检测华裔年长人士的早期痴呆症征状Detection of mild dementia in community living Chinese older adults

Linda CW Lam

Department of Psychiatry

The Chinese University of Hong Kong

香港中文大学精神科学系林翠华教授

Hong Kong - A rapidly ageing population香港 : 一个急速老化的人口

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Population projection (2004) - Elderly population constitutes 27% of total population in 2033

人口预测 (2004): 于 2033 年 , 老年人占总体人口的 27%

Dementia epidemic老年痴呆症的流行性

• Commonest neurodegenerative disorder of old age.最常见的老年神经退化失调

• Over 25% of subjects will suffer from dementia in the 8th decade of life. 八十岁或以上长者 , 超过四分一患有痴呆症

Current scene for Dementia Care痴呆症照顾 - 现況• HK Dementia Prevalence

Study 香港痴呆症流行病学研究 (2006)– Over 80% of community dwelling

persons with demented are mild.逾八成在社区的痴呆症患者的病况属轻微

– Only 11% had been diagnosed as dementia.只有 11% 曾被诊断为患上痴呆症

– Caregivers are not well informed of the diagnosis.照顾者大多对诊断没有认识

– Most moderately and severely demented subjects are not cared at home.

大部份的中度及严重的痴呆症患者都不是在家中接受照料

Dementia Care 痴呆症照顾

Mild 轻度

Moderate 中度

Severe严重

Patient presents to the service病人开始接触服务单位

Cognitive states in aging elders老年人的认知状态

• Normal aging 正常老化– Successful aging 成功老龄

• Preservation of intact cognition, functioning and mood stability保持良好的认知功能，活动功能和情绪稳定

– Physiological aging生理记忆功能衰退

• Degree of cognitive deterioration not associated with functional impairment某程度的认知衰退与 , 大致并不影响生活功能

• Mild Cognitive impairment轻度认知障碍

• Dementia 老年痴呆症

From Preclinical to Clinical AD…临床前期痴呆症诊断…

Clinical dementia临床诊断痴呆

Mild Cognitive Impairment

轻度认知障碍

Physiological Aging

生理性老化

Mild Cognitive Impairment轻度认知障碍

• Subjective Memory complaints 主观性的记忆投诉

• Objective memory impairment 客观性的记忆缺损认知功能测验中 , 记忆表现有初期衰退的征状

• Cognitive function better than demented subjects其他认知功能尚算正常

• Relatively preserved ADL 仍能保持一定的自我照顾能力

• Clinically not demented 不符合临床痴呆症诊断的标准

Petersen et al, 1999

Mild Cognitive Impairment轻度认知障碍• A high risk condition with

progression to clinical dementia, mostly AD.

轻度认知障碍患者属高危一族

• Annual progression rate about 10% in a clinic sample

在门诊个案中，每年转化为痴呆症的患病率约 10%

Petersen, Neurology, 1999; Petersen, Arch Int Med, 2005

Why do we need early detection of dementia?检测华裔年长人士的早期痴呆症征状

Public health perspective公众健康观点• Dementia is an age related disorder.

老年痴呆症是一种年龄有关的疾病。 • Prevalence doubles every 5 years

after the age of 65. 65 岁以后，流行病率会每 5 年增加一倍。

• Intervention that delay the onset of clinical dementia will have positive impact on the prevalence.早期介入治療能延緩临床痴呆症的发病期，对患病将有正面的影响。

Individual patient management个人健康 观点• Early detection of cases will

optimize the benefits of treatment.及早发现的病例，会增加治疗的效益。

• Better personal planning.更好的个人计划。

• Maintain quality of life.保持生活素质。

Clinical Assessment 临床评估• Neuropsychology

神经心理学• Behavioral change

行为改变• Functional deterioration

功能衰退• Neuroimaging

大腦影像素描• Physical investigation

体检

Risk factor for progression to dementia?渐进痴呆症的高危因素 ?

• Old Age 年长。• Family history 家族遗传倾向。• Genetic predisposition ＡｐｏＥ４基因。• Impaired delayed recall in cognitive

test 片段迟延记忆较差。

• Hippocampal atrophy on brain imaging 脑造影扫描中 , 海马状体出现萎缩。

• Impaired ADL noticed by family members 在日常处理繁复的事务 , 能力比以往下降。

Prospective study of MCI in Hong Kong轻度认知障碍追踪研究

24 month follow up study of MCI24 个月的轻度认知障碍追踪研究

Participants参与者• Non-demented subjects recruited

as volunteers from social centre and old age hostels in Hong Kong.由本港的社区中心及老人院招募长者

• Baseline cognitive assessment基础的认知评估

• Follow up for two years定期跟进维期两年

Abbreviated Memory Inventory for Chinese- AMIC簡短中文记忆投诉问卷

• 在过往一个月内 ,你有没有忘记自己的东西放在何处呢？

• 当遇见相熟朋友时，你有没有忘记他们的姓名呢？

• 在谈话过程中，你有没有突然忘记自己想要说的话呢？

• 你认为自己记忆力有没有问题呢？ • 你有没有认为自己记忆能力 ,比周遭同

龄的人较差呢？

Cognitive assessment认知能力检查

• Cantonese MMSE广东话简短智能测验

• Chinese ADAS-Cog中文阿氏痴呆症评估量表–认知部份

• Chinese category verbal fluency test中文口述流畅测试

Chiu et al, Neurology, 1998; Chu et al, Ann Acad Med Singapore, 2000; Lam et al, Demen & Geriatr Disord 2006

Progression at 24 months 跟进进程

Chi Square, p< 0.001

Baseline NC基础正常

Baseline MCI基础轻度认知障碍

FU NC 跟进正常 89 (52.9%) 25 (18.4%)FU MCI跟进轻度认知障碍 42 (25%) 50 (36.8%)FU dementia跟进老年痴呆症 8 (4.8%) 28 (20.6%)Not assessed at FU未能于跟进评估 38 (21.5%) 33 (24%)

Predictors for decline预计衰退指标• ADAS-Cog total score阿氏痴呆症评估量表–总分

• Delay recall 近期片段迟延记忆

• Category verbal fluency test中文口述流畅测试

• aMIC score中文记忆投诉问卷

Detection of early dementia - Education & Training检测早期痴呆症征状 : 教育及训练

Education & Training 教育及训练• Importance of early assessment 及早评估的重要性

– Identify early signs of dementia 及早确认痴呆症的初期征兆

• Risk factors identification 确认高危因素• Family counseling 家庭辅导• Planning for management 制定管理计划

MCI and mild dementia轻度认知障碍 = 痴呆症 ?

• NOT all MCI subjects progress to dementia.不是所有的轻度认知障碍患者会演变成痴呆症

• MCI 轻度认知障碍– Preclinical dementia 临床前的痴呆症– Physiological aging 生理学上的老化– Psychiatric conditions 精神病的征状，如抑郁

– Transient physical problems短暂的身体问题

Management 治疗计划

• Drug use药物• Non-pharmacological treatment for

dementia 非药物治疗• Holistic management plan 整体管理

计划– Caregiver support 照顾者的支持– Social needs 社会上的需要– Advance directives 预設医疗指示

• Not all subjects with mild cognitive impairment and mild dementia need specialist management. 不是所有轻度认知障碍 , 痴呆症患者都需要专科治疗

Summary總結• Dementia epidemic is a

global issue. 痴呆症的流行性渐增是全球问题

• Early detection of cognitive impairment presents an opportunity for reducing the burden.及早发现老年认知障碍 ,提供机会介入 ,减轻各方面的负担

Thank You谢谢 !