修正蒙特利尔认知评估量表评估脑白质疏松症认知功能障碍的效果研究

目的探讨修正的蒙特利尔认知评估量表(MoCA)评估脑白质疏松症认知功能障碍的应用效果。方法选取本院诊治的脑白质疏松症认知功能障碍患者53例为观察组,选取本院同期健康体检人员53例为对照组,均行MoCA和简易精神状态量表(MMSE)评定,比较2组MoCA和MMSE评分结果以及观察组不同严重程度间MoCA和MMSE的评分结果,分析MoCA和MMSE的诊断价值,分析MoCA、MMSE与脑白质疏松症认知功能障碍的相关性。结果观察组MoCA、MMSE量表视觉空间与执行能力评分、命名评分、注意力评分、语言评分、延迟回忆评分、抽象评分、定向力评分、总评分均明显低于对照组。中度认知功能障碍患者MoCA评分、MMSE评分均明显低于轻度认知功能障碍患者,重度认知功能障碍患者均明显低于轻度和中度认知功能障碍患者。MoCA的灵敏度、阴性预测值、约登指数均明显高于MMSE,MoCA的特异度明显低于MMSE,但差异均有统计学意义(P0.05)。MoCA的阳性预测值低于MMSE,差异无统计学意义(P0.05)。MoCA与MMSE具有明显的正相关性,MoCA、MMSE与脑白质疏松症认知功能障碍均具有明显负相关性。结论 MoCA是脑白质疏松症认知功能障碍的有效评估方法,与患者认知功能障碍的严重程度密切相关,灵敏度高,值得临床推广使用。     

血管性痴呆与脑白质疏松的相关研究

目的探讨血管性痴呆(VaD)与脑白质疏松症(LA)的相关性.方法对104例LA患者应用分级法将LA分为4级LA1-LA4;应用MMSE和Hachinski量表诊断VaD.结果与LA1组比较,LA3LA4组VaD发生率有明显上升(P＜0.01),MMSE评分有明显下降(P＜0.01).结论LA的损伤程度与VaD发生率呈正相关,LA分级愈高,痴呆的程度愈重.     

眼底动脉硬化程度颈动脉内膜中层厚度和脑白质疏松的相关性研究

目的观察眼底血管病变与脑白质疏松的相关性,分析颈动脉内膜中层厚度与脑白质疏松及严重程度的相关性。方法收集我院神经内科病房住院患者或体检者138例,根据磁共振影像,分为脑白质疏松组66例和对照组72例,对所有病人行眼底数码照相分析,应用Scheie法对眼底动脉病变分级,超声测量颈动脉内膜中层厚度,根据Fazekas量表对脑白质疏松程度进行分级,分析对比不同级别的脑白质疏松患者的眼底动脉硬化改变程度、颈动脉内膜中层厚度数值。结果脑白质疏松组与对照组比较,眼底改变程度、颈动脉内膜中层厚度值比较差异有统计学意义(P<0.05)。不同级别脑白质疏松改变,存在眼底动脉硬化程度不同。脑白质疏松轻度改变与中度改变颈动脉内膜中层厚度值比较差异有统计学意义(P<0.05);重度改变与轻、中度改变颈动脉内膜中层厚度值比较差异有统计学意义(P<0.05)。结论眼底改变在一定程度上能够反映脑白质疏松的存在及严重程度,脑白质疏松与颈动脉内膜中层厚度有相关性。     

脑白质病变与轻度认知功能障碍的关系

目的 探讨脑白质病变(WML)与轻度认知功能障碍(MCI)的关系.方法 71例WML患者根据头颅MRI检查分为轻度组(27例)、中度组(21例)、重度组(23例),39例无WML的对照者为对照组.对入组者进行神经心理学量表检查;比较各组MCI的患病率,分析WML与MCI的相关性.结果 WML轻、中、重度组的MCI患病率明显高于对照组(均P＜0.01);WML中、重度组简易精神状态检查(MMSE)及蒙特利尔认知评估量表(MoCA)评分显著低于WML轻度组和对照组(均P＜0.01);随着WML程度的加重,除了抽象能力评分,MoCA其他各认知领域的评分均显著降低(均P＜0.05).多元线性相关分析显示,WML程度与MMSE、MoCA总分及除抽象思维能力的各认知域评分呈负相关(r=-0.252 ～-0.782,均P＜0.01).结论 WML可导致MCI,其对认知功能障碍的影响与WML的程度有关.     

脑白质疏松症伴轻度认知损害患者静息态功能磁共振成像研究

目的采用f MRI研究脑白质疏松症伴或不伴轻度认知损害患者静息态脑网络功能连接,探讨静息态fMRI对脑白质疏松症的早期诊断价值。方法共49例脑白质疏松症患者根据临床痴呆评价量表评分分为脑白质疏松症伴轻度认知损害组(LA-MCI组,34例)和脑白质疏松症不伴轻度认知损害组(LA-NMCI组,15例),采用简易智能状态检查量表、蒙特利尔认知评价量表、汉密尔顿抑郁量表17项和汉密尔顿焦虑量表14项评价认知功能、抑郁和焦虑症状,静息态f MRI研究脑网络功能连接。结果LA-MCI组患者年龄大于正常对照组(P=0.003),MMSE(P=0.001,0.000)和Mo CA(P=0.001,0.000)评分高于LA-NMCI组和正常对照组。与正常对照组相比,LA-MCI组患者突显网络内部核团功能连接减弱,突显网络对脑默认网络核团的功能连接呈增强趋势、对中央执行网络的功能连接呈减弱趋势;LA-NMCI组患者突显网络内部核团功能连接减弱,突显网络对脑默认网络核团的功能连接呈增强趋势、对中央执行网络核团的功能连接呈减弱趋势。结论脑白质疏松症伴或不伴轻度认知损害患者静息态激活脑区与正常人群存在差异,可以在一定程度上解释脑白质疏松症伴认知功能障碍的病理生理学机制。     

脑白质疏松患者病情和抑郁的关系研究

目的探究脑白质疏松患者病情和抑郁的关系。方法选取我院于2012-01—2014-01神经内科收治的125例脑白质疏松患者为观察组,选取同期在我院进行体检的、伴头痛头晕症状的125例健康体检者为对照组。对2组患者均进行脑白质病变分级和汉密尔顿抑郁量表评分检测,比较2组患者的一般临床资料及抑郁发生率,进一步分析脑白质疏松病情的严重程度与抑郁的关系。结果 2组患者在年龄和教育背景方面差异具有统计学意义(P0.05);观察组抑郁发生率高于对照组;患者性别、吸烟状况及其他疾病患病状况方面差异无统计学意义(P0.05)。通过Logistics回归分析发现:年龄,教育背景,高血压及脑白质疏松为患者发生抑郁的危险因素(P0.05,P0.01);性别、吸烟、糖尿病及冠心病与抑郁发生无相关性(P0.05)。观察组病情越严重,则抑郁发生率随之升高(P0.05);且各级抑郁平均评分按照脑白质疏松分级逐级升高,差异具有统计学意义(P0.05);2组患者抑郁发生率和抑郁评分对比,观察组显著高于对照组(P0.01)。结论脑白质疏松患者的病情与抑郁发生率之间具有显著关系。     

半胱氨酸蛋白酶抑制剂C与脑白质疏松相关性研究

目的探讨半胱氨酸蛋白酶抑制剂C(CYSC)水平与脑白质疏松的相关性及不同程度脑白质疏松患者血清CYSC水平的差异。方法选择213例脑白质疏松患者(脑白质疏松组)和201名健康体检者(对照组)为研究对象。应用胱抑素C检测试剂盒(乳胶增强免疫比浊法)检测血清CYSC水平,收集临床资料和脑白质疏松的相关可能危险因素,采用MRI的Fazekas方法对脑白质疏松组进行分级,评估不同程度脑白质疏松患者的CYSC水平差异。结果脑白质疏松组的高血压病、糖化血红蛋白、肾功能、同型半胱氨酸和CYSC水平[(0.99±0.28)mg·L~(-1)]与对照组[(0.80±0.20)mg·L~(-1)]比较,差异有统计学意义(P0.05),提示这些因素和CYSC水平与脑白质疏松的发生和严重程度相关。结论对不同脑白质疏松患者进行影像学Fazekas分级后发现,随着Fazekas评分增加CYSC水平随之升高。     

年龄相关性脑白质改变与循环血内皮祖细胞数目及认知功能的关系

目的 探讨年龄相关性脑白质改变的形成机制,以及与循环血内皮祖细胞数目变化和认知功能之间的关系,为年龄相关性脑白质改变及老年人群认知功能障碍的早期防治提供理论依据.方法 经CT或MRI明确诊断的年龄相关性脑白质改变患者40例,采用流式细胞术检测循环血内皮祖细胞数目,简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(MoCA)评价认知功能.采用完全随机设计的单因素方差分析和R×C表格资料的x2检验进行单因素筛查,Logistic回归分析(向后剔除法)确定年龄相关性脑白质改变危险因素.结果 流式细胞术检测显示,年龄相关性脑白质改变组患者循环血内皮祖细胞数目减少,且以病情严重者(29.50±6.26)减少更为显著,与正常对照组(70.50±8.71)和轻至中度组(58.99±7.78)比较,差异具有统计学意义(均P=0.000);循环血内皮祖细胞数目变化与年龄相关性脑白质改变严重程度呈负相关(r=-0.562,P=0.001).重度组患者MMSE评分(23.85±2.35)和MoCA评分(19.80±3.38)显著低于正常对照组(27.10±1.80,26.60±1.23)和轻至中度组(25.80±2.02,23.30±2.87),组间差异有统计学意义(均P＜0.05).年龄相关性脑白质改变组患者主要表现为视空间及执行能力、延迟回忆及定向力障碍(均P＜0.05).结论 循环血内皮祖细胞数目变化可作为年龄相关性脑白质改变发生的预测因素,并是反映疾病严重程度的有效指标.其数目减少可能是形成年龄相关性脑白质改变的重要机制,并是导致老年人群认知功能障碍的重要病因.     

脑白质疏松症对大面积脑梗死预后的影响

目的探讨脑白质疏松症对大面积脑梗死预后的影响。方法收集60例首次卒中即表现为大面积脑梗死的患者的临床资料,分为合并脑白质疏松组(LA 组,30例)和不合并脑白质疏松组(LA-组,30例)。记录2组患者神经影像学表现、患者的病死率及发病2年内卒中的再发率,并根据脑卒中患者临床神经功能缺损程度评分标准和简易智能量表对患者进行神经功能和智能状态的评估。结果合并脑白质疏松症的患者平均年龄偏大,初次梗死时梗死灶的数目较多,有更严重的神经功能缺损和智能障碍,2组之间病死率没有差别。在2年随访期间,合并脑白质疏松组的患者的再次卒中和脑出血的比例均增加。2年随访结束时,合并脑白质疏松组的患者有更严重的神经功能缺损和智能障碍。结论合并脑白质疏松的大面积脑梗死患者预后比不合并脑白质疏松的大面积脑梗死患者预后差。     

老年性脑白质疏松症与血管性认知功能障碍相关性分析

目的探讨老年性脑白质疏松症(LA)与血管性认知功能障碍(VCI)的相关性。方法应用Hachinski和Mo-cA量表,分析老年性脑白质疏松症(LA)与血管性认知功能障碍(VCI)的关联性。结果 LA组与对照组的VCI发生率分别为41.7%和5.4%,差异有统计学意义(P<0.001),Logisistic回归分析显示LA的发生与高龄明显相关(P=0.001),且LA的严重程度与年龄呈正相关(r=0.9384)。结论 LA与VCI呈正相关,高龄是LA发生的最重要危险因素。     

Satisfaction with quality of life varies with temperament types of patients with schizophrenia

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.     

Compliance with health regimens of adolescents with epilepsy

The purpose of this paper was to describe the compliance of adolescents with epilepsy and some factors connected to it. Altogether 300 individuals with epilepsy aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (n= 232) of the selected adolescents with epilepsy returned a questionnaire sent to them relating to compliance. The data were analysed using the SPSS software. Twenty-two per cent of the adolescents with epilepsy felt that they complied fully with their suggested health regimens, while 44% placed themselves in the category of "satisfactory compliance", and the remaining 34% reported poor compliance. Compliance with their recommended life-style was poorest, while the highest degree of compliance was recorded for medication. Background variables, such as the duration of the disease, exercise, smoking, alcohol-intake and the number of seizures, were statistically significantly related to compliance (P< 0.001). Good motivation, a strong sense of normality, experience of results, subjective outcome, energy and will-power, support from parents, physicians and nurses, and a positive attitude towards to the disease and its treatment, no threat to social and emotional well-being and no fears of complications and no fear of seizures explained good compliance (P< 0.001).     

Treatment of patients with tardive dystonia with olanzapine

Tardive dystonia represents a complication of long-term use of neuroleptics and its treatment is often unsatisfactory. Atypical neuroleptics appear to improve tardive dystonia, and cases of tardive dystonia successfully managed with clozapine have been reported. The aim of this open-label video-blinded study was to evaluate the antidystonic efficacy of olanzapine, a new atypical neuroleptic with a low risk of agranulocytosis, in a group of four patients (one man and three women) with tardive cervical dystonia. They developed severe dystonia after several years of neuroleptic treatment. Extensive laboratory evaluations, as well as neurophysiologic and neuroradiologic investigations, were negative. Olanzapine was started at a dose of 5 mg/d and increased up to 7.5 mg/d. All patients were evaluated at baseline and after 2, 4, 8, and 12 weeks of treatment, using the Toronto Western Spasmodic Torticollis Rating Scale, and videotaped. At the end of the trial, the videotapes were reviewed and scored by a blind observer. A self-rating visual analog scale completed the disability evaluation.A moderate to marked improvement in dystonia was observed in all patients, and significant differences were observed in Toronto Western Spasmodic Torticollis Rating Scale scores and videotape ratings after 8 and 12 weeks of treatment compared with the basal values (p < 0.05). The average percentage of improvement in Toronto Western Spasmodic Torticollis Rating Scale score and visual analog scale was 26.4% and 42.6%, respectively. No serious side effects were reported at the maximum dosage reached (7.5 mg/d). This study warrants a larger controlled study to conclusively demonstrate the efficacy of olanzapine in tardive dystonia.     

Relapsing polychondritis with features of dementia with Lewy bodies

We describe a 72-year old man with clinical features suggestive of dementia with Lewy bodies (DLB) who proved neuropathologically to have degeneration induced by relapsing polychondritis (RP), an autoimmune inflammatory disorder of cartilaginous tissues. There was lymphocytic infiltration of the leptomeninges, perivascular cuffing, reactive astrocytosis, and activation of microglia in multiple brain areas all consistent with an immunologically mediated process. There was widespread neuronal loss within the hippocampus, entorhinal cortex, and amygdala as well as diffuse myelin pallor of cortical pathways. Elevated levels of complement proteins and endothelial markers of inflammation were observed, which are similar to previous reports in DLB. This study demonstrates that qualitatively similar inflammation-associated neurodegeneration is present in widespread regions of the brain in a RP case presenting clinically as DLB.Senior authors Arnold Starr and David H. Cribbs contributed equally to this project.Funding supported by ADRC P50 AG16573, NIA-AG-20241 P50 AG000658, and NINDS-NS50895 (DHC)     

Collaborative design of accessible information with people with aphasia

ABSTRACT

Background: People with aphasia report preferences for specially formatted health information materials, but there is little evidence that modified materials result in improved comprehension. Potential explanations for this include language included not taking account of aphasic processing difficulties, topics unrelated to aphasia, lack of clarity regarding the use of images, and the lack of end-user involvement in the design. Additionally, no definitive criteria for production of accessible information have been identified.

Aims: The first aim of this study was to collaborate with people with aphasia in an iterative design process to develop and finalise accessible information materials. The second aim was to identify definitive criteria for use in the future production of information materials for people with aphasia.

Methods and procedure: Prototype materials were developed for the study, based on criteria identified from the existing research into aphasia-accessible information, and on the evidence base concerning language processing in aphasia. Fourteen people with aphasia took part in two rounds of consensus group meetings and viewed information about aphasia presented within the prototype materials. Consensus points were identified within the groups through discussion and through ratings using Likert scales. The set of consensus points and ratings were adapted into criteria for graphic designers to incorporate into subsequent designs of the materials, in order to generate a final version, and related criteria.

Outcomes and results: The group discussions and the ratings of materials led to the identification of an agreed layout within which to present information, and specific criteria for the following: information consisting of one proposition expressed via everyday words and canonical syntactic forms; one or two images relating directly to keywords; sans serif typography with keyword emphasis. Individual preferences with regard to image types were identified. Novel criteria were identified in the study, relating to layout, language, images and typography. These were added to the original set of criteria to form definitive criteria for use in the development of accessible aphasia materials.

Conclusions: This study successfully involved people with aphasia in the design process to produce novel materials, and related design criteria. The resulting materials and criteria differ from those previously proposed, by reflecting directly people with aphasia’s views and preferences, and by incorporating language and images suitable for people with aphasia, based on the existing research evidence and the outcomes of this study. The materials and criteria have the potential to improve people with aphasia’s understanding of health information.