小结
定义
病史和体格检查
关键诊断因素
- 性格、社会行为与习惯粗化
- 言语流畅性或理解能力进行性丧失
- 记忆损伤、定向障碍及失用症的产生
- 进行性自我忽视及抛弃工作、活动与社会接触
其他诊断因素
- 发病年龄早
- FTD 家族史
- 进食习惯改变
- 注意迟钝、幼稚的专注之事、努力不足、冲动反应及强迫行为
- ALS体征
- 震颤麻痹症状
- 肌束颤动、萎缩、反射亢进及运动神经元疾病的其他体征
- 眉间、鼻、吮吸、觅食或抓握反射
- 膀胱及肠道控制功能丧失
危险因素
- MAPT基因突变
- GRN 基因突变
- C9orf72 基因突变
- 外伤性脑损伤
诊断性检查
首要检查
- 正式认知测试
- 脑部 MRI
- 头颅 CT
- 全血细胞计数 (FBC）
- 血清 CRP
- 血清促甲状腺激素 (TSH)
- 游离甲状腺素（T4）
- 生化检查
- 血清尿素
- 血清肌酐
- 肝功能检查 (LFT)
- 血清维生素 B12 水平
- 血清叶酸水平
- 梅毒血清学检查
- HIV 检测
- 血清酶联免疫吸附测定
需考虑的检查
- 脑 18F-脱氧葡萄糖 (FDG) PET
- 脑部单光子发射型计算机断层显像（SPECT）
- 脑活组织检查
- 基因检测
- 结缔组织成套检查
- 血清红细胞沉降率
新兴检查
- 脑脊液分析
治疗流程
所有患者
撰稿人
作者
Raghava Kurup Radhakrishnan, DPM(NIMHANS), DNB(Psych), MRCPsych
Consultant Psycho-geriatrician
Waitemata District Health Board
Auckland
New Zealand
利益声明
RKR declares that he has no competing interests.
Sachin Jauhari, DMH, MRCPsych, FRANZCP
Consultant Psycho-geriatrician
Waitemata District Health Board
Honorary Senior Lecturer in Old Age Psychiatry
University of Auckland
Auckland
New Zealand
利益声明
SJ declares that he has no competing interests.
鸣谢
Dr Raghava Kurup Radhakrishnan and Dr Sachin Jauhari would like to gratefully acknowledge Dr Lawrence Whalley and Dr Chiadi Onyike, the previous contributors to this topic, and colleagues Dr Ann Boston (clinical psychologist), Dr Zara Godinovich (clinical psychologist), and Diane Ellis (clinical nurse specialist) for their suggestions.
利益声明
LW, CO, AB, ZG, and DE declare that they have no competing interests.
同行评议者
Daniel Kaufer, MD
Director
Memory Disorders Program
Department of Neurology
University of North Carolina at Chapel Hill
NC
利益声明
DK has received research support, speaking honoraria, and consulting fees from Eisai, Forest Laboratories, Johnson & Johnson, Medivation, Novartis, Ortho-McNeil, and Pfizer.
Bruce L. Miller, MD
Professor of Neurology
University of California
San Francisco
CA
利益声明
BLM 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
利益声明
PS declares that he has no competing interests.
鉴别诊断
- 阿尔茨海默病 (AD)
- 路易体痴呆(DLB)
- 血管性痴呆
更多 鉴别诊断指南
- 神经姑息治疗的临床指南：AAN 立场声明
- 痴呆诊断和护理的伦理考量：AAN 立场声明
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