專 題 報 導 2014 25 151-157 1 2 1,3 1 2 3 摘 要 2013 (major neurocognitive disorder) Dementia Major neurocognitive disorder 2012 4 1 2010 3560 770 4 6040 ( 20) 45% 40% 15% ( ) 2011 19 2 (65 ) 17 2056 72 2011 2012 5% 2004 26.8% 61.8% 64.5% 3 2000 7
152 4 5 16~42 4 (Alzheimer s disease) (frontotemporal lobe dementia) (dementia with Lewy bodies) (senile plaques) (neurofibrillary tangles) ( ) 50 (post-stroke vascular dementia) (dementia with small vessel diseases) 5% 25% (Parkinson s disease) 6 5 (Parkinson s disease dementia) ( ) ( ) ( ) ( ) (Alzheimer s Association) ( ) 6 8 10 15
153 ( ) E (apolipoprotein E) (amyloid precursor protein) presenilin-1 presenilin-2 Tau E4 2-3 E4 15 7 B12 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 1. (Mini-Mental State Examination, MMSE) ( ) ( 7) ( ) ( ) ( ) 0 ( ) 30 ( ) 8 24 21 16 2. (Clinical Dementia Rating, CDR) 6 6 0-3 5 0 (health) 0.5 (questionable) 1 (mild) 2 (moderate) 3 (severe) 3. (The Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE) 10 IQCODE MMSE 9 4. (Alzheimer s Disease Assessment Scale) 10 5. (Cognitive Abilities Screening Instrument, CASI)
154 (Hasegawa Scale) 20 100 9 (cognitive domain) 11 (American Psychiatric Association) (Diagnostic and Statistical Manual of Mental Disorders, 4th edition; DSM-IV) 2013 (DSM-V) 12 DSM-V (dementia) (neurocognitive disorders NCDs) NCDs (major neurocognitive disorder, major NCD) (mild neurocognitive disorder, mild NCD) (complex attention) (executive ability) (learning) (memory) (language) (perceptual-motor) (social cognition) (National Institute of Neurological and Communi- cative Disorders and Stroke, NINCDS) (Alzheimer s Disease and Related Disorders Association, ADRDA) 1984 13 81% 70% 14 15 (National Institute on Aging, NIA) 2011 (NIA-AA diagnostic criteria) 16 1. 2. 3. 4. 5. (1) (2) (3) (4) (5) ( ) (anti-cholinergics)
155 B12 (subacute combined degeneration) ( ) B12 ( ) ( ) (prion disease) N-methyl-D-aspartate (NMDA) (antipsychotic) (antidepressant) donepezil rivastigmine galantamine NMDA ( memantine) 6 MMSE 2 ( ) CDR 1 NMDA ( ) (behavioral and psychological symptoms of dementia, BPSD) quetiapine risperidone olanzapine ziprasidone sulpiride clozapine citalopram sertraline paroxetine fluoxetine trazodone imipramine
156 B12 ( ) ( ) ( ) 2. The Estimated Report on the Population of Dementia in Taiwan. Taiwan Alzheimer's Disease Association, 2012. 3. Chen TF, Chiu MJ, Tang LY, et al. Institution type-dependent high prevalence of dementia in long-term care units. Neuroepidemiology 2007; 28: 142-9. 4. Chou LF, Fu JL, Wang SJ. The economic costs of dementia in Taiwan. National Chengchi University J 2000; 82: 1-25. 5. Padovani A, Costanzi C, Gilberti N et al. Parkinson's disease and dementia. Neurological Sciences 2006;27 (Suppl 1): S40-3. 6. Alzheimer's Association : 10 warning signs of Alzheimer's disease. The Journal of the Oklahoma State Medical Association 2012;105: 437-44. 7. Blennow K, de Leon MJ, Zetterberg H. Alzheimer's disease. Lancet 2006;368: 387-403. 8. O Connoer DW, Treasure FP, Brook CP, Reiss BB. The influence of education, social class and sex on Mini-Mental State scores. Psychol Med 1989; 19: 771-6. 9. Fuh JL, Lin KN. The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening tool for dementia for a predominantly illiterate Chinese population. Neurology 1995; 45: 92-6. 10. Liu HC, Chuang YY, Lin KN, Fuh JL, Wang PN. The Alzheimer's Disease Assessment Scale: findings from a low-education population. Dement Geriatr Cogn Disord 2002;13:21-6. 11. Teng EL, Homma A. The Cognitive Abilities Screening Instrument (CASI): A practical test for cross cultural epidemiological studies of Dementia. Int Psychogeriat 1994; 6:45-58. 12. David JK. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association 2013: 591-644. 13. McKhann GM. Mental and clinical diagnosis of Alzheimer s disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer s Disease. Neurology 1984; 34: 934-44. 14. Knopman DS, Dekosky ST, Cummings JL, et al. Practice parameter: Diagnosis of dementia (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56: 1143-53. 15. Price JL, Morris JC. Tangles and plaques in nondemented aging and "preclinical" Alzheimer's disease. Ann Neurol 1999; 45: 358-68. 16. McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011; 7: 263-9. 1. Geneva, Dementia: A Public Health Priority. World Health Organization and Alzheimer's Disease International, 2012.
157 Dementia: A Focused Review Ka-Ian Leong 1, Yen-Ching Chen 2, and Jen-Hau Chen 1,3 1 Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; 2 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan As populations around the world are aging rapidly, patients with dementia increase steadily. Dementia is a syndrome characterized by progressive deterioration in cognitive function, including memory, which impairs a person s capacity to function normally. Although dementia mainly affects older people, it is not a normal part of aging. Dementia imposes huge economic burdens worldwide, including Taiwan. Diagnosing dementia is often difficult, particularly in the early stage. However, early diagnosis of dementia is a crucial element in managing dementia. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), dementia in the previous edition was replaced by major neurocognitive disorder. The criteria for major neurocognitive disorder include significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition). Currently, there is no curable treatment for dementia. Pharmacologic and non-pharmacologic treatments may be helpful to both cognitive and behavioral symptoms of dementia. The principal goal of dementia care is to slow the disease progression and improve symptoms. It is also important to reduce the burden of caregivers and thus improve their quality of life. (J Intern Med Taiwan 2014; 25: 151-157)