颈动脉狭窄患者认知损害的临床特点研究

目的了解颈动脉狭窄患者的认知损害特点,并探讨与之相关的可能机制。方法选取91例TIA或小卒中患者作为研究对象,进行TCD和CTA或DSA检查,依据颈动脉狭窄程度将患者分为狭窄组43例(狭窄率≥50%)和对照组48例(狭窄率<50%),采用蒙特利尔认知评估量表(MoCA)对患者进行认知评估,然后对两组患者MoCA总分、子测试得分及相关危险因素进行比较。结果校正性别、年龄、受教育年数、高血压、糖尿病、吸烟和血脂异常因素后,狭窄组患者MoCA总分、执行功能(交替连线试验)、视空间结构功能(复制立方体和画钟)、延迟回忆功能(延迟回忆)方面的测试成绩均低于对照组,差异具有显著性(P<0.05),而命名力、注意力、语言能力、抽象力、定向力,组间差异无显著性(P>0.05)。结论颈动脉狭窄患者存在认知损害,以执行功能、视空间结构功能和延迟回忆功能方面的显著受损为特点。多重血管性危险因素可能促进颈动脉狭窄患者的认知功能减退。     

颈内动脉重度狭窄或闭塞患者脑血管反应性和认知功能的相关性研究

目的 探讨不同部位颈内动脉重度狭窄或闭塞患者的脑血管反应性(cerebral vascular reactivity,CVR)和认知功能改变的特点及两者的相关性。方法 选取颈内动脉重度狭窄或闭塞患者58例为病例组,按照狭窄部位分为左侧狭窄组、右侧狭窄组和双侧狭窄组,另选取正常人20例为对照组,采用经颅多普勒超声(transcranial Doppler,TCD)结合屏气试验分别检测各组屏气指数(breath-holding index,BHI),用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评估各组的认知功能。结果 病例组的BHI均低于对照组,双侧狭窄组低于左、右侧狭窄组; 右侧狭窄组的MoCA视空间/执行得分低于左侧狭窄组和对照组,左侧狭窄组的延迟记忆得分低于右侧狭窄组和对照组,双侧狭窄组的视空间/执行、延迟记忆和语言功能得分均低于对照组,且MoCA总分低于左、右侧狭窄组; 病例组内的BHI与MoCA总分呈正相关(r=0.411,0.474,0.868,P<0.05)。结论(1)颈内动脉重度狭窄或闭塞患者的BHI明显降低,认知功能也有不同程度损害;(2)颈内动脉重度狭窄或闭塞患者的BHI和MoCA总分有明显关系,将两者结合可更全面地反映认知功能。     

头部MRI阴性的颞叶内侧癫痫患者认知功能障碍研究

目的评估头部MRI阴性颞叶内侧癫痫(MTLE)患者认知功能受损特点。方法回顾性分析27名头部MRI阴性的MTLE患者资料,其中左侧MTLE 14例(左侧MTLE组),右侧MTLE 13例(右侧MTLE组)。癫痫患者与性别、年龄和受教育程度严格匹配的14名健康对照者(对照组)均接受蒙特利尔认知评估量表(Mo CA)和失礼识别任务的测评。结果在Mo CA得分方面,两组MTLE患者的Mo CA总分及各分项测试得分均低于对照组(P 0. 05);右侧MTLE组复制立方体得分低于左侧MTLE组和对照组(P 0. 05);右侧MTLE组的画钟试验得分低于左侧MTLE组(P 0. 05);左侧MTLE组句子复述、语言流畅性测试得分低于右侧MTLE组(P 0. 05)。在失礼识别任务得分方面,两组MTLE患者得分均低于对照组(P 0. 05);左侧MTLE组比右侧MTLE组更低(P 0. 05)。结论头部MRI阴性MTLE患者的一般认知功能及高级社会认知功能均受损。     

颈动脉粥样硬化患者认知功能与事件相关电位的改变及其关系

目的 探讨颈动脉粥样硬化(CAS)患者认知功能与事件相关电位(ERP)的改变及其关系.方法 对65例不同程度CAS患者进行简易精神状态检查量表(MMSE)和ERP P300检查及相关性分析;并与对照组进行比较.结果 与对照组比较,轻中度CAS组的注意计算、短程记忆、图形描画评分明显降低(均P＜0.05);P300潜伏期延长、波幅降低 (均P＜0.05);重度CAS组差异更明显(均P＜0.01).与轻中度颈动脉狭窄组比较,重度颈动脉狭窄组在时间定向力、地点定向力、注意计算、短程记忆、言语复述、语言表达、图形描画7个亚项评分方面有显著降低(均P＜0.05);P300潜伏期延长、波幅降低 (均P＜0.05).轻中度、重度CAS患者的MMSE评分与P300潜伏期呈负相关(r=-0.503,-0.589,均P＜0.05),轻中度、重度颈动脉狭窄患者的MMSE评分与P300潜伏期亦呈负相关(r=-0.497,-0.601,均P＜0.05).结论 CAS可导致认知功能障碍和ERP异常,其程度与颈动脉病变程度有关.     

脑血管不同程度狭窄患者认知功能损害的差异

目的探讨不同程度头颈部脑血管狭窄患者认知功能受损程度上的差异。方法选取头颈部狭窄患者90例,根据血管狭窄程度分为轻度狭窄组、中度狭窄组和重度狭窄或闭塞组。重度狭窄或闭塞组根据患者狭窄的部位分为颅内血管狭窄组和颈动脉狭窄组,另选取我院健康体检者80例为对照组。采用MMSE量表和Mo-CA量表对各组进行认知功能测试,比较各组认知功能差异。结果轻度和中度狭窄组患者认知功能与对照组相比差异无统计学意义(P0.05),重度狭窄或闭塞组患者认知功能显著差于对照组(P0.05),重度狭窄或闭塞组中颈动脉狭窄组认知功能显著低于颅内血管狭窄组(P0.05)。结论脑血管重度狭窄或闭塞患者存在一定程度的认知功能损害,这可能与重度脑血管狭窄或闭塞患者低灌注脑血流有关。     

老年慢性脑供血不足认知障碍的研究

目的 分析老年性慢性脑供血不足(CCCI)蒙特利尔认知评估量表(MoCA)及P300改变的特点,以期提高对CCCI认知功能受损的诊断水平.方法 使用MoCA对22例住院老年CCCl患者及16例对照组进行认知功能测定.使用肌电-诱发电位仪的oddball程序检测患者及对照组的P300.结果 老年CCCI组MoCA评定总分低于对照组,差异显著(18.23±1.8 vs 22.19±5.96,P＜0.05)对各项得分分析显示,主要表现在视空间与执行功能和记忆两项差异显著(2.18±0.66 vs 2.62±1.15,P＜0.05;2.64±0.66 vs 3.44±1.15,P＜0.05).老年CCCI组P300峰潜伏期较对照组明显延长(445.45±37.5)ms vs(336.38±16.50)ms,P＜0.01.结论 老年CCCI患者认知功能受损,主要表现在视空间与执行功能和记忆受损较为突出,老年CCCl患者P300峰潜伏期延长反映认知功能受损.MoCA和P300是评估老年CCCI患者认知功能简单有效的方法.     

多发性硬化认知障碍评估及其影响因素分析

目的了解多发性硬化(MS)患者认知功能障碍的特点及其相关因素分析。方法对41例MS患者及41例健康对照组进行蒙特利尔认知评估量表(MoCA)智能测试和常规头颅磁共振(MRI)检查,对41例MS患者进行扩展功能障碍状态量表(EDSS)检查。结果 MS组MoCA得分较对照组明显降低,差异具有统计学意义(P0.01);MoCA评分降低的项目主要以视空间与执行功能、延迟记忆、命名、语言为著,而注意力、抽象能力、计算力及定向力未见明显受损;MoCA评分除与受教育程度、MS分型具有相关性(Pearson相关系数分别为0.576、0.366,P值分别为0.000、0.019)外,与性别、年龄、病程、EDSS评分及常规头颅MRI病灶等级等临床资料均无相关性(P0.05)。结论 MS患者存在认知功能障碍,以视空间与执行功能、命名、延迟记忆、语言为著,注意、计算、抽象、定向能力未见明显受损;MS患者认知功能障碍与患者性别、年龄、病程、神经功能缺损程度、常规头颅MRI所示病灶等级无相关;躯体功能障碍越严重,视空间与执行功能得分越低,即操作智商得分越低。     

脑白质病变与轻度认知功能障碍的关系

目的 探讨脑白质病变(WML)与轻度认知功能障碍(MCI)的关系.方法 71例WML患者根据头颅MRI检查分为轻度组(27例)、中度组(21例)、重度组(23例),39例无WML的对照者为对照组.对入组者进行神经心理学量表检查;比较各组MCI的患病率,分析WML与MCI的相关性.结果 WML轻、中、重度组的MCI患病率明显高于对照组(均P＜0.01);WML中、重度组简易精神状态检查(MMSE)及蒙特利尔认知评估量表(MoCA)评分显著低于WML轻度组和对照组(均P＜0.01);随着WML程度的加重,除了抽象能力评分,MoCA其他各认知领域的评分均显著降低(均P＜0.05).多元线性相关分析显示,WML程度与MMSE、MoCA总分及除抽象思维能力的各认知域评分呈负相关(r=-0.252 ～-0.782,均P＜0.01).结论 WML可导致MCI,其对认知功能障碍的影响与WML的程度有关.     

康复期脑梗死患者蒙特利尔认知评估及其相关因素研究

目的探讨中文版蒙特利尔认知评估表(MoCA)对脑梗死患者认知功能的评分特点,并观察脑梗死部位、吸烟与饮酒因素对MoCA评分的影响。方法选取脑梗死患者150例,记录梗死部位、有无吸烟及饮酒史,并使用MoCA进行评分,分析结果。结果患者抽象、延迟回忆、视空间与执行功能、语言方面得分不高,而命名、注意、定向的得分较理想。左侧半球与右侧半球梗死患者比较,在总分、注意、语言、抽象、延迟回忆和定向方面得分差异具有统计学意义(P0.05)。有吸烟史与无吸烟史患者注意、语言和延迟回忆方面得分比较差异具有统计学意义(P0.05)。有饮酒史与无饮酒史总分、视空间与执行功能、注意与定向方面得分比较差异具有统计学意义(P0.05)。结论 MoCA在临床中评定脑梗死患者认知障碍程度具有可靠的标准效度,脑梗死部位、吸烟与否、饮酒与否均影响患者的认知障碍程度。     

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.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.     

Relationship Between Sluggish Cognitive Tempo and Age and IQ in Preschool and School-Age Children and Adolescents with Autism and with ADHD

Journal of Autism and Developmental Disorders - Relationships between sluggish cognitive tempo (SCT) and age and IQ were investigated in children with autism and/or ADHD covering broader age and IQ...     

Synaptic plasticity and learning and memory: LTP and beyond.

Long-term potentiation (LTP) of synaptic activity is by far the most popular and widely researched model of synaptic plastic changes that might occur during learning. Numerous recent reports, however, have not found a correlation between the inducibility of LTP in the hippocampus and the ability of animals to learn hippocampus-dependent tasks. For example, some experiments with gene deletion (knockout) mice strains have shown that in some strains LTP is not inducible in the dentate gyrus, in area CA3, or CA1, but the animals are still able to learn spatial tasks. This apparent mismatch has rejuvenated the discussion concerning whether LTP is a good model for mechanisms that underlie memory formation in the nervous system. This review analyzes the conditions under which LTP is induced or learning takes place and suggests reasons for the mismatches that can occur and what we can learn from them. High-frequency stimulation protocols and in vitro assays cannot be seen to resemble natural firing patterns or conditions found in the brain. More physiological experimental conditions, especially in vivo recording in awake animals, could lead the way to the development of improved models of learning mechanisms that better correlate with learning abilities of animals.