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1.
目的探讨血管性认知功能障碍(vascular cognitive impairment,VCI)患者血C-反应蛋白(CRP)、血浆同型半胱氨酸(homocystine,Hcy)、VitB12、叶酸(folic acid,FA)水平的差异及其与认知功能障碍严重程度的相关性。方法选择2014年12月~2016年6月南京鼓楼医院集团宿迁市人民医院神经内科门诊及住院患者共100例,根据MoCA量表评分划分为3组,具体为正常对照(normal control,NC)组30例、非痴呆型血管性认知障碍(vascular cognitive impairment no dementia,VCIND)组39例和血管性痴呆(vascular dementia,VD)组31例;所有患者均取晨起空腹肘静脉血测定血CRP、血Hcy、VitB12、FA水平。结果 (1)VCIND组患者CRP和Hcy水平较NC组高,VtimaniB12和血清FA水平较NC组低(P0.05);(2)VD组患者与VCIND组患者比较血CRP和Hcy水平明显升高(P0.05),血VitB12和血FA水平明显下降(P0.05);(3)VD组患者CRP和Hcy水平较NC组高,VtimaniB12和血清FA水平较NC组低(P0.01);(4)VCI(VD组+VCIND组)患者血CRP、Hcy水平与MoCA量表评分呈负相关(r=-0.56,P0.05),血VitB12和FA水平与MoCA量表评分无明显相关性(r=0,P0.05)。结论 VCI患者血清CRP水平升高,血浆Hcy水平升高与VCI具有相关性,血CRP水平升高及高Hcy可能是VCI发病及认知损害进展的重要因素。  相似文献   

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目的探讨MoCA和MMSE在缺血性脑卒中患者认知功能改变中的应用价值。方法选取血管性认知障碍(VCI)组97例和健康组102例为研究对象,均行MoCA、MMSE评估。VCI组依据DSM?Ⅳ结果分为VCIND组、痴呆组。比较各组间MoCA、MMSE评分。结果MoCA量表评分与MMSE评分高度正相关(r=0.873,P0.05);各组MoCA、MMSE评分比较均有显著性差异(P0.01);MoCA量表灵敏度、阴性预测值均优于MMSE量表,但在特异度、阳性预测值、符合率方面差于MMSE量表。结论 MoCA灵敏度较高,利于早期发现VCI,但特异度较低,需进一步结合临床。  相似文献   

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蒙特利尔认知评估量表在轻度认知功能障碍筛查中的应用   总被引:9,自引:1,他引:8  
目的 探讨蒙特利尔认知评估量表(MoCA)在轻度认知功能障碍(MCI)患者筛查中的应用.方法 应用简易精神状态检查量表(MMSE)、MoCA对32例MCI患者和50例健康对照者进行神经心理评估,比较二者筛查MCI的效果.结果 以26分为分界值,MoCA筛查MCI的敏感性为96.87%、特异性为76%,MMSE筛查MCI的敏感性为56.25%、特异性为96%;MoCA中除抽象思维、地点定向两项外,其余各亚项的评分在MCI组和对照组间差异均有统计学意义(P<0.05):MMSE中仅计算与注意力、延迟回忆两项在MCI组和对照组间差异有统计学意义(P<0.05),其余各项差异均无统计学意义(P>0.05).结论 MoCA为高敏感性的MCI筛查工具,能全面评估MCI患者的认知功能.且可用于筛查MMSE得分正常的MCI患者.  相似文献   

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目的评价脑心通胶囊治疗血管性认知障碍的临床疗效和安全性。方法本研究从三个分中心招募血管性认知功能障碍(VCI)患者240例,并随机分为治疗组121例,其中无痴呆血管认知功能障碍(VCIND)患者45例,血管性痴呆(VaD)患者76例;对照组120例,其中VCIND患者44例,VaD患者76例。治疗组给予脑心通胶囊每日口服3次,每次4粒;对照组给予复方丹参片每日口服3次,每次4粒,连续服用3月。比较不同阶段的VCI患者治疗前后简易智能精神状态量表(MMSE)、日常生活能力量表(ADL)的变化。结果治疗组VCIND患者治疗后MMSE和ADL评分均有明显改善,差异有统计学意义(P<0.01)。治疗组VaD患者治疗后MMSE略有改善,差异无统计学意义(P>0.05),而ADL评分有改善,差异有统计学意义(P<0.01)。结论脑心通胶囊能够改善无痴呆血管性认知障碍(VCIND)患者的认知功能。  相似文献   

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目的:探讨蒙特利尔认知功能评估(MoCA)量表筛查缺血性脑卒中后非痴呆型血管性认知功能障碍(VCIND)的应用价值,并与简易精神状态检查(MMSE)量表比较。方法:选取非认知功能障碍(NCI)组76例,VCIND组66例。由2名神经科医生进行MoCA及MMSE量表评估。结果:MoCA总平均分为(22.61±4.722)分,MMSE为(27.35±2.615)分,总分相关分析r=0.765,P=0.000。排除受教育程度影响因素后,受教育年限≤9年者:MoCA除命名分项外,其余各分项在两组间均差异有统计学意义(P〈0.05)。受教育年限〉9年者:MoCA除命名、计算力和定向力分项外,其余各分项在两组间均差异有统计学意义(P〈0.05)。应用ROC曲线及约登指数最大值初步确定MoCA用于识别VCIND与NCI组最佳分界值为24/25分,其筛查VCIND的灵敏度和特异度分别为64.29%和79.31%,优于MMSE(灵敏度61.67%,特异度64.63%),差异有统计学意义(P〈0.05)。结论:MoCA筛查VCIND灵敏度和特异度较高,是一种有效的筛查VCIND量表,但应用于中国人群尚存在不足。  相似文献   

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目的研究神经心理测试及听觉事件相关电位(event related potential,ERP)P300在皮质下缺血性脑血管病(subcortical ischemic vascular disease,SIVD)伴不同程度认知功能障碍的临床应用价值。方法 92例SIVD患者,其中血管性无痴呆型认知损害(vascular cognitive impairment no dementia,VCIND)45例,血管性痴呆(vascular dementia,VaD)47例,同时选取45例未发生脑梗死及认知功能障碍的正常人作为对照组。分别对2组患者住院治疗前及正常对照组进行神经心理测试认知评估量表MMSE、MoCA评分和听觉事件相关电位P300检测。结果入院治疗前,VCIND组、VaD组简易精神状态检查(MMSE)和蒙特利尔认知评估量表(MoCA)评分均较正常组偏低(P0.05),VCIND组较VaD组偏低(P0.05),P300检测:与正常对照组潜伏期(318.689±16.123)ms相比,VCIND组患者潜伏期(360.667±16.082)ms,VaD组患者潜伏期(420.333±21.149)ms,各组间听觉事件相关电位P300潜伏期差异均有统计学意义(P0.05)。结论 SIVD患者存在认知功能损害,以执行功能障碍为主,ERP-P300测试能客观反映VCIND患者早期认知功能障碍,P300潜伏期与MMSE及MoCA有相关性,有利于VCIND早期的诊断。  相似文献   

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血管因素是独立于年龄的导致痴呆的第二大危险因素.在血管性认知损害(VCI)早期即无痴呆型血管性认知功能障碍(VCIND)甚至认知损害发生之前,血管性因素以及脑血管病是唯一可治疗的,并且能够延缓甚至逆转痴呆进展的干预靶点.因此早期诊断出VCIND的病例,治疗血管性因素及脑血管病,有利于VCI的一级预防和二级预防.现对VCIND的诊断、预防和治疗的进展作一综述.  相似文献   

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目的观察高压氧(HBO)联合天智颗粒治疗皮质下缺血性脑血管病伴认知功能障碍的疗效。方法选取我科收治的60例SIVD患者,其中血管性无痴呆型认知损害30例,血管性痴呆30例,同时选取30例未发生脑梗死及认知功能障碍的正常人作为对照组,2组均给予高压氧联合天智颗粒治疗,均治疗40d,治疗前后2组均采用神经心理测试认知评估量表MMSE、MoCA评分和听觉事件相关电位P300检测。结果 2组治疗后MMSE、MoCA评分均有明显提高,P300潜伏期缩短,差异有统计学意义(P0.05),治疗后VCIND组较正常对照组相比差异无统计学意义,VD组较正常对照相比差异有统计学意义(P0.05)。结论 HBO联合天智颗粒治疗SIVD合并认知障碍有效,其中VCIND效果更佳,SIVD合并认知障碍早期治疗更为重要,MMSE、MoCA评分、P300可作为疗效评价的工具。  相似文献   

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目的探讨脑出血患者血清脑源性神经营养因子(BDNF)与痴呆的相关性。方法选取180例脑出血患者,出院后6个月根据认知功能评分分为血管性认知功能障碍组(VCI)60例,其中血管性痴呆组(VD)22例,非痴呆型血管性认知功能障碍组(VCIND)38例;对照组为无认知障碍者120例。入院后及出院后6个月采用酶联免疫吸附法(ELISA)检测血清BDNF水平,分析其与认知功能障碍的相关性。采用ROC曲线分析BDNF对VCI发生的预测价值。结果VCI组年龄、NIHSS评分、出血量、出血部位、Hcy水平及BDNF水平与对照组比较差异有统计学意义(P<0.05)。多因素分析示高龄、NIHSS评分高、大量出血、脑叶出血、Hcy水平升高及BDNF水平降低是脑出血患者发生VCI的危险因素(P<0.05)。出院时6个月VCIND组与对照组MMSE评分、BDNF水平均高于入院时(P<0.05)。出院后6个月VD组BDNF水平高于入院时(P<0.05)。出院后6个月3组MMSE评分比较差异有统计学意义(P<0.05),两两比较,VD组与VCIND组MMSE评分低于对照组(P<0.05),VD组MMSE评分低于VCIND组(P<0.05)。入院时及出院后6个月3组BDNF水平比较差异有统计学意义(P<0.05),两两比较,入院时及出院后6个月VD组与VCIND组BDNF水平均低于对照组(P<0.05),VD组BDNF水平低于VCIND组(P<0.05)。出院后6个月BDNF水平与MMSE评分呈正相关(P<0.05)。BDNF预测VD及预测VCIND的AUC面积分别为0.749、0.704,均>0.7,灵敏度分别为84.2%、85.9%,特异度分别为80.9%、80.6%。结论脑出血患者血清BDNF水平与出血后VCI的发生相关,随着BDNF水平的降低,VCI严重程度随之增加,且入院后血清BDNF水平可以预测VCI的发生,特别是VD发生的标记物之一,临床上血清BDNF水平低的患者需引起重视。  相似文献   

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目的探讨蒙特利尔认知评估量表(MOCA)和简易精神状态量表(MMSE)在帕金森病轻度认知功能障碍(PDMCI)筛查中的应用。方法采用随机抽样方法,应用MOCA和MMSE对75例诊断为PDMCI患者、帕金森病认知功能正常(PDN)患者180例和健康患者145例进行评估,比较二者筛查PDMCI的敏感性和特异性。结果在文盲组MMSE的敏感性为93.10%,特异性为100%,而MOCA的敏感性仅为0%,特异性为92.72%;在小学组MMSE的敏感性为87.50%,特异性为100%,而MOCA的敏感性为41.67%,特异性为79.17%;在初中及以上学历组MMSE的敏感性为27.27%,特异性为100%,MOCA的敏感性为90.91%,特异性为85.71%。结论 MOCA适合初中及以上学历的PDMCI筛查工具,MMSE适合初中以下学历PDMCI筛查工具。  相似文献   

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Education and lifestyle factors linked with complex mental activity are thought to affect the progression of cognitive decline. Collectively, these factors can be combined to create a cognitive reserve or cognitive lifestyle score. This study tested the association between cognitive lifestyle score and cognitive change in a population-based cohort of older persons from five sites across England and Wales. Data came from 13,004 participants of the Medical Research Council Cognitive Function and Ageing Study who were aged 65 years and over. Cognition was assessed at multiple waves over 16 years using the Mini-Mental State Examination. Subjects were grouped into four cognitive states (no impairment, slight impairment, moderate impairment, severe impairment) and cognitive lifestyle score was assessed as a composite measure of education, mid-life occupation, and current social engagement. A multi-state model was used to test the effect of cognitive lifestyle score on cognitive transitions. Hazard ratios for cognitive lifestyle score showed significant differences between those in the upper compared to the lower tertile with a more active cognitive lifestyle associating with: a decreased risk of moving from no to slight impairment (0.58, 95% CI (0.45, 0.74)); recovery from a slightly impaired state back to a non-impaired state (2.93 (1.35, 6.38)); but an increased mortality risk from a severely impaired state (1.28 (1.12, 1.45)). An active cognitive lifestyle is associated with a more favorable cognitive trajectory in older persons. Future studies would ideally incorporate neuroradiological and neuropathological data to determine if there is causal evidence for these associations.  相似文献   

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Multiple cognitive deficits in amnestic mild cognitive impairment   总被引:3,自引:0,他引:3  
OBJECTIVE: To determine if more widespread cognitive deficits are present in a narrowly defined group of patients with the amnestic form of mild cognitive impairment (MCI). METHODS: From a larger sample of patients clinically diagnosed as meeting the criteria of Petersen et al. for amnestic MCI, we selected 22 subjects who had Clinical Dementia Rating scores of zero on all domains besides memory and orientation. These MCI subjects with presumably isolated memory impairments were compared to 35 age-matched normal controls and 33 very mild Alzheimer's disease (AD) patients on a battery of neuropsychological tests. RESULT: In addition to the expected deficits in episodic memory, the amnestic MCI group performed less well than the controls but better than the AD group on design fluency, category fluency, a set shifting task and the Stroop interference condition. Over half the amnestic MCI group (vs. none of the normal controls) scored at least 1 standard deviation below control means on 4 or more of the nonmemory cognitive tasks. CONCLUSIONS: Isolated memory impairment may be fairly uncommon in clinically diagnosed amnestic MCI patients, even when the criteria for amnestic MCI are fairly narrow. Additional cognitive impairments are likely to include fluency and executive functioning. These more diffuse deficits argue for comprehensive cognitive assessments, even when the patient and family are reporting only memory decline, and are consistent with the increase in attention paid to the heterogeneity of MCI.  相似文献   

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Patients with Parkinson’s disease (PD) typically present with motor symptoms, but non-motor symptoms, including cognitive impairment, autonomic dysfunction and neuropsychiatric symptoms, are usually also present, when looked for carefully. The objective of this paper is to provide an up-to-date, comprehensive review of two undecided issues about cognitive impairment in PD patients without dementia: the concept of Mild Cognitive Impairment (MCI) and the concept of Cognitive Reserve (CR). Empirical findings support the value of the concept of MCI in this population, from the early untreated stages onwards. Further studies are needed to establish 1) the clinical-neuroimaging characteristics of MCI subtypes in PD, in comparison to those MCI subtypes in patients without PD; 2) whether different types of MCI in PD are associated with different rates of cognitive decline during the progression of the disease. Preliminary empirical evidence also shows that education might exert a protective effect on cognitive decline in PD and that less educated subjects are at increased risk for developing dementia, lending support to the CR hypothesis, in this population as well. Further studies are necessary to investigate how CR modulates cognitive decline in PD and other frontal-subcortical disorders, e.g. by identifying possible differential effects of CR on different cognitive domains.  相似文献   

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目的探讨简易精神状态量表(MMSE)和蒙特利尔认知评估量表(Mo CA)在遗忘型轻度认知障碍(a MCI)和轻度血管性认知障碍(m VCI)患者中的应用。方法从2012年3月至2015年3月本科收治的年龄60~80岁近200例患者中筛选出a MCI组42例,m VCI组50例,采用分组对照研究,所有患者经过临床痴呆评定量表(CDR)和日常生活能力量表(ADL)评估与接受Mo CA量表中文版和MMSE量表进行认知功能评估。Mo CA与MMSE的评估间隔1h以上,在同一天进行。结果两组患者性别构成比、年龄及受教育程度间差异均无统计学意义(P>0.05)。MMSE量表测评两组间差异无统计学意义(P>0.05)。两组间MMSE分项比较,除a MCI组延迟回忆得分低于m VCI组(P<0.05)外,其余各分项得分无显著性差异(P>0.05)。m VCI组患者Mo CA总分较a MCI组水平低,差异有统计学意义(P<0.05)。两组间Mo CA分项比较,m VCI组视空间执行功能、注意力与计算各项得分低于a MCI组,差异有统计学意义(P<0.05)。a MCI组延迟回忆得分低于m VCI组,差异有统计学意义(P<0.05)。余各分项得分两组间无显著性差异(P>0.05)。m VCI组患者在交替连线、立方体画图及指针得分均低于a MCI组,差异有统计学意义(P<0.05)。相关性分析显示MMSE与Mo CA评分呈正相关关系,a MCI患者中相关系数为0.861,m VCI患者中相关系数为0.762,差异均有统计学意义(P<0.05)。结论 m VCI患者存在包括视空间执行功能、注意力及计算力等多个领域认知功能的损害,与a MCI患者相比,执行功能受损更明显。Mo CA是筛查a MCI及m VCI的一个简便、有效的工具,敏感性高于MMSE,尤其适于对m VCI患者的早期筛查。  相似文献   

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