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Doença de Alzheimer

Last reviewed: 20 Aug 2025
Last updated: 20 Aug 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • perda de memória
  • desorientação
  • disfasia nominal
  • colocar itens no lugar errado/se perder
  • apatia
  • declínio das atividades da vida diária e atividades instrumentais da vida diária (AIVDs)
  • alteração de personalidade
  • exame físico inicial normal
Full details

Other diagnostic factors

  • mudanças de humor e comportamento
  • má qualidade do pensamento abstrato
  • dispraxia construtiva
  • prosopagnosia
  • autoprosopagnosia
Full details

Risk factors

  • idade avançada
  • história familiar
  • genética
  • Síndrome de Down
  • doença cerebrovascular
  • fatores de estilo de vida e ambiente
  • uso de determinados medicamentos
  • Escolaridade inferior ao ensino secundário
  • lesão cerebral traumática
  • depressão
  • perda auditiva
  • doença periodontal
  • comprometimento visual
  • infecção por vírus do herpes simples 1 (HSV-1)
  • hiperlipidemia
  • sexo feminino
  • nível elevado de homocisteína no plasma
  • cirurgia sob anestesia geral
Full details

Diagnostic investigations

1st investigations to order

  • testes cognitivos
  • Hemograma completo
  • perfil metabólico
  • hormônio estimulante da tireoide (TSH) sérico
  • vitamina B12 sérica
  • exame de urina para detecção de drogas
  • TC cranioencefálica (sem contraste)
  • RNM cranioencefálica (sem contraste)
Full details

Investigations to consider

  • Análise do líquido cefalorraquidiano (LCR)
  • reagina plasmática rápida/teste Venereal Disease Research Laboratory (VDRL) séricos
  • teste para sorologia de HIV
  • testes neuropsicológicos formais
  • teste genético
  • PET com fluordeoxiglicose (FDG-PET)
  • Teste de biomarcadores no LCR
Full details

Emerging tests

  • tomografia por emissão de pósitrons (PET) do amiloide
  • biomarcadores sanguíneos

Treatment algorithm

ONGOING

todos os pacientes

Contributors

Authors

Judith Neugroschl, MD

Associate Professor of Psychiatry

Alzheimer's Disease Research Center

Icahn School of Medicine at Mount Sinai

New York

NY

Disclosures

JN participates in research funded by National Institutes for Health (NIH) grants. The Alzheimer's Disease Research Center is a site for clinical research but JN is not the site Principal Investigator, has no role in purchasing nor choosing the studies, and gains no compensation if it succeeds. JN helps to edit the Focus on Healthy Aging Alzheimer's yearly report.

Acknowledgements

Dr Judith Neugroschl would like to gratefully acknowledge Dr Brandy R. Matthews, Dr Asif S. Bhutto, and Dr Julie K. Gammack, the previous contributors to this topic.

Disclosures

BRM, ASB, and JKG declare that they have no competing interests.

Peer reviewers

Roy J. Goldberg, MD, FACP, AGSF, CMD

Medical Director

Kings Harbor Multicare Center

New York

NY

Disclosures

RJG declares that he has no competing interests.

Philip Scheltens, MD, PhD

Professor of Neurology

Department of Neurology/Alzheimer Center

VU University Medical Center

Amsterdam

The Netherlands

Disclosures

PS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission. Lancet. 2024 Aug 10;404(10452):572-628. Abstract

American College of Radiology. ACR appropriateness criteria: dementia. 2024 [internet publication].Full text

McShane R, Westby MJ, Roberts E, et al. Memantine for dementia. Cochrane Database Syst Rev. 2019 Mar 20;(3):CD003154.Full text  Abstract

Birks JS, Chong LY, Grimley Evans J. Rivastigmine for Alzheimer's disease. Cochrane Database Syst Rev. 2015 Sep 22;(9):CD001191.Full text  Abstract

Birks JS, Harvey RJ. Donepezil for dementia due to Alzheimer's disease. Cochrane Database Syst Rev. 2018 Jun 18;(6):CD001190.Full text  Abstract

Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016 May 1;173(5):543-6.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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