Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Am J Med. 2018 Oct;131(10):1161-1169. doi: 10.1016/j.amjmed.2018.01.022. Epub 2018 Feb 6.
Dementia is any decline in cognition that is significant enough to interfere with independent, daily functioning. Dementia is best characterized as a syndrome rather than as one particular disease. The causes of dementia are myriad and include primary neurologic, neuropsychiatric, and medical conditions. It is common for multiple diseases to contribute to any one patient's dementia syndrome. Neurodegenerative dementias, like Alzheimer disease and dementia with Lewy bodies, are most common in the elderly, while traumatic brain injury and brain tumors are common causes in younger adults. While the recent decade has seen significant advancements in molecular neuroimaging, in understanding clinico-pathologic correlation, and in the development of novel biomarkers, clinicians still await disease-modifying therapies for neurodegenerative dementias. Until then, clinicians from varied disciplines and medical specialties are well poised to alleviate suffering, aggressively treat contributing conditions, employ medications to improve cognitive, neuropsychiatric, and motor symptoms, promote evidence-based brain-healthy behaviors, and improve overall quality of life for patients and families.
痴呆是指认知能力的任何显著下降，足以干扰独立的日常功能。痴呆最好被描述为一种综合征，而不是一种特定的疾病。痴呆的原因有很多，包括原发性神经、神经精神和医疗状况。多种疾病共同导致任何一个患者的痴呆综合征是很常见的。神经退行性痴呆，如阿尔茨海默病和路易体痴呆，在老年人中最为常见，而创伤性脑损伤和脑肿瘤则是年轻人常见的病因。尽管近十年来在分子神经影像学、临床病理相关性的理解以及新型生物标志物的开发方面取得了重大进展，但临床医生仍在等待神经退行性痴呆的治疗方法。在那之前，来自不同学科和医学专业的临床医生有很好的机会减轻痛苦，积极治疗相关疾病，使用药物改善认知、神经精神和运动症状，促进基于证据的大脑健康行为，并提高患者和家庭的整体生活质量。
