Kondo N
Department of Psychiatry, Hamamatsu University School of Medicine.
Seishin Shinkeigaku Zasshi. 1995;97(10):825-46.
In this study, clinical diagnosis and results of neuropathological examination were analyzed on 55 demented patients serially autopsied in a geriatric hospital. Based on clinical observations including Hachinski's ischemic score and CT scan, 30 cases were diagnosed as vascular dementia (VD), 16 cases as Alzheimer-type dementia (ATD), 6 as mixed-type dementia (MD), and 5 as other types of dementias. On the results of neuropathological examination, 25 cases were diagnosed as ATD, 19 cases as VD, 5 as diffuse Lewy body disease (DLBD), 4 as MD, and 2 as other types of dementias. The accuracy of the clinical diagnosis for ATD was 78.6%, and that for VD was 53.3%. Thus, misdiagnosis was more frequent on VD. Clinically, VD cases were rarely misdiagnosed as ATD, while ATD or MD cases were more frequently misdiagnosed as VD. Therefore, it is suggested that VD is overdiagnosed. One of the reasons is that risk factors of cerebrovascular disorders increase and Hachinski's ischemic score also becomes higher with the age of the patients. ATD is clinically diagnosed only after excluding other dementing illnesses. More detailed analysis of clinical features including cognitive function and brain images is required for more accurate clinical diagnosis of age-related dementing illnesses. Also in our series, DLBD was the second most frequent degenerative dementia following ATD, although all DLBD cases were clinically misdiagnosed as ATD or VD.
在本研究中，对一家老年医院连续尸检的55例痴呆患者的临床诊断和神经病理学检查结果进行了分析。根据包括哈金斯基缺血评分和CT扫描在内的临床观察，30例被诊断为血管性痴呆（VD），16例为阿尔茨海默型痴呆（ATD），6例为混合型痴呆（MD），5例为其他类型痴呆。根据神经病理学检查结果，25例被诊断为ATD，19例为VD，5例为弥漫性路易体病（DLBD），4例为MD，2例为其他类型痴呆。ATD临床诊断的准确率为78.6%，VD为53.3%。因此，VD的误诊更为常见。临床上，VD病例很少被误诊为ATD，而ATD或MD病例更常被误诊为VD。因此，提示VD存在过度诊断。原因之一是脑血管疾病的危险因素随着患者年龄的增加而增加，哈金斯基缺血评分也会升高。ATD只有在排除其他痴呆性疾病后才能进行临床诊断。为了更准确地临床诊断与年龄相关的痴呆性疾病，需要对包括认知功能和脑图像在内的临床特征进行更详细的分析。在我们的系列研究中，DLBD是仅次于ATD的第二常见的退行性痴呆，尽管所有DLBD病例在临床上都被误诊为ATD或VD。
