熟悉音乐刺激干预对痴呆患者病感失认的随机对照研究

目的探讨熟悉音乐刺激干预对痴呆患者病感失认和生命质量的影响, 为制订个体化干预措施提供参考。方法采用前瞻性、随机对照研究方法, 便利抽样选取2020年1月至2022年6月南京医科大学附属脑科医院收治的104例痴呆患者, 按照随机数字表法分为试验组和对照组各52例。2组患者均给予常规治疗和护理, 试验组给予熟悉音乐刺激干预, 对照组采用不熟悉的音乐干预。干预前和干预3个月后, 采用痴呆病感失认问卷、痴呆生命质量量表评价干预效果。结果干预后, 试验组病感失认总分以及认知减退、人格改变维度得分分别为(27.73 ± 4.56)、(17.37 ± 3.83)、(10.37 ± 2.81)分, 低于对照组的(31.50 ± 4.76)、(19.31 ± 3.67)、(12.19 ± 2.74)分, 差异均有统计学意义(t = 3.98、2.55、3.23, 均P<0.05)。试验组生命质量总分以及正性情绪、归属感、审美感受维度得分分别为(93.12 ± 8.92)、(18.88 ± 3.75)、(9.08 ± 3.25)、(15.27 ± 4.51)分, 高于对照组的(88.73 ± 8....     

脑血管病患者失认症的神经心理学研究

为了解脑血管病患者失认症的类型与半球侧向性,对35例经影像学证实为单一病灶的脑血管病患者进行了汉语失语症检查法及自行设计的失认症检查法测试。结果显示：左半球组出现了物体、图画、色彩的失认,失认性失算,听失认,触觉失认,忽视,地理失定向,身体失认和病觉缺失;右半球组出现了色失认,忽视,地理失定向和病觉缺失。结论：大多数右利手患者的视觉、听觉、触觉、身体认知的优势半球位于左侧大脑半球;右半球可以产生色失认;忽视、病觉缺失在任何半球病变均可产生,右半球的机率高于左半球     

循证护理的理论与实践

老年人谵妄、痴呆和抑郁的护理策略3相关证据3.4痴呆患者的护理痴呆的主要特点就是多重认知缺陷,引起患者的社会或职业功能损害和原先功能的下降.这些认知缺陷包括记忆损害和至少一种以下症状:失语、失用、失认或执行功能下降.影响痴呆患者接受合理及时照顾的一个难点就是诊断,早期阶段的痴呆患者往往处于未被识别和诊断的状态.     

痴呆患者家庭照顾者病耻感现状及影响因素分析

目的:调查痴呆患者家庭照顾者的病耻感水平并分析其影响因素,以期为医护人员制定降低照顾者病耻感的干预措施提供依据。方法:选取2017年12月～2018年3月在东营市某三级甲等医院神经内科记忆门诊就诊的133例患者及照顾者为研究对象,采用自行设计的一般情况调查表、连带病耻感量表对其病耻感现状进行调查。结果:痴呆患者家庭照顾者的病耻感总分为(47. 414±9. 069)分;痴呆患者照顾者的年龄、文化程度、婚姻状况(未婚)、家庭人均月收入及患者的性别负向影响照顾者病耻感水平,而照顾者的居住地、照顾情况、与患者的关系(子女)及痴呆严重程度可正向预测照顾者病耻感水平(P 0. 05),共解释痴呆患者家庭照顾者病耻感的75. 80%。结论:痴呆患者家庭照顾者的病耻感水平处于中等偏高的水平,影响因素包括照顾者年龄、居住地、文化程度、婚姻状况(未婚)、照顾情况、家庭人均月收入、与患者的关系(子女),患者的性别及痴呆严重程度,提示医护人员可有针对性地给予心理支持和干预,降低照顾者的病耻感水平,改善其心理健康状况。     

经验性回避在痴呆患者家庭照顾者附属病耻感与照顾负担间的中介作用

目的 分析经验性回避在痴呆患者家庭照顾者附属病耻感与照顾负担间的中介作用。方法 采用便利抽样法,于2021年10月—2022年2月选取河南省郑州市2家三级甲等医院神经内科门诊及住院部痴呆患者的家庭照顾者为研究对象。采用附属病耻感量表、接纳与行动问卷及Zarit照顾者负担量表对其进行调查,采用SPSS 25.0分析痴呆患者家庭照顾者照顾负担、附属病耻感与经验性回避的相关性,采用AMOS 24.0分析经验性回避在附属病耻感与照顾负担间的中介作用。结果 本组痴呆患者家庭照顾者附属病耻感总分为（44.50±11.68）分、经验性回避总分为（23.57±11.25）分、照顾负担总分为（43.99±11.81）分。痴呆患者家庭照顾者照顾负担总分与经验性回避总分呈正相关（r=0.298,P<0.01）、与附属病耻感总分呈正相关（r=0.210,P<0.01）;附属病耻感总分与经验性回避总分呈正相关（r=0.264,P<0.01）。经验性回避在痴呆患者家庭照顾者附属病耻感与照顾负担间起部分中介作用,中介效应值为0.057,效应占比为19.9%。结论 本组痴呆患者家庭照顾者附属病耻感、经验性回避及照顾负担均处于中等水平,经验性回避在痴呆患者家庭照顾者附属病耻感与照顾负担间起部分中介作用。提示医护人员及社区卫生保健工作者可通过减轻痴呆患者家庭照顾者附属病耻感,降低经验性回避,以减轻其照顾负担。     

痴呆相关病耻感研究进展

本文通过对国内外相关文献的回顾,综述痴呆相关病耻感的产生、测量工具、造成的影响及降低痴呆相关病耻感的干预措施,反思现状并结合我国痴呆群体特点,给出降低痴呆相关病耻感的相关建议。     

脑卒中患者认知障碍研究进展*

脑卒中是神经系统常见病和多发病,不仅引起偏瘫和各种神经定位症状和体征,而且还可以导致记忆障碍、失语、失认、失用、视觉空间障碍等认知功能障碍,甚至发生痴呆~([1]).认知障碍与偏瘫等症状一样,对脑卒中患者的预后都有重要影响.本文就脑卒中患者认知障碍的发生情况、发生机制、危险因素和防治作一综述.     

老年期痴呆的诊断与鉴别

老年期痴呆是指发生在老年期的智能障碍,最常见的是阿尔茨海默病(AD)和血管性痴呆(VD)。AD患者的核心症状是记忆障碍,认知障碍,语言和视空间功能障碍,失认,失用等;多梗死性痴呆(MID)是VD中最常见的类型,患者有多次缺血性脑血管病事件;具有脑梗死局灶定位体征,认知功能障碍表现近记忆力、计算力减退,表情淡漠,焦虑,少语,抑郁或欣快,不能胜任以往熟悉的工作和进行正常交往。可急性起病和阶段性进展,智能损害往往呈斑片状缺损,与血管病变的部位及大小有直接的关系。     

照料者因素与痴呆患者随访依从性的相关性研究

目的了解痴呆患者随访依从性及照料者照料现状,探索照料者因素与痴呆患者随访依从性的相关性及其他影响因素。方法选取2014年11月-2015年7月我院神经内科门诊或住院的痴呆患者285例,对患者随访(180±7)d,根据完成随访与否分为随访组和失访组,对两组患者及主要照料者进行连续观察,包括确定患者痴呆类型、疾病严重程度,调查痴呆患者照料现状及照料者相关因素等。统计随访者及失访者影响因素,采用Logistic回归分析影响随访依从性的因素。结果最终完成随访的患者为153例(53.68%),失访者为132例(46.32%)。对可能影响随访依从性的因素进行分析发现,不仅患者文化程度、患者病程、抗痴呆药物治疗为独立相关因素,照料者的文化程度、是否单独照料者也分别是影响痴呆患者随访依从性的独立相关因素。结论我院入组研究的痴呆患者中重度认知障碍患者所占比率高,患者随访依从性良好率不高,照料者因素中照料者文化程度、是否单独照料者与随访依从性独立相关。     

阿尔茨海默病患者语言认知研究进展

阿尔茨海默病(Alzheimer‘s disease，AD)是一种神经系统进行性变性疾病，是痴呆最常见的原因之一。其临床特点是隐袭起病、持续进展的智能衰退，以认知缺陷为特征，记忆障碍突出，可有视空间障碍、失语、失算、失用、失认、人格改变等，并导致患者社交、生活或职业功能缺损。随着人口老龄化的发展，AD成为老年人最常见的痴呆类型之一。对AD的早期诊断和早期干预成为目前学者们研究的主要方面。     

Cognitive interventions for mild cognitive impairment and dementia: An overview of systematic reviews

PurposeConducting an overview of systematic reviews (SRs)/Meta analyses (MAs) to assess the effectiveness of cognitive interventions on participants with mild cognitive impairment (MCI) or dementia and evaluate the methodological quality of SRs/MAs.MethodsPubMed, EMBASE, Cochrane library, Web of science, China National Knowledge Infrastructure (CNKI) and Chinese Biomedical Databases (CBM) were systematically searched from inception to January 1, 2019 to identify SRs/MAs. Three reviewers independently screened the articles, extracted data and assessed the quality of the included studies according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the quality of evidence.ResultsA total of 22 reviews were included. New meta-analyses (36 RCTs) showed that cognitive interventions were more effective than routine therapies for the alleviation of MCI and dementia symptoms (SMD: 0.62; 95%CI: 0.47, 0.78; I² = 53.9%). The results of AMSTAR-2 showed that the methodological quality of most included studies was critically low, and two reviews were low quality. The lowest score was item 10, none of reviews reported on the sources of funding for the included studies. Followed by the “provide a list of excluded studies and justify the exclusions” item with only one (4.5%) reviews conforming to this item. Results of GRADE manifested that moderate quality evidence was provided in 11 reviews (39.3%), 12 (42.9%) were low quality and 5 (17.8%) were very low.ConclusionThe present SRs/MAs indicated that persons with MCI or dementia could benefit from cognitive interventions. Future trial designs should focus on measuring changes in individual specific cognitive functions. More high-quality evidence is needed to further determine the effectiveness of cognitive interventions.     

An approach to the patient with cognitive impairment: delirium and dementia

Patients with cognitive impairment can be divided into 2 broad groups: those with chronic cognitive decline (most likely diagnosable with a dementia) and those with acute cognitive changes (most likely experiencing a delirium). However, diagnosis in clinical practice is far more complicated than it is in textbooks. Perhaps the greatest hurdle in evaluating the cognitively impaired patient is the clarification of a cohesive history. Unfortunately, the cognitively impaired patient is most often unable to provide such a history, and in the absence of a reliable family member, friend, or caregiver to fill in the gaps, diagnostic clarity can be difficult to achieve. This article outlines the broad diagnostic spectra of delirium and dementia, reviews current understanding of their pathogenesis, and discusses useful diagnostic and therapeutic techniques.     

Mild cognitive impairment: a review and nursing implications

The concept and classification of 'mild cognitive impairment' is disputed territory. This article reviews the literature on mild cognitive impairment and suggests that despite the complexity, early identification of dementia presents an ideal opportunity for nurses to work together with other statutory and voluntary partners, to provide support and intervention for people living with this stage of the condition and their families. Practice that is evidenced through individual and family history, coupled with a range of psychosocial interventions, including a quality-of-life appraisal, would seem an ideal way to structure support at this transitional point in time. A fictitious case study is included which demonstrates that stress and negative adjustment are just as likely to occur early in the course of dementia as later on in the condition.     

Issues related to quality of life measures for persons with dementia

The rising population of elderly worldwide has led to an increasing number of people with dementia. Managing and providing quality care for people with dementia has thus become a priority public health issue in developed countries. Dementia is a gradually degenerative disease. In the absence of a cure, improving, maintaining or maximizing quality of life is becoming the primary goal of nursing care for patients with this disease. Quality of life is an important outcome index of medical care and can be a criterion for making health economics decisions. The fact that dementia is a disease that presents steadily declining cognitive function has led to numerous challenges and debates regarding the optimal concepts and methodologies to be used to measure quality of life in those with dementia. This paper reviews relevant debates on these issues and makes suggestions that may serve as guides to monitoring / studying quality of life in dementia patients.     

Narrative intelligence in nursing: Storying patient lives in dementia care

This paper examines narrative approaches to care within the context of dementia. It reviews the function of stories and explores some of the narrative genres that shape the cultural perceptions of dementia. We argue that narrative intelligence within healthcare is an important element in nurturing communal self‐identity for people living with dementia. Listening and responding to stories and the cultural framework that this encompasses is an embodied action that is not just related to cognitive recall but situates us within a cultural community. People with dementia may have challenges in maintaining narrative legitimacy in the face of fractured stories and incoherent narratives. Health professionals can offer support in reframing and presenting counterstories that maintain identities that can potentially be marginalised, silenced and open to narrative foreclosure. This process requires health professionals to be attentive and responsive to how patients with dementia and their supporters construct and position the stories they tell and the meaning(s) they attach to them.     

Fall risk factors in older people with dementia or cognitive impairment: a systematic review

Title.  Fall risk factors in older people with dementia or cognitive impairment: a systematic review.
Aim.  This paper is a report of a review conducted to identify and summarize specific risk factors for falls in older people with dementia or cognitive impairments as documented by prospective or case–control studies.
Background.  People with dementia have a doubled to threefold risk for falls, but the reasons for this have not yet been fully explained. Several integrative literature reviews discuss possible specific fall risk factors. However, there is lack of a systematic evaluation of studies.
Data sources.  The CINAHL, PubMed, EMBASE and PsychInfo databases were searched for the period between 1980 and May 2007.
Review methods.  A systematic review was conducted. Cohort or case–control studies published in English or German were included if they investigated risk factors for falls or fall-related injuries in a sample consisting of participants with dementia or cognitive impairment. Two reviewers independently assessed study quality.
Results.  Six prospective studies were included in the review. These differed concerning samples, settings, follow-up periods and examined variables. Therefore, meta-analysis was not possible. Eight categories of risk factors emerged: disease-specific motor impairments, impaired vision, type and severity of dementia, behavioural disturbances, functional impairments, fall history, neuroleptics and low bone mineral density.
Conclusion.  There is lack of sound studies examining fall risk factors in cognitively impaired elders. Well-known risk factors such as motor impairment show particular characteristics in people with dementia. In addition, behavioural disturbances contribute to their high risk for falls. Further prospective studies are needed.     

回忆疗法在痴呆症病人中的应用进展

阐述回忆疗法的来源、方法及形式,综述回忆疗法在痴呆症病人中的应用进展。指出回忆疗法作为痴呆症病人的非药物治疗方法,可改善病人认知功能和精神行为症状。但目前回忆疗法在干预时间、频率、开展的形式以及具体的量表方面尚缺乏规范性指南,多是小样本研究,临床干预时间较短。今后应进行多中心、大样本试验研究,开展长期评估跟踪研究,同时应考虑国情、文化背景等问题。     

Anosognosie de l’hémiplégie, personnification de la main paralysée et image du corps

Psychological theories relating to anosognosia for hemiplegia generally suggest that anosognosic patients deny their hemiplegia in order to protect their self-image or avoid negative emotions: that a person tries to deny, refuse or forget hemiplegia, a major handicap, seems an understandable attitude. The psychological theories concerning anosognosia thus imply that psychological reactions to hemiplegia are not affected by the causal cerebral lesions. These interpretations do not account either for the link between right hemisphere lesions and anosognosia or for the links between anosognosia, body schema disorders and specific characteristics of the patients’ discourse when describing their paralysed limbs. The psychoanalytical conception of the links between self-representation and body image enables us to apprehend anosognosia as a neurological pathology of body image.     

Mild Cognitive Impairment and Mild Dementia: A Clinical Perspective

Mild cognitive impairment and mild dementia are common problems in the elderly. Primary care physicians are the first point of contact for most patients with these disorders and should be familiar with their diagnosis, prognosis, and management. Both mild cognitive impairment and mild dementia are characterized by objective evidence of cognitive impairment. The main distinctions between mild cognitive impairment and mild dementia are that in the latter, more than one cognitive domain is invariably involved and substantial interference with daily life is evident. The diagnosis of mild cognitive impairment and mild dementia is based mainly on the history and cognitive examination. The prognosis for mild cognitive impairment and mild dementia is an important motivation for diagnosis because in both, there is a heightened risk for further cognitive decline. The etiology of mild cognitive impairment and mild dementia can often be established through the clinical examination, although imaging and other laboratory tests may also contribute. Although Alzheimer disease is the most common cause of both, cerebrovascular disease and Lewy body disease make important contributions. Pharmacological treatments are of modest value in mild dementia due to Alzheimer disease, and there are no approved pharmacological treatments for mild cognitive impairment of any etiology. Nonetheless, new-onset cognitive impairment is a worrisome symptom to patients and families that demands answers and advice. If a patient is having difficulties managing medications, finances, or transportation independently, diagnosis and intervention are necessary to ensure the health and safety of the patient.