Hammerstrom D C, Zimmer B
J Am Geriatr Soc. 1985 Jun;33(6):397-400. doi: 10.1111/j.1532-5415.1985.tb07149.x.
In a retrospective study of 80 patients over 55 years old, the efficacy of lumbar puncture in evaluating elderly demented patients was examined. Despite a cost of $381 per procedure, in addition to cerebrospinal fluid (CSF) evaluation, no diagnosis was made on the basis of the information obtained in any of the patients (53 per cent) who underwent lumbar puncture. The only abnormalities found were 11 cases of nonspecific elevations in CSF protein and one case of abnormal cellularity not related to bacterial infection. An additional 422 cases of dementia from other series were reviewed, and only four patients were found whose diagnosis could have been made by lumbar puncture--one patient had neurosyphilis, and the other three were postencephalitic. In addition, the literature on complications of lumbar puncture was reviewed. There were no serious complications of lumbar puncture in the present study. The authors concluded that although it is low-risk, lumbar puncture cannot currently be recommended for routine use in the evaluation of elderly demented patients, but should be used in evaluating demented patients under 55 years of age, patients with rapid onset or progression of dementia, patients with syphilis serology in suspected cases of viral encephalitis, and patients with signs and symptoms of fungal meningitis.
在一项针对80名55岁以上患者的回顾性研究中，对腰椎穿刺在评估老年痴呆患者方面的疗效进行了检查。尽管每次操作成本为381美元，且除了脑脊液（CSF）评估外，在接受腰椎穿刺的任何患者（53%）中，根据所获得的信息均未做出诊断。唯一发现的异常情况是11例脑脊液蛋白非特异性升高以及1例与细菌感染无关的细胞异常。另外对其他系列的422例痴呆病例进行了回顾，仅发现4例患者的诊断可通过腰椎穿刺做出——1例患者患有神经梅毒，另外3例为脑炎后患者。此外，还对腰椎穿刺并发症的文献进行了回顾。在本研究中，腰椎穿刺未出现严重并发症。作者得出结论，尽管腰椎穿刺风险较低，但目前不建议将其常规用于评估老年痴呆患者，而应用于评估55岁以下的痴呆患者、痴呆起病或进展迅速的患者、疑似病毒性脑炎病例中梅毒血清学阳性的患者以及有真菌性脑膜炎体征和症状的患者。
