もの忘れ外来を初診した認知症患者本人は何を訴えるか—アルツハイマー病とレビー小体型認知症を対象とした検討

What Dementia Patients Complaint in Their First Visit of Memory Clinic:A comparative study of patients with Alzheimer's disease and dementia with Lewy bodies(DLB)

抄録　アルツハイマー病(AD)173症例およびレビー小体型認知症(DLB)42症例を対象として，もの忘れ外来初診時に半構造化インタビューを行い，患者本人の主訴の内容を分類してADとDLBを比較するとともに，主訴に影響を与える要因を検討した。「もの忘れ主訴群」「具体的身体愁訴群」「訴えなし群」「その他群」の4群の患者比はADとDLBで有意に異なっており，DLBでもの忘れ主訴群が少なかった。「疾患関連主訴群」「具体的身体愁訴群」「訴えなし群」の3群の患者比もADとDLBで有意に異なっており，DLBで疾患関連主訴群が少なかった。この3群間の比較検討では，ADとDLBともに，具体的身体愁訴群と訴えなし群で，認知機能障害の全般重症度が疾患関連主訴群よりも有意に重度であった。もの忘れ主訴群がDLBで少なかったことの背景には，DLBの症状の多様性があると考えられた。疾患関連主訴群がDLBで少なかったことの背景には，DLBでADよりも病識の低下が進行している可能性と，DLB患者が訴えるはずの幻視などの症状が，特に初診の場面では患者にとって言語化しにくいという可能性が考えられた。

　This study compared the chief complaints from 173 patients with Alzheimer's disease(AD)and 42 patients with dementia with Lewy bodies(DLB)and explored the factors affecting them, using the results of a semi-structured interview conducted in the first visit of our memory clinic. In the first analysis, we classified the patients into 4 groups according to their chief complaints：“memory loss”, “specified physical complaint”, “no complaint”, and “other complaints”. The ratios of the 4 groups were significantly different between AD and DLB, and the rate of “memory loss” patients in DLB was smaller than that in AD. In the second analysis, which used the 3 patient groups of “disease-related complaint”, “specified physical complaint”, and “no complaint”, the ratios of the groups were also significantly different between AD and DLB, and the rate of “disease-related complaint” patients in DLB was smaller than that in AD. In the comparison of the 3 complaint groups, overall cognitive severity was significantly worse in “specified physical complaint”, and “no complaint” groups than in the “disease-related complaint” group both in AD and DLB. The lower rate of the patients who complaint memory loss in DLB may stem from the diversity of symptoms in DLB patients. The lower rate of the patients who had disease-related complaint in DLB suggests 2 possibilities. One is that the insight into their disability may be more deteriorated in DLB than in AD patients. Another possibility is that DLB patients may have difficulty in verbalizing their symptoms such as visual hallucination, especially in their first visit to memory clinic.