痴呆的诊断

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1. The clinical criteria for AD are reliable (DSM-IIIR definition; NINCDS-ADRDA and DSM-IV diagnostic criteria).

2. Vascular dementia, dementia with Lewy Bodies and fronto-temporal dementia should be excluded, but the current diagnostic criteria for those diseases are imperfect.

3. Structural neuroimaging is appropriate to detect lesions which may result in cognitive impairment.

4. The CSF-14-3-3 protein is useful when CJD is suspected and recent stroke or viral encephalitis can be excluded.

5. Evidence supports the following tests in the routine evaluation of the demented patient:

- Complete blood cell count
- Serum electrolytes
- Glucose - BUN/creatinine
- Serum B12 levels
- Depression screening - Liver function tests
- Thyroid function tests

6. Evidence indicates the following tests should not be included in the routine evaluation of the demented patient

- Screening for syphilis (unless patient has a specific risk factor, e.g., living in a high-incidence region)
- Linear or volumetric MR or CT measurement strategies
- SPECT
- Genetic testing for DLB or CJD
- APOE genotyping for AD - EEG
- Lumbar puncture (unless presence of metastatic cancer, suspicion of CNS infection, reactive serum syphilis serology, hydrocephalus, age under 55, rapidly progressive or unusual dementia, immunosupression, and suspicion of CNS vasculitis)

7. At this time, there is not enough evidence to support or refute the use of the following tests:

- PET
- Genetic markers for AD not listed above
- CSF or other biomarkers for AD - Tau mutations in patients with FTD
- AD gene mutations in patients with FTD

[引自www.aan.com]