Alzheimer's disease comorbidity in normal pressure hydrocephalus: prevalence and shunt response
Alzheimer's disease comorbidity in normal pressure hydrocephalus: prevalence and shunt response
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DOI：
10.1136/jnnp.68.6.778
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发表时间：
2000-06-01
影响因子：
11
通讯作者：
Graves, W
中科院分区：
文献类型：
--
作者：
Golomb, J;Wisoff, J;Graves, W
在56例接受分流术治疗特发性常压脑积水（NPH）的认知障碍患者中，研究了阿尔茨海默病病理活检的临床影响。认知通过整体恶化量表（GDS）、迷你精神状态检查（MMSE）和一组六项心理测试来测量。步态评估采用客观测量速度和动态指数（AI）。出现神经性斑块（活检阳性）的病例患病率与痴呆严重程度平行增加，从GDS评分为3的患者的18%增加到GDS评分大于或等于6的患者的75%。活检阳性的患者比活检阴性的患者有更多的认知障碍（更高的GDS和更低的MMSE评分）以及更多的步态障碍（更高的疾病评分和更慢的速度）。手术后，步态速度和人工智能评分显著改善，活检阳性和非活检阳性患者的改善程度相当。相似比例的活检阳性和阴性患者也改善了步态，通过主观录像比较来评估。活检组之间在术后心理测量变化的大小或尿控制改善的病例比例方面没有显著差异，阿尔茨海默病病理是老年特发性NPH患者共病的常见来源，它导致与该疾病相关的临床损害。对于准确诊断为NPH的患者，合并阿尔茨海默病病理对分流手术的临床反应没有强烈影响。
The clinical impact of Alzheimer's disease pathology at biopsy was investigated in 56 cognitively impaired patients undergoing shunt surgery for idiopathic normal pressure hydrocephalus (NPH). Cognition was measured by means of the global deterioration scale (GDS), the mini mental status examination (MMSE) and a battery of six psychometric tests. Gait was assessed using objective measurements of velocity and the ambulatory index (AI). The prevalence of cases exhibiting neuritic plaques (positive biopsies) increased in parallel with dementia severity from 18% for patients with GDS 3 to 75% for patients with GDS scores greater than or equal to 6. Patients with positive biopsies were more cognitively impaired (higher GDS and lower MMSE scores) as well as more gait impaired (higher ill scores and slower velocities) than patients with negative biopsies. After surgery, gait velocity and AI scores improved significantly and to a comparable degree for patients with and without positive biopsies. Similar proportions of positive and negative biopsy patients also had improved gait as assessed by means of subjective video tape comparisons. There were no significant differences between the biopsy groups in the magnitude of postoperative psychometric change or in the proportion of cases exhibiting improved urinary control, Alzheimer's disease pathology is a common source of comorbidity in older patients with idiopathic NPH where it contributes to the clinical impairment associated with this disorder. For patients accurately diagnosed with NPH, concomitant Alzheimer's disease pathology does not strongly influence the clinical response to shunt surgery.