Alzheimer病与血管性痴呆临床对照研究

Ａｌｚｈｅｉｍｅｒ病与血管性痴呆临床对照研究程瑞艳老年期痴呆越来越引起人们的关注。为了使老人安度晚年、健康长寿，我院于１９９４年９月在浙江省首先创办了老年心理康复中心。两年多来，我们中心除收治老年期精神病外，还收治老年期痴呆８０例，其中阿尔采木病（Ａ...     

血管性认知功能障碍患者的神经心理学、影像学及事件相关电位的研究

目的　研究血管性认知功能障碍 (VCI)患者的神经心理学、影像学及事件相关电位的特点并探讨其意义。方法　对 78例VCI患者及 4 9名正常人进行中文版简易智能状态检查 (MMSE)量表、头颅CT、事件相关电位检查。结果　 (1)VCI组MMSE总分 (2 4 .35± 3.2 8)分 ,与正常组 (2 5 .0 4± 5 .0 3)分比较差异无显著性(P >0 .0 5 ) ;地点定向、时间定向、短程记忆、计算能力、语言表达、言语复述、图形描画 7项亚项的评分均明显低于正常组 (均P <0 .0 5 )。 (2 )VCI患者脑萎缩明显 ,脑梗死灶位于额、颞叶者及多发性梗死患者MMSE评分降低更显著 (均P <0 .0 5 )。 (3)VCI患者P3 0 0 潜伏期与正常组相比显著延长 (P <0 .0 5 ) ,P3 0 0 潜伏期与MMSE评分呈负相关 (r=- 0 .6 1,P <0 0 5 )。结论　MMSE量表中认知功能亚项的测评 ,有利于早期发现VCI患者的认知功能障碍 ,脑萎缩及脑梗死灶的部位和数目与VCI的程度有关 ;P3 0 0 潜伏期的检测对于早期发现VCI患者的认知障碍及其程度有重要价值。     

Alzheimer病与血管性痴呆临床特点的对照研究

目的 比较Alzheimer病(AD)与血管性痴呆(VD)的临床特点。方法 通过详细收集临床资料，并用痴呆严重程度临床评定量表(CDR)、简易精神状态检查量表(MMSE)、日常生活能力量表(ADL)评定，对38例AD与30例VD患者的发病情况、行为、精神症状特点、认知功能、日常生活能力等进行比较。结果 VD患者多急性发病、呈阶梯性病程、伴有高血压和卒中史；AD患者脑电图改变主要是双额叶及双枕叶的节律改变，以θ波及δ波为主要活动，而VD患者以不对称为主要表现；抑郁、焦虑、欣快的发生率VD患者明显高于AD患者，而幻觉、妄想、饮食障碍则明显低于AD患者；时间定向、地点定向、物体命名评分AD患者明显低于VD患者，而图形描述评分高于VD患者；AD和VD患者存在着躯体生活、工具使用能力下降的不平衡，VD患者躯体生活能力下降更明显。结论 AD与VD患者的临床特点不同，发病基础、行为、精神症状、认知功能、智能障碍、日常生活能力的评价及CT和脑电图的检查等对痴呆的诊断与鉴别诊断均具有重要价值。     

Alzheimer病与血管性痴呆的认知及生活功能变化的随访研究

目的　探讨Alzheimer病(AD)与血管性痴呆(VD)的认知功能和生活功能的衰退模式。方法　入组时、1年后,采用痴呆严重程度临床评定量表(CDR)、简易智能状态检查量表(MMSE)、生活功能量表(ADL)对住院的Alzheimer病与血管性痴呆患者进行检查。患者出院1 年后对原有样本进行面检随访研究,并同时进行上述量表的测查,并分析对认知功能及生活功能的影响因素。结果　1年后AD病死率为3.45%(2/58)、VD病死率为12.12%(4/33)。入组时AD与VD组比较,各痴呆严重程度之间、MMSE总分差异无显著意义(均P>0.05),两者均以记忆力的减退最为明显, 1年后AD组MMSE总分及地点定向、图形描述因子分下降较为显著(P<0.05),而VD组MMSE总分及个因子分下降不明显(均P>0.05),AD组ADL总分及躯体生活功能、工具性生活功能因子分均有不同程度的升高(P<0.05),而VD组ADL总分及躯体生活功能、工具性生活功能因子分没有明显的变化(均P>0.05)。MMSE分与年龄、病程、GDS评级正相关,与ADL总分负相关,ADL总分与年龄、病程、GDS评级正相关,与MMSE分负相关。反映VD患者的空间感知能力损害较AD患者更为明显。结论　AD与VD患者的认知功能和日常生活能力减退各具其特点,这些特点有助于AD和VD的诊断和治疗。     

Alzheimer病、血管性痴呆与ABO血型的关系

血型与一些疾病的相关性曾有过大量研究。在分裂症中,青春型以AB型居多,在情感性精神障碍中,双相型以O型居多。而Alzheimer病(AD)、血管性痴呆(VD)与ABO血型的关系如何,尚未见这方面报道,本研究旨在对此作一探索。     

血管性认知功能障碍患者的事件相关电位分析

目的观察血管性认知功能障碍患者的事件相关电位特性。方法以非认知功能障碍正常对照组、非痴呆型血管认知功能障碍组和血管性痴呆组进行19通道的事件相关电位分析,自动记录反应时间和反应按键的正误,应用重复测量方差分析和配对检验进行比较。结果血管性痴呆组的反应时间(F=54.18,P<0.001)和按键正确率(F=40.23,P<0.001)较正常对照组、非痴呆型血管认知功能障碍组有显著差异,正常对照组的行为绩效反应时间[(325.16±69.39)ms]、正确率[(97.5±1.6)%]优于非痴呆型血管认知功能障碍组[(384.58±76.25)ms,(88.2±8.9)%]和血管性痴呆组[(472.65±89.30)ms,(57.8±7.8)%],后2组行为绩效比较亦存在显著性差异。ERP提示非痴呆型血管认知功能障碍和血管性痴呆的P300、N400潜伏期较正常对照组明显延长,3组潜伏期及波幅比较差异有统计学意义(P<0.05)。结论事件相关电位的P300、N400成分作为一种客观、量化的电生理指标,可用于早期识别脑卒中血管性认知功能障,为非痴呆型血管认知功能障碍的诊断和评估预后提供了重要的客观辅助手段。     

老年期痴呆患者认知与生活功能的相关分析

目的：了解住院老年期痴呆患者认知功能与生活功能受损的相互关系及其影响因素。方法：收集首次住院老年期痴呆患者46例，进行简易智力状态检查（MMSE）及日常生活能力量表（ADL）评分。结果：MMSE总分与ADL总分呈极显著负相关。结论：老年期痴呆患者认知功能受损越重，生活功能受损也越重，其中以定向、言语对生活功能影响最明显，其次是识记与回忆。     

奥拉西坦治疗血管性认知功能障碍的疗效观察

目的观察奥拉西坦治疗血管性认知功能障碍的临床疗效。方法将43例血管性认知功能障碍患者随机分为治疗组和对照组,治疗组在对照组基础性治疗的基础上给予奥拉西坦口服,3个月后运用简易智力状态检查量表(MMSE)积分法进行评价。结果2组MMSE积分治疗后比治疗前均有提高(P<0.01),治疗组总有效率明显优于对照组(P<0.05)。结论奥拉西坦是治疗血管性认知功能障碍的有效药物之一。     

载脂蛋白E基因多态性与Alzheimer病和血管性痴呆的关系

目的 探讨载脂蛋白E(ApoE)基因多态性与Alzheimer病(AD)和血管性痴呆(VD)的关系.方法 用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测79例AD患者(AD组)、85例VD患者(VD组)及156名健康老年人(正常对照组)ApoE基因型和等位基因频率.结果 ApoEε3/ε4基因型及ε4等位基因频率AD组分别为25.3%及17.7%,VD组分别为25.9%及20.5%,正常对照组分别为10.9%及5.7%;AD组及VD组ApoEε3/ε4基因型及ε4等位基因频率显著高于正常对照组(均P＜0.01).结论 ApoEε4等位基因可能是AD和VD共同的危险因素.     

血管性痴呆患者治疗前后P300的变化

目的探讨事件相关电位(Event-related potentials,ERP)P300在评估血管性痴呆(vascular dementia,VaD)患者认知功能中的价值.方法应用Nicolet Bravo脑诱发电位仪对30例VaD患者分别在治疗前和治疗后6周进行ERP P300检测,同期间使用简易精神状况检查(MMSE)来评估患者的认知功能.结果治疗前,VaD组有明显的认知功能缺损,其MMSE[(17.52±3.57)分]分值低于NC组[(26.57±1.43)分,(P＜0.01)].其P300表现为P2、N2、P3潜伏期长,P2、P3波幅低,非靶P2波幅低(P＜0.05～0.01);治疗后,随着VaD患者的认知功能的恢复,其P300主要表现为P3潜伏期缩短,P3波幅的增高(P＜0.05).结论动态检测P300有助于反映VaD患者认知功能的变化,尤其是P3潜伏期的变化较为敏感.     

血管性痴呆与阿尔茨海默病的临床对照研究

目的了解血管性痴呆（VD）与阿尔茨海默病（AD）的临床不同特征。方法以CCMD--3为诊断标准，参照ICD-10，对符合标准的36例VD患者，31例AD患者进行对照分析，长谷川痴呆量表（HDS）及自编问卷进行评定。结果VD与AD的起病形式及病程发展不同，在年龄、性别、病程等无统计学差异的情况下，AD重于VD，两病在轻、中度阶段经治疗可有好转或减轻，在重度期精神症状治疗无显著差异。结论重视疾病的早期诊断，抓住治疗时机，可延缓和减少疾病恶化及并发症发生。     

Oligoclonal immunoglobulin bands in cerebrospinal fluid of patients with Alzheimer''s disease and vascular dementia

We examined serum and cerebrospinal fluid (CSF) of 16 patients with Alzheimer's disease (AD), 28 patients with vascular dementia (VD), their age-matched controls and multiple sclerosis (MS) patients in order to evaluate the humoral immune response within the central nervous system both quantitatively and qualitatively. Intra-blood-brain barrier (BBB) protein synthesis was calculated by CSF IgG index. The presence of oligoclonal banding (OCB) was investigated with agarose isoelectric focusing (IEF) followed by immunoblotting with antihuman IgG. No patient with AD and only 4 patients with VD had slightly elevated IgG indexes, and no statistically significant differences in the indexes were found between the two groups. No bands were found in the CSF of AD patients but 3 VD patients had OCB in both serum and CSF. One VD patient had bands in serum but no bands in CSF. No kappa or lambda free light chains were found in those demented patients with demonstrable bands in the CSF and serum. No OCB were found in control sera and CSF. For comparison, the majority of patients with MS had OCB in CSF. Thus, no consistent increase of intrathecal protein synthesis was found in patients with AD and VD. Methodological differences explain at least part of the conflicting results published earlier.     

阿尔茨海默氏病与血管性痴呆临床特点的对照研究

目的比较阿尔茨海默氏病（AD）与血管性痴呆（VD）的临床特点。方法对39例AD和38例VD患者的精神行为症状特点、伴随的躯体疾病、头颅CT检查以及脑电图检查进行比较。结果AD组与VD组在幻觉、妄想等精神病性症状方面无明显差异,在抑郁、焦虑等情绪障碍以及行为脱抑制方面有显著差异;AD组伴随的躯体疾病无明显特异性,VD组多伴发高血压、冠心病;AD组头颅CT多表现为脑萎缩,VD组多表现为脑梗塞;脑电图检查AD组无明显特异性,VD组界限脑电图居多。结论AD与VD患者的BPSD及所伴随的躯体疾病可有不同特点,CT和脑电图的检查等对痴呆的诊断与鉴别诊断均具有重要价值。     

阿尔茨海默病与血管性痴呆患者临床特征和影像学比较

目的 探讨阿尔茨海默病(AD)和血管性痴呆(VaD)患者的临床特征和影像学改变,以期寻找鉴别诊断的方法. 方法 收集武警广东医院老年病科自2006年8月至2011年6月收治的162例和同期本地区痴呆症状调查发现的42例痴呆患者的临床资料,采用简易精神状况检查(MMSE)量表进行筛选,其中AD患者114例、VaD患者90例,分析并比较AD、VaD患者的认知能力、行为症状和影像学资料. 结果 与VaD患者比较,AD患者女性较多,文化程度普遍较高,病程更长,差异有统计学意义(P＜0.05);VaD患者注意和计算分项评分低于AD患者,AD患者短程记忆、语言复述和阅读理解分项评分低于VaD患者,差异有统计学意义(P＜0.05); AD患者重复收敛行为的发生高于VaD患者,差异有统计学意义(P＜0.05);AD患者海马萎缩的比例高于VaD患者,VaD患者脑区域发生血管病变的发生率明显高于AD患者,差异均有统计学意义(P＜0.05). 结论 AD和VaD患者具有不同的临床特征和影像学改变,是由各自的病变本质、病变部位和病理机制所共同导致的.     

阿尔茨海默病与血管性痴呆病人智力与记忆功能的对照研究

目的 比较阿尔茨海默病(AD)与血管性痴呆(VD)病人的智力与记亿功能。方法 采用韦氏成人智力量表及韦氏记忆量表对23例AD和27例VD病人进行测查。结果 智力方面，朋病人的知识、领悟、算术、相似性、数字广度、词汇、图形排列等7项分测验及言语智商、总智商均明显低于VD病人，突出表现在知识、领悟及相似性方面；其它各项分测验差别均无显著性意义(P均＞0．05)。记忆方面，AD病人的定向、累加、再认、视觉再生、联想学习、背数等6项分测验及记亿商均明显低于VD病人，突出表现在定向、累加、视觉再生及背数方面；其它各项分测验差别均无显著性意义(P均＞0．05)。结论 AD及VD病人均呈现明显的智力及记亿功能障碍，但AD病人受损更为严重。     

EEG in the differential diagnosis between Alzheimer''s disease and vascular dementia

Demented patients with Alzheimer's disease (AD) (n = 67), multi-infarct dementia (MID) (n = 77) and probable vascular dementia (PVD) (n = 45) were studied with electroencephalography (EEG). All patients underwent a routine EEG examination and quantitative EEG was recorded from 14 patients with AD, 20 with MID, and 12 with PVD. The patient groups did not differ in regard to sex, age, education, or degree of dementia. Diffuse abnormality of EEG increased in AD, while driving response to photic stimulation and the mean frequency of background activity decreased in all groups with increasing degree of dementia. In quantitative EEG, the percentage of alpha power decreased and those of theta and delta power increased relative to the degree of dementia. Focal abnormalities, and irritative (spikes and/or sharp waves) and slow wave paroxysms were more common in MID than in AD. Patients with different types of dementia did not differ significantly in regard to diffuse abnormality, occurrence of driving response, mean background frequency, or parameters of quantitative EEG. The mean frequency of background activity and the degree of diffuse abnormality correlated with central and cortical atrophy, white matter low attenuation seen on computed tomography, and with neuropsychological findings.     

Neuropsychological differentiation between normal aging, Alzheimer''s disease and vascular dementia

A random sample of 182 elderly community residents and 211 demented patients were studied using the D-Test Battery based on the Luria's neuropsychological investigation method. A steady but selective cognitive impairment was observed with increasing age in normal healthy subjects. The most sensitive areas of cognition to the effects of normal aging were mnestic and conceptual functions, as well as arithmetical skills. The age-related changes could be clearly differentiated from the changes found in patients with mild degree of dementia. The test also differentiated patients with mild, moderate and severe dementia from each other on the basis of their social competence. It failed to demonstrate specific patterns of impairment and to clearly differentiate between patients with Alzheimer's disease and vascular dementia who had the same degree of cognitive decline. Further qualitative analyses are needed to improve the sensitivity and specificity of the test.     

Decreased myelin lipids in Alzheimer''s disease and vascular dementia

The lipid composition of white matter and myelin from the semioval centre was studied in autopsy material from cases with Alzheimer's disease (AD) (n = 11), vascular dementia (VD) (n = 7), and age-matched controls (n = 11). In AD and VD the white matter content of phospholipids and cholesterol was reduced to 72-76% of the control values (P less than 0.01), the diminution of cerebrosides and sulphatides was more pronounced (55-69%) (P less than 0.001) while the concentration of gangliosides did not change significantly (87-90%). The myelin composition was the same in the 3 groups, suggesting that the white matter involvement is not caused by alteration of the myelin structure. The altered lipid composition in white matter in AD and VD suggests that the myelin sheath is the primary lesion site.     

阿尔茨海默病及血管性痴呆患者血清胆固醇及甲状腺激素变化的临床研究

目的探讨阿尔茨海默病(AD)和血管性痴呆(VaD)与血清胆固醇、甘油三脂、甲状腺激素的关系。方法对35例AD、35例VaD和16例健康对照组血清胆固醇、甘油三脂、甲状腺激素进行测定,并进行组间对比研究。结果 AD组和VaD组血清胆固醇、甘油三脂明显高于对照组(P<0．05),并且Va[)组甘油三脂水平与对照组相比差异更明显(P<0．01),而AD和VaD之间无显著性差异(P>0．05);AD组和VaD组血清总T4(TT4)水平明显高于健康对照组(P<0．01),而总T3(TT3)及TSH 3组之间无显著性差异。结论甲状腺激素代谢异常可能与 AD及VaD发病有关;血清胆固醇和甘油三脂增高与AD和VaD有明显的关系,降低胆固醇及血脂可能对AD和 VaD预防和治疗有益。     

CT in the differential diagnosis between Alzheimer''s disease and vascular dementia

A prospective series of consecutively admitted patients with Alzheimer's disease (AD) (n = 68), multi-infarct dementia (MID) (n = 79) and probable vascular dementia (PVD) (n = 46) were studied by CT of the head. In MID 88.6% and in PVD 41.3% of the patients had at least one brain infarct on CT, but only one patient (1.5%) with AD. White matter low attenuation (WMLA) also differentiated MID and PVD from AD, especially among patients aged 75 years or less, and with mild or moderate dementia. In all types, brain atrophy on CT had a positive correlation with the degree of dementia. Infarcts and WMLA on CT, but not brain atrophy seem to be of differential diagnostic value between vascular and degenerative dementia.