老年发病的运动神经元病临床特点及诊治:15例病例系列分析OACSTPCD

Background Motor neuron disease(MND)is a neurodegenerative disease with poor prognosis.It typically occurs in middle-aged individuals,and there is a lack of research on MND in the elderly in China.Objective To explore the clinical characteristics and prognosis of MND in individuals over 60 years old.Methods Clinical data about elderly patients with MND admitted to the Seventh Medical Center of Chinese PLA General Hospital from September 2008 to September 2023 were collected and analyzed for their clinical features,diagnosis,and outcomes.Results A total of 15 elderly patients with MND were included,with 10 males and 5 females.The average age was 66.2±5.71 years,and the onset age ranged from 60 to 79 years.Four cases presented with bulbar onset,6 cases with unilateral upper limb onset,3 cases with unilateral lower limb onset,1 case with bilateral lower limb onset,and 1 case with onset in all four limbs.Seven patients developed bulbar symptoms within 18 months onset,and 3 cases had respiratory muscle involvement.In terms of clinical classification,9 cases had amyotrophic lateral sclerosis,4 cases had progressive spinal muscular atrophy,and 2 cases had progressive bulbar palsy.Six patients were initially misdiagnosed,resulting in a misdiagnosis rate of 40%.Five patients gave up treatment,and the treatment outcomes for the remaining patients were poor.Conclusion MND in older adults is common in males and often presents with unilateral limb onset.Bulbar onset is more frequent,and patients with limb onset are more likely to develop bulbar symptoms earlier.There is a higher proportion of respiratory muscle involvement.The findings suggest that MND with onset in older age may have a shorter survival period,a higher co-morbidity rate,a higher misdiagnosis rate,and a higher treatment abandonment rate.