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痴呆相关的安全和社会问题

Authors
Daniel Press, MD
Michael Alexander, MD
Section Editors
Steven T DeKosky, MD, FAAN, FACP, FANA
Kenneth E Schmader, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
段晓宇, 主任医师

引言

痴呆患者的决策能力下降。因此，安全问题是护理痴呆患者的重要方面。随着痴呆进展，相对可以预测会出现不同的安全问题。前瞻性地处理这些问题可防止严重事件发生。

本专题将讨论痴呆相关安全及社会问题的识别和处理，包括决策能力、驾驶、理财能力、烹饪、闲逛和走失、跌倒、独居以及选举。痴呆的神经精神症状的处理和晚期痴呆患者的舒缓治疗将单独讨论。 (参见“痴呆患者神经精神症状的处理”和“晚期痴呆患者的舒缓医疗”)

痴呆相关记忆和行为问题的药物治疗也将单独讨论。 (参见“痴呆的治疗”)

决策能力

损害认知功能的任何疾病或治疗都可能导致能力下降。患者能力下降的可能性与认知损害的严重程度相关，但诸如简易智能状态检查(Mini-Mental State Exam, MMSE)等总体认知功能的简单测定并不能代替对患者能力的评估。虽然阿尔茨海默病(Alzheimer disease, AD)所致痴呆患者的得分低(如总分30分时，得分<16分)与能力受损密切相关，但得分较高可能与完全决策能力相关或不相关。

轻至中度痴呆患者中，言语推理和言语记忆是能解释大多数知情同意能力测定结果的两个认知领域。个体对自己记忆问题自知力的评估也与决策能力有关。

                   

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Literature review current through: 2017-06 . | This topic last updated: 2017-02-09.
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