老年与非老年多灶脑梗塞性痴呆临床比较

本文对４６例老年与３２例非老年多灶脑梗塞性痴呆进行临比较发现：老年组情感脆弱及强哭强笑发生率明显高于非老年组，意识障碍亦较非老年多见；崦脑衰弱症状、情绪高涨、幻觉和感知觉综合障碍的发生率较非老年组为低。神经损害两组右侧偏瘫均较多见，震颤麻及吞咽困难的发生率老年组明显高于非老组。另外老年组脑部梗塞灶较多，且多为出血性，其痴呆程度相对较重。     

老年与非老年的谵妄患者比较分析

目的:探讨老年与非老年谵妄患者的临床特征及谵妄的影响因素。方法:以谵妄量表为工具,调查我院2005年全年精神科会诊的50例谵妄患者,非老年组29例,老年组21例,均符合中国精神障碍分类与诊断标准第3版和美国精神障碍诊断与统计手册第4版谵妄诊断标准,进行回顾性分析。结果:非老年组谵妄由脑外伤、中毒与成瘾物质戒断引起者显著较老年组为多,而老年组由脑卒中、痴呆、心血管疾病、呼吸系统疾病引起者显著较非老年组为多,差异显著。白细胞和中性粒细胞数增多、高红细胞压积、低血钾、血氧分压降低、高尿素氮、住院时间延长与谵妄程度有关。结论:老年与非老年的谵妄病因有所不同,老年人意识障碍较重,病情波动大。感染、内环境失衡与谵妄程度有关。     

老年人多灶脑梗死性痴呆的临床分析

本文对 3 4例老年人多灶脑梗死痴呆与 2 1例非老年多灶脑梗死性痴呆与 2 1例非老年多灶脑梗死性痴呆进行临床对照研究 ,以探讨老年人多灶脑梗死性痴呆的特点。现整理报告如下。1　资料与方法1 1　研究对象　选取 1990年 1月～ 2 0 0 0年 12月在我院神经内科住院 ,头颅ＣＴ扫描证实为多灶性脑梗死且符合ＤＳＭ -Ⅳ—关于多灶脑梗死性痴呆诊断标准的 5 3例患者作为研究对象。按发病年龄自然分成老年组 (≥ 60岁 )及非老年组 (<60岁 )。老年组 3 4例 ,男 2 4例 (70 6% ) ,女 10例 (2 9 4% ) ,男∶女 =2 4∶1,发病年龄 60～ 85岁 ,平均 67 8±…     

非老年脑梗死患者发病的相关因素研究

目的研究非老年脑梗死患者发病的相关因素。方法选取2012-03—2014-03在我院接受治疗的150例梗死患者进行研究,将患者分为非老年组和老年组,统计2组患者的睡眠情况、高血压史、高血脂史、糖尿病史、吸烟、酗酒、家族史等情况,并进行统计学分析。结果实验组睡眠质量差者明显高于对照组;实验组中吸烟者明显高于对照组;实验组有糖尿病史者明显低于对照组;实验组中高同型半胱氨酸人数明显低于对照组;实验组中有家族史者明显高于对照组,差异均具有统计学意义(P0.05)。结论影响非老年脑梗死患者发病的相关因素较多,其中睡眠质量差、高血压史、高血脂史、吸烟、酗酒、糖尿病史、高同型半胱氨酸和有家族史等因素均与患者发病相关。其中,睡眠质量差为对非老年脑梗死患者最危险的因素,需要广大患者注意。     

表现为精神障碍的老年慢性硬膜下血肿46例临床分析

目的 研究老年慢性硬膜下血肿(CSDH)伴发精神障碍的临床特征。方法 对46例住院的老年CSDH患伴发的精神障碍进行分析。结果 老年CSDH伴发的精神障碍以抑郁症状为主，占45．65％，其次神经衰弱占36．96％、记忆障碍占34．78％、智能障碍占23．91％及人格改变占21．74％；左侧CSDH伴发精神障碍较右侧多见，且血肿主要位于额、颞叶；血肿量大、颅内压增高明显以意识障碍多见，慢性进展型的颅高压以抑郁症状多见。结论 了解老年CSDH引起精神障碍的临床特征，有助于本病的诊断，避免误诊误治。     

老年贫血患者认知功能障碍分析

目的：分析并研究老年患者贫血与认知功能障碍的相关性。方法选取2011-05-2014-05来我院血液科门诊及住院的老年贫血患者120例,同时选择我院120例健康老年体检者作为对照组,用简易智能量表（MMSE）评价2组患者认知功能障碍发生率,定向力、计算力、注意力、记忆力、语言能力、表达能力及MMSE分值差别;同时将老年贫血患者按贫血程度分为轻中度贫血组和重度贫血组,比较2组认知功能障碍发生率、MMSE评分差别。结果贫血组认知功能障碍发生率大于对照组,贫血组MMSE分值低于对照组;贫血组计算力及注意力、记忆力较对照组明显下降（P＜0.05）,2组患者定向力、语言表达能力无显著差异（P＞0.05）。重度贫血患者认知功能障碍发生率高于轻中度贫血患者,MMSE分值低于轻中度贫血患者组（P＜0.05）。结论老年贫血患者与认知功能障碍有关,且贫血越严重,认知功能障碍发生率越高,MMSE分值越低。     

老年与非老年抑郁症的临床特征差异

目的:探讨老年期抑郁症的临床特征。方法:以60例老年期抑郁症患者作老年组,选60例非老年期抑郁症患者为非老年组。对两组分别用汉密尔顿抑郁量表和汉密尔顿焦虑量表进行评定。结果:老年组抑郁症状中激越和疑病症状显著高于非老年组(P<0.01),老年组的躯体症状中自主神经系统症状、心血管系统症状和消化系统症状显著高于非老年组(P<0.05或P<0.01);躯体性焦虑和认知障碍、焦虑/躯体化和睡眠障碍的严重程度均显著高于非老年组(P<0.05或P<0.01)。结论:老年期抑郁症激越、疑病、躯体症状、焦虑、睡眠障碍及认知障碍等更加突出。     

老年急性脑梗死早期静脉溶栓治疗疗效及安全性研究

目的探讨老年急性脑梗死早期静脉溶栓治疗的疗效及安全性。方法 对近5年接受静脉溶栓治疗的119例急性脑梗死的临床疗效进行回顾分析。结果 两组溶栓治疗后神经功能缺损均较治疗前明显改善(P<0.05);老年组42例与非老年组77例之间比较,显效率(54.7％,59.6％)和总有效率(83.2％,85.6％)均无明显差异(P>0.05);老年组和非老年组出血转化率比较,无显著性差异(P>0.05)。结论 早期静脉溶栓是一种治疗老年急性脑梗死安全有效的方法。     

老年脑梗死患者认知功能与头颅磁共振成像关系分析

目的探讨老年脑梗死患者梗死部位与认知功能障碍的相关性。方法对80例老年脑梗死患者依据《美国精神障碍诊断与统计手册》对认知功能障碍进行诊断,均用头颅磁共振检查明确病灶部位和范围;同时随机选择无明确梗死灶的80例老人为对照组。用中文版简易智能状态检查表和中文版蒙特利尔认知评估量表分别对两组患者认知功能做联合评估;半年后分别对以上患者复查其认知功能。结果脑梗死患者认知功能障碍的发生率为48.75%,脑梗死组侧别与对照组在认知功能上比较,脑梗死双侧组认识功能障碍发生率高于脑梗死单侧组,左侧脑梗死组认识功能障碍发生率高于右侧组。脑梗死患者中认识功能障碍发生率的次序由高到低为皮质组、丘脑组、基底节及内囊组、脑干组。结论脑梗死患者的认知功能障碍与病灶部位有相关性。     

老年无症状性脑梗死抑郁状态及影响因素的研究

目的探讨老年无症状性脑梗死(ACI)患者抑郁的特点及影响因素。方法用Hamilton抑郁量表对经CT或MRI证实的80例老年ACI患者进行抑郁状态测查,对梗死灶的部位、数量,合并症、烟酒嗜好、性别及文化程度等相关因素进行统计学分析。结果ACI抑郁发生率为36％,其中轻度抑郁为24％,中度抑郁为10％,重度抑郁为2％;抑郁症状以焦虑／躯体化、阻滞和睡眠障碍为主要表现;多灶性梗死组HAMD分、焦虑／躯体化分、阻滞及睡眠障碍分显著高于单灶性梗死组(P<0．01或0．05);皮质下梗死组HAMD分、焦虑／躯体化分、阻滞分显著高于皮质梗死组(P<0．05);多灶性梗死、皮质下梗死更易出现抑郁;抑郁症状的发生与伴有高血压、糖尿病及有烟酒嗜好有关。结论抑郁情绪为老年ACI患者较常见的症状,其产生与脑损伤的生物效应有关,且受多种因素的影响。     

Nonmetabolic causes of triphasic waves: a reappraisal

Two more patients with triphasic waves (TW) on their EEGs in the absence of metabolic disturbances are described. One patient had coma associated with cerebellar hematoma, the other had mild dementia associated with idiopathic calcifications of the basal ganglia and normal auditory brainstem responses, subcortical and cortical somatosensory evoked potentials. Neurologic examination failed to show asterixis in both patients. The literature on nonmetabolic causes of TW was also reviewed, and the clinical and anatomic reports of 10 patients have been analyzed: 7 patients had focal brainstem-diencephalic lesions (craniopharyngioma: 2 patients; thalamic gliomas: 3 patients; pontine stroke: 2 patients), and 3 patients suffered from diffuse subcortical or multifocal encephalopathies (Binswanger's encephalopathy: 1 patient; cerebral carcinomatosis: 1 patient; multifocal cerebral lymphoma: 1 patient). From the clinical point of view, patients with nonmetabolic diseases causing TW presented either disturbance of higher cerebral functions with no asterixis or sudden onset of coma. It is concluded that TW may result from focal brainstem/diencephalic lesions or from diffuse subcortical or multifocal encephalopathies in the absence of concomitant metabolic abnormalities. Nonmetabolic causes of TW should be suspected in patients presenting with neurologic disturbances not associated with asterixis.     

脑血管病性痴呆与Alzheimer病患者脑局部区域的血流量

目的 测定多灶脑梗塞痴呆及Ａｌｚｈｅｉｍｉｅｒ病患者的脑局部区域的血流量（ｒＣＢＦ），方法 用＾１３３氙（＾１３３Ｘｅ）吸入法测定１０例多灶脑梗塞痴呆患者。１０例Ａｌｚｈｅｉｍｅｒ病及２０名正常人的ｒＣＢＦ。结果 两个病例组双半球，脑干－小脑ｒＣＢＦ均明显低于正常健康组，脑梗塞痴呆组多数病例双侧半球灰质ｒＣＢＦ降低呈斑块状，Ａｌｚｈｅｉｍｅｒ病例组均为双侧大脑半球弥散性对称性的ｒＣＢＦ降低，前乾脑     

Progression of illness in the differential diagnosis of primary dementia

The diagnostic utility of determinations of insidious or stepwise progression of illness was examined in 124 geriatric inpatients with primary dementia. Such determinations failed to distinguish patients with primary degenerative dementia of the Alzheimer type from those with multi-infarct dementia. Episodic behavioral complications, especially depression and delusions, in the patients with primary degenerative dementia were associated with stepwise progression. Determinations of stepwise progression were made in only six (15%) of the 40 demented patients with at least two cerebral infarctions, a finding inconsistent with current diagnostic criteria for multi-infarct dementia.     

Neurologic complications in long-standing nephropathic cystinosis

The central nervous system has been considered to be uninvolved in nephropathic cystinosis. Survival into adulthood, following renal dialysis and transplantation, has brought attention to the sequelae of long-standing cystinosis. We examined 14 patients with cystinosis, 12 of whom had undergone renal transplantation. Two patients had neurologic symptoms. One patient had progressive bradykinesia, dementia, and spasticity with computed tomographic scan evidence of cerebral atrophy and multifocal mineralization in bilateral internal capsules and periventricular white matter. One patient had behavioral and, to a lesser extent, cognitive disturbance and computed tomographic scan evidence of marked, progressive cerebral atrophy. Although the remaining patients had normal results of neurologic examinations, 11 had roentgenographic evidence of generalized cerebral atrophy; 2 of these had abnormal electroencephalograms, 1 had borderline-deficient intellectual function, and 2 had computed tomographic scan evidence of multifocal, intracerebral mineralization. The patients with nervous system abnormalities were not distinguished by patterns of medication use, demographic or laboratory features, or the relative severity of cystinosis. Although the neurologic involvement in these patients suggests that cystinosis may eventually involve the central nervous system, the differential diagnosis must include other complications from renal failure, dialysis, and immunosuppression.     

进展性卒中与疱疹病毒感染相关性临床研究

目的 :探讨进展性卒中 (SIP)的临床特点及与人疱疹类病毒感染的相关性 ,为 SIP的临床诊治提供依据。方法 :对 47例 SIP患者进行 CT、 MRI、MRA、 DSA及颈动脉超声检查 ,分析影像学和临床特征 ;采用金标斑点法检测静脉血清人巨细胞病毒 (HCMV)和人疱疹病毒 (HSV) Ig M,并与非脑血管病患者组 (193例 )进行比较 ;用免疫组化方法检测骨髓细胞中的 HCMV基质蛋白 PP6 5抗原 ;加用磷甲酸钠 (PFA)抗病毒治疗 ,观察疗效。结果 :SIP患者 CT显示的脑梗死灶 90 .91%位于不同脑叶皮质、皮质下 ,呈单发或多发性不规则小斑片状低密度影 ;全部受检者均存在脑供血主要动脉或主要分支的狭窄或闭塞 ;HCMV和 HSV Ig M阳性率 90 .91%,与对照组比较有显著性差异 (P<0 .0 1) ;加用抗病毒药物 (PFA)疗效显著。结论 :脑 CT显示皮质、皮质下不规则小斑片状脑梗死灶 ,脑主要供血动脉或 /和主要分支狭窄或闭塞 ,是 SIP的影像学特征 ;结合抗病毒药物治疗疗效显著 ;SIP与人疱疹病毒感染明显相关。     

Platelet MAO activity in geriatric patients with depression and dementia

The authors studied platelet MAO activity in psychiatrically hospitalized geriatric patients with depression and dementia. Platelet MAO activity was higher in demented patients with and without depression and in depressed patients with reversible dementia than in nondemented depressed patients. The data suggest that abnormally high platelet MAO activity may reflect a predisposition to the development of a dementia syndrome.     

Multifocal periodic lateralized epileptiform discharges (PLEDs): EEG features and clinical correlations.

OBJECTIVE: To analyze the clinical and EEG findings of patients with multifocal periodic lateralized epileptiform discharges (PLEDs). METHODS: EEGs containing multifocal PLEDs (3 or more foci of PLEDs) were reviewed. Thirty-five patients (15 males and 20 females), from 2.5 months to 91 years old, met the criteria for multifocal PLEDs. RESULTS: The disease processes identified in the patients included vascular lesions in 9, central nervous system infections in 7, metabolic/toxic disorders in 6, exacerbation of a chronic seizure disorder in 6, hypoxic ischemic insults in 3, and fat embolism, paraneoplastic encephalitis, cerebral metastasis, and multiple sclerosis in one each. Twenty patients died. Detection of the spatiotemporal distribution of multifocal PLEDs was facilitated by the use of Laplacian montages. CONCLUSIONS: Multifocal PLEDs were recorded in 35 patients and were associated with processes resulting in diffuse or multifocal cerebral dysfunction. Multifocal PLEDs indicate a significant disturbance of cerebral function and are associated with a mortality rate of 57%.     

Intracranial dural arteriovenous fistula (DAVF) presenting progressive dementia and parkinsonism.

We studied three patients with dural arteriovenous fistula (DAVF). Major symptoms were progressive dementia and parkinsonism, both of which progressed in step-wise fashion. Two of the three patients showed diffuse cerebral white matter lesions on brain CT and MRI. Progressive dementia and parkinsonism in our patients could be caused by diffuse cerebral parenchymal disturbance: impaired cerebral circulation due to severe venous hypertension. DAVF is important for the differential diagnosis in patients with progressive dementia and parkinsonism.     

Dementia in hereditary cerebral hemorrhage with amyloidosis-Dutch type

Sixteen patients with hereditary cerebral hemorrhage with amyloidosis-Dutch type were examined neuropsychologically. Abnormalities were found in all patients, and dementia was present in 12 of them. Three patients were tested twice at an interval of some years. All three exhibited a progressive intellectual deterioration and memory disturbance; in two of them there was no evidence of intercurrent strokes. Cerebral amyloid angiopathy can lead to dementia because it produces multiple focal cerebral lesions, but a chronic ischemic or metabolic effect on brain parenchyma may play a contributing role.     

Hhcy对脑小血管病患者认知功能的影响

目的探讨高同型半胱氨酸血症(Hhcy)对脑小血管病(SVD)患者认知功能的影响。方法 142例SVD患者根据认知功能分为痴呆组、认知功能障碍非痴呆组、认知功能正常组,测定研究对象血浆同型半胱氨酸(Hcy)水平及MMSE、画钟测验评分。结果 (1)Hcy水平痴呆组明显高于认知功能障碍非痴呆组(P<0.05),认知功能障碍非痴呆组高于认知功能正常组。(2)Logistic回归分析得出Hcy水平升高是小血管病患者认知功能损害的独立危险因素。(3)Hhcy对MMSE总评分、定向功能、语言功能以及反应视空间功能、动作的计划性和执行功能画钟测验均有独立的危险性,其OR值分别为1.044、1.057、1.040、1.251。结论 Hcy水平升高是脑小血管病认知功能损伤的独立危险因素,对总体认知功能、定向功能、语言功能以及视空间功能、动作的计划性和执行功能有独立影响作用。