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CRITERIILE NINCDS-ADRDA PENTRU DIAGNOSTICUL

DE BOALA ALZHEIMER

PROBABILA:

I. Criterii pentru diagnosticul clinic de boall Alzheimer probabili:

a. Demen{!diagnqqti-c.aJd prin examen clinicrgi docurnentata-prin testul MMSE, g9al1 de demenla Blessed
saualttestsimilaf gi confirmat[prin examen neuropsihologicl /"t'eti' ]'t/!'-:t' it:'t''/ '";'/ ]
b. D_efiqlle_ in _dq-u4_s_aq m4i mu[te qli.icpgniliyq;
c. Caracter prog!re*|.i1 al afectdrii memoriei qi altor func{ii cognitive:
d. $!ap _{e c_qtit!-gt}4 ! galtelaJi;
e. Debut intre 499! 9Ldg. p-ni, de obicei dup[ varsta de 6l_$e*ani;
f. A,bs-e-tla bglilor si5tgmice saq alto^r boli neuropsihiatrice care sd fie responsabile pentru deficitele

qlg4ltiye.

II. Diagnosticul de boall Alzheimer probabili este sus{inut de:

I o,, ia. D__glgrioarea progresivi a fqncJllfol cognitive. qi anume a limbajului (.q@1q), a executdrii secvenJiale a
actelor motorii (EpfqLi), a percepliilor qi interpretdrii acestora (agnglS);

\b. A&9.1qry4 qctivita(ilor zitnice

;i aprilll tqlbpf4filqt

ir,ir'irt c. I_s1gr!q-fqx!lial de.d-emgnli,-maiales

d-"_

qqmpq4a4-e_.41;

confiq4at 4,eu1gpa!o,lqg[9;

utrneaza:

d.

j
i. Examen LCR nonnal { + ,*l
:
EEG ii. Traseu EEG normal sau cu modificdri nespecifice (procent crescut de unde lente) i
gr iii. Atrofie cerebral6 progresiv[ observati prin examin[ri de imagerie cerebral[ repetate.

LCe

Ju*.'

de boali Alzheimer probabill numai dacl celelalte

cauze de demen{i au fost excluse:
tl, r t I a. Platouri in cursul progresiei bolii;
lb. ryqzellq-de glq1plgme asociqtg cum sunt: depresia, insomnia, incontinen{a, idei delirante, halucinalii,
] agitalie cu paroxisme verbale, emo{ionale sau motorii, tulburdri sexuale qi pierdere ponderal[;
1". P:e.rS{,tA_A-l!gt -s-qryr-+*e qi s-!gp!-o.4e- neurologice la unii paciQnli" mai ales in"-fbZelp avansatp d"e !oal[,
inclusiv semne motorii ca hipertonia, mioclonusul sau tulburarea de mers;
if j,d. Q1-cqreb14l normal pgptru vals-la rqsp-e,9!iv6.

III. Alte caracteristici care susfin diagnosticul

qr

IV. Caracteristici care fac dubitabil diagnosticul de boall Alzheimer probabill:

'[

O.Urt brusc al simptomatologiei:

{b,:Semne neurologice focale cum sunt hemipareza, tulburarea de sensibilitate obiectivd, afectarea campului
_. vizual, tulburarea de coordonare, 4pfuqlg p-r-e-gec-g h gUr$ul e.volqtiei bqlii;
epileptice sau tulburarea de mers ?p1{,u19 plgcocg ig-c--u1g-g,|e-Vo-lqtrigi-bo!-1,

Q.rCrizele

Avand invedere o multitudine de studii recente, atat clinice cat Si de laborator, prin care s-a demonstrat cd boala Al:heimer se
asocia:d ft'ecyent cu factori de risc yasculari, in ultima rreme este folosit din ce in ce mai autoritar diagnosticul de boald
tdegenet'ativa si t 0!gulard!.

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CRITERIILE NINDS.AIRENS PENTRU DIAGNOSTICUL DE DEMENTA VASCULARA

PROBABILA:
I. Criterii pentru diagnosticul clinic de demen(I vascularl probabill:
6)Or*qA definit6 printr-un declin cognitiv fa![ de un nivel anterior gi manifestd prin afectarea memoriei
-minimdou}alte arii cognitive (orientare, aten{ie, limbaj, integrare vizual-spalia16, funclie executivd,
aocuLentatd prin iesie neuropsihologicel'
.o"troiH#or, praxie), evidenliati prin exame"
"tmidpi
deficitele trebuie sd fie suficient de severe incat sd interfere cu activitdlile zilnice dincolo de deficitele

qi a

neurologice majore determinate de accidentele vasculare cerebrale (de exemplu deficitul motor);
stdrii de
re de di,
teqtprqp-qsprgptihglggiq4,.Dg-gp-e"I*sgqgslul#e*93z*-rJg**"
irnpig4iqe
care
si
senzoriat sj mglor major,

deficitele

definiti prin prezenla:

g4, as
""t "fa,
",
semnelor negrologi.ce.&sale qvideqtlalg pfip,9*-T-qq]-91luf-cJ!-ai-q n"qurql,og!c., cum sunt hemipareza, pareza
**rulMUiniki, tulburarea de sensibilitate, hemianopsia" dizartria,prezente sub forma
fa"ir16 c*t
"1A,
semiologicd de sindrom neurovascular (cu sau ftrd istoric clinic de accident vascular cerebral) qi
2. dovadi imagislicS de boal6 cerebrovasculard (QT sAu-lRM-cerebral). sqb for!0a;
* infarctelor cerebrale multiple in teritoriul vaselor mari,
* a unui singur infarct situalstrategic (girus angular, talamus, parteabazalla emisferului cerebral, teritoriul
arterei cerebrale posterioare sau teritoriul arterei cerebrale anterioare),
* a lacunelor multiple la nivelul ganglionilorbazali sau substanlei albe,
* a leziunilor extensive la nivelul substanlei albe periventriculare sau
* a oricdror combinatii de asemenea leziuni.
manifestatd printr-una dintre urmdtoarele :
O relatie de cauzd-efect intre dementd.si boaJq
n o a!:i,

1.

2.

elgli_

_r_;

a deficitelor cognitive.
AUi"pta sau fluctuantd a funclillor cognitive sap progresie ,,in trepte"

II. Caracteristici care sus{in diagnosticul

de demen{5 vasculari probabill:

(mers cu paqi mici. magnetic, apraxic-ataxic sau de tip

(ai,Aparilia precoce a unie 1U_lbUgfi dg -14_ers,

parkinsonian);
Istoric de afbctarg a sJabil-it6tii si pqsturii, cu aparilia cdderilor frecvente, neprovocate;
Tulburari miciionale" cu necesitatea imperioasd de a urina, polaikiurie gi alte simptome neexplicate de o
afecliune urologicd;
f0 Sindrom psudobulbar:
i_de persgnal.ilglgSi a,ls afectu.Eli" abulie, depresie, incontinen{i emolionald qi alte
@
- deficite de tip subcortical, inclusiv retard psihomotor qi sindrom disexecutiv.

III. Caracteristici care fac dubitabil diagnosticul

t?
\+--l Debut
.-.-

de demenfi vascularl

ffi Absenta s-emnplgr fo*de-*puJ91ggig9.-W*e;99$Hgfuffir1**

probabill:

-q-og*ry"g";

(D; Absen1" teEunitor cerebrovasculare caracteristiqe,la -e531g9ry-19*i!R3gl;lig3-g-e--r-e,,hde-[CJ;-+]] I-BMI).

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CRITERIILE MCI(EITH REVIZUITE PENTRU DIAGNOTICUL DE DEMENTA CU CORPI LEWY

PROBABILA:
I. Criteriul esen{ial necesar pentru diagnosticul demen{ei cu corpi Lewy posibile sau probabile:
a.D_pmglAdefinitd ca un declin cognitiv pfeelqsiy suficient de important pentru a interfera cu activitatea
sociald sau cu ocupalia obignuitS.
b. 4&glg{9q_pf99_n!pt14!?! p9ry$9t14 e 11qmojigi p_W!e_pp_t1u 4para."peap61at in fazele iniliale ale bolii@ap

@,p-I9gl-e--s-ia.a9-eplgia,

c. QefigIe-de--A1gU!9'-d-e-fuf9ti9--eXgq"Utj"v-L

de.-

jnlggfa-fe,.ViZ-u.A-l-ppatria!4 pSt

-fi

progmiqe4te. -,;, rJ

L i'l', i , t,-'',,

II. Manifestiri clinice esenfiale:

* 2 sunt obligatorii pentru diagnosticul de demen{i cu corpi Lewy probabill,

* 1-"-esle--qHigt*qdc--p."eJm*ragsslie-ul-rds".dpms*S-s.s*sqrol*r*eJr-pp.s$Jk

a. Iu&Urare39gprliy4'{llqtuan-t-a -c,u.--y,-an-atri!p1oi1q1}ale als" aJsnli-ei s.i ale""4-tve.Ulu-istarii-d-e-c-o-nJti-9rUa;

b.

LIalU.qU1|U*v.-1aUe"l9*t99ir-Le--q!9__b_hplgnna-t-e

p_i_d"gtqliste; !

c. !s!q:r9-9ji:tl9-q-qg9nk!e-{e pglbir!9pjs.rp. I

III. Manifestlri clinice sugestive:

,r

clinice esenfiale, diagnosticul de demenfi cu corpi Lewy probabill poate fi statrilit. (>.7 t >-l
* I)iagnosticul de demen{i cu corpi Lewy probabili nu poate fr stabilit numai pebaza manifestirilor
clinice sugestive:
,
I
lui REM
a.
b. Sgnsibllit4tg sgv-eri la p.e_qr.glgp1i9e; I
c. LefUEltedU-S_4[ tt4.4qpq11or.ul.qi de ddpamind la nivelul ganglionilor bazali evidenfiat prin SPECT sau PET. a,

IV. Manifestlri clinice care sprijini diagnosticul de demenfi cu corpi Lewy (de obicei prezente dar care
nu au specificitate diagnostici):
i a. C_qdS!

repetate qi sirrcope:

\4*

., b. P-ied_et! q!SSl_4fi| de gonglientdtranzitorii, neexplicate

gg|oj1-o_$A sgyg{i, de ex. hipotensiune oftostaticd, incontinen!5 urinard
Halu_9-118fi!9-q!Le*1!pu! decat vizuale

ic. Disfunctie

fd
i

e. Delir

if.

sistem_ati_2.4J

Depresie

nivelul lobului ternporal media! (e.xa4en IRM sau CT)

n. lgedgtge ggger4lizalp l "gaptirii SIPCTIPET de perfuzie, qu activitale ogclpitali reduq[
I
] i. Scintigrafie miocardic6 cu captare anormalS (redus[) de [4IBG
Unae lente proeminente pe EEG cu_ unde ascu{ite tranzitorii temporqlg.

fg.

BStgt;u_a prezervare a strqglu{l.oJ de la

i,j.

V. Diagnosticul de demen{5 cu corpi Lewy este mai pu(in probabill:

a. ln prezenta bql-ir*gglgblS-v-as--s"u-l.4pe*atestate prin semne clinice focale sau prin imagerie cerebralS
b. In prezenla qIq4S"i ?_t!g 4fe.-c"1iu.11i gitem-lce .s911 c-ergbqqle care ar putea s5 fie rdspunzdtoare in parte sau in
totalitate pentru tabloul clinic
c. QacA pq* iU ggll r_q-ryir I "ap,aqg d g abla .in stadi ul de demenjd severS.

VI. Secvenfa temporali

D*SlL%lqgJ1eptpi

ry.(

simptomelor:

-L__ey! trebqie-.di4gosljgfi5
(dae4par_k*in_s-s,,r11,s!.1u"lgcts.p--rgzgnil.

atulgi cand demenla

{ty

lorN

apaye

inainlea parkinsonismului sau simultan cu acesta

Tennenul de dementrd asociatd bolii Parkinson trebuie folosit pentru a descrie demenfa care apare in contextul unei boli
Parkinson cunoscute.
In activitate practicd trebuie folosit termenul care este cel rnai potrivit situaliei clinice gi termeni generici cum ar h cel de boald cu
corpi Lewy pot fi adesea utili.
In activitatea de cercetare, qalrd trebuie lbcutd diqlinctia intre dementa cufqtpr t-eWV qi aemenla
ambele fenotipuri clinice pot

as

olii

Pa-rkinso4-Cg_con!-[-Uq

fi considerate impreun6 in categorii cum sunt boalq cu comi

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u0a-

CRITERIILE GRUPURILOR DIN LUND $I MACHESTER PENTRU DIAGNOSTICUL DE DEMENTA

FRoNToTEMPoRALA pnon.q,gnA:
I. Manifestiri clinice esenfiale pentru diagnosticul de demenfi fronto-temporali probatrili:
Ttrlhur ar e a d e c omport ame nt
-de.buttr;id9s*atpregr.e$g]snja;

- pierdere plglgEEitl..g.-v.qlyjtS a {ggpgglglUi*{q Sigg-(neglijarea igienei personale, etc.);

-pierclere'pgq*-l*s.Y9I.$19.ac.@.in.s.gp,1cJ.a't.p.,(pierdereatactuluisocial,infractriuni.
cum ar fi furtul din rnagazine, etc.);

- semne p1ggo.-cg,de &altlb:Uc(irnpulsuri sexuale neinhibate, compofiament violent, glume nepotrivite, etc.);
- Ugi d4AtggeltAb" iufl-ex-lbllit-ale.
hlpgqlffit(-odificari de dieta, consum excesiv de alimente, manii alimentare, fumat sau consum de
alcool excesive, explorare oral[ a obiectelor, etc.);
- qqp1p_o.11?Il19gL,ql9,Le'9tjp._i1p3lg9y9_fp_1rl (plirnbare excesiv6, gesturi manieriste repetate ca b6t5i din palme,
."rtri*A;fiui, p."o"rpuie excesivd gi ritual pentru imbr6cat, tezatrizare a diferitelor obiecte, folosire a
toaletei, etc.);
clg_pq&mqglde_Uliliz_alg (explorare excesivd gi continud a obiectelor din mediul inconjuritor);
- tqlburue-&-&$r"s,i u,sulsirit-alp;

lfpgjl1!-t-.

iL-o-r.p:-qprji.lipsa.s-sultl-e-+li-zarii

-b-qtii.l

Tulburarea afectivit
- d"p*ti", anxietate, sentimentalism exagerat, idei fixe qi suicidare, delir (pfggocqpi--tf-e,-c.atp.efd;
-ipohondrie,preocup[risomaticebizate(p1.-e!p--"-q-Si.t-t9-c-{19are);
-indiferenl4.p,g-q.Itq[a-!,4,-4p-4!-!E--lrps4empalie,i.q!q jmpatig!;
-epglql-ie_0ips_a*49-.$po!-tp,q-ei1a1e,i1e{ie).

Tulburareu de limbai

-qdg*.a,1q
-

qt".t_""" i

e c p,l_alte--S.U

;-;b;i"

a hrylpjgr]q! spoqt4rr gi a vocabularului (,.economie" in exprimare, lipsd de spontaneitate);

(iepetarea unui repertoriu modest de cuvinte, fraze sau locufiuni);

A-

pe-{s9ye-ra{e ;

0! _s1adiu,l tardjv).
Orientarea spatiald ;i praxia sunt cctnservale

- rLUllSlI]

Semneclinicelaexamenulneurologic ., i
-reflexeprimitive(U,.1-q"q-p); .'ri.'"r':r ' 'i

:!i {l'/

.-. ;i 7 /', ;y.,,, tt .i

;rt',i

- incontinen{d (preco-9e);
e, f t g|d ttaJe, qe$o- r- Gald.iy ) ;
- h ipotens iu ne arteri 416- 9-U v4lqry o-$9 il.ante.

q\_ig-gzi

Investigatii paraclinice si neuropsihologice

- traseu electroencefalografi c 1i-g{llql

- imagerie cerebral6 (str:ucturaTiffinclionalb)

qo-dlfic_4rip.qq$qmlnant la nivelul lobilor frg4tali qi temporali

G4er!-qr);

- alterarea testelor neuropsihologice ,,de lob frontal",

staligl-4,.

II. Caracteristici care sus{in diagnosticul

@ebut inainte de 65 de ani;

de demen{fl

fronto-temporali probabili:

Qlstoric familial pentru o afecliune similar[ la o rudI de gradul I;

(boali de neuron motor)'
QPareze de nervibulbari, deficit motor, amiotrofii, fascicula{ii
ITI. Elemente de excludere a diagnosticului de demenfi fronto-temporali probabili:
Onebut abrupt al simptomatologiei, de tip ictal;
ofraumatism cranio-cerebral premergator debutului simptomatologiei;
[OAmnezie sever6 precoce;
{SO"rori"ntare paliali precoce, cu rat[cirea pacientului in medii familiare, localizare deficitari a obiectelor;

lpapraxie severS precoce;

Olimbaj logoclonic cu pierderea ;irului gandirii;
OMioclonii;
ODeficite cortico-bulbare gi spinale;

QAtaxie cerebeloas[;
OCoreo-atetoz6;
f OUoAifrcXA patologice precoce qi severe ale traseului electroencefalografic;
sau
lfliffii^fi;rrt i" irr"E .i, cerebrala (eziuni multiple evidentiate prin cr sau IRM sau modificdri structurale
) functionale la nivelul girusului postcentral);
loi"ril, ,**ri"i"" sau de laborator care si pledeze pentru diagnosticul altei afecliuni neurologice sau
L-irflu*utorii (scleroz[ multipl5, sifilis, SIDA, encefaliti herpeticl, etc.)'

fV. Elemente de exclud ere relativd

probabili:
Qlstoric tipic de alcoolism cronic;

a diagnosticului de

demenli frontotemporali

QHipertensiune arterial[ cu valori susJinut crescute;

g f*io.ic de boall vasculard (angin[ pectoral5, claudicalie, etc.).

7-

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Dementa corticala

Dementa subcorticala

Caracteristici
Afectare aptitudini vizuo-spatiale
Afectare atentie
Memorie
Afazie, agnozie, aPraxie
Afectare functie executive
(planifi care, ar ganizar e,
secventiere, abstractizare)
Bradipsihie

Dementa cortitrala
Da
Da
R erremorare : recunoastere
Da
(apar precoce)
Da, afectare congruenta cu
alte tulburari

Dementa subcorticala
Da
Da
Rememorare > recunoastefe
Nu
(iu cazuri severe * anollie)
Da, atingere disProPortionata

Nu

Da
(apare precoce)

Tulburari de calcul

(prezenta in stadii severe)

Da
(apar Brecoce)

f)izartrie

Nn

Modifi care personalitate

Dispozitie depresiva
Modificari postura
Bradikinezie
Tulbrrari de coordonare

Nu

\4iscari anormale
(cclree, trelnor, distorlie)

(prezenta in stadia severe)

Nrt

Nu (vertical)
Nu
Nn
(prezente in stadii sevele)
Nu
(in d. Alzheimcr rnioclonii)

Nu
(prezente in stadii severe)
Da
(apare precoce)
Da (apatie,inertie)

Da
Da (curbat)
Da
Da
Da