2. 看出來哪裡怪嗎？

6. 認知功能疾患的重要性 Mental disorders among older adults--ECA 7.9 0 Others 8.3 0 Personality disorders 0 0.1 Somatization 0 0.1 Schizophrenia 2.6 0.9 Alcoholism 5.2 5.5 Anxiety disorders 18.5 2.5 Affective disorders 30.2 4.9 Cognitive impairment inpatients community

16. 失智症的流行病學 - 生命損失 Reference: WHO(2006). NEUROLOGICAL DISORDERS. Public health challenges

17. 失智症的分類 血管型失智症 (10-20%) 混和型失智症 (10%) 可逆型、可治療型失智症 (10-15%) 阿茲海默型失智症 額顳葉型失智症 路易氏體失智症 進行性核上麻痺症 韓汀頓氏症 HIV-Related dementia Dementia 退化型失智症 (60%) 皮質型 下皮質型

26. 阿茲海默症 (Alzheimer’ s Disease, AD) Alzheimer Disease Progression Greater incidence of mood and behavioral disturbances Possible mood and behavioral disturbances Apathy & depression Mood and behavior Bradykinesia, at risk for falls Repetitive actions, apraxia Difficulty writing and using Motor Misidentifies familiar persons and places May get lost at times, even inside the home Seeks familiar and avoids unfamiliar Orientation Expressive and receptive aphasia Moderate aphasia Mild aphasia Language Mixes up past and present Chronic, recent memory loss Loss of recent memory Memory Needs reminders with all ADL’s Needs reminders and help with most ADL’s Needs reminders with some ADL’s Activities of daily living (ADL) Late Stage Middle Stage Early Stage Function

33. 失智症的診斷流程 Memory Impairment Drugs & other Dementia Delirium Depression AD AD + VaD VaD + AD VaD Lewy body Lewy + AD Other Alcohol Recreational Medications Others Alone + Dementia Pseudo dementia + Dementia ? ? ? ? ? ? The following diagram presents an outline of the diagnostic process for dementia. Many of the elements are discussed in greater depth in aetiology of dementia.

35. 失智症的診斷區別 (Delirium vs Dementia) Usually Alzheimer's disease, vascular dementia, or Lewy body dementia Usually an acute illness or drugs ; in older people, usually infection, dehydration, or drugs Cause ( 起因 ) Lost, especially for recent events Jumbled and confused Memory ( 記憶 ) Sometimes difficulty finding the right word Slow, often incoherent ( 無邏輯 ), and inappropriate Use of language ( 談話 ) Impaired Varies Orientation to surroundings ( 定向感 ) Maintained until late stages Greatly impaired Attention ( 注意力 ) Possibly none Almost always present; may be a severe illness , drug use or withdrawal , or a problem with metabolism Presence of other disorders or physical problems ( 是否合併其他可能身體疾病或疾患 ) Months to years Days to weeks Duration ( 病程持續時間 ) Slow ( 緩慢進行 ) Sudden ( 突然發生 ) Development ( 病程發展 ) Nonemergency medical attention Emergency medical attention Need for treatment Dementia Delirium Feature

36. 失智症的診斷結果分佈

56. Any Questions?