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。     

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。     

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。     

上海市卢湾区一个社区老年期痴呆患病率分析

目的 分析本地老年期痴呆患病情况。方法 采用简易智力状态检查量表（MMSE）作为调查筛选工具,对本社区55岁以上人群进行老年痴呆患病率的调查。结果 AD和VD的患病率分别为2．31％和4．87％,痴呆总 患病率为3．67％。痴呆总患病率与国内报道相近,但VD患病率高于AD。本组男女二性患病率无显著性差异。结论 高龄、文化程度低可能是AD和VD的共同易患因素和重要危险因素。     

成都地区1997年和2000年两次老年期痴呆患病率调查结果的比较

目的了解老年期痴呆和阿尔茨海默病（AD）患病率在不同时间的变化。方法分别于1997年6月至1998年4月（第1次）和2000年11月至2001年3月（第2次），在成都地区用多层分级整群抽样方法，对调查时年龄≥55岁的社区人口进行痴呆患病率调查，两次调查的程序和使用工具相同。采用美国精神障碍诊断与统计手册第3版修订本的标准诊断痴呆。结果第1次调查实查5353人，失访202人，漏查率3．64％；诊断痴呆患者143例。第2次调查实查3908人，失访407人，漏查率9．43％；诊断痴呆患者107例。第1次与第2次调查现场诊断不一致的患者6例，均为轻度痴呆。第1次调查的痴呆、AD和血管性痴呆（VD）患病率分别为2．67％、2．04％和0．39％，第2次调查为2．74％、2．00％和0．46％，差异均无统计学意义（P〉0．05）。结论≥55岁的人口中，痴呆、AD和VD患病率在一定时期内保持稳定。对界于轻微认知功能损害与轻度痴呆之间的患者诊断较为困难，随访对明确诊断是必要的。     

阿尔茨海默病和血管性痴呆听觉事件相关电位P300比较研究

目的 探讨阿尔茨海默病（AD）和血管性痴呆（VD）在听觉事件相关电位P300检测中的不同特点。方法 收集符合ICD-10诊断标准的30例AD和36例VD患者，并以35例健康老人作对照组（NC）。使用丹麦仪器以及“听觉靶-非靶刺激序列”为诱发事件，完成P300检测。结果 （1）3组在靶潜伏期Cz脑区N2以及在靶波幅Cz脑区P2、P3和非靶波幅Cz脑区P2上均有显著差异（P〈0．01）。（2）AD主成分N2表现为延迟，与NC组和VD组有极显著性差异（P〈0．01）。（3）AD组和VD组靶波幅P3和非靶波幅P2均见降低，与NC组比较也有显著性差异（P〈0．05-〈0．01）。结论 提示作为反映AD和VD认知功能障碍的客观生理指标，P300有可能作为AD和VD辅助诊断的一个脑电生理学标志。P300检查可作为老年神经精神科的必查项目。     

急性脑梗塞后痴呆影响因素探讨

目的 了解急性脑梗塞后病人认知功能和痴呆的发生率及其影响因素。方法 采用简易智力状态检查表（MMSE）对74例急性脑梗塞病人认知功能进行检查。对有认知受损者时一步检查日常生活能力量表（ADL）和Hachinski缺血指数量表（HIS）以确诊血管性痴呆（CD），并对VD组和非痴呆组两组病人临床资料进行统计分析。结果 21例确诊为VD，VD发生率为28．38％，其中≥65岁VD发生率为31．91％，MMSE分值与年龄，文化程度有明显相关，年龄大、文化程度低者MMSE分值低。两组病人比较，年龄有明显差异，VD组明显高于非痴呆组。结论 对急性脑梗塞病人尤其是老年病人需注意认知功能的减退，以便早期发现VD。     

老年期痴呆的血浆半胱氨酸浓度检测的临床意义

目的：检测两种老年期痴呆即阿尔茨海默病（AD）和血管性痴呆（VD）患者血浆同型半胱氨酸（Hcy）水平,探讨其临床意义。方法：选取AD患者55例（AD组）、VD患者58例（VD组）和正常体检者30名（正常对照组）。VD组和AD组均按病情严重程度再分组：按痴呆严重程度根据总体衰退量表评分,得分3、4分者为轻度组,5分为中度组,6、7分为重度组。用酶联免疫吸附测定法测定受试对象血浆Hcy水平。结果：与正常对照组比较,AD组和VD组患者血浆Hcy明显升高（P〈0.05）,AD组与VD组间血浆Hcy水平差异无统计学意义（P=0.740 9）;AD重度组与AD轻度组比较（P〈0.05）,VD重度组与VD轻度组比较（P〈0.05）。结论：测定血浆Hcy水平对诊断AD和VD有帮助;AD和VD的病情严重程度与血浆Hcy水平有一定相关性。     

血管性痴呆患者脑脊液铝水平检测

为探讨血管性痴呆（VD）与老年性痴呆（AD）在发病机制上是否有某些共同点，对50例VD患者及25例健康对照组进行脑脊液（CSF）铝水平检测。结果表明，VD组CSF铝水平为2．48±2．42μmol／L，对照组为0．53±0．61μmol／L，VD组较对照组显著增高（P＜0．001）。推测VD发病机制可能与AD有某些共同之处。     

中日两国痴呆老人患病类型及精神行为症状的比较

目的比较探讨中日两国痴呆老人患病类型及精神行为症状（BPSD）发生率的差异。方法以辽宁省沈阳市苏家屯地区3432例65岁以上老年人为调查对象进行痴呆的流行病学调查，并与在日本新渴县丝鱼川地区调查结果比较。结果（1）调查地区痴呆的患病率为8．13％，低于日方调查结果10．6％。其中阿尔茨海默病（AD）占23．9％（日本为57．1％），血管性痴呆（VD）为56．6％（日本为22．6％）。（2）痴呆患者的精神行为症状（BPSD）的发生率两国之间无明显性差异，但不安症状、忧郁、烦躁、依赖等情感方面的变化以及大小便失禁症状方面，中方的发生率明显高于日方。结论老年痴呆已经成为当今中国的一个重大社会问题，中日两国痴呆患者患病类型及BPSD发生率出现差异的原因与两国之间的医疗保障制度以及生活水平不同相关。     

Neuroimaging in epilepsy in tropics

Epilepsy is a major public health problem in many tropical countries. Also, some of the tropical diseases are major contributors to the higher prevalence of epilepsy in these countries. The etiologic factors responsible for epilepsy in these countries are quite different from those in the developed world. This article discusses the etiologic factors and neuroimaging of epilepsy in light of the conditions in these tropical countries.     

癫痫与抑郁关系的研究进展

抑郁是癫痫患者中常见的精神障碍,严重地影响了患者的生活质量。传统的观点认为癫痫患者因为存在着诸多社会学问题易出现抑郁倾向,癫痫和抑郁是单向的联系,但大量的研究已经证明癫痫和抑郁之间存在双向的联系,一种异常状态的存在可能易转化为另一种异常状态的发展。癫痫和抑郁存在着共同的发病机制。本文主要就癫痫和抑郁的双向联系以及抗抑郁药物在癫痫患者中的应用进行阐述。     

Increase in cathepsin D activity in rat brain in aging

Cathepsin D-like activity in homogenates of five brain areas of 3-month-old and 24-month-old Fischer 344 rats was measured. With hemoglobin as substrate at pH 3.2, more than 90% of the activity was inhibited by pepstatin. In each area studied, activity was more than twice as high in the old rat brain: 140-160% higher in the cortex, cerebellum, pons-medulla, and striatum and 90-100% higher in the hippocampus and spinal cord. The greatly increased metabolic capacity in the absence of an increase in protein turnover may have a role in age-related pathological degeneration in the brain.     

Sudanophilic lipid accumulation in astrocytes in periventricular leukomalacia in monkeys

Summary Sudanophilic lipid accumulation is a characteristic feature of periventricular leukomalacia (PVL) of infants. At least two types of lipid-containing cells have been identified, one being the macrophage, the other the pre-myelin glial cell. A third type of lipid-containing cell has been seen in two monkeys with spontaneous PVL. Electron microscopically this cell appears to be an astrocyte. This probably represents a reaction of the astrocyte to hypoxia and may be the equivalent of the hypertrophic astrocytes found in human infants.Supported in part by NIH grant HDO 8633 and the Regional Primate Research Center Grant RR-00166     

Characteristics of nociceptors in the periodontium--an in vitro study in rats

Recent studies have indicated that nociceptors can be classified into various types according to their physiological properties. These studies have clarified that the frequency distribution of various nociceptor types is different among body sites and animal species. In the present study, we investigated the physiological properties of rat's periodontal nociceptors in an in vitro jaw-nerve preparation. Responses were recorded from functional single filaments in the inferior alveolar nerve. To determine the nociceptor type, calibrated von Frey filaments, heat, and bradykinin (BK) stimuli were used. We found five subtypes of nociceptors in the periodontal ligaments of the lower incisor: Adelta-high threshold mechanonociceptors (Adelta-HTM, n=28), Adelta-mechanoheat nociceptors (Adelta-MH, n=6), Adelta-polymodal nociceptors (Adelta-POLY, n=26), C-high threshold mechanonociceptors (C-HTM, n=3) and C-polymodal nociceptors (C-POLY, n=4). Most nociceptors were Adelta-innervated, while only a small number of C-innervated nociceptors were found. The present results suggest that periodontal nociceptors transmit mainly fast pain, and may thus play a role in rapid detection of injure-related stimuli during mastication.     

Defects in Bioenergetic Coupling in Schizophrenia

Synaptic neurotransmission relies on maintenance of the synapse and meeting the energy demands of neurons. Defects in excitatory and inhibitory synapses have been implicated in schizophrenia, likely contributing to positive and negative symptoms as well as impaired cognition. Recently, accumulating evidence has suggested that bioenergetic systems, important in both synaptic function and cognition, are abnormal in psychiatric illnesses such as schizophrenia. Animal models of synaptic dysfunction demonstrated endophenotypes of schizophrenia as well as bioenergetic abnormalities. We report findings on the bioenergetic interplay of astrocytes and neurons and discuss how dysregulation of these pathways may contribute to the pathogenesis of schizophrenia, highlighting metabolic systems as important therapeutic targets.     

Issues in evaluation of cognition in the elderly in developing countries

Background:

Developing regions of the world host the majority of elderly subjects who are at risk for dementia. Reliable epidemiological data from these countries is invaluable in tackling this global problem. Scarcity of such data in literature is largely attributable to problems that are unique to developing communities worldwide.

Objective:

To classify and describe the problems that interfere with the collection of reliable epidemiological data on cognitive impairment in the elderly in developing communities, and to suggest practical solutions for some of them.

Methods:

Inferring from the experiences of a large, ongoing, population-based study on the cognitive impairments in the elderly in South India and from the review of literature.

Conclusion:

A fatalistic attitude regarding aging in the communities, significant heterogeneity in educational abilities and activities of daily living, high illiteracy among rural subjects, and lack of an organized health care system and updated demographic figures are some of the major factors that contribute to technical, namely, methodology-related problems and practical, namely, subject-related problems in such epidemiological studies.     

Progress in neuroprotection in Parkinson's disease

Slowing or aborting the progress of neurodegeneration in Parkinson's disease (PD) remains the most important unmet need of this disorder. There are several recent developments in trial design and also in drugs under investigation for possible neuroprotective effect. Emphasis has been placed on clinical as opposed to imaging end-points and these include change in a clinical rating scale, e.g. United Parkinson's disease Rating Scale (UPDRS), or time to additional therapy. The introduction of the delayed-start, or wash-in, trial design adds an additional dimension to drug evaluation for neuroprotection. Compounds that have been recently tested in clinical trial include the monoamine oxidase-B inhibitor rasagiline, the anti-apoptotic agents TCH346 and CEP1347, and the promitochondrial agent creatine. The dopamine agonists have been evaluated for a neuroprotective effect using imaging end-points. Perhaps the most important and simplest concept for neuroprotection has been the theory that early dopaminergic support for the degenerating dopaminergic system per se provides significant long-term clinical benefit for PD patients.     

Increase in noradrenaline-synthesizing enzyme activity in medulla oblongata in Parkinson's disease

Summary Dopamine beta hydroxylase (DBH), the noradrenaline-synthesizing enzyme, and phenylethanolamine-N-methyltransferase (PNMT), the adrenaline-synthesizing enzyme, were assayed in 18 areas of brain stem in eight cases of parkinsonian syndromes and of four age- and postmortem delay-matched controls. Dissection was performed by the punch technique and enzyme activities assayed by radiometric methods. No significant change was found for PNMT activity. DBH activity was significantly increased in the A2-C2 area of the medulla oblongata (including the nucleus tractus solitarius) in the cases of Parkinson's disease.The A2-C2 area is known to be implicated in the control of blood pressure in rats. These findings are discussed in relation to orthostatic hypotension and the influence ofl-dopa therapy.Supported by grants from INSERM ATP 657897, ATP 8179113, CRL 79-1-356-6, DGRST (80 E 0882), FRMF, and Sandoz-France France