巴金森病失智症、路易氏體失智症、與阿茲海默症之神經精神症狀比較研究

Comparison studies of the neuropsychiatric symptoms of Parkinson’s diseae dementia, dementia with Lewy bodies, and Alzheimer’s disease

邱百誼(Pai-Yi Chiu)

指導教授 ： 賴德仁

中山醫學大學/醫學院/醫學研究所/博士(2016年)

摘要

研究目的：以往的研究發現巴金森病失智症(Parkinson’s disease dementia, PDD)之臨床以及病理特徵與路易氏體失智症(dementia with Lewy bodies, DLB)較相似，而與阿茲海默症 (Alzheimer’s disease, AD) 較不同，因此有許多專家認為巴金森病失智症與路易氏體失智症是相同的疾病實體。本研究的目的在探討探討巴金森病失智症之神經精神症狀與路易氏體失智症及阿茲海默症之異同。並且希望藉由這項研究可以提供臨床的證據來驗證巴金森病失智症與路易氏體失智症是否為相同的疾病實體。
研究方法及資料：本研究有兩個部份，首先是主研究部分，我們在台灣中部一家區域醫院陸續蒐集了新診斷的巴金森病失智症病患共125名，再選擇年齡與失智程度相當(matched)的250名路易氏體失智症病患與500名阿茲海默症病患，即以1:2:4的比例進行一個個案對照研究，研究主要的工具採結構式問卷中文版的12項項目之神經精神量表(Neuropsychiatric Inventory, NPI)。接著是次研究，我們再從所有主研究受試者當中選擇282名病患，包括41名巴金森病失智症病患，59名路易氏體失智症病患與182名阿茲海默症作完整的憂鬱症頻率與嚴重度評估。兩個研究主要的分析方法以SPSS for windows 19.0版套裝軟體進行「邏輯回歸分析」、「變異數分析」及「卡方檢定」等。
研究結果：主研究的全部875名受試者中，有513名(58.6%) 是女性而362名(41.4%) 是男性。在比較臨床神經精神症狀表現後發現，巴金森病失智症與阿茲海默症的神經精神量表總分、照顧者負擔總分、以及使用抗精神藥物的比例均較路易氏體失智症顯著較少(全部的p值均小於0.001)。至少有一項以上的神經精神症狀比例在巴金森病失智症、路易氏體失智症、與阿茲海默症分別是95.2%、99.2%、與96.8%。與路易氏體失智症比較起來，巴金森病失智症在以下幾項症狀的分數均顯著較低，包括妄想、幻覺、激動、焦慮、躁動與異常行為等。在使用邏輯回歸分析比較全部失智病患之後發現，較嚴重的神經精神症狀與年紀較輕、失智程度較嚴重、及診斷為路易氏體失智症有顯著相關。在次研究關於憂鬱症的評估方面，路易氏體失智症在憂鬱症的頻率以及嚴重度也是較巴金森病失智症或阿茲海默症高，巴金森病失智症與阿茲海默症的表現較相近。持續性地失去快樂(pervasive anhedonia)在區別路易氏體失智症與阿茲海默症有很高的價值。
結論與建議：巴金森病失智症之神經精神症狀，包括憂鬱症在內，與阿茲海默症較相似而與路易氏體失智症顯然不同。這樣的結果與一般先前國外的研究告訴我們巴金森病失智症在臨床與病理的各項表現與路易氏體失智症幾乎無發區分的結論也顯然不同。我們的研究因此提供了巴金森病失智症與路易氏體失智症是不同的疾病實體的佐證，需要更多與更進一步地研究與比較來驗證。此外，本研究也發現失智症病患合併嚴重的神經精神症狀與年紀較輕、失智程度較嚴重及診斷為路易氏體失智症有顯著相關。

關鍵字

巴金森病失智症；路易氏體失智症；阿茲海默症；神經精神症狀；憂鬱

並列摘要

Objective：Previous studies on the clinical and pathological manifestations of Parkinson’s disease dementia (PDD) have reported findings more similar to dementia with Lewy bodies (DLB) than to Alzheimer’s disease (AD). The first aim of this study was to investigate the neuropsychiatric symptoms of PDD compared to DLB and AD. The second was to provide the evidence of whether PDD and DLB belong to the same disease entity.
Methods and Materials： First, we conducted a case-control study on 125 newly diagnosed consecutive PDD patients and age- and dementia stage-matched controls with either DLB (N = 250) or AD (N = 500) who visited the same hospital over the same period. For each case and control, neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory (NPI). Second, we selected 282 patients with PDD (N = 41), DLB (N = 59) or AD (N = 182) who were given a complete assessment of frequency and severity of depression using multiple criteria and scales. After the data collection, valid samples were processed and analyzed by descriptive statistics, Chi-square tests and ANOVA by SPSS for windows 19.0.
Results：Overall, 513 (58.6%) patients were female and 362 (41.4%) were male. Comparisons of clinical data revealed that the PDD group, similar to the AD group, had a lower NPI total score, NPI caregiver burden score, and rate of antipsychotic use (all p < 0.001) than the DLB group. One or more psychiatric symptoms were reported in 95.2% of the PDD, 99.2% of the DLB, and 96.8% of the AD patients. The PDD group had lower subscores in the items of delusions, hallucinations, agitation, anxiety, irritation, aberrant motor behavior compared to the DLB group. Severe neuropsychiatric symptoms among all dementia patients were associated with younger age, more advanced stage, and a diagnosis of DLB. Depression in DLB was more severe and more frequent than PDD or AD. Association of depression with PDD was more like that of AD than DLB. Pervasive anhedonia has high diagnostic value for the differentiation of DLB with AD.
Conclusion and Suggestion：Neuropsychiatric symptoms in PDD were more like those in AD than in DLB. Our findings provided an evidence that PDD and DLB might not be the same disease entity. Severe neuropsychiatric symptoms in degenerative dementia were associated with younger age, more advanced stage of dementia, and a diagnosis of DLB.

並列關鍵字

Parkinson’s disease dementia ； dementia with Lewy bodies ； Alzheimer’s disease ； neuropsychiatric symptoms ； depression

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