痴呆常见类型及鉴别课件.pptVIP

出血性痴呆? 脑实质内出血、蛛网膜下腔出血后引起的痴呆。丘脑出血导致认知功能障碍和痴呆常见。硬膜下血肿也可以导致痴呆，常见于老年人，部分患者认知障碍可以缓慢出现。 阿尔茨海默病 路易体痴呆 额颞叶痴呆 血管性痴呆 病 史 逐渐加重的记忆及认知障碍 逐渐出现的认知障碍，多于1年内出现帕金森综合征表现 隐匿起病，缓慢进展，早期多有人格改变 多有多次脑梗死病史 病 理 脑萎缩：常累及额、颞、顶叶，海马极度萎缩。 老年斑 神经原纤维缠结 路易体弥漫性分布于大脑皮质 局限性额颞叶萎缩。 Pick病可见Pick细胞和Pick小体 病灶涉及额叶、颞叶及边缘系统，或损害了足够容量的脑组织 记忆障碍 早期以近记忆下降为主 记忆力障碍较轻 记忆障碍较轻，尤其空间定向保存较好 阶梯式发展、波动性 认知障碍 学习新知识困难 计算力障碍 视空间障碍 波动性认知功能障碍 认知功能障碍晚期出现 精神异常 敏感、多疑、易激惹、易伤感，焦虑、抑郁 视幻觉 早期出现人格情感改变：易激惹、暴怒、固执、淡漠、抑郁, 行为异常 Kluver-Bucy综合征 其他 锥体外系功能障碍 缓慢进行性失语不伴其他认知功能障碍 辅助检查 CT可见脑萎缩，脑室扩大，MRI可见双侧颞叶、海马萎缩 脑脊液tau蛋白升高、 Aβ42降低 有家族史患者可进行APP、PS、1PS2基因检测。 影像学多无明显特异性表现 CT/MRI: 局限性额或前颞叶萎缩 遗传学: 17q21, tau蛋白基因突变 CT、MRI可见多发性脑梗死，或累及海马、丘脑等重要部位的梗死病灶 治 疗 胆碱酯酶抑制剂 美金刚 胆碱酯酶抑制剂 抗精神病药物 慎用多巴胺 安定类 SSRI 脑血管病二级预防 改善认知治疗 In this test, the patient is asked to draw a clock face depicting a specified time: in this example, 2:45. The drawing is then rated on a scale of 10 to 1, with 10 being an accurate and well-organized depiction and 1 being an incoherent or uninterpretable scribbling. Two studies found clock drawing to be highly correlated with several independent global measures of dementia severity. It is also very well accepted by patients. Although clearly not diagnostic, clock drawing affords a convenient screening tool when sophisticated neuropsychologic testing is not available. It is especially helpful in the primary care setting in identifying patients who may require further cognitive assessment. In assessing the drawings, the clinician should apply the following criteria: Normal: The hands are in the correct position in a score of 10. Mild impairment: Compared with an accurate rendering of a clock showing a time of 2:45, errors are noticeable in the placement of hour and minute hands in a score of 8. Moderate impairment: The clock face is distorted, numbers are out of sequence, missing, or outside of the boundaries of the clock face in a score of 4. Severe impairment: The drawing is only vaguely representative of a clock in a score of 2. Sou