血管性认知功能障碍与同型半胱氨酸、颈动脉粥样硬化的关系

目的探讨血管性认知障碍(vascular congnitive impairment,VCI)与血清同型半胱氨酸(homocysteine,Hcy)及颈动脉粥样硬化的关系。方法选取2007年2月至2009年7月的缺血性卒中患者147例,依据卒中后3个月的认知评定结果及相应的诊断标准分为VCI组和认知正常组(对照组),所有病例均进行颈动脉超声检测,并测定两组患者的血清Hcy,并对两组的神经心理检查结果进行比较分析。结果 VCI组患者的血浆Hcy水平明显高于对照组,两组间的差异具有统计学意义(P0.05),按颈动脉粥样硬化程度分组后发现颈动脉内膜中层厚度(intima—mediathickness,IMT)1.0mm组简易精神状态量表(mini-mental state examination,MMSE)得分高于IMT1.0mm组(P0.05)。结论 VCI与血清Hcy及颈动脉粥样硬化密切相关。     

亚甲基四氢叶酸还原酶(MTHFR)C677T基因多态性与血管性认知功能障碍相关性的研究

目的 探讨亚甲基四氢叶酸还原酶(MTHFR) C677T突变基因与血管性认知功能障碍(VCI)的关系.方法 采用酶联免疫法测定血浆同型半胱氨酸(Hcy)浓度,应用聚合酶链反应-限制性内切酶片段长度多态性技术检测143例VCI患者、122例无认知损害脑梗死患者及140例正常对照的MTHFR C677T基因型.结果 (1)VCI组、脑梗死组和对照组的血浆同型半胱氨酸(Hcy)平均水平分别为(12.257±3.595) μmol/L、(11.028 ±3.198)μmol/L、(9.784±3.074) μmol/L,两病例组Hcy水平明显高于正常对照组(P＜0.05);(2)3组研究对象的TT基因型分布有明显差异(x2=19.464,P＜0.01),CT型及CC型分布无差异(P＞0.05);VCI组及脑梗死组的T等位基因发生频率明显高于正常对照组(P＜0.05),相对危险度分别为1.79和1.47;(3)VCI组、脑梗死组及正常对照组中,MTHFR基因有C677T突变者(尤其TT型者)血浆Hcy水平均显著高于无基因突变者.结论 血浆Hcy水平升高是VCI和脑梗死共同的致病基础;MTHFR C677T基因突变致血浆Hcy水平升高可能是VCI发病的重要遗传因素.     

血浆同型半胱氨酸与脑梗死及颈动脉粥样硬化相关性的研究

目的探讨同型半胱氨酸水平与脑梗死、颈动脉粥样硬化的关系。方法将508例分为脑梗死组368例和对照组140例,测定血浆同型半胱氨酸水平与糖尿病、高血压、年龄、性别、血脂等各指标间的关系;同时做颈动脉彩色多普勒超声检查,比较脑梗死组与对照组、颈动脉硬化组与颈动脉正常组同型半胱氨酸水平变化。结果脑梗死组与对照组血浆同型半胱氨酸水平升高分别为309例和23例,各占84.2%和16.4%,同型半胱氨酸水平分别为(25.33±5.66)umol/L和(12.52±3.16)umol/L,两组比较有统计学意义(P<0.001)。脑梗死组中伴颈动脉粥样硬化的患者血浆同型半胱氨酸水平明显高于颈动脉正常者(P<0.001)。结论高同型半胱氨酸血症是脑梗死独立的危险因素,与颈动脉粥样硬化及斑块形成有关。     

中青年缺血性脑血管病与血浆高同型半胱氨酸血症的相关性研究

目的探究血浆高同型半胱氨酸血症对中青年缺血性脑血管病的影响。方法本研究选取2012年1月至2016年3月于我院进行诊治的短暂性脑缺血发作患者45例,脑梗死患者45例,同期选取我院健康体检的志愿者50例为对照组,比较三组患者血浆高同型半胱氨酸水平,并进行相关性分析。结果三组患者同型半胱氨酸水平比较,差异明显(F=30.152,P0.05),短暂性脑缺血发作组同型半胱氨酸水平低于脑梗死组(t=8.153,P0.05),高于对照组(t=6.294,P0.05);脑梗死组高同型半胱氨酸血症发生率(86.67%)明显高于短暂性脑缺血发作组(68.89%),短暂性脑缺血组发作高于对照组(12%),短暂性脑缺血发作组与脑梗死组高血压、高血糖、高血脂发生率无明显差异(P0.05),均高于对照组(P0.05);将高同型半胱氨酸血症、高血糖、高血压、高血脂等指标纳入Logistic多因素回归模型中,高同型半胱氨酸血症与缺血性脑血管病存在相关性(P0.05)。结论血浆高同型半胱氨酸血症是中青年缺血性脑血管病的危险因素,与缺血性脑血管病存在相关性,血浆高同型半胱氨酸血症患者应警惕缺血性脑血管病的发生。     

丁苯酞联合高压氧治疗老年血管性痴呆的疗效及对同型半胱氨酸的影响

目的观察丁苯酞联合高压氧对老年血管性痴呆的疗效及对同型半胱氨酸的影响。方法选取2010-01—2013-12我院治疗的老年血管性痴呆患者80例为研究对象,采用随机数表法分2组各40例;对照组给予高压氧治疗,观察组在对照组基础上给予丁苯酞胶囊治疗;治疗前及治疗后3月比较2组简易智力状态检查量表(MMSE)评分和日常生活能力量表(ADL)评分;分析2组治疗前及治疗后1、3月患者血清同型半胱氨酸浓度的变化。结果观察组MMSE评分治疗后明显高于同期对照组,差异有统计学意义(P0.05)。观察组治疗后ADL评分明显高于对照组,差异具有统计学意义(P0.05)。观察组有效率87.5%,对照组为67.5%,观察组明显高于对照组(P0.05)。2组Hcy浓度治疗后3月均明显低于治疗前(P0.05)。观察组Hcy浓度治疗后3月明显低于对照组(P0.05)。结论联合治疗可明显提高患者的MMSE评分及ADL评分,降低患者血浆Hcy浓度,是一种有效的治疗方式,值得临床使用。     

腔隙性脑梗死后认知功能障碍的影响因素

目的探讨腔隙性脑梗死(LBI)后认知功能障碍的影响因素。方法对136例LBI患者(LBI组)和60例性别、年龄及所伴有的慢性病相匹配的对照者(对照组)分别进行简易精神状态检查(MMSE)量表测验、画钟测验(CDT)、老年性痴呆评定认知分量表中执行命令功能(EF)评分,并对检测结果进行比较。分析LBI患者的年龄、病灶数、伴发疾病(高血压、糖尿病及高脂血症)对上述测验结果的影响。结果(1)LBI组认知功能障碍发生率(55.8%)明显高于对照组(15%),MMSE、CDT评分明显低于对照组,EF得分明显高于对照组(均P<0.01)。(2)LBI组中,≥65岁亚组、多发梗死灶亚组的MMSE、CDT、EF评分与<65岁亚组、单发梗死灶亚组比较差异有统计学意义(P<0.05~0.01),高血压亚组、糖尿病亚组及高脂血症亚组MMSE评分明显低于相应的对照亚组(均P<0.05)。结论LBI患者认知功能障碍发生率明显增高,认知功能下降与LBI患者年龄、脑梗死病灶数及伴有高血压、糖尿病及血脂代谢紊乱有关。     

颈动脉粥样硬化与血管性认知障碍关系的临床研究

目的 研究颈动脉粥样硬化(carotid atherosclerosis,CAS)与血管性认知功能障碍(vascular cognitive impairment,VCI)的关系.方法 通过CED-S、HIS、NIHSS、ADL、MMSE和CMS等量表评测选取58例腔隙性脑梗死患者,并分为VCI组(研究组)34例和认知功能正常组(对照组)24例;所有患者均进行一般情况评定和实验室检查;颈动脉二维彩色多普勒(2D-CDUS)测定各组患者颈动脉粥样硬化;评测各组患者认知功能障碍程度,并对CAS与VCI进行相关性分析.结果 诊断VCI的腔隙性脑梗死患者CAS发生率明显高于认知功能正常患者(P<0.01);研究组双侧CCA、ICA血管内径明显变窄,IMT值较对照组明显增加(P<0.01),粥样硬化斑块积分(PS)亦显著增高(P<0.01);伴CAS的腔隙性脑梗死患者认知功能障碍比不伴CAS的腔隙性脑梗死患者更严重(P<0.01);VCI与颈动脉粥样斑块积分呈显著负相关(r=-0.682,P＜0.01). 结论 CAS的形成与VCI的发生密切相关,CAS是VCI的独立危险因素之一.     

高同型半胱氨酸血症与糖尿病合并血管性痴呆的相关性分析

目的探讨高同型半胱氨酸血症与糖尿病合并血管性痴呆的相关性。方法选取糖尿病合并血管性痴呆患者、非痴呆性血管性认知功能障碍患者、单纯糖尿病患者各60例,分别设为痴呆组、认知障碍组、对照组,采用简易精神状态量表与蒙特利尔认知评估量表进行评估,比较其认知功能评分。采血测定血浆同型半胱氨酸水平,比较3组同型半胱氨酸水平、高同型半胱氨酸血症发生率。根据高同型半胱氨酸血症发生情况将每组分为A组(高同型半胱氨酸血症)、B组(非高同型半胱氨酸血症),比较其认知功能评分。结果 3组MMSE评分、MoCA评分比较差异均有统计学意义(P0.05)。3组同型半胱氨酸水平、高同型半胱氨酸血症发生率比较差异均有统计学意义(P0.05)。痴呆组、认知障碍组、对照组中,A组MMSE评分、MoCA评分均低于B组(P0.05)。高同型半胱氨酸血症与糖尿病合并血管性痴呆呈正相关(r=0.809,P0.05)。结论高同型半胱氨酸血症与糖尿病合并血管性痴呆密切相关,同型半胱氨酸水平越高,认知功能损害越严重。     

缺血性脑卒中血管性认知障碍的危险因素分析

目的分析缺血性脑卒中血管性认知障碍(VCI)的危险因素。方法选取我院经头部MRI、CT确诊的缺血性脑卒中患者120例,根据蒙特利尔(MoCA)及简易精神状态量表(MMSE)评分评估患者认知功能,并根据是否伴VCI分为2组,伴VCI的患者48例为研究组,未伴VCI的患者72例为对照组,分析2组基础资料、血管性因素、病情等。结果 2组年龄、受教育年限、饮酒史、吸烟史比较差异有统计学意义(P0.05);高血压、糖尿病、白质疏松症、脑缺血发作病史比较差异有统计学意义(P0.05);2组发病部位(丘脑)、卒中面积(大面积)、运动障碍比较差异有统计学意义(P0.05);Logistic多因素回归分析证实,高龄、受教育年限短、有吸烟和饮酒史、有高血压、白质疏松症及缺血性脑卒中史、发病部位为丘脑、大面积卒中、伴运动障碍为VCI的主要危险因素。结论高龄、受教育年限短、有吸烟和饮酒史、高血压、糖尿病、白质疏松症及缺血性脑卒中史、发病部位为丘脑、大面积卒中、伴运动障碍均为缺血性脑卒中VCI的危险因素,临床可采取相关措施进行预防和治疗。     

血浆同型半胱氨酸水平与脑梗死关系研究

目的探讨急性脑梗死与血浆同型半胱氨酸(Hcy)的关系。方法 2012-01—2012-04诊治的急性脑梗死患者50例为观察组,选取同期进行健康体检病例50例为对照组,进行血浆同型半胱氨酸检测并比较。根据入院24h内血浆同型半胱氨酸水平是否升高,采用美国国立卫生研究院卒中量表(NIHSS)对2组患者入院时、发病后4周神经功能缺损评分对比。结果血同型半胱氨酸观察组(17.60±8.98)μmol/L,对照组(10.71±4.49)μmol/L,差异有统计学意义(P<0.05);急性梗死患者发病后4周神经功能缺损对比,观察组(9.95±3.63),对照组(7.92±2.82),差异有统计学意义(P<0.05)。结论高同型半胱胺酸血症与急性脑梗死发生发展有密切关系,对急性脑梗患者预后产生不良影响,控制高同型半胱胺酸血症对有效改善脑卒中患者的预后有着重要的指导意义。     

非痴呆型血管性认知功能障碍患者神经心理学特点及石杉碱甲的临床疗效观察

目的：探讨非痴呆型血管性认知功能障碍（VCIND）患者的神经心理学特点,观察石杉碱甲对认知功能损害的改善作用。方法：将64例VCIND患者随机分成2组：常规治疗组和石杉碱甲治疗组;另设健康对照42例。3组均进行简易智能状态检查量表（MMSE）、画钟试验（cDT）测定。VCIND患者治疗第4和第8周时重新测定MMSE及CDT并加以对比。结果：①VCIND组与健康对照组在CDT评分、MMSE总分以及时间定向、地点定向、计算能力、短程记忆、言语复述、阅读能力、语言表达及图形描绘方面的差异有显著统计学意义（P〈0．01）。②石杉碱甲治疗的VCIND患者第8周时MMSE、CDT评分与治疗前及常规治疗组比较均有明显改善。结论：①CDT、MMSE总分及亚项的测评,有利于早期发现VCIND患者的认知功能受损。②石杉碱甲可有效改善VCIND患者的认知功能损害。     

血管性痴呆患者血清尿酸及胆红素水平与认知功能损伤之间的关系

目的评价血管性痴呆患者血清尿酸及胆红素水平与认知功能损伤之间的关系。方法选取2015-01—2018-12在郑州大学第五附属医院神经内科住院治疗的血管性痴呆患者197例,同时,选取95名健康老年人作为对照组,收集2组患者一般资料,对2组患者肝功能、肾功能及血脂水平进行检测,利用量表对2组患者神经心理功能进行测验,比较2组患者血清尿酸和胆红素水平的变化,并研究其与神经心理功能评分的相关性。结果血管性痴呆组患者简易智力状态检查量表(MMSE评分)、剑桥老年认知检查表-中国修订版(CAMCOG-C)评分和画钟试验(CDT)评分均低于对照组,而日常生活能力(ADL)和临床痴呆评定量表(CDR)评分均高于对照组,差异均具有统计学意义(P<0.05);血管性痴呆组患者血清总胆红素、直接胆红素和间接胆红素水平均低于对照组,而尿酸水平高于对照组,差异均具有统计学意义(P<0.05);Pearson相关分析显示,血清尿酸水平与MMSE评分、CAMCOG-C评分和CDT评分均呈负相关(r=-0.217,-0.196和-0.264,均P<0.05),而与ADL评分呈正相关(r=0.302,P<0.05),总胆红素水平与CAMCOG-C评分和CDT评分均呈负相关(r=-0.167和-0.205,均P<0.05),与ADL评分呈正相关(r=0.215,P<0.05);Logistic回归分析显示,MMSE评分与患者教育年限、高血压史及尿酸水平相关(P<0.05)。结论血管性痴呆患者血清尿酸水平升高,且与患者认知功能评分呈负相关,而与患者日常生活能力评分呈正相关;总胆红素水平降低,且与患者认知功能评分呈负相关,而与日常患者生活能力评分呈正相关。高尿酸水平可能与血管性痴呆的发生有关,为血管性痴呆发生的独立危险因素之一。     

Prevalence and patterns of executive impairment in community dwelling Mexican Americans: results from the Hispanic EPESE Study

INTRODUCTION: Little is known about the prevalence of impaired executive control function (ECF) in community dwelling elderly or minority populations. We have determined the prevalence of cognitive impairment and impaired ECF in a community dwelling Mexican American elderly population, and their associations with functional status. SUBJECTS: Subjects were 1165 Mexican Americans age 65 and over who were administered CLOX as part of the third wave of the Hispanic Established Population for Epidemiological Study (HEPESE) conducted from 1998 to 1999. METHODS: ECF was measured by an executive clock-drawing task (CDT) (i.e. CLOX1). Non-executive cognitive function was assessed by the Mini-Mental State Examination (MMSE) and a non-executive CDT (CLOX2). CLOX scores were combined to estimate the prevalence of global CLOX failure (i.e. 'Type 1' cognitive impairment) vs isolated CLOX1 failure (i.e. Type 2 cognitive impairment). RESULTS: 59.3% of subjects failed CLOX1. 31.1% failed both CLOX1 and CLOX2 (Type 1 cognitive impairment). 33.3% failed CLOX1 only (Type 2 cognitive impairment). 35.6% passed both measures [no cognitive impairment (NCI)]. Many subjects with CLOX1 impairment at Wave 3 had normal MMSE scores. This was more likely to occur in the context of Type 2 cognitive impairment. Both CLOX defined cognitive impairment groups were associated with functional impairment. CONCLUSIONS: A large percentage of community dwelling Mexican American elderly suffer cognitive impairment that can be demonstrated through a CDT. Isolated executive impairments appear to be most common. The ability of a CDT to demonstrate ECF impairments potentially offers a rapid, culturally unbiased and cost-effective means of assessing this domain. In contrast, the MMSE is relatively insensitive to ECF assessed by CLOX1.     

达纳康治疗血管性认知功能损害的临床研究

目的评价达纳康(Egb761)治疗血管性认知功能障碍的临床疗效和安全性.方法110例血管性认知功能损害的病人随机分配到治疗组和对照组;治疗组服用达纳康,每次80 mg,每日3次,而对照组服用丹参片,每次2片,每日3次,疗程均为3个月,并应用MMSE和ADL量表评价其疗效.结果治疗组MMSE评分增加较对照组多2.38,差异有统计学意义(P＜0.01);治疗组ADL评分减少较对照组多0.41,但差异无统计学意义(P＞0.05)结论达纳康治疗血管性认知功能损害安全有效.     

脑梗死后认知功能障碍患者血浆同型半胱氨酸水平及叶酸、甲钴胺的治疗作用

目的探讨脑梗死后认知功能障碍与同型半胱氨酸(Hcy)的关系,观察叶酸和甲钴胺对Hcy和认知功能的影响。方法应用荧光偏振免疫分析法测定血浆Hcy水平,比较脑梗死后认知功能障碍组患者和认知功能正常组患者Hcy水平。将脑梗死后认知功能障碍组患者按照有无接受叶酸和甲钴胺治疗随机分为治疗组和对照组,观察两组治疗前后Hcy水平及简易精神状态检查表(MMSE)分值的变化。分析Hcy与MMSE分值的相关性。结果脑梗死后认知功能障碍组患者血浆Hcy水平较认知功能正常组高;治疗组治疗后与治疗前相比,Hcy水平降低,MMSE分值升高;对照组治疗前、后Hcy水平及MMSE分值无明显变化;治疗组治疗后与对照组治疗后相比,Hcy水平降低,MMSE分值升高;脑梗死后认知功能障碍患者Hcy水平与MMSE分值呈负相关。结论脑梗死后认知功能障碍的发生和程度与血浆Hcy水平有关,联合应用叶酸和甲钴胺能改善脑梗死后认知功能障碍患者的认知功能。     

Clock Drawing Test in patients with schizophrenia

Investigations of the usefulness of the Clock Drawing Test (CDT) in schizophrenia have focused primarily on institutionalized or elderly patients. The purpose of the present study was to compare CDT performance of patients with schizophrenia living in the community with that of normal controls. Fifty-three patients with schizophrenia were compared with 66 age- and gender-matched normal controls. The CDT ('free-drawn', 'pre-drawn' and three 'examiner' conditions) and the Mini-Mental State Examination (MMSE) were administered to all participants. In patients with schizophrenia, symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). Patients with schizophrenia had significantly lower scores on the MMSE and the five CDT conditions than the control group. When MMSE scores and level of education were included in the comparisons as covariates, the differences between the two groups remained significant. MMSE scores of the patients with schizophrenia correlated significantly with four clock conditions: 'free-drawn' 'pre-drawn' and two of the 'examiner' conditions (11:10 and 8:20). Poorer performance on the CDT correlated with higher scores on the PANSS positive symptoms subscale. Qualitative analysis of the clocks that were drawn revealed specific errors in the schizophrenia group relating to frontal processes: difficulty placing numbers in the correct position, failure to indicate the minute targets, displacement of the minute hand from the minute number, and failure to draw a longer minute hand. The fact that the CDT is sensitive enough to detect the cognitive impairment inherent in schizophrenia, as well as being correlated with symptom severity, makes this test useful in roughly assessing cognitive state in schizophrenia.     

团体益智类游戏联合吡拉西坦对老年轻度认知障碍患者的效果

目的观察团体益智类游戏联合吡拉西坦对老年轻度认知障碍患者认知功能、生活质量及心理状态的影响。方法选取我科2017年7月~2019年11月之间收治的121例老年轻度认知障碍患者为观察对象,分为对照组60例和观察组61例,对照组给予吡拉西坦及常规护理干预,观察组在对照组的基础上给予团体益智类游戏,6个月后对比两组患者认知功能、生活质量及心理状态和观察组患者依从率。结果两组患者治疗后MMSE评分和MoCA评分明显提高(P<0.05),治疗后观察组MMSE评分和MoCA评分明显优于对照组(P<0.05)。两组患者治疗后QOL-AD评分和ADL评分明显提高(P<0.05),治疗后观察组患者QOL-AD评分和ADL评分明显优于对照组(P<0.05)。两组患者治疗后SAS评分和SDS评分均明显低于治疗前(P<0.05),治疗后观察组患者SAS评分和SDS评分明显低于对照组(P<0.05)。结论团体益智类游戏联合吡拉西坦能够有效改善老年轻度认知障碍患者认知功能,提高日常生活能力改善生活质量,从而有效减轻抑郁和焦虑情绪。     

认知功能筛查量表在MCI和轻度AD患者中的应用

目的:探讨认知功能筛查量表在轻度认知功能损害(Mild Cognitive Impairment,MCI)和轻度阿尔茨海默病(Alzhei mer disease,AD)患者中的应用。方法:对61例MCI患者和47例轻度AD患者进行系列神经心理学测验,同时选择41例正常老年人做对照。结果:MCI组和正常老年人比较,MGR、MMSE的短时记忆亚项、FOM、LM、DR、CDT均有统计学差异。轻度AD组和MCI组比较,MMSE的即刻记忆亚项、RVR、DS、ADL、IADL、POD均有统计学差异。CES-D在三组间无统计学差异。结论:MGR量表可用来鉴别正常人和认知功能损害人群,但不宜用来鉴别MCI和轻度AD患者。RVR和DS量表可以用于鉴别MCI和轻度AD患者。ADL量表在轻度AD患者显示损害,提示AD患者存在日常生活行为能力的损害。     

Relationship between clock drawing test performance and regional cerebral blood flow in Alzheimer's disease: a single photon emission computed tomography study

The clock drawing test (CDT) is a useful tool for screening cognitive impairment. Previous neuropsychological studies have revealed that CDT performance requires several cognitive functions including semantic memory, visuospatial function and executive function. However, the neural substrates involved remain to be elucidated. The aim of the present study was to identify the brain regions responsible for CDT performance in patients with Alzheimer's disease (AD). Twenty-six patients satisfying the National Institute of Neurological and Communicative Disease and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable AD underwent the CDT and the Mini-Mental State Examination (MMSE), together with a N-isopropyl-p-[123I] iodoamphetamine (IMP) single photon emission computed tomography measurements of the resting regional cerebral blood flow (rCBF). The CDT score correlated significantly with the MMSE score (r=0.582; P < 0.05). Stepwise multiple regression analysis revealed that the MMSE score and the left posterior temporal rCBF were major predictors of CDT score. These findings suggest that the CDT score may reflect the severity of dementia, and that it has a close relationship with the left posterior temporal function. Our findings provide the first functional neuroimaging evidence for the neural substrates involved in CDT performance.