早发性与晚发性阿尔茨海默病神经心理损害特征的比较研究  

Comparison of Neuropsychological Impairment between Patients with Early-onset and Late-onset Alzheimer’s Disease

作　　者：温咪咪 刘茂 张晓凡 刘鑫 张旻 WEN Mi-mi;LIU Mao;ZHANG Xiao-fan;LIU Xin;ZHANG Min(Department of Neurology,Tongji Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Special Service Recuperation,Strategic Support Force Medical Center,China Academy of Chinese Medical Sciences,Beijing 100101,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430030 [2]中国人民解放军战略支援部队特色医学中心特勤诊疗三科,北京100101

出　　处：《神经损伤与功能重建》2021年第3期130-134,共5页Neural Injury and Functional Reconstruction

基　　金：科技部政府间国际科技创新合作重点专项(No.2018YFE0118900)。

摘　　要：目的:比较早发性与晚发性阿尔茨海默病(AD)患者神经心理学损害特征的差异。方法:收集2018年10月至2020年10月于武汉同济医院神经内科门诊就诊的诊断为很可能的AD患者137例,其中发病年龄<65岁的早发性AD(EOAD组)65例,发病年龄>65岁的晚发性AD(LOAD组)72例,对患者进行简易智能精神状态检查量表(MMSE)、画钟测验(CDT)、波士顿命名测验(BNT-30)、日常生活能力评定量表(ADL)、神经精神量表(NPI)的评估,对2组患者的基本信息及神经心理学评分进行统计学分析。结果:EOAD组的MMSE分数显著低于LOAD组(P=0.009);2组的CDT、BNT-30、ADL、NPI总分及照料者苦恼评分差异无统计学意义(P>0.05);NPI 12个分项分析可见EOAD组较LOAD组的抑郁及淡漠分数更高(P=0.030,P=0.035),且淡漠的发生率显著增加(52.31%v.s.33.33%,P=0.025)。EOAD患者的NPI总分与MMSE、CDT、BNT-30评分呈负相关,与ADL评分正相关;而LOAD患者的NPI总分仅与ADL评分正相关;EOAD患者与LOAD患者的照料者苦恼评分均与NPI总分正相关。结论:EOAD和LOAD患者在神经心理损害方面具有不同特点,EOAD患者的认知损害程度、抑郁和淡漠症状均较LOAD更严重。Objective:To compare the neuropsychological impairment between patients with early-onset and late-onset Alzheimer’s disease(AD).Methods:Total 137 patients diagnosed with probable AD in the department of Neurology of Tongji Hospital were recruited from October 2018 to October 2020,including 65 cases with early-onset(onset age less than 65 years old)Alzheimer’s disease(EOAD group),and 72 cases with late-onset Alzheimer’s disease(LOAD group).A series of neuropsychological tests including Mini-Mental State Examination(MMSE),Clock Drawing Test(CDT),Boston Naming Test(BNT-30),Activity of Daily Living Scale(ADL),and Neuropsychiatric Inventory(NPI)were performed for all patients.Demographic and neuropsychological data were compared between these two groups of patients.Results:MMSE score of the EOAD group were significantly lower than that of the LOAD group(P=0.009).CDT,BNT-30,ADL,total NPI,and caregiver distress scores showed no significant differences between the two groups.The sub-scores of depression and apathy of the EOAD group were higher than those of the LOAD group(P=0.030,P=0.035),while apathy was significantly more common in the EOAD group than the LOAD group(52.31%v.s.33.33%,P=0.025).The total NPI score of the EOAD group was negatively correlated with MMSE,CDT,and BNT-30 scores,and was positively correlated with ADL score,while that of the LOAD patients was only positively correlated with ADL score.Caregiver distress score was positively correlated with NPI total scores in both groups.Conclusion:Patterns of neuropsychological impairment were different between the EOAD and the LOAD patients with higher degrees of cognitive decline,depression,and apathy in the EOAD patients.

关 键 词：早发性阿尔茨海默病 晚发性阿尔茨海默病 神经心理评估 精神行为症状 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.04[医药卫生—临床医学]