1、排除性标准,缺乏明确的诊断性标记物,没有特异性举例DLDHdementia lacking distinctive histological features FTDfrontotemporal dementiaFTLD-Ufrontotemporal lobar degeneration,ubiquitinated type Lancet Neurol,2005Balit Syndrome:(1)an inability to project gaze voluntarily into the peripheral field and to scan it despite the fact
2、that eye movements are full(psychic paralysis of fixation of gaze);(2)a failure to precisely grasp or touch an object under visual guidance,as though hand and eye were not coordinated;and(3)visual inattention mainly to the peripheral of the visual field,attention to other sensory stiuli being intact
3、.白箭头白箭头:顶枕叶萎缩黑箭头黑箭头:海马结构相对完好Neurology,2004主主要要表表现现Arch Neurol,2006 Neurology,2000Brain,2000J Neurol,2005 Neuron,2004内嗅皮层内嗅皮层是海马旁回内是海马旁回内侧部特殊的灰质结构侧部特殊的灰质结构1231-1-海马旁回(包海马旁回(包括内嗅皮层)括内嗅皮层)2-2-海马海马3-3-齿状回齿状回海马结构海马结构海马海马内嗅皮层内嗅皮层扣带回扣带回丘脑前核乳头丘脑束学习学习和和记忆记忆Papez环路环路感情行为感情行为的基础的基础Nature Reviews,2007早期诊断早期诊断早期
4、干预早期干预Arch Neurol,2005MCI概念的延伸MCI的亚型Arch Neurol,2005MCIADVDFTDDeprDLBMCI临床表型、病临床表型、病理基础的异质性理基础的异质性特异性特异性37-90%敏感性敏感性46-88%预测AD混杂有相当多的非混杂有相当多的非AD患者,影响对早患者,影响对早期干预有效性的评价期干预有效性的评价新的诊断标准新的诊断标准将不再使用将不再使用MCI的概念的概念敏感性敏感性85-94%85-94%特异性特异性83-100%83-100%三者结合Lancet Neurol,2003 与老标准相同,新标准也将这些特殊与老标准相同,新标准也将这些特殊ADAD排排除在外,否则严重除在外,否则严重影响诊断的可靠性影响诊断的可靠性 谢谢!谢谢!