天智颗粒治疗轻、中度阿尔茨海默病临床研究

目的评价天智颗粒治疗轻、中度阿尔茨海默病(alzheimer disease,AD)的有效性及安全性。方法选择简易智能状态量表(MMSE)轻、中度AD患者60例,随机分成治疗组和对照组各30例,治疗组给予天智颗粒联合吡拉西坦治疗,对照组给予吡拉西坦治疗,观察12周。治疗前后应用简易智能状态量表MMSE,日常生活能力量表(ADL)评价临床疗效;用不良反应量表(TESS)评定不良反应。结果观察12周,天智颗粒治疗组较对照组MMES、ADL评分明显改善(P<0.01)。治疗组天智颗粒治疗12周后较治疗前MMSE与ADL分数分别改善3.8分和8.0分(P<0.05,P<0.01)。天智颗粒治疗组不良反应轻,与吡拉西坦对照组比较2组差异无显著意义(P>0.05)。结论天智颗粒能有效治疗轻、中度AD患者,对患者的认知功能和日常生活自理能力均有改善,耐受性好,安全性高。     

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。     

奈非西坦治疗Alizheimer病随机双盲对照研究

目的研究奈非西坦治疗轻、中度AD的有效性和安全性.方法采用前瞻、随机、双盲、安慰剂对照法,奈非西坦组与安慰剂组各26例.总疗程32周(预备期2周、服药期24周、随访期6周).以MMSE、ADL、CGI、WMS、ADS及GDS量表为评定指标,每6周评定一次.结果奈非西坦组患者的认知功能及日常生活功能在治疗12周后开始显效.24周后,MMSE增分率＞50%2例,增分率＞25%22例,而安慰剂组在24周后仅1例好转.奈非西坦组ADL平均减分值为-3.88±3.02,安慰剂组为-0.32±2.68,差异非常显著(P＜0.001).奈非西坦组MQ提高分值10.34±9.92,安慰剂组为3.56±6.72,差异显著(P＜0.01).两组临床总体疗效(CGI),奈非西坦组有效23例,有效率88.45%,安慰剂组有效2例,有效率8%.两组均无严重不良反应.结论奈非西坦作为新一代吡咯烷类促智药是安全有效的,可应用于轻、中度AD患者的治疗.     

奈非西坦治疗Alzheimer病随机双肓对照研究

目的 研究奈非西坦治疗轻、中度AD的有效性和安全性。方法 采用前瞻、随机、双盲、安慰剂对照法,奈非西坦组与安慰剂组各26例。总疗程32周(预备期2周、服药期24周、随访期6周)。以MMSE、ADL、CGI、WMS、ADS及GDS量表为评定指标,每6周评定一次。结果 奈非西坦组患者的认知功能及日常生活功能在治疗12周后开始显效。24周后,MMSE增分率>50％2例,增分率>25％22例,而安慰剂组在24周后仅1例好转。奈非西坦组ADL平均减分值为-3.88±3.02,安慰剂组为-0.32±2.68,差异非常显著(P<0.001)。奈非西坦组MQ提高分值10.34±9.92,安慰剂组为3.56±6.72,差异显著(P<0.01)。两组临床总体疗效(CGI),奈非西坦组有效23例,有效率88.45％,安慰剂组有效 2例,有效率8％。两组均无严重不良反应。结论 奈非西坦作为新一代吡咯烷类促智药是安全有效的,可应用于轻、中度AD患者的治疗。     

艾斯能治疗阿尔茨海默病有效性及安全性的临床研究

目的　评价艾斯能治疗阿尔茨海默病 ( Alzheimer disease,AD)患者的有效性及安全性。方法　对 30例( MMSE≤ 2 6分 ) AD患者进行了多中心、开放、自身对照 1 6周临床试验 ,应用简易智能精神量表 ( MMSE)、AD评定量表 ( ADAS)及 Blessed-Roth痴呆量表判定疗效 ,检测患者生命体征及实验室指标 ,并进行安全性评价。结果　经艾斯能治疗 1 6周后 ,患者的认知功能 :MMSE较治疗前平均提高 3.9分 ,ADAS认知部分改善 5 .4分( P<0 .0 1 ,P<0 .0 5 ) ;患者的日常生活自理能力 :Blessed-Roth日常生活能力部分降低 1 .6分 ( P <0 .0 1 ) ;患者的精神行为异常 :ADAS的非认知行为部分减少 4 .2分 ,Blessed-Roth的人格部分降低 1 .4分 ( P<0 .0 5 ,P<0 .0 1 )。 5例 ( 1 6 % )出现轻度胆碱能兴奋性副作用。结论　艾斯能可改善 AD患者的认知功能、日常生活自理能力和精神行为异常 ,耐受性好 ,安全性高 ,其主要副作用为胆碱能兴奋性胃肠道反应     

智力竞技休闲型活动训练对轻度阿尔采默病患者的影响

目的探讨智力竞技休闲型活动训练对轻度阿尔采默病(AD)患者认知功能和生活功能的影响。方法56例轻度AD患者分为智力活动组(30例)和非智力活动组(26例),智力活动组给予1年的智力竞技休闲型活动训练,采用痴呆严重程度临床评定量表(CDR)、简易精神状态检查量表(MMSE)、成人韦氏记忆量表(WMS)、日常生活能力量表(ADL)在入组时和1年后评定其认知功能及日常生活能力。结果通过有目的的智力竞技休闲型活动训练,1年后两组患者MMSE评分、ADL评分、WMS评分差异均有显著性意义(均P0.05),痴呆程度的演变,差异也有显著性意义(P0.05)。结论智力竞技休闲型活动训练可以延缓病情发展,智力活动是AD的保护性因素。     

日常生活功能量表评定阿尔茨海默病患者日常生活功能的信度与效度及其应用

目的探讨ADL在评定阿尔茨海默病患者日常生活功能中的应用。方法173例阿尔茨海默病（AD）患者应用ADL进行基线期评定,脱落16例。83例在进行为期16周盐酸美金刚治疗后进行第二次评定。74例未治疗者在4周后重复评定。逐步回归分析影响ADL分值相关因素,比较治疗组患者治疗前后ADL分值的。结果逐步回归分析显示MMSE总分、年龄和性别影响ADL总分。中度AD患者在盐酸美金刚治疗16周后ADL总分及IADL分减少。两次不同测定各单项分之间ICC值为0．84—0．96,分半信度为0．91。结论ADL总分受MMSE总分、年龄和性别的影响,盐酸美金刚能够一定程度改善中度AD患者的日常生活功能。ADL具有较好的信度。     

安理申治疗轻中度血管性痴呆的有效性及安全性分析

目的评价安理申治疗轻、中度血管性痴呆（VD）患者的有效性及安全性。方法对86例轻、中度VD患者（简易精神状态检查表（MMSE）得分10-24分]随机分为两组,治疗组和对照组,进行12周临床试验。以MMSE为主要评价指标,日常生活能力量表（ADL）和临床痴呆程度量表（CDR）为次要评价指标。结果结果表明,5mg／d安理申治疗12周时,安理申组较安慰组MMSE、ADL、CDR分数显著改善（依次P〈0．01、〈0．05、〈0．01）。自身对照研究结果显示,5mg／d安理申治疗12周时,治疗后较治疗前MMSE、CDR、ADL分数分别改善3．5、0．6、7．0分（依次P〈0．01、〈0．05、〈0．01）。安理申治疗4周时MMSE分数已有提高（P〈0．05）。结论安理申可显著改善轻中度VD病人的认知功能、痴呆程度和日常生活自理能力,且安全性和耐受性良好,是VD治疗的有效药物之一。     

轻度认知功能障碍的神经心理学和脑血流灌注研究

目的　用神经心理学和脑血流灌注检查探讨轻度认知功能障碍 (MCI)特点 ,分析其与阿尔茨海默病 (AD)和健康衰老的差异。方法　对 2 1例MCI ,18例AD和 19例健康老人进行简易智力状态检查 (MMSE) ,日常生活能力量表(ADL)和总体衰退量表 (GDS)评定 ,韦克斯勒记忆测验 (WMS)及SPECT检查。SPECT结果作半定量分析 (以放射性计数比值 -RAR表示 )。结果　认知功能评定结果 :与健康老人相比 ,MCI除ADL成绩外 ,其余均显著降低 ;与AD相比 ,MMSE、ADL、GDS以及WMS中的短时记忆和语言记忆成绩均显著优于AD(P <0 0 5 )。脑血流灌注比较结果 :MCI组与健康老人各部位的RAR无差异 ;与AD组相比 ,扣带回、左基底节、左枕叶、右颞上回、双侧额叶、双侧颞下回和双侧顶叶RAR均显著增高 (P <0 0 5 )。以顶叶RAR为变量作聚类分析产生两类MCI(MCI 4和MCI 16) ,MCI 16在左丘脑的血流灌注低于健康老人(P <0 0 1) ,在双侧颞下回和右颞上回高于AD(P <0 0 1)。结论　MCI为一组异质性疾病 ,认知功能缺损和脑血流灌注的改变均存在多种类型。顶叶能对MCI进行有效分类。     

中药“菖术汤”治疗血管性痴呆的临床研究

目的：研究“菖术汤”治疗轻,中度血管性痴呆的有效性和安全性。方法：采用自制的“菖术汤”多中心,半随机与阿尼西坦对照,设治疗且和对照组各30例,治疗8周,以MMSE,ADL,GDS,CGI,WMS等量表为评定指标。结果：“菖术汤”治疗组患者的MMSE在治疗第2周即起效,8周时有效率为53．3％（其中显效40％）,与阿尼西坦相似（t=0.626,P=0.731),ADL平均减分值虽未达到＞25％的有效改善程度,但大部分患者日常生活能力均获得了一定改善,而副作用明显低于对照组,结论：“菖术汤”对血管性痴呆安全有效,可用于轻中度血管性痴呆患者的治疗。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -