视觉皮层）右侧代谢均有降低。我们认为存在进展为路易体痴呆的可能性，而非AD或后部皮质萎缩。无论是否存在核心特征和前驱非运动症状，当仅在韦氏成人智力量表第三版中的高级视觉处理（如主观轮廓和积木图案）方面存在困难、脑磁共振成像显示顶枕叶区域和海马体无明显萎缩、脑（18）F-氟脱氧葡萄糖正电子发射断层扫描显示枕叶（包括初级视觉皮层）代谢减低时，提示有这种进展情况。
