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1.
目的探索成功老龄(SA)化的可能机制。,方法(1)样本来源于社区≥65岁老年人。共完成随访156例,其中成功老龄(SA)组73例,常态老龄(uA)组57例,轻度认知功能损害(MCI)组26例。(2)研究工具采用中国老年成套神经心理测验和上海市社区老年人群健康问卷SA2004等。结果(1)SA组老年人在即刻记忆、延迟记忆、长时记忆提取相关测验成绩随访前后差异无统计学意义(P〉0.05),执行功能、序列学习和逻辑推理相关测验成绩随访前后差异有统计学意义(P〈0.05);UA组老年人在工作记忆、执行功能方面的下降有统计学意义(P〈0.05);MCI组老年人成绩的下降项目仅4项。(2)按年龄分组后,神经心理项目测验成绩随访前后比较,差异有统计学意义(P〈0.05)的分量表有10项,其中有9项在71—75岁组下降数值相对最大。(3)躯体活动能力、心理状况及认知功能等基线指标与随访结局指标(健康状况调查问卷各分量表评分)的差异有统计学意义(P〈0.05)。结论(1)SA老年人的高认知水平与大脑的整合功能及有效代偿相关,认知老化过程中执行功能可能属于易感领域,而71—75岁则可能是老年人认知老化的敏感时期。(2)UA、MCI老年人的认知功能仍具一定的可塑性,SA化干预具有现实意义。  相似文献   

2.
老年轻度认知功能损害的脑磁共振显像三维测量研究   总被引:7,自引:0,他引:7  
目的 研究老年轻度认知功能损害者的脑形态结构变化特点。方法 于1999年1月至2000年6月用脑磁共振显像(MRI)三维测量法组织分割和体积测量分析技术,检查有轻度认知功能损害的老年人21例(MCI组)和认知功能正常的老年人29名(NC组)。结果 (1)MRI测量:与NC组相比,MCI组的颅内总体积少5.2%,灰质体积少8.8%,灰质百分比少3.9%,总脑脊液多12.3%,两组差异有显著或非显著性(P<0.05或P<0.01)。(2)多元逐步判别分析:脑灰质和侧脑室体积具有非常显著性判别意义(P<0.01),两组判别总正确率为74.5%。结论 MRI三维测量有助于了解老年轻度认知功能损害者的脑部形态结构的改变。  相似文献   

3.
目的 探讨老年轻度认知功能损害(MCI)的脑诱发电位(BEPs)变化。方法 应用美国Nicolet Spirit脑电生理仪记录23例MCI老年人(MCI组)的脑干听觉效应(ABR),关联性负变(CNV),P300和视觉诱发电位,并与29名认知功能正常的老年人(NC组)进行比较。结果 (1)与NC组相比,MCI组的听觉脑干反应波V绝对波幅和P300的P3靶波幅显著降低(P<0.01)。(2)多元逐步判别分析;ABR波V绝对波幅和P300的P3靶波幅具有极显著性判别意义(P<0.01),两组判别总正确率为75%。结论 多项BEPs检测有助于MCI的诊断。  相似文献   

4.
目的应用经颅多普勒(TCD)进行屏气试验检测,观察轻度认知障碍(MCI)患者的脑血管反应性(CVR)特点。方法180例受试者编入正常对照组、MCI组及阿尔茨海默病(Alzheimerdis—ease,AD),分析屏气指数(BHI)与认知功能及脑血流动力学指标的关系。结果MCI组与正常组及AD组比较,BHI结果有统计学意义(P〈0.01);BHI与视觉ERP的P300潜伏期的相关性最强(r=0.411,P〈0.001);MCI组不同CVR状态下,各组受试者脑动脉硬化及血管狭窄检出率有差异,事件相关电位(ERP)和TCD常规检测指标比较有统计学意义(P〈0.05)。结论BHI的改变与MCI患者的认知功能损害密切相关,CVR检测有助于MCI的病因诊断。  相似文献   

5.
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。  相似文献   

6.
目的探讨轻度认知功能障碍(MCI)老年人多导睡眠图(PSG)变化特点。方法应用多导睡眠生理仪,采用眼电图和下颌肌电图及脑电图技术,对19例MCI老年人(MCI组)的PSG进行全夜监测,并与20名正常老年人(NC组)对照。结果与NC组比较,MCI组睡眠总时间减少[NC组(381±37)min,MCI组(313±67)min,P〈0.01],觉醒时间增加[NC组(30±10)min,MCI组(53±17)min,P〈0.01],睡眠维持率下降[NC组(94±10)%,MCI组(85±13)%,P〈0.05],第1阶段睡眠增加[NC组(14±2)%,MCI组(28±10)%,P〈0.01],第2阶段睡眠降低[NC组(60±4)%,MCI组(51±18)%,P〈0.05]和第3阶段睡眠降低[NC组(9±5)%,MCI组(4±3)%,P〈0.01],REM强度增强[NC组(21±4)%,MCI组(40±22)%,P〈0.01]。结论PSG中的浅睡眠增多,慢波睡眠S3减少可能是MCI病人所具有的电生理学指标之一。  相似文献   

7.
目的:探讨长期住院男性精神分裂症患者的认知功能。方法:采用数字划消测验、空间广度测验评定57例男性长期住院精神分裂症患者(患者组)和57名正常对照者(正常对照组)的认知功能。结果:患者组在数字划消测验的完成时间、漏划个数以及空间广度测验的总分、顺行得分、逆行得分上明显差于正常对照组(t=8.21,t=3.47,t=4.72,t=2.36,t=5.88;P〈0.05或P〈0.001)。相关分析显示,患者的病程、服药时间与数字划消测验的完成时间呈显著正相关(r=0.41,P〈0.01;r=0.30,P〈0.05)。结论:长期住院男性精神分裂症患者的认知功能明显受损,且与患者的病程和服药时间相关。  相似文献   

8.
目的 了解aMCI脑结构改变和相关认知损害特点,探讨准确诊断aMCI的神经影像和神经心理生物指标。方法 3-DMRI采集35例aMCI患者和35名健康对照者脑结构信息,LEAP软件计算左右侧和均侧海马、杏仁核和颞角体积,MoCA测评认知功能。结果两组被试年龄、性别差异无统计学意义(P〉0.05),受教育年限差异有统计学意义(P〈0.01)。aMCI的左、右侧及均侧海马萎缩和右侧颞角扩大(P〈0.05),MoCA总评分和注意力、重复句子、抽象能力、延迟回忆、定向力等亚项得分减低(P〈0.05),MoCA与右、均侧海马及右侧杏仁核呈正相关(P〈0.05)。ROC分析显示Mo—cA总评分、左、右及均侧海马、左、右及均侧杏仁核等指标诊断aMCI准确性高(P〈0.01)。单独认知指标MoCA总评分和重复句子(wilks’Lambda=0.299,X^2=80.905,df=2,P〈0.01)区分aMCI和NC的准确性为88.6%,单独脑结构指标均侧海马和杏仁核(wilks’Lambda=0.515,X^244.509,df=2,P〈0.01)的准确性为81.4%,认知和脑结构综合指标MoCA总评分、均侧海马和左侧杏仁核(Wilks’Lambda=0.261,X^2=89.228,df=3,P〈0.01)的准确性为95.7%。结论 aMCI期已出现特异的海马、杏仁核萎缩和弥漫性认知损害,在AD非痴呆期联合应用认知测试和神经影像指标更有助于AD早期准确诊断。  相似文献   

9.
无症状脑梗死与认知功能的关系   总被引:4,自引:0,他引:4  
目的探讨无症状脑梗死(SCI)与认知功能障碍的关系。方法采用简易精神状态检查法(MMSE)及临床痴呆评定量表(CDR)对61例无症状脑梗死患者和79例健康体检者的认知功能进行评分,比较两组轻度认知功能障碍(MCI)的发生率。结果无症状脑梗死组发生轻度认知功能障碍者13例(21.3%),显著高于健康体检组(P〈0.05)。结论SCI与认知功能障碍关系密切。  相似文献   

10.
阿尔茨海默病、血管性痴呆血脂浓度分析   总被引:2,自引:0,他引:2  
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。  相似文献   

11.
Diagnostic Difficulties and Treatment Implications   总被引:1,自引:0,他引:1  
Robert J. Gumnit 《Epilepsia》1987,28(S3):S9-S13
Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.  相似文献   

12.
Cognitive Dysfunction Associated with Antiepileptic Drug Therapy   总被引:7,自引:5,他引:2  
Eileen P.G. Vining 《Epilepsia》1987,28(S2):S18-S22
Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.  相似文献   

13.
Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.  相似文献   

14.
Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.  相似文献   

15.
Hepatic Considerations in the Use of Antiepileptic Drugs   总被引:5,自引:4,他引:1  
Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.  相似文献   

16.
Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.  相似文献   

17.
B. J. Wilder 《Epilepsia》1987,28(S2):S1-S7
Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.  相似文献   

18.
Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.  相似文献   

19.
Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.  相似文献   

20.
Predisposing and Causative Factors in Childhood Epilepsy   总被引:6,自引:2,他引:4  
Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.  相似文献   

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