阿尔茨海默病 (AD) 是一种常见的神经退行性疾病,主要表现为记忆力、思维和日常生活能力的逐渐丧失。AD 的病因不明,但是遗传因素在其中起到了重要的作用。如果你的一级亲属(如父母、兄弟姐妹或子女)患有 AD,那么你患 AD 的风险就会增加。那么,有 AD 家族史的人,需要做什么检查吗?哪里可以查?本文将为你解答这些问题。
有 AD 家族史,需要做什么检查?
目前,没有一种单一的检查可以确诊 AD,通常需要结合临床评估、影像学检查和生物标志物检测等多种手段来进行诊断。如果你有 AD 家族史,但是没有出现任何认知下降的症状,那么你不一定需要做这些检查,因为这些检查并不能预测你是否一定会患 AD。但是,如果你有 AD 家族史,而且出现了一些认知下降的症状,比如记忆力减退、找词变困难、辨别方向的能力下降、判断力下降等,那么你就应该及时去医院做一些检查,以便及时诊断和治疗。以下是一些常用的检查方法:
·临床评估:这是诊断 AD 的基础,主要包括医生问诊、体格检查和认知测试等。医生会询问你的症状、家族史、用药史、过敏史等,以排除其他可能导致认知下降的原因,如药物、感染、代谢异常、抑郁等。体格检查主要是检查你的神经系统功能,如眼球运动、肌力、反射、协调等,以发现是否有神经元损伤的迹象。认知测试主要是通过一些简单的题目或任务来评估你的记忆力、注意力、语言能力、计算能力、执行功能等,以判断你的综合认知水平和受损程度。
·影像学检查:这是诊断 AD 的重要辅助手段,主要是通过扫描你的大脑,来观察你的脑结构和功能是否有异常。常用的影像学检查有结构磁共振(sMRI)、葡萄糖代谢正电子发射断层显像(FDG PET)和淀粉样蛋白正电子发射断层显像(Aβ PET)等。sMRI 可以测量你的脑体积和皮质厚度,看是否有萎缩或变薄的现象,这是 AD 的典型表现之一,尤其是在内侧颞叶和海马区域。FDG PET 可以测量你的脑细胞的葡萄糖摄取情况,看是否有代谢降低的现象,这是 AD 的另一个典型表现,尤其是在颞顶区和后扣带回区域。Aβ PET 可以测量你的脑内淀粉样蛋白的沉积情况,看是否有异常增加的现象,这是 AD 的病理标志之一,尤其是在额叶、顶叶和扣带回区域。
·生物标志物检测:这是诊断 AD 的最新进展,主要是通过检测你的体液中的一些物质,来反映你的脑内的病理改变。常用的生物标志物检测有脑脊液标志物检测和外周血标志物检测等。脑脊液标志物检测是通过腰穿抽取你的脑脊液,然后测量其中的一些物质的含量,如淀粉样蛋白42(Aβ42)、淀粉样蛋白40(Aβ40)、总 tau 蛋白(t-tau)和磷酸化 tau 蛋白(p-tau)等。这些物质可以反映你的脑内淀粉样蛋白沉积和神经纤维缠结的程度,是 AD 的病理标志之一。外周血标志物检测是通过抽取你的血液,然后测量其中的一些物质的含量,除了提到的脑脊液中的标记物,还有如胶质纤维酸性蛋白(GFAP)、神经丝轻链(NfL)等。这些物质可能与你的脑内淀粉样蛋白代谢和突触功能有关,是 AD 的潜在标志物之一。
有 AD 家族史,哪里可以查?
如果你有 AD 家族史,近期又有自觉症状,想要做一些专业检查,你可以去神经内科记忆门诊(详情点击:中国AD临床前期联盟盟成员单位记忆门诊),找到经过我们联盟培训、有经验的医生,进行相应的检查和评估。一些大型的医院或研究机构,还会提供一些先进的影像学检查和生物标志物检测,如 Aβ PET、tau PET 和体液标志物检测等,但是这些检查的费用较高,且不一定包含在医保内,因此需要根据自己的实际情况和医生的建议来决定是否需要做。此外,一些医院或研究机构还会开展一些关于 AD 诊断或治疗的临床研究(详情点击:宣武医院韩璎教授团队AD早期诊断志愿者招募中),如果你符合入组条件,也可以参与其中,以获得一些新的诊断或治疗方法。
有 AD 家族史的人,不一定会患 AD,但是患 AD 的风险会增加。如果你有 AD 家族史,你不必过分担心,但是你应该注意自己的认知状况,如果出现了认知变化的症状,就应该及时去医院做专业检查,以便及时诊断和治疗。目前,诊断 AD 的方法有很多,包括临床评估、影像学检查和生物标志物检测等,你可以根据自己的需要和医生的建议来选择合适的检查方法。
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rgba(0, 0, 0, .15);--weui-FG-5: rgba(0, 0, 0, .05);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #fa9d3b;--weui-YELLOW: #ffc300;--weui-GREEN: #91d300;--weui-LIGHTGREEN: #95ec69;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1485ee;--weui-PURPLE: #6467f0;--weui-WHITE: #fff;--weui-LINK: #576b95;--weui-TEXTGREEN: #06ae56;--weui-FG: #000;--weui-BG: #fff;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: #fa9d3b;--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: #06ae56;--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: #10aeff;--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(0, 0, 0, .5);--weui-TAG-BACKGROUND-BLACK: rgba(0, 0, 0, .05)}.wx-root,body{--weui-BTN-ACTIVE-MASK: rgba(0, 0, 0, .1)}.wx-root,body{--weui-BTN-DEFAULT-ACTIVE-BG: #e6e6e6}.wx-root,body{--weui-DIALOG-LINE-COLOR: rgba(0, 0, 0, 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174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--appmsgExtra-BG: #121212}}.rich_media_content p{clear:both;min-height:1em}td p{margin:0;padding:0}@media(prefers-color-scheme:dark){body:not([data-weui-theme=light]) .rich_media_content img:not(.wx_img_placeholder){filter:brightness(.8)}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) :root{--appmsgPageGap: 20px;--appmsgPageBottomGap: 40px}}:root{--articleFontsize: 17px}:root{--sab: env(safe-area-inset-bottom)}:root{--wxBorderAvatarRatio: 3}:root{--discussPageGap: 20px}:root{--immersive-safe-bottom: env(safe-area-inset-bottom)}:root{--appmsgPageGap: 20px;--appmsgPageBottomGap: 40px}*{margin:0;padding:0}.rich_media_content 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