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1.
阿尔茨海默病(AD)前期,患者认知功能损害主要表现在记忆方面。Petersen等提出轻度认知损伤(MCI)的概念,即记忆力下降比同龄老年人严重,但总体认知功能相对完好,日常生活能力正常,尚未到AD的程度。流行病学研究表明,老年人群中MCI发病率高,并且MCI转化为AD的比率远高于同龄正常老年人。我们于2003年10月至2004年4月采用自由回忆、  相似文献   

2.
目的:观察三种轻度认知功能障碍( MCI )患者的病情转归情况。方法76例MCI患者,根据认知功能障碍程度分为单纯记忆损害(SMI)21例(SMI组)、多领域认知功能损害(MD-MCI)43例(MD-MCI组)、单纯非记忆功能认知受损(NMI)12例(NMI组),观察随访3 a后,比较三组患者的认知功能及病情转归情况。结果3 a后MCI患者认知功能减退明显,MD-MCI组MMSE评分、词语延迟回忆评分、数字广度倒数评分、言语流畅性评分、画钟实验评分、本顿视觉保持正确评分均明显低于SMI组、NMI组(P均<0.05);MD-MCI组进展为阿尔茨海默病(AD)19例,其他类型痴呆4例,AD及痴呆发病率为53.5%;SMI组AD发病率为19.0%(4/21);NMI组痴呆发病率为25%;MD-MCI组AD及痴呆发病率与SMI组、NMI组相比,P均<0.05。 SMI组2例、NMI组3例认知状态恢复正常。结论不同类型的MCI转归不同,MD-MCI型较SMI型、NMI型认知功能损害重,3 a后AD及痴呆发病率高。  相似文献   

3.
轻度认知损害(mildcognitiveimpairment,MCI)是介于正常老年和痴呆之间的一种认知功能损害状态,被认为是阿尔茨海默病(Alzheimerdisease,AD)的一种高危因素。每年大约有10%-15%MCI发展为痴呆,故MCI被认为是AD早期干预治疗的最合适人群。我国2000年北京社区调查结果显示健康老年人MCI发生率为11.8%,与国外文献资料类似。  相似文献   

4.
目的 应用磁敏感加权成像(SWI)分析老年人轻度认知功能障碍(MCI)和阿尔茨海默病(AD)患者脑内铁沉积的特点及其与简易精神状态检查量表(MMSE)评分变化的相关性,评估脑内铁含量增加在预测MCI向AD转化中的价值。方法 选取2009年11月至2013年1月入院于上海交通大学附属上海市第六人民医院老年科的MCI患者22例,AD患者20例及认知功能正常的老年人18例,行常规磁共振成像(MRI)及颅脑SWI检查,使用校正相位图计算出相应的角弧度值,量化海马与尾状核头的铁沉积。采用方差分析进行组间比较;角弧度值与MMSE评分的相关性分析采用Pearson相关性分析方法。MCI组患者随访1年,根据再次MMSE评分结果分为AD转化组和非AD转化组。比较随访前后两组间角弧度值的变化量有无差异。结果 MCI组左侧海马、左侧尾状核头的角弧度值与对照组比较,差异有统计学意义(P<0.05);AD组双侧海马、左侧尾状核头的角弧度值与对照组比较,差异有统计学意义(P<0.05)。双侧海马角弧度值与MMSE评分相关。随访1年后,MCI组22例患者中有5例进展为AD(22.7%),进展为AD的5例患者较稳定于MCI组的17例患者左侧海马角弧度值增加更多(P<0.05)。结论 脑内局灶性铁沉积增加与认知功能减退有关;左侧海马铁沉积的异常增加可能是预测MCI向AD进展的敏感指标。  相似文献   

5.
目的评价轻度认知障碍(McI)患者与非痴呆型血管性认知功能障碍(VICND)患者的屏气指数(BHI)与认知功能的关系。方法 150例受试者分为正常对照组、MCI组及VICND组,应用经颅多普勒(TCD)屏气试验计算BHI,并应用蒙特利尔认知评估量表(MoCA)进行认知功能评分,分析BHI与认知功能的关系。结果MCI组和VCIND组高血压、高血糖、高血脂的患病率均显著高于对照组(P〈0.05),MCI组与VCIND组间比较无显著差异。MCI组和VCIND组BHI,分别为(0.90±0.16)%/s、(0.87±0.19)%/s,均明显低于对照组的(1.37±0.22)%/s。MoCA评分与BHI呈正相关(r=0.803,P〈0.01)结论高血压、糖尿病及高血脂可能与MCI患者及VCIND患者的认知功能下降有关,BHI与认知功能具有一定的相关性。  相似文献   

6.
目的:探讨老年认知功能障碍患者,包括轻度认知功能障碍(MCI)和阿尔茨海默病(AD)患者的3种事件相关电位P300,失匹配负波(MMN)和关联性负变(CNV)的改变,以了解三者在MCI中的诊断价值。方法2011年2月至2013年3月上海交通大学附属第六人民医院老年病科门诊或住院的患者及健康体检者120位,年龄≥60岁。测量轻度AD患者(AD组,n=40)、MCI患者(MCI组,n=40)、认知正常老人(NC组,n=40)的事件相关电位(ERP,包括P300,MMN,CNVM1,CNVM2)的峰潜伏期(PL)与振幅(Amp)。结果 AD组ERP的PL均长于MCI组(P<0.05)。MCI组中P300和MMN的PL[(380.94±37.55),(188.63±31.63)ms]均长于NC组[(342.88±41.72),(137.48±28.69)ms;P<0.05],而MCI组中CNVM1及CNVM2的PL与NC组相比,差异无统计学意义(P>0.05)。AD组与NC组相比,ERP的Amp明显降低(P<0.05)。MCI组中MMN和CNVM2的Amp与NC组相比降低(P<0.05),MCI组与AD组相比,ERP的Amp差异无统计学意义(P>0.05)。结论 P300,MMN和CNV对MCI的诊断有一定的参考价值,其中P300和MMN区分MCI患者与正常人的敏感性略高于CNV。  相似文献   

7.
目的检测老年轻度认知功能损害(MCI)患者的脑诱发电位变化,探索其发展为痴呆的脑诱发电位预测因素。方法前瞻性对照研究。对象为患轻度认知功能损害的老年人(MCI组)和认知功能正常的老年人(NC组)两组。结果23例MCI和29例NC完成了基线脑诱发电位检查。与NC组相比,MCI组的听觉脑干反应波V绝对波幅和P300的P3靶波幅降低有统计学意义(P〈0.01)。多元逐步判别分析显示听觉脑干反应波V绝对波幅和P300的P3靶波幅的判别具有统计学意义(P〈0.01),两组判别总正确率为75%,但Logislic回归分析未发现脑诱发电位指标对MCI是否发展为痴呆有显著性预测作用。结论脑诱发电位检测有助于了解MCI的脑电生理变化,听觉脑干反应波V绝对波幅和P300的P3靶波幅的降低对MCI具有诊断价值。本研究未证实4种检测的脑诱发电位指标对预测MCI发展为痴呆有统计学意义。  相似文献   

8.
目的探讨简易认知量表(Mini-Cog)和8条目痴呆筛查问卷(8-item ascertain dementia, AD8)对80岁以上老年人群早期轻度认知功能障碍(mild cognitive impairment, MCI)的筛查价值。 方法选取杭州市某福利中心的2014年10月前已入住的908名高龄老年人进行Mini-Cog和AD8筛查,随访5年后对仍然健在且能配合完成检查者进行二次认知功能评估。计算Mini-Cog和AD8初筛的敏感度和特异度,并分析随访5年后AD8的ROC曲线结果以及两种量表的一致性检验结果。 结果908例高龄老年人中523例确诊为痴呆(不计入后续筛查及随访调查),余385例筛查结果显示:Mini-Cog、AD8诊断MCI的敏感度分别为54.88%、57.32%,特异度分别为85.52%、86.43%。随访5年后仍健在且接受二次评估的老年人共167名,其中认知功能正常106例(54例出现认知功能下降),MCI 61例(36例出现认知功能进一步下降)。对于随访5年的认知功能正常者及MCI者,AD8诊断的AUC分别为0.572(95%CI=0.486-0.658)、0.723(95%CI=0.611-0.835),Mini-Cog和AD8(以得分>3为分界线)诊断的一致性Kappa值分别为0.105、0.018和0.225、0.524。 结论AD8和Mini-Cog均具有一定的MCI评估效能,尤其适用于养老机构及社区高龄老年群体的认知功能筛查。  相似文献   

9.
目的 探讨Alzheimer病(AD)转归与外周免疫功能变化的关系。方法 对32例处于痴呆前阶段的老年人(PD组)和其中发展为AD的11例老年人(PD1组)以及16例正常老年人(对照组)进行5项免疫指标(IgA,IgG,IgM,IL-1β,IL-2)的检测,并进行组间比较。结果 与对照组相比,AD患者IgA,IL-1β,IL-2浓度明显升高(P<0.05);AD患者与其处于痴呆前阶段时相比较,IgA,IL-2浓度明显升高(P<0.05),IL-1β升高但差异不显著(P>0.05);在痴呆前阶段的老年人中,与未发展为AD老年人和正常老年人相比较,最终发展为AD老年人的IL-1β浓度明显升高(P<0.05)。结论 患者免疫功能改变是引发AD病的病因之一,对处于轻度认知障碍的老年人,当其免疫功能改变时(IL-1β明显升高),AD发病率会大大增加。  相似文献   

10.
部队干休所老年人轻度认知功能损害调查   总被引:12,自引:1,他引:11  
目的 了解老年人轻度认知功能损害 (MCI)的现状 ,为研究Alzheimer病 (AD)提供依据。 方法 采用中文版简易智能状态检查 (MMSE)、总体衰退量表、日常生活能力、哈金斯基缺血指数及汉密尔顿抑郁量表等量表为筛查工具 ,对石家庄市 2 6个部队休干所的 2 6 74名≥ 6 0岁的离退休干部进行MCI患病率调查。 结果 老年人MCI的患病率为 8 0 8% ,其中男性标化患病率为6 87% ,女性标化患病率为 10 38% ,女性高于男性 (P <0 0 1) ;老年人MCI的患病率随年龄增长有升高的趋势 (P <0 0 1) ;随着文化程度的提高 ,MCI患病率有降低的趋势 (P <0 0 5 )。 结论 部队干休所老年人MCI的患病率低于欧美国家。应加强对老年MCI患者这一痴呆高危人群进行监测 ,早期进行干预治疗 ,从而延缓或阻止病情进展为AD。  相似文献   

11.
目的探索序列位置效应联合延迟回忆在区分不同认知障碍水平人群的诊断价值。方法共纳入310例受试,其中认知正常(NC)组128例,轻度认知功能障碍(MCI)组133例,轻度阿尔茨海默病(AD)组49例。3组性别、年龄、受教育程度无显著性差异。所有受试进行成套神经心理学测验,使用听觉词语学习测验量表华山版(AVLT-H)进行序列位置效应的研究。结果AVLT-H即刻回忆第2次、第3次以及短延迟、长延迟的首因效应在3组间得分差异有统计学意义(P<0.05),近因效应在MCI、轻度AD组得分差异无统计学意义(P>0.05)。长延迟回忆首因效应+短延迟回忆作为联合指标可比其他记忆指标更好区分不同水平认知人群,其敏感度、特异度分别为83.21%、71.43%(NC比MCI);85.71%、92.86%(NC比轻度AD);66.67%、75.57%(MCI比轻度AD)。结论长延迟回忆的首因效应联合短延迟回忆可辅助区分不同认知障碍水平患者。  相似文献   

12.
Prevalence and incidence of predementia syndromes vary as a result of different diagnostic criteria, as well as different sampling and assessment procedures. Mild cognitive impairment (MCI) is thought to be a prodromal phase of dementia and therefore highly predictive of subsequent conversion. The aim of our study was to investigate the risk of conversion to dementia for different MCI subtypes diagnosed according to standardized and recently revised criteria (amnestic; impairment of memory plus other cognitive domains; nonamnestic). Participants were recruited among the 2,866 patients referring to the Memory and Cognitive Disorders Unit of the Local Health Unit of Bologna, Maggiore Hospital, between October 2000 and February 2006. In this preliminary study we analyzed data from 52 elderly outpatients with a diagnosis of MCI and a mean follow-up of 1.21+/-0.61 years (range 0.23-3.10 years). Mean age was 72.8+/-6.6 years, males were 61.5%. Mean baseline mini mental state examination (MMSE) score was 27.1+/-1.5. There were 15 incident cases of dementia (28.8%), with Alzheimer's disease (AD) accounting for 53.3% of all cases, AD with cerebrovascular disease for 33.4% and fronto-temporal dementia for 13.3%. Overall rate of conversion was 23.8 per 100 person-years. During the same follow-up period, 53.8% of participants remained stable and 17.3% reverted to normal. Rates of conversion for the specific MCI subtypes were 38 per 100 person-years for amnestic MCI, 20 per 100 person- years for non-amnestic MCI, and 16 per 100 person-years for memory plus other cognitive domains MCI. With respect to non-converters, converters were generally older (76.1+/-4.2 vs. 71.5+/-7.0 years, p=0.021), had a lower MMSE score (26.4+/-1.66 vs. 27.4+/-1.4, p=0.035) and a higher prevalence of atrophy at neuroimaging (73.7% vs. 42.4%, p=0.047). Moreover, with respect to non-converters, converters tended to have higher serum high density lipoprotein (HDL) levels, and lower serum folate levels. No difference was observed for the other study variables, included MCI subtype. Our findings suggest that the current definitions for MCI subtypes, particularly those referring to individuals with multiple or non-amnestic cognitive impairment, include a substantial number of individuals who may not progress to dementia. The possible role of cortical atrophy and low folate in the conversion from MCI to dementia could have important implications, because both conditions are easily identifiable. Moreover, low folate status is potentially amenable to therapeutic options. Although discouraging with respect to the clinical usefulness of currently available MCI criteria, our results raise the possibility that defining a protocol of multiple clinical risk factors may be useful in identifying MCI individuals at increased risk of conversion.  相似文献   

13.
OBJECTIVES: To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. DESIGN: Validation study. SETTING: A community clinic and an academic center. PARTICIPANTS: Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). MEASUREMENTS: The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. RESULTS: Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). CONCLUSION: MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.  相似文献   

14.
目的通过对高原地区藏、汉族轻度认知障碍(MCI)与AD病人血清氧化低密度脂蛋白(oxLDL)和髓过氧化物酶(MPO)含量的分析,探索低氧环境下其与不同民族间MCI和AD发病的关系。方法选取青海省西宁地区藏、汉族的MCI和AD病人以及健康对照人群(NC)各30例。对所有入组者进行一般信息调查,采用MMSE量表评估认知功能,采用ELISA法检测血清oxLDL和MPO水平。oxLDL、MPO水平与MMSE评分的关系采用Spearman相关分析。采用多因素Logistic回归分析藏、汉族MCI和AD的主要危险因素。结果两民族NC组间比较,汉族oxLDL水平显著低于藏族(P<0.05);两民族AD组间比较,汉族oxLDL水平显著低于藏族(P<0.01)。藏族中,MCI组和NC组的oxLDL水平较AD组显著降低(P<0.01),MCI组MPO水平显著低于AD组(P<0.01);汉族中,NC组MPO水平显著低于AD组(P<0.05)。Spearman相关分析显示,汉族oxLDL水平与MMSE评分呈负相关(r=-0.737,P<0.001);藏族oxLDL和MPO水平均与MMSE评分呈负相关(r=-0.794,P<0.001;r=-0.742,P<0.001)。多因素Logistic回归分析显示,oxLDL水平升高是两民族发生MCI和AD的独立危险因素;MPO水平升高是藏族发生MCI和AD的独立危险因素。结论高原地区藏、汉族的认知功能与血清oxLDL和MPO水平有关。联合检测两个指标有助于筛选高危人群。  相似文献   

15.
目的探讨颈动脉斑块与老年广泛性脑萎缩并发认知功能障碍的相关性。方法选择连云港市第二人民医院就诊或体检发现的中、重度广泛性脑萎缩的老年患者45例,按认知功能分为:正常组15例、轻度认知功能损害(MCI)组15例和阿尔茨海默病(AD)组15例。所有受试者均接受颈动脉斑块检测,并分析颈动脉斑块与简易智能状态检查量表(MMSE)评分的关系。结果与正常组比较,AD组和MCI组颈动脉内膜中层厚度[(IMT)(2.37±0.28)mm和(2.35±0.13)mmvs(1.76±0.09)mm]及高回声斑块[(17.71±2.30)mm2和(18.96±2.12)mm2 vs(14.25±2.29)mm2]明显增加(P<0.05),MMSE评分[(5.80±3.53)分和(17.40±3.92)分vs(25.73±3.08)分]明显降低(P<0.05);与MCI组比较,AD组MMSE评分明显降低(P<0.05)。3组低回声及混合回声斑块平均面积差异无统计学意义(P>0.05)。线性回归分析显示,IMT与MMSE评分呈负相关(P=0.000)。结论脑萎缩伴IMT或高回声斑块平均面积增多的患者易发生认知功能损害,IMT越高认知功能越低;颈部超声检查可视为老年脑萎缩患者并发认知功能损害的随访指标之一。  相似文献   

16.
MCI is regarded as a precursor of dementia, but not all patients with MCI actually develop dementia. As Alzheimer and vascular dementia (AD and VD, respectively) are thought to share many common etiopathogenetic mechanisms, we investigated whether the vascular risk factor atrial fibrillation affect the risk of conversion to dementia for different MCI subtypes diagnosed according to international criteria. One-hundred-eighty elderly outpatients with MCI and 431 elderly outpatients with a normal cognition were followed-up for a mean of 3 and 4 years, respectively. The risk of conversion to dementia associated with atrial fibrillation was studied in both samples using a Cox proportional-hazards model adjusted for sociodemographic and medical variables. Overall conversion rate to dementia was 10.5 (8.0-13.8) per 100 person-years in the MCI group and 2.2 (1.5-3.1) per 100 person-years in the normal cognition group. Atrial fibrillation was significantly associated with conversion to dementia (hazard ratio=HR=4.63, 95% confidence interval=Cl=1.72-12.46) in the MCI group, but not in the cognitively normal group (HR=1.10, 95% Cl=0.40-3.03). Current diagnostic criteria for MCI subtypes define heterogeneous populations, but atrial fibrillation can be useful in identifying people with increased risk of conversion to dementia.  相似文献   

17.
目的评估词语记忆量表在区分正常老年人、轻度认知功能损害(MCI)及轻度阿尔茨海默病(AD)患者中的应用。方法选择认知功能正常者108例(对照组),MCI患者105例(MCI组)及轻度AD患者57例(轻度AD组),进行简易智能状态检查量表及词语记忆量表检查,量表内容包括词语即刻回忆、延迟回忆、原词再认和新词再认,并分析各组的词语记忆得分及组间比较。结果与对照组比较,MCI组及轻度AD组的词语记忆量表各项得分均降低,且延迟回忆得分降低显著,差异有统计学意义(P=0.000);3组间各项得分比较,差异有统计学意义(P=0.000),MCI组与轻度AD组比较,延迟回忆、原词再认和新词再认差异有统计学意义(P<0.05);多因素分析对年龄和教育程度进行调整后,年龄影响第1次即刻回忆、第2次即刻回忆、延迟回忆;临床诊断影响词语记忆量表的各项得分,差异有统计学意义(P=0.000)。结论词语记忆量表中的延迟回忆及延迟再认有助于MCI的早期识别以及MCI与轻度AD的鉴别。  相似文献   

18.
OBJECTIVES: To investigate prevalence and incidence of mild cognitive impairment (MCI) and its risk of progression to dementia in an elderly Italian population.
DESIGN: Longitudinal.
SETTING: Population-based cohort aged 65 and older resident in an Italian municipality.
PARTICIPANTS: A total of 1,016 subjects underwent baseline evaluation in 1999/2000. In 2003/04, information about cognitive outcome was collected for 745 participants who were free of dementia at baseline.
MEASUREMENTS: MCI (classified as with or without impairment of the memory domain), dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) diagnosed according to current international criteria.
RESULTS: Overall prevalence of MCI was 7.7% (95% confidence interval (CI)=6.1–9.7 %) and was greater with older age and poor education. During 4 years of follow-up, 155 incident MCI cases were diagnosed, with an incidence rate of 76.8 (95% CI=66.8–88.4) per 1,000 person-years. Approximately half of prevalent and incident MCI cases had memory impairment. Compared with normal cognition, multivariable-adjusted risk for progression from MCI with memory impairment to dementia was 4.78 (95% CI=2.78–8.07) for any dementia, 5.92 (95% CI=3.20–10.91) for AD, and 1.61 (95% CI=0.37–7.00) for VaD. No association with dementia risk was found for MCI without memory impairment. Approximately one-third of MCI cases with memory impairment did not progress to dementia.
CONCLUSION: MCI occurs often in this elderly Italian cohort and is associated with greater risk of AD, but only when the impairment involves the memory domain. However, a substantial proportion of MCI cases with memory impairment do not progress to dementia.  相似文献   

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