安理申治疗轻中度血管性痴呆的有效性及安全性分析

目的评价安理申治疗轻、中度血管性痴呆（VD）患者的有效性及安全性。方法对86例轻、中度VD患者（简易精神状态检查表（MMSE）得分10-24分]随机分为两组，治疗组和对照组，进行12周临床试验。以MMSE为主要评价指标，日常生活能力量表（ADL）和临床痴呆程度量表（CDR）为次要评价指标。结果结果表明，5mg／d安理申治疗12周时，安理申组较安慰组MMSE、ADL、CDR分数显著改善（依次P〈0．01、〈0．05、〈0．01）。自身对照研究结果显示，5mg／d安理申治疗12周时，治疗后较治疗前MMSE、CDR、ADL分数分别改善3．5、0．6、7．0分（依次P〈0．01、〈0．05、〈0．01）。安理申治疗4周时MMSE分数已有提高（P〈0．05）。结论安理申可显著改善轻中度VD病人的认知功能、痴呆程度和日常生活自理能力，且安全性和耐受性良好，是VD治疗的有效药物之一。     

盐酸多奈哌齐(安理申)治疗血管性痴呆(VaD)有效性及安全性的临床观察

目的评价安理申(Aricept)治疗血管性痴呆(Vascular dementia,VaD)的有效性及安全性.方法40例VaD患者进行12周的安理申治疗临床观察,按简易智能状态量表(MMSE)、临床痴呆程度量表(CDR)及日常生活自理量表(ADL)进行治疗前后的疗效评定.结果研究结果表明,5 mg/d安理申治疗4周、12周时,治疗后较治疗前MMSE、临床痴呆程度量表(CDR)及日常生活自理量表(ADL)数均分有改善(P＜0.01).40例服用安理申的患者中,2例出现头晕、恶心,1例出现运动减少、肌肉强直的类帕金森氏综合症副反应,1例出现轻度的躁动、情绪易激惹等阳性精神症状.结论安理申能有效治疗VaD患者,对患者的认知功能、痴呆程度和日常生活自理能力均有改善,耐受性好,安全性高.     

盐酸多奈哌齐(安理申)治疗血管性痴呆的临床P300、N400对比研究

目的对安理申治疗血管性痴呆患者进行临床P300、N400对比研究.方法对40例血管性痴呆患者治疗前后进行P300、N400检测并进行MMSE、CDR和ADL的评定.结果研究结果表明,5 mg/d安理申治疗12周时,治疗后较治疗前MMSE、CDR、ADL及P300、N400潜伏期分别改善4.1,0.7,8.2和21 ms,37 ms(P依次＜0.01,0.05,0.01,0.01).结论事件相关电位P300、N400是一种客观神经电生理指标,结果表明安理申能有效治疗VaD患者,对患者的认知功能、痴呆程度和日常生活自理能力均有改善,耐受性好,安全性高.     

辛伐他汀对轻、中度老年痴呆合并高脂血症病人疗效的影响

目的观察辛伐他汀对轻、中度老年痴呆合并高脂血症病人降血脂疗效和对痴呆进展的影响。方法选择120例轻、中度老年痴呆合并高脂血症病人随机分为研究组和对照组。对照组给予常规治疗,研究组在相同基础上每晚加服辛伐他汀20mg。比较两组治疗前及治疗后4、12周的血清总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及简易智能状态量表(MMSE)、临床痴呆程度量表(CDR)和日常生活自理量表(ADL)分数等指标,以MMSE、CDR和ADL为主要评价指标。结果研究组TC,TG,LDL-C,HDL-C,MMSE、CDR及ADL分数的改善优于对照组,差别有显著性意义(P<0.05)。结论辛伐他汀降血脂同时能延缓轻、中度老年痴呆的进展。     

颅脑损伤后长期昏迷患者的催醒治疗体会

目的评价盐酸多务哌齐（Donepezil，商品名：安理中）活疗血管性痴呆的疗效及安全性。方法对60例血管性痴呆患者进行多奈哌齐和吡拉西坦的对照治疗，其中治疗组（安理申）30例，对照组（吡拉西坦）30例，治疗12周。应用简易精神状态检（MMSE），日常生活能力量表（ADL）评定临床疗效。结果治疗组血管性痴矛患者认知功能及日常生活活动能力改善明显，与对照组比较差异有显著性意义（P〈0．01）。安理申不良反应少且轻微，多为一过性，患者耐受性好。结论安理申对于轻、中度血管性痴呆有良好的治疗效果及安全性。     

安理申联合奥拉西坦治疗血管性痴呆临床观察

目的观察安理申联合奥拉西坦对血管性痴呆的治疗效果。方法选取2018-01-12郑州大学第一附属医院收治的70例血管性痴呆患者,按随机数字表分为2组,观察组采用安理申联合奥拉西坦治疗,对照组单用安理申治疗,对比2组治疗效果,检测治疗前后简易智能精神状态评估量表(MMSE)和日常生活能力评定量表(ADL),评定患者的智能状态和日常生活能力,检测血中转化生长因子-β(TGF-β)、胰岛素样生长因子-1(IGF-1)、细胞间黏附分子-1(ICAM-1)、内皮素(ET)与外周血内皮祖细胞(EPC)水平。结果治疗后观察组MMSE和ADL评分均高于对照组(P0.05),TGF-β和IGF-1水平高于对照组(P0.05),ICAM-1水平、ET水平均低于对照组(P0.05),EPC水平高于对照组(P0.05)。结论安理申联合奥拉西坦通过提高TGF-β、IGF-1、EPC水平,降低ICAM-1、ET水平,改善血管性痴呆患者的MMSE和ADL评分,其疗效优于单用安理申。     

轻至中度阿尔茨海默病患者认知和生活功能的自然演变

目的　了解阿尔茨海默病 (AD)认知和生活功能的自然演变。方法　对不服任何益智药的 30例轻度和 2 1例中度AD病人连续随访 30周。以简易智能状态检查量表 (MMSE)、Alzheimers痴呆缺陷量表 (ADS)、日常生活能力量表 (ADL)、成人韦氏记忆量表 (WMS)为评定工具 ,每 6周评定 1次。结果　 30周后 ,MMSE平均下降 (0 .2 5± 2 .5 8)分 (P >0 .0 5 ) ,ADS平均下降 (1.6 3± 4 .33)分 (P <0 .0 5 ) ,ADL平均上升 (2 .0 4± 6 .76 )分 (P <0 .0 5 ) ,WMS平均上升(3.37± 9.2 4 )分 (P <0 .0 5 )。结论　轻至中度AD病人认知功能和日常生活能力是缓慢减退的。轻至中度AD病人仍有低水平的学习能力。     

安理申联合尼莫同及恩必普治疗血管性痴呆临床分析

目的 评价安理申联合恩必普及尼莫同对血管性痴呆患者认知、行为功能障碍的改善作用.方法 将90例患者随机分为2组,安理申联合治疗组45 例,安理申治疗组45 例,2组年龄、性别及病情等一般情况差异无统计学意义.治疗前和治疗后8、16 周进行MMSE量表、ADL量表测评.治疗前后均检测血常规、肝肾功能和心电图.结果 安理申联合治疗组治疗血管性痴呆患者8、16周后,认知功能的改善和行为能力的改善均明显好于安理申治疗组(P<0.05).结论 安理申联合治疗组对血管性痴呆症认知功能、行为能力改善效果较单用安理申明显,且无明显不良反应.     

石杉碱甲治疗血管性痴呆的临床研究

目的：观察石杉碱甲治疗轻、中度血管性痴呆（VaD）的临床疗效和安全性。方法：78例轻、中度VaD患者随机分为两组。石杉碱甲组39例：男性24例,女性15例,年龄（71．8±7．2）岁;对照组39例：男性26例,女性13例,年龄（72．3±6．9）岁。石杉碱甲组给予石杉碱甲0．1mg,bid,口服;对照组给予维生素C100mg,bid,口服。两组总疗程为12周。采用简易精神状态检查表（MMSE）、临床痴呆程度量表（CDR）和日常生活能力量表（ADL）作为评价指标。结果：石杉碱甲治疗12周后MMSE、CDR及ADL分数分别较对照组和治疗前明显改善（P〈0．01）。结论：石杉碱甲可显著改善VaD患者的认知功能,且安全性良好。     

天智颗粒治疗轻、中度阿尔茨海默病临床研究

目的评价天智颗粒治疗轻、中度阿尔茨海默病(alzheimer disease,AD)的有效性及安全性。方法选择简易智能状态量表(MMSE)轻、中度AD患者60例,随机分成治疗组和对照组各30例,治疗组给予天智颗粒联合吡拉西坦治疗,对照组给予吡拉西坦治疗,观察12周。治疗前后应用简易智能状态量表MMSE,日常生活能力量表(ADL)评价临床疗效;用不良反应量表(TESS)评定不良反应。结果观察12周,天智颗粒治疗组较对照组MMES、ADL评分明显改善(P<0.01)。治疗组天智颗粒治疗12周后较治疗前MMSE与ADL分数分别改善3.8分和8.0分(P<0.05,P<0.01)。天智颗粒治疗组不良反应轻,与吡拉西坦对照组比较2组差异无显著意义(P>0.05)。结论天智颗粒能有效治疗轻、中度AD患者,对患者的认知功能和日常生活自理能力均有改善,耐受性好,安全性高。     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.     

Un nouveau cadre conceptuel de travail pour une psychiatrie revisitée ? Introduction à deux articles de E. Kandel

In two articles which appeared in the American Journal of Psychiatry and that were subsequently translated for Évolution Psychiatrique, E. Kandel examines the bases for a reinterpreted psychiatry that is prepared to confront the major challenge of the 3rd millenium: that of insight into the mind and brain. This requires a major reorganization of the discipline, which involves a reinvestment of the scientific approach and a critical  assessment of the data provided by psychoanalytical psychiatry and cognitive neurosciences. Seven concepts have therefore been proposed for interactive re-examination: consciousness, the unconscious, memory, emotion, development, desire, impulse. The dynamic relations existing between genetics and the environment allow one to see how evolutions are possible from actions at different levels, both psychotherapeutic and pharmacological. Imaging and other techniques provide additional objective information to the process of human interaction which remains the basis of psychiatry. A common framework for psychiatry and the neurosciences, a reconsideration and renewal of the psychoanalytical approach are both possible and necessary.     

Opioids and the developing organism: A comprehensive bibliography, 1984–1988

A comprehensive bibliography of the literature concerned with opioids and the developing organism for 1984-1988 is presented. Utilized with companion papers (Neurosci. Biobehav. Rev. 6:439-479; 1982; 8:387-403; 1984), these articles cover the clinical and laboratory references beginning in 1875. For the years 1984, 1985, 1986, 1987, and 1988, a total of 877 citations were recorded. A series of indexes accompanies the citations in order to make the literature more accessible. These indexes are divided into clinical and laboratory topics, and subdivided into such topics as the type of opioid explored and the general area of biological interest (e.g., physiology).     

La biologie et le futur de la psychanalyse : un nouveau cadre conceptuel de travail pour une psychiatrie revisitée

The American Journal of Psychiatry has received a number of letters in response to my earlier “Framework” article (1). Some of these are reprinted elsewhere in this issue, and I have answered them briefly there. However, one issue raised by some letters deserves a more detailed answer, and that relates to whether biology is at all relevant to psychoanalysis. To my mind, this issue is so central to the future of psychoanalysis that it cannot be addressed with a brief comment. I therefore have written this article in an attempt to outline the importance of biology for the future of psychoanalysis.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.