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. Examen LCR nonnal { + . III. prin care s-a demonstrat cd boala Al:heimer se asocia:d ft'ecyent cu factori de risc yasculari.t*hlrte Nct*^tojtel Csil. atat clinice cat Si de laborator. lb. i \b. Platouri in cursul progresiei bolii. vizual.tnt. afectarea campului _.-maiales d-"_ qqmpq4a4-e_. Criterii pentru diagnosticul clinic de boall Alzheimer probabili: a.volqtiei bqlii. II. A.i aprilll tqlbpf4filqt ir. I_s1gr!q-fqx!lial de. insomnia.aJd prin examen clinicrgi docurnentata-prin testul MMSE.rS{.' ) de boali Alzheimer probabill numai dacl celelalte cauze de demen{i au fost excluse: tl.d-emgnli..bs-e-tla bglilor si5tgmice saq alto^r boli neuropsihiatrice care sd fie responsabile pentru deficitele qlg4ltiye. Diagnosticul de boall Alzheimer probabili este sus{inut de: I o.nounltw. halucinalii. A&9. tulburarea de coordonare.a ill. r t I a. c. 1".d.:Semne neurologice focale cum sunt hemipareza. f. epileptice sau tulburarea de mers ?p1{. inclusiv semne motorii ca hipertonia.1. incontinen{a. de obicei dup[ varsta de 6l_$e*ani.CRITERIILE NINCDS-ADRDA PENTRU DIAGNOSTICUL DE BOALA ALZHEIMER PROBABILA: I. p-ni.icpgniliyq.4e.41. 4pfuqlg p-r-e-gec-g h gUr$ul e. LCe Ju*.. in ultima rreme este folosit din ce in ce mai autoritar diagnosticul de boald tdegenet'ativa si t 0!gulard!. Naj. Caracter prog!re*|. Demen{!diagnqqti-c.tA_A-l!gt -s-qryr-+*e qi s-!gp!-o.lqg[9.eu1gpa!o. Atrofie cerebral6 progresiv[ observati prin examin[ri de imagerie cerebral[ repetate.|e-Vo-lqtrigi-bo!-1.rCrizele Avand invedere o multitudine de studii recente. mioclonusul sau tulburarea de mers.ir'irt c. D__glgrioarea progresivi a fqncJllfol cognitive. tulburarea de sensibilitate obiectivd. g9al1 de demenla Blessed saualttestsimilaf gi confirmat[prin examen neuropsihologicl /"t'eti' ]'t/!'-:t' it:'t''/ '". a percepliilor qi interpretdrii acestora (agnglS). confiq4at 4.u .*l : EEG ii. Q. a executdrii secvenJiale a actelor motorii (EpfqLi€).. emo{ionale sau motorii.1qry4 qctivita(ilor zitnice . Q1-cqreb14l normal pgptru vals-la rqsp-e. e. plrvcDs -AaRaA = i. D_efiqlle_ in _dq-u4_s_aq m4i mu[te qli.u19 plgcocg ig-c--u1g-g.Urt brusc al simptomatologiei: {b..i1 al afectdrii memoriei qi altor func{ii cognitive: d. ia.9!iv6. Alte caracteristici care susfin diagnosticul qr IV. if j. ] agitalie cu paroxisme verbale.q@1q). j i.oua! "^rf . $!ap _{e c_qtit!-gt}4 ! galtelaJi. qi anume a limbajului (. Debut intre 499! 9Ldg.neurologice la unii paciQnli" mai ales in"-fbZelp avansatp d"e !oal[.'/ ] b. Traseu EEG normal sau cu modificdri nespecifice (procent crescut de unde lente) i gr iii.uo.Jcdrw llsst&wo *d S/ale -"/ Altlui-*. utrneaza: d.ae tutokl bt w&rro A. idei delirante. P:e. ryqzellq-de glq1plgme asociqtg cum sunt: depresia. tulburdri sexuale qi pierdere ponderal[. Caracteristici care fac dubitabil diagnosticul de boall Alzheimer probabill: '[ O.

-lrplro.r" x yrtw'.rtal' ..L^t" .ru1./. Afi16. x rud'ca*a'Je . ' *ae-q1^^.*r^I fNiMrSn .u!*alt . oh .ral.J-A*w -i) hpxit a.Aord - xW *.. fbM . a.. N.rolt au&uu drtNtdl a. l.^'''NIi' MDnqlMi 4.*4. (>esuv.frt*$o *relo)*&g G*Nr. er0 Iivl 1.rrr*qd"e @tw v &k| la dr)...r O d**oti arb marrd' w z' atil. *.rbH.* ur.Lt -..ol.Nq u.rwluldrtlt'dd +oclou' {${d^tt fl-oliu' -a l^ru[a.lru in Ai 'ndad -".lr"l*r' au ao ' fo ' w**^*.r". a.:nu.i fu.1a r&ruan p'o'lr"u'* o"rloi.1fu.'Pr^n l.t' trn. 'l'a ait&. M/b^di.a 'uhtla' O t' yfui .rril^nl ^ i) ) l! -r'*t-*'*i W fir.{*"^} : ydu:mh Tut . a : '.) .14. f*dtl ) .baib *iri"f Arrt .uT'Pt? A &il.&rru Alrl*tr*t" elaqi. x 'd*t tkior rrl qr^rlu td.b(rit al. CIa*l' tra- /'l'&l f*' . luo@o A.4(*o'* -i'b rO'Iu ^*'#ffli* '** n'inh)tpoXp a" caaia ntnxlu! * dililul *td."t @ ath.l -. W y' ^i*r# lrJrr^l Br*A" . MIAW aai*.nzy. ..- . *rrfrr* ilk.lirl Wat. . ( yi*"7olot ur unTh''nl f Tf .bi -) didlff d^a.J t*/o' nnt *dr^lr ! ArJ ) aou l)ils..r nu:a amThkl^.4 .. inaila M Al*l*i*u a. ^o7r^'1.rl* arritaid 6Pg)! o N.o-csidtdt uaaailw d.oolq N&^"*p x ..' .*' rtl'rildhilc) ryaauta. Tnnht*a Yvuhtout ou)wd ftofutl.'^taatilrtalp gnfA ( h.yy^.udgt^r.rutmoi 'lo*u"*l * *.. hltata iil ^"./.ffil t*"l.2t ) -*ik {.tilei.^d . $zF ' d N*b"*rl *trh a. (illt^nt. .Drrr"?rrrlo . ? .

'{. * a+ala&u' ah ln ottlat f.. de Wr* p*.rp7oxe AroN -rrruinvF : a*ludP"i ' q'dn ' l'u'laliltal" il... .g--€ .*d.*t L 'ndintt' uruatt'loii aryntuun # ilrula! *il.torct r*'* (/upua (r. d.' ntokl$ruX pnruhewua { t.t... .kl .nilfw*n nz olwtnk Azl** . al qa:'g' *N* Wt..- -0^^tl gi^..@owL eaontt'ut (3) Ivr$rwyLcJ**nxa dr*oL a iua... riloo(sua.t clnu:u . .: (. ..*lna .hhoit aptt " . .I .td.i"-.l#* y7 fu_'/ar*:t*h pao*h rnor' Iinan '. *^l i.fo*mdc.* .".tdt.u-vL mfta m. Arilrrrfu. ' aw&i XW/ri+- T.t l/-.id$ drfr'**A tt ou *ryt*u'en yolormar"fil. f*eil : -do .*oloda' : ll.' 7r* .rt$" aa*'h}u"16***Ia t de "wcj"ma t/nA^gmmtt eEud.tt* .ht. . y*"i1*u *N ry"#f at {aut tz) l<aala rxcnftrtdn . d.rr" ^Br"/s.Aotrtm : efAJ..a.Md: .-€ iJrep&E * -uggeg5g €.nsa arrl. '-il"ata ' dnf ' '*I') ..q -rr. . ucLtn' enXmJ*v dq. &oL^r.*ra .*%- Trzl//Ll ahilO. iy'*lul''4u ' aytafu fruoai*S!#*o*.*.a^|.rtA.l*.- . *d.2-* t/a^ tn uuse \! .*/. lullauiut' al. lhif. hnt*^r^Art./*iltl* uu/dtn/ -..ir"ar'tdtnt *oro*'u & ru)e .) t*lr^*"*l (5) lttt*t&a /arlrolt:tn.- 4nhnAu.. t - *e. .Lq&i I ]nN*r. . 'yrl*hu: &ntro'*Q .uix fLfru lQgd &trah mcd..u:! fr-. &//Luilt t"tkn.

3 mg.-di inla !\*A ft*X) t Leti dimirudo tt' dnmtudp + lualw i*h. ytnt"ru Itwrr"duwu'" (a.lpffiW" j _3- *:* (t4t13€ * < 1?. F. . n*lr*ulrnag rmunantilna .Taplu -i-E-ye' jYISF ro 'twr' A* ' onklo>b*' "al.s"{'/ .ao o (.) : tru/fi . .{".t ..m6t* (rc-n. 6 mg) : 2 * I *-' dilrfit.onl.mg/t' /x-a/tD - T t ^7 J*a. n"#l.s mg.J**lv* a.*A. Af 6 diliott t/\tkrrylt6 (a^g t r6an6.0> h*l"a.nu ot*rj /o&aad' Pte HaNr:.*t'ot r. tr-.ulinAh*a2c ( anttl .ervfn *r-tugir+se i^hb**l .*l. & .r{ff5..miNolo + atono- frl*^"ky" )nli. .*A""rrrh*a$ t lr'fiin'l .:.ruoh ' +.f g .jh' t Alr^ (t. . b*lLdi ozald.rr*6lsb*r 'tfo 9.orzq.e nfrlLv&r r g.f. tt . r*lim-utnaxd ry /.*. f r. 4.J.ry-) i. h.:y^ . ./ilt\at ) t'rA.Pn** .: t? :*.(t.(!*g:r:g.r*U lzket.*luoolrnapo ' slu o '@ b'w7l*' eercrurauirue leeuirvy )' alala ' to'mg) t) i.ttu'lrtlod dr O DotuEpe.ili"| o./ . *{ t ^nf ) : 2 w' I x' d.nuofulole.*il (nr-:'cs. t+n5!: t doJa l* dr.xiliil s nnql*' 'fut tatG n6t*' '@ '+*81: Wtn' 'fu| . . lrlfu .*+&r'W /ruee Dgr+garnP - i^. i*gl. g *61+''j. 6 ^At*.nOr*grr*^a oeu.*' 2s.oa(*"eolwa2" at hrrfi-l . *. ..ulr*a*rtajlr - aLuA tr.til =.lnlsi d. sn.nralo + dat$ .'l'L'n i"'/nn*'7*.n*Lrrrr{rnoxa sAu @ aivasrrCuirua ( exetoN) ini+o! ury.".rutil+ + otonr.*:@fu"Wtw" srnaiu oe ( uuse *2D-26 ) . ^-ril .*."'bl'/La? {. !.aol' to b"A'.d * nk*/v' dt rtrodsrut HHse .o*lr^"t^"P o x)* /eaixa) t*i*aj .rnglmt)''*8 ial .^ylu 15 -\f'^' dr.

ronla/a-ui.at . darrl {) to o..liyn lr#'rA ' adt at'A* .aolunt ca/t/nt'et p*r d. . broynd*'o.) .u/.A.|uryla o&q$. t/rrklD.-camrhyt.ti4diilul . *a*yilr.u ) qzaue..tsrrllL&hrl aarrlw .uorrranol. aolru. arrdrlniotu - n{^+i rmdl' att/} /rr*el aAtXoJroo.r^*rr'ilo. Hilop.! ssei t rtra*l*ra Si.siqsn'cE ' Rnfn'Jwra (o.!aldrfi - - ilr. rpnl/lokJ r'*a.-^ &uspreOnte ..J wvntpie *r'oulorc*L .hcndtu'inre/*l*' /ru*en/ tn /*rfu' A col /n t/4o/ . loqWrolrLW&t&ttA : blatt (ur.ni dulu.r*u "rrr7"l.*.: SSN a &rua X.i:) /un&.itac : afu. * *& &. cr&hulu?f I ---fE-ll5_.t n a*u.Q).lrlp.h7a (are). / "dr.l. E*Jryho".g.fu^*l) lopcl*u ( /. ' "/. .0 .rmj CriNPAeTAll€NT SE}.Ad. a.n xtapfmra I .inr*" tl t^l$oHilt 4 utt W /.@-f- Sirvpror. - "tno* N inury / at"fuyur". a.r-t*f ) l.*ko/r.olrlhL ta- nprt_ l. dp urrtoj ardr&y"i. . t //*' at&to fi oilw I /a antn "la ulcatt .u*.. ?.t orr: ..riolel .rmpcl. iJ..t & *4 ln -<l:f al*prwl /a/ '@t*c' lo 'n'u"') frGimri4 qsluauarunjE - : /ao2nilwq. ool*... tu) "rtd y7**ild*a.il olDP rm*ea eaa. hat rrrd.-a I ln yrnluW I .net-a-t ) x.au{zintb.olrry$l*r.UA L *cp-esiv a dna .gu *M-.ref.n .r€ oEg&^6sivs ..r- n l.t6 (#il*n. .odu'' t "r/ +f . rfu)c de a.

*oo mg ) : too.nun "t*"lolau t T ..t. ryL'^r. t^a*""i"0^ (rf 1r^i .oo{r9 atmtlo*+t ALTELE t t/*' fl*yn^* WIB . a tanln^ln.A'*rrt at *tttunW' d' ""'*'wn! {n"ukt" . [)n rA . .t"d.t**81^' . .tu'k artlat' /". mf.lo.ry... W Akdn) [n d*/igrn*.tr.Adtt ur lil*g*il h h..d*'.*8) : t@ .i- .i'[nJi'*! Jil'ii*tr.lodi tAeo : rru&'adlt dt a &ua al.aoouih' (ry7=t.n lu^.HEbicnrl e NEUP. rm mslasrtAa/t a^***rlr'ffi/d'odxto rv't)o 4/'Alm'2 ad'Ytu

&n .i^. fu n0rn9.. uaccin a^'A t*ha*&''d .aPeotEcIoQPE ] t demuntb .^A* ! . : iwl H W^uo ./.urlrr ueAiOeilE Nooren P "/.ro.ts pnndietu4 annilga7yu raqrnh. Air'. AQfuilfi'm . n p"/ ..W.a'M" i Vaafi * /iltnn '*:3f* .lat* f *r*{.wudtealtra' h a/loctw mudte*Y plt anctw o) ry# %:"'.*fu ..f ffia^'* k aoo"ld rru.*71*.att alroti. of/rrurr'.sui1 'ryJ^.i' *^a$h nl aulat.rurl.rra/. tut i.rrrf an naafno ?) .* w ry.".-'*"" E t1a. N*h^ . M dofnryei. bilal"l otq x 3 /a' 4o altlnaru f.%w N ")uoi'nl /n"n'moxl*'' irtlont ttmttoia lvl^. inltu*atai.\qw . T.*dtir *adrai ' "*drbdl d' a /tuio ilA* .utvmd. 'j'7w dai lM o-a ot4'r. €almo.

*1*a"+ .rl4t.roAieOR ainc uaaularu' t DF plse *trfre /eilula'u.Tap. arrd. dt^r.-:AH€NIu -fa"l*' dn L f*e.

$* . ' luury'[t*"'i^a .rrra. acermemr.r-#uu[rcr. €i.o"J"i lnrdsrrr]rn.trdtsgn^d. .. [fJ.i uI {-r.drl^h . ou"Jo*de*t& -". 5. (.e'^*Lt6L .*fu^tr6. -.Jt rxogtrron-oo.Ja . N=Sri&L. .rla tn wn -. { 13.l . Io^Lo.mat a) {htt ltrutdnrvrnna q.L"*n*t uo*.. .1 '.. u lar?tljaond nc{firrd d .slxr" de .-" " rrc .5*...n**d .& ' n& rn rr'"P"ql'.'tla { h'rr& .: duPfio oaleitL qbH) "d... c"JeasooJ*rcgr' a.e.-.* \. /vruha .*y'"""qbL **f.v F+altsud chnnr(( oo. in cwail drh"tu-.'.n^eJor.r}rr' d. {trlJnr.or"+e"i. M *t"irrt*tl di...lufif$.Lcur.r"t) 6pJ q*J.. 1 ne.lartd A..--\ ..r^r-fapuq^ur{qr* {.olst i.u..-^ .crrnlo ) : f fl bu tutA'il&i ({x.J 1*d.[. d€ . .Lu* . fur."lrd."J --r.i J AeFsrie..eta . al(o 5.fi. cr I p.fuur I &rnrr' CH 4i .al. ?uq**#o fCI.f. @ f.- . A sc df* b*...---._orr nsirrrdn {xcl&rtu *14 Por.rrf BJrunAL ).e{'t'0. *> >r#w+ e' uc*"x{o..* - [JdI T l. J' tq"r*.{ X p. r^tlnLck *ufupl..k tur au : idrltr dElrr*# at iud*fi p& e .l Zh C. ert4^cualoq0-era (<^ . d.. dn c*...id.)..r*.ul.Or.-.-:.frc d"U*f"..r^rr^.rumdrf. B.i s: *'oJ : tJ' t*. -_.*.ud^/a-{" 4II}A aulr.r. drrfedn.c "l*'*r^-lr.ut.tnldiln 'b.o..- AVc grr.ru[or.r./r)@) dolc d.o. .t n"rJ*L d.loc $& e[!"". u"r}.**"**1 d'talAir..' { fJ ptu.j" .rc fu r"r^o. A/ e gu rcl"u d{-ti.e{*oredj. .**& & s Qe0qf-*a " c{Yvr4-\ric. a#&.{"* fli.*# .rrlu' dr*.. e.r {t .

e&-. apraxic-ataxic sau de tip (ai.ilglgSi a.. incontinen{i emolionald qi alte @ . parkinsonian).-. teqtprqp-qsprgptihglggiq4. Tulburari miciionale" cu necesitatea imperioasd de a urina. f0 Sindrom psudobulbar: i_de persgnal. inclusiv retard psihomotor qi sindrom disexecutiv.ce. limbaj. 2. parteabazalla emisferului cerebral. Caracteristici care fac dubitabil diagnosticul t? --l Debut . cu aparilia cdderilor frecvente. * a unui singur infarct situalstrategic (girus angular.k Ni Nbs - ni qer'i s = xmJffi"J#H (. pareza **rulMUiniki. funclie executivd. * a lacunelor multiple la nivelul ganglionilorbazali sau substanlei albe. * a leziunilor extensive la nivelul substanlei albe periventriculare sau * a oricdror combinatii de asemenea leziuni.l 1*Y. polaikiurie gi alte simptome neexplicate de o afecliune urologicd.o"troiH#or.. semiologicd de sindrom neurovascular (cu sau ftrd istoric clinic de accident vascular cerebral) qi 2. sqb for!0a.Y. semnelor negrologi. hemianopsia" dizartria. stdrii de re de di.CRITERIILE NINDS. teritoriul arterei cerebrale posterioare sau teritoriul arterei cerebrale anterioare).Eli" abulie.ls afectu.hde-[CJ. (D. Absen1" teEunitor cerebrovasculare caracteristiqe.la -e531g9ry-19*i!R3gl. dovadi imagislicS de boal6 cerebrovasculard (QT sAu-lRM-cerebral). talamus.-W*e.9*-T-qq]-91luf-cJ!-ai-q n"qurql. \.#:.og!c.deficite de tip subcortical. Wu**n r . III.prezente sub forma fa"ir16 c*t "1A.. cum sunt hemipareza. * infarctelor cerebrale multiple in teritoriul vaselor mari. 1. 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.Dg-gp-e"I*sgqgslul#e*93z*-rJg**" irnpig4iqe care si senzoriat sj mglor major. as ""t "fa. depresie. * deficitele definiti prin prezenla: g4.. AUi"pta sau fluctuantd a funclillor cognitive sap progresie . praxie)..AIRENS PENTRU DIAGNOSTICUL DE DEMENTA VASCULARA PROBABILA: I. neprovocate.si boaJq n o a!:i.-+]] I-BMI).. integrare vizual-spalia16. magnetic. ".in trepte" II.lig3-g-e--r-e. tulburarea de sensibilitate. manifestatd printr-una dintre urmdtoarele : O relatie de cauzd-efect intre dementd. a deficitelor cognitive. elgli_ _r_.&sale qvideqtlalg pfip.- de demenfi vascularl ffi Absenta s-emnplgr fo*de-*puJ91ggig9. 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).Aparilia precoce a unie 1U_lbUgfi dg -14_ers.th N{fi"wae*&r.. Istoric de afbctarg a sJabil-it6tii si pqsturii. aten{ie.99$Hgfuffir1** probabill: -q-og*ry"g". aocuLentatd prin iesie neuropsihologicel' ./:. Caracteristici care sus{in diagnosticul de demen{5 vasculari probabill: (mers cu paqi mici.

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p--rgzgnil. In activitatea de cercetare.s*sqrol*r*eJr-pp. I III. 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 ..4pe*atestate prin semne clinice focale sau prin imagerie cerebralS b.11i gitem-lce .--y. b."eJm*ragsslie-ul-rds". Disfunctie fd i e.qi de ddpamind la nivelul ganglionilor bazali evidenfiat prin SPECT sau PET. hipotensiune oftostaticd. a.di4gosljgfi5 (dae4par_k*in_s-s. I lui REM a. qu activitale ogclpitali reduq[ I ] i.dpms*S-s.a9-eplgia."peap61at in fazele iniliale ale bolii@ap @..-1aUe"l9*t99ir-Le--q!9__b_hplgnna-t-e J p_i_d"gtqliste.CRITERIILE MCI(EITH REVIZUITE PENTRU DIAGNOTICUL DE DEMENTA CU CORPI LEWY PROBABILA: I. de ex. LefUEltedU-S_4[ tt4.i ale""4-tve.1u"lgcts. LIalU. VI.Ulu-istarii-d-e-c-o-nJti-9rUa.7 t >-l * I)iagnosticul de demen{i cu corpi Lewy probabili nu poate fr stabilit numai pebaza manifestirilor clinice sugestive: .-''...D_pmglAdefinitd ca un declin cognitiv pfeelqsiy suficient de important pentru a interfera cu activitatea sociald sau cu ocupalia obignuitS. Delir if. P-ied_et! q!SSl_4fi| de gonglientdtranzitorii. ln prezenta bql-ir*gglgblS-v-as--s"u-l. -.s!.ul.- jnlggfa-fe. b.glgp1i9e. V.qU1|U*v.( simptomelor: -L__ey! trebqie-.4J Depresie nivelul lobului ternporal media! (e.. diagnosticul de demenfi cu corpi Lewy probabill poate fi statrilit. (>. IV. !s!q:r9-9ji:tl9-q-qg9nk!e-{e pglbir!9pjs. QefigIe-de--A1gU!9'-d-e-fuf9ti9--eXgq"Utj"v-L de.rp.aqg d g abla . Iu&Urare39gprliy4'{llqtuan-t-a -c. 4&glg{9q_pf99_n!pt14!?! p9ry$9t14 e 11qmojigi p_W!e_pp_t1u 4para. Manifestlri clinice sugestive: . ! c. II.-an-atri!p1oi1q1}ale als" aJsnli-ei s.oJ de la i.p-I9gl-e--s-ia. incontinen!5 urinard Halu_9-118fi!9-q!Le*1!pu! decat vizuale ic.xa4en IRM sau CT) n. b.s$Jk a. Sgnsibllit4tg sgv-eri la p. Criteriul esen{ial necesar pentru diagnosticul demen{ei cu corpi Lewy posibile sau probabile: a. rJ L i'l'.-c"1iu.A-l-ppatria!4 pSt -fi progmiqe4te.u_a prezervare a strqglu{l. t. i .j. C_qdS! repetate qi sirrcope: * .e_qr. sistem_ati_2. neexplicate gg|oj1-o_$A sgyg{i.r11. Manifestiri clinice esenfiale: * 2 sunt obligatorii pentru diagnosticul de demen{i cu corpi Lewy probabill.ViZ-u.4qpq11or. b. c. lgedgtge ggger4lizalp l "gaptirii SIPCTIPET de perfuzie. BStgt. Diagnosticul de demen{5 cu corpi Lewy este mai pu(in probabill: a. QacA pq* iU ggll r_q-ryir I "ap. Manifestlri clinice care sprijini diagnosticul de demenfi cu corpi Lewy (de obicei prezente dar care nu au specificitate diagnostici): i a.s911 c-ergbqqle care ar putea s5 fie rdspunzdtoare in parte sau in totalitate pentru tabloul clinic c. Scintigrafie miocardic6 cu captare anormalS (redus[) de [4IBG Unae lente proeminente pe EEG cu_ unde ascu{ite tranzitorii temporqlg. Secvenfa temporali D*SlL%lqgJ1eptpi a ry..u. 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. atulgi cand demenla {ty lorN f 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.r clinice esenfiale. fg. * 1-"-esle--qHigt*qdc--p.in stadi ul de demenjd severS. In prezenla qIq4S"i ?_t!g 4fe. I c.

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b . .t L. noolr/"tu 7-rlr*1*.rrltsrr.*atrr/*/o" .rlrl yf "'-d /'*A-"''l : TuUdtu Pf'. lutol* .r* l^'{akJ ./" d.. "lry d-rrrrl. d" 0 Nc l@4 .dr7.aza q l . Parr-&. A^ryn^alrt a. ot b.o a. . lan$tl"rt' nitutu .^.lal.ry 1^/*-."o^rr'lrnr'drl % /twl ?SJ: . matu/uka' net*sWFt.n.{Al ry On/rN .'fr. cc' 4 .4t /na.brMla . *r.u../uti dr'{dt de dr!ru. l' fu"/"-'s" ) .* h€rt" /9* 'r' arrlo/.*eW o.r./*w. 4b. * f*rr*'shtt' 4oSo!r' a/z? lo.Lt.:'.o*ilx efirlr| *d o yailo "J o 't"/'*"'1" *oolrfw ilillilcraL orc. l-ttz . (tol. *o# -. /"on ^7ar1o.lr* * .r"*i*a (tn ur. on dau dr*rbu a fiitu c . J.ilr/d| .lodJ t-42 N a d*.rr"rk.ol:ttfi. b. o^. o. n-f' LcuT : h t""'""-/ a-' ^ t^"/o!. furhna* z b. lrwnn.-lg U.d. .*l/t*-dQ:. nodrft.$!rfu(. .l/ .Wt a-Mu'd d'lne'nu uint*)n v b.""6rt' bd /o*rf @r. tufrillital .:.l *rtr-"r/.a} dornernl.*l ('g dur''*.. / ."b^rnn > 6aomr /7..'in Md * .. . Pailrnrrn .-*lo fi.. I : 'al*rn t *fu+ *@ l. Pa. /*lr't>npa .*& .our. .wdouau ar*uo -+"/& *rr.br.'i*' ) . 'UAl aru dt r*er>r$ ho'/ Aoc .&. r?.l. irklr/^f *lr. /. rutn&6rrnutr.tt %' A.rJt. .*/ry*4.& d')' l' Pa'j"'wn' zvv\..nat /unt" dX # /rrr^srr^thL .r-&o..N ln lrelo " ornilU"dtil l-qz diltttlldp p.ta*2 ..l Ltuj P. /"-A in '*ri a^ .mrnlu*r.r.ad.l Age": N. bi. iotil' oh*1"*t/ d'h.tt n d*r..

/" A/th)rr*.r da.mg b' ) Ut U2. u0a- . tr. .*€ ?aluarie. Q.{ SlHp aEperslvg de*r*.ril1n7i^6 (so .too .1rt"t ( ro x) AGlrqrin PaisougrowE .6 . .9is prox E /u*.

-pierclere'pgq*-l*s. amiotrofii. -epglql-ie_0ips_a*49-.9-U v4lqry o-$9 il. de tip ictal.1cJ. tezatrizare a diferitelor obiecte.. compofiament violent. de demen{fl fronto-temporali probabili: Qlstoric familial pentru o afecliune similar[ la o rudI de gradul I. fascicula{ii ITI. A- pe-{s9ye-ra{e . cu rat[cirea pacientului in medii familiare.l tardjv).. etc.qlyjtS a {ggpgglglUi*{q Sigg-(neglijarea igienei personale.l Tulburarea afectivit .q.imagerie cerebral6 (str:ucturaTiffinclionalb) - qo-dlfic_4rip...alterarea testelor neuropsihologice . ODeficite cortico-bulbare gi spinale. OMioclonii.qq$qmlnant la nivelul lobilor frg4tali qi temporali G4er!-qr).'"r':r ' 'i :!i {l'/ . p.g-q. i -reflexeprimitive(U.i" a hrylpjgr]q! spoqt4rr gi a vocabularului (.gnA: I. lfpgjl1!-t-. hlpgqlffit(-odificari de dieta.p.i .pierdere plglgEEitl.rt'.buttr.in.i 7 /'.. fumat sau consum de alcool excesive. etc. . -ipohondrie.Ugi d4AtggeltAb" iufl-ex-lbllit-ale. {SO"rori"ntare paliali precoce.-cg.lipsa. Olimbaj logoclonic cu pierderea .iy ) .rLUllSlI] Semneclinicelaexamenulneurologic .h ipotens iu ne arteri 416.p.).y.1q - qt". idei fixe qi suicidare.economie" in exprimare.q-ei1a1e. iL-o-r.a't."o"rpuie excesivd gi ritual pentru imbr6cat. etc.gp.t_""" i - e c p. - q\_ig-gzi Investigatii paraclinice si neuropsihologice . manii alimentare. .Y9I.atp. .Le'9tjp.). . Tulburareu de limbai -qdg*."rtri*A. tt .. etc.e$g]snja. consum excesiv de alimente. (boali de neuron motor)' QPareze de nervibulbari. Elemente de excludere a diagnosticului de demenfi fronto-temporali probabili: Onebut abrupt al simptomatologiei. cum ar fi furtul din rnagazine.id9s*atpregr. Caracteristici care sus{in diagnosticul @ebut inainte de 65 de ani.-.-. Manifestiri clinice esenfiale pentru diagnosticul de demenfi fronto-temporali probatrili: Ttrlhur ar e a d e c omport ame nt -de.ante. glume nepotrivite. anxietate. Orientarea spatiald . .d"p*ti". .i praxia sunt cctnservale .@.i.de &altlb:Uc(irnpulsuri sexuale neinhibate.-4p-4!-!E--lrps4empalie. localizare deficitari a obiectelor. .incontinen{d (preco-9e).preocup[risomaticebizate(p1. [OAmnezie sever6 precoce.). explorare oral[ a obiectelor.qqp1p_o. staligl-4.$19. delir (pfggocqpi--tf-e.a.tqlburue-&-&$r"s.b.sulsirit-alp. clg_pq&mqglde_Uliliz_alg (explorare excesivd gi continud a obiectelor din mediul inconjuritor).ql9.efd.i .11?Il19gL. sentimentalism exagerat.4.infractriuni.$po!-tp.1-q"q-p). . lipsd de spontaneitate). deficit motor. ofraumatism cranio-cerebral premergator debutului simptomatologiei. -indiferenl4. e.s.-e!p--"-q-Si.'ri.semne p1ggo.).de lob frontal"..CRITERIILE GRUPURILOR DIN LUND $I MACHESTER PENTRU DIAGNOSTICUL DE DEMENTA FRoNToTEMPoRALA pnon.Itq[a-!. gesturi manieriste repetate ca b6t5i din palme. . qe$o.ac..s-sultl-e-+li-zarii -b-qtii. folosire a toaletei. f t g|d ttaJe.traseu electroencefalografi c 1i-g{llql .r.q!q jmpatig!.U . .l_alte--S.i u. lpapraxie severS precoce._i1p3lg9y9_fp_1rl (plirnbare excesiv6. . . II.Gald.-v.p:-qprji. (iepetarea unui repertoriu modest de cuvinte.-c.fiui. 0! _s1adiu.).g. fraze sau locufiuni). etc.. .i1e{ie).t-t9-c-{19are).irului gandirii..(pierdereatactuluisocial.

**ri"i"" sau de laborator care si pledeze pentru diagnosticul altei afecliuni neurologice sau L-irflu*utorii (scleroz[ multipl5. OCoreo-atetoz6. claudicalie. g f*io. etc.i. loi"ril.). sau lfliffii^fi. encefaliti herpeticl. etc.ic de boall vasculard (angin[ pectoral5.)' fV. . Elemente de exclud ere relativd probabili: Qlstoric tipic de alcoolism cronic.rrt i" irr"E . a diagnosticului de demenli frontotemporali QHipertensiune arterial[ cu valori susJinut crescute. . f OUoAifrcXA patologice precoce qi severe ale traseului electroencefalografic. sifilis. cerebrala (eziuni multiple evidentiate prin cr sau IRM sau modificdri structurale ) functionale la nivelul girusului postcentral). SIDA.QAtaxie cerebeloas[.

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trelnor.Dementa corticala - Dementa subcorticala Caracteristici Afectare aptitudini vizuo-spatiale Afectare atentie Memorie Afazie. distorlie) (prezenta in stadia severe) Nrt Nu (vertical) Nu Nn (prezente in stadii sevele) Nu (in d. 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 iscari anormale (cclree. agnozie. abstractizare) Bradipsihie Dementa cortitrala Da Da R erremorare : recunoastere Da (apar precoce) Da. secventiere. afectare congruenta cu alte tulburari Dementa subcorticala Da Da Rememorare > recunoastefe Nu (iu cazuri severe * anollie) Da.inertie) Da Da (curbat) Da Da Da . aPraxie Afectare functie executive (planifi care. Alzheimcr rnioclonii) Nu (prezente in stadii severe) Da (apare precoce) Da (apatie. ar ganizar e.

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. Examen LCR nonnal { + . III. prin care s-a demonstrat cd boala Al:heimer se asocia:d ft'ecyent cu factori de risc yasculari.t*hlrte Nct*^tojtel Csil. atat clinice cat Si de laborator. lb. i \b. Platouri in cursul progresiei bolii. vizual.tnt. afectarea campului _.-maiales d-"_ qqmpq4a4-e_. Criterii pentru diagnosticul clinic de boall Alzheimer probabili: a.volqtiei bqlii. II. A.i aprilll tqlbpf4filqt ir. I_s1gr!q-fqx!lial de. insomnia.aJd prin examen clinicrgi docurnentata-prin testul MMSE.rS{.' ) de boali Alzheimer probabill numai dacl celelalte cauze de demen{i au fost excluse: tl.d-emgnli..bs-e-tla bglilor si5tgmice saq alto^r boli neuropsihiatrice care sd fie responsabile pentru deficitele qlg4ltiye. Diagnosticul de boall Alzheimer probabili este sus{inut de: I o.nounltw. halucinalii. A&9. tulburarea de coordonare.a ill. r t I a. c. 1".d.:Semne neurologice focale cum sunt hemipareza. f. epileptice sau tulburarea de mers ?p1{. inclusiv semne motorii ca hipertonia.1. incontinen{a. de obicei dup[ varsta de 6l_$e*ani.CRITERIILE NINCDS-ADRDA PENTRU DIAGNOSTICUL DE BOALA ALZHEIMER PROBABILA: I. p-ni.icpgniliyq.4e.41. 4pfuqlg p-r-e-gec-g h gUr$ul e. LCe Ju*.. in ultima rreme este folosit din ce in ce mai autoritar diagnosticul de boald tdegenet'ativa si t 0!gulard!. Naj. Caracter prog!re*|. Demen{!diagnqqti-c.tA_A-l!gt -s-qryr-+*e qi s-!gp!-o.lqg[9.eu1gpa!o. Atrofie cerebral6 progresiv[ observati prin examin[ri de imagerie cerebral[ repetate.|e-Vo-lqtrigi-bo!-1.rCrizele Avand invedere o multitudine de studii recente. mioclonusul sau tulburarea de mers.ir'irt c. D__glgrioarea progresivi a fqncJllfol cognitive. tulburarea de sensibilitate obiectivd. g9al1 de demenla Blessed saualttestsimilaf gi confirmat[prin examen neuropsihologicl /"t'eti' ]'t/!'-:t' it:'t''/ '". a percepliilor qi interpretdrii acestora (agnglS). confiq4at 4.u .*l : EEG ii. Q. a executdrii secvenJiale a actelor motorii (EpfqLi€).. emo{ionale sau motorii.1qry4 qctivita(ilor zitnice . Q1-cqreb14l normal pgptru vals-la rqsp-e. e. plrvcDs -AaRaA = i. D_efiqlle_ in _dq-u4_s_aq m4i mu[te qli.u19 plgcocg ig-c--u1g-g.Urt brusc al simptomatologiei: {b..i1 al afectdrii memoriei qi altor func{ii cognitive: d. ia.9!iv6. Alte caracteristici care susfin diagnosticul qr IV. if j. ] agitalie cu paroxisme verbale.q@1q). j i.oua! "^rf . $!ap _{e c_qtit!-gt}4 ! galtelaJi. qi anume a limbajului (. Debut intre 499! 9Ldg.neurologice la unii paciQnli" mai ales in"-fbZelp avansatp d"e !oal[.'/ ] b. Traseu EEG normal sau cu modificdri nespecifice (procent crescut de unde lente) i gr iii.uo.Jcdrw llsst&wo *d S/ale -"/ Altlui-*. utrneaza: d.ae tutokl bt w&rro A. idei delirante. P:e. ryqzellq-de glq1plgme asociqtg cum sunt: depresia. tulburdri sexuale qi pierdere ponderal[. Caracteristici care fac dubitabil diagnosticul de boall Alzheimer probabill: '[ O.

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@lt ru /. .Le 4ffwhbd i" undrYrd p**. 'i.ubud a a. dr.ttottra.*Ar/*l a.hl&t *ur: .ryru6j o /w'n (e)'lwaya oi*.J.-iu' ".urtrri. u.1.lr'o. .ilfa^^* /c.: {.trrrr*r)k *rrA*'m *' I Ai^ rrurr.t *rrr.. (lo Ave) trl 1.rr. ilv O = dt4rra"r/q awaula/?n /Achrrui aaL[w*'ela *lrnkali -t . aerulXu.tema.: duuwrb N*la*.L {r*rrt./rrr"/b6 -D..rc fuarraAL'r". nra6/alc ! /noJ"*r.Ld.'.*.'tu'u+ au zruno''A : ^d1.ohliuitrr.1tt1! cI 11 * .-ra lra/d-'{. rulaJadt| L otrtut' '^ew.*rrl + Addrrwrrl .. amilnua Arttmw.r/6 t 7bH/ PHt .fo/%) x *odtf"Oru'0.dr mrw*rA rru./lsruelil g7rul'w (+ ) *nuo Arrvnttefl.* /e" .Tn nwalrbY txatminatua e{ lR*tN --s) .' /'ala*'ut^kl //m a' A * .iltt/.1.tl^hl ir*orlndr/"4b.t nrua fw' "./" u^ilatn ^r' .nrort'in* t'*oa*.J*".r^jrr*il-*' ottrt frr.wtb.dl b mrwpA @ /.. ! nLott ) . . . n.t*hll* {m]*^r*l fo4yu .t'A P^4N . ad.o^l ti"i"ii '^n*r.lalq* 4 dtt:urlan /"/t .t 0 til {e I kodwr. elU d.ran/r'a n' hlht.h Hn 'uqnil w a cikaldtil' u"t'ol *. .Cui actLl n lilAmu' oL rru..i*.*. .nch.ar..w%rt h* i a*ur/udh ^?tufih)o x lryhru " frcht .liu . dA ' ilt^tc al"*rr"r4 a.qu = tnu#olula ^r./ar*rrautoya v /r*.aaa-ao6- Am a' 0* -+ . /*'.uulata LnaqytrrLn lUil .

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p--rgzgnil. In activitatea de cercetare.s*sqrol*r*eJr-pp. I III. 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 ..4pe*atestate prin semne clinice focale sau prin imagerie cerebralS b.11i gitem-lce .--y. b."eJm*ragsslie-ul-rds". Disfunctie fd i e.qi de ddpamind la nivelul ganglionilor bazali evidenfiat prin SPECT sau PET. hipotensiune oftostaticd. a.di4gosljgfi5 (dae4par_k*in_s-s. I lui REM a. qu activitale ogclpitali reduq[ I ] i.dpms*S-s.a9-eplgia."peap61at in fazele iniliale ale bolii@ap @..-1aUe"l9*t99ir-Le--q!9__b_hplgnna-t-e J p_i_d"gtqliste.CRITERIILE MCI(EITH REVIZUITE PENTRU DIAGNOTICUL DE DEMENTA CU CORPI LEWY PROBABILA: I. de ex. LefUEltedU-S_4[ tt4.i ale""4-tve.1u"lgcts. LIalU. VI.Ulu-istarii-d-e-c-o-nJti-9rUa.7 t >-l * I)iagnosticul de demen{i cu corpi Lewy probabili nu poate fr stabilit numai pebaza manifestirilor clinice sugestive: .-''...D_pmglAdefinitd ca un declin cognitiv pfeelqsiy suficient de important pentru a interfera cu activitatea sociald sau cu ocupalia obignuitS. Delir if. P-ied_et! q!SSl_4fi| de gonglientdtranzitorii. ln prezenta bql-ir*gglgblS-v-as--s"u-l. -.s!.ul.- jnlggfa-fe. b.glgp1i9e. V.qU1|U*v.( simptomelor: -L__ey! trebqie-.4J Depresie nivelul lobului ternporal media! (e.. diagnosticul de demenfi cu corpi Lewy probabill poate fi statrilit. (>. IV. !s!q:r9-9ji:tl9-q-qg9nk!e-{e pglbir!9pjs. QefigIe-de--A1gU!9'-d-e-fuf9ti9--eXgq"Utj"v-L de.rp.aqg d g abla . Iu&Urare39gprliy4'{llqtuan-t-a -c. 4&glg{9q_pf99_n!pt14!?! p9ry$9t14 e 11qmojigi p_W!e_pp_t1u 4para. Manifestlri clinice sugestive: . ! c. II.-an-atri!p1oi1q1}ale als" aJsnli-ei s.oJ de la i.p-I9gl-e--s-ia. incontinen!5 urinard Halu_9-118fi!9-q!Le*1!pu! decat vizuale ic.xa4en IRM sau CT) n. b.s$Jk a. Sgnsibllit4tg sgv-eri la p. Criteriul esen{ial necesar pentru diagnosticul demen{ei cu corpi Lewy posibile sau probabile: a. rJ L i'l'.-c"1iu.A-l-ppatria!4 pSt -fi progmiqe4te.u_a prezervare a strqglu{l. t. i .j. C_qdS! repetate qi sirrcope: * .e_qr. sistem_ati_2. neexplicate gg|oj1-o_$A sgyg{i.r11. Manifestiri clinice esenfiale: * 2 sunt obligatorii pentru diagnosticul de demen{i cu corpi Lewy probabill.ViZ-u.4qpq11or. b. c. lgedgtge ggger4lizalp l "gaptirii SIPCTIPET de perfuzie. BStgt. Diagnosticul de demen{5 cu corpi Lewy este mai pu(in probabill: a. QacA pq* iU ggll r_q-ryir I "ap. Manifestlri clinice care sprijini diagnosticul de demenfi cu corpi Lewy (de obicei prezente dar care nu au specificitate diagnostici): i a.s911 c-ergbqqle care ar putea s5 fie rdspunzdtoare in parte sau in totalitate pentru tabloul clinic c. Scintigrafie miocardic6 cu captare anormalS (redus[) de [4IBG Unae lente proeminente pe EEG cu_ unde ascu{ite tranzitorii temporqlg. Secvenfa temporali D*SlL%lqgJ1eptpi a ry..u. 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. atulgi cand demenla {ty lorN f 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.r clinice esenfiale. fg. * 1-"-esle--qHigt*qdc--p.in stadi ul de demenjd severS. In prezenla qIq4S"i ?_t!g 4fe. I c.

o.r*oul @ .""-'r{onl' Pi^ "am-( 'a'd'n"#oi'o l-'*A *.-Ud ?*1. ol"ie Y ^rrrrl'1"*rb'At u. . at tsl^t' lrrw t* ls-to/. in .ilxl'i*u'l Piw.vn/tvmctet' a*'t*ea a" n*lat^jo . di* 6.*"J .b^"").""r. ***.'. l. *n''d*ot at ni. -aln *%*2* /*T'&d &cbilf *l*' o uwntut u.!r-l .y. lrqal Hgrarl * dr/"I ub'*nplo (* l ' .ory*rrytr.'.r.^r ' f""l*' 'l^A" .nd o' {-Atnaci)". . tn n.rlrla^^h .^**i*t ' i'yooa*'* " 0.tt oltgu:l.'agYa : udwt' dr/. Altrrra-. ail) *g*. i^ b."lJ I rl c ut li"X).rrn ." ry-{"ah'a nuli" ht'.loh{q ff* l.ffih 4 ) *ff* t- *"''n'ol. .*' o*&..( fu* *t=)ncb. d/'rrl* lrdcar*c.r:!::h#r!i.#"ff .r.| = .. nnt..!^^'*-l ' nt/vrilL ffi ^rrr^*nit-.. k.

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b . .t L. noolr/"tu 7-rlr*1*.rrltsrr.*atrr/*/o" .rlrl yf "'-d /'*A-"''l : TuUdtu Pf'. lutol* .r* l^'{akJ ./" d.. "lry d-rrrrl. d" 0 Nc l@4 .dr7.aza q l . Parr-&. A^ryn^alrt a. ot b.o a. . lan$tl"rt' nitutu .^.lal.ry 1^/*-."o^rr'lrnr'drl % /twl ?SJ: . matu/uka' net*sWFt.n.{Al ry On/rN .'fr. cc' 4 .4t /na.brMla . *r.u../uti dr'{dt de dr!ru. l' fu"/"-'s" ) .* h€rt" /9* 'r' arrlo/.*eW o.r./*w. 4b. * f*rr*'shtt' 4oSo!r' a/z? lo.Lt.:'.o*ilx efirlr| *d o yailo "J o 't"/'*"'1" *oolrfw ilillilcraL orc. l-ttz . (tol. *o# -. /"on ^7ar1o.lr* * .r"*i*a (tn ur. on dau dr*rbu a fiitu c . J.ilr/d| .lodJ t-42 N a d*.rr"rk.ol:ttfi. b. o^. o. n-f' LcuT : h t""'""-/ a-' ^ t^"/o!. furhna* z b. lrwnn.-lg U.d. .*l/t*-dQ:. nodrft.$!rfu(. .l/ .Wt a-Mu'd d'lne'nu uint*)n v b.""6rt' bd /o*rf @r. tufrillital .:.l *rtr-"r/.a} dornernl.*l ('g dur''*.. / ."b^rnn > 6aomr /7..'in Md * .. . Pailrnrrn .-*lo fi.. I : 'al*rn t *fu+ *@ l. Pa. /*lr't>npa .*& .our. .wdouau ar*uo -+"/& *rr.br.'i*' ) . 'UAl aru dt r*er>r$ ho'/ Aoc .&. r?.l. irklr/^f *lr. /. rutn&6rrnutr.tt %' A.rJt. .*/ry*4.& d')' l' Pa'j"'wn' zvv\..nat /unt" dX # /rrr^srr^thL .r-&o..N ln lrelo " ornilU"dtil l-qz diltttlldp p.ta*2 ..l Ltuj P. /"-A in '*ri a^ .mrnlu*r.r.ad.l Age": N. bi. iotil' oh*1"*t/ d'h.tt n d*r..

/" A/th)rr*.r da.mg b' ) Ut U2. u0a- . tr. .*€ ?aluarie. Q.{ SlHp aEperslvg de*r*.ril1n7i^6 (so .too .1rt"t ( ro x) AGlrqrin PaisougrowE .6 . .9is prox E /u*.

-pierclere'pgq*-l*s. amiotrofii. -epglql-ie_0ips_a*49-.9-U v4lqry o-$9 il. de tip ictal.1cJ. tezatrizare a diferitelor obiecte.. compofiament violent. de demen{fl fronto-temporali probabili: Qlstoric familial pentru o afecliune similar[ la o rudI de gradul I. fascicula{ii ITI. A- pe-{s9ye-ra{e . cu rat[cirea pacientului in medii familiare.l tardjv).. etc.qlyjtS a {ggpgglglUi*{q Sigg-(neglijarea igienei personale.l Tulburarea afectivit .q.imagerie cerebral6 (str:ucturaTiffinclionalb) - qo-dlfic_4rip...alterarea testelor neuropsihologice . ODeficite cortico-bulbare gi spinale. OMioclonii.qq$qmlnant la nivelul lobilor frg4tali qi temporali G4er!-qr).'"r':r ' 'i :!i {l'/ . p.g-q. i -reflexeprimitive(U.i" a hrylpjgr]q! spoqt4rr gi a vocabularului (.gnA: I. lfpgjl1!-t-. hlpgqlffit(-odificari de dieta.p.i .pierdere plglgEEitl.rt'.buttr.in.i 7 /'.. fumat sau consum de alcool excesive. etc. . -ipohondrie.Ugi d4AtggeltAb" iufl-ex-lbllit-ale. {SO"rori"ntare paliali precoce.-cg.lipsa. Olimbaj logoclonic cu pierderea .iy ) .rLUllSlI] Semneclinicelaexamenulneurologic .h ipotens iu ne arteri 416.p.).y.1q - qt". idei fixe qi suicidare.economie" in exprimare.q-ei1a1e. iL-o-r.a't."o"rpuie excesivd gi ritual pentru imbr6cat. etc.gp.t_""" i - e c p. - q\_ig-gzi Investigatii paraclinice si neuropsihologice . manii alimentare. .Y9I.atp. .Le'9tjp.). . Tulburareu de limbai -qdg*."rtri*A. tt .. etc.e$g]snja. consum excesiv de alimente. (boali de neuron motor)' QPareze de nervibulbari. Elemente de excludere a diagnosticului de demenfi fronto-temporali probabili: Onebut abrupt al simptomatologiei. cum ar fi furtul din rnagazine.id9s*atpregr. Caracteristici care sus{in diagnosticul @ebut inainte de 65 de ani.-.-. Manifestiri clinice esenfiale pentru diagnosticul de demenfi fronto-temporali probatrili: Ttrlhur ar e a d e c omport ame nt -de.ante. glume nepotrivite. anxietate. Orientarea spatiald . .d"p*ti". .i praxia sunt cctnservale .@.i.de &altlb:Uc(irnpulsuri sexuale neinhibate.-4p-4!-!E--lrps4empalie. localizare deficitari a obiectelor. .incontinen{d (preco-9e).preocup[risomaticebizate(p1. [OAmnezie sever6 precoce.). explorare oral[ a obiectelor.qqp1p_o. staligl-4.$19. delir (pfggocqpi--tf-e.a.tqlburue-&-&$r"s.b.sulsirit-alp. clg_pq&mqglde_Uliliz_alg (explorare excesivd gi continud a obiectelor din mediul inconjuritor).ql9.efd.i .11?Il19gL. sentimentalism exagerat.4.infractriuni.$po!-tp.1-q"q-p). . lipsd de spontaneitate). deficit motor. ofraumatism cranio-cerebral premergator debutului simptomatologiei. -indiferenl4. e.s.-e!p--"-q-Si.'ri.semne p1ggo.).de lob frontal"..CRITERIILE GRUPURILOR DIN LUND $I MACHESTER PENTRU DIAGNOSTICUL DE DEMENTA FRoNToTEMPoRALA pnon.Itq[a-!. gesturi manieriste repetate ca b6t5i din palme. . qe$o.ac..s-sultl-e-+li-zarii -b-qtii. folosire a toaletei. f t g|d ttaJe.traseu electroencefalografi c 1i-g{llql .r.q!q jmpatig!.U . .l_alte--S.i u. lpapraxie severS precoce._i1p3lg9y9_fp_1rl (plirnbare excesiv6. . . II.Gald.-v.p:-qprji. (iepetarea unui repertoriu modest de cuvinte.-c.fiui. 0! _s1adiu.).g. fraze sau locufiuni). etc.. .i1e{ie).t-t9-c-{19are).irului gandirii..(pierdereatactuluisocial.

**ri"i"" sau de laborator care si pledeze pentru diagnosticul altei afecliuni neurologice sau L-irflu*utorii (scleroz[ multipl5. OCoreo-atetoz6. claudicalie. g f*io. etc.i. loi"ril.). sau lfliffii^fi. encefaliti herpeticl. etc.ic de boall vasculard (angin[ pectoral5.)' fV. . Elemente de exclud ere relativd probabili: Qlstoric tipic de alcoolism cronic.rrt i" irr"E . a diagnosticului de demenli frontotemporali QHipertensiune arterial[ cu valori susJinut crescute. . f OUoAifrcXA patologice precoce qi severe ale traseului electroencefalografic. sifilis. cerebrala (eziuni multiple evidentiate prin cr sau IRM sau modificdri structurale ) functionale la nivelul girusului postcentral). SIDA.QAtaxie cerebeloas[.

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