Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
Alzheimers Res Ther. 2018 Mar 1;10(1):27. doi: 10.1186/s13195-018-0356-0.
Dementia due to Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are the two most common neurodegenerative causes of dementia. They commonly occur together, especially in older people, but clinical identification of these diseases in dementia is difficult in such circumstances. We therefore conducted a study using cases with both comprehensive prospective clinical assessments and complete neuropathological examination to determine if it is possible to identify such mixed cases clinically and to determine features which may identify DLB in the presence of AD dementia.
At Newcastle Brain Bank we identified subjects who had a clinical diagnosis of dementia and who also had autopsy diagnoses of pure AD, pure DLB, or mixed AD+DLB. All subjects had undergone prospective longitudinal clinical assessments. Mixed AD+DLB patients met neuropathological criteria for both DLB (limbic/neocortical Lewy body disease) and AD (Braak stage V/VI and CERAD B/C). The records of these subjects were carefully reviewed by two specialists in old-age psychiatry blind to autopsy findings to determine baseline and final clinical diagnoses based on these detailed records. The presence of characteristic Lewy body symptoms and other clinical information was also recorded.
Of 59 subjects included, 19 were AD, 18 DLB, and 22 mixed AD+DLB. At baseline no subjects were correctly identified as having mixed AD+DLB and by final diagnosis only 23% were identified. The only symptom which helped in identifying the presence of Lewy body disease in the context of a mixed AD+DLB dementia was complex visual hallucinations.
Whilst the identification of DLB in the context of a dementia with an AD pattern is difficult, the emergence of complex visual hallucinations in the context of such a degenerative dementia suggests the presence of Lewy body disease and should encourage a careful assessment. Biomarkers appear likely to be necessary to help improve identification of different disease subtypes underlying dementia.
阿尔茨海默病（AD）引起的痴呆和路易体痴呆（DLB）是两种最常见的神经退行性痴呆病因。它们通常同时发生，尤其是在老年人中，但在这种情况下，痴呆症的这些疾病的临床识别是困难的。因此，我们进行了一项研究，使用既有全面前瞻性临床评估又有完整神经病理学检查的病例，以确定是否有可能在临床上识别此类混合病例，并确定在 AD 痴呆存在的情况下可能识别出 DLB 的特征。
在纽卡斯尔脑库，我们确定了有痴呆临床诊断且尸检诊断为单纯 AD、单纯 DLB 或 AD+DLB 混合的受试者。所有受试者均接受了前瞻性纵向临床评估。混合 AD+DLB 患者符合 DLB（边缘/新皮质路易体病）和 AD（Braak 阶段 V/VI 和 CERAD B/C）的神经病理学标准。两位老年精神病学专家在不了解尸检结果的情况下仔细审查了这些受试者的记录，根据这些详细记录确定基线和最终临床诊断。还记录了特征性路易体症状和其他临床信息。
在 59 名受试者中，19 名患有 AD，18 名患有 DLB，22 名患有 AD+DLB 混合。在基线时，没有受试者被正确识别为患有 AD+DLB 混合，只有 23%的受试者通过最终诊断被识别。唯一有助于在 AD+DLB 痴呆背景下识别路易体病存在的症状是复杂的视觉幻觉。
虽然在 AD 模式痴呆的背景下识别 DLB 是困难的，但在这种退行性痴呆的背景下出现复杂的视觉幻觉表明存在路易体病，并应鼓励进行仔细评估。生物标志物似乎有助于提高对痴呆症下不同疾病亚型的识别。
