?????????????

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??????????
?????????? ???????????
2
?????

• ???????3500??????
• ????460???
• ????7?????????
• ???20???????

??/?? ?? ?? ?? ?? ?? ??? ??
?? ?? 500? 500? 290? 150? 110? 110? 100?
???????????????????????,2008,2?18?
http//www.tds.org.tw/html/front/bin/ptdetail.phtm
l?Part022Category121256)
3
????65??????5???????
?? 65-69 70-74 75-79 80-84 85-89 ?90
  1.2 2.2 4.3 8.4 16.3 30.9

• ??4????(???????????????),?4???????????????,?Jorms
  Model????4??????????,???????????????,???5???????
  ??,??????????

???????????????????????,2008,2?18?
http//www.tds.org.tw/html/front/bin/ptdetail.phtm
l?Part022Category121256)
4
????????

• ??2009??????250??,????????12??,???????????????????
  ??2010??1???30,439?(??????,2010?5?14???????)?
• ???65??????????????????,?????????,???????????(???,
  2001)?
• ??????????36?(?????????,2006)

?????(2000)?????-??????????????? ????,?????
5
??? Dementia

• ??????????????, ??????????? (?????????????) ???,
  ?????????????

Small et al. JAMA 19972781363-1371
?????(2006)?????????,????????????????
6
? ?

• ???? (Immediate memory)
• ???? (Recent memory) ???? (Short
  term memory)
• ???? (Remote memory)
  (Long term memory)

?????(2006)?????????,????????????????
7
?????????
???? ???
???? ?? ??
????? ?? ????
??????????? ?? ??
????? ????? ????
??? ???? ???
????????? ?? ???
?????(2006)?????????,????????????????
8
?? Other dementia 10-20 (?????????B12????????)
?????Alzheimers disease 50-60
??? Mixed dementia 10
?????Vascular dementia 10-20
?????(2006)?????????,????????????????
9
??????????(Behavioral Problems)
? ? ? ? ?
? ? ( apathy) ? ? ( agitation) ? ? ( anxiety) ? ? ( irritability) ? ? ( depression) ???? ( motor behavior) ???? ( disinhibition) ???? ( appetite change) ???? ( night behavior) ? ? ( delusions) ? ? ( hallucinations) 70 60 45 42 38 38 36 31 24 22 10
???(2006)?????????,????????????????
10
?????????? (?? BPSD)

• ???(depression)
• ????? (psychotic symptoms)
• 1. ??(delusions)
• 2. ??(misidentifications)
• 3. ??(hallucinations)
• ???? (behavioral disturbance)
• 1. ???? (aggression)
• 2. ???? (wake-sleep disturbance)
• 3. ?? (getting lost)
• 4. ???? (repeatitive phenomena)
• 5. ?? (wandering)
• 6. ???? (hyperphagia)
• 7. ???? (hoarding behavior)
• 8. ?????? (inappropriate sexual behavior)

???(2006)?????????????,????????????????
11
???????

• ?????????????????????????,???????????????????????
  ????,????????????????
• ???????????????????book????????????????????????
  ??????????????????

?????????????,2008?2?26??http//www.tada2002.org.t
w/index_news.php?ncid2nc2id16
12

• ?????????????????????,???????????????,???????????
  ???,??????(??)???????(?)???
• ????????????????????????,????????????????????????
  ?????,???????,????????

?????????????,2008?2?26??http//www.tada2002.org.t
w/index_news.php?ncid2nc2id16
13

• ??????????????????????????????????????????????
  ????????????????????
• ????????????????????,????????????????????????????
  ??,?????????????

?????????????,2008?2?26??http//www.tada2002.org.t
w/index_news.php?ncid2nc2id16
14

• ??????????????????,?????????,????????????????,???
  ??????????????????????
• ????????????????????,???????????,???????????,????
  ???????????????????????,??????????????????????

?????????????,2008?2?26??http//www.tada2002.org.t
w/index_news.php?ncid2nc2id16
15

• ???????????,?????????,??????????,????????????????
  ????????????
• ??????????????????????????,?????????,?????? ?????
  ??????????????????

?????????????,2008?2?26??http//www.tada2002.org.t
w/index_news.php?ncid2nc2id16
16
???????????????(???????)

• ??????,??????
• ??????,??????
• ??????,??????
• ??????,??????
• ??????,??????
• ??????,??????
• ??????,??????

???(2006)?????????????,????????????????
17
?????

• ??????,??????,?????????????,??????????????
• ????????,???????????,?????????,?????????
• ??????????????,??????????,???????????????,????????
  ??

18
???????????(SPMSQ)

• ??????,?????????????????????????,??10?,??????3?(?)
  ??,????????????????,???????????????????,??????????
  ?????

19
???????????(SPMSQ)
???? ?????1-10???,?????????????,(??????,????4-1?)
.?????????????????.
- ? ? ? ? ? ?
1.?????? ???????????.
2.??????? ???????.
3.??????? ????????????????????????????????????????.
4.?????????? ???????????????????,???????????????????????.
4-1.???????? ????????????.
20
5.????? ??????????????.
6.???????? ???????????.
7.???????? ??????.
8.???????? ??????.
9.????????? ???????,???????????????????.
10.?20?3???,???3???. ?????????????????????.
_____________ ????? ? ?0-2???????
? ?5-7? ???????? ? ?3-4????????? ?
?8-10????????? ?????????????????????.
??????????????????.
21
??????

• 1. ??
• 2. ???????
• 3. ????
• MMSE
• (Mini-Mental State Examination,??????)
• CDR
• (Clinical Dementia Rating Scale, ???????)
• 4. ????? AD DSM-IV, NINCDS-ADRDA

?????(2006)?????????,????????????????
22
?????????
?????? ??????
????(CBC) ????(????) ???B12?? ????? ?????? ??????????? ??????? ????? ??X?????? ?????? ?????? ??? ????????? (PET/SPECT)
?????(2006)?????????,????????????????
23
??????????

• ???????
• ??????
• ?????
• ???????
• ??.??.??.???.
• ????.??

??????(2008)??????GROUP HOME,????????????????????
???????,???????????????????
24
????BPSD?????

• ???????????????,????????????????????????????,?????
  ?????????????????????????,???????????????,????????
  ,????,???????????,?????????,????????

???(2006)?????????????,????????????????
25
????BPSD?????

• ?????? ?????? (risperidone),???
  (olanzapine),??? (quetiapine) ??????????,????,????
  ????
• ???? ???????????????????,??????????
• ???? ????????????????????????????

???(2006)?????????????,????????????????
26
????????

• ???????, ????, ??????? Educational
  interventions of caregivers
• ???????
  Other nonpharmacologic interventions, such as
  behavioral modification, music therapy
• ?????????? Pharmacotherapy for
  behavioral problems
• ????
  Pharmacotherapy for cognitive symptoms

?????(2006)?????????,????????????????
27
??????

• ?????????(?????)??.??.????.????.??.??.??
• ?????
• ????
• ?????????
• ?????????
• ???????????
• ???????????????
• ????????
• ?????

??????(2008)??????GROUP HOME,????????????????????
???????,???????????????????
28
????????

• ??
• ?????????,?????
• ?????

?????(2006)?????????,????????????????
29
?????????(IPA)??????????

• ?????????????????
• ??????????????????,????????????????????????????,??
  ??????????
• ???????????
• ????-- ??????????
• ?????????????
• ???????????????
• ?????????????

???(2006)?????????????,????????????????
30
?????????(IPA)??????????

• ?????????????????
• ????????????,??(?)?????????
• ??????????
• ???????,???????,???????????????
• ??????????????????????????????
• ??????????????????

???(2006)?????????????,????????????????
31
????????(1)

• ???????
• ??????????
• ????????
• ?????????????????,?????????
• ???????,??????

?????(2006)?????????,????????????????
32
????????(2)

• ????????????
• ??????????
• ????????,????????
• ?????????,????
• ??2-3??,?????????

?????(2006)?????????,????????????????
33
??????

• ???(incidence)
• 1. Qiu et al (2001) ??
• 1296 (75?),??2.8?,109? AD ,
  ??lt 8y 2.6??
• 2. Wilson et al (2002) ???
• 733?(75?,??18?),??4.5?,
  111?AD,??????????
• 3. Scarmeas et al (2001) ??
• 1772,??2.9?,277???,??
  13?????????????38?

?????(2006)?????????,????????????????
34
????????

• Henry Brodaty (2006)
• ???????????? 2 ?,?????????20 ,
• ??? 5 ?, ????? 50

35
??????????

• ???
• ????????????????
• ????????? (ApoE4)
• ????
• (1) ???(mental activity)
• (2) ?????
• (3)????????????????????
• (4) ?????

??????????(??? 92.2.19) ?????????(???? 92?3?)
?????(2006)?????????,????????????????
36
??????????
??????????

• ???????
• ????(??)
• ???
• ????
• ????(????)
• ??????
• ? ??
• ? ????? (NSAID)
• ? ????? (Statins)

• ??
• ??
• ???
• ???
• ??????? (ApoE 4/4)
• ?????
• ???

?????(2006)?????????,????????????????
37
???????

• 5925 ??????6-8?,??????????????34? (Arch Intern
  Med 20011611703-8)
• The Nurses Health Study19,000
  ??(70-81?)??8-15?,?????1.5?????????????38????????(
  JAMA 20042921454-61)
• The Honolulu-Asia study 2257????(71-93?)??
• 7?,?????0.25????????????????2????77.(JAMA
  20042921447-53)

?????(2006)?????????,????????????????
38
???????????? (Mediterranean Diet and AD)

• ???????????
• ?????
• ??????
• ??2258?????262??????????
• ?????????????????40 (HR 0.60)

Scarmeas N. Ann Neurol 200659912-21
?????(2006)?????????,????????????????
39
Fratiglioni L, et al. Lancet Neurology
20043343-53
?????(2006)?????????,????????????????
40
?????????

• ??????
• ??????
• ??????
• ??????

• ??????
• ??????
• ??????
• ??????

?????(2007)??????????????????????,???????????????
??
41
???????

• ???????????????
• ????????????????

?????(2007)??????????????????????,???????????????
??
42
??,????! ??!????????, ????????,
???????????????, ?????????,???
?????????,??? ????????????,
??????????! ????????,???????, ???????,????,
?????? ???????????, ??????!
43
??!???????????? ??????????? ????????????
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???????????, ???,?????????????!
???,??????????!
??!??,???????????? ???,?????
????,???????? ?????, ????????????
???????, ?????????????
44
??! ??????????,?????, ?? ??????????,
???,???, ?????? ??????????? ???????????
?? ?????????????????? ??