Gottfries C G, Balldin J, Blennow K, Bråne G, Karlsson I, Regland B, Wallin A
Department of Psychiatry and Neurochemistry, University of Gothenburg, Mölndal Hospital, Mölndal, Sweden.
J Neural Transm Suppl. 1994;43:203-9.
In 40 patients with Alzheimer's disease (AD) 56 patients with senile dementia of Alzheimer type (SDAT) and 45 patients with vascular dementia (VAD) degree of dementia was rated into mild, moderate and severe according to DSM-III-R and on the GBS scale. Basal cortisol levels were determined and a dexamethasone test (DST) performed. Basal cortisol levels were high in all the dementia groups. Forty percent of AD patients, 54% of SDAT patients and 49% of VAD patients were non suppressors. Significant correlations between post DST cortisol levels and rated variables were seen mainly in the VAD group. The pathological DST could hardly be explained by presence of depression. In dementia, especially those with white matter disturbances, disconnections between cortical areas (hippocampus) and hypothalamus can be assumed explaining a reduced inhibitory tone on hypothalamus. When characterizing VAD patients with pathological DST these patients were significantly more intellectually impaired, showed higher degree of anxiety, restlessness and fear-panic than VAD patients with normal DST. Some behaviourial disturbances in dementia disorders may be a consequence of HPA over activity rather than a consequence of the dementia process itself.
对40例阿尔茨海默病（AD）患者、56例阿尔茨海默型老年痴呆症（SDAT）患者和45例血管性痴呆（VAD）患者，根据《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）并采用GBS量表将痴呆程度分为轻度、中度和重度。测定基础皮质醇水平并进行地塞米松试验（DST）。所有痴呆组的基础皮质醇水平均较高。40%的AD患者、54%的SDAT患者和49%的VAD患者为非抑制者。DST后皮质醇水平与评定变量之间的显著相关性主要见于VAD组。病理性DST几乎不能用抑郁症的存在来解释。在痴呆症中，尤其是那些有白质障碍的患者，可以假定皮质区域（海马体）与下丘脑之间的联系中断，这解释了对下丘脑抑制性张力的降低。当对病理性DST的VAD患者进行特征描述时，这些患者在智力上明显受损，表现出比DST正常的VAD患者更高程度的焦虑、不安和恐惧-惊恐。痴呆症中的一些行为障碍可能是下丘脑-垂体-肾上腺（HPA）过度活动的结果，而不是痴呆过程本身的结果。
