孔脳症にアルツハイマー型認知症が合併し，幻視・幻聴を認めた1症例

A Patient Suspected with Alzheimer-type Dementia, Showing Visual and Auditory Hallucinations Probably Due to Associated Porencephaly

抄録

　近年，さまざまな認知症を来す疾患が知られており，臨床現場で鑑別困難な症例も少なくない。今回我々は，アルツハイマー型認知症が疑われ，合併する孔脳症が原因と考えられる幻視・幻聴を呈した症例を経験した。認知機能障害と幻覚症状の関連の有無が検討され，鑑別疾患としてレビー小体型認知症が考えられたが，否定するには至らなかった。認知症に伴う精神症状の薬物療法は，高齢者が多いこともあり副作用が問題となるが，今回幻覚症状に対しaripiprazoleを使用したところ，大きな副作用なく改善した。今後，レビー小体型認知症など錐体外路症状の悪化を来しやすい症例の幻覚症状に対しても，使用する価値があると考えられた。

　Recently, various diseases that lead to dementia have been identified, and these diseases are occasionally difficult to discriminate clinically. We examined a patient with suspected Alzheimer-type dementia (ATD) who experienced visual and auditory hallucinations possibly due to associated porencephaly. We examined the relation between cognitive decline and hallucinations and considered the differential diagnosis of dementia with Lewy bodies (DLB), which was a distinct possibility in this patient. When medications for behavioral and psychological symptoms of dementia (BPSDs) are prescribed careful treatment of side effects is required, because the patients are usually elderly. We administered aripiprazole to treat hallucinations in this patient, who showed improvement without any side effects. Aripiprazole may be administered to patients who are susceptible to aggravated extrapyramidal signs such as DLB.