在初级保健的老年痴呆症的诊断和治疗.pptVIP

Dementia Diagnosis and Treatment in Primary Care Bill Lyons Bree Johnston Division of Geriatrics SF VAMC/UCSF Copyright May 2001 Overview Epidemiology Age associated Cognitive Changes Diagnosis Differential Diagnosis Etiology Workup Non-pharmacologic Treatments Drug Treatments Terminal Care This talk will not be covering: Pathophysiology Genetics Screening issues: Who to screen How to screen Epidemiology Prevalence: 1% at age 60 Doubles every five years 30-50% by age 85 Prevalence curve flattens out at about age 90 4th leading cause of death in the elderly Life expectancy after diagnosis 3-15 years, recent data suggests shorter life expectancy Wolfson, NEJM April, 2001 Epidemiology of Alzheimer’s Accounts for 60-70% of dementia in US Risk factors: Older age Family history (e4 allele and other chromosomal defects) 3x risk with 1st degree relative Female gender Lower education level Head trauma? Vascular Dementias Diagnostic criteria murky Overlap with AD Risk factors Older age Male female, Black race white race HTN Cigarettes, AF, DM, hyperlipidemia Ischemic stroke survivors: 9X increased dementia risk Other Causes of Dementia Dementia with Lewy Bodies #2 in autopsy studies, males females Parkinsonism, little benefit from sinemet, fluctuating impairment, visual hallucinations, neuroleptic sensitivity, rapid progression Frontotemporal Dementias: e.g. Pick’s disease Personality changes, euphoria, apathy, disinhibition, compulsive behaviors Relatively preserved visuospatial function Other Causes of “Cognitive Impairment” PSP related disorders Huntington’s Post-anoxic NPH B12 Hypothyroidism Hypercalcemia Alcohol/thiamine Infections HIV Syphilis Lyme’s CJD Encephelopathy Uremic Hepatic “Reversible Dementias” More properly called “potentially reversible cognitive impairments” Candidates: Drug induced, depression, thyroid, B12, NPH, subdural hematoma Truly reversible 1-3% Most patients go on to develop dementia Depression: 4-7X increase ris