Extrapyramidal motor signs in clinically diagnosed Alzheimer disease
Extrapyramidal motor signs in clinically diagnosed Alzheimer disease
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DOI：
10.1097/00002093-199601020-00008
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发表时间：
1996-06-01
影响因子：
2.1
通讯作者：
Thal, LJ
中科院分区：
文献类型：
--
作者：
Ellis, RJ;Caligiuri, M;Thal, LJ
我们回顾了10年来发表的临床病例系列，讨论了阿尔茨海默病（AD）锥体外系体征（EPS）的横断面频率、发病率、诊断和预后意义。该综述是由最近报道的路易体（LB）病理在许多AD患者的大脑和LB病理与临床帕金森氏症的AD。在回顾的临床病例系列中，我们评估了流行EPS的几个可能的决定因素，包括抗精神病药物的使用，EPS评估技术和痴呆的严重程度。在这些报告中，抗精神病药物是一个公认的帕金森综合征的原因，尽管有些报告没有记录抗精神病药物的使用频率。评估方法也很重要：使用结构化临床研究量表评估EPS的研究报告的频率高于使用常规神经系统检查的研究。帕金森综合征和痴呆严重程度之间的关系是复杂的。一些研究发现，即使在轻度痴呆、未接受过抗精神病药物治疗的AD患者中，也会出现运动迟缓、面部掩蔽和帕金森氏姿势改变。另一方面，随着痴呆症的进展，僵硬变得越来越普遍。即使考虑到初始痴呆严重程度的差异，EPS AD患者的认知和功能下降速度也比无EPS的患者快，死亡时间也比无EPS的患者早。在痴呆与帕金森综合征的鉴别诊断中，各种形式的LB疾病，包括AD与LB，是主要的诊断考虑因素。未来的研究帕金森症的AD应采用标准化的临床评定量表，并应排除患者的抗精神病药物或分析他们的结果分开。除了EPS的总体患病率外，研究者还应报告单个帕金森病体征的频率，以便于进行有意义的研究间比较。
We reviewed clinical case series published over a 10-year period addressing the cross-sectional frequency, incidence, and diagnostic and prognostic significance of extrapyramidal signs (EPS) in Alzheimer disease (AD). The review was prompted by recent reports of Lewy body (LB) pathology in the brains of many AD patients and the association of LB pathology with clinical parkinsonism in AD. In the clinical case series reviewed, we evaluated several possible determinants of prevalent EPS, including neuroleptic use, EPS assessment technique, and dementia severity. Neuroleptics were a well recognized cause of parkinsonism in these reports, though some failed to document the frequency of neuroleptic use. Assessment methods were also important: Studies using structured clinical research scales to rate EPS reported higher frequencies than studies employing routine neurological examination. The relationship between parkinsonism and dementia severity was complex. Some studies found bradykinesia, facial masking, and parkinsonian postural changes even in mildly demented, neuroleptic-naive AD patients. Rigidity, on the other hand, became increasingly common as dementia progressed. AD patients with EPS showed faster cognitive and functional decline and earlier death than those without EPS, even after consideration of differences in initial dementia severity. In the differential diagnosis of dementia with parkinsonism, LB disease in its various forms, including AD with LB, is the principal diagnostic consideration. Future studies of parkinsonism in AD should employ standardized clinical rating scales and should exclude patients on neuroleptics or analyze their results separately. Investigators should report frequencies for individual parkinsonian signs in addition to the overall prevalence of EPS to facilitate meaningful comparisons across studies.