养血清脑颗粒治疗血管性痴呆临床评价

目的:观察养血清脑颗粒对血管性痴呆患者认知功能的影响。方法:将50例血管性痴呆患者随机分成治疗组和对照组(各25例),对患者治疗前及治疗后3个月的简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)及生活能力评分(ADL评分)进行相互与自身对照比较。结果:治疗组治疗前后MMSE、MoCA、ADL评分比较均有明显改善(P<0.01),治疗组与对照组相比有显著性差异(P<0.01),治疗组优于对照组。结论:养血清脑颗粒对血管性痴呆患者认知能力及日常生活能力改善有显著疗效。     

HIV相关脑痴呆BOLD fMRI运动功能成像

目的:应用功能磁共振成像(fMRI)研究正常健康受试者及HIV相关脑痴呆患者的右手运动功能区并且探讨其应用价值.方法:10例HIV相关脑痴呆患者和8例健康受试者,设计右手相关运动功能实验,采取右手抓握运动方法,结合患者情况分析早期认知运动功能损伤的皮质位置区域和激活情况.结果:正常健康受试者右手运动功能区多位于左侧(对...     

军队高龄离退休干部痴呆及其主要亚型的患病率调查

目的:调查军队高龄离退休干部痴呆及其主要亚型的患病率。方法:选择石家庄市28个部队休干所80岁以上离退休干部1086例,以诊断为依据进行横断面调查研究。采用中文版简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、总体衰退量表、日常生活能力量表及哈金斯基缺血指数量表等作为筛查工具,进行痴呆及其主要亚型的患病率调查。结果:实际调查1086例中,痴呆158例,患病率为14.5%。主要亚型:很可能阿尔茨海默病(AD)和可能AD 86例,患病率为7.9%,占痴呆患者的54.5%;血管性痴呆(VaD)49例,患病率为4.5%,占痴呆患者的31.0%;混合性痴呆17例,患病率为1.5%,占痴呆患者的10.8%;其他类型痴呆6例,患病率为0.6%,占痴呆患者的3.7%,包括帕金森病痴呆4例,路易体痴呆2例。初中以上文化程度患者痴呆总患病率及AD患病率非常显著低于小学文化程度患者(P<0.01);两组VaD患病率比较,则差异不显著(P>0.05)。结论:提高老年人群的医疗保健水平,早期识别轻度认知障碍功能(MCI)并实施病因干预,有助于降低痴呆患病率。     

康复训练对血管性痴呆的影响

目的探讨康复训练对血管性痴呆患者的有效性。方法将63例轻、中度血管性痴呆患者随机分为康复训练组和对照组,康复训练组进行药物治疗基础上的12周的康复训练,对照组单用药物治疗。应用痴呆严重程度临床评定量表(CDR)、简易智力状态检查量表(MMSE)、成人韦氏记忆量表(WMS)、日常生活能力量表(ADL)分别在入组时和12周末评定其认知功能及日常生活能力。结果12周末两组患者MMSE、WMS评分差异均有显著意义(p<0.05)。ADL评分康复训练组差异有显著性(p<0.05),而对照组差异无显著性(p>0.05)。且治疗前后MMSE、WMS、ADL评分改善程度康复训练组明显好于对照组(p<0.05)。结论康复训练能显著改善患者的认知功能和日常生活自理能力,延缓病情发展。提示对血管性痴呆应采取综合康复措施。     

脑梗死患者认知功能损害的临床研究

目的：观察脑梗死患者的认知功能损害情况。方法：对脑梗死66例根据简易智能状态检查量表（MMSE）及成人韦氏智力量表（WAIS）评分,将其分为痴呆组及非痴呆组,并与健康对照组30例进行认知功能比较。结果：脑梗死痴呆组和非痴呆组MMSE评分及韦氏智力量表评分显著低于健康对照组（P〈0.01）;两组MMSE评分显著低于对照组（P〈0.01）。结论：脑梗死患者在痴呆前已存在不同程度的认知功能损害,须早期应用多种神经心理量表评价其认知功能,为针对性治疗提供依据。     

脑苷肌肽注射液联合尼莫地平片治疗血管性痴呆的临床观察

目的:观察脑苷肌肽注射液联合尼莫地平片治疗血管性痴呆的临床效果.方法:选取住院的血管性痴呆患者78例随机分为治疗组和对照组,各39 例,治疗组给与脑苷肌肽注射液联合尼莫地平片治疗,对照组给与胞二磷胆碱钠和尼莫地平片治疗,连续应用20 d,疗程结束后采用简明心理状况测验量表(MMSE)对两组患者治疗前后认知功能进行评定,并比较两组患者的治疗效果.结果:两组患者治疗前后MMSE评分和总有效率经统计学处理,差异有统计学意义(P＜0.05).结论:脑苷肌肽注射液联合尼莫地平片治疗血管性痴呆的临床效果较好,值得临床推广使用.     

系统性红斑狼疮颅内微结构的扩散峰度成像研究

目的:利用磁共振扩散峰度成像(DKI)技术评估神经精神狼疮患者(NPSLE)及无神经精神症状的系统性红斑狼疮患者(non-NPSLE)颅内微结构的改变,探讨fMRI参数与认知功能的关系。方法:采用3.0T MR仪对22例NPSLE患者、21例non-NPSLE患者及20例年龄及性别与两组患者相匹配的健康志愿者(HC)行MR DKI扫描。应用Functool软件对DKI数据进行后处理,测量双侧背侧丘脑(DT)、扣带回后部(PCG)、豆状核(LN)及侧脑室后角旁白质(PWM)的平均峰度值(MK)。同期采用简易智能评定量表(MMSE)、(北京版)蒙特利尔认知评估量表(MoCA)对所有研究对象的认知功能进行评估。采用协方差分析比较3组间各部位MK值的差异,采用Spearman秩相关法对MK值与认知功能评分的相关性进行分析。结果:与HC组比较,NPSLE组和non-NPSLE组在双侧PCG及左侧DT的MK值明显降低(P<0.01),两组患者间的MK值在各感兴趣区均无统计学差异(P>0.05)。三组研究对象双侧PCG的MK值与MoCA评分呈正相关(右侧PCG:rs=0.291,P=0.046;左侧PCG:rs=0.364,P=0.017)。结论:DKI技术有利于评估SLE患者颅内微结构的损伤,SLE患者认知功能的减低与扣带回后部微结构的异常改变有关。     

重症肌无力患者静息态脑功能磁共振成像与认知功能的研究

目的 运用静息态脑功能磁共振成像(rs-fMRI)技术探索重症肌无力患者(MG)脑功能局部一致性(Re-Ho)及认知功能的改变.方法 30例重症肌无力患者(MG组)和30例健康志愿者(对照组)分别进行rs-fMRI检查和临床量表评分.采用双样本t检验对两组受试者全脑的ReHo值及临床量表评分进行组间差异分析,MG患者异...     

皮质下血管性认知功能障碍的脑默认网络静息态功能磁共振研究

目的运用静息态功能磁共振成像(rs-fMRI)研究皮质下缺血性血管性认知功能障碍(VCI-SIVD)患者在静息状态下的脑默认网络(DMN)。方法收集缺血性脑小血管疾病患者68例,经临床痴呆量表评分后分为血管性痴呆组(VaD组)12例,非痴呆型血管性认知功能障碍组(VCIND组)21例,认知功能正常者35例为对照组,分别采集高分辨率结构像和静息态功能磁共振数据,通过独立成分分析方法(ICA)计算并对比3组患者脑功能活动的改变。采用两样本t检验分别对VCIND组与正常对照组、VaD组与VCIND组、VaD组与正常对照组DMN的功能连接进行组间比较,观察静息状态下脑默认网络的改变情况,并分析VaD患者DMN默认网络与认知功能间的相关性。结果与正常对照组相比,VCIND组患者默认网络脑区的功能连接既有增高也有降低,增高的脑区包括双侧顶叶及颞中回,降低的脑区包括眶额叶、内侧前额叶、前扣带回及双侧枕叶;VaD组患者出现双侧小脑的功能连接增强,VaD组眶额叶、额中回、额下回、双侧枕叶及双侧颞叶的功能连接减低;VaD患者DMN统计脑图与数字连线A、数字符号转换、MOCA等多个临床量表评分存在显著相关性,差异有统计学意义(P0.05)。结论在静息状态下,血管性认知功能障碍患者的大脑默认模式网络存在异常,并存在以执行功能障碍为主的多个领域的认知功能损害,其认知功能障碍可能与额叶-皮质下环路受损有关。独立成分分析在评价血管性认知功能障碍及其早期诊断中有重要价值。     

轻度血管性认知障碍患者内颞叶体积与记忆力的相关性研究

目的 探讨轻度血管性认识障碍(mVCI)患者内颞叶体积和记忆功能改变的相关性.方法 采用MRI技术测定32例mVCI患者和30例正常对照者杏仁核、海马及海马旁回体积.应用痴呆简易筛查量表(MMSE)和韦氏记忆量表评定受试者记忆功能. 结果 mVCI患者和正常对照组比较,杏仁核、海马及海马旁回体积无显著差异(P>0.05).右侧海马体积与再认评分呈正相关性(r=0.586,P=0.021).左侧杏仁核与视觉再生评分呈负相关性(r=-0.400,P=0.043).右侧海马旁回与联想学习评分呈正相关性(r=0.418,P=0.033).结论 mVCI患者的记忆功能已有损害.MRI检查与认知神经心理学的联合研究能为早期诊断mVCI提供有力的参考依据.     

Regional cerebral blood flow in Parkinson's disease as an indicator of cognitive impairment

OBJECTIVE: To investigate the pattern of regional cerebral blood flow (rCBF) deficits in Parkinson's disease patients in relation to cognitive decline and to assess the clinical usefulness of single photon emission tomography (SPET) scanning in differentiation between Parkinson's disease patients with dementia and those without cognitive deficits. METHODS: We performed Tc-ECD SPET in 60 patients with idiopathic Parkinson's disease (F: 25, M: 35), with average age of 68.4 years (SD+/-7.3, range 51-81 years). All patients were examined neurologically with the assessment of stage and severity of Parkinson's disease (Hoehn-Yahr scale, UPDRS, Schwab-England scale). Detailed neuropsychological examination was performed in each Parkinson's disease patient. On the basis of DSM-IV criteria of dementia and the results obtained in psychological examination, the whole group was divided into three subgroups: I, with no cognitive changes (n = 17); II, with mild cognitive impairment (n = 25); and III, with dementia (n = 18). RESULTS: There was noticeable significant decrease of perfusion in all areas in Parkinson's disease patients when compared to the age-matched control group of healthy volunteers (n = 20). In group III, perfusion was significantly decreased (when compared to groups I and II), particularly in parietal and temporal areas with the predominance of the left side. Regression analysis revealed two independent factors related to dementia: decrease of perfusion within left temporal lobe and its increase within left thalamus. CONCLUSION: Parkinson's disease patients with dementia showed left temporo-parietal hypoperfusion as compared to a group of patients without dementia, which resembles perfusion deficits described in Alzheimer's disease. The hypoperfusion of the left temporal lobe with increase of rCBF within the left thalamus might be clinically useful in discrimination of Parkinson's disease patients with dementia against those without cognitive impairment.     

Effect of regular exercise on senile dementia patients

Dementia population worldwide is considerable in elderly people. Exercise regulates the brain function, but the mechanism by which it does so is unknown. The effect of regular exercise on cognitive function and exercise capacity in senile dementia patients was investigated. Thirty female patients with senile dementia who participated in the study were divided into two groups: the exercise group (EG, n = 15) and the control group (CG, n = 15). The exercise group completed a regular exercise program, and their cognitive function, activities of daily living and exercise capacity levels were evaluated at baseline, 6 months and after 12 months. Subjects exercised 30 - 60 minutes per day, 2 - 3 times per week for 12 months. Mini-mental state examination (MMSE) (pre: 14.53 +/- 5.34, post: 17.47 +/- 6.90) and ADL (pre: 14.40 +/- 5.32, post: 17.53 +/- 5.46) scores were significantly enhanced in the exercise group with senile dementia, compared to those in the control group. Exercise capacities such as cardiopulmonary function (pre: 128.47 +/- 55.43, post: 184.40 +/- 41.16), muscle strength (pre: 10.07 +/- 3.61, post: 13.7 +/- 3.90), muscular endurance (pre: 8.13 +/- 4.45, post: 12.13 +/- 5.14), flexibility (- 1.53 +/- .30, post: 2.20 +/- .70, balance (pre: 1.73 +/- .28, post: 1.20 +/- .77), and agility (pre: 21.80 +/- 3.24, post: 10.87 +/- 2.99) also increased in the exercise group. Our findings showed that regular exercise can enhance cognitive and functional activity scores in dementia patients, suggesting that senile dementia may improve by participating in a regular exercise program.     

无痴呆的血管性认知损害全脑DTI直方图分析

目的:利用磁共振扩散张量成像(DTI)直方图分析,明确无痴呆的血管性认知损害(VCIND)患者的脑异常改变及DTI直方图指标与简易智能量表(MMSE)的相关性。方法:对13例VCIND患者和13例健康志愿者行常规MRI和DTI检查,获得全脑平均扩散率(MD)和各向异性分数(FA)图像后,分别绘制出全脑MD和FA直方图并对其进行分析。结果:与正常对照组比较,VCIND患者平均全脑FA直方图示峰位置左移,平均FA值降低(P=0.002),峰高增高(P=0.034),MD直方图明显右移、平均MD值增高(P=0.014),峰高降低(P=0.002),峰位置右移(P=0.004)。各项指标与MMSE评分均无显著相关性。结论:VCIND患者存在脑扩散异常,全脑DTI直方图分析有助于本病的诊断。     

老年痴呆的MRI研究

目的 :研究核磁共振 (MRl)对阿尔茨海默氏病 (A1zheimerDisease ,AD)和血管性痴呆 (VascularDementia ,VD)的诊断价值。方法 :对 18例阿尔茨海默氏病、15例血管性痴呆及 9例混合性痴呆进行磁共振成象。结果 :阿尔茨海默氏病表现为海马萎缩 (p <0 .0 5 )、钩间距增宽 (p <0 .0 5 ) ;血管性痴呆可分为多梗死性痴呆 (MultipleInfarctDementia ,MID)和皮层下动脉硬化性脑病 (Binswanger’sDementia ,BD)两种类型 ,海马体积、钩间距变化不明显。结论 :MRI对痴呆的诊断和鉴别诊断极有价值     

Changes in local cerebral blood flow by neuroactivation and vasoactivation in patients with impaired cognitive function

Imaging of local cerebral blood flow (ICBF) may serve as an important supplementary tool in the aetiological assessment of dementias. In early or preclinical disease, however, there are less characteristic changes in ICBF. In the present study it was investigated whether vasoactivation or neuroactivation may produce more pronounced local ICBF deficits. Local CBF was investigated by using technetium-99m hexamethylpropylene amine oxime and single-photon emission tomography (SPET) in 80 patients (50 with mild cognitive impairment and 30 with dementia of Alzheimer type (DAT), all without evidence of cerebrovascular disease) at rest (baseline) and during activation. In 31 studies patients underwent vasomotor activation with acetazolamide, while 62 studies were performed under cognitive challenge (neuroactivation by labyrinth task). Cortical activity relative to that of cerebellum increased significantly in a right temporal region and tended to increase in other cortical regions upon vasoactivation. In contrast, neuroactivation reduced cortical activity relative to that of cerebellum in several left and right temporal and in left parietal regions. Visual classification of SPET images of patients with probable DAT by three observers resulted in a reduction of the number of definitely abnormal patterns from 9/12 to 4/12 by vasoactivation and an increase from 10/18 to 15/18 by neuroactivation. Correspondingly, abnormal ratings in patients with mild cognitive dysfunction were reduced from 7/19 to 5/19 by vasoactivation and were increased from 12/2I to 18/21 by neuroactivation. In conclusion, vasoactivation does not enhance local relative perfusion deficits in patients with cognitive impairment of non-vascular aetiology, whereas neuroactivation by labyrinth task produces more pronounced local flow differences and enhances abnormal patterns in ICBF imaging.     

Late-onset dementia: structural brain damage and total cerebral blood flow

PURPOSE: To prospectively compare indicators of structural brain damage and total cerebral blood flow in patients with late-onset dementia, subjects of the same age with optimal cognitive function, and young subjects. MATERIALS AND METHODS: The institutional ethics committee approved the studies, and all participants (or their guardians) gave informed consent. The test group included 17 patients older than 75 years (four men, 13 women; median age, 83 years) and with a diagnosis of dementia according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The control group included 16 subjects (four men, 12 women; median age, 87 years) with optimal cognitive function, who were selected from among 599 elderly subjects enrolled in a population-based follow-up study, and 15 young healthy subjects (seven men, eight women; median age, 29 years). Measurements of intracranial and total brain volumes, structural brain damage, and cerebral blood flow were obtained with magnetic resonance imaging. Mean values were compared with the t test; medians, with the Mann-Whitney U test. RESULTS: Values for total brain volume were significantly smaller in elderly subjects (P < .001) but did not differ significantly between patients with dementia and subjects of the same age with optimal cognitive function (P = .69). Among the elderly, significantly higher scores for number and extent of white matter areas of signal hyperintensity (P = .028) and lower magnetization transfer ratios (P = .016) indicated greater structural brain damage in those with dementia. Cerebral blood flow was 246 mL/min lower (P < .001) in elderly subjects than in young subjects. In patients with dementia, cerebral blood flow was 108 mL/min lower than that in subjects of the same age with optimal cognitive function (551 vs 443 mL/min, P < .001). CONCLUSION: The combined observations of more structural brain damage and lower cerebral blood flow in demented elderly individuals than in subjects of the same age with optimal cognitive function support the hypothesis that vascular factors contribute to dementia in old age.     

MR signal abnormalities in memory disorder and dementia

MR imaging of the brain, performed in 86 normal subjects and 113 patients with objective memory disorder or dementia, demonstrated white- and gray-matter areas of high signal intensity on long TR images (short and long TE). Hyperintensities were analyzed with respect to size (on a scale of 0-3) and location: lesions were periventricular, subcortical, or cortical. The patients with memory disorder and dementia were categorized as having probable/possible Alzheimer disease, a combination of Alzheimer disease and multiinfarct cognitive disorder, or multiinfarct cognitive disorder alone on the basis of clinically determined Hachinski ischemic scores. Significant correlations were found between age and scores for periventricular lesions (r = .40, p less than .0005) and subcortical lesions (r = .39, p less than .0005) in normal subjects. Correlations were also found between the Hachinski ischemic score and scores for periventricular lesions (r = .21, p less than .01), subcortical lesions (r = .27, p less than .0002), and cortical lesions (r = .32, p less than .0005) in subjects with memory disorder/dementia. Comparing multiinfarct cognitive disorder, Alzheimer disease, and normal groups, the mean scores for periventricular lesions were 12.0 +/- 4.6, 7.6 +/- 4.8, and 3.4 +/- 2.6, while mean scores for subcortical lesions were 10.8 +/- 12.2, 4.1 +/- 6.4, and 0.8 +/- 1.2, respectively. Periventricular lesions were present in 99-100% of patients with Alzheimer disease and multiinfarct cognitive disorder. On the other hand, subcortical lesions, which were identified in 100% of patients with multiinfarct cognitive disorder, were present in only about half of the patients with Alzheimer disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

Utility of different MR modalities in mild cognitive impairment and its use as a predictor of conversion to probable dementia

RATIONALE AND OBJECTIVES: Mild cognitive impairment has been regarded as a pre-Alzheimer condition, but some patients do not develop dementia. The authors' objective was to determine whether findings from a combined use of H1 magnetic resonance spectroscopy (MRS), perfusion imaging (PI), and diffusion-weighted imaging (DWI) would predict conversion from amnesic mild cognitive impairment to dementia and to compare the diagnostic accuracy in discriminating patients with probable Alzheimer disease (AD), mixed dementia (MD), Lewy body dementia (LBD), pre-Alzheimer disease mild cognitive impairment (MCI), vascular MCI (VaMCI), and anxious or depression patients with cognitive impairment (DeMCI). MATERIALS AND METHODS: A longitudinal cohort of 119 consecutive and incident subjects (73 women, 46 men; age 70 +/- 9.5 years) who fulfilled the criteria of amnesic MCI was followed for a mean period of 29 months. At baseline, a neuropsychological examination and standard blood test were performed, and different areas were examined by proton MRS, PI, and DWI. Among the group of patients considered to have AD, we also included patients with MD because these patients have a neurodegenerative component. RESULTS: After the follow-up period, 54 patients were considered as converted to dementia (49 with AD; 5 with LBD), 28 patients as MCI, 22 patients as DeMCI, and 15 patients as VaMCI. We found that N-acetylaspartate (NAA)/creatine (Cr) ratios in posterior cingulated gyri (PCG) predict the conversion to probable AD with a sensitivity of 82% and specificity of 72%, and NAA/Cr ratios in the left occipital cortex (LOC) had a sensitivity of 78% and specificity of 69%. When we used spectroscopy in the PCG and LOC to differentiate the types of MCI and dementias, we found significance differences in NAA/Cr, NAA/myoinositol (mI), NAA/choline (Cho), mI/NAA, and Cho/Cr ratios. The apparent diffusion coefficient (ADC) values in the right hippocampus showed differences in patients with LBD and DeMCI (P = .003), LBD with MCI (P = 0.48), and LBD and VaMCI (P = .009). CONCLUSIONS: NAA/Cr ratios in PCG and LOC can predict the conversion from MCI to dementia with high sensitivity and specificity. MRS can differentiate AD from MCI, but cannot differentiate the types of MCI. DWI in the right hippocampus presents higher values of ADC in LBD and allows differentiating it from MCI.     

What can imaging tell us about cognitive impairment and dementia?

Dementia is a contemporary global health issue with far reaching consequences, not only for affected individuals and their families, but for national and global socio-economic conditions. The hallmark feature of dementia is that of irreversible cognitive decline, usually affecting memory, and impaired activities of daily living. Advances in healthcare worldwide have facilitated longer life spans, increasing the risks of developing cognitive decline and dementia in late life. Dementia remains a clinical diagnosis. The role of structural and molecular neuroimaging in patients with dementia is primarily supportive role rather than diagnostic, American and European guidelines recommending imaging to exclude treatable causes of dementia, such as tumor, hydrocephalus or intracranial haemorrhage, but also to distinguish between different dementia subtypes, the commonest of which is Alzheimer’s disease. However, this depends on the availability of these imaging techniques at individual centres. Advanced magnetic resonance imaging (MRI) techniques, such as functional connectivity MRI, diffusion tensor imaging and magnetic resonance spectroscopy, and molecular imaging techniques, such as 18F fluoro-deoxy glucose positron emission tomography (PET), amyloid PET, tau PET, are currently within the realm of dementia research but are available for clinical use. Increasingly the research focus is on earlier identification of at risk preclinical individuals, for example due to family history. Intervention at the preclinical stages before irreversible brain damage occurs is currently the best hope of reducing the impact of dementia.