Del-Ser T, Munoz D G, Hachinski V
Seccion de Neurologia, Hospital Severo Ochoa, Madrid, Spain.
Neurology. 1996 Mar;46(3):682-6. doi: 10.1212/wnl.46.3.682.
Incontinence is a hallmark of dementia, but little is known about its inception in different types of dementing disease. We recorded the dates of onset of dementia and of urinary incontinence in 73 demented patients followed for 5.6 +/- 2.5 years. The pathologic diagnosis was Alzheimer's disease (AD) in 29 cases, diffuse Lewy body disease (DLBD) in 11 cases, AD with Lewy bodies (AD+LB) in 13 cases, and AD with vascular lesions (AD+VL) in 20 cases. The onset of urinary incontinence was significantly earlier in DLBD cases (3.2 +/- 1.4 years after dementia onset) than in AD (5.9 +/- 2.5), AD+LB (5.8 +/- 2.4), and AD+VL (6.5 +/- 2.3) (p < 0.01). At the onset of bladder incontinence, the mean score in the Extended Dementia Scale was significantly higher (i.e., cognition was better) in DLBD cases (109.3 +/- 70.8) than in AD (21.3 +/- 40.4), AD+LB (45.6 +/- 45.1), and AD+VL (39.2 +/- 54.9) cases (p < 0.01). Urinary incontinence is associated with severe cognitive decline in pure AD but usually precedes severe mental failure in DLBD cases. This temporal pattern of cognitive decline and incontinence could be useful in differentiating these two dementing illnesses.
尿失禁是痴呆症的一个标志，但对于其在不同类型痴呆疾病中的发病情况却知之甚少。我们记录了73例痴呆患者的痴呆发病日期和尿失禁发病日期，随访时间为5.6±2.5年。病理诊断为阿尔茨海默病（AD）29例，弥漫性路易体病（DLBD）11例，路易体痴呆（AD+LB）13例，伴有血管病变的阿尔茨海默病（AD+VL）20例。DLBD病例中尿失禁的发病明显早于AD（痴呆发病后5.9±2.5年）、AD+LB（5.8±2.4年）和AD+VL（6.5±2.3年）（p<0.01）。在膀胱失禁发病时，DLBD病例在扩展痴呆量表上的平均得分显著更高（即认知功能更好）（109.3±70.8），高于AD（21.3±40.4）、AD+LB（45.6±45.1）和AD+VL（39.2±54.9）病例（p<0.01）。在单纯AD中，尿失禁与严重认知衰退相关，但在DLBD病例中通常先于严重精神衰退出现。这种认知衰退和尿失禁的时间模式可能有助于区分这两种痴呆疾病。
