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1.
阿尔茨海默病(AD)是以认知功能损害为突出表现的神经系统退变性疾病。轻度认知功能障碍(MCI)是认知功能低于同龄及文化背景的正常人但未达到痴呆程度的认知功能损害状态,被认为是痴呆、特别是AD的危险因素。临床及流行病学的研究表明MCI存在着异质性,有关MCI的概念及转归一直存在争论。随着对AD痴呆前阶段的关注,有必要了解MCI的含义及其变化。本文复习了MCI概念的提出、定义及其内容上发生的变化,并介绍了新的NIA—AD工作组AD诊断指南。  相似文献   

2.
随着人口老龄化的到来,老年性相关疾病的发生越来越突出,轻度老年认知功能障碍是老年性痴呆的高危人群,是介于正常认知老化与轻度痴呆之间的一种临床状态。然而,在临床常规工作对轻度老年认知功能障碍认识严重不足,故加强对老年早期认知功能障碍的认识水平,提高对老年人早期认知功能障碍的评估与筛查,是尽早干预和预防老年性痴呆发生的重要保障。  相似文献   

3.
Morris JC 《Geriatrics》2005,(Z1):9-14
Alzheimer's disease (AD) is a progressive neurodegenerative disorder that is characterized by a gradual decline of numerous cognitive processes, culminating in dementia. Mild cognitive impairment (MCI) is a relatively broad clinical condition involving a slight memory deficit, which in many cases represents a transitional state between normal cognition and AD. Much research is currently being conducted on MCI, since any therapy that is effective at treating this early manifestation of dementia may provide an opportunity for managing the disease while patient function is relatively preserved. Current research seeks to develop disease-modifying treatments that intervene in the pathobiologic processes involved in MCI and AD. Another goal of current research is to develop antecedent biomarkers that can be used to detect AD prior to the appearance of symptoms and before substantial and irreversible brain damage occurs.  相似文献   

4.
Many studies have been devoted to the cognitive changes associated with age, and several attempts have been made for their classification in order to distinguish normal from pathologic changes. In the last few years, a consensus has been reached to classify elderly people in three groups: a) cognitively normal subjects whose cognitive functions score in the range of those of healthy subjects paired according to age and educational level, presenting or not memory complaints; b) subjects with dementia; c) an intermediate group of subjects presenting a cognitive impairment not severe enough to meet the criteria for dementia. The term mild cognitive impairment (MCI) has been proposed to describe these subjects who are at high risk to progress to dementia in the years following the diagnosis. For the first time, MCI construct allows the recognition of the prementia phase of degenerative or vascular cerebral diseases progressing to dementia. However, the lack of clear operational diagnostic criteria and ambiguities about the signification of MCI make the interpretation of the results of studies devoted to this concept hazardous. From a practical point of view, the physician, when faced with a patient complaining of his\her memory, should answer two main questions. "How to recognize memory disorders resulting from incipient AD?" and "What is the signification of memory complaints not related to AD?" The semioloy of memory complaints and the qualitative aspects of the memory deficit allow the diagnosis of incipient AD with pretty good accuracy. Due to the location of the first lesions of AD in hippocampal regions, memory disturbances in AD are related to a deficit in memorization of new information in episodic memory. Conversely, memory disorders related to normal aging, depression, and degenerative or vascular brain lesions not involving hippocampus, are related to deficits in the processes of recall of previously memorized informations. Benign memory complaints have been considered to be linked to the decrease of memory performance, and defining a special group of normal elderly subjects. However, no direct relationship has been demonstrated between memory complaints and performance. In our opinion, all memory complaints are essentially related to psychoaffective disturbances, mainly anxiety, changes in identity and decrease of self-esteem associated with aging.  相似文献   

5.
Despite of the positive medical and scientific advances generated through the mild cognitive impairment (MCI) diagnosis, as we will see along this paper, the concept of MCI presents several major limitations. MCI defines a syndrome and therefore it may be the consequence of different diseases with distinct aetiologies. Furthermore, the philosophy behind the MCI scenario has been to detect a group of symptoms that eventually will evolve into a distinct disease. In contrast, our nowadays aim is to detect a disease in its earlier stages that eventually will evolve from one clinical syndrome to another. As an example, our aim now is to detect early AD that initially will manifest as a memory syndrome and eventually will evolve into a dementia syndrome. Consequently, in order to overcome the syndromical diagnosis behind MCI, the concept of prodromal AD (Prd-AD) has recently emerged. Prd-AD is defined as the symptomatic predementia phase of AD, generally included in the MCI category; this stage is characterised by symptoms not severe enough to meet currently accepted diagnostic criteria for AD. Being a nosological concept, it has several potential advantages related with early diagnosis and treatment, together with the possibility to contribute to the development of disease modifying drugs.  相似文献   

6.
With the projected dramatic increase in the number of people who will be diagnosed with Alzheimer's disease (AD) in the coming years, interest is growing in identifying and treating adults at high risk for developing the disorder. Recent research suggests that individuals who will go on to receive a diagnosis of AD exhibit deficits in cognitive performance years beforehand. Those with mild cognitive impairment (MCI), for example, have characteristic cognitive deficits, such as memory loss, and convert to a diagnosis of AD at a faster rate than cognitively healthy controls. MCI has thus become a focus of research because it may help identify high-risk individuals for whom prophylactic treatments designed to slow the progress toward AD can be prescribed. After describing the diagnostic criteria and dementia outcomes associated with MCI, this article discusses several challenges to the study of cognitive impairment before the diagnosis of AD.  相似文献   

7.
CSF biomarkers for mild cognitive impairment   总被引:4,自引:0,他引:4  
A correct clinical diagnosis of Alzheimer's disease (AD) early in the course of the disease is of importance to initiate symptomatic treatment with acetylcholine esterase inhibitors, and will be even more important when disease-arresting drugs, such as beta-sheet breakers or gamma-secretase inhibitors, will reach the clinic. However, there is no clinical method to determine if a patient with mild cognitive impairment (MCI) has incipient AD, i.e. will progress to AD with dementia, or have a benign form of MCI without progression. Thus, there is a great clinical need for diagnostic biomarkers to identify incipient AD in MCI cases. Three cerebrospinal fluid (CSF) biomarkers; total-tau (T-tau), phospho-tau (P-tau) and the 42 amino acid form of beta-amyloid (Abeta42) have been evaluated in numerous scientific papers. These CSF markers have high sensitivity to differentiate early and incipient AD from normal ageing, depression, alcohol dementia and Parkinson's disease, but lower specificity against other dementias, such as frontotemporal and Lewy body dementia. However, if the CSF biomarkers are used in the right clinical context, i.e. together with the cumulative information from the clinical examination, standard laboratory tests and brain-imaging techniques [single photon emission tomography (SPECT) and magnetic resonance tomography (MRT) scans], they may have a role in the clinical evaluation of MCI cases.  相似文献   

8.
OBJECTIVES: To investigate whether mild cognitive impairment (MCI) with multiple impaired cognitive domains (mcd-MCI) is a prodromal manifestation of vascular dementia (VaD). DESIGN: Prospective cohort study. SETTING: Geriatric unit of the Ospedale Maggiore Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy. PARTICIPANTS: Four hundred community-dwelling subjects aged 65 and older who came freely to the geriatric unit as part of a comprehensive geriatric assessment program were evaluated for memory impairment or other cognitive disorders. Subjects with MCI were kept under observation for 3 years. MEASUREMENTS: Subjects with MCI were studied by applying a standardized clinical evaluation and a conducting a computed tomography brain scan. Cognitive performance was assessed using the Mini-Mental State Examination, the Clock Drawing Test, and a comprehensive battery of neuropsychological tests. Cardiovascular comorbidity was assessed on the basis of medical history and using electrocardiography, echocardiography, and carotid color Doppler ultrasound. RESULTS: MCI was found in 65 of the 400 community-dwelling subjects; 31 were classified with amnestic MCI (a-MCI) and 34 with mcd-MCI. A dysexecutive syndrome characterized people with mcd-MCI, who had significantly more vascular comorbidity and signs of vascular disease on brain imaging as well as a higher prevalence of extra pyramidal features, mood disorders, and behavioral symptoms than people with a-MCI. Twenty of the 65 subjects with MCI (31%) progressed to dementia within 3 years of follow-up: 11 subjects with Alzheimer's disease (AD) and nine with VaD. All patients who evolved to AD had been classified with a-MCI at baseline, whereas all patients who evolved to subcortical VaD had been classified with mcd-MCI at baseline. CONCLUSION: All subjects who converted to subcortical VaD had been classified with mcd-MCI, suggesting that mcd-MCI might be an early stage of subcortical VaD.  相似文献   

9.
部队老年人轻度认知损害的发生及向Alzheimer病的转化情况   总被引:7,自引:0,他引:7  
目的调查部队老年人轻度认知损害(MCI)的发病率及向Alzheimer病(AD)的转化率,为进一步研究AD提供依据。方法以2001年石家庄市26个部队休干所MCI患病率调查的2674名60岁及以上的离退休干部为研究对象,对患病率调查时诊断为MCI的216例患者和2302名认知正常受试者进行为期3年的队列研究,比较MCI患者和认知正常受试者AD的平均年发病率。结果认知正常的老年人MCI的发病率为4.8%(人年),AD的平均年发病率为0.8%(人年);MCI患者AD的平均年发病率为5.6%(人年);男性和女性MCI患者AD的平均年发病率差别无统计学意义(P〉0.05);随着文化程度的提高,MCI患者AD的平均年发病率有降低的趋势(P〈0.05);而随着年龄的增长,MCI患者AD的平均年发病率有增高的趋势(P〈0.01)。MCI转化为AD的相对危险性为认知正常者的7.4倍。结论军队老年MCI患者转化为AD的危险性远远大于认知正常的老年人,应加强对老年MCI患者这一AD高危人群的监测。  相似文献   

10.
Mounting evidence suggests that diabetes mellitus (DM) is associated with mild cognitive impairment (MCI), vascular dementia and Alzheimer’s disease (AD). Biological, clinical and epidemiological data support a close link between DM and AD. Increasingly, studies have found that several antidiabetic agents can promote neurogenesis, and clinically ameliorate cognitive and memory impairments in different clinical settings. Data has shown that these antidiabetic drugs positively affect mitochondrial and synaptic function, neuroinflammation, and brain metabolism. Evidence to date strongly suggests that these antidiabetic drugs could be developed as disease-modifying therapies for MCI and AD in patients with and without diabetes.  相似文献   

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