老年人不同亚型轻度认知功能损害调查

目的了解贵州省贵阳市城区≥60岁,老年人轻度认知功能损害(MCI)及其不同亚型的发病情况。方法通过问卷询问和量表测试,对贵阳市城区2 200名≥60岁认知正常老年人进行随访研究,运用简易智能状态检查量表(MMSE)进行认知功能评定,研究对象的一般情况描述及比较采用χ2检验和u检验。结果贵阳市城区老年人MCI的发病密度为15.6/1 000人年;遗忘型MCI的发病密度为11.0/1 000人年,无遗忘型-单领域型发生,所有遗忘型MCI均为多领域型;非遗忘型MCI的发病率为4.6/1 000人年,其单领域型和多领域型的发病密度为0.4/1 000人年和4.2/1 000人年;女性、文盲发生非遗忘型MCI较多(P0.05)。结论不同亚型的发病情况有差别,不同特征人群的发病分布情况也不同。     

社会资源对老年人轻度认知功能损害发病影响

目的了解社会网络和社会活动2种社会资源对老年人轻度认知功能损害(MCI)及其不同亚型发病的影响,为采取干预措施提供参考依据。方法采用前瞻性研究的方法,对贵州省贵阳市城区老年人认知功能状况基线调查中认知功能正常,且完整填写社会资源情况的2 144名≥60岁老年人进行认知功能状态的随访调查,采用Cox回归模型分析不同社会资源情况对随访老年人MCI及其亚型发病的影响。结果 2 144名预期随访对象中,实际随访到1 401人,其中新发MCI病例102例,发病密度为15.21/1 000人年,其中遗忘型MCI(aMCI)71例,非遗忘型MCI(naMCI)31例,发病密度分别为10.59/1 000人年和4.62/1 000人年;1 401名老年人中,与子女、亲戚、朋友和邻居有相聚的老年人分别占58.7%、55.8%、64.1%和68.2%,在婚且非独居老年人占66.9%,社会资源丰富程度为不良、较小、适量和丰富的老年人分别占3.7%、20.2%、48.0%和28.0%,不参加集体活动、参与智力活动、参与体力活动和参与其他类型活动的老年人分别占12.9%、16.2%、57.6%和13.3%,偶尔和经常活动的老年人分别占35.8%和51.3%;Cox单因素回归分析结果表明,有子女看望和与朋友相聚是MCI(RR子女=0.647,95%CI=0.437～0.957;RR朋友=0.657,95%CI=0.445～0.972)及aMCI(RR子女=0.504,95%CI=0.316～0.805;RR朋友=0.600,95%CI=0.376～0.956)发病的保护因素;Cox多因素回归分析结果表明,有子女看望是MCI及aMCI发病的保护因素,与朋友相聚是aMCI发病的保护因素。结论有子女看望和与朋友相聚等社会资源是aMCI的保护因素。     

社区老年人轻度认知功能损害的转归研究

目的 了解贵阳市社区老年人轻度认知功能损害(MCI)的转归.方法 以2004年及2005年贵阳市社区老年人MCI流行病学调查的人群为研究对象,3 a后对基线调查时经简易智能状态检查法(MMSE)筛查后诊断为MCI以及认知正常的受试者队列进行随访.比较MCI和认知正常受试者的不同状态转化率,并用寿命表法对各组的生存率进行分析.结果 根据纳入和排除标准,原有343例MCI患者(遗忘型MCI 246例,非遗忘型MCI 97例)和2 200例认知正常者进入队列.随访结束时,正常组失访560例(25.3%),MCI组失访82例(23.9%),其中遗忘型MCI组65例,非遗忘型MCI组17例.正常组与MCI组间、不同亚型MCI组间失访率的差别均无统计学意义(P>0.05).MCI组的死亡率为12.6%,痴呆转化率为5.7%;正常组死亡率为8.7%,痴呆转化率为1.7%,两组间差别有统计学意义(P<0.001).MCI组死亡的概率约是正常组的1.4倍,发展为痴呆的概率约为正常组的3.4倍.遗忘型MCI和非遗忘型MCI组的死亡率分别为12.2%和13.8%,痴呆转化率分别为5.5%和6.3%,MCI保持率分别为19.3%和12.5%,认知正常转化率分别为63.0%和67.4%.非遗忘型MCI患者死亡、发展为痴呆及转为正常的概率均高于遗忘型MCI,遗忘型MCI保持率高于非遗忘型MCI,但差别均无统计学意义.随着观察时间的延长,各组的生存率均逐渐下降.与正常组相比,MCI及各型MCI患者的生存率均较低.结论 MCI的死亡率与痴呆转化率均高于认知正常组,且分型后不同亚型MCI的转归有所不同.     

老年轻度认知功能障碍患者认知评分变化3年前瞻性研究

目的 探讨社区老年轻度认知功能障碍(MCI)患者认知评分变化及其在阿尔茨海默病(AD)预测中的价值.方法 采用多级整群抽样方法选择对象,对贵阳市社区老年人开展3年前瞻性研究,将基线MCI患者前后简易智能状态检查(MMSE)总分及各领域得分变化进行对比分析,并对MCI患者不同转归结局MMSE前后得分进行比较,采用logistic回归分析方法对其在AD发病的危险性进行估计.结果 MCI患者基线和随访对认知功能总分及各领域得分差异有统计学意义(P＜0.05).结局为痴呆者基线MMSE得分低于保持MCI和转为正常者(P＜0.05).Logistic回归分析显示定向力下降的MCI患者转化为AD的危险性较高(OR=1.730,95％CI=1.283～2.332).结论 MCI患者各领域得分及MMSE总分较低者更容易转化为AD.在MCI转归为痴呆的过程中,定向力得分下降可能是其中一个重要的预测因子.     

轻度认知功能障碍认知改变的“病例-病例”研究

[目的]通过对社区老年人的横断面调查,以探究社区老年人轻度认知功能障碍者的流行病学分布特征和认知改变的地区差异。[方法]于2006年9~12月,用典型抽样法抽取太原市矿区和大同市矿区60岁及以上老年人作为研究对象,进行基线调查。调查内容包括一般情况、认知功能和生理指标。太原矿区共凋查1713人,从中筛出轻度认知功能障碍(MCI)患者作为一组病例来源,大同矿区共调查1420人,从中筛出MCI患者作为另一组病例来源,经年龄性别匹配后进行不同地区(太原-大同)的病例-病例研究。资料用SPSS11.0软件包进行统计分析。[结果]太原市矿区MCI患病率为5.43%,大同地区MCI患病率为5.77%;不同地区间病例比较结果显示:知识(t=4.305,P=0.000)、算术(t=2.454,P=0.016)、填图(t=2.419,P=0.018)、短期视觉记忆(t=3.026,P=0.003)几个方面的差异有统计学意义。[结论]两地区间MCI患病率不同,在不同地区同质MCI的认知功能改变存在一定差异,故制定不同区域MCI预防措施时应考虑不同侧重点。     

社区55岁及以上人群轻度认知功能障碍与跌倒风险的关联研究

  目的   探讨轻度认知功能障碍(mild cognitive impairment, MCI)与社区人群跌倒风险的关联, 为预防老年人跌倒提供参考。   方法   2015年9月, 对宁夏吴忠市参加基本公共卫生体检的826名55岁及以上社区人群进行认知功能测评, 2016年3月期间(6个月后)通过电话随访调查跌倒发生情况并比较不同人群跌倒发生率; 采用非条件Logistic回归分析模型分析跌倒与轻度认知功能障碍的相关性。   结果   共有521人完成了随访, 其中MCI组127人。2015年9月~2016年3月期间, 共有32人报告发生跌倒, 发生率为6.1%(32/521), 其中女性跌倒发生率(8.85%, 23/260)高于男性(3.45%, 9/261), 两组差异有统计学意义(RR=2.56, P=0.010)。MCI组发生率(9.45%, 12/127)是非MCI组的1.86倍, 差异具有统计学意义(RR=1.86, P=0.073);多因素分析控制了性别、年龄和文化程度等人口学变量后, MCI与跌倒发生风险无明显性关联(OR=1.41, P=0.382)。   结论   社区老年人群跌倒发生率较高, 且女性高于男性; 尚未观察到MCI与人群跌倒发生风险明显相关, 需要今后大样本人群研究进一步验证。     

老年人轻度认知功能损害与社会支持关系

目的了解不同社会支持情况对贵州省贵阳市城区≥60岁老年人轻度认知功能损害(MC I)及其不同亚型发病的影响。方法采用前瞻性研究的方法,对基线调查时认知功能正常且完整填写社会支持情况的2 156名≥60岁贵阳市城区老年人进行认知功能状态随访,采用Cox回归模型分析不同社会支持情况对随访老年人MC I及其亚型发病的影响。结果拥有客观支持是避免MC I(ID=14.76/1 000人年,RR=0.424,95%CI:0.220～0.819)及遗忘型MC I(ID=10.22/1 000人年,RR=0.366,95%C:I 0.174～0.767)发病的保护因素;遗忘型MC I中收入来源数量≥2种者发病密度(ID)较高(ID=12.29/1 000人年),而在非遗忘型MC I中发病密度较低(ID=3.35/1 000人年);靠夫妇双方收入作为家庭经济收入的老年人发生非遗忘型MC I的危险性(ID=3.05/1 000人年)低于收入仅靠他人的老年人(ID=10.39/1 000人年,RR=0.253,95%C:I 0.106～0.601);未发现其他社会支持情况对不同亚型MC I发病有影响(P>0.05)。结论社会支持...     

遗忘型轻度认知损害与阿尔茨海默病的脑影像结构特点研究

阿尔茨海默病(alzheimer's disease,AD)是一种渐进性的神经退行性疾病,主要表现在多种认知功能的逐渐减退,最终进展为全面性痴呆。轻度认知损害(mild cognitive impair-ment,MCI)是介于AD与正常老年人之间的一个临床阶段,常被认为是AD的高危因素。MCI可分为4种临床亚型:遗忘型MCI,包括单域遗忘型MCI和多域遗忘型MCI;非遗忘型MCI,包括单域非遗忘型MCI和多域非遗忘型MCI[1]。其中的遗忘型MCI(amnestic MCI,aMCI)最受关注,因其每年     

蒙特利尔认知量表中文版诊断老年轻度认知功能损害的应用研究

目的 探讨蒙特利尔认知量表(Montreal cognitive assessment,MoCA)中文版诊断老年轻度认知功能损害(mild cognitive impairment,MCI)的效能.方法 选取73例MCI患者为MCI组和51例认知功能正常者为对照组,对两组进行均衡性检验及MoCA中文版评估.结果 MCI...     

老年人轻度认知功能损害与ApoE基因多态性关系

目的探讨社区老年人轻度认知功能损害(MC I)及其亚型发病与Apo E基因多态性的关系。方法对贵州省贵阳市城区≥60岁认知功能正常老年人2 207名随访3年后,选择新发MC I患者和相应对照进行1∶2匹配巢式病例对照研究;Apo E等位基因分型测定采用限制性片段长度多态性分析技术(RFLP-PCR);采用COX模型拟合条件Logistic回归分析法进行影响因素分析。结果 MC I新发病例105例,发病密度为18.2/千人年;其中遗忘型发病密度为12.9/千人年;非遗忘型发病密度为5.4/千人年;单因素分析显示,携带Apo Eε4基因是未分型MC I和遗忘型MC I发病的共同危险因素(OR=2.463,95%CI=1.372～4.433;OR=2.824,95%CI=1.375～5.876),携带Apo Eε2基因是非遗忘型MC I发病的危险因素(OR=3.688,95%CI=1.140～11.930);而携带Apo Eε3基因可降低未分型MC I及非遗忘型MC I的发病风险(OR=0.478,95%CI=0.275～0.864;OR=0.380,95%CI=0.147～0.984);控制受教育程度及相关血脂因...     

蒙特利尔认知评估量表在老年轻度认知功能障碍筛查中的应用

目的探讨蒙特利尔认知评估量表（MoCA）在老年轻度认知功能障碍（MCI）患者筛查中的应用。方法选择老年MCI患者56例为MCI组和认知功能正常者50例为对照组,分别给予MoCA、简易精神状态检查量表（MMSE）评估,并分析评估结果。结果 MCI组和对照组MoCA总分明显低于MMSE总分（P〈0.01）。MoCA筛查MCI的敏感性为96.4%、特异性为84%;MMSE筛查MCI的敏感性为35.7%、特异性为100%。MoCA中除定向力项外,总分及其余各亚项的评分在MCI组和对照组间差异均有统计学意义（P〈0.01）。结论 MoCA为高敏感性的MCI筛查工具,能全面评估MCI患者的认知功能,筛查MCI的敏感性优于MMSE。     

2008年中国戒烟大赛厦门赛区参赛者半年戒烟效果评价

[目的]评价厦门市参加中国戒烟大赛人群的戒烟效果,探讨影响戒烟行为的主要因素,为开展控烟工作提供依据。[方法]对2008年参加中国戒烟大赛厦门赛区的712名报名者,在戒烟大赛开始半年后,随机抽取20%进行电话随访。随访内容包括吸烟情况、戒烟情况和复吸情况。[结果]单因素分析显示参赛者的文化程度、婚姻、吸烟量、烟龄、戒烟次数、戒烟态度、戒烟措施和是否得到支持对成功戒烟有影响,差异有统计学意义(P﹤0.05);多因素Logistic回归分析显示戒烟成功的影响因素的OR值从大到小依次为家人亲戚支持、戒烟次数、吸烟量(P﹤0.05)。[结论]开展群体性戒烟竞赛对吸烟者戒烟起推动作用,家庭约束力和社会环境是戒烟成败的关键,营造不吸烟的环境关系到控烟工作的成败。     

Amyloid and tau imaging,neuronal losses and function in mild cognitive impairment

Objectives: Establish new approaches for early diagnosis of dementia, based on imaging amyloid and tau pathology, cell losses and neuronal function, in subjects with mild cognitive impairment (MCI),. The overall aim is to develop effective tools for monitoring disease progression in the living patient to facilitate discovery of early therapeutic interventions to modify the course of the disease.Design: Use 2-(l-(6-[(2-[F-18]fluoroethyl)(methyl)amino]-2-naphthyl)ethylidene)malononitrile ([F-18]FDDNP) in combination with positron emission tomography (PET) to produce dynamic images for quantification of regional cortical brain deposition in MCI patients and compare them with controls subjects and patients with Alzheimer’s disease (AD). Comparison with other molecular imaging probes for neuronal losses and function were also made.Setting: Patients are positioned supine in the tomograph bed with his/her head in the detector ring field. Upon injection of the molecular imaging probe (e.g., [F-18]FDDNP) images are obtained at very short time intervals for up to two hours. This results in dynamic sequences of brain distribution of the probe.Participants: Patients with clinical diagnosis of AD, MCI and control subjects.Measurements: Subjects in the categories established above were scanned with [F-18]FDDNP-PET and quantification performed using Logan parametric graphical analysis to measure relative quantitative amyloid loads throughout the brain within patient groups. These results were compared in the same patients with cell losses in hippocampus using 4-[F-18]fluoro-N-(2-[4-(2-methoxyphenyl)-l-piperazinyl]ethyl)-N-(2-pyridinyl)benzamide,([F-18]MPPF) and regional cerebral glucose metabolic rates using 2-deoxy-2-[F-18]fluoro-2-deoxy-D-glucose (2-[F-18]FDG).Results: [F-18]FDDNP reliably follows neuropathological progression (amyloid plaques [SP]; neurofibrillary tangles [NFT]) in the living brain of AD patients and those with MCI. The distribution of [F-18]FDDNP brain cortical accumulation correlates well with behavioral measures (e.g., MMSE scores) and follows known patterns of pathological distribution observed at autopsy. We have also established conversion of controls to MCI and MCI to AD with precision and sensitivity in patients and control subjects in follow-up studies. Moreover, we have established that hemispheric cortical surface mapping of [F-18]FDDNP binding is a powerful tool for assessment and visualization of the rate of brain pathology deposition. A strong correlation of [F-18]FDDNP binding, cell losses in hippocampus and decreased glucose utilization ([F-18]FDG PET) in several neocortical regions was found in the same AD and MCI subjects. Conclusions: The combined evaluation of [F-18]FDDNP PET (targeting NFT and_SP) with neuronal losses in the hippocampus and with [F-18]FDG PET (targeting neuronal function) offers the opportunity for reliable, noninvasive detection of MCI patients at risk for AD. The approach offers a glimpse to the molecular and cellular mechanisms associated with dementia and provides a means for their assessment in the living patient. Monitoring disease progression in MCI patients demonstrates the usefulness of this imaging approach for early diagnosis and provides a means for evaluation of neuroprotective agents and drugs aimed at prevention and modification of disease progression.     

西安城区群居老人痴呆早期症状的调查与分析

[目的]调查西安城区养老院和干休所群居老人痴呆早期症状现况。[方法]采用人口学、健康史、MMSE、ADL、HDS等问卷和量表进行筛查。[结果]群居老人老年痴呆的早期症状明显,最多为记忆力减退,计算、学习新知等能力下降和急躁、易怒等情绪不稳次之,定向障碍和猜疑、主动性差、偏执等人格改变较少;MCI患病率13.3%,以75～84岁最多。[结论西安城区群居老人痴呆早期症状明显,尤以近事记忆减退突出,MCI患病率较高。     

MCI及AD患者血清一氧化氮和超敏C反应蛋白的变化

目的观察轻度认知障碍(MCI)及阿尔茨海默病(AD)患者一氧化氮(NO)及超敏C-反应蛋白(hs-CRP)的变化。方法用硝酸还原法及免疫散射比浊法检测正常老年人(对照组)、MCI患者(MCI组)及AD患者(AD组)血清中NO及hs-CRP的水平。结果与对照组比较,MCI与AD组NO水平明显降低(P<0.01),hs-CRP水平明显升高(P<0.01),MCI组与AD组NO水平及hs-CRP水平无明显差异(P>0.05)。结论 MCI及AD患者可能存在炎症反应诱导的内皮功能损伤。     

Symptom Clusters of Neuropsychiatric Symptoms in Mild Cognitive Impairment and Their Comparative Risks of Dementia: A Cohort Study of 8530 Older Persons

ObjectivesNeuropsychiatric symptoms (NPS) have been recognized to increase the risk of dementia among individuals with mild cognitive impairment (MCI). However, it is unclear whether the risk is shared across the various NPS or driven primarily by selected few symptoms. This study sought to provide confirmatory evidence on the comparative risk of dementia across the various NPS in MCI.DesignCohort study (median follow-up 4.0 years; interquartile range 2.1–6.4 years).SettingAlzheimer's Disease Centers across the United States.ParticipantsParticipants ≥60 years of age and diagnosed with MCI at baseline (n = 8530).MeasuresParticipants completed the Neuropsychiatric Inventory–Questionnaire at baseline and were followed up almost annually for incident dementia. Symptom clusters of NPS, as identified from confirmatory factor analyses, were included in Cox regression to investigate their comparative risks of dementia.ResultsThree symptom clusters of NPS were identified among participants with MCI, namely hyperactivity, affective, and psychotic symptoms. The risk of dementia was present among participants with affective symptoms [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.4–1.9] and psychotic symptoms (HR 1.6, 95% CI 1.2–2.2), but not among those with hyperactivity symptoms (HR 1.1, 95% CI 0.9–1.3). The risk was higher when affective symptoms and psychotic symptoms co-occurred (HR 2.5, 95% CI 2.0–3.2), with one-half of the participants in this group developing dementia within 2.7 years of follow-up.Conclusions and ImplicationsThe findings illustrate the potential usefulness of NPS as a convenient prognostic tool in the clinical management of MCI. They also suggest the need for future research to focus on affective/psychotic symptoms in MCI when studying the neurobiological links between NPS and neurodegenerative processes.     

Diabetes and Prediabetes Inhibit Reversion from Mild Cognitive Impairment to Normal Cognition

ObjectivesDiabetes and prediabetes contribute to an increased risk of cognitive decline and dementia. Currently, it remains unclear whether elevated blood HbA1c levels, including prediabetes levels, affect reversion from mild cognitive impairment (MCI) to normal cognition. This study, therefore, aimed to examine the prospective associations of diabetes and prediabetes with reversion from MCI to normal cognition among community-dwelling older adults.DesignLongitudinal cohort study with a 4-year follow-up.Setting and ParticipantsCommunity-dwelling older adults with MCI, aged ≥65 years at baseline (n = 787).MethodsParticipants’ medical history of diabetes and blood HbA1c levels at baseline were assessed, and they were classified as control, prediabetes, and diabetes. Objective cognitive screening was performed using a multicomponent neurocognitive test at baseline and follow-up. Reversion from MCI to normal cognition over 4 years was determined. In the longitudinal analysis, we performed multiple imputations to adjust for a selection bias and loss of information.ResultsThe reversion rates of MCI in the control, prediabetes, and diabetes groups were 63.4%, 55.6%, and 42.9%, respectively, in the completed follow-up dataset, and 54.6%, 47.2%, and 34.1%, respectively, in the imputed dataset. Multivariate logistic regression showed that diabetes decreases the probability of MCI reversion both before and after multiple imputations [odds ratio (OR) 0.37; 95% confidence interval (CI) 0.18–0.74 for before imputation, OR 0.37; 95% CI 0.19–0.72 for after imputation]. Furthermore, prediabetes also showed significantly decreased probabilities of MCI reversion both before and after multiple imputations (OR 0.57; 95% CI 0.34–0.94 for before imputation, OR 0.60; 95% CI 0.37–0.97 for after imputation).Conclusions and ImplicationsDiabetes and prediabetes could inhibit MCI reversion. Adequate glycemic control may be effective in enhancing the reversion from MCI to normal cognition in a community setting.     

轻度认知障碍及阿尔茨海默病患者甲状腺功能的变化

目的探讨轻度认知功能障碍及阿尔茨海默病患者甲状腺功能的变化。方法用放射免疫法检测轻度认知功能障碍（mildc ognition impairment,MCI）、阿尔茨海默病（Alzheimer＇s disease,AD）组,及正常老年人组三碘甲状腺原氨酸（triiodo-thyronine,T3）、T4甲状腺素（tetraiodothyronine,T4）、游离三碘甲状腺原氨酸（free triiodothyronine,FT3）、FT4游离甲状腺素（free thyroxine,FT4）、促甲状腺激素（thyrotropin,TSH）水平。结果MCI患者T3的水平明显降低〔（0.51±0.14）μg/L〕,AD患者T3的水平明显降低〔（0.54±0.11）μg/L〕,与对照组〔（0.74±0.17）μg/L〕比较,差异有统计学意义（均P〈0.01）;MCI及AD患者的FT3水平也明显降低〔（1.62±0.34）pmol/L,（1.55±0.32）pmol/L〕,与对照组〔（1.94±0.46）pmol/L〕比较,差异有统计学意义（均P〈0.01）;与对照组TSH〔（2.94±2.12）mU/L〕比较,MCI患者TSH水平〔（2.62±1.98）mU/L〕无明显变化（P〉0.05）,AD患者TSH水平明显降低〔（1.54±0.88）mU/L〕（P〈0.01）。结论MCI及AD患者甲状腺功能降低,TSH在MCI向AD的转变过程中可能有临床参考价值。     

基于联合模型的老年人轻度认知功能障碍发病风险预测研究

目的构建并比较基于6种不同认知功能测量量表的老年人轻度认知功能障碍(MCI)发病风险动态预测模型。方法基于2005-2020年阿尔茨海默病神经影像学倡议的纵向数据, 以简易精神状态量表(MMSE)、社会功能活动调查表(FAQ)、阿尔茨海默病评定量表认知分量表(ADAS-Cog11、ADAS-Cog13)、阿尔茨海默病评定量表延迟词语回忆(ADASQ4)和Rey听觉词语学习即刻测验(RAVLT_immediate)作为纵向认知功能评估指标评估认知功能的纵向变化, 利用联合模型分析纵向认知功能评估指标变化轨迹与生存结局MCI之间的关系, 构建老年人MCI发病风险预测模型, 以线性混合模型对纵向评估指标的变化轨迹建模, 以比例风险模型对生存过程建模, 通过关联参数(α)将两个子模型联系起来。采用受试者工作特征曲线下面积(AUC)评价模型在(t, t+Δt)随访时间段的预测效能, 其中t选取第30、42、54个月, Δt选取15和21个月。基于预测模型, 选取1名研究对象示例进行MCI发病风险个体动态预测。结果最终纳入544名基线认知状态正常的老年人(≥60岁), 其中11...