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 !