轻度认知损害研究进展

因为在老年性痴呆 (Ａｌｚｈｅｉｍｅｒｄｉｓｅａｓｅ,ＡＤ)的治疗方面 ,已开始出现很有希望的苗头 ,有关研究的注意力已经开始转向如何尽早识别其智能衰退的早期症候 ,以期预防、减缓或逆转痴呆的脑功能损害。轻度认知损害 (ｍｉｌｄｃｏｇｎｉｔｉｏｎｉｍｐａｉｒｍｅｎｔ,ＭＣＩ) ,即常发生在老年性痴呆临床前期的一种综合征 ,可能是老年性痴呆发病的早期信号 ,它有助于发现最需要早期干预的个体[1] 。我们就ＭＣＩ的概念、诊断标准、神经影像、外周标志及其与早期ＡＤ的关系等进行综述。一、ＭＣＩ的沿革及概念1.沿革 :老年人中常见未…     

轻度认知功能损害——AD的极早期阶段?

轻度认知功能损害 (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 ,为正常老年和Ａｌｚｈｅｉｍｅｒ病 (Ａｌｚｈｅｉｍｅｒｄｉｓｅａｓｅ,ＡＤ)的分界线 ,有其相应的神经影像及神经病理改变形式 ,认知损害亦有一定特点。有人认为ＭＣＩ是正常老年与ＡＤ的过渡阶段 ,也有人认为ＭＣＩ就是临床前的ＡＤ ,最新报道认为它代表ＡＤ的极早期阶段。因而ＭＣＩ群体的研究对ＡＤ的早期诊断和早期干预有着重要的意义 ,是近年来老年痴呆研究的热点。文献中关于ＭＣＩ曾有多种描述的术语。…     

轻度认知障碍的现代概念和研究进展

在有关老化和痴呆的研究中 ,认知障碍的最早期阶段的特征一直是人们关注的焦点。介于正常老化和非常轻微的痴呆或阿尔茨海默病 (Ａｌｚｈｅｉｍｅｒ’ｓｄｉｓｅａｓｅ ,ＡＤ)之间的认知状态正在成为痴呆早期诊断和防治研究中最为活跃的领域 ,出现在这个过度阶段的认知障碍被称为轻度认知障碍 (ｍｉｌｄｃｏｇｎｉｔｉｖｅｉｍｐａｉｒｍｅｎｔ,ＭＣＩ) [1 ] 。一、ＭＣＩ的概念、术语和诊断标准1 过去文献中与ＭＣＩ有关的概念和术语 :作为一个笼统的概念 ,广义的ＭＣＩ代表了痴呆流行病学调查中除认知正常和痴呆之外的一个内涵广泛、程度…     

老年人轻度认知功能损害的研究进展

目前 ,随着人口老龄化的发展 ,Ａｌｚｈｅｉｍｅｒ病 (Ａｌｚｈｅｉｍｅｒｄｉｓｅａｓｅ ,ＡＤ)已成为严重危害老年人身心健康、导致残疾最为严重的公共卫生和社会经济问题。据统计 ,在美国 65岁以上的人口中有 1 0 %的人患ＡＤ ,居老年人死亡原因第 4位。由于该病的病程长 ,且无有效的治疗手段 ,给家庭及社会带来沉重的负担 ;故只有早期诊断和治疗才有可能延缓或阻止病情的发展。认知功能损害是痴呆早期的重要临床特征 ,对此 ,我们就老年人轻度认知功能损害 (ｍｉｌｄｃｏｇｎｉｔｉｖｅｉｍｐａｉｒｍｅｎｔ,ＭＣＩ)的最新研究进展做一综…     

动脉粥样硬化性血栓性脑梗塞早期TCD,CT比较研究

选择５４例动脉粥样硬化性血栓性脑梗塞（ＡＴＣＩ）早期临床表现不典型的病例对其早期（发病２４小时内）ＴＣＤ、ＣＴ检查进行回顾性对比研究，结果表明ＴＣＤ异常率（８３．３％）明显高于ＣＴ异常率（５．６％）。ＴＣＤ异常中以血管狭窄为主，以ＭＣＡ受累最多。提示ＴＣＤ能及时提供脑血液动力学变化，弥补了ＣＴ对ＡＴＣＩ早期诊断的不足。临床上对无明显定位体征而ＴＣＤ提示脑血管狭窄的病例，需警惕ＡＴＣＩ的可能。     

焦虑和抑郁障碍共病临床特征的对照研究

为了探讨焦虑和抑郁障碍共病 (ＣＡＤ)的性质 ,我们对ＣＡＤ的临床特征做了系统研究。对象　为 1 999年 1 1月至 2 0 0 0年 1 1月在南京脑科医院住院患者 ,75例。入组标准 :符合美国精神障碍诊断与统计手册第 4版 (ＤＳＭ ＩＶ)中主要抑郁症 (ｍａｊｏｒｄｅｐｒｅｓｓｉｏｎ ,ＭＤ)、广泛性焦虑障碍 (ｇｅｎｅｒａｌｉｚｅｄａｎｘｉｅｔｙｄｉｓｏｒｄｅｒ,ＧＡＤ)和惊恐障碍(ｐａｎｉｃｄｉｓｏｒｄｅｒ ,ＰＤ)的诊断标准 ;性别不限 ;年龄 1 8～ 65岁 ;经检查血常规正常 ,心、肝、肾功能正常 ;无精神分裂症、酒精和药物依赖病史 ,无脑器…     

非典型抑郁症的临床研究概况

非典型抑郁症 (ａｔｙｐｉｃａｌｄｅｐｒｅｓｓｉｏｎ ,ＡＤ)是一类对单胺氧化酶抑制剂 (ＭＡＯＩｓ)具有较好效果的抑郁症亚型。ＤＳＭ -Ⅲ认为它缺乏情感性障碍的典型抑郁症状 (ｍａｊｏｒｄｅｐｒｅｓｓｉｏｎ) ,而置于非特异性抑郁症范畴 ,ＤＳＭ -Ⅲ -Ｒ亦未再对其症状特点加以描述 ,但在以后又发现它具有特异的临床特征而再次为ＤＳＭ-Ⅳ所接受。本文就其诊断标准及近年来手边有关资料作一复习 ,并作以下概述。1　ＡＤ的诊断标准对ＭＡＯＩｓ异丙肼比丙咪嗪效果更好的一类抑郁症的研究始于 195 0年代。Ｗｅｓｔ等 (195 9)又发现[1] ,…     

急性脑梗死患者白细胞变形能力、粘附功能和粘附分子表达的变化

目的探讨白细胞变形能力、粘附功能和白细胞粘附分子与急性脑梗死发生的关系。方法检测了６８例急性脑梗死患者急性期（发病３、７、１５天）和恢复期（２１、３０天）、４２例脑出血患者和６０名健康人外周血白细胞滤过指数（ＬＦＩ）、白细胞粘附率（ＬＡＲ）、白细胞ＣＤ１８表达和血清可溶性细胞间粘附分子１（ｓＩＣＡＭ１）浓度变化。结果急性脑梗死患者ＬＦＩ、ＬＡＲ、ＣＤ１８表达和ｓＩＣＡＭ１浓度均明显增高，与对照组和脑出血组比较差异有显著意义；脑梗死患者恢复期ＬＦＩ、ＬＡＲ、ＣＤ１８表达和ｓＩＣＡＭ１浓度明显低于急性期。随着病情好转，ＬＦＩ、ＬＡＲ、ＣＤ１８表达和ｓＩＣＡＭ１浓度逐渐降低，第３、７、１５、２１、３０天各指标比较差异有极显著意义。有并发症者各指标变化较无并发症者更明显。急性脑梗死患者ＬＦＩ、ＬＡＲ与ＣＤ１８表达和ｓＩＣＡＭ１浓度呈正相关。ＬＦＩ与ＬＡＲ呈正相关。结论急性脑梗死患者白细胞变形能力降低、粘附功能和ＣＤ１８表达及可溶性细胞间粘附分子１浓度增高，可能与急性脑梗死的发生、发展有关     

情感性障碍CIDI—C与SCAN多中心现场测试对比研究

目的：了解ＣＩＤＩ－Ｃ／ＩＣＤ－１０,ＣＩＤＩ－Ｃ／ＤＳＭ－Ⅲ－Ｒ,ＳＣＡＮ／ＩＣＤ－１０,ＳＣＡＮ／ＤＳＭ－Ⅲ－Ｒ诊断系统诊断情感性障碍的信度和效度。方法：所有研究者在培训后,应用ＣＩＤＩ－Ｃ和ＳＣＡＮ量表,对其单位中符合ＣＣＭＤ－２诊断标准的情感性障碍,精神分裂症和神经症病人按住院或门诊顺序进行测试,测试资料应用ＷＨＯ提供的ＣＩＤＩ－Ｃ／ＩＣＤ－１０,ＣＩＤＩ－Ｃ／ＤＳＭ－Ⅲ－Ｒ,ＳＣＡＮ／Ｉ     

阿尔茨海默病患者ApoE基因多态性分析

阿尔茨海默病 (Ａｌｚｈｅｉｍｅｒｄｉｓｅａｓｅ ,ＡＤ)具有多基因遗传倾向。位于染色体 19ｑ13的ＡｐｏＥ基因是ＡＤ的易患基因之一 ,其基因多态性在不同种族人群间表现不同。目前有关ＡｐｏＥ与ＡＤ关系的研究大多源自西方人群。本研究旨在探讨ＡｐｏＥ基因单核苷酸多态性在中国散发性ＡＤ发病机制中的作用。研究对象 :ＡＤ组患者 32例 ,男 10例 ,女 2 2例 ,平均年龄(70 .31± 9.74)岁 ,细微精神状态检查 (ＭＭＳＥ )得分 8～ 14,日常生活量表得分 38～ 46。痴呆诊断标准依据美国精神障碍诊断与统计手册第四版 (ＤＳＭ Ⅳ ) ,ＡＤ诊断标…     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

The organization of the connections between the cortex and the claustrum in the monkey

The distribution of labelled cells and of extracellular granules in the claustrum has been studied after injections of horseradish peroxidase in several areas of the neocortex. The frontal and parietal lobes are related to the anterior and posterior halves respectively of the claustrum, and the occipital and temporal cortex to the posterior and inferior margins. Parts of the claustrum related to areas of the cortex in the frontal lobe overlap considerably in the antero-posterior dimension with parts related to widely separated but interconnected areas of the parieto-temporal cortex. Areas of cortex within one lobe which are interconnected are related to parts of the claustrum which overlap in the dorsoventral dimension.     

Investigating the construct validity of the SPAI-C: comparing the sensitivity and specificity of the SPAI-C and the SAS-A

Investigates the construct validity of the Social Phobia and Anxiety Inventory for Children (SPAI-C) by comparing its sensitivity and specificity with another self-report measure of social anxiety, the Social Anxiety Scale for Adolescents (SAS-A). Participants were 252 adolescents (124 males and 128 females) 13-17 years old. Adolescents completed the SPAI-C and the SAS-A and were interviewed using the Anxiety Disorders Interview Schedule for DSM-IV: Child Version (ADIS-IV:C). Parents were also interviewed and composite diagnoses were formed. Youth were classified as socially phobic or non-anxious based on these composite diagnoses. By comparing clinical cutoff scores with diagnostic group classification, the sensitivity and the specificity of the SPAI-C and SAS-A were compared. Results indicated that the SPAI-C was a more sensitive measure than the SAS-A (61.5% vs. 43.6%) providing evidence of the scale's construct validity. The two measures were similar with regard to specificity (82.7% for both). Implications of these results for assessment and research are discussed.