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Seishin Igaku Volume 50, Issue 2 （February 2008）

精神医学 50巻2号（2008年2月発行）

Japanese English

研究と報告

レビー小体型認知症とパーキンソン病を合併したアルツハイマー型認知症は臨床的に鑑別できるか？―2症例を通じての検討 Is It Possible Clinically to Distinguish Dementia with Lewy Bodies from Alzheimer-type Dementia with Parkinson's Disease?：Based on clinical evaluation of two patients 内海雄思 ^1,2 , 井関栄三 ¹ , 村山憲男 ^1,3 , 一宮洋介 ¹ , 新井平伊 ² Yushi UTSUMI ^1,2 , Eizo ISEKI ¹ , Norio MURAYAMA ^1,3 , Yosuke ICHIMIYA ¹ , Heii ARAI ² ¹順天堂大学医学部附属順天堂東京江東高齢者医療センター・メンタルクリニック ²順天堂大学医学部精神医学 ³日本大学大学院文学研究科心理学専攻博士後期課程 ¹Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan ²Department of Psychiatry, Juntendo University School of Medicine ³Doctor Course of Psychology, Graduate School of Literature and Social Sciences, Nihon University キーワード： Dementia with Lewy bodies , Alzheimer-type dementia , Parkinson's disease , Visuoperceptual disability , Bender gestalt test Keyword: Dementia with Lewy bodies , Alzheimer-type dementia , Parkinson's disease , Visuoperceptual disability , Bender gestalt test pp.123-131

発行日 2008年2月15日 Published Date 2008/2/15

DOI https://doi.org/10.11477/mf.1405101131

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　パーキンソン病(PD)を合併したアルツハイマー型認知症(ATD)と診断した症例1とレビー小体型認知症(DLB)と診断した症例2について，共通の画像検査と神経心理検査を施行した。DLBの改訂版臨床診断基準では，両者ともにprobable DLBを満たしていた。脳SPECTでは，後頭葉の血流低下が症例2でみられたが，症例1ではみられなかった。ベンダーゲシュタルトテストでは，DLBに特有の視覚認知障害が症例2で認められたが，症例1では認められなかった。PDを合併したATDとDLBは異なる概念であり，今回の検討から視覚認知障害の有無で両者を臨床的に鑑別できることが示された。

　For two patients showing mild dementia, we carried out neuropsychological tests such as MMSE, WAIS-III, WMS-R and Bender gestalt test (BGT) as well as radiological examinations such as MRI, SPECT and MIBG scintigraphy. Both patients met the criteria for the clinical diagnosis of probable dementia with Lewy bodies (DLB), because case 1 revealed a core feature, parkinsonism, and a suggestive feature, REM sleep behavior disorder, in addition to a central feature, progressive cognitive decline, while case 2 revealed three core features, fluctuating cognition, visual hallucinations and parkinsonism, and two suggestive features, REM sleep behavior disorder and neuroleptic sensitivity, in addition to a central feature. However, case 1 also met the criteria for the clinical diagnosis of probable Alzheimer's disease (AD). Both patients exhibited mild medial temporal lobe atrophy on MRI, and low myocardial uptake on MIBG scintigraphy. In contrast, case 1 did not show occipital hypoperfusion on SPECT, although case 2 did. Case 1 showed the BGT score below a cutoff point of DLB with the preserved gestalt in BGT performance, while case 2 showed the BGT score over a cutoff point of DLB with the destroyed gestalt. These findings indicate that case 1 does not show visuoperceptual disability characteristic of DLB, although case 2 does. Therefore, case 1 was diagnosed as Alzheimer-type dementia (ATD) with Parkinson's disease (PD), while case 2 was diagnosed as DLB. For differentiating DLB from ATD with PD, it is useful to detect the presence of visuoperceptual disability using BGT as well as SPECT.