摘要
目的:阿尔茨海默病(Alzheimer’s disease,AD)与特发性正常颅压脑积水(idiopathic normalpressurehydrocephalus,iNPH)可共病,但临床常被忽视。本文通过病例回顾和文献复习,探讨二者共病的临床特征及诊断方法,以提高临床工作中AD与iNPH共病的识别能力。方法:通过1例AD与iNPH共病的病历回顾和文献复习,探讨其临床特征、脑脊液生物标记物对AD和iNPH的鉴别诊断价值,同时也综述了脑室腹腔脑脊液分流术对共病患者的治疗作用。结果:AD与iNPH共病常见,AD中18-42%合并iNPH,iNPH中约26%合并存在AD病理学改变,AD和iNPH认知功能障碍具有不同的特征,脑室腹腔脑脊液分流术可使共病患者获益,术后步态和平衡功能显著提高,认知障碍也有可能改善。结论:AD和iNPH均多见于老年人,对共病患者的及时识别,有助于早期开始针对性治疗,包括脑脊液分流术。
Objective Alzheimer disease(AD)can be a common comorbid condition of idiopathic normalpressurehydrocephalus(iNPH),but it tends to beignored in clinical practice.To improve the capacity of recognition of this condition,one case was reported and relevant literatures were reviewed,the clinicalfeatures and methods which could be used for diagnose were discussed.Methods One patient diagnosed as comorbid AD withiNPH was reported.Clinical features and the value of biomarkers in cerebral spinal fluid for differential diagnosis were reviewed.AD neuropathology in iNPH andresponse to shunt surgery were reviewed.Results Cognitive impairment has different features in AD and iNPH.AD is a common comorbid condition of iNPH ranging between 18–42%,about 26%of patients with iNPH had coexisting AD pathology,which does not significantly influence the clinical response to shunt surgery.Patientsof iNPHwith or without AD pathology showed similar improvement in gait and balance after shunt surgery and perhaps in cognitive function.Conclusion Both AD and iNPHare common in the elderly patients.The earlyrecognizingof comorbid AD with iNPH is helpful for treatments including shunt surgery.
作者
赵忙所
魏妍
黄方杰
周世梅
王静
黄静芬
刘建平
乔立艳
Zhao Mang-suo;Wei Yan;Huang Fang-jie;Zhou Shi-mei;Wang Jing;Huang Jing-fen;Liu Jian-ping;Qiao Li-yan(The department of Neurology,Tsinghua University Yuquan Hospital)
出处
《阿尔茨海默病及相关病杂志》
2018年第3期188-192,共5页
Chinese Journal of Alzheimer's Disease and Related Disorders
关键词
阿尔茨海默病
特发性正常颅压脑积水
共病
分流术
Alzheimer disease
idiopathic normal pressure hydrocephalus
comorbid
shunt surgery
