認知症診療ガイドライン2017_100_第1章.indd
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1 1 CQ ICD 10 /Alzheimer National Institute on Aging Alz heimer s Association workgroup NIA AA 5 DSM 5 ICD NIA AA 2011 Alzheimer 2 2 DSM neurocognitive disorders dementia major neurocognitive disorder DSM ICD G G2 G1 G G4 G1 6 ICD
2 1CQ NIA AA a b c d e 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 DSM 5 DSM A B C D DSM World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 10th Revision. Geneva World Health Organization McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer s disease recommenda tions from the National Institute on Aging Alzheimer s Association workgroups on diagnostic guidelines for Alzheimer s disease. Alzheimers Dement American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM 5. Arlington, VA American Psychiatric Association PubMed #1 "Dementia/diagnosis" Majr OR "Dementia/classification" Majr OR dementia TI AND definition* TIAB OR criteria TIAB OR concept* TIAB OR "Cognition Disorders/diagnosis" Majr OR "Cognition Disorders/ classification" Majr OR cognition disorder* TI OR "cognitive dysfunction" TI AND definition* TIAB OR criteria TIAB OR concept* TIAB #1 /MTH OR /TI OR /MTH OR /TI AND SH,,, X,, OR /TH OR /TI AND /TI OR /TIOR /TI OR /TI OR /TI OR /TI OR /TI OR /TI OR /TI OR /TI 3
3 CQ 1 2 DSM 5 major neurocognitive disorder DSM 5 mild neurocognitive disorderdsm 5 subjective cognitive impairment SCI subjective cognitive decline SCD National Institute on Aging Alzheimer s Association workgroup NIA AAAlzheimer preclinical Alzheimer s disease 1 Alzheimer MCI due to Alzheimer s disease 2 Alzheimer Alzheimer s disease dementia Alzheimer 3 3 stage 1stage 2 stage 3 DSM neurocognitive disorders delirium major neurocognitive disorder DSM 5 mild neurocognitive disorderdsm vascular cognitive impairment VCI vascular dementia VaD 5 VCI VaD cerebral autosomal dominant arteriop athy with subcortical infarcts and leukoencephalopathy CADASIL cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy CARASIL Binswanger Alzheimer VaD vascular cognitive disorder VCD CQ Petersen 7 DSM 5 NIA AA ICD CQ4B 5 age associated memory impairment AAMIaging associated cognitive decline AACDmild cognitive disorder MCDmild neurocognitive decline MNCD cognitive impairment no dementia CIND 9 1 Sperling RA, Aisen PS, Beckett LA, et al. Toward defining the preclinical stages of Alzheimer s disease recommendations 4 1
4 1CQ 1 2 from the National Institute on Aging Alzheimer s Association workgroups on diagnostic guidelines for Alzheimer s disease. Alzheimers Dement Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer s disease recom mendations from the National Institute on Aging Alzheimer s Association workgroups on diagnostic guidelines for Alzhei mer s disease. Alzheimers Dement McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer s disease recommenda tions from the National Institute on Aging Alzheimer s Association workgroups on diagnostic guidelines for Alzheimer s disease. Alzheimers Dement American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM 5. Arlington, VA American Psychiatric Association Hachinski V, Iadecola C, Petersen RC, et al. National Institute of Neurological Disorders and Stroke Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke Roman GC, Sachdev P, Royall DR, et al. Vascular cognitive disorder a new diagnostic category updating vascular cognitive impairment and vascular dementia. J Neurol Sci Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med World Health Organization. International Statistical Classification of Diseases and Related Health problems. 10th Revision. Geneva World Health Organization PubMed #1 "Dementia/diagnosis" Majr OR "Dementia/classification" Majr OR dementia TI AND definition* TIAB OR criteria TIAB OR concept* TIAB OR "Cognition Disorders/diagnosis" Majr OR "Cognition Disorders/ classification" Majr OR cognition disorder* TI OR "cognitive dysfunction" TI AND definition* TIAB OR criteria TIAB OR concept* TIAB #1 /MTH OR /TI OR /MTH OR /TI AND SH,,, X,, OR /TH OR /TI AND /TI OR /TIOR /TI OR /TI OR /TI OR /TI OR /TI OR /TI OR /TI OR /TI 5
5 CQ 1 3 DSM 5 Alzheimer Lewy HIV Parkinson Huntington 1 1 ICD 10 Alzheimer 2 DSM 5 Alzheimer Lewy HIV Parkinson Huntington 3 B 12 treatable dementia World Health Organization. International Statistical Classification of Diseases and Related Health problems. 10th Revision. Geneva World Health Organization American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM 5. Arlington, VA American Psychiatric Association PubMed #1 "Dementia/etiology" Majr OR dementia TI AND etiology OR "Cognition Disorders/etiology" Majr OR cognition disorder* TI OR "cognitive dysfunction" TI AND etiology AND "Risk Factors" Majr OR risk factor* TI #1 /MTH OR /TI OR /MTH OR /TI AND SHOR /TI or /TI 6 1
6 1CQ Alzheimer Lewy /Parkinson Huntington 2VaD VaD VaD VaD HIV AIDS Creutzfeldt Jakob 8 9 Cushing 10 Marchiafava Bignami B 1 Wernicke Korsakoff B 12 D A 5 FU B C D Wilson 11 Behçet Sjögren Fahr AND /TH OR /TI OR /TI AND PT OR SHAND /TI or / TI 7
7 CQ 1 4 Alzheimer DSM 5 1 Alzheimer Alzheimer
8 1CQ 1 4 1Alzheimer Alzheimer 2 Alzheimer Alzheimer 3 Alzheimer Alzheimer 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM 5. Arlington, VA American Psychiatric Association PubMed #1 "Dementia/diagnosis" Majr OR dementia TI AND diagnosis OR diagnostic OR "Cognition Disorders/ diagnosis" Majr OR cognition disorder* TI OR "cognitive dysfunction" TIAND diagnosis OR diagnostic AND "Diagnosis, Differential" Majr OR "Diagnostic Errors" Mesh OR "differential diagnosis" TI OR diagnostic error* TI OR misdiagnosis TI #1 /MTH OR /TI OR /MTH OR /TI AND SH,,, X,, OR /TH OR /TI AND /MTH OR /TI OR /MTH OR /TI OR /TI 9
9 CQ % A % % 1 2, % CI % %CI , , , [%] ~69 70~74 75~79 80~84 85~89 90~94 95~[ 歳 ] 男性女性全体
10 1CQ 1 5 [100 万人 ] [ 年 ] 2 Alzheimer s Disease International. World Alzheimer Report 2015 The Global Impact of Dementia an analysis of prevalence, incidence, cost and trends. London Alzheimer s Disease International 高所得国 低 ~ 中所得国 1 Dodge HH, Buracchio TJ, Fisher GG, et al. Trends in the prevalence of dementia in Japan. Int J Alzheimers Dis Ikejima C, Hisanaga A, Meguro K, et al. Multicentre population based dementia prevalence survey in Japan a preliminary report. Psychogeriatrics Alzheimer s Disease International. World Alzheimer Report 2015 The Global Impact of Dementia an analysis of preva lence, incidence, cost and trends. London Alzheimer s Disease International Matthews FE, Arthur A, Barnes LE, et al. A two decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England results of the Cognitive Function and Ageing Study I and II. Lancet Qiu C, von Strauss E, Bäckman L, et al. Twenty year changes in dementia occurrence suggest decreasing incidence in central Stockholm, Sweden. Neurology Schrijvers EM, Verhaaren BF, Koudstaal PJ, et al. Is dementia incidence declining? Trends in dementia incidence since 1990 in the Rotterdam Study. Neurology Doblhammer G, Fink A, Fritze T. Short term trends in dementia prevalence in Germany between the years 2007 and Alzheimers Dement Satizabal CL, Beiser A, Chêne G, et al. Temporal trends in Dementia Incidence in the Framingham Study Jul 17 Copenhagen AAIC PubMed #1 "Dementia/epidemiology" Majr OR dementia TIAND "Morbidity" Mesh OR morbidity TI OR incidence TI OR prevalence TI #1 /TH OR /TI AND /TH OR /TI OR /TI AND /TH OR /TI OR / TI OR /TI 11
11 CQ 1 6 Alzheimer B 2010 Alzheimer 67.6% 19.5% Lewy / Parkinson 4.3% Alzheimer 1990 Alzheimer 80 2 Alzheimer Alzheimer 6 Lewy 1 Alzheimer % % %
12 1CQ Dodge HH, Buracchio TJ, Fisher GG, et al. Trends in the prevalence of dementia in Japan. Int J Alzheimers Dis Wakutani Y, Kusumi M, Wada K, et al. Longitudinal changes in the prevalence of dementia in a Japanese rural area. Psychogeriatrics Sekita A, Ninomiya T, Tanizaki Y, et al. Trends in prevalence of Alzheimer s disease and vascular dementia in a Japanese community the Hisayama Study. Acta Psychiatr Scand PubMed #1 "Dementia/epidemiology" Majr OR dementia TIAND "Morbidity" Mesh OR morbidity TI OR incidence TI OR prevalence TIAND subtype TI OR subtypes TI OR "sub type" TI OR "sub types" TI #1 /TH OR /TI AND /TH OR /TI OR /TI OR /TI AND /AL 13
13 CQ 1 7 C % 1 70 HR p % HR , % p % p [%] [ 年 ] 知症者の平均余命の喪失報告年認 1 % Brodaty H, Seeher K, Gibson L. Dementia time to death a systematic litera ture review on survival time and years of life lost in people with dementia. Int Psychogeriatr
14 1CQ 1 7 % Schrijvers EM, Verhaaren BF, Koudstaal PJ, et al. Is dementia incidence declining? Trends in dementia incidence since 1990 in the Rotterdam Study. Neurology Langa KM, Larson EB, Karlawish JH, et al. Trends in the prevalence and mortality of cognitive impairment in the United States is there evidence of a compression of cognitive morbidity? Alzheimers Dement Qiu C, von Strauss E, Bäckman L, et al. Twenty year changes in dementia occurrence suggest decreasing incidence in central Stockholm, Sweden. Neurology Doblhammer G, Fink A, Fritze T. Short term trends in dementia prevalence in Germany between the years 2007 and Alzheimers Dement Brodaty H, Seeher K, Gibson L. Dementia time to death a systematic literature review on survival time and years of life lost in people with dementia. Int Psychogeriatr PubMed #1 "Dementia/mortality" Majr OR "Cognition Disorders/mortality" Majr OR "Dementia/epidemiology" Majr OR "Cognition Disorders/epidemiology" Majr AND "Mortality" Mesh OR mortality TIAB OR survival TIABAND "Morbidity" Mesh OR "Life Expectancy" Mesh OR "morbidity" TI OR "incidence" TI OR "prevalence" TI OR "disease duration" TI OR "dementia" TI AND "morbidity" TI OR "incidence" TI OR "prevalence" TI #1 /MTH OR /TI OR /MTH OR /TI AND /TI OR /TH OR / TI OR /TI OR /TH OR /TH OR /TI OR /TI OR /TI 15
15 CQ 1 8 Alzheimer β(aβ) 1 Alzheimer Lewy α Lewy Lewy 2 Parkinson Lewy Lewy Alzheimer 3 Pick fronto temporal lobar degeneration FTLD TDP 43 fused in sarcoma FUS 4 Pick Pick TDP 43 FTLD FTLD Aβ Alzheimer primary age related tauopathy PART 5 CA1 Alzheimer FTLD 16 1
16 1CQ chronic traumatic encephalopathy CTE 7 8 Alzheimer Alzheimer 314 CQ Braak H, Braak E. Neuropathological staging of Alzheimer related changes. Acta Neuropathol Braak H, Del Tredici K, Rüb U, et al. Staging of brain pathology related to sporadic Parkinson s disease. Neurobiol Aging McKeith IG, Dickson DW, Lowe J, et al. Diagnosis and management of dementia with Lewy bodies third report of the DLB Consortium. Neurology Mackenzie IR, Neumann M, Bigio EH, et al. Nomenclature and nosology for neuropathologic subtypes of frontotemporal lobar degeneration an update. Acta Neuropathol Crary JF, Trojanowski JQ, Schneider JA, et al. Primary age related tauopathy PART a common pathology associated with human aging. Acta Neuropathol Brenowitz WD, Monsell SE, Schmitt FA, et al. Hippocampal sclerosis of aging is a key Alzheimer s disease mimic clini cal pathologic correlations and comparisons with both alzheimer s disease and non tauopathic frontotemporal lobar degeneration. J Alzheimers Dis McKee AC, Daneshvar DH, Alvarez VE, et al. The neuropathology of sport. Acta Neuropathol Prins ND, Scheltens P. White matter hyperintensities, cognitive impairment and dementia an update. Nat Rev Neurol PubMed #1 "Dementia/pathology" Majr OR dementia TI AND patholog* TI OR neuropatholog* TIAND "Brain/ pathology" Majr OR "Parkinson Disease/pathology" Majr OR "Inclusion Bodies/metabolism" Mesh AND neuropathologic TI OR neuropathological TI OR pathologic TI OR "Frontotemporal Lobar Degeneration/ pathology" Mesh OR "Lewy Body Disease/pathology" Mesh OR "Alzheimer Disease/pathology" Majr OR Alzheimer* TI AND patholog* OR neuropatholog* AND "Brain/pathology" Mesh OR "Parkinson Disease/ pathology" Mesh OR "primary age related tauopathy" TIAB OR PART TI AND "pathological feature" TIAB OR "pathological process" TIAB OR "pathologic process" TIAB OR "neuropathological criteria" TIAB OR neuropathological stage* TIAB OR pathogenic mechanism* TIAB OR "Frontotemporal Lobar Degeneration/classification" Majr OR "Lewy Body Disease/physiopathology" Majr OR "Tauopathies/pathology" Majr AND "Aging/pathology" MajrOR "Athletic Injuries/pathology" Majr AND Cognition Mesh AND "Brain/pathology" Majr OR "Inclusion Bodies/metabolism" Mesh AND neuropatholog* TI OR patholog* TI OR "pathologic assessment" TIAB #1 /TH OR /TI OR Alzheimer/TI OR /TI OR Lewy /TI AND /TH OR /TI OR Parkinson /TH OR Parkinson/TI AND SH OR /TH AND /TI AND /TI OR /TI OR Alzheimer/TI OR /TI OR Lewy /TI 17
認知症治療薬の考え方，使い方
Ch a pterⅠ 1 はじめに わが国における高齢者の認知症有病率は今後も高くなり 認知症者が増 加していく可能性が示されている1,2 海外においても アジア アフリカ などを中心に今後の認知症者数が増大する可能性が指摘されている 一 方 欧米においては認知症者発症率の減少を指摘する報告もある しかし 高齢化もあって認知症者数は増加すると考えられ わが国のみならず世界 の認知症者数は増加すると考えられている
PET n = 7 AD n = 20 図 3 PiB AD A 3. わが国のアミロイド PET の現状 PET 100 PiB 15 BF 図 4 J-ADI 105 図 5 20%MCI 60% AD 90% MCI AD AD E ApoE 4 AD 4 図 6 4.
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認知症診療 実践ハンドブック
Ⅰ. 認知症 軽度認知障害の診断 治療へのアプローチ 1 認知症の症候, 検査, 診断 1 認知症の症候, 検査, 診断 1 認知症 軽度認知障害の概念, 実態, 診断への道筋 A 認知症 軽度認知障害とは? 1. 認知症の概念と診断基準認知症とは一度正常に発達した認知機能が後天的な脳の障害によって持続的に低下し, 日常生活や社会生活に支障をきたすようになった状態を指す. 診断基準として, 世界保健機関による国際疾病分類第
Diagnosis of Dementia: Update
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1) 認知症 1 軽度認知障害 () とはどのような状態でしょうか? の診断基準を教えてください. 1 概要 Mild Cognitive Impairment() とは本来 Alzheimer 病 (AD) など認知症とはいえないが, 知的に正常ともいえない状態を指す. 最近ではおおよそ AD の前駆状態を意味する用語と捉える人が多い. このような状態が注目される背景には, 新治療薬開発により AD
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