晚发型抑郁障碍与轻度认知功能损害患者的认知功能差异研究

目的 探讨晚发型抑郁障碍患者与轻度认知功能损害患者的认知功能损害的差异.方法 研究对象为2012年7月～2013年8月上海市精神卫生中心老年科住院与门诊就诊符合DSM—Ⅳ诊断标准且起病年龄≥60岁的抑郁障碍患者,共26例为晚发型抑郁障碍组（LOD组）,另选择26例轻度认知功能损害的患者（MCI组）与26例正常老年人（NC组）.认知功能评估采用简明精神状态量表（MMSE）、蒙特利尔量表（MoCA）.结果 MMSE总分、MMSE分测验中计算力与注意力及MoCA总分、MoCA分测验中连线、注意、持续注意、计算、复述、延迟回忆在LOD组与MCI组差比较异无统计学意义（P＞0.05）,两组与NC组比较差异有统计学意义（P＜0.05）.三组在MMSE分测验的时间定向、延迟回忆、三步指令、书写书面指令及MoCA分测验的复制图、画钟、命名比较,MCI组均值最低,与NC组比较差异有统计学意义（P＜0.05）,与LOD组比较差异无统计学意义（P＞0.05）.结论 LOD组认知功能在注意力、延迟回忆、连线测验方面与MCI组损害程度相当.MCI组认知功能受损范围较LOD组广泛.     

非痴呆帕金森病患者认知功能状态分析

目的 分析非痴呆帕金森病(PD)患者认知功能的特点及其影响因素,为早期诊断和干预PD认知功能损害提供依据. 方法 选择广州军区广州总医院神经内科自2010年1月至201 1年10月收治的PD患者56例,采用简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评定其认知功能,Logistic逐步回归分析PD患者认知功能损害的影响因素. 结果 以MMSE为评估标准时,6例(7.14％)PD患者存在轻度认知功能损害(MCI);而以MoCA为标准时,40例(71.43％)PD患者存在MCI.MMSE和MoCA评分均与患者文化程度呈正相关关系(r=0.483,P=0.007;r=0.503,P=0.000).MMSE各认知域中评分下降幅度较大的是视空间、计算及注意力、复述和延迟记忆.认知域评分低于相应认知域总分患者例数较多的为延迟记忆、视空间、即刻记忆和复述.MoCA各认知域评分下降幅度较大的为复述、延迟记忆、抽象、视空间与执行;认知域评分低于相应认知域总分患者例数较多的为延迟记忆、复述、注意和视空间与执行.Logistic逐步回归分析显示文化程度和临床分型是影响PD认知功能损害的主要因素,即文化程度较低,少动强直型和混合型的PD患者认知功能损害风险增高. 结论 认知功能损害在PD患者中常见,以延迟记忆、视空间与执行、计算及注意力、抽象和复述等认知域为主.文化程度和临床分型是PD认知功能损害的主要影响因素.     

简易精神状态量表和蒙特利尔认知评测量表对急性期缺血性脑血管病患者认知功能障碍筛查能力的比较研究

目的 比较简易精神状态量表（Mini-Mental State Examination,MMSE）和蒙特利尔认知评测量表（Montreal Cognitive Assessment,MoCA）对急性期缺血性脑血管病患者认知功能障碍的筛查能力。方法 对筛选的107例发病7 d内的短暂性脑缺血发作（transient ischemic attack,TIA）或脑梗死患者应用MMSE及MoCA量表进行认知功能障碍的评测,比较经两量表评测筛查出认知障碍患者的比例。根据患者教育程度对应的MMSE临界值筛选出MMSE评分在正常范围的患者,以MoCA量表评分26分为临界值将受试者分为MoCA评测正常组与异常组,比较两组在各个认知领域的得分。结果 107例患者MMSE平均分25.89±3.65分,MoCA平均分20.67±4.56分。MMSE评测异常者8例（7.5%）,正常者99例（92.5%）。MoCA评测异常者98例（91.6%）,正常者9例（8.4%）。MoCA评测正常者MMSE评测均正常。MMSE评测正常的99例患者中,MoCA评测正常者9例（9.1％,9/99）,评测异常者（<26分）90例（90.9％,90/99）。MoCA评测异常组在视空间与执行能力、命名、延迟记忆等认知领域得分低于MoCA评测正常组（P＜0.05）。结论 MoCA量表在筛查急性缺血性脑血管病患者认知障碍方面可能比MMSE量表更敏感,MMSE正常MoCA评测异常的患者认知损害主要表现在视空间执行功能、命名、延迟记忆等方面。     

脊髓小脑共济失调12型患者认知功能障碍的研究

目的探讨脊髓小脑共济失调(SCA)12型患者是否存在认知功能障碍及其影响因素。方法采用蒙特利尔认知评估量表(MoCA)、简易精神状态检查量表(MMSE)对5例SCA12型患者(SCA12型组)及13名健康体检者(正常对照组)进行认知功能评估;采用国际协作共济失调评估量表(ICARS)进行共济失调严重程度评分。结果 MoCA评分结果显示,SCA12型组存在认知功能障碍5例(100%),正常对照组存在认知功能障碍10例(77%)。MMSE评分结果显示,SCA12型组存在认知功能障碍2例(40%),正常对照组存在认知功能障碍1例(7.7%)。SCA12型组MoCA和MMSE评分明显低于正常对照组(均P<0.05)。SCA12型组ICARS评分为23～75分,平均(42.6±21.0)分。正常对照组均无共济失调。Spearmans相关性分析显示,SCA12型患者MMSE评分与病程呈负相关(r=-0.894,P=0.041);MoCA抽象功能得分与病程呈负相关(r=-0.884,P=0.047)。结论 SCA12型患者可并发认知功能障碍,这可能与其病程较长有关。     

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.     

上海社区老年抑郁障碍与遗忘型轻度认知功能损害患者的认知功能对照研究

目的:探讨上海社区老年抑郁障碍与遗忘型轻度认知功能损害(aMCI)患者之间认知功能的神经心理学差异。方法:1 068例社区老人中符合美国精神障碍诊断与统计手册第4版临床定式检查(SCID)的老年抑郁障碍患者13例及亚临床抑郁患者7例,共20例作为抑郁障碍组(DD组),并选取性别、年龄、教育程度均匹配的aMCI患者20例(aMCI组)及正常老人20名(NC组)作为对照,采用简明精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)进行认知功能的测评。结果:3组在MMSE总分及地点定向力、计算与注意力、三步指令评分,以及MoCA总分、复制图、注意、计算、延迟回忆、时间定向评分差异有统计学意义(P0.05或P0.001)。DD组MMSE总分(P=0.034)、计算力与注意力(P=0.009)以及MoCA总分(P=0.002)、计算(P=0.006)、抽象思维(P=0.030)、时间定向(P=0.044)评分明显好于aMCI组。结论:社区老年抑郁障碍患者认知功能受损程度较老年aMCI患者轻。     

脑型Wilson病患者认知功能障碍与负性情绪研究

目的 分析脑型WD患者的认知功能损害与负性情绪的特点.方法 对30例脑型WD患者和30例对照者组采用简易智能量表(MMSE)、MoCA量表进行认知功能评估.采用抑郁自评量表(SDS)和焦虑自评量表(SAS)进行情绪状态评估,并进行分析.结果 脑型WD患者组MMSE、MoCA量表评分均较正常组低,差异具有统计学意义(P<0.05);脑型WD患者组SDS评分和SAS评分均较正常组高,差异有统计学意义(P<0.01).结论 脑型WD患者存在认知功能损害和明显的抑郁和焦虑情绪.神经精神量表是客观的评价脑型WD患者神经心理状况的有效手段.     

蒙特利尔认知评估量表在帕金森病认知障碍患者中的应用价值

目的 分析蒙特利尔认知评估(MoCA)量表(中文版)在筛查帕金森病(PD)患者中认知障碍的应用价值.方法 使用RoSA编制的,根据年龄及教育程度调整的MMSE分界值筛出整体认知功能正常的213例PD患者,并进一步使用MoCA量表对其进行分组,MoCA评分≥26分的PD患者入PD认知正常组(PD-NC组),MoCA评分<26分的PD患者入PD认知损害组(PD-CI组).比较2组患者MoCA各分测验分数的差异及认知功能改变的特点,并应用单因素及多元Logistic回归分析PD患者认知损害的影响因素.结果 (1)PD组患者中52.6%(112/213)的患者MoCA评分<26分;(2)与PD-NC组比较,PD-CI组在MoCA视空间和执行、命名、注意力、语言、抽象、延迟回忆、定向分测验中得分诸项比较均有统计学意义;(3)Logistic回归分析结果显示,低文化程度是PD患者认知损害的影响因素(OR:0.72,95%CI0.64～0.81,P<0.05).结论 MMSE正常者中仍然存在相当比例的患者MoCA评分异常.因此,临床上建议使用MoCA对PD患者认知水平进行测试,在患者未达到PD痴呆时,应结合患者的教育水平及时发现并处理患者认知损害症状,使PD患者得到及时治疗并能提高生活质量.

Abstract：

Objective To examine the application of Montreal Cognitive Assessment (MoCA) in Parkinson' s disease (PD) patients with normal general cognitive function by Mini-Mental State Examination (MMSE) evaluation.Methods PD patients were examined with MMSE, and those having a normal ageand education-adjusted MMSE score were included in the further study of MoCA testing.The patients with MoCA score not less than 26 were selected into normal control PD-NC group, and the patients with less than 26 into cognitive impaired PD-CI group.Scores of MoCA subtests were used in PD-CI group and PD-NC group to characterize cognitive changes in PD patients with mild cognitive impairment (MCI).MoCA score in PD-CI group used as dependent variable, and sex, educational level, age, course of disease, Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Self-rating depression Scale (SDS), Self-rating Anxiety Scale (SAS) and Unified Parkinson' s Disease Rating Scale (UPDRS) were used as independent variable, the risk factors of CI in PD patients was analysed by Linear Regression Analysis.Results There are 52.6% (112/213) PD patients with MMSE ≥ 26 while their MoCA < 26.Significant differences were observed in subtests of MoCA in visuospatial, executive, naming, attention,language, abstract, delayed recall and orientation between PD-CI group and PD-NC group (all P <0.01).Univariate and multivariate regression analysis showed that educational level is the most significant factor in PD-CI (OR:0.72, 95% CI 0.64-0.81, P < 0.05).Conclusions There is a high proportion of PD patients whose MMSE test showed normal but MoCA test showed cognitive impairment.MoCA examination was used to detect cognitive function of PD patients.Furthermore we suggest consider the education level in PD patients when evaluate their cognitive function.     

晚发型抑郁障碍患者认知功能损害的神经心理学特点

目的 探讨晚发型抑郁障碍患者认知功能损害的情况.方法 选择2012年7月～2013年8月上海市精神卫生中心老年科住院与门诊符合DSM-Ⅳ诊断标准的起病年龄≥60岁的抑郁障碍患者26例为晚发型抑郁障碍组（LOD组）,同时选取性别、年龄1∶1匹配的上海社区正常老人26例作为正常对照（NC）组.认知功能评估采用简明精神状态量表（MMSE）、蒙特利尔量表（MoCA）.结果 LOD组与NC组比较MMSE总分、时间定向力、地点定向力、计算力与注意力差异有统计学意义（P＜0.05）.两组MoCA总分及各因子分,两组之间在MoCA总分、画钟、注意、持续注意、计算、复述、延迟回忆及时间定向差异有统计学意义（P＜0.05）.结论 晚发型抑郁障碍患者认知功能存在损害且涉及范围较广,包括注意力、执行功能、延迟回忆、定向力等方面.     

脑小血管闭塞患者认知功能变化的临床研究

目的探讨脑小血管闭塞(SAO)患者认知功能障碍的特点。方法临床收集110例患者和50例正常对照人群,根据MRI T2加权像和FLAIR像将病例组分为单纯性腔隙性脑梗死(ILI)组和缺血性白质疏松(ILA)组,分别进行简明精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)。结果①与对照组比较,ILI组和ILA组患者的MMSE和MoCA评分均明显低(P<0.05);②与对照组比较,ILI组患者注意计算、短程记忆、图形描画评分显著降低(P<0.05);ILA组患者时间定向、注意计算、短程记忆、语言理解和图形描画评分显著降低(P<0.05)。结论①脑小血管病变,可导致认知功能下降,ILA时最为显著;②ILA组患者主要表现为执行功能、视空间功能、注意计算、短程记忆等认知方面的障碍。     

Cognitive Function Assessment and Prediction for Subjective Cognitive Decline and Mild Cognitive Impairment

Brain Imaging and Behavior - Alzheimer’s disease (AD) is a progressive and irreversible neurodegenerative dementia. Recent studies found that subjective cognitive decline (SCD) may be the...     

Cognitive and Social Cognitive Self-assessment in Autistic Adults

Journal of Autism and Developmental Disorders - An aspect of metacognition associated with broader functional abilities in several clinical conditions, but previously unexamined in autism, is...     

Establishment of Cognitive Relations Based on Cognitive Informatics

Cognitive informatics (CI) is an interdisciplinary study on modelling of the brain in terms of knowledge and information processing. In CI, objects/attributes are considered as neurons connected to each other via synapse. The relation represents the synapse in CI. In order to represent new information the brain generates new synapse or relation between the existing neurons. Therefore, the establishment of cognitive relations is essential to represent new information. In order to represent new information, we propose an algorithm which creates cognitive relation between the pair of objects and attributes by using the relational attribute and object method. Further, the cognitive relations between the pair of objects or attributes within the context could be checked with newly defined conditions, i.e. the necessary and sufficient condition. These conditions will evaluate whether the relational object and attribute is adequate to have relations between the pair of objects and attributes. The new information is obtained without increasing the number of neurons in brain. It is achieved by creating cognitive relations between the pair of objects and attributes. The obtained results are beneficial to simulate the intelligence behaviour of brain such as learning and memorizing. Integrating the idea of CI into cognitive relations is a promising and challenging research direction. In this paper, we have discussed it from the aspects of cognitive mechanism, cognitive computing and cognitive process.     

Cognitive rehabilitation

During these last 30 years, cognitive rehabilitation has accomplished dramatic improvement. In this paper, we review progress in four main domains: the development of pragmatic and ecological approaches in neuropsychological rehabilitation; the development of computerised rehabilitation; rehabilitation of executive functions; cognitive rehabilitation in degenerative dementia. Finally, we present a single-case study, recently published elsewhere, showing the effectiveness of rehabilitation of verbal working memory in a patient with left hemisphere stroke. In addition, future issues for rehabilitation research are presented. The development of bottom-up rehabilitation strategies as well as the use of inter-hemispheric interactions appears as future promising tracks for clinical rehabilitation.     

Cognitive Ecology

Cognitive ecology is the study of cognitive phenomena in context. In particular, it points to the web of mutual dependence among the elements of a cognitive ecosystem. At least three fields were taking a deeply ecological approach to cognition 30 years ago: Gibson’s ecological psychology, Bateson’s ecology of mind, and Soviet cultural‐historical activity theory. The ideas developed in those projects have now found a place in modern views of embodied, situated, distributed cognition. As cognitive theory continues to shift from units of analysis defined by inherent properties of the elements to units defined in terms of dynamic patterns of correlation across elements, the study of cognitive ecosystems will become an increasingly important part of cognitive science.     

Cognitive Computation

We present a proposal as to how to create a Cognitive Machine. We start by raising a set of basic questions relevant to the creation of such a machine. These include the nature of human cognition and how it might be modelled, is consciousness crucial for cognition, and how might an autonomous cognitive agent impute the internal mental state of another such agent. In the following sections we propose a set of possible answers to these questions. The paper finishes with conclusions as to the most viable and interesting directions to be pursued to create cognitive machines.     

Cognitive memory

Regarding the workings of the human mind, memory and pattern recognition seem to be intertwined. You generally do not have one without the other. Taking inspiration from life experience, a new form of computer memory has been devised. Certain conjectures about human memory are keys to the central idea. The design of a practical and useful “cognitive” memory system is contemplated, a memory system that may also serve as a model for many aspects of human memory. The new memory does not function like a computer memory where specific data is stored in specific numbered registers and retrieval is done by reading the contents of the specified memory register, or done by matching key words as with a document search. Incoming sensory data would be stored at the next available empty memory location, and indeed could be stored redundantly at several empty locations. The stored sensory data would neither have key words nor would it be located in known or specified memory locations. Sensory inputs concerning a single object or subject are stored together as patterns in a single “file folder” or “memory folder”. When the contents of the folder are retrieved, sights, sounds, tactile feel, smell, etc., are obtained all at the same time. Retrieval would be initiated by a query or a prompt signal from a current set of sensory inputs or patterns. A search through the memory would be made to locate stored data that correlates with or relates to the prompt input. The search would be done by a retrieval system whose first stage makes use of autoassociative artificial neural networks and whose second stage relies on exhaustive search. Applications of cognitive memory systems have been made to visual aircraft identification, aircraft navigation, and human facial recognition.Concerning human memory, reasons are given why it is unlikely that long-term memory is stored in the synapses of the brain’s neural networks. Reasons are given suggesting that long-term memory is stored in DNA or RNA. Neural networks are an important component of the human memory system, and their purpose is for information retrieval, not for information storage. The brain’s neural networks are analog devices, subject to drift and unplanned change. Only with constant training is reliable action possible. Good training time is during sleep and while awake and making use of one’s memory.A cognitive memory is a learning system. Learning involves storage of patterns or data in a cognitive memory. The learning process for cognitive memory is unsupervised, i.e. autonomous.