阿尔茨海默病的语言障碍特点

语言障碍是大脑高级功能障碍的敏感指标之一.阿尔茨海默病（AD）早期即可出现语言功能障碍,随着疾病的进展,在病程的不同阶段有不同的表现.现对AD语言障碍的特点及临床策略作一综述.1 AD患者语言障碍的特点由于大脑皮层及皮层下语言网络结构及其联络纤维广泛受损,导致AD患者出现语言障碍,并有其特殊的模式及演变过程,涉及口语表达、复述、理解、命名、阅读及书写等各个方面.AD的言语障碍与痴呆严重程度呈正相关.国外学者研究认为,AD患者的语言障碍经历以下四个阶段：命名性失语,经皮质感觉性失语,Wernicke失语,完全性失语.早期AD的言语障碍表现更多具备流利性失语的特征.疾病初期表现为以理解障碍为主,属于经皮层感觉性失语,晚期则出现输出障碍.AD的语言障碍临床主要表现为以下几方面：（1）初期在自发言语中,明显的找词困难是AD患者首先表现的语言障碍.关键词：阿尔茨海默病;语言障碍;评估;治疗     

阿尔茨海默病与睡眠障碍

阿尔茨海默病(Alzheimer disease,AD)是一种与年龄有关的慢性神经系统的退行性疾病,睡眠障碍是AD常见的临床表现之一。现有研究显示AD与睡眠障碍具有双向交互的关系,睡眠障碍可以增加脑内β淀粉样蛋白(amyloidβ-protein,Aβ)的沉积进而增加AD发生风险,同时AD睡眠调节通路上关键部位的退行性改变也是导致睡眠障碍的病因,伴有睡眠障碍的患者较不伴有睡眠障碍的患者有更高的风险发展为认知障碍。因此,积极干预睡眠障碍可能成为防治AD的临床新思路。本文对AD与睡眠障碍的相互关系进行综述。     

脑型肝豆状核变性患者中文书写特点

目的 通过观1察脑型肝豆状核变性患者中文书写特点,探讨基底神经节病变与中文书写的关系.方法 采用汉语失写检查法对35例脑型肝豆状核变性患者进行中文书写检查.结果 ①22例患者出现书写障碍(62.9%),以看图书写成绩最差,其他依次为主动书写、听写、自动书写和抄写.②14例患者出现语言性书写障碍(40%),11例患者出现运动性书写障碍(31.4%).其中存在多种书写障碍类型并存的现象.③在语言性书写障碍的患者中:构字障碍12例,字词错写4例,语法错误2例.④在运动性书写障碍的患者中:小写症5例,震颤性书写4例,重复性书写2例.结论 书写障碍是脑型肝豆状核变性的常见症状,以构字障碍最多见,提示基底神经节参与汉字书写过程.     

阿尔茨海默病相关嗅觉障碍研究进展

阿尔茨海默病(Alzheimer disease,AD)的典型表现为进行性记忆力下降和逐渐加重的认知功能障碍,AD患者出现典型表现时多处于疾病中晚期,已经错过了治疗的最佳时期。多项研究表明AD患者早期即可出现嗅觉功能障碍,且出现时间早于情景记忆下降等典型表现。本文对AD患者相关嗅觉功能障碍的病理、临床表现、嗅觉功能障碍检测方法及其应用等方面的进展进行综述。     

Alzheimer病相关的睡眠障碍

Alzheimer病(AD)患者睡眠障碍很常见，睡眠障碍对痴呆有推波助澜作用；睡眠障碍也可能是AD危险因素之一，不可理解的顽固性失眠常为痴呆先兆症状。现介绍与AD相关的睡眠障碍研究进展。     

轻度认知功能障碍与阿尔茨海默病患者感觉障碍 及其电生理改变研究进展

阿尔茨海默病（AD）是最常见的中枢神经退行性疾病之一，常隐匿起病，目前尚缺乏有效 的治疗手段。轻度认知障碍（MCI）是介于正常衰老与痴呆之间的一种认知功能损害状态，部分MCI可 发展成为AD。AD 的核心临床症状主要为记忆障碍、认知功能障碍、人格和行为改变。多项研究表明 AD 可能伴随有感觉障碍，如嗅觉、视觉、听觉等，其中嗅觉障碍可能是MCI 或AD 早期的临床症状之一， 并且在MCI 及AD 患者中可出现感觉相关电生理改变。现就MCI 及AD 患者感觉障碍及其电生理研究进 行综述。     

Alzheimer病的精神病性症状：附50例调查分析

作者对50例 Alzheimer 病(AD)患者作了调查,发现 AD 患者的精神病性症状较为常见,其中34%的 AD 患者有思维障碍、20%的患者有知觉障碍、40%的患者有抑郁症状、16%的患者有躁狂症状、86%的患者有行为障碍。作者对各种精神病性症状作了初步的分析讨论。     

阿尔茨海默病嗅觉障碍的研究

目的 :研究阿尔茨海默病 (AD)患者嗅觉障碍。方法 :配对的AD患者和正常老年人各 3 0例 ,分别行简易智能状态检查(MMSE)、日常生活活动量表 (ADL)、图片识别试验、气味感知阈值、图片介导的气味识别试验及气味再认记忆试验检查。结果 :AD组的气味感知、气味识别和气味再认记忆功能较正常对照组差 (P <0 0 1) ;相关分析显示 ,AD组患者的嗅觉障碍与MMSE总分密切相关 (P <0 0 5 ) ;结论 :AD患者的嗅觉功能全面受损 ,嗅觉障碍是疾病的早期症状 ,是认知障碍的简单反映     

阿尔茨海默病相关睡眠障碍的临床管理

随着人口老年化的迅速发展,老年人口数量将越来越多,阿尔茨海默病(Alzheimer Disease,AD)的患病人数也将随之日益增多,并成为一个严重的社会问题和家庭问题。睡眠障碍包括觉醒频度和持续睡觉的增加,慢波睡眠和快动眼相(REM)睡眠的减少,以及日间瞌睡,或简单地概括为“睡眠/觉醒循环障碍”,即夜间睡眠或日间觉醒状态的“碎片化”[1]。在 AD 患者中,睡眠障碍的发生率为34％~82％[2]。睡眠障碍的发生不仅使患者的社会、认知功能进一步加重,同时还会加重其看护者的身心负担,进而引起他们的睡眠问题[3]。因此在 AD 治疗中,尽早发现或治疗 AD 患者的睡眠障碍,改善其睡眠质量,非常有必要。本文从睡眠障碍的临床管理角度,着重回顾了 AD 相关睡眠障碍的临床特点、发病机制、临床评估、治疗策略,为 AD 相关的睡眠障碍临床管理及后续相关研究提供参考。     

阿尔茨海默病遗传基因与胰岛素代谢通路的关联研究进展

阿尔茨海默病(AD)与正常老化的可预测性认知功能障碍不同,AD为多个认知领域早期进行性下降的痴呆。糖尿病和遗传因素可影响AD发病风险。AD和糖尿病具有多种共同的疾病特征,包括胰岛素信号受损,胰岛素抵抗和认知功能障碍等,而进行鼻内吸入胰岛素治疗的AD患者显示部分认知功能症状的改善。多中心全基因组关联研究发现多个基因位点与AD风险相关。文中就近年来基于胰岛素代谢通路与AD遗传基因研究进展进行综述。     

Impaired spelling in Alzheimer's disease: a linguistic deficit?

Different kinds of real words and pronounceable pseudowords (PWs) were presented for writing to dictation to patients with the diagnosis of probable Alzheimer's disease (AD) and to age- and education-matched healthy controls. Though spelling less accurately on all tasks, AD patients responded in a manner generally qualitatively similar to controls. Except for a slightly enhanced effect of spelling regularity in real word writing accuracy, AD patients showed the same sensitivity to various lexical, orthographic and phonological variables as controls. Both groups showed no difference in spelling accuracy for words and PWs with regular vs ambiguous spelling patterns, and groups also showed similar orthographic preferences when spelling PWs having several different acceptable pronunciations. Finally, AD patients and controls produced similar types of errors when spelling real words. Dementia severity was related to the overall accuracy, but not to the pattern, of spelling responses. It is suggested that the decline in response accuracy in cognitively demanding writing tasks in patients with more advanced dementia is most likely due to semantic impairment and impairments of nonlinguistic functions of attention, executive control and praxis, rather than to a disturbance within language specific processes.     

The agraphia of Alzheimer's disease.

Hypothesizing that agraphia in Alzheimer's disease (AD) reflects disturbances in multiple cognitive domains, we evaluated writing samples from 33 patients meeting strict criteria for probable AD. We found agraphia to be common on a standard narrative writing task. When compared with 41 education- and age-matched normal control subjects, AD patients had significantly lower writing scores, wrote significantly fewer words, mentioned significantly fewer categories of information, and were significantly more likely to make writing errors. On stepwise regression procedures, neuropsychological measures of visuoperceptual impairment and disease severity were the strongest predictors of agraphia, but other analyses indicated that measures of language, praxis, and attention could also contribute significantly to agraphia. On two writing tasks, we failed to confirm the previous contention that agraphia is a marker for familial AD. However, there was a highly significant interaction between family history, oral naming, and writing: patients with nonfamilial AD, but not those with a family history of dementia, showed a strong correlation between naming and writing performance. We conclude that agraphia in AD can be variously determined and that agraphia is not a reliable marker for familial disease.     

Frequency of behavioral symptoms characterizes agitation in Alzheimer's disease

This study describes two well-characterized groups of Alzheimer's disease (AD) patients with similar levels of cognitive functioning, but with different overall behavioral disturbance levels. We sought to determine the nature of this difference-whether AD patients with higher levels of behavioral disturbance (n = 148) differ from less disturbed AD patients (n = 235) in terms of (a) the range of symptoms exhibited, (b) the frequency of occurrence of these symptoms, or (c) both of these. We defined and operationalized 'diversity of behaviors' and 'frequency' with respect to the item-level responses on the Cohen-Mansfield agitation inventory (CMAI). We found that, in these two samples of AD patients, differences occurred in the frequency of 10 out of 21 behaviors, rather than in a variety of endorsed behaviors. These 10 behaviors, observed at different frequencies in both groups, may be useful for monitoring change in studies of drugs or behavioral interventions for behavioral disturbance in persons with AD.     

Central and peripheral agraphia in Alzheimer's disease: from the case of Auguste D. to a cognitive neuropsychology approach

Since the observation of Auguste D. by Al?is Alzheimer, it is an acknowledged fact that writing is one of the cognitive functions that are weakened early in Alzheimer's disease (AD). This study aimed to examine the cognitive nature of this disorder and question the hypothesis of a standard progression (Platel et al., 1993) from lexical to other central and more peripheral processes. A large group of mild to moderate AD patients (n=59) and a group of healthy elderly controls were submitted to an extensive assessment of both the central and peripheral components of writing. A comparison of groups indicated that AD patients performed more poorly than controls on a wide range of writing measures. It revealed a predominantly lexical disorder, but also found evidence of associated disorders located at different stages in the spelling system (phonological route, graphemic buffer, allographic store, graphic motor patterns). A multiple single-case analysis, using a specific methodology, allowed us to delimit individual profiles of agraphia. It revealed a wide variety of agraphia syndromes, including a far from negligible number of patients with selective damage to one of the central or peripheral components, as well as patients with multiple writing impairments. A positive correlation was observed between the severity of the dementia and spelling/writing measures (lexical and allographic). This study does not support the hypothesis of a uniform progression. Rather, it points to heterogeneous profiles of agraphia and suggests that the first signs of writing impairment in AD stem from changes at different points in the broad anatomical network subserving spelling and writing abilities.     

Sleep disturbance in mild to moderate Alzheimer's disease

BACKGROUND AND PURPOSE: To determine the prevalence of sleep disturbance in a memory clinic population of Alzheimer's disease (AD) patients and identify its clinical correlates. PATIENTS AND METHODS: Data from 215 attendees at a memory clinic, who were diagnosed with Alzheimer's disease, were examined. This included data from cognitive, functional and neuropsychological assessments. Sleep disturbance was determined using the question about diurnal rhythm disturbance on the BEHAVE-AD questionnaire. Two groups, with and without sleep disturbance, were compared. Group differences were analysed using univariate analysis and stepwise logistic regression analysis. RESULTS: The prevalence of sleep disturbance in this sample was 24.5%. The BEHAVE-AD 'aggressiveness' (P=0.009) and 'global rating' (P=0.029) (a measure of global impact of behavioural disturbance) were found to be significant predictors of sleep disturbance in AD. CONCLUSIONS: Sleep disturbance in AD is associated with other behavioural symptoms, notably aggressiveness. Sleep disturbance in AD has significant impact on the patient and/or caregiver. Consideration of co-morbid behavioural symptoms may aid the clinician in choosing a suitable treatment for sleep disturbance in AD.     

Disrupted sleep and circadian patterns in frontotemporal dementia

Background:  A study of the pattern of Sleep/Wake disturbance in frontotemporal dementia (FTD).
Methods:  Sleep diaries and prolonged actigraphy were used to record the activity, sleep and wake of 13 patients with a clinical diagnosis of FTD. These were compared with diaries and actigraphy from normal age/sex matched controls and also to a population with probable Alzheimer's disease (AD).
Results:  There was significant sleep/wake disturbance in FTD. This occurred throughout the course of the illness and the nature of the sleep disturbance was different to patients with AD. FTD subjects showed increased nocturnal activity and decreased morning activity compared with controls, suggesting possible phase delay. Sleep diary data confirmed decreased sleep efficiency and decreased total sleep in all FTD patients.
Conclusions:  We describe significant sleep disturbance in non-institutionalized patients with FTD and suggest that early sleep disturbance may help differentiate between FTD and AD.     

Alzheimer病与血管性痴呆临床特点的对照研究

目的 比较Alzheimer病(AD)与血管性痴呆(VD)的临床特点。方法 通过详细收集临床资料，并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)、日常生活能力量表(ADL)评定，对38例AD与30例VD患者的发病情况、行为、精神症状特点、认知功能、日常生活能力等进行比较。结果 VD患者多急性发病、呈阶梯性病程、伴有高血压和卒中史；AD患者脑电图改变主要是双额叶及双枕叶的节律改变，以θ波及δ波为主要活动，而VD患者以不对称为主要表现；抑郁、焦虑、欣快的发生率VD患者明显高于AD患者，而幻觉、妄想、饮食障碍则明显低于AD患者；时间定向、地点定向、物体命名评分AD患者明显低于VD患者，而图形描述评分高于VD患者；AD和VD患者存在着躯体生活、工具使用能力下降的不平衡，VD患者躯体生活能力下降更明显。结论 AD与VD患者的临床特点不同，发病基础、行为、精神症状、认知功能、智能障碍、日常生活能力的评价及CT和脑电图的检查等对痴呆的诊断与鉴别诊断均具有重要价值。     

Neural substrates for writing impairments in Japanese patients with mild Alzheimer's disease: a SPECT study

Language is fairly well preserved in most patients with mild Alzheimer's disease, but writing ability seems to be impaired even in the early stages of the disease. To investigate the neural bases of writing impairments in Alzheimer's disease (AD), we examined the correlation between writing ability and regional cerebral blood flow (rCBF) in 52 Japanese patients with mild AD compared to 22 controls, using single photon emission computed tomography (SPECT). We found that, compared with control subjects, Kana writing to dictation and copying Kanji words were preserved in AD patients, but writing to dictating Kanji words was impaired. We classified the errors in the Kanji dictation task into four types to investigate the correlation between rCBF and the error type, as follows: non-response errors, phonologically plausible errors, non-phonologically plausible errors, and peripheral errors. Non-response errors, which indicated difficulty with retrieving Kanji graphic images, were the most frequent. When controlled for confounding factors, the number of non-response errors negatively correlated with rCBF in the left inferior parietal lobule, the posterior middle and inferior temporal gyri, and the posterior middle frontal gyrus. Thus, the impaired recall of Kanji in early Alzheimer's disease is related to dysfunctional cortical activity, which appears to be predominant in the left frontal, parietal, and temporal regions.