Geldmacher D S, Whitehouse P J
University Alzheimer Center, University Hospitals of Cleveland, Department of Neurology, Case Western Reserve University School of Medicine, OH 44120, USA.
Neurology. 1997 May;48(5 Suppl 6):S2-9. doi: 10.1212/wnl.48.5_suppl_6.2s.
Accurate diagnosis of dementia is essential to provide appropriate treatment as well as patient and family counseling. It may be difficult to differentiate dementia from delirium. In addition, several features distinguish dementia from depression, but the two can coexist and the distinction may be uncertain. Dementias can be grouped into two categories: dementia that presents without prominent motor signs and dementia that presents with prominent motor signs. Dementias without prominent motor signs include Alzheimer's disease, frontotemporal dementia, and Creutzfeld-Jakob and other prion diseases. Dementias characterized at onset by prominent motor signs include dementias with Lewy bodies, idiopathic Parkinson's disease, progressive supranuclear palsy, cortico-basal ganglionic degeneration, hydrocephalus, Huntington's disease, and vascular dementia. Routine diagnostic steps include a careful history, mental status screening, laboratory and imaging studies, and neuropsychologic testing. Genetic testing is available, but its use is controversial and raises complex ethical questions.
准确诊断痴呆症对于提供适当的治疗以及对患者和家属进行咨询至关重要。将痴呆症与谵妄区分开来可能很困难。此外，有几个特征可将痴呆症与抑郁症区分开来，但两者可能并存，区分可能并不确定。痴呆症可分为两类：无明显运动体征的痴呆症和有明显运动体征的痴呆症。无明显运动体征的痴呆症包括阿尔茨海默病、额颞叶痴呆以及克雅氏病和其他朊病毒病。起病时有明显运动体征的痴呆症包括路易体痴呆、特发性帕金森病、进行性核上性麻痹、皮质基底节变性、脑积水、亨廷顿舞蹈病和血管性痴呆。常规诊断步骤包括详细的病史、精神状态筛查、实验室和影像学检查以及神经心理学测试。基因检测可行，但它的使用存在争议并引发复杂的伦理问题。
