Erkinjuntti T
Department of Neurology, University of Helsinki, Finland.
Acta Neurol Scand. 1987 Dec;76(6):433-42. doi: 10.1111/j.1600-0404.1987.tb03599.x.
A prospective series of consecutively admitted demented patients were examined in order to evaluate the role of common clinical methods in the differential diagnosis between Alzheimer's disease (AD) and vascular dementia. Patients fulfilling the DSM-III criteria for vascular dementia were divided into multi-infarct dementia (MID) and probable vascular dementia (PVD), the latter including also cases with combined vascular and degenerative dementia. The series consisted of 68 patients with AD, 79 with MID and 46 with PVD. These groups did not differ in regard to sex, age or degree of dementia. Absence of cardio- and cerebrovascular diseases differentiated AD from MID and PVD. Also absence of corticospinal tract signs and gait disorders differentiated AD from MID and PVD and that of bulbar signs AD from MID. Infarcts and white matter low attenuation on CT differentiated MID and PVD from AD. Altogether 88.6% of the MID patients and 41.3% with PVD had brain infarct on CT, but only one with AD. Ischemic scores seemed also to be useful in the differential diagnosis between AD and vascular dementia. Quantitative neuropsychology, EEG, routine cerebrospinal fluid and other laboratory investigations, including serum glucose and plasma lipids, seem to be less valuable.
为评估常用临床方法在阿尔茨海默病（AD）与血管性痴呆鉴别诊断中的作用，对一系列连续收治的痴呆患者进行了前瞻性研究。符合DSM-III血管性痴呆标准的患者被分为多发梗死性痴呆（MID）和可能的血管性痴呆（PVD），后者还包括血管性和退行性痴呆合并的病例。该系列研究包括68例AD患者、79例MID患者和46例PVD患者。这些组在性别、年龄或痴呆程度方面无差异。无心血管和脑血管疾病可将AD与MID及PVD区分开来。无皮质脊髓束征和步态障碍也可将AD与MID及PVD区分开来，而无延髓征可将AD与MID区分开来。CT上的梗死灶和白质低密度可将MID和PVD与AD区分开来。共有88.6%的MID患者和41.3%的PVD患者在CT上有脑梗死，但AD患者仅有1例。缺血评分似乎在AD与血管性痴呆的鉴别诊断中也有用。定量神经心理学、脑电图、常规脑脊液及其他实验室检查，包括血糖和血脂检查，似乎价值较小。
