Maiovis Pantelis, Ioannidis Panagiotis, Konstantinopoulou Elina, Karacostas Dimitris
B' Department of Neurology, AHEPA University Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece,
Acta Neurol Belg. 2015 Mar;115(1):27-31. doi: 10.1007/s13760-014-0310-2. Epub 2014 May 31.
Early onset dementia (EOD) is a major diagnostic challenge as it often presents with atypical features and may be attributed to treatable diseases. Primary degenerative dementias (Alzheimer's disease-AD, frontotemporal lobar degeneration-FTLD, Lewy body dementia-LBD), although traditionally considered to affect older people, are still a main cause of EOD. 491 demented patients were assessed from January 1, 2003 to December 31, 2010 in the Neurology Department of a tertiary referral center. Patients were classified as AD, behavioral variant frontotemporal dementia (bvFTD), non-fluent agrammatic variant primary progressive aphasia (naPPA), semantic variant PPA (svPPA), corticobasal degeneration (CBD), or progressive supranuclear palsy (PSP) who also met criteria for naPPA and LBD. Finally, their demographic characteristics were analysed, according to age at onset (EOD <65 years, late onset dementia-LOD ≥65 years). From the 491 patients, 137 (27.9 %) were EOD. In the EOD group, 52 (38 %) were diagnosed with bvFTD, 34 (24.8 %) with AD, 27 (19.7 %) with naPPA, 10 (7.2 %) with svPPA, 12 (8.8 %) with CBD or PSP, and 2 (1.5 %) with LBD. Demographic characteristics did not differ significantly among diagnostic categories in the EOD group, while in the LOD group FTLD patients were younger and more frequently men compared to both AD and LBD patients. EOD patients had more years of education than LOD patients. Degenerative disorders as causes of EOD are not rare. High clinical alertness is warranted to achieve correct and timely diagnosis.
早发性痴呆(EOD)是一项重大的诊断挑战,因为它常常表现出非典型特征,且可能由可治疗的疾病引起。原发性退行性痴呆(阿尔茨海默病 - AD、额颞叶变性 - FTLD、路易体痴呆 - LBD),尽管传统上认为其影响老年人,但仍是早发性痴呆的主要病因。2003年1月1日至2010年12月31日期间,在一家三级转诊中心的神经科对491例痴呆患者进行了评估。患者被分类为AD、行为变异型额颞叶痴呆(bvFTD)、非流利性语法缺失变异型原发性进行性失语(naPPA)、语义变异型PPA(svPPA)、皮质基底节变性(CBD)或进行性核上性麻痹(PSP),后者也符合naPPA和LBD的标准。最后,根据发病年龄(早发性痴呆<65岁,晚发性痴呆 - LOD≥65岁)分析了他们的人口统计学特征。在这491例患者中,137例(27.9%)为早发性痴呆。在早发性痴呆组中,52例(38%)被诊断为bvFTD,34例(24.8%)为AD,27例(19.7%)为naPPA,10例(7.2%)为svPPA,12例(8.8%)为CBD或PSP,2例(1.5%)为LBD。早发性痴呆组各诊断类别之间的人口统计学特征无显著差异,而在晚发性痴呆组中,与AD和LBD患者相比,FTLD患者更年轻且男性更常见。早发性痴呆患者的受教育年限比晚发性痴呆患者更多。作为早发性痴呆病因的退行性疾病并不罕见。需要高度的临床警惕性以实现正确和及时的诊断。