Clinical and psychometric distinction of frontotemporal and Alzheimer dementias
Clinical and psychometric distinction of frontotemporal and Alzheimer dementias
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DOI：
10.1001/archneur.64.4.535
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发表时间：
2007-04-01
影响因子：
--
通讯作者：
Morris, John C.
中科院分区：
文献类型：
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作者：
Liscic, Rajka M.;Storandt, Martha;Morris, John C.
背景：符合国家神经和交流障碍与中风研究所以及阿尔茨海默病和相关疾病协会阿尔茨海默病 (AD) 标准的患者中有一部分在尸检中证实患有额颞叶变性 (FTLD)，无论是否伴有 AD。因此，这两种疾病的临床表型可能重叠。目的：确定在最初表现时区分 AD 和 FTLD 的临床和心理指标。设计：记忆和衰老的纵向研究。地点：华盛顿大学医学院阿尔茨海默病研究中心。参与者：48 例临床特征明确的尸检确诊 FTLD 病例（27 例患有 FTLD）。 心理测试结果）与 27 例尸检确诊的 AD 病例进行比较。结果：行为异常，特别是冲动 (P < .001)、去抑制 (P < .001)、社交退缩 (P = .01) 和进行性非流利性失语症，将 FTLD 患者与 AD 患者区分开来。在情景记忆的视觉测试中，FTLD 患者的表现优于 AD 患者 (P = .01)，但在单词流畅性方面表现较差 (P = .02)（表现与失语症特征相关）。其他认知和临床特征，包括执行功能障碍和记忆障碍，在 FTLD 和 AD 组之间具有可比性。 48 名 FTLD 患者中有 11 名伴有组织病理学 AD。结论：FTLD 的临床和认知特征可能与 AD 重叠，尽管行为和语言困难与 FTLD 不同。 FTLD 患者的记忆丧失可能部分反映了语言功能障碍导致的找词困难。近四分之一的 FTLD 患者存在组织病理学 AD，这使得 FTLD 和 AD 临床表型的重叠更加复杂。
Background: A proportion of patients who meet the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Associations criteria for Alzheimer disease (AD) have frontotemporal lobar degeneration (FTLD) confirmed at autopsy, with or without concomitant AD. Thus, the clinical phenotypes of the 2 disorders may overlap.Objective: To identify clinical and psychometric indicators that distinguish AD from FTLD at initial presentation.Design: Longitudinal study of memory and aging.Setting: Alzheimer's Disease Research Center, Washington University School of Medicine.Participants: Forty-eight clinically well-characterized cases of autopsy-confirmed FTLD (27 with psychometric testing results) were compared with 27 autopsy-confirmed AD cases.Results: Behavioral abnormalities, particularly impulsivity (P < .001), disinhibition (P < .001), social withdrawal (P = .01), and progressive nonfluent aphasia, distinguished individuals with FTLD from those with AD. The individuals with FTLD performed better than those with AD on a visual test of episodic memory (P = .01), but worse on word fluency (P = .02) (performance correlated with aphasic features). Other cognitive and clinical features, including executive dysfunction and memory impairment, were comparable between the FTLD and AD groups. Concomitant histopathological AD was present in 11 of the 48 individuals with FTLD.Conclusions: Clinical and cognitive features of FTLD may overlap with AD, although behavioral and language difficulties distinguish those with FTLD. Memory loss in those with FTLD may in part reflect wordfinding difficulties stemming from language dysfunction. Compounding the overlap of FTLD and AD clinical phenotypes is the presence of histopathological AD in almost one fourth of individuals with FTLD.