老年轻度认知功能损害的脑磁共振显像三维测量研究

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。     

画钟测验联合MMSE在老年认知功能障碍筛查中的应用

目的探讨使用画钟测验（CDT）联合简易智力状况检查（MMSE）筛查老年认知功能障碍的可行性。方法采用多阶段分层整群抽样方法,抽取河北省石家庄市、唐山市、张家口市和邯郸市4个地区共3040名60岁以上老人,对所有被试采集一般人口学资料,同时进行CDT和MMSE评估。结果所有被调查者CDT平均（3．01士1．37）分,低于4分者为43．7％;其中男性老年人cDT〈4分者35．0％,明显低于女性的65．0％,差异有统计学意义（χ2=35．58,P〈0．01）。不同年龄段CDT〈4分者分别为60～64岁（32．2％）,65～69岁（35．8％）,70～74岁（45．6％）,75～79岁（57．5％）,≥80岁（75．1％）。不同文化程度CDT〈4分者分别为文盲82．8％,小学49．3％,初中35．7％,高中30．0％,大专以上24．8％。在2358名MMSE正常老年人中CDT测验低于正常者890名（37．74％）;在1715名CDT测验正常的老年人中检测出MMSE异常者247名（14．40％）。按照CDTO～4分划分为5组进行MMSE评分比较,5组间比较差异有统计学意义（F=402．68,P〈0．01）。CDT得分与MMSE总分、视空间功能、计算力、命名、记忆力、定向力均呈正相关（r分别为0．575,0．423,0．438,0．106,0．249,0．357;P〈0．01）。结论CDT得分在一定程度上反映老年人认知、执行功能损害的状况,CDT联合MMSE可作为筛查老年人认知功能障碍的有效方法。     

社区老人抑郁症状的5年随访

目的 了解老年人群抑郁症状的动态变化及与痴呆的联系。方法 在５年中对７９７名５５岁以上居民以流调用抑郁自评量表（ＣＥＳ－Ｄ）作两次调查。结果 ５年前后老年人群的抑郁症状群发生率为４．９％￣８．３％及６．８％￣１０．７％，无显著变化；６０例新发生Ａｌｚｈｅｉｍｅｒ病（ＡＤ）者，与正常老人相比，发病前ＣＥＳ－Ｄ总分相近，复访时高于正常组；以血管性痴呆（ＶＤ）为主的其它痴呆３３例，初访和复访的ＣＥＳ－Ｄ     

长谷川和夫痴呆量表在农村老年人群中的测查

以长谷川和夫痴呆量表（ＨＤＳ）于１９９０年５月对我县农村中６０岁以上的老年人群进行测查，所调查的８个乡登记老人８５６４人，实查７８５６人（占９１．７％），其中男３２４６人，女４６１０人。年龄６７．０±９．１岁，文盲６０７６人，有脑血管病史者１３４０人，高血压病史者１０５８人，其他脑部疾病１０５人。按不同的文化程度划分智能受损的标准。结果平均为２０．５±２．５分，男２５．４±２．１分，女１８．９±１．５分，以男性显著较高。智能未受损７０４６人（８９．７％），轻度受损５３４人（６．８％），中度受损２２０人（２．８％），重度受损５６人（０．７％）。年龄愈大、受损愈重。有脑血管病史者受损也显著较重。作者认为ＨＤＳ设计简单、合理，应用方便，可用于农村老年人群中痴呆患者的筛选     

成功老龄化机制的系列研究:随访部分

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。     

社区老年人感觉器官功能缺陷与认知功能障碍的关系

目的 探讨老年人感觉器官功能缺陷与认知功能损害的关系。方法 采用横断面随机整群分层抽样方法调查≥60岁河北省社区老年人,通过面对面的访谈获取一般人口学资料,并评估感觉器官缺陷状况包括视觉、听觉、味觉、嗅觉功能;同时采用简易精神状态检查量表（MMSE）和蒙特利尔认知评估量表（MoCA）进行认知功能评定。结果 （1）调查3075名老年人,有感觉器官缺陷者共1223名（39．8％）。（2）感觉器官缺陷组MMSE总分和MoCA总分为（25．52±4．32）,（22．03±5．49）分低于无感觉器官缺陷组（26．41±3．86）,（23．17±5．04）分,差异有统计学意义（t分别为5．84,5．84,P〈0．01）;（3）感觉器官缺陷被试者中检出认知功能损害者26．5％高于无感觉器官缺陷者18．8％,患白内障／眼底病变者中认知功能障碍检出率为24．6％高于未患白内障／眼底病变者20．5％,听力障碍者中认知功能障碍检出率为31．5％高于无听力障碍者19．1％,存在嗅觉障碍者中认知功能障碍检出率为19．1％低于未患嗅觉障碍者21．8％,存在味觉障碍者中认知功能障碍检出率为27．6％高于未惠味觉障碍者21．7％,差异均有统计学意义（X^2分别为25．58,13．47,55．08,7．82,9．96;P〈0．05）;老视者中认知功能障碍检出率为21．7％,非老视者为22．2％,差异无统计学意义（X^2=0．09,P=0．954）。（4）以认知功能障碍为因变量,各个感觉器官缺陷为自变量进行Logistic回归分析：白内障／眼底病变（Wald=8．85,P=0．003,RR=1．09,95％CT：1．03～1．16）和听力障碍（Wald=7．52,P=0．006,RR=1．19,95％CI：1．05～1．34）是认知功能的影响因素。结论 存在感觉器官缺陷的老年人认知功能水平低于无感觉缺陷的老年人,其中视觉和听觉障碍是认知功能损害的高危因素。     

社区老年人5年随访中痴呆等疾病的死亡率分析

为了分析痴呆致死亡的危险性并探讨其它疾病对寿命的影响，对３５３１名社区老年人（≥６５岁）进行５年随访调查，其中的１９７例痴呆中Ａｌｚｈｅｉｍｅｒ病（ＡＤ）１２７例、血管性痴呆（ＶＤ）５３例、其它痴呆（ＯＤ）１７例。除统计死亡率外，采用Ｃｏｘ法予相对危险性（ＲＲ）及归因危险性（ＡＲ）分析。结果显示，痴呆的年死亡率达１９．８９％，其中ＡＤ、ＶＤ和ＯＤ分别为１７．６８％、２５．７０％及２１．７１％。按年龄分组计算，６５～７４岁组痴呆的ＲＲ值（ＡＤ５．３５，ＶＤ７．１９）接近恶性肿瘤（５．５８）；≥７５岁组痴呆的ＲＲ值高于所有其它疾病，各种痴呆死亡归因危险性（ＡＲ合计值）高达２３．７１％。提示ＡＤ和ＶＤ均是导致死亡的恶性疾病，≥７５岁者尤甚，亟待在社区防治中引起高度重视。     

利培酮对精神分裂症病人的认知功能影响及其护理相关性分析

认知功能障碍是精神分裂症的核心特征［１］，也是影响精神病临床护理工作的一个重要环节。为此，本文从护理角度出发以氯氮平作为对照组，观察利培酮对精神分裂症病人的认知和行为的影响，旨在为临床护理工作提供参考。１资料与方法１．１对象系１９９７年１０月～１９９８年３月在我院首次住院的４０例病人，其诊断符合ＣＣＭＤ－２－Ｒ中精神分裂症的诊断标准。年龄１８～５９岁之间。病程１～３年。随机分为利培酮和氯氮平组，每组男∶女＝３∶１。利培酮组平均年龄为（３６．５±７．９）岁，氯氮平组为（３７．５±８．９）岁。两组在…     

社区老年人群心身健康状况的5年随访研究

目的 揭示老年人群躯体疾病谱及伤残等情况的动态变化。方法 对上海市静安区老年人群应用“上海市老年研究访问卷”（１９８７年）、“上海市老年调查访问卷”（１９９２年）５年间进行两次调查。结果 １．多数老年人自我评价健康状况比５年差，但６３．３％的老人心理、情绪的自我评价与５年前相仿；２．约８０％的老人患有一种或一种以上的躯体疾病，患病率在１０％以上者为高血压、心脏病、关节疾病、白内障或青光眼、肺气肿或     

重视Alzheimer病的诊治

Alzheimer病（AD）是以进行性认知功能损害为主要临床表现的大脑变性疾病，占整个痴呆的50％～80％左右。国外报道AD在65岁以上的老年人群中的患病率为5％～10％，我国主要城市65岁以上老年人群的患病率约为6．6％，80岁以上老年人群则明显上升。随着人口老龄化的日趋严重，AD已经成为危害老年人健康的主要疾病之一因此，重视AD的诊治，对延缓AD的发展，改善患者的健康和生活质量具有非常重要的意义。     

Baseline saliva level of 3-methoxy-4-hydroxyphenylglycole (MHPG) associates with a consequent cognitive decline in non-demented elderly subjects: three-years follow-up study

The aim of the study was to explore the relation between saliva level of 3-methoxy-4-hydroxy-phenylglycol (MHPG) and a later cognitive decline in non-demented elderly subjects. We have reported that sMHPG in 214 elderly subjects living in the community (age 74.5±5.9years) was associated with scores on the Mini-Mental State Examination (MMSE) and the Frontal Assessment Battery (FAB) in 2004 to 2006 (Time A). The same cohort underwent these cognitive tests again from 2007 to 2009 (Time B). The cognitive function of the 147 of 214 subjects could be reassessed by the same cognitive tests. The score on the FAB, but not the MMSE, was significantly reduced at Time B (14.6±2.6) compared with that of Time A (15.2±1.9). There was a significant negative correlation between the baseline sMHPG and the changes in the FAB score subtracted from Time B to Time A or the scores on the FAB at Time B in men, but not at Time A. These correlations were not found in women. These data indicate that high sMHPG might be associated with subsequent cognitive decline assessed by the FAB in non-demented elderly men living in the community.     

The quantification of the relative effects of age and NART-predicted IQ on cognitive function in healthy old people

The cognitive function of 598 healthy old people aged 70 years or over resident in the community was measured by Mini-Mental State Examination (MMSE) and National Adult Reading Test (NART). The 598 subjects, who were asymptomatic and on no medication, showed no significant correlation between age and NART-predicted intelligence quotient (NARTIQ), but there were significant correlations between both age and MMSE score and NARTIQ and MMSE score. These cross-sectional data suggest that the rate of decline of cognitive function may be significantly greater in subjects with lower NARTIQs; however, longitudinal data are required to test this hypothesis. The provision of normative data from a substantial number of community-resident old people should assist later studies designed to detect the precise effects of cerebral pathology or systemic disease on cognitive function in old people.     

Longitudinal analysis of the effect of apolipoprotein E epsilon4 and education on cognitive performance in elderly subjects: the PAQUID study

BACKGROUND: The apolipoprotein E (apoE) epsilon4 allele has been shown to be a risk factor for dementia, but it is not clear to what extent apoE affects overall cognitive function in non-demented elderly subjects, or how this risk may be modified by gene-environment interactions. OBJECTIVE: To examine changes in cognitive function in elderly people as a function of the apoE epsilon4 phenotype. METHODS: A community based prospective cohort study of 600 non-demented subjects aged over 65 years living in Gironde (France) was analysed to evaluate change over time (seven years) in scores on the mini-mental state examination (MMSE). RESULTS: Age at cohort inception was negatively associated with cognitive performance for both epsilon4 carriers and non-carriers (p < 0.001). The evolution of MMSE scores differed as a function of age: scores remained stable among younger subjects but decreased over time in older subjects. The epsilon4 allele was shown to be significantly associated with lower cognitive performance at baseline (p = 0.02). The course of cognitive performance during the follow up was the same for both epsilon4 carriers and non-carriers. Lower educational level was associated with lower cognitive performance at baseline (p < 0.001) and the effect of an epsilon4 allele on cognitive performance disappeared after adjustment for education. When incident cases of dementia were excluded, the results were unchanged except for the course of the MMSE scores, which now remained stable over time in the older subjects. CONCLUSIONS: apoE epsilon4 carriers show decreased MMSE scores compared with epsilon4 non-carriers, but the effect of apoE on cognition disappears after adjustment for education. Non-demented elderly people maintain a stable cognitive performance regardless of their apoE phenotype.     

简易精神状态量表和蒙特利尔认知评测量表对急性期缺血性脑血管病患者认知功能障碍筛查能力的比较研究

目的比较简易精神状态量表(Mini-Mental State Examination,MMSE)和蒙特利尔认知评测量表(Montreal Cognitive Assessment,MoCA)对急性期缺血性脑血管病患者认知功能障碍的筛查能力。方法对筛选的107例发病7 d内的短暂性脑缺血发作(transient ischemic attack,TIA)或脑梗死患者应用MMSE及MoCA量表进行认知功能障碍的评测,比较经两量表评测筛查出认知障碍患者的比例。根据患者教育程度对应的MMSEI临界值筛选出MMSE评分在正常范围的患者,以MoCA量表评分26分为临界值将受试者分为MoCA评测正常组与异常组,比较两组在各个认知领域的得分。结果 107例患者MMSE平均分25.89±3.65分,MoCA平均分20.67±4.56分。MMSE评测异常者8例(7.5%),正常者99例(92.5%)。MoCA评测异常者98例(91.6%),正常者9例(8.4%)。MoCA评测正常者MMSE评测均正常。MMSE评测正常的99例患者中,MoCA评测正常者9例(9.1%,9/99),评测异常者(26分)90例(90.9%,90/99)。MoCA评测异常组在视空间与执行能力、命名、延迟记忆等认知领域得分低于MoCA评测正常组(P0.05)。结论 MoCA量表在筛查急性缺血性脑血管病患者认知障碍方面可能比MMSE量表更敏感,MMSE正常MoCA评测异常的患者认知损害主要表现在视空间执行功能、命名、延迟记忆等方面。     

Utility of a modified Mini-Mental State Examination with extended delayed recall in screening for mild cognitive impairment and dementia among community dwelling elders

The objective of this study was to test the utility of additional delayed recall of the three recall items of the Folstein Mini Mental State Evaluation (MMSE) as a screening measure for mild cognitive impairment and dementia in the elderly. It used a cross-sectional study of subjects, who were administered a brief memory screening battery which included the MMSE and extended delayed recall of the three MMSE recall items at 5 minute intervals. The criteria for cognitive status was determined on the basis of the neurological and neuropsychological evaluation. One hundred and two elderly persons who were recruited through a memory screening program were diagnosed as cognitively normal (N=52), mild cognitively impaired (N=24), or demented (N=26). The observed sensitivity of 83.3% and specificity of 90.4% was achieved across three delayed recall trials in differentiating cases with mild cognitive impairment (without dementia) from individuals with normal cognition and was superior to the total MMSE score alone (sensitivity/specificity: 70.8%/84.6%). Cumulative recall for the three MMSE items across only two delayed recall trials demonstrated a sensitivity of 96.2% and specificity of 90.4% in differentiating between cases of dementia versus cases diagnosed with no cognitive impairment. The three trial delayed recall score enhanced prediction of mild cognitive impairment in at-risk elderly living with the community and may have promise in the development of future screening batteries.     

APOE-epsilon4 is associated with memory decline in cognitively impaired elderly

OBJECTIVE: To investigate whether the association between APOE-epsilon4 and memory decline is modified by baseline cognition and age in a population-based elderly sample. METHODS: The study sample consisted of 1,243 subjects, 62 to 85 years old, with a Mini-Mental State Examination (MMSE) score between 21 and 30 and known APOE phenotypes. Memory performance was measured with an abbreviated Auditory Verbal Learning Test (AVLT) at baseline and repeated after 3 years (n = 854). Memory decline was defined as a decrease of at least 1 SD from the mean change score on immediate recall (IR), delayed recall (DR), and retention, based on the AVLT. RESULTS: Multivariate logistic regression analyses showed that APOE-epsilon4 is associated with memory decline in cognitively impaired subjects (MMSE score, 21 to 26) (OR for decline on IR adjusted for age, sex, education, and baseline recall score, 3.8; 95% CI, 1.4 to 10.0; adjusted OR for decline on DR, 2.9; 95% CI, 1.2 to 7.0; adjusted OR for decline on retention, 3.3; 95% CI, 1.1 to 10. 1), but not in cognitively normal subjects (MMSE score, 27 to 30) (adjusted OR for decline on IR, 1.1; 95% CI, 0.6 to 2.0; adjusted OR for decline on DR, 1.0; 95% CI, 0.6 to 1.8; adjusted OR for decline on retention, 1.5; 95% CI, 0.7 to 3.0). In particular, cognitively impaired epsilon4 carriers older than 75 years were at high risk of memory decline (adjusted OR for decline on IR, 4.5; 95% CI, 1.4 to 13.8; adjusted OR for decline on DR, 3.6; 95% CI, 1.2 to 10.8; adjusted OR for decline on retention, 6.6; 95% CI, 1.5 to 29.7). CONCLUSIONS: APOE-epsilon4 was associated with memory decline in subjects with cognitive impairment, but not in normally functioning subjects. Contrary to AD studies, our study suggests that the risk of APOE-epsilon4 on memory decline does not decrease at higher ages.     

Adverse life event and risk of cognitive impairment: a 5-year prospective longitudinal study in Chongqing, China

Background and purpose: Current knowledge of factors that increase or decrease the risk of cognitive impairment in elderly people is limited. Recently adverse life events appeared to be associated with the increased risk of cognitive impairment in elderly people. However, this is less studied. We conducted a 5‐year prospective study to evaluate the association between adverse life events and the risk of cognitive impairment in Chinese elderly people. Methods: Of 9167 community residents aged 55 years and over, 5262 were enrolled into the study and followed up annually for 5 years. At baseline demographic data, smoking and drinking status, medical history, adverse life events, clinical, functional and cognitive status, depressive symptom, and complementary data were collected. The cognitive status was assessed using a structured battery of neuropsychological tests. Subjects were followed‐up annually to assess the cognitive function during follow‐up. Results: Over the follow‐up period of 5 years, cognitive impairment developed in 569 subjects. Among the adverse life events, the death of the spouse and a financial crisis were associated with the increased risk of cognitive impairment. These associations persisted after adjusting for the subjects with possible baseline pre‐clinical cognitive impairment, depressive symptom, stroke and vascular risk factors respectively. Conclusions: Adverse life events, such as the death of a spouse and a financial crisis, are associated with a higher risk of cognitive impairment. Further in‐depth longitudinal and intervention studies are needed to confirm the causal relationship between adverse life events and risk of cognitive impairment in the future.     

Mini-Mental State Examination: a normative study in Italian elderly population

The Mini-Mental State Examination (MMSE), a brief test to assess cognitive status, is heavily influenced by age and education. It was administered to 1019 elderly subjects (aged 65–89 years) living in three different Italian cities. A statistical non-linear regression model was built up in order to obtain adjustment coefficients to reduce the influence of demographic variables on the MMSE raw scores. Age and educational level were significantly and independently associated with the MMSE score. Results of a multiple linear regression with transformation of age and education provided adjustment coefficients of the MMSE raw scores. Data from this study will ameliorate the overall reliability of MMSE as a screening test for cognitive impairment in elderly people.     

Cognitive function and length of survival in elderly subjects living at home.

177 people aged 65 or over, chosen at random from larger representative samples of elderly people living at home in Newcastle upon Tyne, were given the Weschler Adult Intelligence Scale (WAIS) or a shortened form of it, and followed up for 7 years or till death. Discriminated function analysis showed that the power of the test score to predict death occurring within 2 years was not explained away by its correlations with age, sex, social class or physical disability. Exclusion of clinically diagnosed chronic brain syndromes reduced but did not abolish the relationship found to exist between test score and outcome. The ascertainment of impaired cognitive functioning has important applications in the assessment of prognosis and in the planning of care of elderly people.