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1.
目的 研究低频重复经颅磁刺激(rTMS)对卒中后记忆障碍(PSMD)患者认知及事件相关 电位P300 的影响。方法 前瞻性连续纳入2019 年9 月至2020 年6 月于徐州市中心医院康复科门诊或 住院诊疗的PSMD 患者50 例,采用随机数字表法分为刺激组和假刺激组各25 例。两组在常规药物及康 复治疗的基础上,刺激组予低频(1 Hz)rTMS 治疗,假刺激组予假rTMS 治疗,治疗4 周。治疗前及治疗 4 周后均对患者进行简易精神状态检查(MMSE)、蒙特利尔认知评估量表(MoCA)、Rivermead 行为记忆量 表(RBMT- Ⅱ)、改良Barthel 指数(MBI)及P300 的评定并进行组间治疗前后的比较。结果 治疗前两组 的MMSE、MoCA、RBMT- Ⅱ和MBI 之间的差异均无统计学意义(均P > 0.05),治疗4 周后刺激组MMSE 评分[(21.52±4.51)分]、MoCA 评分[(16.80±3.88)分]、RBMT- Ⅱ评分[(17.28±3.30)分]、MBI 评分 [(64.60±14.21)分]、P300 潜伏期[(346.04±40.25)ms],波幅[(10.76±3.44)μV]均优于假刺激组[分 别为MMSE 评分(18.28±4.56)分、MoCA 评分(13.92±4.58)分、RBMT- Ⅱ评分(14.52±3.81)分和MBI 评 分(52.80±13.93)分、P300 潜伏期(383.39±51.23)ms、波幅(7.28±3.00)μV],治疗前后各量表及P300 参数的差值刺激组均优于假刺激组[MMSE、MoCA、RBMT- Ⅱ、MBI、P300 潜伏期和P300波幅差值分别 为:(4.68±1.63)分比(2.40±1.61)分,(4.82±1.56)分比(1.82±1.33)分,(5.04±1.21)分比(2.44±1.85)分, (21.80±7.62)比(13.20±6.60),-45.52(-121.69,-0.67)ms比-21.10(-60.61,29.31)ms,5.36(2.08,8.21)μV 比1.18(0.12,2.08)μV;均P< 0.05]。结论 低频rTMS 可提高PSMD患者的记忆功能,更有助于日常生 活能力的恢复,P300 更客观地体现低频rTMS 改进记忆功能效果。  相似文献   

2.
目的 探讨早期康复在重症卒中治疗中的疗效和价值。方法 选择134 例重症脑卒中患 者,进行早期康复治疗干预,包括认知功能训练、运动功能训练和日常生活活动能力训练。于治疗前24 h 及治疗4 周后分别采用简易精神状态检查量表(MMSE)、FugI-Meyer 运动功能评分(FMA)和Barthel 指数 (BI)进行评定。结果 对比患者早期康复治疗前后结果,MMSE[(19.16±8.86)分比( 22.33±7.36)分]、 FMA[(34.08±22.21)分比( 53.96±24.79)分]、BI[ (35.38±19.83)分比( 61.78±18.88)分]评分均较干预 前提高,差异均有统计学意义(P< 0.05)。结论 早期康复可以显著减少卒中后认知和运动功能障碍的 发生,减少致残率,提高患者的生存质量。  相似文献   

3.
目的 探讨左侧前额叶背外侧皮质(L-DLPFC)的间断θ短阵快速脉冲(iTBS)模式重复经 颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)和传统模式rTMS 对精神分裂症患者阴性症状 及认知功能的影响。方法 选取2018年9月至2020年3月哈尔滨精神专科白渔泡医院收治的80例精神 分裂症患者作为研究对象,按随机数字表法分为iTBS组(n=40)和rTMS组(n=40)。iTBS组接受iTBS刺激联 合药物治疗,rTMS组给予传统模式重复经颅磁刺激联合药物治疗。两组均刺激L-DLPFC,5次/周,治疗 4 周,共20 次。治疗前后,采用阳性与阴性症状量表(PANSS)比较两组患者的阴性症状,采用威斯康星 卡片分类测验(WCST)测评两组患者的认知功能。结果 与治疗前相比,治疗后两组患者的PANSS 阴性 量表分数[iTBS组:(29.81±4.02)分比(26.22±3.88)分,t=10.540;rTMS组:(30.91±5.53)分比(27.35±4.99)分, t=9.786]、总分[iTBS 组:(78.14±7.59)分比(73.65±5.43)分,t=6.219;rTMS 组:(78.88±10.00)分比 (75.21±9.14)分,t=9.297]、反应缺乏分数[iTBS 组:(15.70±1.71)分比(14.76±1.75)分,t=3.641;rTMS 组: (15.56±2.44)分比(14.12±2.03)分,t=7.792]、思维障碍分数[iTBS 组:(7.68±1.53)分比(7.32±1.18)分, t=2.837;rTMS 组:(7.85±1.84)分比(7.21±1.72)分,t=4.875]、WCST中完成第一个分类所需应答数[iTBS 组:128.00(50.50,128.00)比106.00(42.00,128.00),Z=-4.92;rTMS 组:128.00(98.25,128)比106.50(36.75, 128.00),Z=-4.86]、非持续性错误[iTBS 组:87.00(62.50,95.00)比74.00(42.00,91.00),Z=-4.55;rTMS 组: 89.50(80.75,96.50)比68.00(53.00,82.75),Z=-4.33]均显著降低(P< 0.05);与治疗前相比,两组治疗后 的WCST中正确应答数[iTBS 组:40.00(33.50,57.50)比59.00(53.50,79.50),Z=-4.92;rTMS 组:39.50(32.75, 46.00)比58.00(46.79,75.50),t=-4.86]、概念化水平百分数[iTBS 组:0.09(0.05,0.23) 比0.18(0.14,0.34), Z=-5.30;rTMS 组:0.08(0.05,0.16)比0.19(0.15,0.24),Z=-5.09]均显著升高(P< 0.05)。两组治疗后的 PANSS、WCST各项目评分及评分差值比较,差异均无统计学意义(P > 0.05)。结论 在总刺激数一定 的条件下,iTBS 及传统模式10 Hz rTMS 均能改善精神分裂症患者的阴性症状及认知功能,且疗效相当, 但iTBS 模式耗时更少。  相似文献   

4.
目的 观察超低频经颅磁刺激(ILF-TMS)治疗缺血性脑卒中后失眠的临床疗效。方法 选 取60例缺血性脑卒中后失眠患者,按照随机数字表法将其分为常规治疗组(30例)和ILF-TMS治疗组(30 例), 两组患者均口服酒石酸唑吡坦片,每晚睡前口服5 mg。ILF-TMS 治疗组在此基础上加用ILF-TMS 治疗, 常规治疗组每日接受伪ILF-TMS治疗,患者治疗前和治疗后(10 d 后)均给予匹兹堡睡眠质量指数(PSQI) 和多导睡眠图(PSG)相关参数评价睡眠情况,PSG 评价参数主要包括总睡眠时间(TST)、睡眠潜伏期(SL) 以及睡眠NREM(S1、S2、S3 +S4 )、REM 的睡眠结构比。结果 治疗前两组患者PSQI、TST、SL、S1、S2、 S3+S4、REM 评分比较,差异无统计学意义(P> 0.05)。常规治疗组患者10 d 后PQSI评分较前明显降低 [(18.03±1.37)分比(12.60±2.43)分];TST 较前明显延长[(251.42±42.42)min 比(288.80±40.32)min]; SL 较治疗前有显著缩短[(39.60±17.62)min 比(34.40±14.89)min],差异均有统计学意义(P < 0.05),睡 眠结构S1、S2、S3+S4、REM 较治疗前均无明显变化。ILF-TMS 治疗组患者10 d 后PQSI评分较前明显降 低[(18.17±1.29)分比(10.40±2.13)分];TST较前明显延长[(241.50±51.75)min 比(353.45±52.20)min]; SL 较治疗前有显著缩短[(40.80±17.47)min 比(26.60±13.22)min],差异均有统计学意义(P < 0.05),而 睡眠结构S1、S2、S3+S4、REM 较治疗前均无明显变化。与常规治疗组比较,ILF-TMS 治疗组患者治疗后 PSQI评分更低,TST更长,SL更短,差异均有统计学意义(P< 0.05)。结论 ILF-TMS 可以改善缺血性脑 卒中后失眠症状,短期(10 d)ILF-TMS 治疗尚不能改善缺血性脑卒中后失眠患者的睡眠结构。  相似文献   

5.
目的 观察高频重复经颅磁刺激(rTMS)治疗卒中后肩手综合征的临床疗效。方法 选取 2019年6月至2020年10月在淮安市康复医院康复科病房住院的60例卒中后肩手综合征患者,按照随机 数字表法将其分为对照组(30例)和治疗组(30例)。两组患者均接受常规止痛治疗和常规康复治疗。对照 组在常规治疗的基础上给予伪rTMS治疗,治疗组在常规治疗的基础上给予5 Hz的rTMS治疗。两组均治 疗2 周,每周治疗6 d。治疗过程中对照组脱落1 例,治疗组脱落2 例。两组患者治疗前后均采用视觉模 拟评分(VAS)评价疼痛程度,采用Fugl-Meyer运动功能评分量表上肢部分(FMA-UE)评价上肢运动功能,采 用排水法评价患侧前臂肿胀程度,采用匹兹堡睡眠质量指数(PSQI)评价睡眠状态。结果 经过2 周的治 疗,两组患者的疼痛程度均缓解,差异有统计学意义(P< 0.05);治疗组治疗后的疼痛改善程度优于对照 组,差异有统计学意义[(4.30±1.10)分比(4.85±0.86)分,P < 0.05]。两组患者治疗后的患肢活动功能 均优于治疗前,差异有统计学意义(P<0.05);治疗组患者治疗后的改善程度优于对照组,差异有统计学意 义[(31.00±4.00)分比(35.89±4.74)分,P<0.05]。两组患者的患肢肿胀程度较治疗前均有减轻(P<0.05), 治疗组患者治疗后的肿胀减轻程度优于对照组,差异有统计学意义[(52.85±12.48)ml比(47.70±11.17)ml, P< 0.05]。两组患者的睡眠质量较治疗前均有显著改善,差异有统计学意义(P < 0.05);治疗组患 者治疗后的睡眠质量与对照组比较,差异无统计学意义[(7.70±2.00)分比(7.37±2.26)分,P > 0.05]。 结论 高频rTMS 可以明显改善卒中后肩手综合征患者的疼痛程度和临床症状,2 周时间的高频rTMS 治 疗较常规治疗不能明显改善睡眠质量。  相似文献   

6.
目的 探讨高频重复经颅磁刺激(rTMS)对甲基苯丙胺(MA)依赖者戒断后焦虑、抑郁及渴 求的疗效及安全性评价。方法 采用随机对照研究,前瞻性选取蚌埠强制隔离戒毒所戒毒的男性MA依 赖者47 例,将所有被试者按随机数字表法分为研究组和对照组,研究组接受系统的高频(10 Hz)rTMS 治 疗,对照组接受rTMS 的伪刺激治疗,每周3 次,共治疗4 周。在基线时和治疗第4 周末分别应用焦虑自 评量表(SAS)、抑郁自评量表(SDS)和视觉模拟标尺(VAS)评定患者的焦虑、抑郁和心理渴求情况,干预 期间采用不良反应问卷记录出现的不良反应。结果 治疗第4周末,研究组SAS评分[(43.17±8.60)分]、 SDS 评分[(48.00±8.12)分]和VAS 评分[1.00(0,2.75)分]较基线时SAS 评分[(46.71±8.64)分]、SDS 评分[(52.96±7.66)分]和VAS 评分[4.00(2.00,5.75)分]降低,差异均有统计学意义(均P< 0.05),且低 于对照组[分别为(48.74±8.92)、(53.13±6.61)、4.00(0,6.00)分],差异均有统计学意义(均P< 0.05)。对 照组治疗第4 周末SAS、SDS 评分及VAS 评分与基线时比较,差异均无统计学意义(均P> 0.05)。研究组 8 例(33.33%)患者发生不良反应,其中头痛6 例,头晕1 例,耳鸣1 例,患者均可耐受;对照组患者未发生 不良反应事件。结论 高频rTMS 可改善MA 依赖者的焦虑、抑郁及渴求情况,轻微不良反应发生较为 普遍。  相似文献   

7.
目的 探讨双相情感障碍躁狂发作患者攻击行为与执行功能之间的相关性。方法 采用 修订版外显攻击行为量表(MOAS)对2018 年6 月—2019 年2 月在山东省精神卫生中心门诊就诊或者住 院治疗的164例双相情感障碍躁狂发作患者攻击行为进行评定,MOAS评分≥5分为攻击组,MOAS<5分 为非攻击组。用威斯康星卡片分类测验(WCST)评估受试者的执行功能,用贝克-拉范森躁狂量表(BRMS) 评估受试者的临床症状。结果 双相情感障碍躁狂攻击组患者BRMS总分[(25.78±4.32)分]高于非攻击组 [(24.69±4.29)分](P<0.05),攻击组WCST正确数[(42.52±7.23)分]、分类数[(7.61±3.48)分]低于非攻 击组[(44.29±9.14)、(8.06±2.12)分];错误数[(43.03±8.43)分]、持续错误数[(29.08±5.55)分]、非持 续错误数[(26.84±5.78)分]均高于非攻击组[(41.32±8.18)、(28.58±7.22)、(25.03±5.80)分],差异有统 计学意义(P< 0.05),双相情感障碍躁狂患者MOAS 评分与WCST错误数、持续性错误数、非持续性错误 数呈正相关(P< 0.05),与分类数呈负相关(P < 0.05)。结论 双相情感障碍躁狂患者攻击行为与执行 功能存在相关性,执行功能受损可能与双相情感障碍躁狂攻击行为的发生机制有关。  相似文献   

8.
目的 分析心因性非痫性发作(PNES)患者的抑郁、焦虑症状及人格特质。方法 选取 2020 年 1 月至 2021 年 3 月在首都医科大学宣武医院神经内科治疗的 22 例 PNES 患者(PNES 组)及 40 例 癫痫患者(癫痫组)的一般人口学及相关临床资料,使用 24 项汉密尔顿抑郁量表(HAMD-24)、汉密尔顿 焦虑量表(HAMA)及明尼苏达多项人格测验(MMPI)评估患者的抑郁、焦虑状态及人格特质。比较两组 患者一般人口学特征、临床资料、抑郁、焦虑状态及人格特质的差异。结果 PNES 组本次发作有诱发 因素者占比、发作频率高于癫痫组,差异有统计学意义(P< 0.05);HAMA 总分[11.80(7.00,15.50)分比 8.50(5.00,14.00)分]、躯体性焦虑因子评分[5.30(2.00,9.50)分比 3.10(1.00,4.75)分]、HAMD-24 总分 [10.60(5.50,14.50)分比7.30(5.00,8.50)分]、焦虑/躯体化症状因子评分[4.00(2.50,5.00)分比2.80(2.00, 4.00)分]、睡眠障碍因子评分[1.80(0,3.00)分比 1.00(0,2.00)分]、绝望感因子评分[1.10(0,2.00)分 比 0.40(0,1.50)分]高于癫痫组,差异有统计学意义(Z=2.13、1.98、1.97、2.64、2.15、2.76;P< 0.05); PNES 组 MMPI 中的疑病[(67.36±2.02)分比(56.79±1.21)分]、抑郁[(64.09±2.10)分比(52.07±1.97)分]、 癔病[(67.00±1.79)分比(54.62±1.17)分]、精神衰弱的标准分[(65.55±2.15)分比(58.40±1.82)分]高 于癫痫组,神经质[(71.32±2.05)分比(56.88±1.12)分]和掩饰性因子评分[(45.09±2.38)分比(38.57± 0.98)分]高于癫痫组(t=4.77、4.15、6.00、2.41、6.74、2.53;P< 0.05),非社会性因子评分低于癫痫组 [(44.91±2.03)分比(53.24±1.63)分],差异有统计学意义(t=-3.10,P< 0.01)。结论 PNES 相对癫痫患 者的抑郁、焦虑症状明显,具有神经质、掩饰性的人格特质,而癫痫患者的非社会化倾向更加明显。  相似文献   

9.
目的 探讨低频重复经颅磁刺激(rTMS)联合氟伏沙明治疗儿童青少年首发强迫障碍的临 床疗效。方法 选取2021年6月至2022年3月在青岛市精神卫生中心门诊和住院的58例首发强迫障碍 患儿为研究对象,采用随机数字表法分为试验组和对照组,每组 29 例。试验组采用低频 rTMS 联合氟伏 沙明治疗,对照组采取伪刺激联合氟伏沙明治疗,两组均观察治疗 8 周。采用耶鲁 - 布朗强迫障碍量表 (Y-BOCS)、汉密尔顿焦虑量表(HAMA)、不良反应症状量表(TESS)对两组患儿进行评估。采用重复测量 方差分析比较治疗前及治疗第 2、4、6、8 周末两组患儿的强迫症状严重程度、焦虑情况,并比较两组患 儿的治疗总有效率和不良反应发生率。结果 两组患儿治疗前的Y-BOCS、HAMA 评分比较,差异无统 计学意义(P> 0.05)。试验组患儿治疗第 2、4、6、8 周末的 Y-BOCS 评分与对照组比较[(26.10±5.11)分 比(30.24±3.79)分、(22.48±5.09)分比(25.76±4.60)分、(17.34±5.15)分比(20.31±5.65)分、(12.59±5.82)分比 (16.31±6.71)分],差异均有统计学意义(均P< 0.05);HAMA 评分与对照组比较[分别为(19.41±4.02)分 比(22.55±3.88)分、(15.62±4.53)分比(18.90±3.39)分、(11.66±3.11)分比(15.62±3.23)分、(8.31±2.19)分 比(12.55±2.68)分],差异均有统计学意义(均P< 0.01)。重复测量方差分析结果显示,两组患儿的 Y-BOCS、HAMA 评分存在组间、时间和交互效应,差异均有统计学意义(均P< 0.05)。进一步分析显示, 试验组在治疗第 2 周末起效,而对照组在治疗第 4 周末起效。试验组的治疗总有效率为 93.11%(27/29), 高于对照组的 72.41%(21/29),差异有统计学意义(Z=1.980,P< 0.05)。两组患儿的不良反应发生率比较 [37.93%(11/29)比 27.59%(8/29)],差异无统计学意义(χ2 =0.704,P> 0.05)。结论 低频 rTMS 联合氟伏 沙明治疗儿童青少年首发强迫障碍能够改善患儿的强迫症状和焦虑症状,治疗2周可起效,有效率较高。  相似文献   

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目的 探讨卒中后抑郁(PSD)大鼠海马缝隙连接蛋白Cx36 与认知功能障碍的相关性,探 寻PSD认知功能障碍的潜在发病机制。方法 将42 只大鼠随机分为正常组、卒中组、抑郁组、PSD组、 生理盐水组、甘珀酸(CBX)组和全反式维甲酸(ATRA)组,每组6 只。抑郁组每天随机给予1 种慢性不可 预测的温和性刺激并孤养;向卒中组大鼠的运动皮层注射内皮素-1 制备局灶性缺血型大鼠模型,PSD 组、生理盐水组、CBX 组和ATRA 组在卒中组的基础上叠加抑郁刺激建立PSD 模型。在PSD 造模的同 时,PSD 组不进行干预;生理盐水组每天腹腔注射生理盐水1 ml;ATRA组每天腹腔注射浓度为1 mg/ml 的1 ml 乙醇和磷酸盐缓冲液(按1∶9 配置);CBX 组按照20 mg/kg 的标准每天腹腔注射CBX。于卒中 术后28 d,采用糖水实验、水迷宫实验、穿梭实验检测大鼠的兴趣缺失感、空间记忆能力、学习记忆能 力,验证PSD认知障碍模型是否诱导成功;采用Real-time PCR检测大鼠海马Cx36 mRNA表达变化;采用 Western blotting 检测和免疫荧光检测大鼠海马Cx36 蛋白的表达量和平均荧光强度。结果 术后28 d, PSD 组大鼠体重[(257.05±4.74)g]低于正常组[(352.00±7.99)g]、卒中组[(303.95±4.63)g],差异有 统计学意义(P<0.05);PSD组大鼠24 h糖水饮用率[(61.92±3.12)%]低于正常组[(83.40±5.38)%]、卒中 组[(88.03±3.65)%]、ATRA组[(71.15±4.55)%],高于CBX组[(49.62±5.85)%],差异有统计学意义(P< 0.05);PSD组大鼠水迷宫潜伏时间[(51.18±4.14)s]长于正常组[(9.05±2.22)s]、卒中组[(9.06±2.25)s]、 ATRA组[(32.92±2.29)s],短于CBX 组[(91.13±3.27)s],差异有统计学意义(P< 0.05);PSD组穿梭实验 主动逃避次数[(10.67±1.51)次]少于正常组[(18.00±2.10)次]、卒中组[(16.5±1.87)次]和ATRA 组 [(13.83±1.17)次],多于CBX 组[(7.00±1.26)次],差异有统计学意义(P< 0.05)。术后28 d,PSD组海马 区Cx36 mRNA 表达量(0.50±0.03)低于正常组(1.04±0.07)、卒中组(1.07±0.10)和ATRA组(0.76±0.11), 高于CBX 组(0.20±0.06),差异有统计学意义(P< 0.05);PSD组海马区Cx36 蛋白相对表达量(0.60±0.07) 低于正常组(0.86±0.05)、卒中组(0.88±0.03)和ATRA 组(0.77±0.07),高于CBX 组(0.56±0.02),差异 有统计学意义(P < 0.05);PSD 组海马区Cx36 蛋白平均荧光强度(0.36±0.03)低于正常组(1.00±0.03)、 卒中组(0.97±0.03)和ATRA 组(0.50±0.02),高于CBX 组(0.21±0.03),差异有统计学意义(P < 0.05)。 结论 PSD 大鼠海马Cx36 蛋白水平降低,CBX 干预能降低Cx36 蛋白表达并且大鼠认知功能障碍加重, ATRA干预能增加Cx36 蛋白的表达并且大鼠认知功能障碍稍有好转。  相似文献   

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Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.  相似文献   

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A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.  相似文献   

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Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005  相似文献   

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Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.  相似文献   

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After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.  相似文献   

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