中国阿尔茨海默病痴呆诊疗指南(2020年版)

2021-03-14 中国老年保健协会 阿尔茨海默病分会研究小组 中华老年医学杂志, 2021,40(03)

采用国际通用的循证医学研究方法,从6 922项阿尔茨海默病(AD)痴呆诊疗的原始研究中筛选符合纳入标准的367项进行系统评价和荟萃分析,并参考全国德尔菲共识调查结果,形成了17条主要推荐意见和42条次

中文标题:

中国阿尔茨海默病痴呆诊疗指南(2020年版)

发布日期:

2021-03-14

简要介绍:

采用国际通用的循证医学研究方法,从6 922项阿尔茨海默病(AD)痴呆诊疗的原始研究中筛选符合纳入标准的367项进行系统评价和荟萃分析,并参考全国德尔菲共识调查结果,形成了17条主要推荐意见和42条次要推荐意见,供临床医生使用。(1)对于拟行AD痴呆诊断的患者,应在适当的场景中使用经过验证的本土化工具进行临床评估(2B,共识率为98.16%,下同)。(2)认知功能评估是AD痴呆诊断的首选方法,应正式评估综合认知和至少4个认知领域(2B,96.93%)。(3)在做出AD痴呆诊断前,应评估与认知障碍相关的精神行为和生活功能,通过对患者和知情者面诊,进行观察和量表评估(2B,97.55%)。(4)在AD痴呆诊断常规检查流程中,应推荐脑CT和MRI检查,在可行的情况下首选MRI头颅冠状位内侧颞叶扫描或海马体成像(2B,98.77%)。(5)当病史和常规检查不能明确AD痴呆诊断时或早发型痴呆、前驱期或非典型AD患者,应与患者或家属讨论使用PET或脑脊液或血液AD生物标志物检测,在可行的情况下将患者转诊至相关研究中心或专科中心(2B,97.55%)。(6)对于有痴呆家族史或快速进展型/非典型痴呆患者,应与患者或家属讨论使用基因检测,在可行的情况下将患者转诊至相关研究中心或专科中心(1A,98.77%)。(7)在AD鉴别诊断的常规检查流程中,应推荐血液常规、生化和血清学检查,对潜在可治疗的认知障碍危险因素进行评估(2B,97.55%)。(8)有经验的临床医生,应采用以病史和检查证实的症状学特征为依据的AD痴呆诊断"核心标准"进行AD痴呆的常规临床诊断(1A,89.57%)。(9)首次就诊者或先前的纵向临床评估信息不可用或需要做出治疗选择时,应进行AD痴呆的临床分期或严重程度判断(3C,93.25%)。(10)在做出AD痴呆临床诊断时,应除外其他已知的痴呆病因(2B,98.77%)。(11)AD痴呆的治疗应遵循药物和非药物干预结合的原则,以获得对认知、行为及功能的协同效益(3C,98.16%)。(12)对于轻中度AD痴呆,在与患者或家属充分讨论可能的获益和风险后,应首先提供胆碱酯酶抑制剂治疗(1A,96.93%)。(13)对于中重度AD痴呆,在与患者的家属充分讨论可能的获益和风险后,应选择美金刚治疗或胆碱酯酶抑制剂治疗(1A,96.93%)。(14)当中重度AD痴呆患者对胆碱酯酶抑制剂达到足够且稳定剂量而缺乏满意疗效时,在与患者的家属充分讨论可能的获益和风险后,应加用美金刚治疗(1A,98.16%)。(15)对于AD痴呆的精神行为症状,当常规抗痴呆药物和非药物干预缺乏满意的疗效且足以给他人或患者造成严重困扰或危险时,在与患者的家属充分讨论可能的获益和风险后,应加用非典型抗精神病药物治疗(2B,98.77%)。(16)对于AD引起的情绪症状,可选择对认知无负面影响的5-羟色胺类药物(3C,95.71%)。(17)对于早期AD痴呆或接受常规治疗而缺乏满意疗效的AD痴呆患者,可选择或加用中医药治疗(3C,90.8%)。

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    2022-10-12 ms7000000598878159

    学习了

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    学习~

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    2022-02-09 ms7071465400114157

    学习

    0

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