Earlier and Better Dementia Detection Urged

專家呼籲：失智症應有更好的早期診斷

Too few people with signs of mental decline or dementia are getting checked during routine medical visits or told when a problem is found, says a panel of Alzheimer's disease experts who offered new guidance Sunday.

    研究阿茲海默症（Alzheimer's disease，AD，亦簡稱為「Alzheimer's」）的專家小組(panel)週日（編按：2018 年 7 月 22 日）提出新的臨床診療指引(guidance)。他們表示，具有心智衰退(mental decline)或失智症(dementia)跡象的患者中，極少數是在例行(routine)健康檢查或身體出狀況時，確診罹患阿茲海默症或其他失智症。

線上菲律賓語課程開課囉~

外語教學中心專為本校教職員工生、退休教職員工及校友編製了線上菲律賓語課程， 內容涵蓋了生活必需的 6 大主題，還有真人情境對話影片帶給您身歷其境的學習體驗。 讓您輕鬆學會基礎菲律賓語會話。

詳情請見：東南亞語言暨文化資源網站首頁 → 線上菲律賓語課程

高階英語字彙達人認證

字彙力 UP！英語力 UP UP！

外語教學暨資源中心自 106 學年度起推出高階英語字彙達人認證，鼓勵臺大教職員工生使用「E-freeway 線上外語自學教室」之課程資源，以線上自學方式有效達成學習目標。完成課程並通過考試者將由本中心核發自學證書。

詳情請見本中心 E-freeway 網站--Site Info

外語教學暨資源中心推出「自學圈粉絲團」：http://www.facebook.com/ntufltc/

快加入自學圈粉絲團，讓您的英語自學走在時代的尖端！

外語教學暨資源中心推出「自學圈粉絲團」，快來加入粉絲團，成為自學圈的一員吧！外教中心會不定期地在粉絲團專頁 po 文，提供您各種有益於英語自學的資訊，包括自學軟體、自學影片、自學網站、專業英語、職場英語、主題式英語等等，各式各樣的自學資源，應有盡有！記得鎖定自學圈粉絲團，讓您可以隨時隨地得知英語自學的相關資訊，跟上英語自學的潮流哦~~~

《戰爭與和平》一部世界文學經典改編的史詩鉅片

本片改編自俄國小說家托爾斯泰的「戰爭與和平」。描述拿破崙侵俄戰爭期間，4 個俄國貴族家庭的命運糾纏，更反映了 19 世紀早期動亂的專制帝國社會。「戰爭與和平」在 1956 年曾被搬上銀幕，當時是由奧黛莉赫本與亨利方達主演，但目前很難看到這個版本。本中心推薦的是 2008 年電影迷你影集，共 4 集，每集 100 分鐘。嶄新的劇本，運用現代的敘述構思，配上精製的 3D 特效，拍攝地點包括聖彼得堡與周邊的原址，比如：普希金宮殿、彼得荷夫宮、尤蘇波夫宮、聖彼得的聖保羅要塞和聖保羅大教堂。更難得的是這些景點均被國際歷史文物保護組織列為歷史一級古蹟，並全部真實的呈現在銀光幕前。

Earlier and Better Dementia Detection Urgede
VOA News
July 22, 2018 8:18 PM Associated Press (source)

Earlier and Better Dementia Detection Urged

專家呼籲：失智症應有更好的早期診斷

July 22, 2018 8:18 PM
Associated Press

Too few people with signs of mental decline or dementia are getting checked during routine medical visits or told when a problem is found, says a panel of Alzheimer's disease experts who offered new guidance Sunday.
The idea is to get help sooner for people whose minds are slipping -- even if there's no cure.
Though mental decline can be an uncomfortable topic for patients and their doctors, the panel says family physicians should do a thorough evaluation when concerning symptoms arise and share the diagnosis candidly.
Patients and family members should push for an evaluation if they're worried that symptoms might not be normal aging - the difference between occasionally misplacing keys versus putting them in the freezer or being confused about their function.
"By the time you forget what the keys are for, you're too far gone to participate in your own care. We've lost probably a decade" that could have been spent planning, said the panel's leader, Dr. Alireza Atri, a neurologist at Banner Sun Health Research Institute in Arizona.
It's not just memory that can suffer when mental decline starts, Atri said.
"It's actually people's judgment being off, their character and personality being off," sometimes years before dementia is diagnosed, he said.
The need
About 50 million people worldwide have dementia; Alzheimer's is the most common form. In the United States, nearly 6 million have Alzheimer's and almost 12 million have mild cognitive impairment, a frequent precursor.
In 2015, Alzheimer's Association research using Medicare records suggested that only about half of people who were being treated for Alzheimer's had been told by their health care provider that they had been diagnosed with the disease.
"All too often, physicians will hear of some symptoms or memory complaints from patients or their spouse and say, 'you know, you seem OK to me today,'" so check back in six months, said James Hendrix, an Alzheimer's Association science specialist who worked with the panel. Meantime, the patient may end up hospitalized for problems such as forgetting to take a diabetes medicine because their mental impairment wasn't caught.
"We hear stories all the time of people taking years to get an accurate diagnosis," said Nina Silverberg, a psychologist who runs Alzheimer's programs at the National Institute on Aging, which had no role in the guidelines.
Medicare recently started covering mental assessments as part of the annual wellness visit, but doctors aren't required to do it and there was no guidance on how to do it, she said. In some cases, it might be as cursory as asking "how's your memory?"
The panel was appointed by the Alzheimer's Association and included primary care doctors, aging specialists, nurses and a psychiatrist. Broad guidelines were released on Sunday at the group's international conference in Chicago; details will be published later this year.
The guidelines do not recommend screening everyone. They outline what health workers should do if people describe worrisome symptoms. That includes: checking for risk factors that may contribute to dementia or other brain diseases, including family history, heart disease and head injuries; pen-and-pencil memory tests; imaging tests to detect small strokes or brain injuries that could be causing memory problems.
Tough topic
Dr. Michael Sitorius, family medicine chairman at the University of Nebraska Medical Center, said dealing with mental decline adds to the challenge of caring for often frail elderly patients.
It's a tough diagnosis to make for many doctors, he said, because medical training focuses on "trying to cure people and Alzheimer's and dementia are not curable."
He said he gives his older patients mental tests at their annual checkups — but that sometimes patients or loved ones don't want to hear the results. In those cases, Sitorius still addresses related issues including depression, safeguarding medication, nutrition and whether patients should continue driving.
He said the new guidelines are a welcome reminder for family doctors to tackle these issues earlier.
"Clearly . . . we could do better," he said.
A diagnosis should never be withheld out of fear of making the patient depressed, Atri said.
"We strongly encourage a full disclosure," including diagnosis, stage and prognosis, he said.
Patient's story
At her daughter's urging, Anne Hunt visited her family doctor in 2011 because of increasing forgetfulness. Hunt, 81, who once ran a Chicago cooking school, recalls struggling with memory tests involving letters and numbers that her doctor had her perform.
"I thought, 'OK, this is it, I'm a vegetable,'" Hunt said. But the test results were inconclusive and there was no diagnosis.
"We didn't do much about it," said Bruce Hunt, Anne's husband, until five years later, when her behavior was clearly worsening — more memory lapses, repeating herself and forgetting where to put things.
She was diagnosed with Alzheimer's after an imaging test showed brain changes often seen with the disease. Imaging tests are sometimes used along with mental tests to diagnose the disease or rule out other conditions.
Is it good to know?
"There's no pill they can take to make it go away, so some people think there's no point to getting a diagnosis," but that's not true, the National Institute of [on] Aging's Silverberg said. "It really does offer an opportunity to plan."
Alzheimer's medicines such as Aricept and Namenda can ease symptoms but aren't a cure.
Experts say other benefits include a chance to join experiments testing treatments, resolve finances, find caregivers, make homes safer and use memory aids and calendars to promote independent living.
The Hunts joined support groups and a singing ensemble, hoping that trying new things would help them both cope. They were better prepared than some. Long before her diagnosis, they converted a vintage Chicago apartment building into two spacious homes so they could "age in place" with help from one of their daughters and her family.
Anne Hunt said she had wanted to know the truth about her diagnosis.
"Not to know is to wonder why things are happening to you and you don't understand them," she said. "I would rather know and have somebody help me figure out how can I [I can] control this to the best of my ability."

研究阿茲海默症（Alzheimer's disease，AD，亦簡稱為「Alzheimer's」）的專家小組(panel)週日（編按：2018 年 7 月 22 日）提出新的臨床診療指引(guidance)。他們表示，具有心智衰退(mental decline)或失智症(dementia)跡象的患者中，極少數是在例行(routine)健康檢查或身體出狀況時，確診罹患阿茲海默症或其他失智症。
〔編按：1. 阿茲海默症是一種持續性的神經功能障礙，為最常見的失智症類型，約占 60% ~ 70%。患者的發病進程緩慢，但症狀會隨著時間惡化，從最初的行為能力輕微受損，到後期喪失長期記憶和自理能力等，最終因身體機能逐漸喪失導致死亡。2. 失智症是一種腦部疾病，患者的思考能力和記憶力會逐漸退化，可能出現情緒、語言和行動能力降低等問題，因而影響其日常生活。可參考台灣失智症協會的「認識失智症」：http://www.tada2002.org.tw/About/IsntDementia。〕
即使無法治癒，提出診療指引也是為了讓心智退化(slip)的患者及早獲得幫助。
專家小組表示，儘管心智衰退對病人及醫師來說，可能是個不自在的話題，但令人擔憂的症狀(concerning symptom)出現(arise)時，家庭醫師(physician)仍然應該徹底(thorough)評估患者的狀況，並且坦白(candidly)告知診斷(diagnosis)結果。
病人與家屬如果擔心這些症狀並非正常老化現象：不是偶爾(occasionally)亂放鑰匙找不到(misplace)，而是把鑰匙放在冰箱(freezer)或搞混鑰匙的功能，則應努力爭取(push for . . .)相關評估。
專家小組的主持人阿里瑞薩．亞特里（Alireza Atri）博士說：「等到你忘了鑰匙的功能時，早已來不及參與(participate in . . .)規劃自己的醫療照護了。可以說大概錯過了 10 年。」這 10 年原本可用來規劃個人的醫療照護。阿里瑞薩．亞特里博士是位神經學家(neurologist)，目前服務於美國亞利桑那州（Arizona）的班諾桑健康研究中心（Banner Sun Health Research Institute）。
亞特里博士表示，病人心智開始衰退時，不只有記憶力會受到影響。
他說道：「其實也會喪失判斷力，喪失個性和人格。」，有時候病人早在被診斷(diagnose)出失智症的幾年前就出現這些變化。
失智症診斷需求
全球大約有 5 千萬人罹患失智症；其中最常見的類型就是阿茲海默症。美國近 6 百萬人罹患阿茲海默症，將近 1 千 200 萬人具輕度認知障礙（mild cognitive impairment，MIC），這往往是罹患失智症的前兆(precursor)。
2015 年美國阿茲海默症協會（Alzheimer's Association）以美國醫療保險（Medicare）病例進行的研究顯示，接受阿茲海默症治療的患者中，只有大約半數被醫療照護人員告知診斷出阿茲海默症。
〔編按：美國醫療保險是由美國聯邦政府（U.S. Federal Government）提供給老年人、身心障礙者和重病患者的醫療保險。〕
和專家小組共事的詹姆斯．亨德里克斯（James Hendrix）是阿茲海默症協會的科學專家(specialist)。他表示：「醫師聽了病人或他們的配偶提起某些症狀或抱怨記憶問題後，往往會回應：『你知道嗎？我看你今天挺好的。』」接著安排病人半年後回診。這段期間病人可能因為忘了服用糖尿病(diabetes)藥物等問題，最終(end up)送醫住院治療，而這些問題都是因為沒診斷出心智損傷。
心理學家(psychologist)妮娜．西爾柏格（Nina Silverberg）博士表示：「我們常常聽到有人花了好幾年才獲得確切的診斷結果。」西爾柏格博士在美國國家老年研究所（National Institute on Aging，NIA）主持阿茲海默症的研究計畫。國家老年研究所並未參與研議本次臨床診療指引(guideline)。
〔編按：國家老年研究所位於美國馬里蘭州（Maryland）的貝塞斯達（Bethesda），隸屬美國「國家衛生研究院（National Institute of Health，NHI）」，為了延長人類具備活動力、能夠健康過生活的年限，長期致力於老化相關研究，也是負責阿茲海默症研究的首要聯邦機構。〕
她說美國醫療保險近來開始將心智狀態評估(assessment)納入年度健康檢查（annual wellness visit），但醫師並不一定要進行評估，而且該如何評估也沒有任何臨床診療指引可依循。某些案例中，醫師可能只問了一句「你的記性如何？」就草草(cursory)帶過。
專家小組是由阿茲海默症協會任命(appoint)組成，成員包含基層醫療(primary care)醫師、老化研究專家、護士和精神科醫師(psychiatrist)。小組於週日（編按：2018 年 7 月 22 日）在芝加哥（Chicago）的國際會議上發表(release)了臨床診療指引要點，細節將會稍後於今年（編按：2018 年）公布。
診療指引並不建議為所有人做檢查(screen)，而是概略說明(outline)了醫療人員如果遇到民眾提及令人煩惱的(worrisome)症狀時，該如何因應。因應措施包括為民眾檢查可能導致(contribute to . . .)失智症或腦相關疾病的原因，如家族病史、心臟疾病和頭部損傷；為民眾進行記憶測驗筆試；以及進行影像測試（imaging test）。影像測試能檢測出可能造成記憶問題的輕微中風(stroke)或腦損傷(brain injury)。
棘手的問題
麥可．席多利斯（Michael Sitorius）博士是美國內布拉斯加大學醫學中心（University of Nebraska Medical Center）家庭醫學科(family medicine)的系主任(chairman)。他表示，心智衰退的處理會使得孱弱的(frail)年長病患的照料(care for . . .)更加艱鉅。
他說，由於醫學訓練著重(focus on . . .)「設法治癒病人」，但阿茲海默症和失智症並無法治癒(curable)，因此要判定確診阿茲海默症，對很多醫師來說很困難。
席多利斯博士也表示，他會讓年長病人在年度健康檢查(checkup)時做心智測驗，但有時候病人或家屬、伴侶並不想知道測驗結果。針對這些案例，席多利斯博士仍會提及(address)和失智症相關的議題，包含憂鬱症(depression)、用藥(medication)安全、營養補給，以及病人是否應該繼續開車等。
他說新的診療指引對家庭醫師而言，就是個溫馨小提示(reminder)，提醒他們及早處理(tackle)這些問題。
「很明顯 . . . . . . 我們可以做得更好。」他表示。
亞特里博士也表示，不該因為擔心造成病人沮喪(depressed)而不提供(withhold)該有的診斷。
他說：「我們強烈鼓勵資訊全部公開(disclosure)」，包括診斷、病情發展階段和預後(prognosis)。
病人的故事
安．杭特（Anne Hunt）因為愈來愈健忘(forgetfulness)，在女兒的敦促(urge)下，2011 年去看了她的家庭醫師。現年 81 歲的杭特曾在芝加哥經營一所烹飪學校，她回憶起(recall)掙扎著進行醫師交付的記憶測驗的情形，那測驗包含了文字和數字。
「我心想：『好吧，就是這樣，我是個植物人(vegetable)了。』」杭特說道。然而測驗結果卻沒有定論(inconclusive)，無法確診是否罹患失智症。
「我們因此沒多做什麼。」安的丈夫布魯斯．杭特（Bruce Hunt）說。直到 5 年後，安的症狀明顯惡化，包括更常記錯(lapse)事情、重複說過或做過的事，以及忘了物品該放的位置。
影像測試的結果顯示她腦部出現變化，這種變化常見於阿茲海默症患者身上，於是確診。影像測試有時會和心智測試一起用來診斷阿茲海默症或排除其他疾病的可能性(rule out . . .)。
知道真相好嗎？
國家老年研究所的西爾柏格博士表示：「失智症病人無法靠吃藥的方式痊癒，因此有些人認為診斷毫無意義」，但這種想法並不正確。「診斷的確讓人有機會規劃未來的照護。」
治療阿茲海默症的藥物如「愛憶欣（Aricept）」和「美金剛（Namenda）」等可緩解(ease)症狀但無法根治。
專家表示，接受診斷的其他好處還包括有機會參與試驗性治療的實驗、解決(resolve)財務問題、找尋看護員(caregiver)、改善居家環境，以及使用記憶輔具(aid)和日曆來提升(promote)獨立生活的能力。
杭特夫婦參加了互助團體與合唱團(singing ensemble)，希望藉由嘗試新事物可以幫助他們妥善處理。相較於其他人，他們做了更充分的準備。早在安確診之前，他們已先將位於芝加哥的老式(vintage)公寓改建成(convert . . . into)兩間寬敞的(spacious)房子，以便在其中一位女兒及其家人的協助下，能夠「居家安老（age in place）」。
安‧杭特說她原本就想要知道診斷結果。
「不知道就只能納悶事情為何會發生在自己身上，而且也無法了解來龍去脈」，她說道。「我寧可知道診斷結果，並且有人幫我想辦法，讓我盡我所能(to the best of my ability)地控制病情。」