脑白质疏松症与Binswanger病认知功能障碍的对比研究

目的探讨轻度认知功能障碍与痴呆在单纯脑白质疏松症(LA)、Binswanger病(BD)及脑白质疏松症合并脑梗死(LA CI)中的临床诊断价值.方法单纯LA组27例,BD组33例,LA CI组31例,对照组30例,行简易精神状态量表(MMSE)、临床记忆量表测验(CMS)、轻度认知功能障碍的认知评定并对比分析.结果单纯LA组、BD组、LA CI组MMSE及CMS成绩均明显低于对照组,差异有显著意义(P＜0.05);单纯LA组MMSE及CMS成绩明显高于BD组、LA CI组,差异有显著意义(P＜0.05);单纯LA组认知损害以轻度认知功能障碍为主(77.8%),无1例痴呆;BD组中度认知功能障碍占24.2%,痴呆占75.8%;LA CI组以中度认知功能障碍(19.4%)和痴呆(77.4%)为主.结论轻度认知功能障碍是诊断单纯LA的临床参考指标.中度认知功能障碍和痴呆是诊断BD和LA CI的临床参考指标.     

老年人脑白质疏松症和Binswanger病认知功能的对比研究

目的探讨认知功能障碍程度在老年人脑白质疏松症(LA)和Binswanger病(BD)中的诊断价值。方法采用简易精神状态量表(MMSE)和临床记忆量表(CMS)检查LA、BD患者及健康对照者,比较各组认知功能障碍者的比例。结果①LA组、BD组MMSE及CMS评分均明显低于健康对照组(P均小于0.05)。②BD组MMSE及CMS评分明显低于LA组(P均小于0.05)。③LA组轻度认知功能障碍21例(77.8%);BD组中度认知功能障碍8例(24.2%),痴呆25例(75.8%)。结论LA多有轻度认知功能障碍,而BD多表现为中度认知功能障碍和痴呆。认知功能障碍的程度是临床诊断LA、BD的参考指标。     

血清组胺与脑白质疏松症认知功能障碍的相关性

目的探讨血清组胺水平与脑白质疏松症(LA)认知功能障碍的相关性。方法本文161例,根据头颅MRI表现分为LA组131例和对照组(无LA及认知功能障碍)30例。LA中根据轻度认知功能障碍(MCI)诊断标准及临床痴呆量表筛选出MCI 71例及痴呆30例,无MCI 30例。故分为LA无MCI 30例,LA伴MCI 71例;LA伴痴呆组30例,对照组30例。分析比较4组患者血清组胺值差异情况。结果 LA无MCI组血清组胺含量较正常组高(P0.05);LA伴MCI组血清组胺含量较LA无MCI组高(P0.05);LA伴痴呆组血清组胺含量较LA伴MCI组高(P0.05)。结论 LA患者血清组胺含量高于对照组提示组胺可能参与LA的发生;LA伴痴呆患者血清组胺含量高于LA伴MCI患者,而LA伴MCI患者血清组胺含量高于LA无MCI,提示组胺可能参与LA患者认知功能障碍的发生发展,且与认知功能障碍的严重程度相关。     

单纯脑白质疏松症与脑白质疏松症合并脑梗死记忆障碍的对比研究

目的 探讨单纯脑白质疏松症(LA)记忆障碍特征及合并脑梗死(CI)对LA记忆障碍的影响。方法 用临床记忆量表对30例单纯LA患者,30例LA+CI患者及30例健康老年人进行记忆测查,同时对LA患者进行简明精神状态检查表(MMSE)测查。结果 单纯LA组各项记忆量表分及MQ均明显低于正常对照组(P<0.01),其中图象自由回忆,人像特点联想回忆下降明显;LA+CI组与单纯LA组比较,各项记忆量表分及MQ均显著降低(P<0.05或P<0.01),其中指向记忆下降最明显;MQ≤79者痴呆发生率低于MQ≤69者(P<0.05),符合痴呆者7例均属LA+CI组,单纯LA组无痴呆发生。结论 单纯LA患者有明显的记忆障碍,其记忆损害既有主动回忆困难也有再认障碍,但无痴呆发生。合并脑梗死加重记忆障碍,脑梗死的存在对LA记忆障碍中的主动回忆困难影响更大,同时增加痴呆发生率,且记忆损害越重,痴呆发生率越高。     

蒙特利尔认知评估量表在血管性认知功能障碍中的应用

目的 探讨蒙特利尔认知评估(MoCA)量表(中文版)在血管性认知功能障碍(VCI)中的应用.方法 选择166例具有脑血管病危险因素或脑血管疾病患者,根据VCI诊断标准分为无认知功能障碍(NCI)组(52例)、无痴呆的血管性认知功能障碍(VCIND)组(76例)及血管性痴呆(VD)组(38例),分别给予MoCA量表和简易精神状态检查(MMSE)量表测试.结果 将认知功能障碍MoCA分界值定为26分时,VCIND组MoCA的敏感性为90.79%,MMSE为26.31%;VD组MoCA的敏感性为100%,MMSE为86.84%;MoCA和MMSE特异性分别为84.62%和100%.结论 与MMSE量表相比,MoCA量表更适用于VCI的筛查.     

安理申治疗轻中度阿尔茨海默病有效性及安全性的临床研究

目的　评价安理申 (aricept)治疗轻、中度阿尔茨海默病 (Alzheimerdisease ,AD)的有效性及安全性。方法　对 188例轻、中度AD[简易智能状态量表 (MMSE) 10～ 2 4分 ]患者进行了多中心、随机 12周临床试验 ,其中 89例为单盲、安慰剂对照研究 ,99例为自身对照研究。结果　随机、单盲、安慰剂对照组研究结果表明 ,5mg/d安理申治疗 12周时 ,安理申组较安慰剂组MMSE、临床痴呆程度量表 (CDR)及日常生活自理量表 (ADL)分数显著改善 (P依次 <0 0 1、0 0 5、0 0 1)。自身对照组研究结果显示 ,5mg/d安理申治疗 12周时 ,治疗后较治疗前MMSE、CDR及ADL分数分别改善 3 5、0 6、7 1分(P依次 <0 0 1、0 0 5、0 0 1)。安理申治疗 4周时 ,MMSE分数已有提高 (P <0 0 5 )。 145例服用安理申的患者中 ,7例 (4 8%)出现轻度胆碱能兴奋性不良反应 ,43例安慰剂组中 ,2例 (4 7%)出现头晕、恶心 ,两组差异无显著意义 (P >0 0 5 )。结论　安理申能有效治疗轻、中度AD患者 ,对患者的认知功能、痴呆程度和日常生活自理能力均有改善 ,耐受性好 ,安全性高。     

帕金森病患者认知功能与脑电活动及脑影像学改变的相关性研究

目的研究帕金森病（Parkinsondisease,PD）患者认知功能、脑电活动及脑影像学的相关性。方法对70例PD患者及40例正常人进行中文版简易智能状态检查（MMSE）量表、BEAM频谱分析及脑影像学检查,对经MMSE初步测查后可疑认知功能障碍者进一步行成套神经心理学评估（FOM、RVR、DST、BD、BNT、HAMD）。结果PD痴呆组的神经心理学评估分值明显降低,痴呆组慢波（δ、θ频段）相对功率谱较非痴呆组明显增高（P〈0.01）,而快波（β1、β2频段）的相对功率谱显著降低（P〈0.05）;痴呆组额叶、颞叶的皮质萎缩及皮质下萎缩程度明显增加,且合并脑白质疏松症（LA）者明显高于非痴呆组;PD认知功能损害与额叶脑沟宽度、外侧裂宽度、三脑室宽度、脑室指数、前角指数及δ波功率值相关。结论神经心理学测验有利于发现PD患者的认知功能障碍,PD认知功能障碍与额颞叶皮质萎缩、皮质下机构萎缩程度、δ波功率及抑郁障碍密切相关,合并LA者痴呆发生率高。     

轻至中度阿尔茨海默病患者认知和生活功能的自然演变

目的　了解阿尔茨海默病 (AD)认知和生活功能的自然演变。方法　对不服任何益智药的 30例轻度和 2 1例中度AD病人连续随访 30周。以简易智能状态检查量表 (MMSE)、Alzheimers痴呆缺陷量表 (ADS)、日常生活能力量表 (ADL)、成人韦氏记忆量表 (WMS)为评定工具 ,每 6周评定 1次。结果　 30周后 ,MMSE平均下降 (0 .2 5± 2 .5 8)分 (P >0 .0 5 ) ,ADS平均下降 (1.6 3± 4 .33)分 (P <0 .0 5 ) ,ADL平均上升 (2 .0 4± 6 .76 )分 (P <0 .0 5 ) ,WMS平均上升(3.37± 9.2 4 )分 (P <0 .0 5 )。结论　轻至中度AD病人认知功能和日常生活能力是缓慢减退的。轻至中度AD病人仍有低水平的学习能力。     

修正蒙特利尔认知评估量表评估脑白质疏松症认知功能障碍的效果研究

目的探讨修正的蒙特利尔认知评估量表(MoCA)评估脑白质疏松症认知功能障碍的应用效果。方法选取本院诊治的脑白质疏松症认知功能障碍患者53例为观察组,选取本院同期健康体检人员53例为对照组,均行MoCA和简易精神状态量表(MMSE)评定,比较2组MoCA和MMSE评分结果以及观察组不同严重程度间MoCA和MMSE的评分结果,分析MoCA和MMSE的诊断价值,分析MoCA、MMSE与脑白质疏松症认知功能障碍的相关性。结果观察组MoCA、MMSE量表视觉空间与执行能力评分、命名评分、注意力评分、语言评分、延迟回忆评分、抽象评分、定向力评分、总评分均明显低于对照组。中度认知功能障碍患者MoCA评分、MMSE评分均明显低于轻度认知功能障碍患者,重度认知功能障碍患者均明显低于轻度和中度认知功能障碍患者。MoCA的灵敏度、阴性预测值、约登指数均明显高于MMSE,MoCA的特异度明显低于MMSE,但差异均有统计学意义(P0.05)。MoCA的阳性预测值低于MMSE,差异无统计学意义(P0.05)。MoCA与MMSE具有明显的正相关性,MoCA、MMSE与脑白质疏松症认知功能障碍均具有明显负相关性。结论 MoCA是脑白质疏松症认知功能障碍的有效评估方法,与患者认知功能障碍的严重程度密切相关,灵敏度高,值得临床推广使用。     

我国东北地区神经内科门诊患者认知功能调查及分析

目的 调查东北地区神经内科门诊患者认知功能情况.方法 选取2009年9月～12月吉林大学白求恩第一医院神经内科门诊就诊患者21849例,按照条件依次进行简易精神状态检查表(MMSE)及一系列神经心理评估.结果 轻度认知功能障碍(MCI)占0.40%,其中轻度认知功能障碍-AD型(MCI-A)占0.12%,轻度认知功能障碍-血管型(MCI-V)占0.15%,混合性MCI占0.03%.痴呆患者占0.22%,其中阿尔茨海默病(AD)占0.06%,血管病性痴呆(VD)占0.11%,混合性痴呆(MD)占0.02%.其他占0.17%.男性MCI检出率为0.27%,痴呆检出率为0.22%.女性患者MCI检出率为0.33%,痴呆检出率为0.17%.结论 东北地区血管性认知功能障碍发病率大于老年性认知功能障碍,女性轻度认知功能障碍检出率大于男性,而痴呆检出率小于男性,痴呆检出率随年龄增长成上升趋势,轻度认知功能障碍患者检出率在75岁之前随年龄增加明显升高,75岁前后比较检出率反而下降.     

Association of platelet hyper-aggregability with leukoaraiosis

OBJECTIVES: To investigate whether there is any relationship between leukoaraiosis and platelet hyper-aggregability of the systemic blood. METHODS: Platelet aggregability, leukoaraiosis, hypertension and hematocrit were assessed in 175 consecutive out-patients attending a regular clinic. Platelet aggregability was estimated by an optical analytical method using two different concentrations each of ADP and collagen (the double ADP method). Hyper-aggregability and non hyper-aggregability were defined with this method. RESULTS: Patients with leukoaraiosis (73 cases) showed a significantly higher incidence of platelet hyper-aggregability than patients with no leukoaraiosis (102 cases) (90.4 vs 56.9%, P=0.000001). Leukoaraiosis was also significantly related to age. Hypertension was a less significant risk factor (P=0.023). CONCLUSIONS: Platelet hyper-aggregability is a significant feature in leukoaraiosis, and appears to be a more important risk factor than hypertension. Normalization of platelet hyper-aggregability might offer an alternative strategy for the prevention of leukoaraiosis in patients with platelet hyper-aggregability, although an interventional study is essential.     

Pathomechanism of leukoaraiosis

Ischemic demyelination in the white matter of the brain is a frequent clinical entity. In neuroimaging terms, it is referred to as leukoaraiosis (LA). LA can reflect a broad public health problem, which is caused by a cognitive impairment ranging from mild slowness of thinking to full-blown subcortical dementia. One-quarter of subjects aged 65 yr or over are affected by some degree of white matter changes. There are a number of genetic factors that can be associated with circulatory disturbances of the white matter of the brain. A slight chronic hypoperfusion or an endothelial dysfunction associated with unfavorable genetic variations such as methylenete-trahydrofolate reductase C677T variation and angiotensin-converting enzyme I/D polymorphism then may lead indirectly to a malfunction of the molecular cross-talk between the nucleus and the mitochondria. This results in a decrease in the production of energy in the glia cells and thereby the beginning of demyelination. From another aspect, the presence of either the apolipoprotein E2 or 4 alleles may cause an increased vulnerability to a slight chronic hypoperfusion of the white matter by reducing the range of mechanical and chemical flexibility of the glial cytoskeleton. In consequence of the chronic hypoperfusion, the functionally damaged kinesin protein gives rise also to the disturbances of the trafficking of the myelin basic protein mRNAs in the oligoden-drocytes. On the basis of the current knowledge on LA, this article suggests a hypothetical molecular bridge between the genetic, biochemical, and clinical processes.     

Neuropsychological test findings in subjects with leukoaraiosis

Focal periventricular white-matter changes (leukoaraiosis) have been identified incidentally on brain imaging in normal healthy individuals and more commonly in the elderly and in hypertensive individuals. It has been suggested that leukoaraiosis represents the early stages of Binswanger's leukoencephalopathy, a dementing process thought to be related to hypertensive cerebrovascular disease. To test this hypothesis, extensive neuropsychological tests were administered to 50 consecutive normotensive, middle-aged, healthy volunteers. Ten subjects (20%) had white-matter changes on magnetic resonance scans; 40 subjects (80%) had normal scans. The differences observed on neuropsychological testing between subjects with and without leukoaraiosis were not significant. While this study argues against a link between leukoaraiosis and dementia, prospective longitudinal studies are needed to determine the value of leukoaraiosis in predicting future cognitive decline.     

Genetics of leukoaraiosis

Computed tomography and magnetic resonance imaging of the brains of elderly individuals frequently show areas of altered signal intensity in the periventricular and subcortical white matter, referred to as leukoaraiosis. Although mildly affected individuals appear asymptomatic, larger burdens of leukoaraiosis are associated with deficits of cognition and gait. Histopathologically, areas of leukoaraiosis invariably show sclerosis, luminal narrowing, and tortuosity of small arteries and arterioles, accompanied by variable degrees of gliosis, demyelination, and axonal loss resulting from ischemia. Genetic variation plays a substantial role in interindividual differences in the volume of leukoaraiosis and its associated adverse clinical outcomes. Characterizing genetic factors contributing to interindividual differences in leukoaraiosis has the potential to enhance understanding of molecular determinants of ischemic brain injury and lead to new approaches to the diagnosis, evaluation, treatment, and prevention of this common form of vascular dementia.     

Lacunar infarction with leukoaraiosis may aggravate cognitive dysfunction

This study semi-quantitatively analyzed the effects of leukoaraiosis.Patients with moderate or severe lacunar infarction were found to exhibit low scores on the Montreal Cognitive Assessment Scale (F=12.02,P=0.000),and prolonged P300 Cz2.0 latency (F=16.04,P=0.000).Correlation analysis revealed that the occurrence of leukoaraiosis was negatively correlated with Montreal Cognitive Assessment scores (r=-0.416,P=0.000),and positively correlated with P300 Cz2.0 latency (r=0.538,P=0.000).These findings indicate ...     

老年人脑白质疏松的相关危险因素

目的探讨老年人脑白质疏松(LA)的相关危险因素。方法采集轻度组、中度组及重度组患者的临床资料,并检测其血浆同型半胱氨酸(Hcy)水平。结果轻度组、中度组、重度组的年龄、男性及高血压比例差异有统计学意义(均P0.05),而糖尿病、冠心病、高脂血症及吸烟比率差异均无统计学意义。3组间血浆Hcy水平及高Hcy血症(HHcy)患者比率差异有统计学意义(均P0.01)。多因素分析显示,年龄(OR=1.078,95%CI:1.034~1.123,P=0.000)、男性(OR=2.601,95%CI:1.441~4.692,P=0.002)、高血压(OR=2.672,95%CI:1.493~4.783,P=0.001)、Hcy(OR=1.035,95%CI:1.009~1.059,P=0.007)及HHcy(OR=1.954,95%CI:1.055~3.618,P=0.033)是LA独立危险因素。结论 HHcy、年龄、男性、高血压是老年人LA的独立危险因素。     

Cognitive performance after lacunar stroke correlates with leukoaraiosis severity

BACKGROUND: This study investigates the effect of leukoaraiosis on patients presenting with cognitive impairment after lacunar stroke. METHODS: Fourty-six patients with cognitive impairment and newly discovered lacunar stroke detected by brain magnetic resonance imaging underwent neuropsychological testing. RESULTS: Patients with both lacunar infarct and leukoaraiosis performed less well on cognitive measures, compared to those with lacunar infarcts alone. Additionally, leukoaraiosis severity inversely correlated with cognitive performance. CONCLUSIONS: In patients with lacunar stroke, presence of leukoaraiosis is associated with worse performance in multiple cognitive domains. These findings suggest lacunar infarcts plus leukoaraiosis is a common etiology for vascular dementia.     

脑白质疏松症患者脑血流动力学研究

目的探讨脑白质疏松症患者脑血流动力学变化。方法采用经颅多普勒超声仪检测207例LA患者(病例组)和200例对照组,记录颅内血管MCA、ACA、PCA、ICA、VA和BA平均血流速度(Vm)。结果病例组颅内各组血管平均血流速度均较对照组减低(P<0.05),病例组轻、中、重度LA患者平均血流速度有逐渐减慢的趋势。结论LA患者脑血流平均速度减慢,随着脑白质疏松程度的加重,脑血流量有逐渐减少的趋势。     

Correlation of retinopathy with leukoaraiosis in patients with anterior circulation infarcts

Although retinal and cerebral microvessels share similar embryological, anatomical and physiological characteristics, the correlation between retinopathy and leukoaraiosis (LA), a type of brain microvascular disease, is unclear. In the present study, the sample included 213 patients admitted to the department of neurology from January 2012 through October 2012. MRI and retinal photography were performed within 48 hours of hospitalization, and patient demographics, comorbidities, preadmission medications and laboratory data were collected. MRI images were used to divide the patients into LA and non-LA groups. Using multivariate binary logistic regression, the effects of retinopathy on LA were investigated. Of the 213 patients enrolled, 168 were included in this study (LA, n = 108; non-LA, n = 60). Hypertension, coronary heart disease and carotid artery plaque were more common in the LA group, and these patients showed higher blood levels of C-reactive protein, homocysteine and triglycerides. The incidence of retinopathy was significantly increased in the LA group compared with the non-LA group, and there was a significant correlation between the severity of LA and incidence of retinopathy. Retinopathy is an independent risk factor for LA and can significantly increase the risk of LA when combined with age, coronary heart disease, C-reactive protein, carotid artery plaque or systolic pressure. Taken together, retinopathy is associated with LA in patients with anterior circulation infarcts. Retinopathy is an independent risk factor for LA and an increase the risk of LA, and thus facilitating the evaluation of LA.