阿尔茨海默病、血管性痴呆血脂浓度分析

目的：研究阿尔茨海默病（AD）、血管性痴呆（VD）及轻微认知功能损害（MCI）患者血脂水平的特点。方法：所有研究对象均来自广州市城乡社区及养老院。痴呆诊断采用美国精神障碍诊断与统计手册第4版的标准，MCI诊断参照Petersen的标准。采用酶法进行血脂测定。结果：AD、VD、MCI及正常老人血浆总胆固醇（TC）、三酰甘油（TG）浓度差异无显著性（P〉0．05）。按痴呆程度分组，中度、重度AD患者血浆TG浓度、重度AD患者血浆TC浓度均显著低于正常老人及轻度AD患者（P〈0．05）；轻度AD患者与正常老人血浆TC、TG浓度的差异无显著性（P〉0．05）。不同程度VD患者及正常老人血浆TC和TG浓度的差异无显著性（P均〉0．05）。结论：VD、MCI及轻度AD患者的血浆TC、TG浓度与正常老人相似。AD患者痴呆程度越重，血浆TC、TG浓度越低。     

轻度认知功能障碍和阿尔茨海默病患者血小板α和β分泌酶活性的变化

目的 研究轻度认知功能障碍(MCI)和阿尔茨海默病(AD)患者血小板α和β分泌酶活性及α分泌酶的产物sAPPα含量的变化.方法 对48例其他疾病老年对照者、42例MCI患者及40例AD患者分别进行神经功能评定,用荧光法测定各组患者血小板α和β分泌酶的活性,并用Western印迹检测血小板sAPPα含量.结果 对照组、MCI组和AD组患者α分泌酶活性分别为100.0％±10.6％、78.2％±9.4％和61.8％±7.2％,MCI和AD组与对照组相比均降低,差异有统计学意义(F=22.935,P=0.001)；AD组与MCI组相比亦明显降低,差异有统计学意义.对照组、MCI组和AD组β分泌酶的活性分别为100.0％士11.2％、145.8％士12.7％和189.8％士14.2％；MCI组和AD组均较对照组升高,差异有统计学意义(F=16.368,P=0.001),AD组较MCI组高,差异有统计学意义.sAPPα的含量MCI组和AD组与对照组相比均明显降低；AD组与MCI组相比亦显著降低,差异有统计学意义.结论 MCI组和AD组患者的α分泌酶活性及其产物sAPPα均较对照组降低,β分泌酶活性升高；α和β分泌酶活性改变可能在MCI和AD的发病过程中起着一定的作用,在MCI和AD的诊断中有一定的潜在价值.     

轻度认知功能障碍淋巴细胞及炎症蛋白检测

目的探讨MCI认知功能与淋巴细胞及炎症蛋白的关系。方法研究阿尔茨海默病（AD,36例）、轻度认知障碍（MCI,34例）及认知功能正常老年人（认知正常组,36人）的外周血淋巴细胞亚群、免疫球蛋白及炎性蛋白的差异。结果认知正常组、MCI组与AD患者的免疫球蛋白G（IgG）浓度中位数依次为10.5g/L、10.6g/L、13.1g/L（χ2=14.28,P〈0.01）;辅助性T淋巴细胞（TH）比例的中位数依次为41%、35%、37%（χ2=9.96,P〈0.01）;三组间差异有统计学意义。其中认知正常组与MCI组的IgG差异无统计学意义（Z=0.64,P=0.52）,而AD组IgG水平高于MCI组（Z=3.26,P〈0.01）和认知正常组（Z=3.22,P〈0.01）;认知正常组TH高于AD组（Z=2.55,P〈0.05）和MCI组（Z=2.95,P〈0.01）,而MCI组与AD组的TH差异无统计学意义（Z=0.18,P=0.86）。结论 IgG可能在AD与MCI、认知功能正常者的鉴别方面具有重要意义;TH水平降低可能是认知功能受损的标志。     

MCI患者血清中Tau蛋白 Aβ1-42P-tau的检测价值分析

目的 探讨血清磷酸化Tau（P-tau）、β淀粉样蛋白1-42（Aβ1-42）以及Tau蛋白在轻度认知障碍（MCI）患者中的临床应用价值.方法 采用酶联免疫法测定主诉健忘组（SMC）30例,MCI患者30例,阿尔茨海默病组（AD）68例（轻度AD 24例,中度AD 22例,重度AD 22例）以及健康对照组35例血清中P-tau、Aβ1-42、Tau蛋白水平,并分析三种标记物与疾病的相关性.结果 与对照组及MCI组相比,MCI组、AD组MMSE评分显著上升,差异有统计学意义（P〈0.05）,重度AD组MMSE评分显著高于轻度、中度AD组,两两比较差异有统计学意义（P〈0.05）.与对照组相比,MCI组、AD组P-tau、Tau蛋白水平显著上升,且AD组高于MCI组,而Aβ1-42水平显著下降,且AD组下降幅度大于MCI组,差异有统计学意义（P〈0.05）.其中重度AD组P-tau、Tau蛋白水平高于轻度、中度AD组,而Aβ1-42水平低于轻、中度组,差异有统计学意义（P〈0.05）.SMC 组与对照组相比,各标记物水平差异无统计学意义（P〉0.05）.与单纯Tau蛋白、Aβ1-42、P-tau诊断相比,Tau蛋白、Aβ1-42、P-tau联合诊断的灵敏性、特异性、准确性显著增加,差异有统计学意义（P〈0.05）.结论 MCI病情发生及发展过程可能与血清P-tau、Aβ1-42、Tau蛋白水平异常有关,通过测定这三种标记物可有效预测MCI患者病情进展情况.     

认知功能损害与ApoE基因多态性的关联性研究

目的 探讨认知功能损害与载脂蛋白E（Apo E）基因多态性的相关性。方法 采集46例正常对照（对照组）、67例轻度认知功能损害患者（MCI组）和42例AD痴呆期患者（DAT组）的外周血提取DNA,采用聚合酶链反应-限制性片段长度多态技术（PCR-RFLP）测定上述3组人群中Apo E等位基因的分布频率。结果 3种等位基因在对照组、MCI组和DAT组中的总体分布差异有统计学意义（P=0.018）。ε2和ε3等位基因频率在3组间的分布差异无统计学意义（P=0.373,P=0.302）,但DAT组ε4等位基因的频率显著高于对照组（P=0.011）和MCI组（P=0.019）,ε4等位基因的频率在对照组和MCI组之间的差异无统计学意义（P=0.742）。结论 Apo Eε4等位基因可能在DAT发病中发挥一定作用,但其与MCI的发生可能不具有关联性。     

事件相关电位P300在轻度认知损害中的应用

轻度认知损害（Mild Cognitive Impairment,MCI）是阿尔茨海默病（Alzheimer Disease,AD）的前驱早期阶段,是介于AD和正常衰老之间的一种认知功能损害状态[1]。Petersen等认为MCI具有以下特征：（1）经常为忘事烦恼;（2）与受教育程度、年龄不相称的记忆损害;（3）保持一般的认知功能;（4）日常生活能自理;（5）没有痴呆。相关研究显示,MCI在老年人中的发生率为5．3％,每年有10％～15％的MCI患者转化为AD,而正常老年人群每年转化为AD仅为1％～2％。     

HCL-32在精神科门诊双相障碍诊断中的应用

目的 了解双相障碍的诊断现状及识别率.方法 将符合DSM-Ⅳ抑郁障碍诊断标准的36例门诊患者使用MDQ和HCL-32进行测评,然后按照DSM-Ⅳ诊断标准对所有完成测试的患者进行晤谈并做出诊断.结果 HCL-32的阳性筛检率（72％）高于MDQ（33％）,差异有统计学意义（x2=10.923,P=0.001）;DSM诊断系统晤谈诊断阳性率为47％与HCL-32的阳性率比较差异无统计学意义（x2=0.332,P=0.471）.结论 HCL-32筛查量表检测阳性率高,能够有效避免漏诊,可作为精神科门诊双相障碍诊断的初步筛查工具.     

脑干听觉反应在轻度认知功能障碍老年人和阿尔茨海默病中的应用

目的探讨轻度认知功能障碍老年人(MCI)和阿尔茨海默病(AD)在脑干听觉反应(ABR)检测中的特点,为早期痴呆的诊断提供帮助.方法应用美国Nicolet Bravo脑电生理仪及Click短声刺激,测查36例MCI和30例阿尔茨海默病(AD)和45名健康老人(NC)的ABR.结果 MCI组、AD组及NC组在绝对潜伏期波Ⅲ(Pz脑区),绝对波幅波Ⅲ(Pz脑区),波V(Pz脑区)上有差异极显著性(P＜0.01).与NC组和MCI组相比,绝对潜伏期波Ⅲ(Pz脑区)上,AD组延迟于NC组和MCI组(P＜0.01).波幅分析所见,绝对波幅波Ⅲ(Pz脑区)和绝对波幅波V(Pz脑区)AD组低于NC组和MCI组.MCI组与NC组比较,差异有显著性(P＜0.05).结论 ABR对临床辅助诊断AD和MCI有参考价值.     

广州市城乡65岁及其以上人群痴呆患病率调查

目的调查广州市城乡≥65岁人群痴呆的患病率。方法采用分层随机整群抽样方法对广州市城乡人群进行抽样，用筛查和确诊两阶段法进行调查，实查14个居委会、2个村委会中≥65岁人群共3780人。按美国精神障碍诊断与统计手册第4版的标准诊断痴呆，阿尔茨海默病（AD）诊断采用美国神经病学、语言障碍和卒中研究所及阿尔茨海默病与相关障碍协会的标准。结果（1）查出痴呆患者182例，粗患病率为4．81％；其中AD128例（3．39％），血管性痴呆（VD）44例（1．16％）；经2000年广州市人口年龄构成进行标化，痴呆、AD和VD患病率分别为4．54％、3．17％和1．11％。（2）女性痴呆患者134例，粗患病率（5．98％）高于男性（48例，3．12％；P〈0．001），经年龄标化患病率分别为6．03％和2．74％。（3）痴呆患病率随年龄增长急剧上升。结论广州地区年龄≥65岁老人的痴呆患病率为4．81％，AD患病率高于VD。老年期痴呆患病率随年龄的增长而急剧升高。     

不同类型认知障碍患者的尿液AD7c-NTP与头部MRI、MRS的相关性研究

目的研究对不同类型认知障碍患者的尿液AD相关神经丝蛋白(AD7c-NTP)水平与头颅MRI中海马萎缩程度、MRS中N-乙酰天门冬氨酸(NAA)峰值水平的相互关系。方法选取阿尔兹海默病(AD)、血管性痴呆(VD)、轻度认知障碍(MCI)患者各30例,分别设为AD组、VD组、MCI组,另选取同期体检健康者30例作对照组。取所有受检者晨起时尿液,以酶联免疫吸附法测定AD7c-NTP水平,行头颅MRI及MRS检查。对比四组尿液AD7c-NTP水平、海马萎缩MTA评分、NAA峰值水平,分析尿液AD7c-NTP与海马萎缩MTA评分、NAA峰值水平相关性。结果 MCI组尿液AD7c-NTP水平高于对照组,VD组尿液AD7c-NTP水平高于MCI组,AD组尿液AD7c-NTP水平高于Va D组,差异有统计学意义(P0.05);MCI组海马萎缩MTA评分与对照组比较,差异无统计学意义(P0.05),VD组海马萎缩MTA评分高于MCI组,AD组海马萎缩MTA评分高于VD组,差异有统计学意义(P0.05);MCI组NAA峰值水平与对照组比较,差异无统计学意义(P0.05),VD组NAA峰值水平低于MCI组,AD组NAA峰值水平低于VD组,差异有统计学意义(P0.05);尿液AD7c-NTP水平变化与海马萎缩MTA评分呈正相关关系(P0.05);与NAA峰值水平呈负相关关系(P0.05)。结论 AD、Va D、MCI患者尿液AD7c-NTP水平较高,且不同类型认知障碍患者尿液AD7c-NTP、海马萎缩MTA评分、NAA峰值水平存在明显差异,尿液AD7c-NTP水平变化与MRI改变呈正相关性,与MRS改变呈负相关性。     

轻度认知功能障碍的认识

轻度认知功能障碍（MCI）是指介于痴呆和正常衰老之间的认知功能损害状态。由于概念的混淆、方法的差异及标准的不同,MCI在临床实践中存在着不少困惑。本文回顾了认知功能损害的研究历史,讨论了MCI的概念、诊断标准、临床分型、与正常老化和痴呆的鉴别以及临床预后,探讨了MCI与阿尔茨海默病的关系。     

上海浦东新区55岁及以上人口轻度认知功能障碍及影响因素的调查

目的:探讨上海55岁及以上老年人轻度认知障碍(MCI)的患病率及危险因素的流行病学特征。方法:2011年7月至2012年7月实施抽样调查上海市浦东新区≥55岁户籍人群,应用PPS(probability proportional to size)抽样法,根据Petersen诊断标准、问卷调查及临床医师复核诊断,分析MCI患病率及危险因素。结果:抽取居民4 600人,实际调查4 086人,调查率88.83%。4 086人中,患有MCI者(MCI组)612例,占14.98%,患有阿尔茨海默病者(AD组)201例,占4.92%,正常智力者(正常智力组)3 273例。MCI患病率:女性高于男性(χ2=11.52,P=0.003),且随年龄增长而增高(χ2=196.80,P=0.000);文盲和小学文化程度者高于初中及以上者(χ2=227.03,P=0.000);体力劳动者高于脑力劳动者(χ2=16.76,P=0.000)。以罹患MCI作为应变量,将年龄、性别、高血压、糖尿病、高脂血症、吸烟史、受教育程度等因素中与MCI相关的变量作为自变量,进行二变量的线性Logistic回归分析显示,共病高血压、糖尿病、高脂血症及吸烟、受教育程度低、高龄等易感因素具有独立影响意义(P0.05或P0.01),其中共病高血压、受教育程度低及高龄与AD组的易感因素相同。结论:有效防治高血压、糖尿病及高脂血症等代谢性疾病有利于减少MCI的发生发展。     

两种轻度认知损害患者的神经心理学功能比较

背景区别轻度认知损害（mildcognitiveimpairment,MCI）的两种亚型,即遗忘型轻度认知损害（alTlnesticmildcogni—tiveimpairment,aMCI）和小血管型轻度认知损害（MCIassociatedwithsmallvesseldiseases,sv-MCI）将有利于延缓和预防MCI进展为阿尔茨海默病性痴呆和血管性痴呆。目的识别并区分区aMCI与sv-MCI的神经心理学特征。方法从宣武医院神经科门诊就诊患者或在北京社区进行的一项入户调查中选择符合入组标准的被试。根据Pe—tersen诊断标准筛选aMCI患者50例,根据Hachinski诊断标准筛选sv-MCI患者65例。以上两组患者和49名55岁以上没有认知障碍的社区被试一同接受简明精神状态量表（MiniMentalStateExamination,MMSE）检查及画钟测验（ClockDrawingTest,CDT）与听觉词语学习测验（AuditoryVerbalLearningTest,AVLT,评定即刻记忆、延迟回忆和延迟再认能力）。采用单因素方差分析法比较3组被试各项测验的平均得分,如果结果存在明显差异,再进行多个样本两两比较的Tukey法检验。结果aMCI组和SV．MCI组5项测验平均得分均明显低于健康对照组。aMCI组AVLT即刻记忆、延迟回忆和延迟再认测验得分均低于SV．MCI组。在校正了年龄、性别、受教育年限后,上述差异仍旧存在。结论实验结果与既往结果一致,与SV—MCI患者相比,aMCI患者记忆损害更加明显。记忆相关的评估测验,尤其是AVLT,或将有助于区别这两种MCI亚型。     

Subtypes of mild cognitive impairment in Parkinson's disease: progression to dementia.

The aim of this study was to establish the rate of progression from mild cognitive impairment (MCI) to dementia in patients with Parkinson's disease (PD). PD patients without dementia were recruited in 1997 from an ongoing prospective epidemiological study. The assessment included neurological and psychiatric examinations, a clinical interview based on the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for dementia, and a battery of neuropsychological tests. PD was diagnosed according to established criteria, dementia was diagnosed according to the DSM-III-R criteria, and subtypes of MCI were classified according to modified Petersen's criteria. Seventy-two nondemented PD patients were included. A total of 34 were cognitively intact, whereas 38 were diagnosed with MCI (amnestic, n = 6; single nonmemory domain, n = 17; multiple domains slightly impaired, n = 15). Fifty-nine patients (82%) completed follow-up examination 4 years later, and 18 (62%) of the patients with MCI and 6 (20%) of the cognitively intact PD patients were demented (P = 0.001). Single domain nonmemory MCI and multiple domains slightly impaired MCI were associated with later development of dementia (P = 0.003; P = 0.04), whereas amnestic MCI subtype was not (P = 0.76). We conclude that patients with PD and MCI had a higher risk of developing dementia than cognitively intact PD patients, suggesting that MCI in PD is an early manifestation of dementia. However, these findings should be interpreted with caution due to the relatively small number of subjects included in this study.     

The Montreal Cognitive Assessment: validity and utility in a memory clinic setting.

OBJECTIVE: To prospectively validate the Montreal Cognitive Assessment (MoCA) in a UK memory clinic. METHOD: We administered the MoCA and Mini-Mental State Examination (MMSE) to 32 subjects fulfilling diagnostic criteria for dementia, to 23 subjects fulfilling diagnostic criteria for mild cognitive impairment (MCI), and to 12 memory clinic comparison subjects, at baseline and then at 6-month follow-up. Clinical diagnoses for dementia and MCI were made according to ICD-10 and Petersen criteria. The sensitivity and specificity of both measures were assessed for detection of MCI and dementia. RESULTS: With a cut-off score of 26, the MMSE had a sensitivity of 17% to detect subjects with MCI, whereas the MoCA detected 83%. The MMSE had a sensitivity of 25% to detect subjects with dementia, whereas the MoCA detected 94%. Specificity for the MMSE was 100%, and specificity for the MoCA was 50%. Of subjects with MCI, 35% developed dementia within 6 months, and all scored less than 26 points on the MoCA at baseline. CONCLUSIONS: The MoCA is a useful brief screening tool for the detection of mild dementia or MCI in subjects scoring over 25 points on the MMSE. In patients already diagnosed with MCI, the MoCA helps identify those at risk of developing dementia at 6-month follow-up.     

Identifying dementia in high-risk community samples: the memory and medical care study

The Memory and Medical Care Study (MMCS) is a community-based, longitudinal study of elders at risk for dementia. This paper describes the study methods for identifying subjects with dementia or mild cognitive impairment (MCI) and the validation of these methods. The MMCS cohort was established by identifying subjects at risk for dementia in three previous studies of randomly ascertained samples. Neuropsychologic test score criteria were established to identify MMCS subjects with dementia or MCI. These criteria were validated using a fourth community-based sample of at-risk elders in which dementia was identified by a clinical adjudication panel. Of the 498 MMCS subjects, 70% had dementia and 27% had MCI by the MMCS criteria. In the validation sample, the MMCS dementia classification method was in agreement with the clinical adjudication panel for 81% of cases (kappa = 0.62, 95% confidence interval = 0.45-0.78). The methods used in the MMCS are efficient and reasonably valid for establishing a cohort of subjects to investigate how dementia is assessed, diagnosed, and treated in the community.     

轻度认知功能障碍患者认知损害与血清脑源性神经营养因子水平的相关性

目的 研究轻度认知功能障碍（mild cognitive impairment,MCI）患者认知损害与血清脑源性神经营养因子（brain derived neurotrophic factor,BDNF）水平的关系。 方法 从认知障碍门诊筛选MCI患者30例,正常对照老年人32例,采用酶联免疫吸附法（enzyme linked immunosorbent assay,ELISA）检测MCI患者的血清BDNF水平。 结果 MCI的血清BDNF水平较正常对照组显著升高（P=0.025）,MCI组中血清BDNF与简明精神状态量表（Mini-Mental State Examination Scale,MMSE）中的记忆力（r=-0.494,P=0.009）、语言能力（r=-0.399,P=0.039）呈负相关,与定向力、注意力和计算力、回忆能力无相关性;与临床痴呆量表（Clinical Dementia Rating Scale,CDR）总分呈正相关（r=0.476,P=0.012）;与MMSE总分、全面衰退量表（Global Deterioration Scale,GDS）总分无相关性。 结论 MCI患者的BDNF水平显著升高,提示BDNF可能参与MCI认知损害的病理生理过程     

Prevalence and correlates of behavioral and psychiatric symptoms in community-dwelling elders with dementia or mild cognitive impairment: the Memory and Medical Care Study

BACKGROUND: Little is known about the prevalence and correlates of behavioral and psychiatric symptoms of dementia in community-dwelling elders with dementia or mild cognitive impairment (MCI). METHODS: 512 people with Mini-Mental State Examination (MMSE) scores < 24 or a decline of at least 4 points over two administrations, and their knowledgeable informants (KIs) were enrolled in the MMCS. The classification of subjects as having dementia or MCI was based on a neuropsychological battery of four tests, not a clinical diagnostic evaluation. The sample for this study included 454 subjects (dementia n = 333; MCI n = 121) and their KIs. Demographic and health-related characteristics of subjects and KIs were obtained during KI interviews. Multivariate logistic regression was used in statistical analysis. RESULTS: Compared to dementia subjects, those classified as MCI had a lower prevalence (47.1% vs 66.1%) of any symptoms (psychosis, depression, or agitation), and of agitation (24.8% vs 45.1%). Symptoms of psychosis and depression also were less prevalent, even though differences did not reach statistical significance. In the dementia group symptoms were associated with a report of a physician's diagnosis of dementia, greater functional impairment, and a KI who was a child/child-in-law. In those with MCI, symptoms were correlated with being white, greater functional impairment, and a younger, less educated, KI. CONCLUSIONS: Psychiatric and behavioral symptoms were common in community-residing elders with cognitive impairment, but their prevalence and correlates differed by study classification as having dementia or MCI. Identifying and treating these symptoms may benefit patients with cognitive impairment and their families. Longitudinal studies on the predictors, changes in prevalence, and effectiveness of treatments for psychopathology of dementia are needed.