计算机化认知训练对脑卒中后认知功能障碍的影响

目的 探讨计算机化认知训练对脑卒中后认知功能障碍的影响。方法 将90例脑卒中后认知功能障碍(PSCI)患者随机分为对照组(30例)、人工组(30例)及计算机组(30例),3组患者均给予常规的内科治疗及肢体康复训练,人工组增加人工认知功能训练,计算机组增加基于认知能力评定与康复系统(CAARS)的计算机辅助认知训练,训练时间共4周,5 d/周,60 min/d,在基线时、训练结束时及训练结束12周后采用蒙特利尔认知评估量表(MoCA)评估各组患者的认知功能。结果 在训练结束时和训练结束12周后,人工组和计算机组的MoCA总分、注意力、抽象能力和记忆力均较对照组改善显著(P<0.05); 且计算机组的视空间执行能力和抽象能力较人工组改善更加显著(P<0.05)。结论 早期的认知功能训练对改善缺血性脑卒中患者急性期的认知功能障碍有积极的作用,且计算机化认知训练较人工认知训练在改善PSCI患者的视空间执行能力和抽象能力方面效果更显著。     

脑卒中后认知功能障碍研究进展

脑卒中后认知功能障碍(post-stroke cognitive impairment,PSCI)是急性脑血管病事件发生后出现的认知功能障碍或是原有认知功能障碍的加重。PSCI不仅影响脑卒中后患者的生活质量,也影响患者对规范治疗的判断力和依从性,是影响患者生存时间的重要因素。本文旨在对PSCI的临床表现、流行病学、发病机制、影响因素、诊断步骤、神经心理学评估、影像学表现以及干预和治疗的最新进展进行综述,重点聚焦于PSCI发病机制和影像学表现的最新进展,以期为PSCI的早期诊断和防治策略提供参考依据。     

脑卒中急性期应用MoCA预测中期认知损害的临床研究

目的探讨简易床旁检查(蒙特利尔认知评估量表,MoCA)在脑卒中急性期预测中期认知损害的价值。方法收集我院脑卒中患者,脑卒中后5~9d应用MoCA评估,基线状态下采集临床、功能、神经影像学数据。脑卒中后6~9个月进行广泛的神经心理学和功能评估。结果纳入138例患者,随访81例,48例诊断为PSCI,控制年龄、受教育程度、病态前病态和认知情况、脑卒中严重程度、以往存在腔隙性梗死等变量,发现MoCA、脑白质疏松症与PSCI独立相关。结论在轻度脑卒中患者中,MoCA可能在急性期预测中期认知损害情况,是脑卒中急性期较好的检查工具之一。     

计算机辅助认知训练联合多奈哌齐治疗卒中后认知障碍

目的研究计算机辅助认知训练联合多奈哌齐治疗卒中后认知障碍的临床疗效。方法筛选脑卒中后轻中度血管性认知障碍的患者83例,随机分为2组。其中,对照组42例予脑卒中规范治疗并口服盐酸多奈哌齐5 mg,qd;观察组41例在上述治疗基础上应用计算机辅助认知训练,40 min/d,每周5 d。治疗前及6周后应用蒙特利尔认知测验(MoCA)评价总体认知功能;数字广度测验评估注意力及工作记忆;连线测验评估执行功能;动物流畅性测验评估语言功能;改良Barthel指数(MBI)评估患者日常生活活动能力。结果治疗6周后,观察组和对照组在MoCA评分、数字广度测验正背及倒背、连线测验B-连线测验A、言语流畅性测验、日常生活能力评分均明显改善,差异有统计学意义(P<0.01)。其中,观察组在MoCA、数字广度测验正背及倒背、言语流畅性测验、日常生活能力评分方面较对照组明显提高,差异有统计学意义(P<0.05)。结论计算机辅助认知训练联合多奈哌齐治疗卒中后认知障碍,能显著改善患者整体认知功能、注意力、工作记忆、言语能力、日常生活能力,提高患者的生活质量。     

高压氧配合计算机辅助认知训练治疗血管性认知障碍的疗效观察

目的观察高压氧(HBO)配合计算机辅助认知训练对血管性认知障碍的作用。方法 28例血管性痴呆患者随机分为治疗组(n=14)和对照组(n=14)。2组常规治疗相同,治疗组加用高压氧及计算机辅助认知训练。结果治疗组认知功能改善方面明显优于常规对照组,差异有统计学意义(P0.05)。结论高压氧配合计算机辅助认知训练能显著改善血管性认知障碍的认知功能。     

脑卒中后抑郁合并认知损害的磁共振扩散张量成像研究

目的 探讨脑卒中后抑郁(PSD)合并卒中后认知功能损害(PSCI)患者的磁共振扩散张量成像(DTI)表现及脑卒中后抑郁合并认知功能损害的发病机制。方法 选取武汉大学中南医院2014年10月～2015年12月首发急性脑卒中患者52例,进行汉密尔顿抑郁量表(HAMD)、简明精神状态检查量表(MMSE)、蒙特利尔认知评估(MoCa)量表评分,分为PSD合并PSCI组13例(A组),PSD组(B组)11例,PSCI组(C组)12例,单纯脑卒中组16例(D组)。进行磁共振平扫及DTI扫描,比较各组不同部位FA值的差异。结果 A组与D组比较,双侧额叶、双侧半卵圆中心、左侧颞叶、左侧丘脑、右侧壳核FA值减低,差异有统计学意义(P<0.05)。结论 PSD合并PSCI患者可能具有相对独立的发病机制,与双侧额叶、双侧半卵圆中心、左侧颞叶、左侧丘脑及右侧壳核损害有关。     

肠道菌群及其代谢产物与卒中后认知功能障碍相关性的研究进展

卒中后认知功能障碍（PSCI）在脑卒中患者中较为常见，影响了卒中患者的生活质量及预后，其危险因素的研究也越来越受到人们的重视。肠道菌群及其代谢产物作为近年来的研究热点之一，已被证实与中枢神经系统疾病的发生发展密切相关，尤其是脑卒中患者。有文章表明，肠道菌群及其代谢产物与早期认知功能下降及PSCI均密切相关。本文将综述肠道菌群及其代谢产物和脑卒中的相互作用机制，卒中后肠道菌群的变化，以及改变的肠道菌群和代谢产物对脑卒中及PSCI的影响，并探讨胆碱、益生菌、抗生素等在PSCI防治方面的潜在价值，为PSCI的防治提供新思路。     

术后认知功能障碍

术后认知功能障碍(Postoperative Cognitive Dysfunction,POCD)是外科手术后常见的一种中枢神经系统的并发症,多发生于65岁以上患者.其主要表现为手术后出现记忆力,精神集中能力,语言理解力的受损及社会适应能力的下降等认知功能损伤,严重影响患者生活质量.手术后认知障碍的发生机制目前尚不清楚,早期诊断和干预,以及后期治疗等方面都还不是很成熟.本文从发病机制,影响因素,病情评估,预防治疗,动物模型等方面对POCD进行论述,并对其可能的分子机制进行探讨和预测.     

认知功能训练对改善脑卒中后吞咽障碍患者功能的影响

目的探讨认知功能训练对脑卒中后吞咽障碍患者吞咽的功能影响。方法将40例吞咽障碍合并认知功能障碍患者随机分为治疗组和对照组,分别进行MMSE,吞咽功能评分(藤氏评分)进行评定,对其进行吞咽功能训练及吞咽功能合并认知功能训练。结果治疗后2个月,2组患者MMSE及吞咽功能评分均有提高,配合认知康复训练后的治疗组吞咽功能与对照组治疗后相比较,显著改善(P<0.05)。结论对于合并认知障碍的吞咽障碍卒中患者,同时给予认知康复训练和吞咽训练,有利于认知功能和吞咽功能的及早康复,对提高患者的生存质量具有重要意义。     

轻型缺血性脑卒中患者认知功能障碍的相关因素分析

目的探讨轻型缺血性脑卒中患者认知功能障碍(post-stroke cognitive impairment,PSCI)的发生率和相关危险因素。方法选取2017-09-2018-09就诊于中国人民解放军联勤保障部队第989医院神经内科的首发轻型缺血性脑卒中患者共120例,采用MMSE评分、MOCA评分将其分为PSCI组57例和N-PSCI组63例,对2组一般资料及相关影响因素进行单因素分析,有显著差异的指标进行多因素Logistic回归确定其影响程度。结果轻型缺血性脑卒中患者PSCI的发生率高达47.5%,其中以延迟回忆和视空间及执行功能最为明显;单因素分析表明,2组年龄、高血压、静止性脑梗死、Fazekas评分差异有统计学意义(P0.05);多因素Logistic回归分析提示,高血压、静止性脑梗死为PSCI的独立危险因素(P0.05)。结论轻型缺血性脑卒中患者PSCI的发生率较高,高血压、静止性脑梗死可能是其独立的危险因素。     

Active cognitive lifestyle associates with cognitive recovery and a reduced risk of cognitive decline

Education and lifestyle factors linked with complex mental activity are thought to affect the progression of cognitive decline. Collectively, these factors can be combined to create a cognitive reserve or cognitive lifestyle score. This study tested the association between cognitive lifestyle score and cognitive change in a population-based cohort of older persons from five sites across England and Wales. Data came from 13,004 participants of the Medical Research Council Cognitive Function and Ageing Study who were aged 65 years and over. Cognition was assessed at multiple waves over 16 years using the Mini-Mental State Examination. Subjects were grouped into four cognitive states (no impairment, slight impairment, moderate impairment, severe impairment) and cognitive lifestyle score was assessed as a composite measure of education, mid-life occupation, and current social engagement. A multi-state model was used to test the effect of cognitive lifestyle score on cognitive transitions. Hazard ratios for cognitive lifestyle score showed significant differences between those in the upper compared to the lower tertile with a more active cognitive lifestyle associating with: a decreased risk of moving from no to slight impairment (0.58, 95% CI (0.45, 0.74)); recovery from a slightly impaired state back to a non-impaired state (2.93 (1.35, 6.38)); but an increased mortality risk from a severely impaired state (1.28 (1.12, 1.45)). An active cognitive lifestyle is associated with a more favorable cognitive trajectory in older persons. Future studies would ideally incorporate neuroradiological and neuropathological data to determine if there is causal evidence for these associations.     

The cognitive laterality battery: tests of specialized cognitive function

The Cognitive Laterality Battery of neuropsychological tests is described and normative data and statistics are presented. Selection of tests was based on converging evidence from studies on patients with unilateral cerebral lesions, complete forebrain commissurotomy, and on normal subjects suggesting that visuospatial skills are primarily related to the right hemisphere while verbal and sequential skills are primarily related to the left. Factor analyses confirmed the dichotomy of the test choices. It is suggested that test results on individuals be interpreted as a cognitive profile defining the relative performance of specialized functions rather than the relative right or hemisphere locations. Previous studies with the CLB are described.     

Multiple cognitive deficits in amnestic mild cognitive impairment

OBJECTIVE: To determine if more widespread cognitive deficits are present in a narrowly defined group of patients with the amnestic form of mild cognitive impairment (MCI). METHODS: From a larger sample of patients clinically diagnosed as meeting the criteria of Petersen et al. for amnestic MCI, we selected 22 subjects who had Clinical Dementia Rating scores of zero on all domains besides memory and orientation. These MCI subjects with presumably isolated memory impairments were compared to 35 age-matched normal controls and 33 very mild Alzheimer's disease (AD) patients on a battery of neuropsychological tests. RESULT: In addition to the expected deficits in episodic memory, the amnestic MCI group performed less well than the controls but better than the AD group on design fluency, category fluency, a set shifting task and the Stroop interference condition. Over half the amnestic MCI group (vs. none of the normal controls) scored at least 1 standard deviation below control means on 4 or more of the nonmemory cognitive tasks. CONCLUSIONS: Isolated memory impairment may be fairly uncommon in clinically diagnosed amnestic MCI patients, even when the criteria for amnestic MCI are fairly narrow. Additional cognitive impairments are likely to include fluency and executive functioning. These more diffuse deficits argue for comprehensive cognitive assessments, even when the patient and family are reporting only memory decline, and are consistent with the increase in attention paid to the heterogeneity of MCI.     

Relationship of leukoaraiosis to cognitive decline and cognitive aging.

OBJECTIVE: Leukoaraiosis (LA) is a common finding on MRI scans of the elderly. However, its exact relationship to cognitive decline and dementia is in dispute. Because LA involves the paracallosal white matter, we sought to determine if LA, uncomplicated by ischemic lesions or complaints of cognitive impairment, is associated with cognitive loss or difficulties with interhemispheric integration of behavioral functions. METHODS: Two hundred fifty-seven MRI scans with deep white matter changes were screened. After a chart review, 38 patients had uncomplicated LA, and 31 gave informed consent to undergo cognitive and behavioral testing. RESULTS: LA severity was not related to any of the cognitive or behavioral assessments. However, some dependent measures showed medium effect sizes that were in keeping with published findings, indicating that LA has a marginal impact on cognition. In comparison, robust relationships with age were found for certain tasks, suggesting that our cohort size was sufficient to detect meaningful clinical relationships. CONCLUSION: Based on statistical interpretations using effect sizes, LA severity may be better viewed as a biomarker for physiological brain aging that is in advance of chronological age, leaving the elderly individual at greater risk for developing dementia.     

Mild cognitive impairment and cognitive reserve in Parkinson's disease

Patients with Parkinson’s disease (PD) typically present with motor symptoms, but non-motor symptoms, including cognitive impairment, autonomic dysfunction and neuropsychiatric symptoms, are usually also present, when looked for carefully. The objective of this paper is to provide an up-to-date, comprehensive review of two undecided issues about cognitive impairment in PD patients without dementia: the concept of Mild Cognitive Impairment (MCI) and the concept of Cognitive Reserve (CR). Empirical findings support the value of the concept of MCI in this population, from the early untreated stages onwards. Further studies are needed to establish 1) the clinical-neuroimaging characteristics of MCI subtypes in PD, in comparison to those MCI subtypes in patients without PD; 2) whether different types of MCI in PD are associated with different rates of cognitive decline during the progression of the disease. Preliminary empirical evidence also shows that education might exert a protective effect on cognitive decline in PD and that less educated subjects are at increased risk for developing dementia, lending support to the CR hypothesis, in this population as well. Further studies are necessary to investigate how CR modulates cognitive decline in PD and other frontal-subcortical disorders, e.g. by identifying possible differential effects of CR on different cognitive domains.     

中文版MoCA和MMSE在诊断遗忘型轻度认知功能障碍中的应用

目的 研究中文版蒙特利尔认知评估量表(MoCA)在遗忘型轻度认知障碍(aMCI)诊断筛查中的作用. 方法 以2009-05-2010-03在卫生部北京医院神经内科门诊就诊的患者为检查对象,筛选出aMCI患者31例及健康对照者30名,分别进行简易精神状态量表(MMSE)、MoCA等量表检测,计算两量表诊断aMCI的敏感性和特异性并进行比较,分析MoCA在诊断aMCI中的作用和特点. 结果 以26分作为分界值时,MMSE和MoCA诊断aMCI的敏感性分别为9.68%和87.10%,特异性分别为93.33%和73.33%.MoCA的敏感性显著高于MMSE. 结论与MMSE 相比,MoCA以其较高的敏感性在筛查aMCI中具有较大作用,而且可对多个认知领域的功能进行检测,有望在多个认知损害类型的研究中起到重要作用.     

Application of a cognitive neuroscience perspective of cognitive control to late-life anxiety

Recent evidence supports a negative association between anxiety and cognitive control. Given age-related reductions in some cognitive abilities and the relation of late life anxiety to cognitive impairment, this negative association may be particularly relevant to older adults. This critical review conceptualizes anxiety and cognitive control from cognitive neuroscience and cognitive aging theoretical perspectives and evaluates the methodological approaches and measures used to assess cognitive control. Consistent with behavioral investigations of young adults, the studies reviewed implicate specific and potentially negative effects of anxiety on cognitive control processes in older adults. Hypotheses regarding the role of both aging and anxiety on cognitive control, the bi-directionality between anxiety and cognitive control, and the potential for specific symptoms of anxiety (particularly worry) to mediate this association, are specified and discussed.