31.2 📚 國考版醫垫國考 / PGY OSCE

31.2.0.1 📌 Cram Sheet

31.2.0.1.1 🔥 高 yield 10 條
  1. 5 倧類AD 60-80% / VaD 15-20% / DLB 5-10% / FTD < 5% / Mixed
  2. AD = 挞進健忘 + 語蚀 + 空間
  3. VaD = 階梯 + focal neuro
  4. DLB = visual hallucination + parkinsonism + 波動 + REM behavior + 抗粟神病過敏
  5. FTD = 人栌 / 行為 / 語蚀 + < 65 yo + 蚘憶盞對保留
  6. Reversible: B12 / TSH / NPH / syphilis / HIV / depression
  7. MMSE < 24 vs MoCA < 26
  8. AD 藥: ChEI + memantine
  9. 22E new: Lecanemab / Donanemab (anti-amyloid mAb)
  10. DLB 絊 haloperidol → 嚎重 EPSavoid
31.2.0.1.2 🔢 必背
項目 æ•žå­—
AD 比䟋 60-80%
VaD 15-20%
DLB 5-10%
MMSE max 30
MMSE abnormal < 24
MoCA max 30
MoCA abnormal < 26
FTD onset < 65 yo (often 50-60s)
Lecanemab dosing IV q2w
31.2.0.1.3 ⚠ 陷阱
  • 老化當倱智
  • DLB 絊 haloperidol
  • 䞍查 reversible
  • Pseudodementia 䞍認
  • Lecanemab 絊 APOE4 homozygote 䞍譊告 ARIA

31.2.0.2 ⭐ 高 yield 摘芁

31.2.0.2.1 Type 區分必背衚
AD VaD DLB FTD
Onset Insidious 階梯 Fluctuating Insidious
Memory First Variable Less prominent Spared early
Personality Late Late + Early
Hallucination 晚 少 + Visual 少
Parkinsonism 晚 + variable + 少
Risk APOE4 Vascular α-synuclein C9orf72, MAPT, GRN
MRI Hippocampal atrophy Vascular lesion Less characteristic Frontal/temporal atrophy
31.2.0.2.2 DLB Diagnostic Criteria

Core features (4) - Fluctuating cognition - Visual hallucinationrecurrent, well-formed - Parkinsonism - REM sleep behavior disorder

Supportive: severe sensitivity to antipsychotic + autonomic dysfunction + low DAT uptake

31.2.0.2.3 FTD Variants
  • bvFTD: behavior, disinhibition, apathy
  • PPA (primary progressive aphasia):
    • Semantic variant
    • Non-fluent variant
    • Logopenic variant
31.2.0.2.4 Reversible Dementia (Must rule out)
  • B12, TSH, syphilis (RPR + VDRL)
  • HIV
  • NPH (MRI + LP tap)
  • Subdural (CT)
  • Brain tumor (CT/MRI)
  • Pseudodementia (PHQ-9, history)
31.2.0.2.5 AD Workup
  • Cognitive screen (MMSE, MoCA)
  • Lab: CBC, CMP, B12, TSH, RPR, HIV
  • MRI brain
  • 進階: amyloid PET, CSF (Aβ42/tau), APOE4 genotyping
  • 22E: blood-based biomarkers emerging
31.2.0.2.6 AD Drugs
Drug 適甚 副䜜甚
Donepezil 5-23 mg mild-severe GI, bradycardia
Rivastigmine mild-moderate; DLB +奜 GI, weight loss
Galantamine mild-moderate GI
Memantine moderate-severe dizziness
Lecanemab mild AD/MCI Aβ+ ARIA
Donanemab mild AD/MCI Aβ+ ARIA
31.2.0.2.7 Lecanemab/Donanemab Caveats
  • Amyloid PET / CSF biomarker confirm before
  • APOE4 homozygote 高 ARIA
  • MRI monitoring
  • IV infusion
  • 健保未涵蓋

31.2.0.3 🎯 自我檢枬

  1. AD 比䟋? → 60-80%
  2. DLB 4 core features? → fluctuation / visual hallucination / parkinsonism / REM behavior
  3. DLB 為䜕避 haloperidol? → 嚎重 sensitivity (severe EPS, NMS)
  4. FTD 早期突出? → 行為 / 人栌 / 語蚀蚘憶盞對保留
  5. Reversible 6 個? → B12 / TSH / NPH / syphilis / HIV / depression
  6. MMSE < ? abnormal? → 24
  7. MoCA < ? abnormal? → 26
  8. Lecanemab 䞻芁副䜜甚? → ARIA
  9. Memantine 機蜉? → NMDA antagonist
  10. APOE4 homozygote 颚險? → AD risk + ARIA risk on anti-amyloid

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