輕度認知障礙之診斷與治療：台北榮總經驗

The Diagnosis and Treatment of Mild Cognitive Dementia: Experiences at Taipei Veterans General Hospital

王培寧(Pei-Ning Wang)；林克能(Ker-Neng Lin)；劉秀枝(Hsiu-Chih Liu)

MCI ； 極早期失智症 ； 阿茲海默症 ； 認知功能 ； 脂蛋白基因 ； mild cognitive impairment ； very early dementia ； Alzheimer's disease ； cognition ； apolipoprotein E

應用心理研究

55期（2012 / 09 / 01）

15 - 35

繁體中文

輕度認知障礙（mild cognitive impairment, MCI）是一個介於正常認知功能與輕度失智症之間的一種過渡階段，雖然有少部分的患者會由MCI回復到正常的認知功能，但就大部分的患者而言，這是一個會退化到失智症的高危險群。台北榮總失智症研究團隊10幾年來就失憶型MCI（amnestic MCI）進行了多項長期追蹤研究。失憶型MCI的患者的記憶力和生活功能表現，介於正常老人和輕度阿茲海默失智症之間，海馬迴的體積和每年萎縮的速率也是介於正常老人和輕度阿茲海默失智症之間，同時脂蛋白（Apolipoprotein）基因E第四型，也會增加失憶型MCI每年轉變成為阿茲海默失智症的機率。所以整合目前國際上和我們團隊的研究成果顯示，失憶型MCI無論就認知功能、相關基因和影像學的表現，都符合極早期阿茲海默症（Alzheimer's disease）的表徵。在2011年公布的MCI診斷標準中，已建議將臨床上有失憶型MCI且合併有阿茲海默症生物標記的患者，診斷為因阿茲海默症導致的MCI（MCI due to Alzheimer's disease)，更強調這可能就是極早期阿茲海默症。雖然目前對MCI尚未有臨床試驗證實有效的藥物治療，但仍可能經由危險因子的控制和認知功能訓練等非藥物治療來減緩其病程，以達早期診斷早期治療的目標。

Mild cognitive impairment (MCI) is a transitional state between normal cognition and mild dementia. Although some MCI patients return back to normal cognition, most MCI progress to dementia. The dementia research group in Taipei Veterans General Hospital has conducted several prospective studies to evaluate the manifestation of amnestic MCI and the outcomes of patients who develop the disease. Patients with amnestic MCI experience levels of performance in memory and daily function that range between normal elderly and mild Alzheimer's disease (AD) dementia patients. The hippocampal volume and annual atrophy rates of hippocampus in patients with amnestic MCI also range between normal elderly and mild AD dementia patients. Apolipoprotien E ϵ 4 may increase the risk and shorten the duration of the progression from amnestic MCI to AD dementia. Integrating the present evidence from literature and our research, the clinical, genetic and neuroimaging features of amnestic MCI appear very similar to very early AD. The 2011 diagnostic criteria for MCI suggest diagnosing MCI patients coexisting with AD biomarkers as MCI due to AD. This new criteria emphasize the evidence suggesting that MCI with AD biomarkers may actually be the very early stages of AD. Until now, there is no proved pharmacological treatment for MCI. However, we may decelerate the progression from MCI to dementia by controlling the risk factors and cognitive training. Early diagnosis and early treatment is the best therapy for dementia.

1. Albert, M. S.,DeKosky, S. T.,Dickson, D.,Dubois, B.,Feldman, H. H.,Fox, N. C.,Phelps, C. H.(2011).The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging and Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease.Alzheimer's & Dementia,7(3),270-279.
2. Basser, P. J.,Mattiello, J.,LeBihan, D.(1994).MR diffusion tensor spectros copy and imaging.Biophysical Journal,66(1),259-267.
3. Bosch, B.,Arenaza-Urquijo, E. M.,Rami, L.,Sala-Llonch, R.,Junque, C.,Sole-Padulles, C.,Bartres-Faz, D.(2012).Multiple DTI index analysis in normal aging, amnestic MCI and AD. Relationship with neuropsychological performance.Neurobioogy of Aging,30(1),61-74.
4. Buschke, H.,Fuld, P. A.(1974).Evaluating storage, retention, and retrieval in disordered memory and learning.Neurology,24(11),1019-1025.
5. Chang, C. C.,Kramer, J. H.,Lin, K. N.,Chang, W. N.,Wang, Y. L.,Huang, C. W.,Wang, P. N.(2010).Validating the Chinese version of the Verbal Learning Test for screening Alzheimer's disease.Journal of International Neuropsychoogicall Society,16(2),244-251.
6. Chen, N. C.,Lin, Y. I.,Chang, C. C.,Lin, K. N.,Chuang, Y. C.,Chen, C.,Wang, P. N.(2011).Learning and error patterns in the Chinese Verbal Learning Test in subjects with mild cognitive impairment and normal elderly.Acta Neurology Taiwan,20(2),114-124.
7. Clare, L.,Woods, R. T.,Moniz Cook, E. D.,Orrell, M.,Spector, A.(2003).Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia.Cochrane Database Systematic Reviews,4
8. Crook, T.,Bahar, H.,Sudilovsky, A.(1987).Age-associated memory impairment: Diagnostic criteria and treatment strategies.International Journal of Neurology,21-22,73-82.
9. Doody, R. S.,Ferris, S. H.,Salloway, S.,Sun, Y.,Goldman, R.,Watkins, W. E.,Xu, Y.,Murthy, A. K.(2009).Donepezil treatment of patients with MCI: A 48-week randomized, placebo-controlled trial.Neurology,72(18),1555-1561.
10. Douaud, G.,Jbabdi, S.,Behrens, T. E.,Menke, R. A.,Gass, A.,Monsch, A. U.,Smith, S.(2011).DTI measures in crossing-fibre areas: Increased diffusion anisotropy reveals early white matter alteration in MCI and mild Alzheimer's disease.Neuroimage,55(3),880-890.
11. Hong, C. J.,Liu, T. Y.,Liu, H. C.,Wang, S. J.,Fuh, J. L.,Chi, C. W.,Sim, C. B.(1996).Epsilon 4 allele of apolipoprotein E increases risk of Alzheimer's disease in a Chinese population.Neurology,46,1749-1751.
12. Kamboh, M. I.(1995).Apolipoprotein E polymorphism and susceptibility to Alzheimer's disease.Human Biology,67(2),195-215.
13. Levy, R.(1994).Aging-associated cognitive decline. Working Party of the International Psychogeriatric Association in collaboration with the World Health Organization.International Psychogeriatrics,6(1),63-68.
14. Mariani, E.,Monastero, R.,Mecocci, P.(2007).Mild cognitive impairment: A systematic review.Journal of Alzheimer's Disease,12(1),23-35.
15. Massoud, F.,Leger, G. C.(2011).Pharmacological treatment of Alzheimer disease.Canadian Journal of Psychiatry,56(10),579-588.
16. Morris, J. C.(1993).The Clinical Dementia Rating (CDR): Current version and scoring rule.Neurology,43(11),2412-2414.
17. Morris, J. C.,Storandt, M.,Miller, J. P.,McKeel, D. W.,Price, J. L.,Rubin, E. H.,Berg, L.(2001).Mild cognitive impairment represents early-stage Alzheimer disease.Archives of Neurology,58(3),397-405.
18. Olazaran, J.,Muniz, R.,Reisberg, B.,Pena-Casanova, J.,del Ser, T.,Cruz-Jentoft, A. J.,Sevilla, C.(2004).Bensfits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease.Neurology,63(12),2348-2353.
19. Perneczky, R.,Pohl, C.,Sorg, C.,Hartmann, J.,Komossa, K.,Alexopoulos, P.,Kurz, A.(2006).Complex activities of daily living in mild cognitive impairment: Conceptual and diagnostic issues.Age Ageing,35(3),240-245.
20. Petersen, R. C.,Parisi, J. E.,Dickson, D. W.,Johnson, K. A.,Knopman, D. S.,Boeve, B. F.,Kokmen, E.(2006).Neuropathologic features of mnestic mild cognitive impairment.Archives of Neurology,63(5),665-672.
21. Petersen, R. C.,Roberts, R. O.,Knopman, D. S.,Boeve, B. F.,Geda, Y. E.,Ivnik, R. J.,Jack, C. R., Jr.(2009).Mild cognitive impairment: Ten years later.Archives of Neurology,66(12),1447-1455.
22. Petersen, R. C.,Smith, G. E.,Waring, S. C.,Ivnik, R. J.,Tangalos, E. G.,Kokmen, E.(1999).Mild cognitive impairment: Clinical characterization and outcome.Archives of Neurology,56(3),303-308.
23. Petersen, R. C.,Thomas, R. G.,Grundman, M.,Bennett, D.,Doody, R.,Ferris, S.,Thal, L. J.(2005).Vitamin E and donepezil for the treatment of mild cognitive impairment.New England Journal of Med,352(23),2379-2388.
24. Rapp, S.,Brenes, G.,Marsh, A. P.(2002).Memory enhancement training for older adults with mild cognitive impairment: a preliminary study.Aging Mental Health,6(1),5-11.
25. Tuokko, H.,Frerichs, R. J.(2000).Cognitive impairment with no dementia (CIND): longitudinal studies, the findings, and the issues.Clinical Neuropsychology,14(4),504-525.
26. Tuokko, H.,Morris, C.,Ebert, P.(2005).Mild cognitive impairment and everyday functioning in older adults.Neurocase,11,40-47.
27. Wang, P. N.,Chou, K. H.,Lirng, J. F.,Lin, K. N.,Chen, W. T.,Lin, C. P.(2012).Multiple diffusivities defined white matter degeneration in amnestic mild cognitive impairment and Alzheimer's disease.Jurnal of Alzheimers Disease,30(2),423-437.
28. Wang, P. N.,Hong, C. J.,Lin, K. N.,Liu, H. C.,Chen, W. T.(2011).APOE epsilon4 increases the risk of progression from amnestic mild cognitive impairment to Alzheimer's disease among ethnic Chinese in Taiwan.Journal of Neurology, Neurosurgery & Psychiatry,82(2),165-169.
29. Wang, P. N.,Lirng, J. F.,Lin, K. N.,Chang, F. C.,Liu, H. C.(2006).Prediction of Alzheimer's disease in mild cognitive impairment: A prospective study in Taiwan.Neurobiology of Aging,27(12),1797-1806.
30. Wang, P. N.,Liu, H. C.,Lirng, J. F.,Lin, K. N.,Wu, Z. A.(2009).Accelerated hippocampal atrophy rates in stable and progressive amnestic mild cognitive impairment.Psychiatry Research: neuroimaging,171(3),221-231.
31. Winblad, B.,Palmer, K.,Kivipelto, M.,Jelic, V.,Fratiglioni, L.,Wahlund, L. O.,Petersen, R. C.(2004).Mild dognitive impairment-beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment.Journal of Internal Medicine,256(3),240-246.
32. Woodard, J. L.,Goldstein, F. C.,Roberts, V. J.,McGuire, C.(1999).Convergent and discriminant validity of the CVLT (dementia version). California Verbal Learning Test.Journal of Clinical Experimental Neuropsychology,21(4),553-558.
33. World Health Organization(1993).The ICD-10 classification of mental and behavioutal disorders: Diagnostic criteria for research.Geneva:World Health Organization.
34. Yeh, Y. C.,Lin, K. N.,Chen, W. T.,Lin, C. Y.,Chen, T. B.,Wang, P. N.(2011).Functional disability profiles in amnestic mild cognitive impairment.Dementia and Geriatric Cognitive Disorders,31(3),225-232.
35. Yu, F.,Rose, K. M.,Burgener, S. C.,Cunningham, C.,Buettner, L. L.,Beattie, E.,McKenzie, S. E.(2009).Cognitive training for early-stage Alzheimer's disease and dementia.Journal of Gerontology Nursing,35(3),23-29.

1. 陳錫晚,陳瑛治(2019)。認知運動操對失智症預防之應用。長期照護雜誌，23(1)，61-74。
2. 郭麗敏,莊宇慧,高薇淇(2019)。淺談失智症遊戲。護理雜誌，66(1)，101-106。
3. 魏碧美、陳敏佳、徐文俊、邱逸榛(2017)。輕度認知功能障礙長者其家庭照顧者負荷改善案例－以家庭為基礎之個案管理計畫。護理雜誌，64(3)，105-111。
4. (2012)。及時診治與平安善終。應用心理研究，56，9-11。
5. (2021)。後疫情下機構式晚期失智者安寧照護倫理議題初探。社區發展季刊，175，179-193。