{"id":27019,"date":"2023-04-23T23:05:30","date_gmt":"2023-04-23T16:05:30","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27019"},"modified":"2023-04-23T23:05:30","modified_gmt":"2023-04-23T16:05:30","slug":"benh-alzheimer-dinh-nghia-nguyen-nhan-va-chan-doan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/benh-alzheimer-dinh-nghia-nguyen-nhan-va-chan-doan\/","title":{"rendered":"B\u1ec7nh Alzheimer: \u0110\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n v\u00e0 ch\u1ea9n \u0111o\u00e1n"},"content":{"rendered":"

B\u1ec7nh Alzheimer l\u00e0 m\u1ed9t b\u1ec7nh n\u00e3o tho\u00e1i h\u00f3a nguy\u00ean ph\u00e1t ch\u01b0a r\u00f5 c\u0103n nguy\u00ean, v\u1edbi nh\u1eefng n\u00e9t \u0111\u1eb7c tr\u01b0ng v\u1ec1 h\u00f3a th\u1ea7n kinh v\u00e0 th\u1ea7n kinh b\u1ec7nh l\u00fd. Kh\u1edfi ph\u00e1t<\/a> th\u01b0\u1eddng \u00e2m \u1ec9 v\u00e0 ti\u1ebfn tri\u1ec3n t\u1eeb t\u1eeb nh\u01b0ng b\u1ec1n v\u1eefng qua nhi\u1ec1u n\u0103m. Kh\u1edfi ph\u00e1t c\u00f3 th\u1ec3 \u1edf gi\u1eefa l\u1ee9a trung ni\u00ean ho\u1eb7c th\u1eadm ch\u00ed s\u1edbm h\u01a1n nh\u01b0ng t\u1ec9 l\u1ec7 m\u1eafc cao h\u01a1n \u1edf tu\u1ed5i gi\u00e0. Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u1edfi \u0111\u1ea7u tr\u01b0\u1edbc tu\u1ed5i 65-70, th\u01b0\u1eddng c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb sa s\u00fat tr\u00ed tu\u1ec7 t\u01b0\u01a1ng t\u1ef1, qu\u00e1 tr\u00ecnh ph\u00e1t tri\u1ec3n b\u1ec7nh nhanh h\u01a1n v\u00e0 c\u00f3 nh\u1eefng n\u00e9t \u01b0u th\u1ebf t\u1ed5n th\u01b0\u01a1ng th\u00f9y \u0111\u1ec9nh v\u00e0 th\u00e1i d\u01b0\u01a1ng, bao g\u1ed3m r\u1ed1i lo\u1ea1n vong ng\u00f4n ho\u1eb7c r\u1ed1i lo\u1ea1n vong h\u00e0nh.<\/strong><\/p>\n

\"H\u00ecnh
H\u00ecnh \u1ea3nh ng\u01b0\u1eddi b\u1ec7nh Alzheimer<\/figcaption><\/figure>\n

1. Nguy\u00ean nh\u00e2n<\/b><\/h2>\n

\u0110\u1ea1i th\u1ec3: S\u1ef1 teo n\u00e3o lan t\u1ecfa v\u1edbi c\u00e1c n\u1ebfp nh\u0103n v\u1ecf n\u00e3o gi\u00e3n r\u1ed9ng, c\u00e1c khe r\u00e3nh v\u00e0 c\u00e1c n\u00e3o th\u1ea5t c\u0169ng gi\u00e3n r\u1ed9ng.<\/p>\n

Vi th\u1ec3: S\u1ef1 gi\u1ea3m s\u00fat \u0111\u00e1ng k\u1ec3 trong c\u00e1c n\u01a1-ron \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf h\u1ed3i h\u1ea3i m\u00e3, ch\u1ea5t v\u00f4 danh, nh\u00e2n \u0111\u1ecf, v\u00f9ng v\u1ecf n\u00e3o tr\u00e1n v\u00e0 th\u00e1i d\u01b0\u01a1ng \u0111\u1ec9nh. Xu\u1ea5t hi\u1ec7n c\u00e1c m\u1ea3ng t\u01a1 th\u1ea7n kinh c\u1ea5u t\u1ea1o b\u1edfi c\u00e1c s\u1ee3i xo\u1eafn k\u00e9p, c\u00e1c m\u1ea3ng n\u00e3o suy (Senile plaques) v\u1edbi s\u1ef1 l\u1eafng \u0111\u1ecdng m\u1ea3ng amyloid v\u00e0 c\u00e1c th\u1ec3 h\u1ed1c h\u1ea1t.<\/p>\n

H\u00f3a th\u1ea7n kinh: Gi\u1ea3m s\u00fat r\u00f5 r\u1ec7t ch\u1ea5t d\u1eabn truy\u1ec1n th\u1ea7n kinh acetylcholin v\u00e0 c\u00e1c d\u1eabn ch\u1ea5t truy\u1ec1n th\u1ea7n kinh, \u0111i\u1ec1u h\u00f2a th\u1ea7n kinh kh\u00e1c.<\/p>\n

2. Ch\u1ea9n \u0111o\u00e1n<\/b><\/h2>\n

2.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/b><\/h3>\n

2.1.1. L\u00e2m s\u00e0ng<\/h4>\n

a. C\u00e1c bi\u1ec3u hi\u1ec7n suy gi\u1ea3m nh\u1eadn th\u1ee9c<\/i><\/p>\n

–\u00a0S\u1ef1 suy gi\u1ea3m tr\u00ed nh\u1edb: l\u00e0 tri\u1ec7u ch\u1ee9ng \u0111\u1eb7c tr\u01b0ng, s\u1edbm, \u0111i\u1ec3n h\u00ecnh v\u00e0 n\u1ed5i b\u1eadt c\u1ee7a sa s\u00fat tr\u00ed tu\u1ec7. Theo ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh, suy gi\u1ea3m tr\u00ed nh\u1edb ng\u00e0y c\u00e0ng n\u1eb7ng h\u01a1n.<\/p>\n

–\u00a0R\u1ed1i lo\u1ea1n \u0111\u1ecbnh h\u01b0\u1edbng: l\u00e0 nh\u1eefng tri\u1ec7u ch\u1ee9ng quan tr\u1ecdng trong b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng (r\u1ed1i lo\u1ea1n \u0111\u1ecbnh h\u01b0\u1edbng v\u1ec1 kh\u00f4ng gian, \u0111\u1ecba l\u00fd r\u1ea5t r\u00f5 r\u1ec7t\u2026)<\/p>\n

–\u00a0C\u00e1c tri\u1ec7u ch\u1ee9ng suy gi\u1ea3m ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c kh\u00e1c:<\/p>\n

+\u00a0<\/b>Vong ng\u00f4n: c\u00f3 th\u1ec3 l\u00e0 vong ng\u00f4n bi\u1ec3u hi\u1ec7n ho\u1eb7c vong ng\u00f4n ti\u1ebfp nh\u1eadn.<\/p>\n

+\u00a0<\/b>Vong tri: gi\u1ea3m ho\u1eb7c m\u1ea5t kh\u1ea3 n\u0103ng nh\u1eadn bi\u1ebft, g\u1ecdi t\u00ean \u0111\u1ed3 v\u1eadt, \u0111\u1ed1i t\u01b0\u1ee3ng\u2026 m\u1eb7c d\u00f9 c\u00e1c c\u01a1 quan c\u1ea3m gi\u00e1c, gi\u00e1c quan kh\u00f4ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng.<\/p>\n

+\u00a0<\/b>Vong h\u00e0nh: r\u1ed1i lo\u1ea1n kh\u1ea3 n\u0103ng ho\u1ea1t \u0111\u1ed9ng m\u1eb7c d\u00f9 c\u00e1c c\u01a1 quan ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng kh\u00f4ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng.<\/p>\n

+\u00a0<\/b>Gi\u1ea3m kh\u1ea3 n\u0103ng t\u01b0 duy tr\u1eebu t\u01b0\u1ee3ng, kh\u1ea3 n\u0103ng t\u00ednh to\u00e1n, l\u1eadp k\u1ebf ho\u1ea1ch, s\u00e1ng t\u1ea1o, quy\u1ebft \u0111\u1ecbnh, kh\u1ea3 n\u0103ng ph\u1ed1i h\u1ee3p, theo d\u00f5i v\u00e0 th\u1ef1c hi\u1ec7n c\u00e1c ho\u1ea1t \u0111\u1ed9ng ph\u1ee9c t\u1ea1p.<\/p>\n

b. C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng thu\u1ed9c l\u0129nh v\u1ef1c nh\u1eadn th\u1ee9c<\/i><\/p>\n

–\u00a0C\u00e1c tri\u1ec7u ch\u1ee9ng lo\u1ea1n th\u1ea7n: 30-40% c\u00e1c b\u1ec7nh nh\u00e2n sa s\u00fat tr\u00ed tu\u1ec7 c\u00f3 hoang t\u01b0\u1edfng.<\/p>\n

\u1ea2o gi\u00e1c c\u00f3 \u1edf 20-30% b\u1ec7nh nh\u00e2n sa s\u00fat tr\u00ed tu\u1ec7. H\u1ed9i ch\u1ee9ng Capgras<\/p>\n

–\u00a0C\u00e1c r\u1ed1i lo\u1ea1n c\u1ea3m x\u00fac: Tr\u1ea7m c\u1ea3m v\u00e0 lo \u00e2u \u0111\u01b0\u1ee3c g\u1eb7p \u1edf 40-50% c\u00e1c b\u1ec7nh nh\u00e2n sa s\u00fat tr\u00ed tu\u1ec7.<\/p>\n

–\u00a0C\u00e1c thay \u0111\u1ed5i v\u1ec1 nh\u00e2n c\u00e1ch: B\u1ec7nh nh\u00e2n tr\u1edf n\u00ean thu m\u00ecnh l\u1ea1i, c\u00f3 b\u1ec7nh nh\u00e2n tr\u1edf n\u00ean b\u1ee7n x\u1ec9n, ho\u00e0i nghi, ghen tu\u00f4ng v\u00f4 l\u00fd, tr\u1ebb con h\u00f3a, \u0103n m\u1eb7c c\u1ea9u th\u1ea3, c\u00f3 khuynh h\u01b0\u1edbng c\u00f3p nh\u1eb7t b\u1ea9n th\u1ec9u\u2026<\/p>\n

–\u00a0R\u1ed1i lo\u1ea1n h\u00e0nh vi: K\u00edch \u0111\u1ed9ng v\u1ec1 \u0111\u00eam, r\u1ed1i lo\u1ea1n h\u00e0nh vi \u0103n u\u1ed1ng v\u00e0 b\u00e0i ti\u1ebft\u2026<\/p>\n

–\u00a0C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c:<\/p>\n

+\u00a0<\/b>C\u00e1c d\u1ea5u hi\u1ec7u th\u1ea7n kinh khu tr\u00fa c\u00f3 th\u1ec3 g\u1eb7p trong sa s\u00fat tr\u00ed tu\u1ec7<\/p>\n

+\u00a0<\/b>H\u1ed9i ch\u1ee9ng ho\u00e0ng h\u00f4n (Sundown)<\/p>\n

+\u00a0<\/b>L\u00fa l\u1eabn, k\u00edch \u0111\u1ed9ng, ng\u00e3<\/p>\n

c. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n<\/i><\/p>\n

–\u00a0\u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n sa s\u00fat tr\u00ed tu\u1ec7 c\u1ea7n c\u0103n c\u1ee9 v\u00e0o c\u00e1c ti\u00eau chu\u1ea9n sau (ICD-10 ho\u1eb7c DSM-IV):<\/p>\n

+\u00a0<\/b>C\u00e1c tri\u1ec7u ch\u1ee9ng t\u1ed3n t\u1ea1i \u00edt nh\u1ea5t 6 th\u00e1ng<\/p>\n

+\u00a0<\/b>Suy gi\u1ea3m tr\u00ed nh\u1edb: \u0111\u1eb7c bi\u1ec7t l\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng ghi nh\u1eadn c\u00e1c th\u00f4ng tin m\u1edbi v\u00e0 kh\u1ea3 n\u0103ng nh\u1edb l\u1ea1i c\u00e1c ki\u1ebfn th\u1ee9c \u0111\u00e3 h\u1ecdc \u0111\u01b0\u1ee3c tr\u01b0\u1edbc kia.<\/p>\n

+\u00a0<\/b>Suy gi\u1ea3m c\u00e1c ho\u1ea1t \u0111\u1ed9ng nh\u1eadn th\u1ee9c kh\u00e1c (c\u1ea7n c\u00f3 \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c bi\u1ec3u hi\u1ec7n \u0111\u00e3 m\u00f4 t\u1ea3).<\/p>\n

+\u00a0<\/b>C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng thu\u1ed9c l\u0129nh v\u1ef1c nh\u1eadn th\u1ee9c c\u00f3 th\u1ec3 c\u00f3<\/p>\n

+\u00a0<\/b>C\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean x\u1ea3y ra m\u00e0 kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c k\u00e8m theo.<\/p>\n

+\u00a0<\/b>C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u1eb7c tr\u01b0ng c\u1ee7a b\u1ec7nh Alzheimer<\/p>\n

2.1.2. C\u1eadn l\u00e2m s\u00e0ng<\/h4>\n

C\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh c\u00e1c x\u00e9t nghi\u1ec7m sau, t\u00f9y t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3:<\/p>\n

a. C\u00e1c tr\u1eafc nghi\u1ec7m t\u00e2m l\u00fd<\/i><\/p>\n

–\u00a0\u0110\u00e1nh gi\u00e1 nh\u1eadn th\u1ee9c (MMSE, GPCOG, Mini-Cog, ADAS-Cog, Wechsler\u2026)<\/p>\n

–\u00a0\u0110\u00e1nh gi\u00e1 tr\u1ea7m c\u1ea3m (Ham-D, Beck, GDS\u2026)<\/p>\n

–\u00a0\u0110\u00e1nh gi\u00e1 lo \u00e2u (Ham-A, Zung,\u2026)<\/p>\n

–\u00a0\u0110\u00e1nh gi\u00e1 r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7 k\u00e8m theo (PSQI,\u2026)<\/p>\n

–\u00a0C\u00e1c tr\u1eafc nghi\u1ec7m \u0111\u00e1nh gi\u00e1 nh\u00e2n c\u00e1ch (EPI, MMPI\u2026)<\/p>\n

b. T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi c. M\u00e1u l\u1eafng<\/i><\/p>\n

d. Sinh h\u00f3a:\u00a0<\/i>X\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan, th\u1eadn, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, glucose, HbA1C, canxi, phosphate m\u00e1u, vitamin b12, folate, hormon tuy\u1ebfn gi\u00e1p, m\u1ee1 m\u00e1u, cholinesterase m\u00e1u.<\/p>\n

e. X\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u<\/i><\/p>\n

f. Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh:\u00a0<\/i>Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh s\u1ecd n\u00e3o, c\u1ed9ng h\u01b0\u1edfng t\u1eeb s\u1ecd n\u00e3o, SPECT, PET, fMRI \u2026 h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n, lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o v\u00e0 t\u1ed5n th\u01b0\u01a1ng cho\u00e1n ch\u1ed7 kh\u00e1c. Si\u00eau \u00e2m \u1ed5 b\u1ee5ng, ch\u1ee5p X quang tim ph\u1ed5i ph\u00e1t hi\u1ec7n c\u00e1c b\u1ec7nh \u0111\u1ed3ng di\u1ec5n ho\u1eb7c bi\u1ebfn ch\u1ee9ng.<\/p>\n

g. Th\u0103m d\u00f2 ch\u1ee9c n\u0103ng:\u00a0<\/i>\u0110i\u1ec7n n\u00e3o \u0111\u1ed3, l\u01b0u huy\u1ebft n\u00e3o, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, si\u00eau \u00e2m doppler xuy\u00ean s\u1ecd\u2026<\/p>\n

h. M\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m chuy\u00ean bi\u1ec7t:\u00a0<\/i>huy\u1ebft thanh ch\u1ea9n \u0111o\u00e1n giang mai, x\u00e9t nghi\u1ec7m t\u1ef1 kh\u00e1ng th\u1ec3 (kh\u00e1ng th\u1ec3 kh\u00e1ng phospholipid, kh\u00e1ng th\u1ec3 kh\u00e1ng \u0111\u00f4ng Lupus, kh\u00e1ng th\u1ec3 kh\u00e1ng nh\u00e2n,\u2026), HIV, gen test, amyloid-PET\u2026<\/p>\n

2.2. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/b><\/h3>\n

–\u00a0R\u1ed1i lo\u1ea1n tr\u1ea7m c\u1ea3m<\/p>\n

–\u00a0S\u1ea3ng<\/p>\n

–\u00a0H\u1ed9i ch\u1ee9ng qu\u00ean th\u1ef1c t\u1ed5n: b\u1ec7nh tuy\u1ebfn gi\u00e1p, thi\u1ebfu vitamin b12,<\/p>\n

–\u00a0Sa s\u00fat tr\u00ed tu\u1ec7 nguy\u00ean ph\u00e1t kh\u00e1c (nh\u01b0 trong c\u00e1c b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u, b\u1ec7nh Pick, b\u1ec7nh sa s\u00fat tr\u00ed tu\u1ec7 th\u1ec3 Levy, b\u1ec7nh Creuzfeldt – Jacob ho\u1eb7c b\u1ec7nh Huntington, sa s\u00fat tr\u00ed tu\u1ec7 trong b\u1ec7nh Parkinson\u2026)<\/p>\n

–\u00a0C\u00e1c tr\u1ea1ng th\u00e1i nhi\u1ec5m \u0111\u1ed9c<\/p>\n

T\u00f3m l\u1ea1i, b\u1ec7nh Alzheimer l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5 bi\u1ebfn \u1edf ng\u01b0\u1eddi cao tu\u1ed5i v\u00e0 c\u00f3 \u1ea3nh h\u01b0\u1edfng l\u1edbn \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. Hi\u1ec7n ch\u01b0a c\u00f3 ph\u01b0\u01a1ng ph\u00e1p ch\u1eefa tr\u1ecb ho\u00e0n to\u00e0n cho b\u1ec7nh Alzheimer, tuy nhi\u00ean c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng b\u1ec7nh c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m thi\u1ec3u c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 t\u0103ng c\u01b0\u1eddng ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

B\u1ec7nh Alzheimer l\u00e0 m\u1ed9t b\u1ec7nh n\u00e3o tho\u00e1i h\u00f3a nguy\u00ean ph\u00e1t ch\u01b0a r\u00f5 c\u0103n nguy\u00ean, v\u1edbi nh\u1eefng n\u00e9t \u0111\u1eb7c tr\u01b0ng v\u1ec1 h\u00f3a th\u1ea7n kinh v\u00e0 th\u1ea7n kinh b\u1ec7nh l\u00fd. Kh\u1edfi ph\u00e1t th\u01b0\u1eddng \u00e2m \u1ec9 v\u00e0 ti\u1ebfn tri\u1ec3n t\u1eeb t\u1eeb nh\u01b0ng b\u1ec1n v\u1eefng qua nhi\u1ec1u n\u0103m. Kh\u1edfi ph\u00e1t c\u00f3 th\u1ec3 \u1edf gi\u1eefa l\u1ee9a trung ni\u00ean ho\u1eb7c th\u1eadm […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"\nB\u1ec7nh Alzheimer: \u0110\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n v\u00e0 ch\u1ea9n \u0111o\u00e1n - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh Alzheimer l\u00e0 m\u1ed9t b\u1ec7nh n\u00e3o tho\u00e1i h\u00f3a nguy\u00ean ph\u00e1t ch\u01b0a r\u00f5 c\u0103n nguy\u00ean, v\u1edbi nh\u1eefng n\u00e9t \u0111\u1eb7c tr\u01b0ng v\u1ec1 h\u00f3a th\u1ea7n kinh v\u00e0 th\u1ea7n kinh b\u1ec7nh l\u00fd...\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"B\u1ec7nh Alzheimer: \u0110\u1ecbnh ngh\u0129a, nguy\u00ean nh\u00e2n v\u00e0 ch\u1ea9n \u0111o\u00e1n - 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