Abstract:

Objective: To compare the differences in clinical characteristics, cognitive function, laboratory and neuroimaging features between patients with dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). Methods: Twenty patients with DLB and 20 patients with PDD diagnosed at The First Hospital of Hebei Medical University from July 2024 to April 2026 were enrolled. Demographic characteristics, time of symptom onset, core clinical symptoms, neuropsychological assessments, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), antiparkinsonian medication dosage [levodopa equivalent daily dose (LEDD)], motor function assessed by Unified Parkinson's Disease Rating Scale (UPDRS), as well as neuroimaging and laboratory findings were collected and compared between the 2 groups. Results: Compared with the DLB group, the PDD group had a longer disease duration (Z= -3.279, P=0.001), a longer interval from disease onset to motor symptoms (Z= -3.564, P=0.000), the frequencies of cognitive fluctuations (Fisher's exact probability: P=0.000) and delusions (Fisher's exact probability: P=0.003) were lower. The PDD group showed higher language score (Z= -2.498, P=0.013), lower delayed recall score (Z=2.008, P=0.046), higher total MoCA score (Z= -1.994, P=0.048), and higher visuospatial and executive function score (Z= -3.523, P=0.000). In addition, the PDD group had a higher LEDD (Z= -2.153, P=0.032), lower total bilirubin (Z=1.989, P=0.048) and serum uric acid (Z=2.976, P=0.003), but higher serum sodium (Z= -2.274, P=0.024) and high-density lipoprotein cholesterol (Z= -2.111, P=0.036). Conclusions: Cognitive fluctuation and visuospatial dysfunction are valuable clinical features for differentiating DLB from PDD. Routine biochemical parameters, including serum uric acid, high-density lipoprotein cholesterol and serum sodium, may provide additional clues for the differential diagnosis between these two disorders.

Key words: Lewy body disease, Parkinson disease, Cognition disorders, Neuropsychological tests, Uric acid, Diagnosis, differential

摘要：

目的: 对比路易体痴呆（DLB）与帕金森病痴呆（PDD）患者在临床特征、认知功能、实验室及影像学检查等方面的差异。方法: 纳入2024年7月至2026年4月河北医科大学第一医院诊断为很可能的路易体痴呆或帕金森病痴呆患者各20例，收集社会人口学资料、症状出现时间、核心症状、神经心理学测验[简易智能状态检查量表和蒙特利尔认知评价量表（MoCA）等]、药物剂量[如左旋多巴日等效剂量（LEDD）]、运动功能评估（统一帕金森病评价量表）以及影像学和实验室检查资料。结果: 与DLB组相比，PDD组总病程较长（Z= -3.279，P=0.001），运动症状出现时间较晚（Z= -3.564，P=0.000）；波动性认知障碍（Fisher确切概率法：P=0.000）和妄想（Fisher确切概率法：P=0.003）发生率较低；语言功能评分较高（Z= -2.498，P=0.013），回忆能力评分较低（Z=2.008，P=0.046），MoCA总评分（Z= -1.994，P=0.048）及视空间和执行功能分评分（Z= -3.523，P=0.000）较高；LEDD较高（Z= -2.153，P=0.032）；总胆红素（Z=1.989，P=0.048）和尿酸（Z=2.976，P=0.003）水平较低，血钠（Z= -2.274，P=0.024）和高密度脂蛋白胆固醇（Z= -2.111，P=0.036）水平较高。结论: 波动性认知障碍和视空间能力损害对路易体痴呆与帕金森病痴呆临床症状的鉴别具有重要价值，血清尿酸、高密度脂蛋白胆固醇、血钠等生化指标可为二者的鉴别诊断提供辅助线索。

关键词: Lewy体病, 帕金森病, 认知障碍, 神经心理学测验, 尿酸, 诊断，鉴别

CLC Number: 

• R741