广州市城乡55岁及以上人群痴呆患病率调查

目的调查广州市城乡≥55岁人口痴呆的患病率。方法采用分层整群抽样方法,将广州市12个区市分为老城区、新城区、郊区,根据各层≥55岁的人口数占广州市相应年龄段人口总数的比例确定各层应查人数,实查5276人。调查采用筛查和确诊两阶段法,按美国精神障碍诊断和统计手册第4版的标准诊断痴呆。结果①查出痴呆患者183人,粗患病率为3.47%,其中阿尔茨海默病(AD)、血管性痴呆(VD)和其他痴呆的粗患病率分别为2.43%、0.85%和0.19%。年龄标化后的痴呆、AD和VD患病率分别为1.94%、1.28%和0.55%。②女性痴呆粗患病率高于男性(4.35%vs2.21%,P<0.001),二者的年龄标化患病率分别为1.12%、2.72%。痴呆患病率随年龄增长而上升。③农村人口的痴呆患病率(4.32%)高于城镇人口(3.27%),差异有统计学意义(P<0.01)。④文盲者的痴呆患病率(6.17%)较小学(2.68%)和初中及其以上(1.41%)文化程度者高(P<0.001)。结论AD是广州地区老人中主要的痴呆类型,VD次之。老年期痴呆患病率随年龄的增长而升高。文化程度低者痴呆患病率较高。     

经影像学支持的阿尔茨海默病与血管性痴呆的临床比较研究

目的研究阿尔茨海默病(AD)和血管性痴呆(VD)的临床特征,寻找鉴别诊断的有效方法.方法共125例AD患者和97例VD患者,包括北京协和医院的门诊痴呆患者171例和流行病学调查中受访的痴呆患者51例,AD患者均有头颅MRI资料,VD患者都有头颅MRI或CT资料.按照美国精神医学会的<精神障碍诊断和统计手册>第四版(DSM-Ⅳ)标准诊断痴呆,很可能AD采用美国神经病学、语言障碍和卒中-老年性痴呆和相关疾病学会(NINCDS-ADRDA)标准,很可能VD采用美国国立神经病与卒中研究所/瑞士神经科学国际协会(NINDS-AIREN)标准.比较AD和VD患者在认知功能、行为症状、日常活动能力和影像学方面的差异,采用Logistic二元多重回归模型确定鉴别诊断的有效指标.结果不同痴呆阶段的AD和VD患者具有不同的临床特征,两者间的鉴别指标随痴呆进展而变化轻度AD患者学习能力较VD患者减退明显(Fuld物体记忆储存分分别为6.3±2.4、8.0±1.7,P=0.040),鉴别中度AD和VD患者的有效指标是注意力(数字广度测验倒背分分别为2.2±1.4、1.0±1.2,P=0.004)和综合语言能力(简易智能状态检查法综合语言能力分分别为6.3±1.1、5.3±1.7,P=0.001),重度AD患者以短时记忆减退(Fuld物体记忆总分分别为3.1±1.7、6.0±4.3,P=0.046)为著.轻中度AD患者在理财和打电话上逊于VD患者,VD患者则在与肢体活动有关的日常活动中表现退步(均P<0.05).重度VD患者的日常生活活动能力总分明显低于同阶段AD患者(49.3±14.8,62.4±14.9,P=0.032).重复收敛行为是鉴别中重度AD和VD患者的有效指标(均P<0.05).结论 AD和VD具有不同的临床特征.两者的差别是由各自的病变性质、部位和病理生理机制所决定的.     

PET/CT在老年期痴呆中的应用研究进展

老年期痴呆泛指60(65岁)以上人群中发生的各种类型痴果,最常见的是阿尔茨海默病(AD)和血管性痴果(VD).国外的流行病学资料表明,65岁以上老人中,痴呆的患病率为15%,其中9%为AD,4%为VD[1].     

老年期痴呆129例的临床研究

目的探讨老年期痴呆的病种分布、临床表现、影像特点和诊断方法.方法采用综合分析方法对129例老年期痴呆患者进行临床症状、神经心理、MRI检查,并以112名老年健康体检者为对照,总结了各种痴呆的特点和诊断方法.结果 1 29例老年期痴呆中,阿尔茨海默病(Alzheimer's disease, AD)55例,血管性痴呆(vascular dementia, VD)46例 ,混合性痴呆(mixed dementia, MD)18例.3种痴呆中记忆障碍均存在(100%),卒中病史在AD组中无,在VD组和MD组中分别为39例(84%)和7例(39%);神经系统局灶征在AD 组中未能发现,在VD组和MD组中分别为44例(95%)和5例(27%);影像变化AD组中全部有脑萎缩(100%),VD组多发性脑梗死42例(93%),MD组全部有脑萎缩(100%)和全部有腔梗(100%),但腔梗数量不超过5个.结论 (1)对各种痴呆的诊断步骤,应先符合痴呆的标准,再根据AD、VD和MD的标准进行分型.(2)老年期痴呆以AD为最多见,VD次之.(3)不同痴呆各有其不同的临床特点AD起病慢,无神经系统局灶征, 影像变化以脑萎缩为主,Hackinsk i缺血评分＜4分; VD多有脑血管病病史,起病快,有神经局灶征,影像变化以脑梗死为主 ; MD多兼有AD和VD的特点,脑血管病史不甚明确,影像学上既有脑萎缩又有散在的腔梗,数量多在5个以上.     

智力竞技型休闲活动对阿尔茨海默病的影响

目的　探讨智力竞技型休闲活动 (以下简称智力活动 )对阿尔茨海默病 (AD)的影响。方法　采用分层随机整群抽样方法 ,以淄博市各层人口所占总人口比例确定各层应查≥ 5 5岁人群 ,共 6 5 6 0人 ,实查 6 348人。调查采用筛查和确诊两阶段法 ,按美国精神障碍诊断与统计手册第 4版的标准诊断痴呆 ,同时进行自编智力活动问卷调查 ,并进行流行病学及卫生统计学分析。结果 (1)查出痴呆患者共 138例 ,患病率为 2 17%。其中AD为 1 6 1% ,血管性痴呆 (VD)为 0 4 1% ,其他痴呆为0 16 %。 (2 )有智力活动组的AD患病率 (0 6 7% ,11例 )低于无智力活动组 (1 94 % ,91例 ;P <0 0 1)。(3)分层分析结果显示 ,同一层中有智力活动组的AD患病率均低于无智力活动组 (P <0 0 5和P <0 0 1)。 (4)有智力活动组的AD患病年龄 [(84± 7)岁 ]较无智力活动组 [(71± 8)岁 ]晚 (P <0 0 1) ;且痴呆的程度 (中、重度为 0 2 4 % )较无智力活动组 (1 70 % )轻 (P <0 0 1)。结论　智力活动有助于降低罹患AD的风险 ,对AD可能有保护作用。     

社区阿尔茨海默病早期征象的研究

目的　了解阿尔茨海默病 (AD)患者的早期征象。方法　在 1997年 6月至 1998年 4月对成都市 5 35 3名年龄≥ 5 5周岁的社区人群进行痴呆患病率调查的基础上 ,于 2 0 0 0年 11月 12日至2 0 0 1年 3月 2 1日仍用两阶段法随访其中的 36 87名正常人群。实际随访 2 86 9名 (77 81% ) ,失访 818名 (2 2 19% )。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 ,用美国神经病语言障碍和卒中研究所及阿尔茨海默病与相关障碍协会的AD标准做出可能AD和很可能AD诊断 ,用临床痴呆程度评定量表评定痴呆严重程度。结果　 (1)查出可疑痴呆 5 8例 (2 0 4 % ) ,AD2 5例 (0 88% )。(2 )AD患者年龄 [(79± 6 )岁 ]高于可疑痴呆者 [(76± 8)岁 ]和正常人 [(6 6± 7)岁 ;P <0 0 0 1]。(3)AD患者基线简易精神状态检查 (MMSE)总分及各分项评分均低于可疑痴呆者和正常人 ,均P <0 0 0 1。AD患者随访时的MMSE总分和积木测验评分下降了 [(6 86± 5 77)分和 (4 11± 6 4 1)分 ],下降程度快于可疑痴呆者 [(3 5 5± 4 5 0 )分和 (4 89± 6 89)分 ]和正常人 [(0 5 6± 3 76 )分和 (1 11± 6 86 )分 ;P <0 0 5 ]。有记忆力减退病史者 (2 83例 )中 ,AD患者的比例 (44 0 % )显著高于可疑痴呆者 (32 8% )和正常人 (9     

听觉P300对血管性痴呆早期诊断及鉴别诊断的价值

目的探讨P300对血管性痴呆(VD)的早期诊断及与Alzheimer病(AD)鉴别的价值.方法分别对20名正常人(NC)、20例VD患者、24例无痴呆脑梗死患者(CI)及20例AD患者进行神经心理学量表长谷川智力量表(HDS)评分,并选用听觉oddball序列分别对上述各组进行P300测试.结果 (1)VD组与CI组及NC组比较,N2、P3潜伏期(PL)明显延长(均P<0.05);P3PL与HDS评分呈负相关(r=-0.686,P＜0.01),且较HDS更为敏感;梗死部位与P300变化有一定关系,梗死位于颞叶、额叶的患者与其他梗死部位的患者相比,P3PL异常率明显增高(P＜0.05).(2)AD组与VD组相比,N1 PL更长,差异有显著性(P<0.05).结论 (1)P300对VD的早期诊断具有重要意义.(2)N1PL在VD与AD的鉴别诊断中有一定的意义.     

上海市卢湾区一个社区老年期痴呆患病率分析

目的 分析本地老年期痴呆患病情况。方法 采用简易智力状态检查量表（MMSE）作为调查筛选工具,对本社区55岁以上人群进行老年痴呆患病率的调查。结果 AD和VD的患病率分别为2．31％和4．87％,痴呆总 患病率为3．67％。痴呆总患病率与国内报道相近,但VD患病率高于AD。本组男女二性患病率无显著性差异。结论 高龄、文化程度低可能是AD和VD的共同易患因素和重要危险因素。     

广州市城乡65岁及其以上人群痴呆患病率调查

目的调查广州市城乡≥65岁人群痴呆的患病率。方法采用分层随机整群抽样方法对广州市城乡人群进行抽样，用筛查和确诊两阶段法进行调查，实查14个居委会、2个村委会中≥65岁人群共3780人。按美国精神障碍诊断与统计手册第4版的标准诊断痴呆，阿尔茨海默病（AD）诊断采用美国神经病学、语言障碍和卒中研究所及阿尔茨海默病与相关障碍协会的标准。结果（1）查出痴呆患者182例，粗患病率为4．81％；其中AD128例（3．39％），血管性痴呆（VD）44例（1．16％）；经2000年广州市人口年龄构成进行标化，痴呆、AD和VD患病率分别为4．54％、3．17％和1．11％。（2）女性痴呆患者134例，粗患病率（5．98％）高于男性（48例，3．12％；P〈0．001），经年龄标化患病率分别为6．03％和2．74％。（3）痴呆患病率随年龄增长急剧上升。结论广州地区年龄≥65岁老人的痴呆患病率为4．81％，AD患病率高于VD。老年期痴呆患病率随年龄的增长而急剧升高。     

阿尔采默病和血管性痴呆死亡病例病程分析

目的 分析住院老年痴呆患者起病年龄,死亡年龄及病程。方法 对住院87例痴呆患者起病年龄,死亡年龄,病程进行统计分析,并对阿尔采默病(AD)与血管性痴呆(VD)组间及组内进行对照。结果 AD的起病年龄高于VD(P<0.01),AD的平均死亡年龄大于VD(P值<0.01),AD组的平均病程为(4.0±2.7)年,VD组的平均病程为(4.6±3.8)年,AD与VD的病程无明显差异(P>0.05),AD平均病程女性大于男性(P<0.05),男性平均(3.3±2.1)年,女性(5.3±3.1)年。结论 女性AD的生存时间明显长于男性,AD病人与VD病人存在不同的死亡影响因素。     

Early stages in the formation of the cerebellum in the frog

The formation of the cerebellum was studied during the first 6 months of the tadpole stage of the bullfrog by using standard histological methods and reconstructions from serial horizontal sections. Three major developmental phases were noted in the formation of the cerebellum. (1) During the first 5 weeks of development, the neuroepithelium proliferated and the dorsal mesencephalic plates increased in size. (2) Starting in the sixth week, a patch of neuroepithelium began to differentiate and gave rise to a small population of Purkinje cells. In subsequent weeks, the area of differentiation continued to spread and a Purkinje cell layer became established along the dorsal margin of the cerebellar plate. (3) In the 12th week, the ventrolateral part of the cerebellar plate began to increase in size and generate two populations of small cells. The lateralmost part of the neuroepithelium in this area generated a group of cells that formed an external granular layer that was one cell deep. Cells of this external granular layer migrated inward into the primitive molecular layer, and by the 26th week only a remnant of an external granular layer remained in the cerebellum. The more medially situated part of the neuroepithelium gave rise to another population of small cells that formed a column, which appeared to be continuous with the Purkinje cells, but differed from them in size. It should be noted that full maturation of the cerebellum occurs during metamorphosis, which in this species remains some 2 years away.     

Inhomogeneities in the propagation of the slow wave in the stomach

The propagation of the slow wave in the stomach and its role in inducing sweeping peristaltic contractions toward the pylorus, essential for a proper digestion and emptying, have been studied for many years. Irregularities in the timing or in the pattern of propagation of the slow wave have been known to induce various gastric malfunctions and, recently, several types of gastric dysrhythmias have been described which could lead to gastric contraction abnormalities. In this study, Du et al. have analyzed the disturbances caused by a simple transmural incision in a human stomach, performed to obtain a biopsy of the muscle, on the propagation pattern of the slow wave. In addition, they show that such an incision may by itself also induce new types of gastric dysrhythmias. These results are important in demonstrating that the function of the stomach can easily be disturbed by such procedures. This mini‐review describes several ways in which inhomogeneities in propagation may affect the conduction pattern of the slow wave, including the genesis of several dysrhythmias, and what is currently known about their impact on gastric contraction and digestion.     

Dysthymic disorder in the aged in the community

Summary The prevalence of dysthymic disorder and and its relationship to social and health variables were investigated in a Finnish population aged 60 years or over. The prevalence was lower in men (17.2 per 100) than in women (22.9 per 100). In the total population the occurrence was higher in the widowed (24.9 per 100) than in the married (18.3 per 100). In men, dysthymic disorder was more common in those with a lower educational level (22.6 per 100) than with a higher educational level (15.1 per 100), and more common in persons receiving long-term institutional care or home nursing or home help (28.7 per 100) than in persons living independently at home (14.6 per 100). The rate was not related to age, marital status or occupation. In women, the occurrence was not related to age, marital status, education, occupation or form of social and health care. The female rate was higher than the male in the older group (70 yrs. +), in married persons, in those with a higher educational level and in those living independently at home. Underdiagnosing was evident. The occurrence of dysthymic disorder was related to poor health and poor functional status and to the occurrence of social and health stressors. No differences were found in the occurrence of the related factors between persons with dysthymic disorder and persons with major depression. Our results support the conclusion that the majority of cases of dysthymic disorders in the elderly are affective illnesses and not personality disorders.     

Cells in the pretectal olivary nucleus are in the pathway for the direct light reflex of the pupil in the rat

Extracellular microelectrode recordings from 148 single cells in the pretectum of the hooded rat were classified according to their temporal response properties to light stimulation of their retinal receptive fields. Fifty-six cells were classified as tonic-on cells, 22 cells were classified as tonic-off cells, and 53 cells were classified as phasic cells. Seventeen cells could not be assigned to one of these 3 groups. The diameters of the receptive field centers of the tonic-on pretectal cell were clustered about a mean of 31° and the temporal response of these cells was sustained. Constriction of the contralateral pupil was produced by electrical stimulation through the recording electrode at sites containing tonic-on pretectal cells, but not at sites containing tonic-off pretectal cells or phasic pretectal cells. For this reason, we argue that tonic-on cells are likely to mediate constriction in the light reflex of the rat's pupil. Receptive field maps together with electrolytic marking lesions at recording and stimulation sites showed that tonic-on pretectal cells are retinotopically organized and are aggregated in a strip running from the dorso-medial tip of the pretectum to the ventro-lateral boundary. The anatomical distribution of these cells is coextensive with the region known as the pretectal olivary nucleus (PO) in the rat^26,27.Using fine microelectrodes, recordings were obtained from 27 axons presumed origin (fibers). Of these, 14 were tonic-on, 10 were phasic, 2 were tonic-off, and 2 were unclassified. Recordings from tonic-on fibers were obtained near tonic-on pretectal cells, typically in the most dorsal light-responsiveness region of the pretectum. These fibers were activated by single pulse electrical stimulation of the optic chiasm. The mean receptive field center diameter of 6 tonic-on fibers was 10.1°, or about a factor of 3 less than that of pretectal tonic-on cells. The mean conduction velocity of 14 tonic-on fibers was 3.1 m/s.We argue that the tonic-on cells of the PO serve to integrate signals from tonic-on center retinal ganglion cells with adjacent receptive fields to provide signals for constriction of the pupil to neurons in the oculomotor nucleus.     

Experiences in the United States--a difference in the status in the United States and that in Japan]

Child and adolescent psychiatry has been established as a subspecialty in the United States. The systematic education, training and research opportunities are currently available and child and adolescent psychiatry is a major part of psychiatric practice in the US. However, there are many burdens to overcome to provide adequate child mental health care. Several important focus on child mental health care in US are to 1) improve the assessment of and recognition of mental health needs in children, 2) promote scientifically-proven and evidence based interventions and 3) increase access to and coordination of quality mental health care services. To understand the current status and problems in child and adolescent psychiatry in US may help the Japanese psychiatrists to develop and establish child and adolescent psychiatry in Japan.     

Organization in the descending tracts of the dorsolateral funiculus in the cat

Organization of the fibers in the descending tracts of the dorsolateral funiculus of the cervical spinal cord was investigated in cats. The spinal cord was penetrated with microelectrodes at 400 mum intervals in the medio-lateral direction at the c5/c6 and c6/c7 segmental borders. Silicon substrate microelectrodes with a linear arrangement of activated iridium contacts were used. The stimulus consisted of a 20 ms train of charge balanced biphasic current pulses at 330 Hz. The evoked activities from selected forelimb muscles were acquired into computer. Only the data points with an activation threshold of less than 35 muA were considered in the analysis. Muscle contractions were mostly in the form of short twitches. In both spinal segments, an area of high threshold was found in the middle of the dorsolateral funiculus. Majority of the muscles studied had a dorsal or ventral concentration of activation points. The distal muscles were mostly activated in the ventro-lateral aspect of the funiculus, while the elbow muscle maps spread to both dorsal and ventral sides. These results show a functional organization in both cervical segments studied, with overlapping regions between the areas dedicated for each forelimb muscle.     

Apoplexy in the everyday practice in the eighteenth century

We report the original recipes applied to treat apoplexy in the eighteenth century, as written in the personal notes of doctor of that century.     

Local nonuniformities in the syncytium of the horizontal cells of the retina in the turtle

Electrical coupling between horizontal cells of the turtle retina was investigated by means of two microelectrodes (current and recording ones) penetrating neighbouring cells at a fixed distance from each other. The morphological coupling was revealed by means of fluorescent dye Lucifer Yellow. The electrical coupling was confirmed between elements of similar type (L1--axonal terminals, or L2--cell bodies, or R/G type cells) and no coupling was found between elements of different types, though L1 and L2 are directly connected through thin axons. In the L1 syncytium the electrical coupling at small (less than or equal to 50 microns) but fixed distances between microelectrodes could differ several times depending on the minimal displacement of microelectrodes. This local nonuniformity of coupling can be explained on the basis of structural nonuniformities in the L1 (axon terminal) network. It is unlikely however that the structural nonuniformities can influence the functional properties of horizontal cell network when the retina is stimulated adequately (by light).