精神医学63巻8号

2021年08月発行

特集 認知症診療における精神科医の役割を再考する

脳神経外科と連携が必要な認知症疾患—治療可能な認知症治療にかかわる脳神経外科医から精神科医への期待

著者： 中島円¹ 川村海渡¹ 宮嶋雅一²

所属機関： ¹順天堂大学医学部脳神経外科 ²順天堂大学医学部附属順天堂東京江東高齢者医療センター脳神経外科

ページ範囲：P.1247 - P.1255

文献概要

抄録　認知症の原因疾患の中には脳神経外科治療により改善が得られる病態がある。脳神経外科が関与する疾患の中でも，慢性硬膜下血腫や髄膜種などの頭蓋内良性腫瘍性病変による緩徐な脳への圧迫が生じるものは，認知症状が主訴になる場合も少なくない。ただし，これらの疾患はCT，MRIなどの画像診断で容易に原因を確定し得る。一方，2020年に診療ガイドラインが改訂され，第3版が発行された特発性正常圧水頭症は，高齢者に歩行障害，尿失禁，認知症などの症候をもたらす疾患で，脳脊髄液が頭蓋外へ排泄されにくくなり，脳内に貯留する病態と考えられているが，病態・症候に多様性を示す疾患である特徴から，いまだ不明な点が多い。疾患の病態/治療を明らかとしていくため，脳神経外科医，精神科医，脳神経内科医，神経病理医，また治療デバイスの改善には，工学系との円滑な連携のもと，多方面からの疾患アプローチが必要とされている。

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