阿尔茨海默病共病特发性正常压力脑积水1例——病例报告及文献回顾

One Case of Alzheimer’s Disease Comorbid with Idiopathic Normal Pressure Hydrocephalus—Case Report and Literature Review

摘要: 目的：阿尔茨海默病(Alzheimer’s disease, AD)与特发性正常压力脑积水(idiopathic normal pressure hydrocephalus, iNPH)在老年人群可共病，但临床常常发生漏诊。本文通过病例回顾和文献复习，探讨二者共病的临床特征、诊断方法以及疗效观察，以提高临床工作中AD与iNPH共病的识别能力。方法：通过1例AD与iNPH共病的病例回顾和文献复习，探讨其临床特征、神经心理测评以及脑脊液放液试验对AD和iNPH的鉴别诊断价值，同时也综述了脑室腹腔脑脊液分流术对共病患者的治疗作用。结果：AD与iNPH共病在老年人群中常见，AD中约18%合并iNPH，iNPH中约14.8%合并AD，AD和iNPH的临床表现具有不同的特征，脑室腹腔脑脊液分流术可使共病患者获益，术后步态和尿便障碍显著提高，认知障碍也有明显改善。结论：AD和iNPH均多见于老年人，对共病患者的及时有效识别，有助于早期开始针对性治疗，包括脑脊液分流术联合药物治疗。

Abstract: Objective: Alzheimer’s disease (AD) can be a common comorbid condition of idiopathic normal pressure hydrocephalus (iNPH), but it often escapes diagnosis in clinical practice. To improve the capacity of recognition of this condition, one case was reported and relevant literatures were re-viewed, the clinical features and methods that could be used for diagnose were discussed. Methods: One patient diagnosed as comorbid AD with iNPH was reported. Clinical features, neuropsychologi-cal tests and the cerebrospinal fluid tap test for differential diagnosis were reviewed. The effect of ventriculo-peritoneal shunt was reviewed. Results: AD comorbid with iNPH is common in old peo-ple, AD is a common comorbid condition of iNPH about 18%, about 14.8% of patients with iNPH had coexisting AD pathology, and there are different clinical features in AD or iNPH. Ventricu-lo-peritoneal shunt can benefit both, showing obvious improvement in gait and urinary disorders or cognitive function. Conclusion: Both AD and iNPH are common in elderly patients. The early recog-nition of comorbid AD with iNPH is helpful for treatments including shunt surgery together with drugs.