Weiner M F, Risser R C, Cullum C M, Honig L, White C, Speciale S, Rosenberg R N
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas 75235-9070, USA.
Am J Psychiatry. 1996 Oct;153(10):1269-73. doi: 10.1176/ajp.153.10.1269.
The authors compared clinical findings of Alzheimer's disease and the so-called Lewy body variant of Alzheimer's disease.
Available data were analyzed on the clinical features of 58 patients with Alzheimer's disease and 24 patients with the Lewy body variant of Alzheimer's disease who underwent postmortem examination.
The proportion of men was significantly larger in the Lewy body variant group than in the Alzheimer's disease group (66.7% versus 34.5%), and, concordantly, the Lewy body variant group was slightly taller. The prevalence of hallucinations and delusions was significantly higher in Lewy body variant subjects than the Alzheimer's disease subjects, but there were no significant differences between the two groups in educational attainment, family history of dementia, age at onset, duration of illness, cognitive impairment, overall severity of illness, or neuropsychological findings. Patients with the Lewy body variant of Alzheimer's disease tended to experience more frequent extrapyramidal side effects of neuroleptics than did the patients with Alzheimer's disease, but for patients in the two groups who were not exposed to neuroleptics, there was little difference in frequency of extrapyramidal side effects. CSF concentration of homovanillic acid (HVA) was significantly lower in the Lewy body variant patients, even when correction was made for height.
The Lewy body variant of Alzheimer's disease may be suspected in elderly male dementia patients who otherwise meet criteria for Alzheimer's disease but who manifest significant psychiatric symptoms and neuroleptic-induced extrapy-ramidal side effects and have low levels of CSF HVA.
作者比较了阿尔茨海默病与所谓的阿尔茨海默病路易体变异型的临床发现。
分析了58例阿尔茨海默病患者和24例接受尸检的阿尔茨海默病路易体变异型患者的临床特征的现有数据。
路易体变异型组男性比例显著高于阿尔茨海默病组（66.7%对34.5%），相应地，路易体变异型组稍高一些。路易体变异型患者幻觉和妄想的患病率显著高于阿尔茨海默病患者，但两组在受教育程度、痴呆家族史、发病年龄、病程、认知障碍、疾病总体严重程度或神经心理学发现方面无显著差异。与阿尔茨海默病患者相比，阿尔茨海默病路易体变异型患者倾向于更频繁地出现抗精神病药物的锥体外系副作用，但对于两组未接触抗精神病药物的患者，锥体外系副作用的频率差异不大。即使校正身高后，路易体变异型患者脑脊液中高香草酸（HVA）浓度仍显著较低。
对于符合阿尔茨海默病标准但出现明显精神症状、抗精神病药物所致锥体外系副作用且脑脊液HVA水平低的老年男性痴呆患者，可能怀疑为阿尔茨海默病路易体变异型。
