轻度认知功能障碍的神经心理学研究和ApoE基因多态性分析

阿尔茨海默病 (AD)是最常见的老年病 ,患病率逐年上升 ,早诊断早治疗才有可能延缓或阻止病情发展。轻度认知功能障碍 (MCI)是介于痴呆和正常衰老间的认知缺损状态 ,随年龄增加有逐步增加的AD发病危险性。估计有 10 %～15 %的MCI在 1年后发展为AD ,比健康老年人发生痴呆的比例高 10倍。如果早期发现和监护 ,在这个阶段进行干预 ,使进展为AD的时间推迟 ,则意义重大。资料和方法 :MCI组 :2 3例 ,男 7例 ,女 16例 ;平均年龄(77 0± 9 1)岁 ,平均受教育年限 (7 5± 3 9)年。根据PetersenMCI诊断标准入组。健康组 :2 8名 ,男 14名 ,女 14…     

事件相关电位P300在轻度认知损害中的应用

轻度认知损害（Mild Cognitive Impairment,MCI）是阿尔茨海默病（Alzheimer Disease,AD）的前驱早期阶段,是介于AD和正常衰老之间的一种认知功能损害状态[1]。Petersen等认为MCI具有以下特征：（1）经常为忘事烦恼;（2）与受教育程度、年龄不相称的记忆损害;（3）保持一般的认知功能;（4）日常生活能自理;（5）没有痴呆。相关研究显示,MCI在老年人中的发生率为5．3％,每年有10％～15％的MCI患者转化为AD,而正常老年人群每年转化为AD仅为1％～2％。     

轻度认知障碍的转化及相关因素研究进展

轻度认知障碍（MCI）是介于正常衰老与痴呆之间的一种过渡状态,具有发展为痴呆的高度危险性。本文将对近年MCI的转化及转化率,转化的认知功能评估、生物学指标、神经影像学、危险因素及药物干预等研究进展进行全面综述。     

轻度认知损害向老年性痴呆转化的临床研究

目的 研究轻度认知损害(mild cognitive impairment,MCI)向痴呆自然转化过程及多奈哌齐对转化的干预影响.方法 总结98例MCI患者情况,将服用多奈哌齐和未服用任何胆碱酯酶抑制剂的遗忘型MCI(aMCI)及非aMCI患者按年龄、性别、认知减退程度及ApoEε4携带情况分层配对研究,分析各组向痴呆转化率以及MMSE、阿尔茨海默病(AD)评定量表(ADAS-Cog)和aMCI组修订韦氏记忆量表(WMS-R)变化.结果 由aMCI向AD转化率,服用和未服用多奈哌齐组于1年时分别为15.1%和8.3%(P＜0.05),2年时分别为24.2%和12.5%(P＜0.01).由非aMCI向AD转化率,服用和未服用多奈哌齐组,于1年时分别为13.0%和5.5%(P＜0.05),2年时分别为21.7%和16.6%(P＜0.05).服用多奈哌齐6个月时,aMCI组MMSE提高(0.1±1.3)分,对照组下降(0.3±2.4)分;ADAS-Cog下降(1.4±4.7)分,对照组升高(0.03±4.55)分;WMS-R改善(4.8±4.1)分,对照组下降(3.7±5.2)分,治疗组与自然病程对照组比较差异有统计学意义(P＜0.01),并可维持1～2年.多奈哌齐还能延缓携带ApoEε4的MCI患者向AD转化,但与自然病程组比较无统计学意义(P＞0.05),尚有待扩大样本量继续研究观察.多奈哌齐对认知相关区脑萎缩有减缓趋势.结论 本组资料提示,多奈哌齐能推迟MCI向AD转化.     

社区老人轻度认知功能损害的预后和转归

目的 随访观察社区老年人群中轻度认知功能损害（MCI）的预后及转归。方法 采用前瞻性纵向研究方法,对一批60岁以上社区老人（n=4275)进行追踪观察,其中,重点为归入MCI组的216例非痴呆老人的5年及10年的预后和转归,并应用多因素分析方法。比较MCI和非MCI老人发生死亡或痴呆的结局。结果 （1）5年随访,MCI组有45．8％死亡,有16．49％转变为痴呆;10年随访,MCI组转变为痴呆者高达42．1％。（2）Logistic逐步回归分析示,MCI对死亡和痴呆具有重要的预测作用。MCI老人5年内死亡的概率是无MCI老人的2．20倍（95％CI：1．88－2．56）;5年后的MCI发生痴呆的可能性是无MCI老人的3．26倍（95％CI：2．39－4．46）。10年后的MCI发生痴呆的可能性是MCI老人的4．35倍（95％CI,1．60－2．29）。结论 社区老人中早期伴有的轻度认知功能损害,将成为今后可能发生痴呆或死亡的主要危险因素,必须引起高度重视。     

氢质子磁共振波谱对轻度认知功能损害的诊断价值

轻度认知功能损害(mild cognitive impairment,MCI)是指有轻度记忆或其他认知功能损害但无痴呆的一组临床综合征,是一种介于健康老年人和轻度痴呆之间的临床过渡状态[1-2],每年10%～15%的MCI转变为阿尔茨海默病(AD),是健康老年人发生AD的10倍[3].我们观察MCI与健康老年人在左侧海马等部位的氢质子磁共振波谱(1H-MRS)表现差异,旨在探讨1H-MRS对于MCI的诊断价值及所示代谢物比值与认知损害的相关性.     

静息状态功能磁共振成像在轻度认知损害中的研究进展

轻度认知损害(mild cognitive impairment,MCI)是记忆力或其他认知功能损害程度超过个体年龄和教育水平所允许的范围,未达痴呆标准,对日常生活无显著影响,处于正常老龄和痴呆之间的过渡状态.根据记忆功能是否受损,可将MCI分为遗忘型MCI(amnestic MCI,aMCI)和非遗忘型MCI(non-amnestic MCI,naMCI)[1-2].神经退行性病变所致的aMCI极有可能是阿尔茨海默病(Alzheimer's disesse,AD)的前驱阶段[3].因此,寻找MCI向AD进展的生物学预测标记,对AD早期诊断具有重要意义.     

城乡社区≥55岁人群、可疑痴呆和痴呆患者死亡率及生存率的研究

目的　了解社区≥ 5 5周岁人群、可疑痴呆和痴呆患者的死亡率及生存率。方法　在1997年调查成都地区城乡社区≥ 5 5周岁人群 5 35 3人中痴呆患病率的基础上 ,于 2 0 0 0年用随机整群抽样方法抽取 384 1人调查其死亡及生存情况。在 384 1人中随访到 30 5 8人 ,死亡 391人 ,外出或迁出 392人。基线调查用美国精神障碍诊断与统计手册第 3版修订本的标准诊断痴呆 ,用临床痴呆程度评定量表评定痴呆程度。结果　 (1)基线调查时被评为筛查阴性、复查正常、可疑痴呆和痴呆的患者 ,3 3年后随访时的死亡率分别为 2 9% (2 35人 )、6 2 % (85人 )、15 0 % (19例 )和 2 8 5 % (5 2例 )。其中阿尔茨海默病 (AD)、血管性痴呆 (VD)和其他类型痴呆 (OD)患者死亡率分别为 2 8 8% (40例 )、33 9% (8例 )和 19 9% (4例 )。 (2 )筛查阴性、复查正常、可疑痴呆和痴呆患者的生存率分别为90 5 %、81 8%、6 0 0 %和 37 6 % (χ2 =36 1 31,P <0 0 0 1)。从发病时起 ,AD、VD、OD的 5 0 %生存率时间分别为 7 0年、4 2年、10 3年。结论　痴呆患者死亡率高 ,可疑痴呆者次之 ,正常人最低 ;而生存率则相反。VD患者的死亡率高于AD和OD患者且存活期短。     

轻度认知功能障碍研究进展

定义和分类 轻度认知功能障碍(maild cognitive impaiment,MCI)是一种界于正常和痴呆之间的认知状态.MCI病人比普通人更容易发展成为痴呆.MCI大体上可以分为三类[1]:1)遗忘型MCI,以记忆区域的认知缺损为主,更容易发展成为阿尔兹海默病(AD);2)多领域型MCI,表现为多个方面的认知轻度缺损,可以进展为AD,也可以进展为血管性痴呆(VD),也可以是正常的认知成熟过程;3)非遗忘单领域型MCI,表现为除记忆以外的单领域认知缺损,可以发展成非AD型痴呆(如混合型痴呆,VD,Lewy小体痴呆,局部萎缩等).以后人们扩充了分类[2],也有分为:1)年龄相关的记忆缺损(AAMI);2)年龄相关的认知减退(AACD);3)遗忘型MCI( MCIa);4)非痴呆型认知缺损(CIND).     

老年轻度认知功能障碍与同型半胱氨酸 血脂的相关性分析

正轻度认知功能障碍(mild cognitive impairment,MCI)是近年来提出的新概念,介于正常衰老与极早期痴呆间的一种以认知功能损害为主要特征的中间状态。随着社会老龄化,老年人的发病率明显高于年轻人。研究表明,MCI患者进展为痴呆的发病率为正常人的10倍,故MCI人群将成为痴呆的高危人群,但存在异质性~([1])。心脑血管损害的重要危险因素之一的高同型半胱氨酸血症已被广泛认可。多数学者认为高同型半胱氨酸血症是痴呆的危险因素之一。McCully     

Treatment Considerations in Anticonvulsant Monotherapy

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.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.     

Un nouveau cadre conceptuel de travail pour une psychiatrie revisitée ? Introduction à deux articles de E. Kandel

In two articles which appeared in the American Journal of Psychiatry and that were subsequently translated for Évolution Psychiatrique, E. Kandel examines the bases for a reinterpreted psychiatry that is prepared to confront the major challenge of the 3rd millenium: that of insight into the mind and brain. This requires a major reorganization of the discipline, which involves a reinvestment of the scientific approach and a critical  assessment of the data provided by psychoanalytical psychiatry and cognitive neurosciences. Seven concepts have therefore been proposed for interactive re-examination: consciousness, the unconscious, memory, emotion, development, desire, impulse. The dynamic relations existing between genetics and the environment allow one to see how evolutions are possible from actions at different levels, both psychotherapeutic and pharmacological. Imaging and other techniques provide additional objective information to the process of human interaction which remains the basis of psychiatry. A common framework for psychiatry and the neurosciences, a reconsideration and renewal of the psychoanalytical approach are both possible and necessary.     

Opioids and the developing organism: A comprehensive bibliography, 1984–1988

A comprehensive bibliography of the literature concerned with opioids and the developing organism for 1984-1988 is presented. Utilized with companion papers (Neurosci. Biobehav. Rev. 6:439-479; 1982; 8:387-403; 1984), these articles cover the clinical and laboratory references beginning in 1875. For the years 1984, 1985, 1986, 1987, and 1988, a total of 877 citations were recorded. A series of indexes accompanies the citations in order to make the literature more accessible. These indexes are divided into clinical and laboratory topics, and subdivided into such topics as the type of opioid explored and the general area of biological interest (e.g., physiology).     

La biologie et le futur de la psychanalyse : un nouveau cadre conceptuel de travail pour une psychiatrie revisitée

The American Journal of Psychiatry has received a number of letters in response to my earlier “Framework” article (1). Some of these are reprinted elsewhere in this issue, and I have answered them briefly there. However, one issue raised by some letters deserves a more detailed answer, and that relates to whether biology is at all relevant to psychoanalysis. To my mind, this issue is so central to the future of psychoanalysis that it cannot be addressed with a brief comment. I therefore have written this article in an attempt to outline the importance of biology for the future of psychoanalysis.     

Facteurs de risque environnementaux à la schizophrénie

Schizophrenia is currently a major concern, its prevalence being estimated at around 1% and its social consequences being severe. The elucidation of the pathophysiology of the disease is difficult due to the great variability of clinical expressions, the instability of the clinical symptoms during the evolution and the absence of reliable biological markers. The existence of a familial aggregation in schizophrenia is well known, the risk of presenting the disease for first-degree relatives of patients being 5 to 10 times higher than the risk observed in the general population. The genetic component was further confirmed by twin and adoption studies. Although the concordance for the disease is higher (40 to 70%) among monozygotic twins as compared with dizygotic twins (15%) it does not reach 100%, which implies that environmental factors modulate the effects of the genotype. However, the role of these factors and especially their interaction with genetic factors remain unclear but the implications of some specific environmental factors are well documented by recent research data. The current literature on sex differences in schizophrenia is consistent. Several studies have suggested that male and female patients may differ in age at the onset and expression of clinical symptoms. Complications during pregnancy or birth-giving may increase the risk of developing schizophrenia later in life. The major complications are oxygen deprivation during pregnancy, bleeding, maternal malnutrition or infection (exposure to influenza, for example). A low birth weight is associated with an increased risk of schizophrenia. Psychoses are more common among people living in an urban environment and among those born during winter months. Schizophrenia is probably more prevalent in people who are living promiscuously, are subject to toxic abuse, poor nutrition and stress but here more precise data are needed. Moreover, immigrants have a higher risk of developing psychotic disorders. In addition, head traumas are associated with an increased risk of schizophrenia. Though they are contentious, some studies suggest that substance abuse (cannabis use in European countries) is related to the development of schizophrenia, especially in people with genetic vulnerability. Moreover, substance misuse may worsen the symptoms. If the environment is sufficiently stressful, people with a high genetic vulnerability will develop some degree of mental illness, including schizophrenia. Conversely, a less stressful or a protective environment may decrease the risk of its onset in persons with a predisposition to schizophrenia.     

Introduction: Goals

Summary: Epilepsy is characterized by recurrent seizures. Many epilepsies with focal seizures as well as convulsive generalized seizures respond satisfactorily to antiepileptic drugs (AEDs) that reduce repetitive firing (e.g., phenytoin, carbamazepine, and valproate) or that augment GABA_A-mediated inhibition (e.g., phenobarbital and benzodiazepines). A number of drugs presently under development, such as NMDA receptor antagonists, loreclezole, losigamone, meth-ysticine, and dextromethorphan, are promising in acute animal models of otherwise drug-resistant convulsant activity. As a result of recent studies in both experimental models and surgically resected human epileptic brain, the prospects for development of AEDs have significantly improved. Several new AEDs recently have reached the commercial market or are in experimental or clinical trials. A comparative presentation of the standing of the new AEDs with respect to their efficacy and side effects is necessary, but still very difficult. Because initial experience with new AEDs is restricted to populations with severe drug-resistant epilepsy, the crucial question whether potential new AEDs can alter prognosis is not yet definitively answered. There is a clear need to compare the effects of standard AEDs and new AEDs in naive patients and over longer follow-up periods. Moreover, because of the strong desire to develop antiepileptic therapy that directly treats the primary etiology of a given epileptic syndrome , or modifies the neurobiological processes that cause recurrent seizures, better experimental epilepsy models for chronic epilepsy and further clinical studies are necessary to increase the knowledge on the pathophysiology of distinct epileptic syndromes. In this respect, studies on the differences between responders and nonresponders to a given AED treatment are extremely valuable.