34个性格行为问题帮助诊断早期失智症

“Has the person become agitated, aggressive, irritable, or temperamental?” the questionnaire asks. “Does she/he have unrealistic beliefs about her/his power, wealth or skills?” 

“人有变得焦躁不安、具攻击性、易怒、情绪起伏不定吗？”这份调查表问到。“她/他有对自己的能力、财富或技能抱着妄信吗？”

Or maybe another kind of personality change has happened: “Does she/he no longer care about anything?” 

又或许，她/他的个性有了另一种转变：“对任何事都漠不关心？” 

If the answer is yes to one of these questions — or others on a new checklist — and the personality or behavior change has lasted for months, it could indicate a very early stage of dementia, according to a group of neuropsychiatrists and Alzheimer’s experts. 

如果对上述问题之一的回答是肯定的，或对这份新检查清单上的其他问题有肯定的回答，且这些性格或行为的转变已经持续数月，那么根据一群神经心理学家与阿尔茨海默氏症专家的说法，这可能意味着某人正处于失智症（痴呆症）极早期阶段。

They are proposing the creation of a new diagnosis: mild behavioral impairment. The idea is to recognize and measure something that some experts say is often overlooked: Sharp changes in mood and behavior may precede the memory and thinking problems of dementia. 

这些学者在提倡一种新的诊断类别——轻度行为障碍(mild behavioral impairment, M.B.I.)，旨在辨认与测量某些专家认为常遭忽视的面向：心情与行为的急剧变化，可能在失智症造成的记忆与思考困难之前出现。

The group made the proposal on Sunday at the Alzheimer’s Association International Conference in Toronto, and presented a 34-question checklist that may one day be used to identify people at greater risk for Alzheimer’s. 

该研究团队上周日于多伦多的阿尔茨海默氏症国际年会(Alzheimer's Association International Conference)发表了这份提案，并提出一个列有34个问题的检查清单。或许这份清单有天能用来识别较易罹患阿尔茨海默氏症的人。

 “I think we do need something like this,” said Nina Silverberg, the director of the Alzheimer’s Disease Centers program at the National Institute on Aging, who was not involved in creating the checklist or the proposed new diagnosis.

“我认为这样的诊断工具确实有需要，”在美国国家老龄化研究所(National Institute on Aging)主持阿尔茨海默氏症中心计划(Alzheimer's Disease Centers program)的妮娜．席维伯格(Nina Silverberg)表示。她并未参与这份检查清单的设计或提出这个新诊断类别。 

“Most people think of Alzheimer’s as primarily a memory disorder, but we do know from years of research that it also can start as a behavioral issue.”

“大多数人都认为阿尔茨海默氏症主要是记忆方面的毛病，不过我们从多年的研究中的确得知，这种病症初发时，也可能从行为开始出问题。”

Under the proposal, mild behavioral impairment (M.B.I.) would be a clinical designation preceding mild cognitive impairment (M.C.I.), a diagnosis created more than a decade ago to describe people experiencing some cognitive problems but who can still perform most daily functions.

这份提案指出，临床上应该先进行轻度行为障碍诊断，再进行轻度认知障碍(mild cognitive impairment, M.C.I.)诊断。轻度认知障碍是十多年前创造出来的诊断类别，用来描述有些人有点认知问题，但日常生活功能大抵正常。

Dr. Zahinoor Ismail, a neuropsychiatrist at the University of Calgary and member of the group proposing the new diagnosis, said studies and anecdotes suggested that emotional and behavioral changes were “a stealth symptom,” part of the dementia disease process, not separate from it. 

札希努．伊斯梅尔(Zahinoor Ismail)博士是加拿大卡尔加里大学(University of Calgary)的神经心理学家，也是提出这个新诊断类别的研究团队成员。他表示，各项研究与生活轶事都表明，情绪与行为的转变是”神不知鬼不觉的征候”，属于失智症发展过程，不应与失智症分开视之。 

Whatever is eroding memory and thinking skills in the dementia process may also affect the brain’s systems of emotional regulation and self-control, he said.

伊斯梅尔表示，不论在失智症中损害记忆与思考能力的因素是什么，都可能影响脑部调节情绪与自制的系统。

If two people have mild cognitive impairment, the one with mood or behavior changes develops full-blown dementia faster, he said. Alzheimer’s patients with those symptoms “do much worse over time”; after death, autopsies have shown they had more brain damage.

他表示，如果拿两个都有轻度认知障碍的人相较，出现心情或行为转变的那个人，失智症会更快全面发作。有这些心情与行为征候的阿尔茨海默氏症患者，“随着时间过去，病情会变得比其他人严重得多”。死亡之后的尸检也显示他们的脑部受损更厉害。

Of course, not everyone experiencing mood swings with age is suffering warning signs of dementia. Dr. Ismail emphasized that, to be considered M.B.I., a symptom should have lasted for at least six months and be “not just a blip in behavior, but a fundamental change.” 

当然了，不是每个随年龄增长心情也起伏不定的人就是在为失智症的警讯所苦。伊斯梅尔博士强调，要确定有轻度行为障碍，某个症状必须持续至少六个月，“不仅仅是行为偶尔失常而已，而是彻底的改变。”

Still, some experts worry that naming and screening for such an early-stage syndrome might end up categorizing large numbers of people, making some of them concerned they will develop Alzheimer’s when there are not yet effective treatments for the disease. 

然而还是有些专家担心，为这么早期的症状定名并进行筛检，最终可能会把一大群人列入某个分类里，导致其中一些人担心在阿尔茨海默氏症尚无有效治疗手段的时候会患上这种病。

“There’s the potential benefit of early diagnosis, identifying people more likely to decline,” said Dr. Kenneth Langa, a professor of internal medicine at the University of Michigan. But “the flip side is overdiagnosis, labeling someone and getting people in the clinical cascade, where you start doing the test and people start doing more brain imaging and being at the doctor’s more and getting more concerned. 

“早期诊断、辨认出那些更可能患病的人或许有好处，”芝加哥大学(University of Michigan)内科教授肯尼斯．兰加(Kenneth Langa)博士表示。不过“从另一面来看，这也是过度诊断、给人贴标签、让人陷入没完没了的临床程序。当你开始做检测，民众就要开始做更多脑部显影扫描、更常看医生，也会产生更多担心”。

“If it becomes a routine practice, that’s a huge amount of dollars.” 

“要是这成了例行工作，得花上很一大笔钱。” 

Dr. Langa, who has written about M.C.I., cited the experience with that designation. Many people given an M.C.I. diagnosis do not develop full-blown dementia even a decade later, and as many as 20 percent have later been deemed cognitively normal, he said.

兰加医师曾撰文探讨轻度认知障碍，并在文中援引了使用这个诊断类别的经验。他表示，许多被诊断出有轻度认知障碍的人，甚至在诊断十年后都没有完全发展成失智症，其中还有多达20%的人的认知功能稍后又被判为正常。

That could be because on the day they were screened, their cognitive function was lower than usual, possibly a result of stress or medications they were taking for other conditions.

这可能是因为他们在做筛查那天的认知功能有失水平，或许是出于压力，又或许是他们因其他健康问题所服用的药物所致。

“That’s one of the things that makes me think twice” about creating M.B.I., said Dr. Langa, who recommended the checklist be tested by researchers before doctors began using it.

“那正是我三思的原因之一，”兰加谈到创立轻度行为障碍时这么说。他建议医师在开始使用这份核查清单之前，应该先把它交由研究人员进行测试。

Others are more enthusiastic. 

其他人的看法则较为乐观。

“We have to improve our ability to identify people at risk,” said Arthur Toga, a neuroscientist at University of Southern California. Eventually “there will be an effective treatment,” he said, “and there’s too much unknown about this disease anyway.” 

“我们必须提升辨识风险族群的能力，”南加州大学(University of Southern California)的神经学家阿瑟．托加(Arthur Toga)表示。假以时日，“一定会出现有效治疗手段，”他说道。“毕竟，这种病有太多未知之处了。”

Dr. Toga said that his mother exhibited frustration and other emotional changes in her 70s, years before she developed Alzheimer’s. He believes her moods stemmed from dismay felt by his mother, a retired teacher, while trying to hide something family members had not yet noticed: “her ever decreasing cognitive capacity with words.” 

托加博士表示，他的母亲是退休教师，在七十多岁时出现了挫折感以及其他情绪变化，比她最后患上阿尔茨海默氏症的时间早上好几年。他认为母亲情绪欠佳，是因为她在试图掩饰家人尚未注意到的事情，并因此感到气馁，此事就是“她对言谈的认知能力每况愈下”。 

Indeed, Dr. Langa and others said, memory tests are not always able to detect early problems because some people, especially highly educated ones, may be skilled enough at taking tests that their scores do not reflect the full extent of their cognitive slippage. 

兰加博士与其他学者表示，记忆测验的确不能每次都侦测到早期问题，因为有些人可能很会应付考试（尤其是那些教育程度很高的人），以至于测出来的分数无法反映出认知能力下降到何种程度。

Dr. Mary Ganguli, a professor of psychiatry, neurology and epidemiology at the University of Pittsburgh, said people often came in reporting that they or a family member had stopped doing something they always enjoyed, like baking a certain Thanksgiving dessert or tinkering with the lawn mower in springtime. 

玛莉．冈古力(Mary Ganguli)博士是匹兹堡大学(University of Pittsburgh)的精神病学、神经病学和流行病学教授，她表示人们常在就诊时表示，自己或某位家人不再从事他们向来喜爱的某项活动了，像是烘焙某种感恩节点心，或是春天的时候对除草机修修弄弄。

Even the patient may not know why, she said. They may be uninterested in the activity because “they couldn’t figure out how to do it anymore.”

她表示，就连病人自己可能都不明白原因何在。他们可能因为“不再知道该怎么做”而对某件事失去兴趣。

Usually, when Dr. Ganguli asks if the patient is having trouble remembering things, “They will say, ‘Yes, but it’s not the biggest problem,’” she said. “But if I assess them, I find memory problems.” 

通常当冈古力询问病人是不是记不住事情的时候，“他们会说：‘是啊，可是没啥大不了的。’”她说，“不过要是我做检测，就会发现他们的记忆有问题。”

Some experts supporting the new diagnosis said that unlike most cognitive problems, some mood and behavior symptoms could be treated with therapy and medication. “We can make them sleep better, we can take the edge off depression, we can help the family learn how to manage the problems,” Dr. Ganguli said. 

支持前述新诊断类别的一些专家表示，有些情绪与行为症状能通过治疗手段或药物改善，这与大多数的认知障碍不同。“我们可以让当事人睡得更好、减轻他们的沮丧程度、帮助家属学习处理各种问题，”冈古力医师表示。

Dr. Ismail said apathy was a common symptom, but he has seen starker changes. One patient in her 70s became so sexually uninhibited, she “went from prude to promiscuous,” he said. Another, a law-abiding 67-year-old woman, suddenly “started smoking crack.” Both later developed dementia. 

伊斯梅尔博士则表示，漠然无感是常见的症状之一，不过他也见识过截然不同的转变。有位女性病人在七十多岁时变得性欲勃发，“从老古板变成豪放女”。另一位奉公守法的67岁女性则突然“开始抽强效可卡因”。这两位不久都患上了痴呆症。

Mood and behavior changes have long been recognized as early-warning signs of frontotemporal dementia, which accounts for about 10 percent of dementias.

长久以来，心情与行为变化都被视为额颞叶痴呆的早期警讯，它在全部痴呆症中约占10%。

Palmer Posvar, a patient of Dr. Ganguli’s, was in her 50s when she started taking food off other people’s plates, asking to borrow money from friends and trying to pawn heirloom jewelry, said her husband, Wesley. At 54, she was found to have frontotemporal dementia. Now 64, Mrs. Posvar can no longer speak and she falls so frequently that she was recently moved from their house in Fox Chapel, Pa., to a nursing home.

冈古力的病人帕尔玛．波斯瓦(Palmer Posvar)的丈夫韦斯利(Wesley)说，帕尔玛在五十多岁的时候开始拿别人盘子里的东西来吃、向朋友借钱，还想把家传珠宝拿去典当。她在54岁时被诊断出患有额颞叶痴呆。现年64岁的波斯瓦太太已丧失语言能力，而且时常跌倒，所以近来从宾州福克斯查普尔的住处送去了养老院。

Still, “early diagnosis is a double-edged sword,” Mr. Posvar said when asked about creating a mild behavioral impairment category. 

然而，“早期诊断是把双刃剑。”当我们询问波斯瓦先生对创造“轻微行为障碍”这个诊断类别有什么看法，他如此表示。

The upside is that “there are medications which help manage mood and behavior,” and clinical trials that these patients might qualify for, he said. But “does that become part of your health record that’s accessible by insurance companies” or employers, he wondered.

他说，好处是“有药物能协助控制心情与行为举止”，此外病人或许能参加一些他们符合资格的临床试验。不过他怀疑“受测纪录会列入你的个人健康史，保险公司可以调阅”，雇主可能也会查看。

“And do you really want to know? Because there’s no cure yet.” 

“而且你真想知道么？这种病目前还没法治疗。” 

Some experts said they believed the benefits of the new diagnosis outweighed the drawbacks.

一些专家表示，他们相信这种新诊断类别的利大于弊。

“We should not be ignoring them, waiting for the cognitive manifestations to appear,” Dr. Ganguli said, “because we may be missing the opportunity.” 

“我们不应该无视这些征候、坐等认知障碍出现，”冈古力表示，“我们可能会因此错失治疗契机。”