血管紧张素转换酶基因插入缺失多态性与血管性痴呆关系的Meta分析

目的探讨血管紧张素转换酶基因插入缺失多态性与血管性痴呆的关系。方法全面检索相关文献,凡是涉及血管紧张素转换酶基因插入缺失多态性与血管性痴呆关系的研究都被仔细评估。采用Meta分析方法对相关研究进行综合分析。结果全世界总共10个合格研究纳入本分析。未发现出版偏倚,主要是亚洲人群研究之间存在异质性,未发现血管紧张素转换酶基因插入缺失多态性是血管性痴呆的危险因素。结论未发现血管紧张素转换酶基因插入缺失多态性是血管性痴呆的危险因素。     

载脂蛋白E基因多态性与血管性痴呆的关系

目的探讨载脂蛋白E(ApoE)基因多态性与血管性痴呆的关系,并分析其可能的作用机制。方法应用聚合酶链反应-限制性片段长度多态性技术,检测65例血管性痴呆患者(血管性痴呆组)和120名健康受试者(对照组)的ApoE基因型和基因频率;同时对血清总胆固醇、甘油三酯、低密度脂蛋白和高密度脂蛋白进行检测,分析ApoE基因多态性对血脂代谢的影响。结果血管性痴呆组与对照组均以ε3/3基因型出现频率最高,但血管性痴呆组患者的ε4基因出现频率(14.6%)显著高于对照组(4.6%,P<0.01)。血管性痴呆组血清总胆固醇水平明显高于对照组(P<0.05)。在血管性痴呆组,ε4基因具有升高血清总胆固醇水平的作用;而在正常对照组,ε2基因具有降低血清甘油三酯和低密度脂蛋白水平的作用,说明ε4基因与血清总胆固醇水平升高具有相关性。结论ApoEε4是血管性痴呆发病的的遗传易感因子;血管性痴呆患者存在血脂代谢紊乱,且受ApoE基因的调控,ApoE基因可能通过引起血脂代谢紊乱而增加血管性痴呆发病危险性。     

血尿酸在血管性痴呆患者中的临床诊疗价值

目的探讨血管性痴呆的发病危险因素。方法测定50例血管性痴呆患者及50例正常体检者的血尿酸水平,根据颈动脉硬化程度将血管性痴呆患者进行分组,采用临床痴呆量表(clinical dementia rating,CDR)对血管性痴呆患者评分。结果血管性痴呆患者血尿酸水平较正常对照组高,且血尿酸水平随着颈动脉硬化程度而递增(P0.05)。血管性痴呆的严重程度与血尿酸水平呈负相关(P0.05)。结论高尿酸血症可能是血管性痴呆的发病危险因素。     

同型半胱氨酸与血管性轻度认知功能障碍的相关性

轻度认知功能障碍(mild cognitive impairment,MCI)是介于正常老化与痴呆之间的一种过渡状态,是痴呆的前期阶段.血管性轻度认知功能障碍(vascular mild cognitive impairment,VMCI)是MCI的一个亚型,系病因分型,是血管性痴呆(Vascular dementia,VD)的前期阶段.目前VMCI的危险因素及发病机制尚不清楚.本研究的目的 在于探讨同型半胱氨酸(homocysteine,Hey)水平与VMCI的相关性,研究与VMCI相关的危险因素,为预防VD提供依据.     

血管性痴呆患者血清IL-6 IL-8和sTWEAK水平临床研究

目的观察血管性痴呆患者血清IL-6、IL-8和可溶性肿瘤坏死因子样凋亡微弱诱导剂(sTWEAK)的水平,探讨其在血管性痴呆发病中的作用。方法收集2015-10—2016-10在焦作市第二人民医院住院诊断为血管性痴呆的患者64例为血管性痴呆组(VD组),同时选取59例与病例组性别、年龄、脑血管病危险因素及文化程度匹配的人群为对照组(NC组)。检测2组患者血清IL-6、IL-8和sTWEAK值。结果 VD组IL-6和IL-8明显高于NC组,差异有统计学意义(P0.05)。VD组sTWEAK明显低于NC组(P0.05)。VD组MMSE与IL-6、IL-8之间存在相关关系,相关系数分别为0.712、0.783,为高度线性正相关关系,与sTWEAK存在相关关系,相关系数为-0.616,为显著线性负相关关系。NC组中MMSE与IL-6、IL-8、sTWEAK之间无相关性(P0.05)。结论 IL-6和IL-8可能参与了血管性痴呆的炎性反应,sTWEAK对血管性痴呆可能有一定的保护作用,炎症反应有可能是血管性痴呆发病机制之一。     

血管性痴呆106例临床分析

目的 探讨血管性痴呆的临床及相关问题，加深对血管性痴呆的认识。方法 收集近8年来106例血管性痴呆的临床资料进行分析。结果 发现血管性痴呆与既往史、脑血管病发生的次数、病灶部位、病灶数目及有无脑萎缩等有相关性关系。106例基本治愈18例，显著进步46例，进步26例，无效16例。结论 血管性痴呆的发生与上述因素有关；脑萎缩可以是血管性痴呆的直接因素或加重因素；通过有效治疗，部分病例预后良好。     

血管性痴呆患者血清SCD40L与Hcy的相关性研究

目的探讨血管性痴呆患者血清SCD40L与Hcy的关系,探讨其在血管性痴呆预防中的意义。方法血管性痴呆组30例,同龄正常对照组30例,采用双抗体夹心酶联免疫吸附法(ELISA)及化学发光免疫法分别检测血清SCD40L、Hcy的水平。结果血管性痴呆患者血清SCD40L、Hcy水平均明显高于正常对照组(P0.001),且血清SCD40L与Hcy呈显著正相关。结论血清SCD40L、Hcy水平增高是血管性痴呆发生的一个重要危险因子,参与血管性痴呆的发病机制,通过对血清SCD40L、Hcy水平的检测,为预防血管性痴呆发生提供理论依据。     

中国人ApoE基因多态性与血管性痴呆关系的Meta分析

目的评价我国人群ApoE基因多态性与血管性痴呆的关系。方法对1996年1月至2011年5月公开发表的关于中国人血管性痴呆ApoE基因多态性的病例对照研究进行Meta分析。结果共纳入20个病例对照研究。Meta分析结果表明,中国人携带ε4等位基因的个体发生血管性痴呆的危险性的合并OR值为2.20[95%CI(1.81,2.66)];中国汉族人携带ε4等位基因的个体发生血管性痴呆的危险性的合并OR值为3.11[95%CI(2.06,4.69)]。结论载脂蛋白E基因多态性与中国人血管性痴呆相关,携带ε4等位基因的个体有发生血管性痴呆的倾向。     

有效防治高血压和糖尿病是预防痴呆的关键

老年性痴呆主要包括阿尔茨海默病(AD)、血管性痴呆(VD)和混合性痴呆(MD).随着对痴呆相关疾病认识的逐渐深入,痴呆危险因素、病因和发病机制日益受到关注.     

血管性痴呆小鼠海马CaMPKⅡ表达变化及哈伯因治疗效果

目的:观察血管性痴呆小鼠海马组织CaMPKⅡ基因的表达水平及哈伯因治疗效果,进而探讨血管性痴呆发病的分子生物学机制。方法:用双侧颈总动脉线结、反复缺血再灌注的方法制备血管性痴呆模型,并进行学习、记忆成绩测试,应用RT-PCR技术检测海马细胞内CaMPKⅡ基因的表达。结果:模型组CaMPKⅡmRNA含量显著低于假手术组、哈伯团组(P<0.05);假手术组和哈伯因组间无明显差别。结论:海马CaMPKⅡ的基因表达减少可能参与了血管性痴呆分子生物学发病机制,而哈伯因提高了海马CaMPKⅡ基因表达的同时,也改善临床症状。     

Genetics of dementia

Genetic factors are now recognized to play an important role in most age-related dementias. Although other factors, including aging itself, contribute to dementia, in this review the authors focus on the role of specific disease-causing genes and genetic factors in the most common age-related dementias. They review each dementia within the context of a genes/environment continuum, with varying levels of genetic versus environmental influence. All major classes of dementia will be discussed but greatest attention will be given to the most common dementia, Alzheimer's disease, for which several new genetic factors were recently identified.     

Genetic counselling and genetic screening for Alzheimer's disease and other dementias

Genetic and nongenetic factors have been identified to have roles in the etiology of dementia. Etiologic heterogeneity and genetic heterogeneity are recognized, especially for Alzheimer's disease which is the most common form of dementia. Asymptomatic individuals are increasingly requesting genetic services such as genetic counselling, predictive testing and screening for genetic risk factors. This paper provides an overview of the current knowledge about genetic counselling and genetic screening for dementia as well as guidelines for the physician.     

Is Alzheimer's disease preventable? A review of two decades of epidemiological research

This paper reviews the epidemiological literature on Alzheimer's disease. Increasing age emerges as one of the most powerful risk factors for the development of dementia/Alzheimer's disease across all populations studied. Examination of age-independent risk factors suggests that there are few environmental or clinical factors that seem to be related consistently to increased risk of dementia/Alzheimer's disease. In contrast, familial/genetic risk factors do seem to influence the incidence of dementia/Alzheimer's disease. Age, ethnicity and gender all have been found to moderate the effects of both genetic and environmental risk factors.The overall weight of evidence suggests that the primary influence of both risk and protective factors is to modify rather than determine the expression of dementia during the course of the adult lifespan.     

Genetic characteristics of dementia in Taiwan

The most common causes of dementia in Taiwan are Alzheimer's disease (AD) followed by vascular dementia (VaD). Several genetic studies have documented an increased risk of AD among apolipoprotein E gene allele 4 (ApoE4) carriers in Taiwanese (ethnic Chinese). Although ApoE4 is considered the most important risk factor for AD, the ApoE4 allele frequency is lower in Taiwanese (around 7%), than that in most Caucasian populations (over 10%). This phenomenon raises the hypothesis that low ApoE4 allele frequency contributes to the low prevalence of AD in Taiwanese. Other studies of the genetic impacts on modulation or regulation of manifestations, progression, and treatment response of AD in Taiwan have been inconclusive. Familial AD, which is conferred by PS1 gene mutation has been identified. There were very few studies of fronto-temporal dementia (FTD) or dementia with Lewy body (DLB) in Taiwan. Genetic studies of VaD remain limited and only NOTCH3 gene mutation has been detected in a Taiwanese cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) family. Limited data indicated that non- ApoE4-associated AD may represent a larger proportion of AD in Taiwanese, suggesting the existence of novel genetic factors which remain to be identified.     

A pilot study of risk factors for dementia in Parkinson's disease

To determine whether the risk factors for dementia in idiopathic Parkinson's disease (IPD) are similar to the risk factors for Alzheimer's disease, we conducted a case-control study of potential risk factors. A structured interview was administered to surrogates of 17 demented subjects with IPD and 54 nondemented subjects. Two factors emerged as possible risks for dementia. Demented patients were older than nondemented patients, although the duration of symptoms was similar. A family history of dementia was present in 30% of the demented group and 5.6% of the nondemented group. Dementia was most often reported among siblings. No difference was seen in toxic and occupational exposure, personal habits, or medical or surgical illnesses. We conclude that dementia in IPD shares some common risk factors with Alzheimer's disease. Efforts to assess the contribution of genetic susceptibility or shared environmental influences may clarify the relationship between these two diseases.     

Risk factors of cognitive decline in residential care in Hungary

OBJECTIVE: The incidence of dementia is known to vary between nations due to population specific interactions of genetic and epigenetic risk factors. Since this type of data was missing from the Central-Eastern part of Europe, especially from Hungary, an ongoing prospective multicentre study was initiated 3 years ago to determine the impact of some well-known social and biological dementia risk factors and the prevalences and conversion rates of dementia and depression syndromes. METHODS: As part of this work, the effects of age, gender, education, smoking and alcohol consumption were investigated in residental homes-based cohort of more than 2,100 elderly. RESULTS: Forty-eight percent of the entire population showed clinical signs of cognitive decline. Eighteen percent, 22%, 16% and 10% were classified as mild cognitive impairment, mild, moderate and severe stages of cognitive decline, respectively. Considered individually, all the examined dementia risk factors were significantly related to the presence of the cognitive decline. Age, female gender and regular drinking increased the risk, while smoking, higher level of education and occasional or former history of alcohol consumption were protective factors. The male gender associated regular alcohol consumption represented the strongest risk, especially with low education levels. When the different severity subgroups were compared, similar risk tendencies have been observed, but the most robust effects were associated with the most severe stages. CONCLUSIONS: The well-known dementia risk and protective factors are confirmed in our study. Taking these variables into consideration, the Hungarian cohort is similar to other ethnic groups in Europe.     

Midlife activity predicts risk of dementia in older male twin pairs

BackgroundThis was a prospective study of dementia to elucidate mechanisms of disease risk factors amenable to modification and specifically to determine whether midlife cognitive and physical leisure activities are associated with delayed onset or reduced risk of dementia within older male twin pairs.MethodsThe co-twin control design used prospectively collected exposure information to predict risk of dementia 20 to 40 years later. The subjects were community-dwelling and nursing home residents living throughout the continental United States. We studied 147 male twin-pairs who were discordant for dementia or age of dementia onset and were members of the National Academy of Sciences–National Research Council Twin Registry of World War II veterans and participants in the Duke Twins Study of Memory in Aging. The main outcome measure was diagnosed dementia by using a two-stage screen and full clinical evaluation. Conditional odds ratios were estimated for the association between midlife leisure activities and late-life dementia.ResultsGreater midlife cognitive activity was associated with a 26% risk reduction for dementia onset. Protective effects were most robust in monozygotic twin pairs, where genetic and early-life influences were most tightly controlled, and for activities that were often cognitive and social in nature. Cognitive activity was particularly protective among monozygotic twin pairs carrying the apolipoprotein E ε4 allele, with a 30% risk reduction. Midlife physical activity did not modify dementia risk.ConclusionsParticipation in a range of cognitively and socially engaging activities in midlife reduced risk for dementia and AD in twins discordant for onset, particularly among twin pairs at elevated genetic risk, and might be indicative of an enriched environment.     

Evolution of HIV dementia with HIV infection

Dementia remains one of the most fearsome complications of HIV infection. It also poses a significant challenge for the clinician both in terms of diagnosis and treatment. The use of antiretroviral agents has led to a decrease in the incidence of HIV dementia but the prevalence of milder forms of neurocognitive impairment has increased. Occasionally, the immune reconstitution caused by these agents may target the brain leading to a syndrome characterized by a severe, progressive and often fatal dementia. The progression of HIV dementia may also be determined by host and viral genetic factors, and the existence of co-morbid factors such as drug abuse, hepatitis C infection and aging. Oxidative stress markers appear to be predictive of active dementia. However, currently there is no specific treatment available for HIV dementia.     

Identifying risk for dementia across populations: A study on the prevalence of dementia in tribal elderly population of Himalayan region in Northern India

Introduction:

Studies have suggested that dementia is differentially distributed across populations with a lower prevalence in developing regions than the developed ones. A comparison in the prevalence of dementia across populations may provide an insight into its risk factors. Keeping this in view, a study was planned to evaluate the prevalence of dementia in tribal elderly population.

Materials and Methods:

A cross-sectional comprehensive two-phase survey of all residents aged 60 years and older was conducted. Phase one involved screening of all individuals aged 60 and above with the help of a cognitive screen specifically developed for the tribal population. Phase two involved clinical examination of individuals who were suspected of dementia as per the developed cognitive screening test.

Results:

The results revealed that no individual above 60 years of age in the studied population was diagnosed as a case of dementia. Thereby, pointing out at some unknown factors, which are responsible for prevention of dementia.

Discussion:

The differences between the prevalence rate in this study and other studies in India appear to be a function of a valid regional difference. Environmental, phenotypic and genetic factors may contribute to regional and racial variations in dementia. Societies living in isolated hilly and tribal areas seem less predisposed to dementia, particularly age related neurodegenerative and vascular dementia, which are the most common causes for dementia in elderly. This may be because some environmental risk factors are much less prevalent in these settings.Key Words: Dementia, populations, risk, tribal     

Associations between family history of Parkinson's disease and dementia and risk of dementia in Parkinson's disease: A community-based, longitudinal study.

Dementia is common in patients with Parkinson's disease (PDD). The etiology of PDD is still unclear, but exciting advances have been made in discovering pathogenetic components in Parkinson's disease (PD), implicating the role of genetic factors. It is, however, still controversial whether genetic factors also contribute to the development of dementia in PD. Thus, we investigated the association between development of dementia and a positive family history of PD or dementia in a community-based study of PD in Rogaland County, Norway (n = 219). The patients were followed prospectively with neurological and neuropsychological assessments. Dementia was more common in patients with a strong family association of PD (first-degree relatives > second-degree relatives > no family history; P < 0.05). However, time to dementia did not differ between the two groups. No associations between dementia in PD and familial occurrence of dementia could be shown. Further studies with larger samples are needed to explore a possible relationship between a family history of PD and development of dementia in PD and its potential pathogenetic mechanisms.