强迫症的临床特征

目的：探讨强迫症（ＯＣＤ）的临床表现。方法：对４０例符合ＤＳＭ－ⅣＯＣＤ诊断标准病人进行以下量表和问卷评定：强迫症量表（Ｙ－ＢＯＣＳ）,Ｈａｍｉｌｔｏｎ抑郁量表（ＨＡＭＤ）,Ｈａｍｉｌｔｏｎ焦虑量表（ＨＡＭＡ）,Ｍａｒｋｓ恐怖强迫量表（ＭＳＣＰＯＲ）,临床疗效总评量表（ＣＧＩ）和艾森克个性问卷（ＥＰＱ）;并对６５名正常人进行ＥＰＱ测试。结果：１５岁以前发病患者的ＭＳＣＰＯＲ的工作适应能力下降（ＷＤ）分显著高于１５岁以后发病患者;合病组病人的ＨＡＭＤ和ＥＰＱ的神经质分显著高于非合病组;洗涤／回避组的ＨＡＭＡ评分显著较高,迟缓／仪式化组的发病年龄显著较低,两组的ＭＳＣＰＯＲ的ＷＤ评分均显著高于强迫检查行为组。结论：１５岁以前发病,合病组,主要表现迟缓／仪式化或洗涤／回避症状的病人是ＯＣＤ较为严重的亚型。     

苯妥英钠脑病

为了尽早对苯妥英钠（ＤＰＨ）脑病作出诊断以保护癫痫儿童的智力。方法对３３例ＤＰＨ脑病进行了分析，对其中２４例进行了修订韦氏成人智力量表（ＷＡＩＳ－ＲＣ）及韦氏儿童智力量表（ＷＩＳＣ）测验并与性别、年龄、病情相匹配的另外２４例接受卡马西平（ＣＢＺ）治疗的病人及２４例正常者进行了比较。结果全部ＤＰＨ脑病病人均系长期ＤＰＨ治疗和血药浓度偏高的患者，主要临床表现提示进行性恶化的智力衰退，反应迟钝及思睡，癫痫发作可能增多，脑电图（ＥＥＧ）慢波及痫样放电增多，可有脑脊液（ＣＳＦ）蛋白中等增高。神经系统症状体征一般在减药或停药后明显好转或消失。ＷＡＩＳ－ＲＣ及ＷＩＳＣ的分数在ＤＰＨ组明显比ＣＢＺ组及正常组低，Ｐ值分别为＜０．０５及＜０．０１，这说明长期用ＤＰＨ治疗可能对智力有害。结论如果能慎重选用抗癫痫药，防止ＤＰＨ脑病的发生，将是保护癫痫儿童智力的一个较佳手段     

社交恐怖症的临床症状特征

对５０例社交恐怖症（ＳＰＨ）病人与６５例正常人按要求填写社交回避与苦恼量表（ＳＡＤ），抑郁自评量表（ＳＤＳ），Ｍａｕｄｓｌｅｙ强迫症状问卷（ＭＭＯＣＩ），症状自评量表（ＳＣＬ－９０），评分结果与国内常模进行比较，同时对病人的社会功能缺陷筛选量表（ＳＤＳＳ）进行评定。结果发现，ＳＰＨ病人ＳＣＬ－９０评分除躯体化和敌对因子分外，其它各因子分均高于国内常模，病人的ＳＡＤ、ＳＤＳ和ＭＭＯＣＩ分均显著高于对     

癫痫智能障碍的WAIS—RC智力量表P300测试的对比研究

目的：探讨癫痫智能障碍的ＷＡＩＳ－ＲＣ智力量表与Ｐ３００潜伏期二者之间的关系。方法：对６６例２０－５０岁癫痫患者（病人）用ＷＡＩＳ－ＲＣ测出全智商（ＦＩＱ）、以纯音“ｏｄｄｂａｌｌ”刺激序列从Ｃｚ引出Ｐ３００（Ｐ３），测其峰时（ＰＬ）和波辐（Ａｍｐ）。以５０例年龄、性别、文化水平相匹配的志愿健康人为对照，病人按ＦＩＱ〈９０分和≥９０分（知能正常）分为Ａ和Ｂ两组。然后将客Ｐ３各参量（主要为ＰＬ）进行     

Ⅱ型糖尿病伴脑梗死病人血浆氧化修饰低密度脂蛋白测定的意义

探讨血浆氧化修饰低密度脂蛋白水平的变化与Ⅱ型糖尿病（ＤＭ）伴脑梗死（ＣＩ）的关系。方法：应用ＥＬＩＳＡ法测定ＤＭ伴ＣＩ病人血浆ＯＸＬＤＬ的水平,另设单纯性ＣＩ组及正常对照组。结果（１）无论是否合并ＤＭ,ＣＩ组病人血浆ＯＸＬＤＬ水平较正常对照组明显增高;且ＤＭ伴ＣＩ组明显高于单纯于ＣＩ组。（２）血浆ＯＸＬＤＬ水平与ＬＤＬ－Ｃ、ａｐｏＢ水平呈正相关,而与ＨＤＬ－Ｃ水平呈负相关。结论：ＯＸＬＤＬ在ＤＭ伴     

合并多器官功能衰竭的急性脑血管病患者神经内分泌的改变

本实验动态测定了急性脑血管病（ＡＣＶＤ）并发多器官功能衰竭（ＭＯＦ）患者血清生长激素（ＧＨ）、泌乳素（ＰＲＬ）、促黄体生长素（ＬＨ）、促滤泡成熟激素（ＦＳＨ）、睾酮（Ｔ）、孕酮（Ｐ）、雌二醇（Ｅ２）、皮质醇（Ｆ）和血浆促肾上腺皮质激素（ＡＣＴＨ）水平的变化，并与ＡＣＶＤ各疾病组对比。结果发现：ＧＨ、ＰＲＬ、ＡＣＴＨ、Ｆ及ＦＳＨ水平显著升高；ＡＣＶＤ并发ＭＯＦ重型患者（ＭＯＦ积分＞４分）ＰＲＬ、ＧＨ、Ｆ水平显著高于轻型患者（ＭＯＦ积分≤４分）。结果提示ＰＲＬ、ＧＨ和Ｆ可能参与了ＡＣＶＤ并ＭＯＦ的病理生理过程     

脑卒中患者智能测试方法的比较

目前在临床上所采用的智能测试方法大多针对严重智力损害痴呆患者，而且在其有效性和操作可行性方面也存在一定的局限［１］。本文通过对３３例脑卒中患者先后做韦氏成人智力量表（ＷＡＩＳ－Ｒ）、韦氏记忆量表（ＷＡＭＳ－Ｒ）、长谷川痴呆量表（ＨＤＳ）结果的比较分析...     

载脂蛋白E与脑动脉硬化症

本文观察７８例脑动脉硬化症患者与对照组４４例，对其血清载脂蛋白Ｅ（ＡＰＯＥ）和高密度脂蛋白（ＨＤＬ－Ｃ）、低密度脂蛋白（ＬＤＬ－Ｃ）、胆固醇（ＴＣ）、甘油三脂（ＴＧ）、载脂蛋白ＡＩ（ＡＰＯＡＩ）、载脂蛋白Ｂ（１００）（ＡＰＯＢ（１００））进行含量测定，并将ＡＰＯＥ与ＨＤＬ－Ｃ、ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡＰＯＡＩ、ＡＰＯＢ（１００）逐一进行相关比较，结果发现：脑动脉硬化症病人（ＣＡＳ）血清ＡＰＯＥ、ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡＰＯＢ（１００）明显高于正常对照组（Ｐ＜０．０１），ＨＤＬ－Ｃ显著低于正常对照组（Ｐ＜０．０１），ＡＰＯＡＩ无明显变化（Ｐ＞０．０５），且ＡＰＯＥ与ＨＤＬ－Ｃ呈负相关；与ＬＤＬ－Ｃ、ＴＣ、ＴＧ、ＡＰＯＢ（１００）呈正相关；与ＡＰＯＡＩ无直线相关关系。提示ＡＰＯＥ可做为诊断脑动脉硬化症的重要指标。     

左旋千金藤啶碱治疗精神分裂症初步探讨

目的 探讨国产多巴胺阻滞剂－－克旋千金藤啶碱（Ｌ－ＳＰＤ）治疗精神分裂症的疗产及副作用。方法 对１３例符合ＣＣＭＤ－２－Ｒ诊断标准长期住院的精神分裂症患者,且此药治疗８周以上,用临床大体评定量表（ＧＡＳ）、临床大体印象量表（）ＣＧＩ＿ＧＩ）评定疗效,用副反应量表（ＴＥＳＳ）评定副反应。结果 ＧＡＳ量表分值明显提高,有效率为６９．２％。结论 Ｌ－ＳＰＤ对精神分裂症有一;定疗效,它可能成为唯一国产的抗     

急性脑血管病并／不并多器官功能衰竭患者下丘脑—垂体—肾上腺皮质轴功能研究

应用放射免疫分析法对１６７例急性脑血管病（ＡＣＶＤ）患者血清泌乳素（ＰＲＬ）、生长激素（ＧＨ）、皮质醇（Ｆ）及血浆促肾上腺皮质激素（ＡＣＴＨ）水平变化进行了观察。结果发现：ＡＣＶＤ患者ＰＲＬ、ＧＨ、ＡＣＴＨ与Ｆ水平均显著高于对照组，ＡＣＶＤ并多器官功能衰竭（ＭＤＦ）患者４种激素水平显著高于ＡＣＶＤ各疾病组，随ＡＣＶＤ病程不同，４种激素水平也相应改变，１周时水平最高，２周后逐渐恢复、ＡＣＶＤ并ＭＤＦ重型患者（ＭＤＦ积分＞４分）ＰＲＬ、ＧＨ与Ｆ水平显著高于轻型患者（ＭＤＦ积分≤４分）。结果提示ＰＲＬ、ＧＨ和Ｆ可能参与了ＡＣＶＤ并ＭＤＦ的病理生理过程。     

酒中毒患者的认知特点

目的：探讨酒中毒患者的认知特点。方法：采用中国成人智力量表（CISA）、韦氏记忆量表－中国修订（WMS）、酒精依赖诊断量表（SCID－AD）和自编饮酒情况调查表对被试者进行测验和调查。酒中毒患者49例,正常人30例。结果：酒中毒患者与正常人CISA各量表分、智商、各种智力因素商比较,具有显著或极显著差异。两组WMS各量表分和记忆商数比较也具有显著或极显著性差异。酒中毒患者记忆下降比例明显高于智力下降比例,且下降程度也要严重得多。结论：酒中毒患者的认知功能有明显下降,记忆的下降程度比智力的下降程度更为严重,明显受病程和开始饮酒年龄的影响。“流体智力”下降的速度比“晶体智力”方面的能力更快。     

Memory disorders in probable Alzheimer''s disease: the role of hippocampal atrophy as shown with MRI.

Magnetic resonance based volumetric measures of hippocampal formation, amygdala (A), caudate nucleus (CN), normalised for total intracranial volume (TIV), were analysed in relation to measures of cognitive deterioration and specific features of memory functions in 18 patients with probable Alzheimer's disease. Neuropsychological examination included the mini mental state examination (MMSE), the Mattis dementia rating scale (DRS), tests of executive functions, assessment of language abilities and praxis, the Wechsler memory scale (WMS), the California verbal learning test (CVLT) and the Grober and Buschke test. The volume of the hippocampal formation (HF/TIV) was correlated with specific memory variables: memory quotient and paired associates of the WMS; intrusions and discriminability at recognition for the Grober and Buschke test. By contrast, except for intrusions, no correlations were found between memory variables and the volume of amygdala (A/TIV). No correlations were found between the volume of caudate nuclei (CN/TIV) and any neuropsychological score. The volume of the hippocampal formation was therefore selectively related to quantitative and qualitative aspects of memory performance in patients with probable Alzheimer's disease.     

轻度认知功能障碍患者的神经心理学研究

目的 探讨轻度认知功能障碍(MCI)患者神经心理学的特点. 方法 对42例MCI患者和55例健康对照者进行多项神经心理学检查,包括简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、临床痴呆评定量表(CDR)、语言流畅性测验(RVR)、韦氏智力测验(WAIS-RC)[包括数字广度测验(DS)、积木测验(BD)、相似性测验]、韦氏记忆测验(WMS-R)(包括逻辑记忆、联想学习、视觉再认、图片回忆)、日常生活能力量表(ADL),比较2组患者上述量表评分和MMSE、MoCA量表各亚项评分的差异.结果 与对照者比较,MCI患者MMSE、MoCA总分和RVR、WAIS-RC、WMS-R分测验,MoCA量表各亚项(地点定向力除外),MMSE量表中计算与注意、延迟回忆两亚项评分较低,差异均有统计学意义(P<0.05).结论 MCI患者不仅记忆受损,其计算与注意力、命名、视空间结构能力、执行功能也可受损,尤以延迟回忆、计算与注意力受损明显.MoCA涵盖了重要的认知领域,能较全面评估MCI患者的认知功能,值的临床推广应用.     

Changes in depressive symptoms and functional disability among community-dwelling depressive older adults

ABSTRACT Background: Previous studies have shown that the presence of depressive symptoms among older persons was evidently associated with subsequent physical and functional decline. However, few studies have directly examined the impact of changes in depressive symptoms or depressed mood on changes in functional ability. The present prospective study examined whether changes in the levels and remission of depressive symptoms were associated with changes in functional ability among community-living older persons who were treated for depressive symptoms in a primary care setting. Methods: Older persons aged 60 and above with depressive symptoms (N = 267) were followed up in a primary care treatment program over 12 months. Geriatric Depression Scale (GDS-15), and instrumental and basic activities of daily living (IADL and ADL) were measured at baseline and at 12-month follow-up. The associations of GDS change scores and conversion to non-depressed status with ADL and IADL change scores, controlling for baseline covariates including chronic medical comorbidity and Mini-Mental State Examination (MMSE), were examined in multiple regression analyses. Results: An improvement in GDS scores (baseline score minus 12-month score) was significantly associated with improvement (12-month score minus baseline score) in ADL (β = 0.355, p < 0.001) and IADL scores (β = 0.165, p = 0.018) after adjusting for baseline functional status, MMSE, chronic medical comorbidities, and other variables. In particular, conversion in GDS status to "non-depressive" state (GDS ≤4) was associated with an improvement in ADL change scores (β = 0.281, p = 0.019). Conclusion: In depressed older persons, an improvement in depressive symptoms was associated with improved functional ability.     

The effect of the living situation on the severity of dementia at diagnosis.

INTRODUCTION: Previous studies have shown that social determinants not directly involved in the disease process may be implicated in the timing of dementia diagnosis. This study explores the relationship between a patient's living situation and the severity of dementia at diagnosis. METHODS: Data were collected from the baseline interviews of 1,325 patients with cognitive decline enrolled in the Consortium for the Investigation of Vascular Impairment of Cognition study. Data collected included: age, sex, living situation and scores on the Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), the Functional Rating Scale (FRS), the Disability Assessment for Dementia (DAD) scale and the Cumulative Illness Rating Scale (CIRS). Living situation was grouped as: (1) lives alone, (2) lives with spouse, (3) lives with child, relative or other and (4) lives in a nursing home. A general linear model univariate analysis was used to compare patients by their respective living situations for differences in mean scores on each of the 4 measures of dementia severity. RESULTS: Statistical analysis of both unadjusted data and data adjusted for age, sex and CIRS scores showed significant differences among the groups. Those who lived alone were diagnosed at an earlier stage (mean scores: MMSE 21.4, GDS 3.6, FRS 20.0, DAD 29.8) followed by those who lived with a spouse (mean scores: MMSE 20.5, GDS 3.7, FRS 20.4, DAD 28.0), those who lived with a child or other (mean scores: MMSE 19.3, GDS 3.9, FRS 22.5, DAD 24.9) and finally those who lived in a nursing home (mean scores: MMSE 15.2, GDS 4.8, FRS 27.5, DAD 16.9). CONCLUSION: Living situation is related to the severity of dementia at diagnosis. Primary care providers should have a low threshold for case-finding in older adults who live with family or friends.     

多奈哌齐联合尼莫地平治疗中重度阿尔茨海默病的疗效及安全性

目的：观察多奈哌齐联合尼莫地平治疗中、重度阿尔茨海默病（AD）的疗效及安全性。方法：32例中、重度AD患者随机分为多奈哌齐组及多奈哌齐＋尼莫地平（联用尼莫地平）组。采用简易精神状态量表（MMSE）、临床痴呆评定量表（CDR）歧全面衰退量表（GDS）评定疗效。结果：多奈哌齐组MMSE和CDR评分较治疗前明显改善；联用尼莫地平组3种量表评分较治疗前均显著改善。两组均无严重不良反应。结论：多奈哌齐联用尼莫地平较单用多奈哌齐可能更显著改善中、重度AD的认知功能，两种药物安全性俱佳。     

离退休老人轻度认知功能损害研究

目的：探讨离退休老人轻度认知功能损害(MCI)的发生率及其影响因素。方法：采用哈金斯基缺血指数(HIS)、简易智能状态检查(中文版)(MMSE)、Reisberg总体衰退量表(GDS)、日常生活活动能力(20项版本)(ADL)等，对420名离退休老人MCI的发生情况及其影响因素进行调查，分析相互问关系。结果：离退休老人中MCI的发生率为8．6％，随年龄的增长而有升高趋势，但各年龄组之间差异无显著性。结论：离退休老人中MCI较常见，应对老年人群进行MCI的监测和干预，阻止和延缓MCI发展为痴呆，提高老年人的寿命和生活质量。     

The need for a consensus in the use of assessment tools for Alzheimer's disease: the Feasibility Study (assessment tools for dementia in Alzheimer Centres across Europe), a European Alzheimer's Disease Consortium's (EADC) survey

AIMS: To ensure that all Alzheimer centres across Europe are capable of using a similar method of data collection. Information about the patient assessment tools used by each participating centre was obtained and normal clinical practice in each EADC centre was documented by collecting data from routine new patient consultation. METHODS: Twenty new consecutive patients with objective memory impairment were recruited in each Alzheimer centre over 6 months. Each patient consultation was carried out according to routine clinical practice. Patient data were recorded using the anonymous patient protocol (demographic, diagnosis, MMSE score, patient assessment scales, and most prominent behavioural problem). Information about neuropsychological assessment tools used in each centre was take to account to harmonise research practice for future multicentre collaboration. RESULTS: Seven hundred and four patients from 36 memory clinics in 13 countries across Europe participated in the study. [M:F ratio 0.67. Mean age 75.4 SD 9.3 (51-102) Mean MMSE 21 SD 6 (0-30)] Five hundred and fifty-five patients had a clinical diagnosis of dementia [Alzheimer's disease (68.5%), vascular dementia (10.3%), frontal lobe dementia (5.6%), Lewy body dementia (4.1%), mixed dementia (5.6%)]. Duration of symptoms: 0-6 months 6.5%; 6-12 months 16.1%; 1-2 years 30.5%; 2-5 years 46.9%. Assessment scales used: Clinical Dementia Rating (CDR) 48.9%, Reisberg's Global Deterioration Scale (GDS) 38.6%, ADL/IADL (Lawton and Brody, 1969) 37.5%, Neuropsychological Inventory (NPI) 28.6%, Geriatric Depression Scale 22%, ADL (Katz et al., 1963) 19.2%, ADAS-Cog 14.9%, Cornell Scale for Depression 12.9%, Grober and Bushke Selective Reminding Test 11.5%, ADCS/ADL 7.7%. 64.8% of the patients experienced behavioural symptoms: apathy 13.6%; anxiety 12.8%; dysphoria 9.9%; irritability 7.8%; agitation 5.5%; hallucinations 3.6%; delusions 3.6%, sleep disorder 2.4%; desinhibition 2%. CONCLUSIONS: The most common type of cognitive decline was Alzheimer's disease followed by mild cognitive impairment and vascular dementia. CDR, GDS Reisberg, and ADL/IADL were used widely (40-50%). The NPI, geriatric depression scale and ADL (Katz, 1963) were only used in 20% of the centres. We verified large differences in the tools use in the EADC centres to evaluate patients with dementia across Europe. There is a need for a consensus in the use of assessment tools for dementia in Alzheimer's centres in Europe.     

单纯脑白质疏松症与皮质下动脉硬化性脑病患者记忆障碍的对比研究

目的比较单纯脑白质疏松症(LA)与皮质下动脉硬化性脑病(SAE)患者记忆障碍的特征。方法采用临床记忆量表对单纯LA、SAE患者各30例进行记忆功能检测及简易精神状态量表(MMSE)检测,并与30名健康老年人比较。结果单纯LA组患者各项记忆量表成绩及记忆商(MQ)均明显低于健康对照组(均P<0.01),其中图像自由回忆(12±5)、人像特点联系回忆(16±5)下降明显;单纯LA组各项记忆量表成绩及MQ均高于SAE组(P<0.05～0.01),其中SAE组患者指向记忆(10±7)、联想学习(14±5)明显下降;单纯LA组无痴呆发生,SAE组22例MMSE≤19分,痴呆发生率73.33%;MQ>70的患者痴呆发生率明显低于MQ≤69的患者(P<0.01)。结论(1)单纯LA组患者有明显记忆障碍,但程度明显轻于SAE患者;(2)单纯LA组患者无痴呆发生,SAE组痴呆发生率高,且与记忆损害程度成正比。     

社区痴呆患者的家庭照料者心理状况研究

目的：为了社区痴呆患者的家庭照料者心理状况及相关因素，方法：采用MMSE，ADL，GDS，Be-AD和GHQ对103例社区痴呆患者的家庭照料者心理状况进行调查并分析。结果：家庭照料者的焦虑失眠症状明显，主要是痴呆患者的精神／行为问题相关，与照料者本身的年龄，文化和对痴呆知识的了解程度有关。结论：对老年痴呆的照料以及照料者的心理健康状况值得重视。