鼻咽癌放疗导致海马损伤及认知功能障碍研究进展

放射性认知功能障碍是鼻咽癌患者放疗后常见并发症,主要与神经发生障碍、胶质细胞损伤、血管损伤和细胞因子表达异常有关。随着医学的进步,功能磁共振可以提示认知障碍的早期病变,屏蔽海马及药物治疗(美金刚、多奈哌齐、贝伐单抗等)等方法可改善放射性认知障碍。本文总结了放射性认知障碍的发病机制、影像学、放疗剂量学和治疗方法。     

脂蛋白相关磷脂酶A2、胰岛素样生长因子-1与老年VD患者认知功能的关系及预测价值研究

目的 探讨脂蛋白相关磷脂酶A2（Lp-PLA2）、胰岛素样生长因子-1（IGF-1）与老年血管性痴呆（VD）患者认知功能的关系及预测价值。方法 选择2019 年3～6 月在我院接受治疗的VD 患者60 例为研究对象，同时选取同期在我院接受检查的健康者60 例为对照组，比较两组患者的Lp-PLA2、IGF-1、简易智力状态检查量表评分（MMSE）水平；采用Pearson 相关性分析法对Lp-PLA2、IGF-1 与MMSE 评分的相关性进行分析；采用受试者工作曲线（ROC）下面积（AUC）比较Lp-PLA2、IGF-1 对VD 的预测价值。结果 观察组患者的Lp-PLA2 水平明显高于对照组（P＜0.05），观察组患者的IGF-1、MMSE 评分明显低于对照组（P＜0.05）；Lp-PLA2 与MMSE 评分呈负相关性，IGF-1 与MMSE 评分呈正相关性；Lp-PLA2 与IGF-1 诊断VD 的AUC 值分别为0.940、0.954。结论Lp-PLA2 水平越低，IGF-1 水平越高，患者的认知功能越好，且Lp-PLA2、IGF-1 对老年VD 患者均具有较高的预测价值。     

复方玄驹胶囊联合山海丹颗粒治疗勃起功能障碍临床疗效观察

目的观察复方玄驹胶囊联合山海丹颗粒治疗勃起功能障碍。方法选择广西中医药大学第一附属医院仁爱分院男科门诊确诊为勃起功能障碍伴高脂血症患者30例,采用复方玄驹胶囊(口服,3粒/次,3次/天)和山海丹颗粒(1袋/次,3次/天),4周为一个疗程,服用三个疗程,采用自身前后对照的方法,根据服药前后各项指标的变化情况评价疗效。结果用药三个疗程后,患者IIEF-5评分显著性升高,患者总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)表达水平均降低,高密度脂蛋白(HDL-C)升高。结论复方玄驹胶囊联合山海丹颗粒可以改善高血脂症患者的勃起功能,同时降低血脂,效果显著,值得临床推广使用。     

Drug Burden Index and Cognitive and Physical Function in Aged Care Residents: A Longitudinal Study

ObjectivesAnticholinergic/antimuscarinic and sedative medications (eg, benzodiazepines) have been found to be associated with poorer cognitive and physical function and mobility impairment in older age. However, previous studies were mostly conducted among community-dwelling older individuals and had often a cross-sectional design. Accordingly, our aim was to examine longitudinal associations between cumulative exposure to anticholinergic and sedative medications and cognitive and physical function among residents from aged care homes.DesignLongitudinal study.Setting and ParticipantsA total of 4624 residents of Dutch aged care homes of whom data were collected between June 2005 and April 2014.MethodsOutcome measures were collected with the Long-Term Care Facilities assessment from the international Residential Assessment Instrument (interRAI-LTCF) and included the Cognitive Performance Scale, the Activities of Daily Living (ADL) Hierarchy scale, a timed 4-meter walk test, distance walked, hours of physical activity, and days being outside. Cumulative exposure to anticholinergic and sedative medications was calculated with the Drug Burden Index (DBI), a linear additive pharmacological dose-response model. Associations were examined with linear mixed models to take the potential dependence of observations into account (ie, data were collected at repeated assessment occasions of residents who were clustered in aged care homes). Analyses were adjusted for sex, age, dementia, comorbidity (neurological, psychiatric, cardiovascular, oncological, and pulmonary), fractures, depressive symptoms, and medications excluded from the DBI.ResultsWe observed significant longitudinal associations between a higher DBI and poorer ADLs, fewer hours of physical activity, and fewer days being outside. We found no significant longitudinal association between a higher DBI and poorer cognitive function.Conclusions and ImplicationsOver time, cumulative exposure to anticholinergic and sedative medications is associated with poorer physical but not cognitive function in aged care residents. Careful monitoring of aged care residents with high cumulative anticholinergic and sedative medication exposure is needed.     

Utilidad diagnóstica de test cognitivos breves en el cribado de deterioro cognitivo

Introduction and objectivesThis study aims to assess and compare the diagnostic performance of brief cognitive tests for cognitive impairment (CI) screening recommended by the Spanish guidelines for the integral care of people with Alzheimer's disease and other dementias.Material and methodsWe performed a phase iii study into the accuracy of diagnostic tests, including patients with suspected CI in a primary care setting. All patients completed the Mini–Mental State Examination (MMSE), the Mini Examen Cognoscitivo (MEC), the Short Portable Mental Status Questionnaire (SPMSQ), the Memory Impairment Screen (MIS), the Clock Drawing Test (CDT), the Eurotest, the Fototest, and the Memory Alteration Test (M@T). CI was diagnosed independently by researchers blinded to scores on these tests. Diagnostic performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC).ResultsThe study included 141 individuals (86 with CI). The Eurotest and M@T (AUC ± SE: 0.91 ± 0.02 and 0.90 ± 0.02, respectively) took longer to administer (mean [SD]: 7.1 [1.8] and 6.8 [2.2] min, respectively) and have significantly better diagnostic performance compared to the MMSE, MEC, SPMSQ, and CDT, but not compared to MIS or Fototest (both with an AUC of 0.87 ± 0.03), with the latter taking less than half as long to administer (2.8 [0.8] min). The M@T and MIS only evaluate memory, and the latter cannot be administered to illiterate people.ConclusionThe most advisable tests for CI screening in primary care are the Eurotest, M@T, and Fototest, with the latter being the most efficient as it takes half as long to administer.     

Association of blood lipids,atherosclerosis and statin use with dementia and cognitive impairment after stroke: A systematic review and meta-analysis

BackgroundTrial and observational evidence is conflicting in terms of the association of blood lipids, atherosclerosis and statin use with dementia and cognitive impairment in the general population. It is uncertain whether the associations occur in stroke patients, who are at known higher risk of cognitive decline. This systematic review was to synthesize the evidence for these associations among stroke patients.MethodsMEDLINE, EMBASE, the Cochrane Library and trial registries were searched. We included randomized controlled trials (RCTs) or observational cohort studies conducted among patients with stroke and reported on the association of blood lipids, atherosclerosis or statin use with dementia or cognitive impairment. Meta-analysis was conducted separately for crude and maximally adjusted odds ratios (ORs) and hazard ratios (HRs).ResultsOf 18,026 records retrieved, 56 studies (one RCT and 55 cohort studies) comprising 38,423 stroke patients were included. For coronary heart disease, the pooled OR of dementia and cognitive impairment was 1.32 (95%CI 1.10–1.58, n = 15 studies, I² = 0%) and 1.23 (95%CI 0.99–1.54, n = 14, I² = 26.9%), respectively. Peripheral artery disease was associated with dementia (OR 3.59, 95%CI 1.47–8.76, n = 2, I² = 0%) and cognitive impairment (OR 2.70, 95%CI 1.09–6.69, n = 1). For carotid stenosis, the pooled OR of dementia and cognitive impairment was 2.67 (95%CI 0.83–8.62, n = 3, I² = 77.9%) and 3.34 (95%CI 0.79–14.1, n = 4, I² = 96.6%), respectively. For post-stroke statin use, the pooled OR of dementia and cognitive impairment was 0.89 (95%CI 0.65–1.21, n = 1) and 0.56 (95%CI 0.46-0.69, n = 3, I² = 0%), respectively. No association was observed for hypercholesterolemia. These results were mostly consistent with adjusted ORs or HRs, which were reported from limited evidence.ConclusionAtherosclerosis was associated with an increased risk of post-stroke dementia. Post-stroke statin use was associated with decreased risk of cognitive impairment. To confirm whether or not statins confer advantages in the post-stroke population in terms of preventing cognitive decline over and above their known effectiveness in reducing risk of further vascular events, further stroke trials including cognitive assessment and observational analyses adjusted for key confounders, focusing on key subgroups or statin use patterns are required.