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 (thousands) (千个) 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 Moderate 中度 Severe 严重

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… Mild Cognitive Impairment 轻度认知障碍 Physiological Aging 生理性 老化 Clinical dementia 临床诊断痴呆

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 MCI 24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 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%) Chi Square, p< 0.001

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

Non-pharmacological treatment for dementia 非药物治疗 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

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