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1.
背景阿尔茨海默病(Alzheimer disease,AD)和轻度认知功能障碍(mild cognitive impairment,MCI)患者均以记忆障碍为早期突出表现,但临床上患者常有注意力下降的表现,影响到工作和日常生活.目的探讨轻度AD患者和MCI患者的持续注意、选择注意和分散注意功能.设计病例-对照研究.单位一所大学医院神经内科和一所大学的心理学系.对象实验于2003-11/2004-01在北京大学第一医院神经心理室完成,选择18例轻度AD患者(AD组),19例MCI患者(MCI组)和20例正常对照组.干预对轻度AD患者、MCI患者和正常对照进行持续操作任务(continuous performance test,CPT)实验测查持续注意功能,简化的斯特鲁普(Stroop)实验测查选择注意功能,应用纸笔形式的双任务实验测查分散注意能力.主要观察指标在CPT和Stroop实验中主要观察反应时和错误率,在双任务实验中主要观察双任务下降程度.结果CPT实验中,轻度AD组反应时、漏报率和虚报率均高于正常对照组[(539.29±103.86)ms比(458.47±40.87)ms,4.08%(3.13,13.64)比0.91%(0.60,1.90),1.51%(0.64,2 54)比0.43%(0.37,0.84),P<0.05],MCI组和正常对照组间无差别;3组的漏报率随时间增高,10~15 min明显.10 min后轻度AD患者的异常率明显增高(10 min内异常率为33 33%,20 min异常率77 8%).Stroop实验中,3组被试均表现出明显的干扰效应;轻度AD组反应时长于MCI组和正常对照组[(579 19±89.93)ms,(524.28±68.96 ) ms,(486.75±51.58)ms,P<0 05],错误率干扰量高于其他两组[11.25%(7 50,22.50),2 50%(-2.50,5.00),2.50%(0.00,4.38),P<0.05];MCI组总错误率以及一致和中性条件下的错误率高于正常对照组[5.83%(4.17,8.33)比2.92%(1.67,3.96),5.00%(2.50,7.50)比0.00%(0.00,2.50),5 00%(2.50,10.00 )比2.50%(0.00,5.00),P<0.05].双任务实验中轻度AD组双任务减退量高于MCI组和正常对照组[1.03(0.49,3.75),0.46(0.08,1.02),0.10(-0.25,0.64),P<0.05];MCI组和正常对照组间无差别.同一组轻度AD患者,Stroop实验和CPT实验异常率高于双任务实验(81.25%,77.8%,29.41%).结论与正常老年人相比,轻度AD患者的持续注意、选择注意和分散注意能力下降,选择及持续注意障碍较突出.MCI患者选择注意功能有下降的趋势,持续和分散注意正常.轻度AD患者、MCI患者和正常老年人持续注意能力随时间下降,10 min后明显.较长时间的CPT实验容易检出轻度AD患者的持续注意障碍.  相似文献   

2.
背景:阿尔茨海默病(Alzheimer disease,AD)和轻度认知功能障碍(mild cognitive impairment,MCI)患者均以记忆障碍为早期突出表现,但临床上患者常有注意力下降的表现,影响到工作和日常生活:目的:探讨轻度AD患者和MCI患者的持续注意、选择注意和分散注意功能。设计:病例-对照研究:单位:一所大学医院神经内科和一所大学的心理学系。对象:实验于2003—11/2004—01在北京大学第一医院神经心理室完成,选择18例轻度AD患者(AD组),19例MCI患者(MCI组)和20例正常对照组。干预:对轻度AD患者、MCI患者和正常对照进行持续操作任务(continuous performance test,CPT)实验测查持续注意功能,简化的斯特鲁普(Stroop)实验测查选择注意功能,应用纸笔形式的双任务实验测查分散注意能力。主要观察指标:在CPT和Stroop实验中主要观察反应时和错误率,在双任务实验中主要观察双任务下降程度。结果:CPT实验中,轻度AD组反应时、漏报率和虚报率均高于正常对照组[(539.29&;#177;103.86)ms比(458.47&;#177;40.87)ms,4.08%(3.13.13.64)比0.91%(0.60,1.90),1.51%(0.64,2.54)比0.43%(0.37,0.84),P&;lt;0.05],MCI组和正常对照组间无差别;3组的漏报率随时间增高,10~15min明显:10min后轻度AD患者的异常率明显增高(10min内异常率为33.33%,20min异常率77.8%)。Stroop实验中,3组被试均表现出明显的干扰效应;轻度AD组反应时长于MCI组和正常对照组[(579.19&;#177;89.93)ms,(524.28&;#177;68.96)ms,(486.75&;#177;51.58)ms,P&;lt;0.05],错误率干扰量高于其他两组[11.25%(7.50,22.50),2.50%(-2.50,5.00),2.50%(0.00.4.38),P&;lt;005];MCI组总错误率以及一致和中性条件下的错误率高于正常对照组[5.83%(4.17.8.33)比2.92%(1.67,3.96),5.00%(2.50,7.50)比0.00%(0.00,2.50).5.00%(2.50.10.00)比2.50%(0.00,5.00),P&;lt;0.05]。双任务实验中轻度AD组双任务减退量高于MCI组和正常对照组[103(0.49,3.75),0.46(0.08,1.02),0.10(-025,0.64),P&;lt;0.05];MCI组和正常对照组间无差别。同一组轻度AD患者,Stroop实验和CPT实验异常率高于双任务实验(81.25%,77.8%,29.41%)。结论:与正常老年人相比,轻度AD患者的持续注意、选择注意和分散注意能力下降,选择及持续注意障碍较突出。MCI患者选择注意功能有下降的趋势,持续和分散注意正常。轻度AD患者、MCI患者和正常老年人持续注意能力随时间下降,10min后明显。较长时间的CPT实验容易检出轻度AD患者的持续注意障碍。  相似文献   

3.
目的 探讨轻度认知功能障碍(MCI)患者的视觉注意功能.方法 采用基本认知能力测验和事件相关电位(ERPs)技术--视觉Oddball试验对16例老年MCI患者(MCI组)和17名年龄匹配的正常老年人(对照组)进行测试,对基本认知能力测验结果、ERPs的行为数据、P3b(选择性注意)和P3a(非选择性注意)的波幅和潜伏期进行比较.结果 MCI组的无意义图形再认和双字词再认成绩明显低于对照组,差异有统计学意义(P<0.05);MCI组的正确率明显低于对照组,反应时明显长于对照组,差异均有统计学意义(P<0.01);MCI组P3a波幅明显低于对照组,P3b潜伏期明显短于对照组,差异有统计学意义(P<0.01);MCI组和对照组无意义图形再认正确数均与P3a波幅相关(P<0.01).结论 MCI患者的非选择性注意功能下降,选择性注意反应速度减慢.  相似文献   

4.
目的 探讨轻度认知功能障碍(MCI)患者的视觉注意功能.方法 采用基本认知能力测验和事件相关电位(ERPs)技术--视觉Oddball试验对16例老年MCI患者(MCI组)和17名年龄匹配的正常老年人(对照组)进行测试,对基本认知能力测验结果、ERPs的行为数据、P3b(选择性注意)和P3a(非选择性注意)的波幅和潜伏期进行比较.结果 MCI组的无意义图形再认和双字词再认成绩明显低于对照组,差异有统计学意义(P<0.05);MCI组的正确率明显低于对照组,反应时明显长于对照组,差异均有统计学意义(P<0.01);MCI组P3a波幅明显低于对照组,P3b潜伏期明显短于对照组,差异有统计学意义(P<0.01);MCI组和对照组无意义图形再认正确数均与P3a波幅相关(P<0.01).结论 MCI患者的非选择性注意功能下降,选择性注意反应速度减慢.  相似文献   

5.
目的探讨质子磁共振波谱(^1H—MRS)对轻度认知功能障碍(MCI)和轻度Alzheimer病(AD)的诊断和鉴别诊断的作用。方法采用刺激回波序列(STEAM),对30例MCI患者、30例轻度AD患者和30例性别、年龄、文化程度匹配健康对照的双侧内侧颞叶^1H-MRS进行分析,比较各组间N-乙酰天门冬氨西受/肌酸(NAA/Cr)、胆碱/肌酸(Cho/Cr)和肌醇/肌酸(MI/Cr)、N-乙酰天门冬氨西受/肌醇(NAA/MI)比值及不对称指数的差别,并对MCI和轻度AD组的简易智能精神状态量表(MMSE)评分与NAA/Cr、Cho/Cr、MI/Cr、NA刖MI进行相关分析。结果MCI组的左侧NAA/Cr及轻度AD组的两侧NAA/Cr显著低于对照组(P〈0.05),MCI组和轻度AD组的两侧NAA/Cr无显著差异(P>0.05)。三组间的Cho/Cr无差异(P>0.05)。MCI组和轻度AD组的两侧MI/Cr显著高于对照组(P〈0.05),MCI组和轻度AD组的左侧MI/Cr有显著差异(P〈0.05)。MCI组和轻度AD组的两侧NAA/MI显著低于对照组(P〈0.05),MCI组和轻度AD组的左侧NAA/MI有显著差异(P〈0.05)。MCI、轻度AD和对照组的NAA/Cr、MI/Cr、NAA/MI有一定的左侧偏性,但三组之间的代谢物不对称指数无显著差异(P〉0.05)。MCI和轻度AD两组的MMSE评分与两侧NAA/Cr明显正相关(P〈0.05)。轻度AD组的MMSE评分与右NAA/MI明显正相关(P〈0.05)。两组合并的MMSE评分与左NAA/Cr、MI/Cr、NAA/MI明显正相关(P〈0.05)。结论MCI、轻度AD患者内侧颞叶NAA/Cr、NAA/MI比值的降低与MI/Cr比值的升高,以及MCI和轻度AD患者的左侧MI/Cr、NAA/MI有显著差异,为MCI和AD的早期诊断和鉴别诊断提供参考。MCI和轻度AD患者NAA/Cr、NAA/MI的变化与痴呆严重程度的相关性,对MCI和AD的疾病进展和治疗监测有重要作用。^1H—MRS是MCI和AD的诊断、鉴别诊断和疾病监测的有用工?  相似文献   

6.
目的探讨轻度认知功能障碍(MCI)患者神经心理学和ApoE基因多态性与健康老年的差异。方法对23例MCI患者和28例健康对照进行简易精神状态检查表、日常生活行为量表、Preffer门诊患者功能缺损调查表、物体记忆测验、词语流畅性测验、数字广度、逻辑记忆、无意义图形、画钟测验、延迟记忆、临床痴呆量表、总体衰退量表、Hachinski缺血积分量表、流调用自评抑郁量表等神经心理学及ApoE基因检查。结果神经心理学检查显示:MCI患者的记忆、执行功能、视空间能力以及注意力、计算力与健康对照组有显著性差异(P<0.05~0.001),尤以记忆(逻辑记忆和语义记忆)最为突出,命名保留,日常生活能力正常;ApoE基因多态性检查显示,McI患者£4携带率约为健康对照的10倍。结论McI是AD的危险因素,应用神经心理学敏感指标结合其他生物学指标如ApoE基因多态性检测可提高AD早期诊断的敏感性和特异性。  相似文献   

7.
阿尔茨海默病(Alzheimer‘s disease,AD)是老年人常见的中枢神经系统退行性疾病,是老年期痴呆最常见的原因。临床上以记忆减退、认知障碍、语言障碍、视空间障碍、人格改变为特征,并影响患者的职业、社交及日常生活自理能力,病情持续进展。轻度认知功能障碍(mild cognitive impairment,MCI)是界于正常和痴呆之间的中间阶段,以记忆障碍为突出表现,可有其他认知功能减退,但日常活动能力正常,不符合痴呆诊断的标准。我们曾对AD和MCI做了多方面的深入研究。本文拟对AD和MCI患者的注意功能进行综述。  相似文献   

8.
目的:探讨血管周围间隙扩大(EPVS)与老年非血管性认知功能障碍的关系。方法:老年非血管性认知功能障碍患者100例,按简易智能状态检查量表(MMSE)评分分为阿尔兹海默病(AD)组52例和轻度认知障碍(MCI)组48例,同期选取35例健康者为正常对照组,3组均行头颅MRI检查,比较3组基底节区EPVS。结果:与正常对照组相比,AD组和MCI组MMSE评分降低(P0.05);与MCI组对比,AD组的MMSE评分降低(P0.05)。AD组及MCI组的EPVS分级构成与正常对照组比较差异有统计学意义(Z=-4.484,Z=-2.832;均P0.05)。AD组与MCI组的EPVS分级构成比较差异无统计学意义(P0.05)。AD及MCI组60~80岁患者的EPVS分级构成与正常对照组比较差异有统计学意义(Z=-3.731,Z=-1.465;均P0.05)。3组80岁者的EPVS分级构成比较差异无统计学意义(P0.05)。AD组及MCI组的EPVS评分高于正常对照组(P0.05),AD组的EPVS评分高于MCI组(P0.05)。60~80岁的AD组及MCI组患者的EPVS评分高于正常对照组(P0.05),AD组EPVS评分高于MCI组(P0.05)。3组80岁的受试者EPVS评分差异无统计学意义(P0.05)。结论:对于60~80岁的人群,EPVS可能可作为非血管性认知障碍严重程度指标。  相似文献   

9.
目的分析轻度认知功能障碍(MCI)和阿尔茨海默病(AD)患者的认知损害程度及血清中p-tau蛋白的含量,并进行相关性分析,为临床诊断MCI提供生物学参考依据。方法 MCI组26例、AD组22例、健康对照组25例,采用简易精神状态量表(MMSE)、蒙特利尔认知评估量表(Mo CA)进行认知功能评分;采用双抗体夹心酶联免疫吸附法(ELISA)检测各组血清p-tau蛋白的浓度;比较各组认知功能评分和p-tau浓度的差别,并进行相关性分析。结果 (1)MCI组和AD组的Mo CA总分、MMSE评分均低于对照组,差异有统计学意义(P<0.05);MCI组的Mo CA总分、MMSE评分均高于AD组,差异有统计学意义(P<0.05)。(2)MCI组和轻度AD组血清p-tau浓度均高于对照组,差异有统计学意义(P<0.05);MCI组p-tau浓度低于AD组,差异有统计学意义(P<0.05)。(3)对照组Mo CA总分、MMSE评分与血清中p-tau蛋白浓度均无相关性(P>0.05);MCI组Mo CA总分、MMSE评分与血清中p-tau蛋白浓度均存在中度负相关(P<0.05);AD组Mo CA总分、MMSE评分与血清中p-tau蛋白浓度均呈中度正相关(P<0.05)。结论血清中p-tau蛋白可能成为诊断MCI的生物学指标,认知功能评分与血清p-tau结合可作为MCI和AD早期诊断、鉴别诊断的重要工具。  相似文献   

10.
轻度认知障碍患者记忆力的功能磁共振研究   总被引:14,自引:5,他引:14  
目的为探索早期诊断阿尔茨海默病 (AD)的方法 ,将神经心理测定和功能磁共振 (fMRI)检查相结合 ,了解轻度认知障碍 (MCI)患者在记忆方面的脑功能情况。方法 9例MCI患者和 9名正常对照在进行无意义图形记忆和再认时行fMRI检查 ,对反应时间、正确率和fMRI的脑激活图进行比较。结果患者的反应时间比正常对照明显延长 (P <0 0 1) ,正确率显著降低 (P <0 0 0 1)。脑激活图显示 ,与对照相比 ,在记忆编码时 ,患者主要在左侧前额叶背外侧和海马旁回、以及以右侧为主的后部脑区激活减弱 ,记忆提取时 ,在双侧前额叶背外侧 ,左侧海马旁回和前扣带回 ,以及后部脑区激活减弱。结论MCI患者的记忆功能已有损害。记忆功能的fMRI检查与认知神经心理学的联合研究能为早期诊断AD提供有力的参考依据。  相似文献   

11.
目的 探索轻度阿尔茨海默病(AD)和轻度认知障碍(MCI)患者在汉语词汇认知加工过程中单个汉字语义和语音时间进程及模式的改变特点。方法 运用反应时方法对轻度AD和MCI患者以及年龄、性别及文化程度相匹配的正常对照(NC)进行汉语单字启动命名任务,任务采用语义、同音、变调和无关对照4种启动类型,设立长短两种刺激呈现间隔(SOA),被试对目标字进行命名,分别记录被试的反应时和错误率,通过语义和语音启动与无关对照反应时比较,判断是否出现语义或语音启动效应。结果 轻度AD和MCI患者各启动类型的反应时均较正常对照延长,正常对照组在长SOA时的反应时短于短SOA时,而轻度AD组长SOA时的反应时较短SOA时长;正常对照组出现同音启动效应,而轻度AD和MCI组出现变调抑制效应。结论 轻度AD和MCI汉字整体认知加工速度减慢,语音加工过程受损。  相似文献   

12.
Brain damage in Alzheimer's disease (AD) and mild cognitive impairment (MCI) is widespread with involvement of large portions of the neocortex and the subcortical white matter. A quantitative measure of neuronal damage of the entire brain might be valuable in the context of large-scale, longitudinal studies of these patients. This study investigated the extent of neuroaxonal injury of patients with AD and MCI using a novel unlocalized proton magnetic resonance spectroscopy ((1)H-MRS) technique, which allows quantification of the concentration of N-acetylaspartate from the whole of the brain tissue (WBNAA). Conventional brain MRI and WBNAA were obtained from 28 AD patients, 27 MCI patients and 25 age-matched controls. Normalized brain volume (NBV) was also measured using an automated segmentation technique. WBNAA and NBV showed a significant heterogeneity between groups (P < 0.001). WBNAA concentration was different between controls and MCI patients (P = 0.003), but not between MCI and AD patients (P = 0.33). NBV differed both between controls and MCI patients (P = 0.02) and between MCI and AD patients (P = 0.03). A multivariate regression model retained WBNAA as the best MRI predictor of the Mini Mental State Examination score (P = 0.001). Significant neuronal damage, which is related to the extent of cognitive decline, can be quantified in the whole brain tissue of patients with AD, using a novel (1)H-MRS approach. The demonstration in patients with MCI of MR structural and metabolic findings, intermediate between those of healthy volunteers and those of AD patients, indicates that neuronal damage is already evident and widespread in individuals with MCI before they are clinically demented.  相似文献   

13.
轻度认知障碍患者计算能力的fMRI研究   总被引:7,自引:4,他引:7  
目的 探讨早期诊断A1zheimer病的方法,以及轻度认知障碍(MCI)患者计算能力损害的脑功能定位。方法 对8例MCI患者和9例正常对照使用神经心理测定和功能磁共振(fMRI)检查相结合的方法,比较两组反应时间、正确率和fMRI的脑激活图。结果 患者的反应时间比对照组延长(退位减法P>0.05,非退值减法P<0.05一0.01),正确率降低(P<0.01-0.001)。脑激活图显示:患者在左侧前额叶外下部,颞叶外侧和顶叶激活减弱(P<0.05),而右侧前额叶外下部激活代偿性增强(P<0.05)。结论MCI患者的计算功能已有损害。计算功能的fMRI与认知神经心理学的联合研究能为早期诊断AD提供有力的参考依据。  相似文献   

14.
Effective and accurate diagnosis of Alzheimer's disease (AD), as well as its prodromal stage (i.e., mild cognitive impairment (MCI)), has attracted more and more attention recently. So far, multiple biomarkers have been shown to be sensitive to the diagnosis of AD and MCI, i.e., structural MR imaging (MRI) for brain atrophy measurement, functional imaging (e.g., FDG-PET) for hypometabolism quantification, and cerebrospinal fluid (CSF) for quantification of specific proteins. However, most existing research focuses on only a single modality of biomarkers for diagnosis of AD and MCI, although recent studies have shown that different biomarkers may provide complementary information for the diagnosis of AD and MCI. In this paper, we propose to combine three modalities of biomarkers, i.e., MRI, FDG-PET, and CSF biomarkers, to discriminate between AD (or MCI) and healthy controls, using a kernel combination method. Specifically, ADNI baseline MRI, FDG-PET, and CSF data from 51AD patients, 99 MCI patients (including 43 MCI converters who had converted to AD within 18 months and 56 MCI non-converters who had not converted to AD within 18 months), and 52 healthy controls are used for development and validation of our proposed multimodal classification method. In particular, for each MR or FDG-PET image, 93 volumetric features are extracted from the 93 regions of interest (ROIs), automatically labeled by an atlas warping algorithm. For CSF biomarkers, their original values are directly used as features. Then, a linear support vector machine (SVM) is adopted to evaluate the classification accuracy, using a 10-fold cross-validation. As a result, for classifying AD from healthy controls, we achieve a classification accuracy of 93.2% (with a sensitivity of 93% and a specificity of 93.3%) when combining all three modalities of biomarkers, and only 86.5% when using even the best individual modality of biomarkers. Similarly, for classifying MCI from healthy controls, we achieve a classification accuracy of 76.4% (with a sensitivity of 81.8% and a specificity of 66%) for our combined method, and only 72% even using the best individual modality of biomarkers. Further analysis on MCI sensitivity of our combined method indicates that 91.5% of MCI converters and 73.4% of MCI non-converters are correctly classified. Moreover, we also evaluate the classification performance when employing a feature selection method to select the most discriminative MR and FDG-PET features. Again, our combined method shows considerably better performance, compared to the case of using an individual modality of biomarkers.  相似文献   

15.
目的 采用Adaboost集成分类方法区分轻度认知障碍(MCI)、阿尔茨海默病(AD)患者与正常对照(NC)的功能与结构磁共振成像数据.方法 对26例MCI患者(MCI组)、26例AD患者(AD组)及30名健康老年人(NC组)的MRI图像进行分析,选择双侧海马体积及3组间存在显著差异脑区的低频振幅值(ALFF)作为分类特征,采用Adaboost集成分类器对3组被试进行两两分类,利用留一交叉验证估算分类准确率.结果 增加性别、年龄和MMSE特征后,Adaboost集成分类方法对AD与MCI、MCI与NC、AD与NC分类准确率分别达98.08%、80.36%和100%.结论 Adaboost集成分类方法可较好地区分MCI、AD与NC.  相似文献   

16.
Background/Aims: The aim of this study was to assess gait characteristics during simple and dual task in patients with mild cognitive impairment (MCI) and compare them with those of healthy elderly subjects and mild Alzheimer’s disease (AD) patients. Methods: We proposed a gait analysis to appreciate walking (simple task and dual task) in 14 MCI, 14 controls and six AD subjects who walked at their preferred speed. A 20‐second period of stabilized walking was used to calculated stride frequency, stride length, symmetry and regularity. Speed walking was measured by electrical photocells. Results: Variables measured during simple and dual tasks showed an alteration of motor function as well in mild AD patients as in MCI patients. Conclusion: At the end of this preliminary study, we defined a specific gait pattern for each cognitive profile. Further researches appear necessary to enlarge the study cohort.  相似文献   

17.
Hippocampal atrophy has been related to mild cognitive impairment (MCI) and early Alzheimer disease (AD), but the diagnostic significance of cross-sectionally determined hippocampal volumes is still ambiguous. Diffusion-Tensor-Imaging (DTI) in MCI patients revealed an association of microstructural changes in hippocampal areas with verbal memory decline. MRI volumetry and DTI were combined to investigate 18 MCI patients attending a memory clinic, and 18 carefully age- and gender-matched healthy controls. Neuropsychological testing, high resolution T1-weighted volume MRI scans, and DTI scans with regions-of-interest in hippocampal areas were applied. Left hippocampal volume was significantly lower (-11%, P = 0.02) in MCI patients than in control subjects. No significant differences were found for the right hippocampus (-4%). Mean diffusivity (MD) was significantly elevated in MCI patients vs. controls in left (+10%, P = 0.002) and right hippocampal areas (+13%, P = 0.02). Hippocampal volume and MD values were not significantly correlated. Combining left hippocampal volume and MD measures showed that lower left hippocampal volumes were associated with poor verbal memory performance particularly when co-occurring with high MD values. No comparable associations could be found regarding the right hippocampal formation and with respect to non-verbal memory function. The results demonstrate that microstructural abnormalities as revealed by DTI are very sensitive early indicators of hippocampal dysfunction. The combination of macro- and microstructural parameters in hippocampal areas could be promising in early detection of neurodegenerative processes.  相似文献   

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