Galasko Douglas
Department of Neurosciences, UC San Diego, 9500 Gilman Drive 0948, La Jolla, CA 92093, USA.
Continuum (Minneap Minn). 2013 Apr;19(2 Dementia):397-410. doi: 10.1212/01.CON.0000429176.37224.58.
This review outlines a practical approach to the history, mental state, neurologic examination, and laboratory tests in the diagnosis of dementia.
Proposed new diagnostic criteria for Alzheimer disease recognize that nonamnestic presentations with symptoms that predominantly affect language, visuospatial abilities, or executive function may occur, particularly with onset before the age of 65. New criteria assign greater likelihood to diagnosis if progressive cognitive decline is documented through serial assessment, or if biomarkers are supportive. In patients aged 80 or older, more than one cause of dementia is often present, for example, Alzheimer disease plus vascular dementia. Clinical diagnostic criteria for non-Alzheimer dementias are evolving, particularly in areas such as frontotemporal dementia. Imaging and CSF biomarkers have been proposed in recent diagnostic criteria for Alzheimer disease. Although biomarkers can provide a higher level of certainty that Alzheimer pathology may or may not be present, biomarkers for non-Alzheimer dementias are lacking.
The availability of biomarkers does not replace or diminish the need for a thorough clinical evaluation. A structured clinical approach helps to define the diagnosis and collects information essential for establishing a comprehensive care plan for patients with dementia and their families.
本综述概述了痴呆诊断中病史、精神状态、神经系统检查及实验室检查的实用方法。
阿尔茨海默病的拟议新诊断标准认识到，可能出现以主要影响语言、视觉空间能力或执行功能的症状为主的非遗忘性表现，尤其是在65岁之前发病时。如果通过系列评估记录到进行性认知衰退，或有生物标志物支持，则新标准赋予诊断更高的可能性。在80岁及以上的患者中，通常存在不止一种痴呆病因，例如，阿尔茨海默病加血管性痴呆。非阿尔茨海默病痴呆的临床诊断标准正在不断发展，尤其是在额颞叶痴呆等领域。阿尔茨海默病的最新诊断标准中提出了影像学和脑脊液生物标志物。虽然生物标志物可以提供更高水平的确定性，以确定是否存在阿尔茨海默病病理，但缺乏非阿尔茨海默病痴呆的生物标志物。
生物标志物的可用性并不能取代或减少全面临床评估的必要性。结构化的临床方法有助于明确诊断，并收集为痴呆患者及其家属制定全面护理计划所需的重要信息。
