北京城乡55岁或以上居民简易智能状态检查测试结果的分布特征

目的研究简易智能状态检查（ＭＭＳＥ）测试结果的分布特征,为制定适合我国国情的筛查分界值的标准提供科学的依据。方法通过分层多级整群抽样,以北京市５５岁或以上５３６７名居民为样本。总结其简易智能状态检查（ＭＭＳＥ）测试结果的百分位数值和均值的年龄、性别和受教育程度的分布;比较我国不同的ＭＭＳＥ筛查分界值检测痴呆的效度。按城市和农村建立多元线性回归方程,分析影响测试结果的因素。结果５５～５９岁至８５岁或以上年龄组的居民,在文盲组、小学组、初中及以上组,中位ＭＭＳＥ成绩分别为２３～１８,２７～２４,２９～２７分。性别、年龄和受教育程度诸因素均对ＭＭＳＥ得分有显著影响（Ｐ＜０．０１）。ＭＭＳＥ的分界值文盲组≤１９分、小学组≤２２分、初中及以上组≤２６分检测痴呆的敏感度（城乡分别为９０．７％和９７．１％）高于既往常用的分界值（城乡分别为６６．７％和７８．６％）。结论ＭＭＳＥ得分是判断认知功能是否正常的非特异性指标,不能取代临床诊断。我们调整的分界值标准,有助于早期发现痴呆病人,减少漏诊。我国既往报道的痴呆患病率远低于西方国家的原因之一可能和筛查分界值较低有关。     

简易智能精神状态检查量表检测老年期痴呆患者的应用探讨

目的 研究简易智能精神状态检查量表(mini-mental state examination。MMSE)的人群分布特征、临床适用性、痴呆筛查的界定值及痴呆早中期的分界值。方法 采用随机分层抽样方式。对北京城乡40岁及以上常模、痴呆及易混淆疾病人群进行MMSE调查研究及统计分析。结果 MMSE检测结果表明．在城乡常模人群间差异有显著性。其分值随年龄增长而下降．文化程度越高分值越高；痴呆筛查的界定值文盲组≤24分、文化组(初小及以上)≤26分．痴呆早中期分界值文盲组为17分、文化组(初小及以上)为19分。结论 MMSE涵盖的认知项目广泛。操作简单方便。筛查痴呆敏感度较高。适于临床广泛应用，但MMSE判断的认知功能下降是非特异性的．受许多疾病及意识、精神状态干扰，故应结合临床综合判断。     

蒙特利尔认知评估量表用于社区轻度认知障碍筛查的初步研究

目的探讨北京版蒙特利尔认知评估量表(MoCA-BJ)用于筛查社区轻度认知障碍(MCI)人群的适用性和最佳分界值。方法以西咸城区50岁以上社区居民为研究对象,采用随机整群抽样方法抽取西咸城区中1195名社区老年人。采用简易精神状态量表(MMSE)对受试者进行认知功能检测,参照MCI诊断标准分为正常组和MCI组,再次进行MoCA-BJ测试。按照受教育程度进行分组,分别绘制各组的受试者工作曲线(ROC),确定最大约登指数所对应的MoCA-BJ截断值。结果MMSE和MoCA-BJ评分显著相关,相关系数为0.791,P<0.001;各组MoCA-BJ最佳分界值分别为19(文盲)、21(小学)、25(初中及以上)。一致性检验Kappa值为0.686,P<0.001,一致性较好。结论MoCA-BJ能有效应用于本地区的MCI人群筛查。     

蒙特利尔认知评估量表用于社区轻度认知障碍筛查的初步研究

目的探讨北京版蒙特利尔认知评估量表(MoCA-BJ)用于筛查社区轻度认知障碍(MCI)人群的适用性和最佳分界值。方法以西咸城区50岁以上社区居民为研究对象,采用随机整群抽样方法抽取西咸城区中1195名社区老年人。采用简易精神状态量表(MMSE)对受试者进行认知功能检测,参照MCI诊断标准分为正常组和MCI组,再次进行MoCA-BJ测试。按照受教育程度进行分组,分别绘制各组的受试者工作曲线(ROC),确定最大约登指数所对应的MoCA-BJ截断值。结果MMSE和MoCA-BJ评分显著相关,相关系数为0.791,P<0.001;各组MoCA-BJ最佳分界值分别为19(文盲)、21(小学)、25(初中及以上)。一致性检验Kappa值为0.686,P<0.001,一致性较好。结论MoCA-BJ能有效应用于本地区的MCI人群筛查。     

业余活动与60岁以上老年人认知功能的关系

目的 探讨业余活动与60岁以上老年人认知功能的关系.方法 采用多阶段整群随机抽样方法调查石家庄市社区1203例60岁以上老年人,根据业余活动量分为高业余活动(n=504)和低业余活动(n=699)组,两组受试者性别、年龄和受教育年限相匹配,差异无统计学意义(P均＞0.05).采用简易智力状况检查(Mini-Mental State Examination,MMSE)和蒙特利尔认知评估(Montreal Cognitive Assessment,MoCA)评价两组受试者的认知功能状况.结果 (1)在1203例老年人中,MMSE筛查阳性率(低于划界值)19.5％(234例),MoCA筛查阳性率(低于划界值)66.9％(805例),MoCA的阳性检出率高于MMSE,差异有统计学意义(P=0.000);(2)按照MMSE和MoCA划界分,高业余活动组与低业余活动组MMSE筛查阳性率的差异无统计学意义(P=0.162),高业余活动组MoCA筛查阳性率高于低业余活动组,差异有统计学意义(P=0.012);(3)高业余活动组与低业余活动组的MMSE总分差异无统计学意义(P=0.061),高业余活动组MoCA总分高于低业余活动组,差异有统计学意义(P=0.011);(4)高业余活动组注意力和计算力、语言及延迟回忆得分高于低业余活动组,差异有统计学意义(P均＜ 0.05).结论 60岁以上高业余活动老年人认知功能损害发生率较低.     

物体记忆测验的北京老年常模及其在轻度认知损害流行病学筛查中的应用

目的建立Fuld物体记忆测验(Fuld object memory evaluation,FOM)量表的北京城乡老年人常模,并分析其在筛查轻度认知损害(mild cognmve impairment,MCI)中的作用。方法采用随机分层抽样方法选取北京城乡60岁及以上居民715名,其中健康人504名(男230名,女274名)及MCI患者211例(男94例,女117例),对其进行FOM测验和其他多种神经心理量表检查。神经内科医师结合临床和纵向资料根据相应诊断标准明确诊断,然后对数据进行统计学分析。结果老年人常模各年龄段界限值:60～70岁15分,70岁以上组14分;首次回忆得分筛查MCI的界限值为6分。结论 FOM能检出患者以记忆为主的认知功能障碍,操作简便,敏感度适中,可作为临床和流行病学筛查MCI的有效工具。     

画钟测验联合MMSE在老年认知功能障碍筛查中的应用

目的探讨使用画钟测验（CDT）联合简易智力状况检查（MMSE）筛查老年认知功能障碍的可行性。方法采用多阶段分层整群抽样方法,抽取河北省石家庄市、唐山市、张家口市和邯郸市4个地区共3040名60岁以上老人,对所有被试采集一般人口学资料,同时进行CDT和MMSE评估。结果所有被调查者CDT平均（3．01士1．37）分,低于4分者为43．7％;其中男性老年人cDT〈4分者35．0％,明显低于女性的65．0％,差异有统计学意义（χ2=35．58,P〈0．01）。不同年龄段CDT〈4分者分别为60～64岁（32．2％）,65～69岁（35．8％）,70～74岁（45．6％）,75～79岁（57．5％）,≥80岁（75．1％）。不同文化程度CDT〈4分者分别为文盲82．8％,小学49．3％,初中35．7％,高中30．0％,大专以上24．8％。在2358名MMSE正常老年人中CDT测验低于正常者890名（37．74％）;在1715名CDT测验正常的老年人中检测出MMSE异常者247名（14．40％）。按照CDTO～4分划分为5组进行MMSE评分比较,5组间比较差异有统计学意义（F=402．68,P〈0．01）。CDT得分与MMSE总分、视空间功能、计算力、命名、记忆力、定向力均呈正相关（r分别为0．575,0．423,0．438,0．106,0．249,0．357;P〈0．01）。结论CDT得分在一定程度上反映老年人认知、执行功能损害的状况,CDT联合MMSE可作为筛查老年人认知功能障碍的有效方法。     

蒙特利尔认知评估量表识别首次卒中后轻度血管性认知障碍的作用

目的 探讨蒙特利尔认知评估量表(MoCA)识别首次卒中后轻度血管性认知障碍(mVCI-FS)的作用,并与简易智能精神状态量表(MMSE)比较. 方法 选取mVCI-FS患者60例.首次卒中后非血管性认知障碍(nVCI-FS)25例,于发病后(12+1)周由不知情的神经科医师进行MoCA及MMSE评估. 结果 MoCA总平均分为(19.78±4.573)分,MMSE为(25.48±3.148)分,偏相关分析间.r=9,P=0.000.MoCA除计算力和言语流畅性外,其余各项在mVCI-FS和nVCI-FS间差异均有统计学意义(P<0.05);MMSE的即刻记忆、计算力、命名和阅读理解在2组间差异无统计学意义(P>0.05).应用ROC曲线和Youden指数最大值初步确定MoCA识别mVCI-FS与nVCI-FS的最佳分界值为21分.以21分为分界值.MoCA筛查mVCI-FS的敏感度和特异度分别为84.6%和76.0%,明显优于MMSE(敏感度59.6%和特异度57.7%),差异有统计学意义(P<0.05). 结论 初步确定MoCA识别mVCI-FS与nVCI-FS的最佳分界值为21分.MoCA筛查mVCI-FS的敏感度和特异度均高,是一种有效的mVCI.FS筛查量表;MMSE对mVCI.FS的敏感度低,识别mVCI-FS的作用有限.     

应用简易智力状态检查量表测试农村中老年人的结果与分析

目的　为探讨简易智力状态检查量表 (MMSE)在测试农村中老年人群和老年期痴呆的可靠性。方法　应用MMSE量表对农村 5 0岁以上人群进行检测 ,并就性别、年龄、文化程度等因素对MMSE评分的影响进行了分析。结果　在农村中老年人群中MMSE总平均分为 ( 2 3 65± 6 74)分 ,低于城市中老年人。其中 ,男性平均分为 ( 2 6 3 4± 3 40 )分 ,女性为 ( 2 2 75± 4 6)分 ,并随年龄增高而降低 ;MMSE各项因子分在文化程度偏低组与偏高的年龄组以及痴呆组的老年人均明显降低。结论　MMSE适宜作为农村老年痴呆调查的筛选工具 ,但农村中老年人的文化程度较低 ,MMSE中的部分项目 (如写句子等 )在实际应用中却有困难 ,应作适当的修改     

老年快速认知筛查量表应用于轻度认知功能障碍筛查的分界值研究

目的:探讨老年快速认知筛查量表(quick cognitive screening scale for elderly,QCSS-E)在社区老年人群中筛查轻度认知功能障碍(mild cognitive impairment,MCI)的分界值。方法:采用QCSS-E对社区223名60岁及以上的老年人进行MCI筛查,同时采用金标准进行临床诊断,根据ROC曲线评估QCST-E筛查MCI的整体性能及理想划界分。结果:223名老人中,确诊为正常老人(NC)160名、MCI42例、轻度痴呆21例,分别占71.75%、18.83%和9.42%;3组QCSS-E得分分别为(77.84±4.69)分、(70.31±3.94)分、(62.14±4.68)分,差异具有统计学意义(P0.01)。当受试者文化程度分别为小学、初中及以上时,QCST-E筛查MCI/NC、轻度痴呆/MCI的最佳临界分为72、67分和73、68分,以该临界分采用QCSS-E筛查MCI/NC及轻度痴呆/MCI的灵敏度、特异度分别为88.1%、90%和90.48%、90.48%,筛查结果和临床诊断一致性检验Kappa值分别为0.680、0.791。结论:QCSS-E根据不同文化程度的分界值对老年人进行MCI筛查具有良好的灵敏度和特异度,其结果和临床诊断一致性较高,适宜基层医疗单位在社区老年人中推广应用。     

Genetic findings in obsessive-compulsive disorder in childhood and adolescence and in adulthood

Obsessive-compulsive disorders (OCD) are on the rise, and affected children, 1-2% of the general population, often are seriously impaired in their development. OCD is characterized by recurrent, intrusive and disturbing thoughts as well as by repetitive stereotypic behaviours. Depending on their age and developmental status, patients usually try unsuccessfully to suppress the obsessive thoughts and compulsive behaviours. The current state of genetic research on OCD and early-onset OCD is presented and discussed. OCD, especially early-onset OCD, has been shown to be familial. Convincing evidence indicates that both environmental and genetic factors substantially influence OCD. Various approaches, including linkage and association studies, yielded conflicting results as well as the notion that multiple genes of modest effect sizes, in interaction with environmental factors, cause vulnerability to the disorder. The phenotypic and genetic heterogeneity of OCD complicate the identification of specific genetic factors. Further studies have to be designed in consideration of subtypes, e.g. age at onset, symptom dimensions, or comorbid disorders.     

Changes in extra- and intracellular pH in the brain during and following ischemia in hyperglycemic and in moderately hypoglycemic rats

Incomplete forebrain ischemia of 15-min duration was induced in rats made hyperglycemic or moderately hypoglycemic prior to ischemia. Tissue CO2 tension, CO2 content, labile tissue metabolites, and extracellular pH (pHe) were measured, and intracellular pH (pHi) was derived by calculation on the assumption that cerebral intracellular fluids can be lumped into one space. In hypoglycemic animals, mean tissue lactate content increased from 2 to 10 mumol g-1. Tissue CO2 content was virtually unchanged and the CO2 tension increased from approximately 50 to approximately 145 mm Hg. In hyperglycemic animals, tissue lactate content rose to 20 mumol g-1, and the CO2 content decreased by 25%, demonstrating that some CO2 was lost to the blood supplied by the remaining perfusion. Accordingly, tissue CO2 tension did not rise above 200 mm Hg. pHe was reduced in proportion to the amount of lactate accumulated, the values obtained in hypo- and hyperglycemic animals showing relatively little scatter (6.76 +/- 0.03 and 6.25 +/- 0.04, respectively). In hypoglycemic animals the extracellular HCO-3 concentration was virtually unchanged, demonstrating that any influx of lactic acid from the cells must have been accompanied by H+ efflux and/or HCO-3 influx via independent routes. In hyperglycemic animals [HCO-3]e fell by greater than 10 mumol ml-1. In both groups [HCO-3]e was reduced during the first 5 min of recovery. Recovery of pHe was slower in hyper- than in hypoglycemic animals. During ischemia calculated pHi fell to 6.37 +/- 0.04 and 5.95 +/- 0.06 in hypo- and hyperglycemic animals, respectively. Differences in pHi were maintained for the first 15 min of recovery, but in both hypo- and hyperglycemic animals pHi had normalized after 30 min. It is concluded that preischemic hyperglycemia leads to a more pronounced intra- and extracellular acidosis than normo- and hypoglycemia, an acidosis that also resolves more slowly during recirculation.     

Dopamine-derived alkaloids in alcoholism and in Parkinson's and Huntington's diseases

Summary Tetrahydroisoquinoline (TIQ) alkaloids and 1-carboxy TIQ derivatives have been found in human fluids and/or tissues. The possible biosynthetic pathways of salsolinol (Sal), taken as an example of TIQs, are discussed, and the possibility that biosynthesis occurs through a stereospecific enzymatic reaction is considered. In this respect, it is reported that the R enantiomer of Sal predominates in urines of healthy volunteers, whereas the S enantiomer predominates in port wine and possibly in other beverages and foods, suggesting that Sal present in humans could have, at least partially, and endogenous enzymatic origin.TIQs and other dopamine-derived alkaloids are weak MAO inhibitors, the R enantiomer of Sal and salsolidine being more potent than the S form.The changes in monoamine oxidase activity and the nigrostriatal concentrations of dopamine and homovanillic acid in Parkinson's and Huntington's diseases and in alcoholism are reviewed. In these pathological situations, changes in the levels of dopamine-derived alkaloid levels may occur. The possibility that the modifications found might cause or contribute to changes in mental and/or neurophysiological states in these pathological situations is considered.