痴呆常见类型及鉴别讲解课件.ppt

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. Sources Juby A. Correlation between the Folstein Mini-Mental State Examination and three methods of clock drawing scoring. J Geriatr Psychiatry Neurol. 1999;12:87–91. Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in AD: a novel measure of dementia severity. J Am Geriatr Soc. 1989;37:725–729. 临床表现 帕金森综合征 发生率75％一80％ 与黑质细胞变性、多巴胺能投射纤维的减少相关 早期出现严重的锥体外系症状多见于病理上的单纯型(不伴AD的病理表现) 运动迟缓、肌张力增高和面具脸最常见，震颤较少，两侧同时发病，多巴胺治疗效果不佳。 锥体外系体征与痴呆同时出现，或两者多于1年之内相继出现 临床表现 快速动眼睡眠期异常行为(RBD) 发生于快速动眼睡眠期，以睡眠中肌肉松弛间断缺失为特点，表现为躯体活动和痉挛增多，可有复杂剧烈的肢体或躯干运动如系扣、摆臂，伴梦境回忆 多导睡眠描记图显示睡眠期间颊下或肢体肌张力增高 RBD一般发生于痴呆出现前数年，这也是其他α-突触共核蛋白病的常见特点 临床表现 对神经安定药的敏感性 对D2受体的拮抗阻滞作用，约半数DLB患者会发生锥体外系症状加重，甚至可能危及患者生命 诊断标准 两个核心表现或一个核心表现加上一个提示性表现可以诊断为很可能的DLB 一个核心表现加上一个或多个支持性表现可以诊断为可能的DLB 治疗 尚无特效治疗，