离退休干部老年期痴呆临床和影像学特征及检查方式的回顾性研究  

Retrospective study on clinical and radiological characteristics and examinations of dementia in elderly retired cadres

作　　者：尚延昌[1] 韦超 解恒革[1] Shang Yanchang;Wei Chao;Xie Hengge(Department of Geriatric Neurology,Second Medical Center&National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心神经内科、国家老年疾病临床医学研究中心,北京100853

出　　处：《中华老年心脑血管病杂志》2025年第4期404-407,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家重点研发计划项目(2022YFC2009905)。

摘　　要：目的探讨老年期痴呆的主要临床表现和影像学特征及检查方式,为优化临床实践提供依据。方法收集2002年5月至2012年8月在解放军总医院老年神经内科住院和神经科认知障碍门诊就诊的患者275例(男性占92.7%),根据诊断结果将患者分为阿尔茨海默病(Alzheimer's disease,AD)组131例,血管性痴呆(vasular dementia,VD)组44例,轻度认知功能障碍(mild cognitive impairment,MCI)组20例,正常组36例,其他认知障碍(other cognitive impairment,OCI)组44例。通过电子病历检索,获取一般情况、痴呆及相关认知障碍诊断情况、重要共病、主要临床表现和影像学特征及检查方式。结果与正常组比较,AD组、VD组、MCI组和OCI组脑血管疾病(30.5%,100.0%,50.0%,22.7%vs 5.6%,P<0.05)和其他相关疾病发生率明显升高,差异有统计学意义(22.1%,27.3%,15.0%,45.5%vs 8.3%,P<0.05)。与正常组比较,OCI组精神行为、锥体外系及运动表现患病率明显升高,差异有统计学意义(P<0.05,P<0.01)。OCI组精神行为表现患病率明显高于AD组、VD组和MCI组,锥体外系、运动表现患病率明显高于AD组,差异有统计学意义(P<0.05,P<0.01)。AD组锥体外系表现患病率明显低于VD和MCI组,差异有统计学意义(P<0.05)。61例(22.2%)患者临床选择头颅CT检查,66例(24.0%)患者进行了磁敏感加权成像(susceptibility weighted imaging,SWI)检查。VD组SWI脑微出血阳性率明显高于AD组(64.3%vs 30.0%,P<0.05)。结论不同类型的老年期痴呆患者的主要临床表现和影像学特征及检查方式存在显著不同,本研究为基于临床需求的影像学检查方式选择和优化提供支持。Objective To explore the main clinical manifestations and radiological characteristics and examination methods of dementia in the elderly in order to provide a basis for optimizing clinical practice.Methods A retrospective study was conducted on 275 patients(92.7%male)who were hospitalized in the Department of Geriatric Neurology and attended the Cognitive Disorders Clinic of the Department of Neurology in Chinese PLA General Hospital from May 2002 to August 2012.According to the results of diagnosis,they were divided into AD group(131 cases),VD group(44 cases),mild cognitive impairment(MCI)group(20 cases),cognitively normal group(36 cases),and other cognitive impairment(OCI)group(44 cases).The general information,diagnoses of dementia and related cognitive disorder,main comorbidities,main clinical manifestations,and radiological characteristics and examination methods were obtained through electronic medical record retrieval.Results The prevalence of cerebrovascular diseases(30.5%,100.0%,50.0%,22.7%vs 5.6%,P<0.05)and other related diseases(22.1%,27.3%,15.0%,45.5%vs 8.3%,P<0.05)were significantly higher in the AD,VD,MCI and OCI groups than the cognitively normal group.The OCI group had more common psycho-behavioral manifestations and extrapyramidal and motor manifestations than the cognitively normal group(P<0.05,P<0.01).In the OCI group,the prevalence of psycho-behavioral manifestations was significantly higher than that of the AD,VD,and MCI groups,and the prevalence of extrapyramidal and motor manifestations was obviously higher than that of the AD group(P<0.05,P<0.01).The AD group had notably lower prevalence of extrapyramidal manifestations than the VD and MCI groups(P<0.05).Among the 61 patients(22.0%)receiving CT scanning and 66 patients(24.0%)undergoing magnetic SWI,the positive rate of cerebral microhaemorrhage on SWI in the VD group was remarkably higher than that of the AD group(64.3%vs 30.0%,P<0.05).Conclusion Significant differences are observed in the main clinical manifestations,radiological charact

关 键 词：痴呆 症状和体征 认知功能障碍 出血 

分 类 号：R74[医药卫生—神经病学与精神病学]