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病例1-2017:一名逐渐发生语言能力进行性丧失的70岁女性
Case 1-2017 — A 70-Year-Old Woman with Gradually Progressive Loss of Language


M.-Marsel Mesulam ... 其他 • 2017.01.12

痴呆诊断的新趋势


曾凡,王延江*

第三军医大学大坪医院神经内科

*通讯作者


痴呆是一组以认知功能障碍为主的临床综合征,其病因复杂,表现多样。如何对认知功能障碍患者进行早期和准确诊断是临床医师经常面临的一个挑战。本期《新英格兰医学杂志》发表了一篇病例讨论,深入剖析了原发性进行性失语(primary progressive aphasia,PPA)的诊断思路1,为认知功能障碍的诊断提供了借鉴。

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病历陈述


Bradford C. Dickerson医师:一名70岁女性因涉及找词的进行性认知困难到本院记忆障碍门诊就诊。她在女儿的协助下接受了医师的访谈。

据报道,患者直至此次评价前大约8年一直身体健康,8年前发生进行性找词困难,同时对一些词的词义感到困惑。例如,在一次关于近期家庭活动的交谈中,她不理解“潘趣酒碗(punch bowl)”是什么意思。此外,患者的自我中心行为逐渐增多,出现该行为时她最常谈论的就是自己。她对于自己生活中近期发生的事件有良好记忆,可以详述多个故事(病史采集过程中时常过分如此,以至于需要重新回到正题)。患者的方向感很好。但对于一名同胞和自己狗的去世,她做出了一反常态的平淡反应(没有家人预料得那么难过)。她偶尔有略微不恰当的行为,例如向并非特别亲近的人说“我爱你”。





作者信息

M.-Marsel Mesulam, M.D., Bradford C. Dickerson, M.D., Janet C. Sherman, Ph.D., Daisy Hochberg, M.S., C.C.C.-S.L.P., R. Gilberto Gonzalez, M.D., Keith A. Johnson, M.D., and Matthew P. Frosch, M.D., Ph.D.
From the Department of Neurology, Northwestern Medicine, Chicago (M.-M.M.); and the Departments of Neurology (B.C.D., J.C.S., K.A.J.), Psychiatry (J.C.S.), Speech, Language, and Swallowing Disorders and Reading Disabilities (D.H.), Radiology (R.G.G., K.A.J.), and Pathology (M.P.F.), Massachusetts General Hospital, and the Departments of Neurology (B.C.D.), Psychiatry (J.C.S.), Radiology (R.G.G., K.A.J.), and Pathology (M.P.F.), Harvard Medical School — both in Boston.

 

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