認知症診療ガイドライン2017_1600_第16章.indd
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1 16 CQ 16 1 B 1 Wernicke Wernicke Korsakoff B 12 B 12 D B Wernicke 3 Caine Wernicke 2 3,4 Wernicke 85% Korsakoff 4 B 6 B 12 B 12 5 Shorvon B 12 B D derma titis diarrhea dementia death
2 16CQ 16 1 D 9 1Wernicke s encephalopathy Caine D, Halliday GM, Kril JJ, et al. Operational criteria for the classification of chronic alcoholics identification of Wernicke s encephalopathy. J Neurol Neurosurg Psychiatry Sechi G, Serra A. Wernicke s encephalopathy new clinical settings and recent advances in diagnosis and management. Lancet Neurol Kopelman MD, Thomson AD, Guerrini I, et al. The Korsakoff syndrome clinical aspects, psychology and treatment. Alcohol Alcohol Lachner C, Steinle NI, Regenold WT. The neuropsychiatry of vitamin B12 deficiency in elderly patients. J Neuropsychiatry Clin Neurosci Shorvon SD, Carney MW, Chanarin I, et al. The neuropsychiatry of megaloblastic anaemia. Br Med J Michelakos T, Kousoulis AA, Katsiardanis K, et al. Serum folate and B12 levels in association with cognitive impairment among seniors results from the VELESTINO study in Greece and meta analysis. J Aging Health Annweiler C, Montero Odasso M, Llewellyn DJ, et al. Meta analysis of memory and executive dysfunctions in relation to vitamin D. J Alzheimers Dis PubMed #1 "Dementia" Mesh OR dementia OR "Cognition Disorders" Mesh OR cognition disorder* OR "cognitive impairment" AND "Avitaminosis" Mesh OR avitaminosis OR "vitamin deficiency" OR "Thiamine" Mesh OR "Vitamin B 1" TI OR "Vitamin B1" TI AND "Korsakoff Syndrome" Mesh OR Wernicke Korsakoff Syndrome* TI OR Korsakoff Psychos* TI OR "Vitamin B 6" Mesh OR "Vitamin B 6" TI OR "Vitamin B6" TI OR "Vitamin B 6 Deficiency" Mesh OR "Vitamin B 12" Mesh OR "Vitamin B 12" TI OR "Vitamin B12" TI OR "Vitamin B 12 Deficiency" Mesh "Vitamin D" Mesh OR "Vitamin D" TI OR "Vitamin D Deficiency" Mesh OR "Folic Acid" Mesh OR "folic acid" TI OR folate TI AND "Executive Function" Mesh OR cognitive function* TI OR "Avitaminosis" Mesh OR avitaminosis TI AND "Hyperhomocysteinemia" Mesh OR hyperhomocysteinemia* TI AND "Cognition Disorders" Mesh OR "cognition disorder*" TI OR "cognitive impairment" TI OR "cognition disorder*" OR "cognitive impairment" OR "cognitive decline" TI #1 /TH OR /TI OR /TH OR /TI OR /TI AND /TH OR /TI OR /TH OR /TI OR /TI AND Thiamine/TH OR Thiamine/TI OR /TI OR B1/TI OR "Vitamin B1"/TI OR "Vitamin B 1"/TI AND Korsakoff /TH OR Korsakoff /TI OR /TI OR /TI OR "Vitamin B6"/TH OR "Vitamin B6"/TI OR B6/TI OR B6 /TH OR "Vitamin B12"/TH OR "Vitamin B12"/TI OR B12/TI OR B12 /TH OR "Vitamin D"/TH OR "Vitamin D"/TI OR D/TI OR D /TH OR "Folic Acid"/TH OR "Folic Acid"/TI OR /TI OR /TH OR /TH OR /TI AND /TH OR /TI 341
3 CQ 16 2 C TSH TSH 1 TPO NAE α N TPO Tg 72% Samuels MH. Psychiatric and cognitive manifestations of hypothyroidism. Curr Opin Endocrinol Diabetes Obes Dugbartey AT. Neurocognitive aspects of hypothyroidism. Arch Intern Med
4 16CQ de Holanda NC, de Lima DD, Cavalcanti TB, et al. Hashimoto s encephalopathy systematic review of the literature and an additional case. J Neuropsychiatry Clin Neurosci PubMed #1 "Dementia" Mesh OR dementia OR "Cognition Disorders" Mesh OR "cognition disorder*" OR "cognitive impairment" AND "Hypothyroidism" Mesh OR hypothyroid* OR "Hashimoto s disease" OR "Hashimoto disease" OR "Executive Function" Mesh OR "Cognition" Mesh OR cognitive function* OR "Cognition Disorders" Mesh OR cognition disorder* OR cognitive disorder* OR cognitive impairment* AND "Hypothyroidism" Mesh OR hypothyroid* OR "Hashimoto Disease" Mesh OR "hashimoto encephalopathy" OR "hashimoto s encephalopathy" OR Hashimoto s disease* OR Hashimoto disease*or "Thyroid Diseases/diagnosis" Majr AND manifestation TI #1 /TH OR /TI OR /TH OR /TI OR /TI AND /TH OR /TI OR /TI 343
5 CQ 16 3 T. pallidum VDRL RPR TPHA TPHA FTA ABS MRI 1,2 G 1,800 2,400 / pdf 1 Clement ME, Okeke NL, Hicks CB. Treatment of syphilis a systematic review. JAMA Ghanem KG. REVIEW Neurosyphilis a historical perspective and review. CNS Neurosci Ther e157 e168. PubMed #1 "Neurosyphilis" Mesh OR neurosyphilis OR "general paresis" OR "progressive paralysis" AND "Dementia" Mesh OR dementia TI OR "Cognition Disorders" Mesh OR "cognition disorder*" OR "cognitive dysfunction" #1 /TH OR /TI AND /TH OR /TI OR /TH OR /TI OR /TI OR /TI
6 16CQ 16 4 重症度重症度CQ 16 4 hepatic encephalopathy HE HE HE 1,2 1unimpaired2 HE unstable3stable HE MRI T1 5 fluid attenuated inversion recovery FLAIR 6 重症度アプローチ 正常 状態アプローチ 認知機能障害なし 潜在性グレードⅠ グレードⅡ グレードⅢ グレードⅣ 不安定急性錯乱症候群発作性肝性脳症昏睡 安定 潜在 慢性低グレード HE 顕在 持続性重度 HE 続発性肝脳変性 1 Córdoba J. New assessment of hepatic encephalopathy. J Hepatol
7 肝性脳症グレード (West Haven 基準 ) 発作性肝性脳症 日 ~ 月単位 HE グレード (West Haven 基準 ) 持続性肝性脳症 日 ~ 月単位 HE グレード (West Haven 基準 ) 潜在性肝性脳症 日 ~ 月単位 臨床的に検知可能な基準 2 Bajaj JS. Review article the modern management of hepatic encephalopathy. Aliment Pharmacol Ther West Haven な 潜在性 HE MHE 持続 能 な な な 性 ー 4 脳 Bajaj JS. Review article the modern management of hepatic encephalopathy. Aliment Pharmacol Ther HE % 7 1 Taniguchi E, Kawaguchi T, Sakata M, et al. Lipid profile is associated with the incidence of cognitive dysfunction in viral cirrhotic patients a data mining analysis. Hepatol Res Seyan AS, Hughes RD, Shawcross DL. Changing face of hepatic encephalopathy role of inflammation and oxidative stress. World J Gastroenterol Córdoba J. New assessment of hepatic encephalopathy. J Hepatol Bajaj JS. Review article the modern management of hepatic encephalopathy. Aliment Pharmacol Ther Pujol A, Pujol J, Graus F, et al. Hyperintense globus pallidus on T1 weighted MRI in cirrhotic patients is associated with severity of liver failure. Neurology McKinney AM, Lohman BD, Sarikaya B, et al. Acute hepatic encephalopathy diffusion weighted and fluid attenuated inversion recovery findings, and correlation with plasma ammonia level and clinical outcome. AJNR Am J Neuroradiol
8 16CQ Bajaj JS. Pinkerton SD, Sanyal AJ. Diagnosis and treatment of minimal hepatic encephalopathy to prevent motor vehicle accidents a cost effectiveness analysis. Hepatology PubMed #1 "Hepatic Encephalopathy" Mesh OR "Liver Diseases/complications" Mesh OR "Liver Diseases" Majr OR "hepatic encephalopathy" OR "liver dysfunction" TI OR liver disease* TIAND "Dementia" Mesh OR dementia TI OR "Cognition Disorders" Mesh OR "cognition disorder*" OR "cognitive dysfunction" #1 /TH OR /TI OR /TI OR /TI OR /TI OR / TH OR /TI OR /TI OR /TI AND /TH OR /TI OR /TH OR /TI OR /TI OR /TI 347
9 CQ 16 5 idiopathic normal pressure hydrocephalus inph inph B inph 1, Saito M, Nishio Y, Kanno S. Cognitive profile of idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Dis Extra PubMed #1 "Hydrocephalus, Normal Pressure" Mesh AND "idiopathic normal pressure hydrocephalus" OR inph #1 /TH AND /AL OR "idiopathic normal pressure hydrocephalus"/al OR inph/al
10 16CQ 16 5 歩行障害, 認知障害, 排尿障害の 1 つ以上 60 歳以上 他の神経疾患, 非神経疾患で症候のすべてを説明できない Evans index>0.3 の脳室拡大 水頭症をもたらす明らかな先行疾患がない はい いいえ possible inph 神経内科 脳神経外科に紹介 MRI(CT) DESH 所見 歩行障害 腰椎穿刺 脳脊髄液検査 圧正常 ( 200 mmh 2O) 細胞 蛋白質正常 腰椎穿刺 脳脊髄液検査 圧正常 ( 200 mmh 2O) 細胞 蛋白質正常 タップテスト 他のタイプの水頭症? probable inph definite inph シャント術 タップテスト反復ドレナージテスト 経過観察鑑別診断再考 1 DESH disproportionately enlarged subarachnoid space hydrocephalus, も の な拡大を 水頭症 脳室の拡大に えて, も が 正 で, シ ス 脳 では拡大 てい 所見を す水頭症 正常圧水頭症, 正常圧水頭症診 イド イン 正常圧水頭症診 イド イン 2 レ ー
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