以快速眼动睡眠行为障碍为首次发病症状的路易体痴呆1例  

A case of dementia with Lewy bodies with rapid eye movement sleep behavior disorder as the initial symptom

作　　者：杜若南 王鑫 张建新[2] 张健一 王志仁[3] 韩笑乐[2] 蔡海鹏[2] Du Ruonan;Wang Xin;Zhang Jianxin;Zhang Jianyi;Wang Zhiren;Han Xiaole;Cai Haipeng(Peking University Huilongguan Clinical Medical School,Beijing 100096,China;Department of Gerontology,Beijing Huilongguan Hospital,Beijing 100096,China;Department of Technology,Beijing Huilongguan Hospital,Beijing 100096,China)

机构地区：[1]北京大学回龙观临床医学院,北京100096 [2]北京回龙观医院老年科,北京100096 [3]北京回龙观医院科技处,北京100096

出　　处：《中华精神科杂志》2025年第4期288-291,共4页Chinese Journal of Psychiatry

基　　金：北京市属医院科研培育计划(PX2021072)。

摘　　要：本文报道1例77岁男性,因“记忆力下降、凭空视物1年余,加重2个月伴敏感多疑”就诊的患者。该患者存在视幻觉,认知障碍呈波动性,体格检查可及帕金森综合征,并存在顽固性便秘、嗅觉失灵;磁共振成像示脑萎缩、双侧海马萎缩;重度记忆缺损、中度智力缺损,MMSE评分12分;脑电图轻度异常;多导睡眠监测提示呼吸暂停综合征可能性较大。家属补充病史患者起病前存在夜间睡眠时挥拳、喊叫、骂人的情况。最终诊断为路易体痴呆。A 77-year-old male patient was admitted to the hospital with the main cause of memory loss,visual hallucination for more than one year,aggravated for two months with sensitivity and paranoia.The patient exhibited signs of loss of smell,axial hypertonia,upper limb hypertonia,slow start,and propulsive gait.Cranial MRI suggested cerebral atrophy,bilateral hippocampal atrophy,and multiple cavernous cerebral infarcts.Severe memory deficits,moderate intellectual deficits,MMSE score of 12,mildly abnormal electroencephalography,and polysomnographic monitoring suggested a high likelihood of apnea syndrome.Prior to the onset of the disease,the patient had a history of swinging,shouting,and cursing during nighttime sleep,according to his family members.The final diagnosis was Lewy body dementia.

关 键 词：痴呆 LEWY体病 认知障碍 幻视 快速眼动期睡眠行为障碍 

分 类 号：R749.1[医药卫生—神经病学与精神病学]