阿尔茨海默病最新国际诊断标准
阿尔茨海默病及其他类型痴呆临床路径
阿尔茨海默病及其他类型痴呆临床路径一、阿尔茨海默病及其他类型痴呆临床路径标准住院流程（一）适用对象。
第一诊断为阿尔茨海默病性痴呆（ICD-10：F00）、血管性痴呆（ICD-10：F01）、见于在他处归类的其他疾病的痴呆（ICD-10：F02）、非特异性痴呆（ICD-10：F03）（二）诊断依据。
根据《国际精神与行为障碍分类第10版》（人民卫生出版社）。
1.存在痴呆的临床表现（出现多种高级皮层功能的紊乱，包括记忆、思维、定向、理解、计算、学习能力、语言和判断功能）。
2.上述表现妨碍个人日常生活。
3.上述表现和功能损害至少存在6个月。
4.除外抑郁、谵妄、精神发育迟滞等。
（三）治疗方案的选择。
根据《中国痴呆与认知障碍诊治指南》（中华医学会神经病学分会痴呆与认知障碍学组编著，人民卫生出版社）、《老年期痴呆防治指南》（卫生部疾病预防控制局、中国疾病预防控制中心精神卫生中心和中华医学会精神病学分会牵头，北京大学医学出版社出版）。
1.进行系统的病史采集，体格检查和神经系统检查，评估患者认知功能、精神行为症状及日常生活能力，并分析影响因素，制定治疗策略。
2.认知改善治疗。
3. 精神行为症状的药物治疗。
4. 非药物干预。
（四）标准住院日为≤35天。
（五）进入路径标准。
1.第一诊断必须符合阿尔茨海默病性痴呆（ICD-10：F00）、血管性痴呆（ICD-10：F01）、见于在他处归类的其他疾病的痴呆（ICD-10：F02）、非特异性痴呆（ICD-10：F03）疾病编码。
2.当患者合并其他疾病，但住院期间不需要特殊处理也不影响第一诊断的临床路径流程实施时，可以进入路径。
（六）住院后的检查项目。
1.必需的检查项目：（1）血常规、尿常规、便常规（潜血）；（2）肝肾功能、电解质、血糖、血脂、心肌酶、凝血功能、乙肝抗体、丙肝抗体、梅毒抗体、艾滋病抗体、甲状腺功能、叶酸、维生素B12、同型半胱氨酸；（3）胸片、心电图、脑电图、头颅CT或核磁。
阿尔茨海默病最新国际诊断标准
阿尔茨海默病最新国际诊断标准过去8年内，国际工作组（IWG）及美国国家老龄问题研究所---阿尔茨海默病协会，推出了阿尔茨海默病(AD)的诊断标准；通过更好的定义临床表型以及将生物标志物整合进诊断进程中，从而全面覆盖疾病各个时期（从无症状到最严重痴呆阶段）。
这些标准最重要的实际应用是允许在疾病前驱期便开展更早的预防手段，并且有利于临床前期AD二级预防的研究。
通过这些标准的研究应用，最终将会发展出一项常规领域能够真正探查AD存在的通用标准。
考虑到现有的IGW研究诊断标准的优缺点，近日The Lancet杂志刊登了一篇文章，提出新的先进性建议，从而对之前诊断框架进行改善。
基于这些提炼，AD的诊断得以简化，只需通过AD临床表型（典型/非典型）联合同AD病理相一致的病理生理生物标志物即可。
另外文章建议疾病的下游标志物，如MRI容积、脱氧葡萄糖PET可更好的用于检测及监控疾病过程。
本文分别详细阐述了典型AD、非典型AD、混合型AD以及AD的临床前阶段的特异诊断标准。
具体如下：一.典型AD的IWG-2 诊断标准（任何时期的A加B两方面）A:特异临床表型：存在早期及显著情景记忆障碍（孤立或与暗示痴呆综合症或轻度认知障碍相关的其他认知、行为改变），包括下述特征：1.患者或知情者诉有超过6个月的，逐步进展的记忆能力下降；2.海马类型遗忘综合症的客观证据，基于AD特异检测方法---通过线索回忆测试等发现情景记忆能力显著下降。
（在疾病中度及重度痴呆阶段海马遗忘综合症可能难于鉴定，体内AD病理证据中足以存在痴呆综合症的相关特点）；B：体内AD病理改变的证据（下述之一）1.脑脊液中Aβ1–42水平的下降以及T-tau或P-tau蛋白水平的上升；2.淀粉样PET成像，示踪剂滞留增加；3.AD常染色体显性突变的存在（常携有PSEN1、PSEN2、APP突变）；典型AD排除标准（补充检查：如血检、脑MRI以排除其它导致认知紊乱或痴呆的疾病，或伴发病症）1.病史：a.突然发病 b.早期出现下述症状：步态障碍、癫痫、行为改变；2.临床特征：a.局灶性神经特征 b.早期锥体外系体征 c.早期幻觉 d.认知波动；其它足以出现记忆及相关症状的严重疾病1.非AD性痴呆；2.重度抑郁；3.脑血管疾病；4.中毒、炎症、代谢紊乱，这些均需要特异的检查；5.同感染或血管损伤一致的，内侧颞叶MRI-FLAIR或T2信号改变；二：非典型AD的IWG-2 诊断标准（任何时期的A加B两方面）A：特异临床表型（下述之一）1.AD后皮质异常（包括：）a.枕颞叶异常：早期、主要及进展性视理解功能或（目标、符号、单词、脸）的视觉辨认能力异常b.双顶叶异常：早期、主要及进展性视觉空间能力障碍，Gerstmann综合征、巴林特氏综合征、肢体失用症或忽视的特点2. AD的进行性失语：早期、主要及进展性的单词检索或句子重复能力受损。
阿尔兹海默症核心诊断标准
阿尔兹海默症核心诊断标准
阿尔兹海默症是一种常见的神经系统退行性疾病，其核心诊断标准包括以下几个方面：
1. 认知障碍：患者必须表现出明显的认知障碍，包括记忆力下降、言语困难、空间定向力下降等。
2. 日常生活障碍：患者的认知障碍必须对其日常生活产生逐渐加重的影响，如无法完成日常任务、失去承担责任的能力等。
3. 慢性进行性病程：患者的认知障碍必须呈现慢性进行性加重的病程，而非突然发作。
4. 排除其他疾病：患者必须排除其他可能导致认知障碍的疾病，如甲状腺功能低下、脑血管疾病等。
以上是阿尔兹海默症的核心诊断标准，早期诊断和干预是该疾病的关键，因此建议在出现认知障碍时及时就医，进行全面的神经系统检查和评估。
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阿尔茨海默病重疾标准
阿尔茨海默病重疾标准
阿尔茨海默病是一种神经系统退化性疾病，主要影响老年人，导致记忆力丧失、认知能力下降、情绪不稳定等症状。
为了统一诊断标准和治疗方案，医学界制定了阿尔茨海默病重疾标准。
根据标准，阿尔茨海默病的诊断需要满足以下条件：患者有明显的认知障碍，包括记忆障碍、语言障碍、行为和心理症状等；这些障碍持续存在，并且影响了日常生活和社交能力；排除其他可能导致认知障碍的疾病和影响。
标准还规定了病情的严重程度分为轻度、中度和重度三种，根据患者的临床表现和认知评估结果进行评估。
针对不同严重程度的患者，制定了相应的治疗方案和康复计划。
阿尔茨海默病重疾标准的制定，有助于提高疾病的诊断准确性和治疗效果，为患者提供更加科学、有效的医疗服务。
同时，也促进了医学界对阿尔茨海默病的深入研究和探索。
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阿尔兹海默影像诊断标准
阿尔兹海默影像诊断标准
阿尔兹海默病，也称为老年痴呆，是一种神经系统变性疾病。
对于阿尔兹海默病的影像学诊断标准，通常需要进行CT和MRI等影像学检查。
CT检查可以发现患者有脑细胞萎缩和脑室系统扩大。
而MRI检查更为清晰，除脑萎缩和脑室扩大以外，还能够明确显示到具体萎缩的部位，比如双侧颞叶或者海马等。
有条件的患者还可以进行CT灌注成像，可以明确观测到顶叶、颞叶、额叶，尤其是双侧颞叶内侧的海马区域，可能会有血流减少、代谢降低。
另外，特殊的成像技术可能会观测到脑内的Aβ沉积。
除了影像学检查，还可以进行神经心理学检查，评估认知功能。
认知功能评估包括记忆功能、言语功能、定向力、应用能力、注意力、知觉（视、听、感知）和执行功能等七个领域。
实验室检查也是诊断阿尔兹海默病的重要手段。
血、尿常规、血生化检查均可正常，脑脊液检查可发现淀粉样蛋白-42（Aβ42）水平降低，总tau蛋白和磷酸化tau蛋白增高。
基因检查也是诊断阿尔兹海默病的一种方法。
如果有明确家族史，可对APP、PSEN1、PSEN2和APOEε4等基因进行检测，突变的发现有助于确诊和疾病的提前预防。
以上信息仅供参考，具体的诊断标准请以医生的意见为准。
阿尔兹海默症诊断新标准
NEW CRITERIA AND GUIDELINES FOR THE DIAGNOSIS OF ALZHEIMER’S DISEASE PUBLISHED FOR FIRST TIME IN 27 YEARS- Research Agenda Suggested for Detecting Pre-Symptomatic Alzheimer’s –- New Alzheimer’s Definition Moves Researchers Closer to Early Detection and Intervention –CHICAGO, April 19, 2011 – For the first time in 27 years, new criteria and guidelines for the diagnosis of Alzheimer‟s disease have been published by three expert workgroups spearheaded by the Alzheimer‟s Association and the National Institut e on Aging (NIA) of the National Institutes of Health (NIH).The workgroups published four articles including ready-to-use clinical diagnostic criteria for Alzheimer‟s disease dementia and mild cognitive impairment (MCI) due to Alzheimer‟s. A research age nda was proposed for preclinical Alzheimer‟s. The use of biomarkers in Alzheimer‟s dementia and MCI due to Alzheimer‟s was also proposed as a research agenda only, and is not intended for application in clinical settings at this time.The articles – colle ctively, the National Institute on Aging/Alzheimer‟s Association Diagnostic Guidelines for Alzheimer‟s Disease –expand the definition of Alzheimer‟s to include two new phases of the disease: (1) presymptomatic and (2) mildly symptomatic but pre-dementia, along with (3) dementia caused by Alzheimer‟s. This reflects current thinking that Alzheimer‟s begins creating distinct and measurable changes in the brains of affected people years, perhaps decades, before memory and thinking symptoms are noticeable.“It is our hope that incorporating scientific knowledge gained and technological advances made over the past quarter century will improve current diagnosis, bring the field closer to earlier detection and treatment, and ultimately lead to effective disease-mo difying therapies,” said William Thies, Ph.D., Chief Medical and Scientific Officer at the Alzheimer‟s Association. “Development and publication of these articles is a major landmark in the field. That said, publication of these articles is not yet the end of the process of developing new diagnostic criteria for Alzheimer‟s, but is another major step in the process.”“The new guidelines reflect today‟s understanding of how key changes in the brain lead to Alzheimer‟s disease pathology and how they relate t o the clinical signs of mild cognitive impairment and Alzheimer‟s disease dementia,” said Creighton Phelps, Ph.D., Program Director of the Alzheimer‟s Disease Centers Program at the National Institutes of Health. “We are also beginning to be able to detect these changes at a preclinical stage, long before symptoms appear in many people. With further research on biomarkers, as set forth in the new guidelines, we may ultimately be able to predict who is at risk for development of mild cognitive impairment and Alzheimer‟s dementia, and who would benefit most as interventions are developed.”The proposed new Alzheimer‟s disease diagnostic guidelines were published online today by Alzheimer‟s & Dementia: The Journal of the Alzheimer‟s Association. Hard copy publication is scheduled for the May 2011 issue of the journal.Three Stages of Alzheimer’s DiseaseThe current diagnostic criteria for Alzheimer‟s*, for the most part, focus on reliable diagnosis when signs of problems in thinking, learning, and memory are noticeable to an individual, family, and friends. But research tells us that Alzheimer‟s likely begins years, maybe even decades, prior to symptoms appearing.The new articles refer to three phases of Alzheimer‟s disease progression over time: Preclinical Alzheimer‟s Disease– Measurable changes in biomarkers (such as brain imaging and spinal fluid chemistry) that indicate the very earliest signs of disease, before outward symptoms are visible. Currently, there are no clinical diagnostic criteria for this phase, but the group provides a scientific framework to help researchers better define this stage of Alzheimer‟s. (See supplement 5.)Mild cognitive impairment (MCI) due to Alzheimer‟s Disease– Mild changes in memory and thinking abilities, enough to be noticed and measured, but not impairment that compromises everyday activities and functioning. Dementia due to Alzheimer‟s Disease–Memory, thinking and behavioral symptoms that impair a person‟s ability to function in daily life. (For more details, see supplement 3.)According to the authors, in order to facilitate the possibility of future presymptomatic treatment of Alzheimer‟s, it was important to define the disease from the earliest changes in the brain, not only the observable, symptomatic stages of the disease. The authors propose that Alzheimer‟s begins with a long asymptomatic period during which detrimental changes are progressing in the brain, and individuals with biomarker evidence of these changes are at increased risk for developing cognitive and behavioral impairment and progression to Alzheimer‟s dementia.A biomarker is a naturally occurring, measurable substance or condition in the body that reliably indicates the presence or absence of disease or the risk of later developing a disease; for example, blood glucose levels are a biomarker of diabetes, and cholesterol levels are a biomarker of cardiovascular disease risk. Both fluid and imaging measures are being tested as possible biomarkers for Alzheimer‟s. (See supplement 4.)There was a broad consensus within the workgroups that much additional research needs to be done to validate the application of biomarkers as they are proposed in the newly-published articles. According to the authors, “The definitive studies … are likely to take more than a decade to fully accomplish. Thus, we must move quickly … and adjust our models and study designs as new data become available.”“If we can definitively determine the risk of developing Alzheimer‟s dementia in people who have biomarker evidence of brain changes but are not showing outward symptoms, we will open an important window of opportunity to intervene with disease-modifying therapies, once they are developed,” Thies said.“In addition, the new criteria give us powerful tools to accelerate our kno wledge in the fightagainst Alzheimer‟s disease. They give us guidelines for getting a more accurate assessment of Alzheimer‟s prevalence. In that way we can better assess the need for everything from research dollars to care services, to patient and caregiver education materials, to nursing home beds, to the number of gerontologists and nurses that we need. And, they give us a basis for creating the next generation of Alzheimer‟s treatments that will be effective in each stage of the disease,” Thies said.Moving the Field Toward Earlier Diagnosis and Treatment of Alzheimer’sThe Alzheimer‟s Association, in its 2010 report titled “Changing the Trajectory of Alzheimer‟s Disease: A National Imperative,” showed that a hypothetical intervention that delayed th e onset of Alzheimer‟s dementia by five years would result in a nearly 45 percent reduction in the number of people with Alzheimer‟s by 2050, and reduce the projected Medicare costs of Alzheimer‟s from $627 billion to $344 billion dollars.The authors of the newly-released articles write, “It is our hope that the advances in preclinical detection of Alzheimer‟s will enable earlier, more effective treatment, just as nearly all of therapeutic gains in cancer, cardiovascular disease, osteoporosis, and diabetes involve treatment before significant clinical symptoms are present. Screening and treatment programs instituted for other diseases … have already been associated with a decrease in mortality due to these conditions.”Thies adds, “Currently, Alzheimer‟s therapies are in development that may be able to slow or stop the progression of the disease. By improving early detection and risk evaluation, we will better be able to test potential therapies and eventually prescribe them for people at increased risk. Ultimately, this approach envisions for Alzheimer‟s what is now common practice in cardiovascular disease, where early signs of risk – for example, in genetic markers or in blood cholesterol and/or blood pressure levels –can be treated to reduce the likelihood of heart attack or stroke later on.”The challenge for Alzheimer‟s now is that there is currently no single, generally accepted way to identify the disease in the earliest stage – before symptoms are evident. It is hoped that the research agenda out lined in the new preclinical Alzheimer‟s article will correct this deficit.Presymptomatic Disease Detection and Treatment –Not a New Idea, Except in Alzheimer’sAccording to the authors, “The concept of a preclinical phase of disease should not be too foreign. Medical professionals readily acknowledge that cancer can be detected at the stage of …carcinoma in situ‟ and that hypercholesterolemia and atherosclerosis can result in narrowing of coronary arteries that is detectable prior to myocardial infarction. It is widely acknowledged that symptoms are not necessary to diagnose human disease. Type II diabetes, hypertension, renal insufficiency, and osteoporosis are frequently detected through laboratory tests, and effective treatment can prevent the emerge nce of symptoms.”“We should be open to the idea that Alzheimer‟s could one day be diagnosed preclinically by the presence of biomarker evidence, which may eventually guide therapy prior to the onset of symptoms. We treat people with diabetes, elevated cholesterol, hypertension and a variety of other illnesses – we do not wait for strokes, heart attacks or other long term complications that we know will occur in significant numbers of those affected. Similarly, our intention is to use these criteria to bet ter determine an individual‟s risk of developing Alzheimer‟s disease. This diagnostic research will help us discover the drugs of the future and prepare for the day when we can administer them to those at risk in order to prevent or delay the emergence of symptoms,” wrote the authors.What Was PublishedThe proposed new diagnostic criteria and research agenda for Alzheimer‟s disease are presented in three documents, plus an introduction.One workgroup updated the 1984 diagnostic criteria for the dementia due to Alzheimer‟s disease. Guy McKhann, M.D., Johns Hopkins University School of Medicine, Baltimore, and David Knopman, M.D., Mayo Clinic, Rochester, Minn., co-chaired this panel.A second workgroup focused on refining the criteria for the symptomatic, pre-dementia phase, referred to as Mild Cognitive Impairment due to Alzheimer‟s disease. Marilyn Albert, Ph.D., Johns Hopkins University School of Medicine, Baltimore, chaired this workgroup.The third workgroup proposed a research agenda (NOT criteria for clinical diagnosis; this is an important distinction. See supplement 4.) for the asymptomatic, preclinical phase of Alzheimer‟s. Reisa Sperling, M.D, Brigham and Women's Hospital, Harvard Medical School, Boston, chaired this group.The introduction prov ides an overview of the changes that have occurred in the Alzheimer‟s field since the first diagnostic criteria were published in 1984, and outlines future challenges that need to be addressed. Clifford Jack, M.D., Mayo Clinic, Rochester, Minn., is lead author of this article.Preliminary recommendations were announced in July 2010 at the Alzheimer‟s Association International Conference on Alzheimer‟s Disease (AAICAD). These early drafts were then made available for comment on the Alzheimer‟s Association w ebsite, along with further presentation and discussion at a variety of medical and scientific meetings.The three sets of recommendations differ in terms of relevance to current clinical practice. The clinical diagnostic criteria for Alzheimer‟s dementia and MCI due to Alzheimer‟s are intended to guide diagnosis in the current clinical setting, such as a doctor‟s office, including settings where no access to testing for biomarkers exists.The use of biomarkers in both Alzheimer‟s dementia and MCI due to Alzheimer‟s disease is intended only for research at this time. However, some biomarkers, especially those using advanced imaging techniques, could enter clinical practice in the near future, though much remains to be learned about their utility in this sett ing.The recommendations of the preclinical Alzheimer‟s workgroup are intended for research purposes only, and do not have any clinical utility at this time.A fourth workgroup has been organized to examine the postmortem, pathological criteria for Alzheim er‟s. The results of their deliberations are expected to appear later in 2011.27年内首次出版发行的阿尔茨海默病诊断的新标准和指南–-研究建议检测症状前的阿尔茨海默病-新的阿尔茨海默病的定义促使研究者进行阿尔茨海默病早期的筛查和干预-2011年4月19日，以阿尔茨海默病协会和国立卫生院(NIH)的国家老年研究所(NIA)为先锋的三个专家工作组在芝加哥于27年内首次发布了诊断阿尔茨海默病的新标准和指南。
老年痴呆诊断标准
老年痴呆诊断标准引言老年痴呆是一种常见的神经退行性疾病，严重影响患者的日常生活能力和社交能力。
因此，及早进行老年痴呆的诊断对于患者及其家人具有重要意义。
本文将详细介绍老年痴呆的诊断标准和相关评估方法。
什么是老年痴呆？老年痴呆是指由大脑退行性病变引起的一组症状，主要包括认知功能下降、记忆力减退、思维能力减退等。
老年痴呆主要发生在60岁以上的老年人群中，其中以阿尔茨海默病最为常见。
早期诊断老年痴呆可以帮助患者及早采取相应的治疗和护理措施，延缓病情进展。
临床特征老年痴呆的临床表现多种多样，不同类型的老年痴呆具有不同的特点。
下面将介绍几种常见老年痴呆的临床特征。
阿尔茨海默病阿尔茨海默病是老年痴呆的主要类型之一，其主要临床特征包括： - 渐进性记忆力减退，尤其是近期记忆力减退 - 语言障碍，如难以找到正确的词汇表达 - 认知功能下降，影响日常生活能力和社交能力衰老性痴呆衰老性痴呆是老年痴呆另一种常见类型，其主要临床特征包括： - 记忆力减退，相对较为轻微 - 注意力不集中，容易犯困和分散注意力 - 思维迟缓，对复杂问题的处理能力下降血管性痴呆血管性痴呆是老年痴呆的一种形式，其主要临床特征包括： - 记忆力减退，尤其是短期记忆 - 注意力不集中，容易分心和忘记正在进行的活动 - 情绪波动，容易焦虑、易怒和抑郁诊断标准为了明确老年痴呆的诊断标准，国际上提出了多个标准体系。
下面将介绍几种常用的老年痴呆诊断标准。
DSM-5诊断标准美国精神疾病诊断与统计手册第五版（DSM-5）将老年痴呆归类为神经认知障碍。
其诊断标准包括： 1. 明确的认知功能下降，包括记忆力减退和其他认知功能减退（如语言、注意力等） 2. 能力损害导致日常生活功能的明显下降 3. 缺乏意识水平的改变，或者通过排除发生在清醒期的病因解释认知功能下降NINCDS-ADRDA诊断标准国际神经病学学会阿尔茨海默病研究组（NINCDS-ADRDA）提出了阿尔茨海默病的诊断标准，包括： 1. 典型的阿尔茨海默病病史和临床表现 2. 发育缓慢而渐进的认知衰退，主要影响记忆、语言和复杂认知功能 3. 排除其他可以导致老年痴呆的原因中国诊断标准中国老年学会于2011年发布了老年痴呆诊断和治疗指南，其诊断标准包括： 1. 年龄大于60岁 2. 进行全面的临床评估，包括病史、家族史、体格检查和认知功能评估 3. 排除其他可以导致老年痴呆的原因评估方法除了临床症状和体格检查外，还可以使用一些评估工具来辅助老年痴呆的诊断和评估。
痴呆诊断标准(一)
痴呆诊断标准(一)痴呆诊断标准痴呆是指因为脑功能障碍而导致的记忆力、认知能力、情感和社交能力等多方面的衰退。
痴呆症状可以表现为记忆力减退、思维迟缓、语言障碍、行为异常等。
为了对痴呆进行准确的诊断，世界卫生组织（WHO）制定了一系列痴呆诊断标准。
DSM-5诊断标准DSM-5是指美国精神疾病诊断和统计手册第五版，该手册对于痴呆的诊断使用以下标准：1.患者存在认知缺陷（多个领域中，至少有一个领域的缺陷可以导致社会和职业功能的下降）；2.认知缺陷是起病后出现的新症状；3.患者存在以上两个标准外的特定临床表现：语言障碍，行为异常，功能障碍或可逆性因素可以被排除。
DSM-5标准要求医生对痴呆的起病、症状、持续时间、影响社会和家庭生活的程度等进行全面的评估、讨论和分析。
ICD-10诊断标准ICD-10是国际疾病分类第十版，该手册对于痴呆的诊断使用以下标准：1.存在持续性认知损伤（记忆力、学习力、注意力、思考能力、语言能力或认知功能能力下降）；2.这种认知损伤对个人、社会和职业生活产生了负面的影响；3.存在以上两个标准外的临床表现：行为异常、情感异常、功能障碍或可逆的因素可排除。
ICD-10标准强调认知能力下降对生活的影响，以及排除其他可以导致认知缺陷的原因。
医生需要与患者本人和关爱者建立联系，获取更全面的评估信息。
NINCDS-ADRDA诊断标准NINCDS-ADRDA诊断标准在对阿尔茨海默病的诊断有很好的适用性，它要求医生在评估患者症状和表现的同时，考虑以下四个方面：1.临床数据；2.细胞和分子生物学数据；3.影像学数据；4.实验室数据。
NINCDS-ADRDA标准注重对阿尔茨海默病的生物标志物的研究和分析。
##结论以上三种痴呆诊断标准针对不同疾病和不同情况，都有其适用性和优势。
医生在进行痴呆诊断时，应结合患者的个人情况，综合考虑不同诊断标准，进行深入研究和评估，最终为患者提供更好的治疗和护理方案。
参考1.World Health Organization. The ICD-10 classification ofmental and behavioral disorders: clinical descriptionsand diagnostic guidelines [M]. Geneva: World HealthOrganization, 1992.2.American Psychiatric Association. Diagnostic andstatistical manual of mental disorders, fifth edition[M]. Washington, DC: American Psychiatric Association,2013.3.McKhann GM, Knopman DS, Chertkow H, et al. Thediagnosis of dementia due to Alzheimer’s dise ase:recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnosticguidelines for Alzheimer’s disease [J]. Alzheimer’s & dementia, 2011, 7(3): 263-269.延伸阅读1.罗连春. 痴呆症的诊断和治疗[M]. 科学出版社, 2019.2.邱勇, 王建成. 痴呆的诊断与治疗 [J]. 中国脑血管病杂志,2018, 15(4): 233-237.3.苏建华, 郑云飞. 新中国痴呆诊断标准发展历程与展望[J]. 中国痴呆杂志, 2021, 16(3): 220-224.结论痴呆诊断标准的制定和应用，提供了更为准确、科学的痴呆病人诊断方法，同时也有助于对不同类型的痴呆进行更加精准的分类和诊治。
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阿尔茨海默病最新国际诊断标准
过去8年内，国际工作组（IWG）及美国国家老龄问题研究所---阿尔茨海默病协会，推出了阿尔茨海默病(AD)的诊断标准；通过更好的定义临床表型以及将生物标志物整合进诊断进程中，从而全面覆盖疾病各个时期（从无症状到最严重痴呆阶段）。
这些标准最重要的实际应用是允许在疾病前驱期便开展更早的预防手段，并且有利于临床前期AD二级预防的研究。
通过这些标准的研究应用，最终将会发展出一项常规领域能够真正探查AD存在的通用标准。
考虑到现有的IGW研究诊断标准的优缺点，近日The Lancet杂志刊登了一篇文章，提出新的先进性建议，从而对之前诊断框架进行改善。
基于这些提炼，AD的诊断得以简化，只需通过AD临床表型（典型/非典型）联合同AD病理相一致的病理生理生物标志物即可。
另外文章建议疾病的下游标志物，如MRI容积、脱氧葡萄糖PET可更好的用于检测及监控疾病过程。
本文分别详细阐述了典型AD、非典型AD、混合型AD以及AD的临床前阶段的特异诊断标准。
具体如下：
一.典型AD的IWG-2 诊断标准（任何时期的A加B两方面）
A:特异临床表型：存在早期及显著情景记忆障碍（孤立或与暗示痴呆综合症或轻度认知障碍相关的其他认知、行为改变），包括下述特征：
1.患者或知情者诉有超过6个月的，逐步进展的记忆能力下降；
2.海马类型遗忘综合症的客观证据，基于AD特异检测方法---通过线索回忆测试等发现情景记忆能力显著下降。
（在疾病中度及重度痴呆阶段海马遗忘综合症可能难于鉴定，体内AD病理证据中足以存在痴呆综合症的相关特点）；
B：体内AD病理改变的证据（下述之一）
1.脑脊液中Aβ1–42水平的下降以及T-tau或P-tau蛋白水平的上升；
2.淀粉样PET成像，示踪剂滞留增加；
3.AD常染色体显性突变的存在（常携有PSEN1、PSEN2、APP突变）；
典型AD排除标准（补充检查：如血检、脑MRI以排除其它导致认知紊乱或痴呆的疾病，或伴发病症）
1.病史：a.突然发病 b.早期出现下述症状：步态障碍、癫痫、行为改变；
2.临床特征：a.局灶性神经特征 b.早期锥体外系体征 c.早期幻觉 d.认知波动；
其它足以出现记忆及相关症状的严重疾病
1.非AD性痴呆；
2.重度抑郁；
3.脑血管疾病；
4.中毒、炎症、代谢紊乱，这些均需要特异的检查；
5.同感染或血管损伤一致的，内侧颞叶MRI-FLAIR或T2信号改变；
二：非典型AD的IWG-2 诊断标准（任何时期的A加B两方面）
A：特异临床表型（下述之一）
1.AD后皮质异常（包括：）
a.枕颞叶异常：早期、主要及进展性视理解功能或（目标、符号、单词、脸）的视觉辨认能力异常
b.双顶叶异常：早期、主要及进展性视觉空间能力障碍，Gerstmann综合征、巴林特氏综合征、肢体失用症或忽视的特点
2. AD的进行性失语：早期、主要及进展性的单词检索或句子重复能力受损。
3.额叶异常：早期、主要及进展性行为改变,包括相关的初级冷漠或行为失控,或认知测试时主要执行能力受损。
4.AD唐氏综合症改变：唐氏综合症患者中发生的以痴呆为特征的，早期行为改变及执行能力障碍。
B：体内AD病理改变的证据（下述之一）
1.脑脊液中Aβ1–42水平的下降以及T-tau或P-tau蛋白水平的上升;
2.淀粉样PET成像，示踪剂滞留增加;
3.AD常染色体显型突变的存在（常携有PSEN1、PSEN2、APP突变）;
非典型AD的排除标准（补充检查：如血检、脑MRI以排除其它导致认知紊乱或痴呆的疾病，或伴发病症）
病史：a.发病突然b.早期或普遍的情景记忆障碍
其它足以出现记忆及相关症状的严重疾病
1.重度抑郁；
2.脑血管疾病;3 中毒、炎症、代谢紊乱;
三：混合型AD的IWG-2 诊断标准（A加B两方面）
A：临床及生物标志物的AD证据（两者均要满足）
1.海马型遗忘综合症或非典型AD的临床表型之一
2.脑脊液中Aβ1–42水平的下降以及T-tau或P-tau蛋白水平的上升；或淀粉样PET成像中示踪剂滞留增加
B：混合病理的临床和生物学标志物证据心血管疾病(条件均需满足)
1.卒中或局灶神经学特征的病史记录;
2.下述一个或多个MRI证据：相应的血管病变、小血管病、腔隙性梗死、脑出血;
路易体病（条件均需满足）
1.下述之一：锥体外系症状、早期幻觉或认知波动;
2.通过PET扫描显示多巴胺转运体异常;
四.AD临床前阶段的IGW-2 诊断标准
无症状高危AD 的IWG-2诊断标准（A加B两方面）
A：缺少特异临床表型的存在（均要满足）
1.无海马型遗忘综合症；
2.无任何非典型AD的临床表型；
B：体内AD病理改变证据（下述之一）
1.脑脊液中Aβ1–42水平的下降以及T-tau或P-tau蛋白水平的上升；
2.纤维状淀粉样PET滞留增加；
症状前AD的IWG-2诊断标准( A加B)
A：缺少特异的临床表型（两者均需要满足）
1.无海马遗忘综合症类型；
2.无任何非典型AD的临床表型；
B：经证实的AD常染色体突变的存在（PSEN1、PSEN2 、APP或其它基因）
另外因AD为一种临床生物学实体，所以提出了一种AD简化算法---在任何条件或疾病任何阶段，对AD的诊断依赖于病理生理学标志物。
具体见下图：。