社区健康老人综合认知训练1年随访观察

目的:探讨综合认知训练对社区健康老人认知功能的长期影响效果. 方法:151名上海市某街道社区年龄≥70岁的老人参加研究.按先后顺序分为认知训练干预组90名和对照组61名.对干预组进行12周(共24次)的综合认知训练,采用中国老年成套神经心理测验(NTBE)及自编健康问卷,分别于干预前、干预结束、干预后1年对两组进行测评. 结果:干预前,干预组NTBE中有1项优于对照组,1项低于对照组(P≤0.05),其他项目两组差异无显著性(P>0.05);1年后随访两组内比较,干预组NTBE分测验有19项(推理训练等)提高,4项下降(P≤0.05);对照组NTBE分测验有11项提高,3项下降(P≤0.05);1年后随访两组间比较,干预组NTBE分测验有3项(推理训练等)优于对照组(P≤0.05). 结论:综合认知训练对社区健康老人多项认知功能在1年后仍有一定影响,其中推理能力较为明显.     

社区健康老人ApoE基因多态性与综合认知训练效果的相关研究

目的 探索ApoE基因多态性与社区健康老人综合认知训练效果的相关性.方法 对89名≥70岁的社区健康老人进行12周共24次的综合认知训练,干预前后采用中国老年成套神经心理测验(NTBE)等评定认知功能,并测定其ApoE基因多态性.结果 ①基线:携带ApoE ε4组NTBE有2项低于不携带ApoE ε4组,差异有统计学意义(P<0.05).②干预后:不携带ApoE ε4组NTBE分测验15项提高而1项下降(P均小于0.05);携带ApoE ε4组NTBE分测验6项提高而1项下降(P均小于0.05).是否带ApoE ε4组之间NTBE各分测验差异无统计学意义(P>0.05).结论 ApoE基因多态性与社区健康老人的认知功能及综合认知训练效果可能存在相关性.     

社区健康老人儿茶酚胺氧位甲基转移酶基因val158met多态性与综合认知训练效果的相关研究

目的 探索儿茶酚胺氧位甲基转移酶(Catechol-O-methyltransferase,COMT)基因val158met多态性与社区健康老人综合认知训练效果的关系.方法 对90名≥70岁的社区健康老人进行12周共24次的综合认知训练,干预前后采用中国老年成套神经心理测验(neuropsychological test battery for elderly,NTBE)评定认知功能,并通过TaqMan探针单核苷酸多态性基因分型技术检测COMT基因val158met多态性.结果 基线时,COMT基因val158met多态性met等位基因携带组(n=38)组和未携带组(n=52)之间NTBE各项分测验成绩的差异均无统计学意义(P>0.05).干预后,未携带met等位基因组NTBE 4项分测验成绩优于携带组(P<0.05);而与基线比较,未携带met等位基因组NTBE的成绩13项提高(P<0.05),1项下降(P<0.05);携带met等位基因组8项提高(P<0.05),3项下降(P<0.05).结论 COMT基因val158met多态性与社区健康老人综合认知训练效果可能相关.     

对社区老人认知功能干预的近期效果

目的:探索对社区老人认知功能干预的近期效果。方法:对某社区65岁以上自愿参加的老人进行为期12周(共24次)的认知功能干预;采用老年成套神经心理测验(NTBE),比较干预组(44名自愿参加的老人)和对照组(51名完成基线和随防评估的老人)认知功能差异。结果:在干预前后两组NTBE的自身比较中:干预组在视觉匹配和推理等项目得分的差异有统计学意义,对照组在运动测验、前摄抑制和学习效应指数等得分的差异有统计学意义。通过Logistic回归分析,认知干预和NTBE相关的项目如下:听觉词汇学习4正确、听觉词汇学习4重复、分类测验、小标记测验、视觉匹配和推理、听觉词汇8插入和连线测验1顺序提示数共7项,均呈正相关。结论:综合认知训练干预在短期内能改善或延缓部分认知功能的衰退,逻辑推理能力是社区老人认知干预的易感领域。     

非痴呆非抑郁帕金森病患者额叶认知功能变化的研究靠

目的探讨帕金森病(PD)患者认知功能变化的特点,以及额叶认知测试对PD患者认知障碍评价的意义.方法采用对额叶认知障碍比较敏感的神经心理方法词语流畅性、连线测验、Stroop字色干扰测验对31例非痴呆非抑郁PD患者和25名年龄、性别、受教育程度相匹配的正常对照进行测试.结果非痴呆非抑郁PD患者与对照组比较额叶认知功能评分较差(词语流畅性P＜0.05、连线试验P＜0.01、Stroop字色干扰测试P＜0.01).结论非痴呆非抑郁的PD患者额叶认知功能显著降低,其机制可能与额叶-纹状体多巴胺环路中递质紊乱有关.     

自适应认知训练对轻度阿尔茨海默病患者的干预作用

目的:探讨自适应认知训练对轻度阿尔茨海默病(AD)患者的干预效果。方法:将60例轻度AD患者随机分为两组;对照组(30例)不采用任何相关干预措施;干预组(30例)采用中文版自适应认知控制(ACE)软件,以iPAD为训练媒介,进行为期12周的侧抑制、方框测验、点击描线、持续注意、心理旋转及空间线索6项训练。干预前后采用蒙特利尔认知评估量表(MoCA)、认知评估量表5项(ACE-5)评估两组认知功能,采用患者健康问卷-9项(PHQ-9)、广泛性焦虑量表-7项(GAD-7)评估干预前后患者情绪变化。结果:MoCA:各组干预前后自身对照及两组间评分比较差异无统计学意义。ACE-5:干预组基础反应时间、字色干扰、任务转换平均反应时间明显少于干预前,空间记忆广度正确应答明显多于干预前(P0.05或P0.01);辨识力评分与干预前比较差异无统计学意义。对照组基础反应时间、字色干扰、空间记忆广度评分较基线明显下降(P均0.05),任务转换、辨识力评分较基线差异无统计学意义。干预后干预组ACE-5中各项分测验成绩明显优于对照组(P均0.01)。结论:12周自适应认知训练对轻度AD患者部分认知控制损害有一定改善作用。     

强迫症患者与精神分裂症患者的神经认知功能特征比较

目的 比较强迫症患者与精神分裂症患者神经认知损害的特点和严重程度. 方法 选择中山大学附属第三医院精神心理科自2011年8月至2012年2月住院的30例强迫症患者(强迫症组)、30例精神分裂症患者(精分症组)及同期30名体检健康者(对照组)为研究对象,采用连线测验、Stroop色字词测验、韦氏记忆测验、改良版威斯康辛卡片分类测验对其进行神经认知功能评定,并应用统计学方法比较. 结果 (1)在连线测验中,强迫症组的连线B测验用时(s)和连线A/B测验用时差要明显差于对照组,差异有统计学意义(P＜0.05);除连线B测验错误次数外,强迫症组其余指标均明显优于精分症组,差异有统计学意义(P＜0.05);精分症组各项指标均明显差于对照组,差异有统计学意义(P＜0.05).(2)在Stroop色字词测验中,强迫症组的色词测验错误率和色词测验用时明显差于对照组,差异有统计学意义(P＜0.05);强迫症组的字测验错误数和字测验用时明显优于精分症组,差异有统计学意义(P＜0.05);精分症组各项指标均明显差于对照组,差异有统计学意义(P＜0.05).(3)在韦氏记忆测验中,强迫症组的图片回忆、再认、联想学习、短时记忆和记忆商数明显差于对照组,差异有统计学意义(P＜0.05);除长时记忆、再认、联想学习和触觉记忆外,强迫症组的其余指标均明显优于精分症组,差异有统计学意义(P＜0.05);精分症组各项指标均明显差于对照组,差异有统计学意义(P＜0.05).(4)在改良版威斯康辛卡片分类测验中,强迫症组(除随机错误数外)和精分症组各项指标与对照组相比均明显差,差异有统计学意义(P＜0.05);强迫症组各项指标均明显优于精分症组,差异有统计学意义(P＜0.05). 结论 强迫症患者的神经认知缺陷特征主要表现在注意狭窄和转换困难,短时记忆和视空间记忆障碍;精神分裂症则表现为全面的神经认知功能损害;强迫症患者总体神经认知功能水平比精神分裂症患者高.     

首次发病的强迫症患者的认知功能

目的探讨首次发病的强迫症患者的认知功能特点。方法采用韦氏智力测验(Wechsler adult intelligence scale,WAIS)、韦氏记忆测验(Wechsler memorys cale,WMS-R)、Stroop测验、连线测验(trail-making test,TMT)A和B、威斯康星卡片分类测验(Wisconsin card sorting test,WCST)对首次发病的强迫症患者30例和正常对照32名进行认知功能评估。结果患者组WMS-R中图片回忆、再认、联想学习等3项成绩均较正常对照组差(P0.05),而Stroop测验中的读字色测验的错误数和用时、TMT-B时间、TMTB-A时间等4项成绩也差于正常对照组(P0.05)。此外,患者组WCST中的完成分类数、正确应答数、错误应答数、持续错误数等4项成绩均较正常对照组差(P0.01)。结论首次发病的强迫症患者存在记忆、注意和执行功能损害。     

儿童少年期精神分裂症患者及其一级亲属认知功能的对照研究

目的:探讨儿童少年期精神分裂症患者及其一级亲属的认知功能状况. 方法:对40例儿童少年期精神分裂症患者(患者组)、80名父母(患者父母组)及22名同胞(患者同胞组)采用注意力测验、WMS-R-逻辑记忆、数字广度、连线测验A和B、词汇流畅性测验、Stroop色词测验及威斯康星卡片分类测验(WCST)评定其认知功能,并与59名健康儿童(健康儿童对照组)及其父母(健康儿童父母组)80名进行比较. 结果:患者组除词汇流畅性测验以外,其他测验成绩差于健康儿童对照组;患者同胞组除数字顺背、词汇流畅性测验、连线测验-A、WCST正确应答数、WCST完成第1个分类应答数以外,其他测验成绩差于健康儿童对照组(P均＜0.001);患者父母组除数字顺背、词汇流畅性测验、连线测验-A以外,其他测验成绩差于健康儿童父母组(P＜0.01或P＜0.001).儿童精神分裂症患者与其父母在注意力测验、WMS-R-逻辑记忆、数字倒背、彩色文字阅读和彩色文字颜色阅读、WCST完成分数上呈正相关(r =0.350～0.615,P＜0.05或P＜0.001). 结论:儿童少年期精神分裂症患者及其一级亲属均存在广泛的认知功能缺陷,但患者的认知功能障碍更为严重.     

社区健康老年人多域认知训练的5年随访研究（英文）

背景:认知训练是一种安全的非药物干预,可能帮助老年个体减轻认知功能减退和预防痴呆症。目标:评估社区健康老年人认知训练的长期效果。方法:上海某城市社区70岁及以上的健康老年人进行筛选后,151名符合纳入标准的个体被分配至干预组(n=90)和对照组(n=61)。干预组每周接受两次推理、记忆和策略的训练,持续12周(共24次)。于基线、12周、和入组后5年时,使用《老年人神经心理测验中文版》(NTBE)、《斯特鲁色词测验》、和《一般健康问卷》分别对个体进行评估。结果:干预组49人(54%)和对照组33人(54%)完成了5年的随访。完成与未完成5年随访的个体之间在基线时的神经认知测量没有显著差异,并且干预组脱落个体和对照组脱落个体之间也没有差异。5年随访时,干预组个体在NTBE和斯特鲁色词测验的61项评估中仅有5项评分(路径A测试和划消测验3)比对照组好,但这些差异没有达到预先确定的统计学水平(p=0.0008)。结论:我们没有证实以往研究的结果,它们报导对社区中老年居民进行简要认知培训会有长期效果。我们无法证实认知训练五年后认知功能的差异不可能是由干预组和对照组脱落不同所致,但可能与样本相对较小和评估项目数目太多有关。今后对于老年人认知训练的干预研究应该建立在假设的基础上(即专注于感兴趣的单个测量结果),使用更大的样本,并将定期强化课程纳入认知训练。     

Ginkgo biloba for the improvement of cognitive performance in multiple sclerosis: a randomized, placebo-controlled trial

OBJECTIVES: To determine if Ginkgo biloba (GB) improves the cognitive performance of subjects with multiple sclerosis (MS). METHODS: Randomized, double-blind, placebo-controlled trial of GB, 120 mg twice a day or placebo for 12 weeks. The primary outcomes were: the long delay free recall from the California Verbal Learning Test-II; the Paced Auditory Serial Addition Test; the Controlled Oral Word Association Test; the Symbol Digit Modalities Test; Useful Field of View Test; and the color-word interference condition from the Stroop Color and Word Test. RESULTS: On completion, the GB group (n=20) was 4.5 seconds (95% confidence interval (CI) (7.6, 0.9), P=0.015) faster than the placebo group (n=18) on the color-word interference condition of the Stroop test. Subjects who were more impaired at baseline experienced more improvement with GB (treatment*baseline interaction, F=8.10, P=0.008). We found no differences on the other neuropsychological tests. Subjects on GB reported fewer cognitive difficulties in the Retrospective Memory Scale of the Perceived Deficits Questionnaire than subjects on placebo (1.5 points, 95% CI (2.6, 0.3), P=0.016). No serious drug related side-effects occurred and GB did not alter platelet function assays. CONCLUSION: Overall, GB did not show a statistically significant improvement in cognitive function. A treatment effect trend, limited to the Stroop test, suggests that GB may have an effect on cognitive domains assessed by this test, such as susceptibility to interference and mental flexibility.     

Cognitive patterns in subtypes of schizophrenia.

AIM: Because of the heterogeneity of schizophrenia, this study researched different cognitive patterns in distinct subtypes of schizophrenic patients. METHODS: Thirty-five Diagnostic and Statistical Manual IV (DSM IV) schizophrenic patients and 35 healthy controls were included. Patients were categorized into deficit, disorganized and positive subtypes with the schedule for the deficit syndrome (SDS) and the positive and negative syndrome scale (PANSS). Executive/attentional functions were assessed with the modified card sorting test (MCST), a test of verbal fluency, the trail making test (TMT) and the Stroop color-word test (Stroop test). Episodic memory was explored through the California verbal learning test (CVLT). RESULTS: The positive subtype had some executive/attentional (fluency and Stroop tests) and mnesic performances in the normal range, suggesting the preservation of good cognitive skills. In contrast, the deficit and disorganized subtypes had major mnesic and executive/attentional dysfunctions compared to healthy subjects. The deficit subtype compared to the control group performed predominantly worse on the MCST and fluency, whereas the disorganized subtype had the lowest scores on the TMT and the Stroop test. CONCLUSION: This study showed distinct cognitive patterns in deficit, disorganized and positive patients in comparison with the controls, suggesting a heterogeneous cognitive dysfunction in schizophrenia.     

综合认知训练对社区老年人工作记忆事件相关电位的影响

目的 探索综合认知训练对社区老年人大脑认知功能的影响及其可能机制.方法 将上海市某街道社区49名老年人(年龄≥70岁)按配对原则分为认知训练干预组(以下简称干预组,27名)和非认知训练组(以下简称对照组,22名).对干预组进行12周(共24次)的认知训练.干预前后采用延迟样本匹配(delayed matching-to-sample,DMS)模式诱发工作记忆事件相关电位(ERPs),分析工作记忆相关ERPs P500的波幅和潜伏期变化.结果 (1)干预前两组间工作记忆ERPs主成分P500的波幅和潜伏期的差异均无统计学意义.(2)与干预前比较,干预组在匹配任务Fp2、F4、Fz、CPz、Pz导联处P500潜伏期缩短,对照组Fp1导联P500潜伏期延迟;干预组不匹配任务Fp2和F4导联P500潜伏期缩短;对照组CPz导联P500波幅降低;差异均有统计学意义(P均<0.05).(3)干预后干预组匹配任务Fpz处波幅高于对照组,差异有统计学意义(P<0.05).(4)干预组工作记忆ERPs P500改善的脑区相对集中于右侧额叶或前额叶.结论 综合认知训练可改善健康老年人大脑认知功能状态,改善的脑区相对集中于右侧额叶/前额叶;综合认知训练对老年人脑功能的可塑性有一定影响.     

Prefrontal Dysfunction in Attention-Deficit/Hyperactivity Disorder as Measured by Near-Infrared Spectroscopy

Recent developments in near-infrared spectroscopy (NIRS) have enabled non-invasive clarification of brain functions in psychiatric disorders with measurement of hemoglobin concentrations as cerebral blood volume. Twenty medication-naïve children with attention-deficit/hyperactivity disorder (ADHD) and 20 age- and sex-matched healthy control subjects participated in the present study after giving consent. The relative concentrations of oxyhemoglobin (oxy-Hb) were measured with frontal probes every 0.1 s during the Stroop color-word task, using 24-channel NIRS machines. During the Stroop color-word task, the oxy-Hb changes in the control group were significantly larger than that in the ADHD group in the inferior prefrontal cortex, especially in the inferior lateral prefrontal cortex bilaterally. The Stroop color-word task used with NIRS may be one useful measurement to assess prefrontal brain dysfunction in ADHD children.     

Decline across different domains of cognitive function in normal ageing: results of a longitudinal population-based study using CAMCOG

Dementia is an important cause of disability in the elderly. There is evidence that cognitive impairment in dementia is on a continuum with cognitive impairment in the non-demented elderly. In order to investigate this possibility, we need detailed knowledge about the population distribution of cognitive function and change in cognitive function. The aim of this study is to describe the change in different domains of cognitive function over 4 years in a population-based sample of non-demented elderly people, and to investigate the effect of sociodemographic variables and baseline cognitive function on change in each of the cognitive domains. Respondents from two group general practice lists (n = 503) were interviewed using the Cambridge Cognitive Examination (CAMCOG) at the incidence wave of the Cambridge City Over-75 Cohort Study and after a mean time period of 3.9 years. One hundred and thirty five of 212 non-demented subjects seen at follow-up completed the CAMCOG at both interviews. The annual rate of change in total CAMCOG score was -1.6 points per year (p < 0.001). There was statistically significant decline in all of the CAMCOG subscales. Greater decline in the Memory subscale was associated with less education (p = 0.03). Greater decline in the Attention/Calculation subscale was associated with manual social class (p = 0.05). Greater decline in the Perception subscale was associated with older age (p = 0.03). Decline in specific cognitive domains may indicate a reversible phase of cognitive impairment and deserves further investigation.     

难治性强迫症患者认知功能及影响因素

目的：探讨难治性强迫症患者认知功能及影响因素。方法：55例难治性强迫症患者（患者组）及60名正常对照者（对照组）进行Stroop色词测验、可反复测查的成套神经心理状态评估工具（RBANS）以及Yale-Brown强迫量表（YBOCS）评定,对心理测查成绩与一般情况进行相关性分析。结果：患者组RBANS在言语功能分上明显低于正常对照组（P〈0.01）。患者的年龄、起病年龄与RBANS即时记忆分、注意分、总分呈负相关（P〈0.05或P〈0.01）;与Stroop中颜色干扰时呈正相关（P〈0.05或P〈0.01）;YBOCS分与Stroop中字义干扰时呈正相关（P〈0.01）。在RBANS各项评分及总分上,有工作的患者组评分（n=30）高于无工作的患者组（n=25）,差异有统计学意义（P均〈0.01）。结论：难治性强迫症患者言语功能明显受损。年龄、起病年龄和症状严重程度与认知功能有显著相关。有工作可能对强迫症患者认知功能有保护性作用。     

Testing cognitive function in elderly populations: the PROSPER study. PROspective Study of Pravastatin in the Elderly at Risk

OBJECTIVES: For large scale follow up studies with non-demented patients in which cognition is an endpoint, there is a need for short, inexpensive, sensitive, and reliable neuropsychological tests that are suitable for repeated measurements. The commonly used Mini-Mental-State-Examination fulfils only the first two requirements. METHODS: In the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), 5804 elderly subjects aged 70 to 82 years were examined using a learning test (memory), a coding test (general speed), and a short version of the Stroop test (attention). Data presented here were collected at dual baseline, before randomisation for active treatment. RESULTS: The tests proved to be reliable (with test/retest reliabilities ranging from acceptable (r=0.63) to high (r=0.88) and sensitive to detect small differences in subjects from different age categories. All tests showed significant practice effects: performance increased from the first measurement to the first follow up after two weeks. CONCLUSION: Normative data are provided that can be used for one time neuropsychological testing as well as for assessing individual and group change. Methods for analysing cognitive change are proposed.