34個性格行爲問題幫助診斷早期失智症
“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?”
“人有變得焦躁不安、具攻擊性、易怒、情緒起伏不定嗎？”這份調查表問到。“她/他有對自己的能力、財富或技能抱着妄信嗎？”
Or maybe another kind of personality change has happened: “Does she/he no longer care about anything?”
又或許，她/他的個性有了另一種轉變：“對任何事都漠不關心？”
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.
如果對上述問題之一的回答是肯定的，或對這份新檢查清單上的其他問題有肯定的回答，且這些性格或行爲的轉變已經持續數月，那麼根據一羣神經心理學家與阿爾茨海默氏症專家的說法，這可能意味着某人正處於失智症（癡呆症）極早期階段。
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.
這些學者在提倡一種新的診斷類別——輕度行爲障礙(mild behavioral impairment, M.B.I.)，旨在辨認與測量某些專家認爲常遭忽視的面向：心情與行爲的急劇變化，可能在失智症造成的記憶與思考困難之前出現。
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.
該研究團隊上週日於多倫多的阿爾茨海默氏症國際年會(Alzheimer's Association International Conference)發表了這份提案，並提出一個列有34個問題的檢查清單。或許這份清單有天能用來識別較易罹患阿爾茨海默氏症的人。
“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.
“我認爲這樣的診斷工具確實有需要，”在美國國家老齡化研究所(National Institute on Aging)主持阿爾茨海默氏症中心計劃(Alzheimer's Disease Centers program)的妮娜‧席維伯格(Nina Silverberg)表示。她並未參與這份檢查清單的設計或提出這個新診斷類別。
“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.”
“大多數人都認爲阿爾茨海默氏症主要是記憶方面的毛病，不過我們從多年的研究中的確得知，這種病症初發時，也可能從行爲開始出問題。”
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.
這份提案指出，臨牀上應該先進行輕度行爲障礙診斷，再進行輕度認知障礙(mild cognitive impairment, M.C.I.)診斷。輕度認知障礙是十多年前創造出來的診斷類別，用來描述有些人有點認知問題，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‧伊斯梅爾(Zahinoor Ismail)博士是加拿大卡爾加里大學(University of Calgary)的神經心理學家，也是提出這個新診斷類別的研究團隊成員。他表示，各項研究與生活軼事都表明，情緒與行爲的轉變是”神不知鬼不覺的徵候”，屬於失智症發展過程，不應與失智症分開視之。
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.
伊斯梅爾表示，不論在失智症中損害記憶與思考能力的因素是什麼，都可能影響腦部調節情緒與自制的系統。
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，如果拿兩個都有輕度認知障礙的人相較，出現心情或行爲轉變的那個人，失智症會更快全面發作。有這些心情與行爲徵候的阿爾茨海默氏症患者，“隨着時間過去，病情會變得比其他人嚴重得多”。死亡之後的屍檢也顯示他們的腦部受損更厲害。
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.”
當然了，不是每個隨年齡增長心情也起伏不定的人就是在爲失智症的警訊所苦。伊斯梅爾博士強調，要確定有輕度行爲障礙，某個症狀必須持續至少六個月，“不僅僅是行爲偶爾失常而已，而是徹底的改變。”
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.
然而還是有些專家擔心，爲這麼早期的症狀定名並進行篩檢，最終可能會把一大羣人列入某個分類裏，導致其中一些人擔心在阿爾茨海默氏症尚無有效治療手段的時候會患上這種病。
“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.
“早期診斷、辨認出那些更可能患病的人或許有好處，”芝加哥大學(University of Michigan)內科教授肯尼斯‧蘭加(Kenneth Langa)博士表示。不過“從另一面來看，這也是過度診斷、給人貼標籤、讓人陷入沒完沒了的臨牀程序。當你開始做檢測，民衆就要開始做更多腦部顯影掃描、更常看醫生，也會產生更多擔心”。
“If it becomes a routine practice, that’s a huge amount of dollars.”
“要是這成了例行工作，得花上很一大筆錢。”
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.
蘭加醫師曾撰文探討輕度認知障礙，並在文中援引了使用這個診斷類別的經驗。他表示，許多被診斷出有輕度認知障礙的人，甚至在診斷十年後都沒有完全發展成失智症，其中還有多達20%的人的認知功能稍後又被判爲正常。
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.
這可能是因爲他們在做篩查那天的認知功能有失水平，或許是出於壓力，又或許是他們因其他健康問題所服用的藥物所致。
“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，”蘭加談到創立輕度行爲障礙時這麼說。他建議醫師在開始使用這份覈查清單之前，應該先把它交由研究人員進行測試。
Others are more enthusiastic.
其他人的看法則較爲樂觀。
“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.”
“我們必須提升辨識風險族羣的能力，”南加州大學(University of Southern California)的神經學家阿瑟‧託加(Arthur Toga)表示。假以時日，“一定會出現有效治療手段，”他說道。“畢竟，這種病有太多未知之處了。”
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.”
託加博士表示，他的母親是退休教師，在七十多歲時出現了挫折感以及其他情緒變化，比她最後患上阿爾茨海默氏症的時間早上好幾年。他認爲母親情緒欠佳，是因爲她在試圖掩飾家人尚未注意到的事情，並因此感到氣餒，此事就是“她對言談的認知能力每況愈下”。
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.
蘭加博士與其他學者表示，記憶測驗的確不能每次都偵測到早期問題，因爲有些人可能很會應付考試（尤其是那些教育程度很高的人），以至於測出來的分數無法反映出認知能力下降到何種程度。
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.
瑪莉‧岡古力(Mary Ganguli)博士是匹茲堡大學(University of Pittsburgh)的精神病學、神經病學和流行病學教授，她表示人們常在就診時表示，自己或某位家人不再從事他們向來喜愛的某項活動了，像是烘焙某種感恩節點心，或是春天的時候對除草機修修弄弄。
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，就連病人自己可能都不明白原因何在。他們可能因爲“不再知道該怎麼做”而對某件事失去興趣。
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.”
通常當岡古力詢問病人是不是記不住事情的時候，“他們會說：‘是啊，可是沒啥大不了的。’”她說，“不過要是我做檢測，就會發現他們的記憶有問題。”
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.
支持前述新診斷類別的一些專家表示，有些情緒與行爲症狀能通過治療手段或藥物改善，這與大多數的認知障礙不同。“我們可以讓當事人睡得更好、減輕他們的沮喪程度、幫助家屬學習處理各種問題，”岡古力醫師表示。
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.
伊斯梅爾博士則表示，漠然無感是常見的症狀之一，不過他也見識過截然不同的轉變。有位女性病人在七十多歲時變得性慾勃發，“從老古板變成豪放女”。另一位奉公守法的67歲女性則突然“開始抽強效可卡因”。這兩位不久都患上了癡呆症。
Mood and behavior changes have long been recognized as early-warning signs of frontotemporal dementia, which accounts for about 10 percent of dementias.
長久以來，心情與行爲變化都被視爲額顳葉癡呆的早期警訊，它在全部癡呆症中約佔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.
岡古力的病人帕爾瑪‧波斯瓦(Palmer Posvar)的丈夫韋斯利(Wesley)說，帕爾瑪在五十多歲的時候開始拿別人盤子裏的東西來吃、向朋友借錢，還想把家傳珠寶拿去典當。她在54歲時被診斷出患有額顳葉癡呆。現年64歲的波斯瓦太太已喪失語言能力，而且時常跌倒，所以近來從賓州福克斯查普爾的住處送去了養老院。
Still, “early diagnosis is a double-edged sword,” Mr. Posvar said when asked about creating a mild behavioral impairment category.
然而，“早期診斷是把雙刃劍。”當我們詢問波斯瓦先生對創造“輕微行爲障礙”這個診斷類別有什麼看法，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.
他說，好處是“有藥物能協助控制心情與行爲舉止”，此外病人或許能參加一些他們符合資格的臨牀試驗。不過他懷疑“受測紀錄會列入你的個人健康史，保險公司可以調閱”，僱主可能也會查看。
“And do you really want to know? Because there’s no cure yet.”
“而且你真想知道麼？這種病目前還沒法治療。”
Some experts said they believed the benefits of the new diagnosis outweighed the drawbacks.
一些專家表示，他們相信這種新診斷類別的利大於弊。
“We should not be ignoring them, waiting for the cognitive manifestations to appear,” Dr. Ganguli said, “because we may be missing the opportunity.”
“我們不應該無視這些徵候、坐等認知障礙出現，”岡古力表示，“我們可能會因此錯失治療契機。”
