緩徐に進行し，奇妙な幻覚妄想を伴った初老期変性性痴呆の1例

A Case of Slowly Progressive Presenile Dementia with Peculiar Hallucination and Delusion

抄録

　発病後10年以上経過して奇妙な幻覚妄想がみられた初老期痴呆例で，変性性痴呆ではあるものの，臨床診断が困難であった1例を経験したので報告する。

　症例は64歳の女性。10年前頃から物忘れを指摘されていたが，その後周囲に無関心となり痴呆症状も進行した。最近になって，奇妙な幻覚，妄想とそれに基づく異常行動がみられた。神経心理学的検査では著明な人格変化，接触性の不良，保続などの脳の前方症状がみられたが，神経学的に異常所見は認められなかった。頭部CT，MRIでは右側優位の前頭，側頭葉の萎縮が認められたが，辺縁はナイフの刃状の萎縮ではなかった。SPECTでは前頭葉から頭頂葉にかけて脳血流の低下が認められた。

　A68-year-old housewife had a history of slowly progressive dementia. At the age of 58 she became aware of her memory problem. Afterward she became apathetic. Just before consultation with us, she experienced peculiar hallucinations and delusions on which she acted. She embarked on long walks, usually involving the same route.

　She showed profound alterations in her personality and behavior. Her behavior pattern was stereotyped. Her spontaneous speech was scarce. Perception, spatial skills and daily memory were relatively preserved. The results of neurological examination were normal. CT and MRI scans revealed circumscribed dull-edged (not knife-edged) fronto-temporal atrophy with slight atrophy of hippocampus. SPECT scans revealed reduction in tracer uptake from the bilateral fronto-temporal to parietal regions.

　Clinical and imaging findings of this patient do not correspond well to the disease entities of primary degenerative dementia such as Alzheimer's disease, dementia with Lewy body disease, Pick's disease and diffuse neurofibrillary tangles with calcification.