{"id":8892,"date":"2025-06-12T15:56:40","date_gmt":"2025-06-12T07:56:40","guid":{"rendered":"https:\/\/wp-cc.meddatas.com\/?p=8892"},"modified":"2025-09-16T13:48:45","modified_gmt":"2025-09-16T05:48:45","slug":"20240807-%e9%b2%8d%e5%a7%a3%e4%bd%9f-a-78-year-old-woman-with-rapidly-progressive-dementia","status":"publish","type":"post","link":"https:\/\/wp-cc.meddatas.com\/?p=8892","title":{"rendered":"\u3010Case Listen and Say\u30112024-N Engl J Med- A 78-Year-Old Woman with Rapidly Progressive Dementia"},"content":{"rendered":"<p style=\"text-align: center;\"><strong>\u6c47\u62a5\u4eba\uff1a\u9c8d\u59e3\u4f5f\uff1b\u6c47\u62a5\u65f6\u95f4\uff1a2024.08.07<\/strong><\/p>\n<p><img loading=\"lazy\" class=\" wp-image-8893 aligncenter\" src=\"https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u9c8d\u59e3\u4f5f.jpg\" alt=\"\" width=\"643\" height=\"299\" srcset=\"https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u9c8d\u59e3\u4f5f.jpg 1642w, https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u9c8d\u59e3\u4f5f-300x140.jpg 300w, https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u9c8d\u59e3\u4f5f-1024x476.jpg 1024w, https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u9c8d\u59e3\u4f5f-768x357.jpg 768w, https:\/\/wp-cc.meddatas.com\/wp-content\/uploads\/2025\/06\/\u9c8d\u59e3\u4f5f-1536x715.jpg 1536w\" sizes=\"(max-width: 643px) 100vw, 643px\" \/><\/p>\n<p style=\"text-align: center;\"><strong><b>Case 23-2024: A 78-Year-Old Woman<\/b><\/strong><strong><b>\u00a0<\/b><\/strong><strong><b>with Rapidly Progressive Dementia<\/b><\/strong><\/p>\n<p style=\"text-align: center;\"><strong><b>N Engl J Med 2024;391:357-69.<\/b><\/strong><strong><b>\uff08<\/b><\/strong><strong><b>DOI: 10.1056\/NEJMcpc2402488<\/b><\/strong><strong><b>\uff09<\/b><\/strong><\/p>\n<ul>\n<li><b><\/b><strong><b>\u4e3b\u8bc9\u4e0e\u73b0\u75c5\u53f2<\/b><\/strong><\/li>\n<\/ul>\n<p>\u60a3\u8005\u4e3a78\u5c81\u5973\u6027\uff0c\u56e0\u201c\u8fdb\u884c\u6027\u8ba4\u77e5\u529f\u80fd\u4e0b\u964d\u4f34\u610f\u8bc6\u6df7\u4e714\u6708\u4f59\u201d\u5165\u9662\u30025\u4e2a\u6708\u524d\uff0c\u60a3\u8005\u56e0\u59d0\u59d0\u53bb\u4e16\u51fa\u73b0\u60c5\u611f\u6de1\u6f20\uff0c\u5bb6\u5c5e\u6700\u521d\u5f52\u56e0\u4e8e\u60b2\u4f24\u53cd\u5e94\u3002\u968f\u540e3\u4e2a\u6708\u5185\uff0c\u8bb0\u5fc6\u529b\u663e\u8457\u6076\u5316\uff0c\u591c\u95f4\u5b9a\u5411\u969c\u788d\u9891\u53d1\uff0c\u9700\u4ed6\u4eba\u534f\u52a9\u5b8c\u6210\u65e5\u5e38\u6d3b\u52a8\uff08\u5982\u8fdb\u98df\u3001\u6d17\u6f31\uff09\u30024\u4e2a\u6708\u524d\u66fe\u56e0\u6025\u6027\u8bed\u8a00\u969c\u788d\uff08\u627e\u8bcd\u56f0\u96be\uff09\u4e8e\u5916\u9662\u5c31\u8bca\uff0cMRI\u63d0\u793a\u53f3\u4fa7\u989d\u53f6\u4e9a\u6025\u6027\u6897\u6b7b\u3001\u53cc\u4fa7\u5c0f\u8111\u6162\u6027\u6897\u6b7b\u7076\u53ca\u8111\u767d\u8d28\u75c5\u53d8\uff0c\u8bca\u65ad\u4e3a\u77ed\u6682\u6027\u8111\u7f3a\u8840\u53d1\u4f5c\uff08TIA\uff09\uff0c\u4e88\u963f\u53f8\u5339\u6797\u6cbb\u7597\u3002\u51fa\u9662\u540e\u8ba4\u77e5\u529f\u80fd\u6301\u7eed\u6076\u5316\uff0c\u51fa\u73b0\u51b2\u52a8\u884c\u4e3a\u3001\u6ce8\u610f\u529b\u7f3a\u9677\u53ca\u4f53\u91cd\u51cf\u8f7b\uff083\u6708\u5185\u4e0b\u964d11 kg\uff09\u3002<\/p>\n<ul>\n<li><b><\/b><strong><b>\u65e2\u5f80\u53f2\u4e0e\u4e2a\u4eba\u53f2<\/b><\/strong><b><\/b><\/li>\n<\/ul>\n<ol>\n<li>\u6162\u6027\u75be\u75c5\uff1a2\u578b\u7cd6\u5c3f\u75c5\u3001\u9ad8\u8840\u538b\u3001\u9ad8\u8102\u8840\u75c7\u3001\u80ba\u6c14\u80bf\u3001\u7761\u7720\u547c\u5438\u6682\u505c\u3001\u7532\u72b6\u817a\u529f\u80fd\u51cf\u9000\u53ca\u80a5\u80d6\u3002<\/li>\n<li>\u80bf\u7624\u53f2\uff1a17\u5e74\u524d\u786e\u8bca\u2161\u671f\u6d78\u6da6\u6027\u5bfc\u7ba1\u4e73\u817a\u764c\uff0c\u884c\u4fdd\u4e73\u624b\u672f\u53ca\u653e\u5316\u7597\uff0c\u540e\u63a5\u53d7\u4ed6\u83ab\u6614\u82ac\u53ca\u4f9d\u897f\u7f8e\u5766\u6cbb\u7597\uff1b14\u5e74\u524d\u56e0\u2160\u671f\u80ba\u817a\u764c\u884c\u624b\u672f\u5207\u9664\uff0c\u5b9a\u671f\u968f\u8bbf\u672a\u89c1\u590d\u53d1\u3002<\/li>\n<li>\u5438\u70df\u53f2\uff1a75\u5305\u5e74\uff0c\u786e\u8bca\u80ba\u764c\u540e\u6212\u70df\uff1b\u5076\u996e\u9152\u3002<\/li>\n<li>\u5bb6\u65cf\u53f2\uff1a\u6bcd\u4eb2\u60a3\u51a0\u5fc3\u75c5\uff0c\u7236\u4eb2\u60a3\u80ba\u6c14\u80bf\u3002<\/li>\n<\/ol>\n<ul>\n<li><b><\/b><strong><b>\u4f53\u683c\u68c0\u67e5 <\/b><\/strong><\/li>\n<\/ul>\n<ol>\n<li>\u751f\u547d\u4f53\u5f81\uff1a\u8840\u538b162\/71 mmHg\uff0c\u4f59\u6b63\u5e38\u3002<\/li>\n<li>\u795e\u7ecf\u7cfb\u7edf\uff1a\u4ec5\u80fd\u5b9a\u5411\u59d3\u540d\uff0c\u6ce8\u610f\u529b\u4e0d\u96c6\u4e2d\uff0c\u8a00\u8bed\u6d41\u7545\u4f46\u601d\u7ef4\u6563\u6f2b\uff0c\u5b58\u5728\u6301\u7eed\u8a00\u8bed\uff1b\u9885\u795e\u7ecf\u3001\u808c\u529b\u3001\u611f\u89c9\u53ca\u53cd\u5c04\u5747\u6b63\u5e38\u3002<\/li>\n<\/ol>\n<ul>\n<li><b><\/b><strong><b>\u8f85\u52a9\u68c0\u67e5 <\/b><\/strong><\/li>\n<\/ul>\n<p>1\u3001\u5f71\u50cf\u5b66<\/p>\n<p>1\uff09\u521d\u6b21MRI\uff084\u6708\u524d\uff09\uff1a\u53f3\u4fa7\u989d\u53f6\u4e9a\u6025\u6027\u6897\u6b7b\u7076\uff08\u6269\u6563\u52a0\u6743\u6210\u50cf\u9ad8\u4fe1\u53f7\uff09\u3001\u53cc\u4fa7\u5c0f\u8111\u6162\u6027\u6897\u6b7b\u7076\u3001\u8111\u767d\u8d28\u591a\u53d1\u9ad8\u4fe1\u53f7\uff08\u63d0\u793a\u5c0f\u8840\u7ba1\u75c5\uff09\uff0c\u68af\u5ea6\u56de\u6ce2\u5e8f\u5217\u89c1\u8111\u53f6\u5206\u5e03\u5fae\u51fa\u8840\u7076\u3002<\/p>\n<p>2\uff09\u672c\u6b21MRI\uff1a\u65b0\u589e\u53cc\u4fa7\u6d77\u9a6c\u3001\u674f\u4ec1\u6838\u53ca\u989e\u53f6\u5185\u4fa7\u5bf9\u79f0\u6027T2\/FLAIR\u9ad8\u4fe1\u53f7\uff0cSWI\u5e8f\u5217\u663e\u793a\u8111\u53f6\u591a\u53d1\u5fae\u51fa\u8840\u53ca\u53f3\u9876\u53f6\u542b\u94c1\u8840\u9ec4\u7d20\u6c89\u79ef\u3002<\/p>\n<p>3\uff09PET-CT\uff1a\u5de6\u80ba\u95e8\u53ca\u7eb5\u9694\u6dcb\u5df4\u7ed3FDG\u9ad8\u6444\u53d6\uff08\u63d0\u793a\u8f6c\u79fb\u6027\u75c5\u53d8\uff09\uff0c\u53cc\u4fa7\u989e\u53f6\u5185\u4fa7\u4ee3\u8c22\u589e\u9ad8\u3002<\/p>\n<p>2\u3001\u5b9e\u9a8c\u5ba4\u68c0\u67e5<\/p>\n<p>1\uff09\u8111\u810a\u6db2\uff08CSF\uff09\uff1a\u86cb\u767d\u5347\u9ad8\uff0847 mg\/dL\uff09\uff0c\u5be1\u514b\u9686\u5e26\u9633\u6027\uff0816\u6761\uff09\uff0c\u7ec6\u80de\u6570\u6b63\u5e38\uff0cHSV-DNA\u9634\u6027\u3002<\/p>\n<p>2\uff09\u8840\u6e05\uff1a\u6297\u795e\u7ecf\u5143\u6838\u6297\u4f531\u578b\uff08ANNA-1\/\u6297Hu\u6297\u4f53\uff09\u9633\u6027\u3002<\/p>\n<p>3\u3001\u75c5\u7406<\/p>\n<p>1\uff09\u6dcb\u5df4\u7ed3\u6d3b\u68c0\uff1a\u5c0f\u7ec6\u80de\u80ba\u764c\u8f6c\u79fb\uff08\u514d\u75ab\u7ec4\u5316Synaptophysin\u3001INSM1\u9633\u6027\uff09\u3002<\/p>\n<p>2\uff09\u5c38\u68c0\uff1a\u6d77\u9a6c\u4e25\u91cd\u786c\u5316\u4f34\u795e\u7ecf\u5143\u4e22\u5931\uff0c\u5e7f\u6cdbT\u7ec6\u80de\u6d78\u6da6\uff08\u7b26\u5408\u526f\u80bf\u7624\u6027\u8111\u810a\u9ad3\u708e\uff09\uff1b\u8111\u6dc0\u7c89\u6837\u8840\u7ba1\u75c5\uff08CAA\uff0cVonsattel 3\u7ea7\uff09\u3002<\/p>\n<ul>\n<li><b><\/b><strong><b>\u9274\u522b\u8bca\u65ad\u4e0e\u8bca\u65ad\u601d\u8def<\/b><\/strong><b><\/b><\/li>\n<\/ul>\n<p>\u60a3\u8005\u8868\u73b0\u4e3a\u5feb\u901f\u8fdb\u5c55\u6027\u75f4\u5446\uff0c\u9700\u4f18\u5148\u6392\u9664\u4ee5\u4e0b\u75c5\u56e0\uff1a<\/p>\n<ol>\n<li>\u8111\u6dc0\u7c89\u6837\u8840\u7ba1\u75c5\u76f8\u5173\u708e\u75c7\uff08CAA-ri\uff09<\/li>\n<\/ol>\n<p>a.\u652f\u6301\u70b9\uff1a\u591a\u53d1\u6027\u8111\u53f6\u5fae\u51fa\u8840\u3001\u767d\u8d28\u75c5\u53d8\u3001CSF\u5be1\u514b\u9686\u5e26\u3002<\/p>\n<p>b.\u77db\u76fe\u70b9\uff1a\u989e\u53f6\u5bf9\u79f0\u6027\u53d7\u7d2f\u7f55\u89c1\uff0c\u708e\u75c7\u4e0e\u6dc0\u7c89\u6837\u8840\u7ba1\u75c5\u53d8\u65e0\u76f4\u63a5\u5173\u8054\uff08\u5c38\u68c0\u8bc1\u5b9e\uff09\u3002<\/p>\n<ol start=\"2\">\n<li>\u81ea\u8eab\u514d\u75ab\u6027\u8111\u708e\uff08\u5c24\u5176\u526f\u80bf\u7624\u6027\uff09<\/li>\n<\/ol>\n<p>a.\u652f\u6301\u70b9\uff1a\u4e9a\u6025\u6027\u8ba4\u77e5\u8870\u9000\u3001\u989e\u53f6\u5185\u4fa7\u9ad8\u4fe1\u53f7\u3001CSF\u5be1\u514b\u9686\u5e26\u3001ANNA-1\u6297\u4f53\u9633\u6027\uff1bPET\u663e\u793a\u7eb5\u9694\u6dcb\u5df4\u7ed3\u8f6c\u79fb\u6027\u5c0f\u7ec6\u80de\u80ba\u764c\u3002<\/p>\n<p>b.\u5173\u952e\u8bc1\u636e\uff1aANNA-1\u6297\u4f53\u4e0e\u795e\u7ecf\u5185\u5206\u6ccc\u80bf\u7624\uff08\u5982\u5c0f\u7ec6\u80de\u80ba\u764c\uff09\u9ad8\u5ea6\u76f8\u5173\uff0c\u4ecb\u5bfcCD8+ T\u7ec6\u80de\u653b\u51fb\u795e\u7ecf\u5143\u3002<\/p>\n<ol start=\"3\">\n<li>\u4e2d\u67a2\u795e\u7ecf\u7cfb\u7edf\u8840\u7ba1\u708e<\/li>\n<\/ol>\n<p>a.\u652f\u6301\u70b9\uff1a\u8111\u6897\u6b7b\u75c5\u53f2\u3001\u5fae\u51fa\u8840\u3002<\/p>\n<p>b.\u6392\u9664\u70b9\uff1a\u8840\u7ba1\u9020\u5f71\u65e0\u5f02\u5e38\uff0c\u708e\u75c7\u5206\u5e03\u4e0e\u8840\u7ba1\u708e\u4e0d\u7b26\u3002<\/p>\n<ol start=\"4\">\n<li>\u611f\u67d3\uff08\u5982HSV\u8111\u708e\uff09<\/li>\n<\/ol>\n<p>a.\u6392\u9664\u70b9\uff1a\u75c5\u7a0b\u8fc7\u957f\uff08\u6570\u6708\uff09\u3001CSF\u75c5\u539f\u5b66\u9634\u6027\u3002<\/p>\n<ul>\n<li><b><\/b><strong><b>\u6700\u7ec8\u8bca\u65ad<\/b><\/strong><\/li>\n<\/ul>\n<ol>\n<li>\u526f\u80bf\u7624\u6027\u8111\u810a\u9ad3\u708e\uff08ANNA-1\u6297\u4f53\u76f8\u5173\uff0c\u7ee7\u53d1\u4e8e\u5c0f\u7ec6\u80de\u80ba\u764c\uff09\u3002<\/li>\n<li>\u8111\u6dc0\u7c89\u6837\u8840\u7ba1\u75c5\uff08CAA\uff09\uff08Vonsattel 3\u7ea7\uff09\u3002<\/li>\n<\/ol>\n<ul>\n<li><b><\/b><strong><b>\u6cbb\u7597\u4e0e\u9884\u540e<\/b><\/strong><\/li>\n<\/ul>\n<p>\u6cbb\u7597<\/p>\n<ol>\n<li>\u514d\u75ab\u6cbb\u7597\uff1a\u9759\u8109\u7cd6\u76ae\u8d28\u6fc0\u7d20\uff083\u5929\uff09\u540e\u8fc7\u6e21\u81f3\u53e3\u670d\u6cfc\u5c3c\u677e\uff0c\u8054\u5408\u6bcf\u6708\u73af\u78f7\u9170\u80fa\uff08\u6291\u5236T\u7ec6\u80de\u6d3b\u6027\uff09\u3002<\/li>\n<li>\u6297\u766b\u75eb\uff1a\u62c9\u79d1\u9170\u80fa\u63a7\u5236\u989e\u53f6\u766b\u75eb\u6837\u653e\u7535\u3002<\/li>\n<li>\u80bf\u7624\u6cbb\u7597\uff1a\u56e0\u60a3\u8005\u8ba4\u77e5\u529f\u80fd\u4e25\u91cd\u53d7\u635f\uff0c\u5bb6\u5c5e\u62d2\u7edd\u5316\u7597\u3002<\/li>\n<\/ol>\n<p>\u9884\u540e<\/p>\n<p>\u60a3\u8005\u51fa\u9662\u540e\u8f6c\u5165\u62a4\u7406\u9662\uff0c\u4f46\u610f\u8bc6\u6df7\u4e71\u53ca\u504f\u6267\u75c7\u72b6\u6301\u7eed\u3002\u6fc0\u7d20\u51cf\u91cf\u671f\u95f4\u56e0\u80ba\u708e\u5e76\u53d1\u547c\u5438\u8870\u7aed\uff0c\u5bb6\u5c5e\u653e\u5f03\u673a\u68b0\u901a\u6c14\uff0c\u8f6c\u4e34\u7ec8\u5173\u6000\u540e\u6b7b\u4ea1\u3002\u5c38\u68c0\u8bc1\u5b9e\u526f\u80bf\u7624\u6027\u8111\u810a\u9ad3\u708e\u4e0eCAA\u5171\u5b58\uff0c\u4e8c\u8005\u5206\u522b\u5bfc\u81f4\u795e\u7ecf\u5143\u7834\u574f\u53ca\u8111\u8840\u7ba1\u75c5\u53d8\uff0c\u52a0\u901f\u75c5\u60c5\u6076\u5316\u3002<\/p>\n<ul>\n<li><b><\/b><strong><b>\u603b\u7ed3<\/b><\/strong><b><\/b><\/li>\n<\/ul>\n<p>\u672c\u4f8b\u7f55\u89c1\u4e4b\u5904\u5728\u4e8e\u4e24\u79cd\u72ec\u7acb\u75be\u75c5\uff08\u526f\u80bf\u7624\u6027\u8111\u708e\u4e0eCAA\uff09\u5171\u5b58\uff0c\u4e14\u5747\u4e0e\u5feb\u901f\u8ba4\u77e5\u8870\u9000\u76f8\u5173\u3002ANNA-1\u6297\u4f53\u4ecb\u5bfc\u7684T\u7ec6\u80de\u653b\u51fb\u662f\u795e\u7ecf\u529f\u80fd\u6076\u5316\u7684\u6838\u5fc3\u673a\u5236\uff0c\u800cCAA\u53ef\u80fd\u52a0\u91cd\u8111\u5fae\u8840\u7ba1\u635f\u4f24\u3002\u6b64\u7c7b\u75c5\u4f8b\u9700\u5f3a\u8c03\u65e9\u671f\u80bf\u7624\u7b5b\u67e5\uff08\u5c24\u5176\u5438\u70df\u53f2\u8005\uff09\u53ca\u591a\u6a21\u6001\u68c0\u67e5\uff08\u6297\u4f53\u68c0\u6d4b\u3001PET\uff09\u7684\u91cd\u8981\u6027\uff0c\u4f46\u9884\u540e\u901a\u5e38\u4e0d\u4f73\uff0c\u514d\u75ab\u6cbb\u7597\u4ec5\u80fd\u90e8\u5206\u7f13\u89e3\u75c7\u72b6\u3002<\/p>\n<p>\u64b0\u7a3f\u4eba\uff1a\u9b91\u5a07\u4f5f<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u6c47\u62a5\u4eba\uff1a\u9c8d\u59e3\u4f5f\uff1b\u6c47\u62a5\u65f6\u95f4\uff1a2024.08.07 Case 23-2024: A 78-Year-Old Wom &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/wp-cc.meddatas.com\/?p=8892\"> <span class=\"screen-reader-text\">\u3010Case Listen and Say\u30112024-N Engl J Med- A 78-Year-Old Woman with Rapidly Progressive Dementia<\/span> \u67e5\u770b\u5168\u6587 &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[131],"tags":[],"_links":{"self":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts\/8892"}],"collection":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8892"}],"version-history":[{"count":2,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts\/8892\/revisions"}],"predecessor-version":[{"id":9035,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=\/wp\/v2\/posts\/8892\/revisions\/9035"}],"wp:attachment":[{"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8892"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8892"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wp-cc.meddatas.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8892"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}