遗忘型轻度认知损害患者海马三维磁共振影像特点

Objective To identify the characteristics of hippocampal 3-dimensional MRI in patients diagnosed as having subtypes of amnestic mild cognitive impairment(aMCI)using hippocampal surfacebased analytic technique.Methods Fifry aMCI patients and 16 healthy controls who were equivalent in age and education(NC)were recruited.Every subiect carried out a 3-dimensional MRI scan.After the imaging data were acquired.the borders of the hippocampus were manually traced in coronal vlew using the software of InsightSNAP1.4.1. Hippocampal volume was computed automatically and statistically analysed.Hippocampal 3-dimension MRI were transformed into 3-dimension parametric surface mesh models of 400×200 prids.Hippocampal radial distance measures which was the distance from the surface point to the central axis were statistically compared between two groups.The radial atrophy significance maps were acquired and adjusted for multiple comparisons.Hippocampal morphological difference maps of aMCI in contrast with NC were acquired.Results The average normalized volume of left hippocampus were(3247.5±600.2)mm3 in aMCI patients and(3467.9±451.3)mm3 in NC subjects.The average normalized volume of right hippocampus were(3416.8±699.1)mm3 in aMCI patients and(3469.1±358.9)mm3 in NC subjects.Comparison of hippocampal volume did not differ significantly between aMCI patients and NC subjects(t=1.161,P=0.255;U=0.178,P=0.859).By using hippocampal surface-based morphologic analytic technique,3-dimension hippocampal morphological difference maps between two groups were acquired,showing significant atrophy on the lateral and inferior hippocampal surface which corresponded to CA1 and subiculum hippocampal subfields bilaterally in aMCI patients compared with NC subjects. Conclusions aMCI patients do not have significant volume loss in the hippocampus. Through hippocampal surface-based morphologic analyses, partial regional atrophy of hippocampus at some degree is found, mainly localizing in the lateral and inferior hippocampal regions which correspond to CA1 and subiculum hippocampal subfields bilaterally in aMCI compared with NC. These results may reflect the early image marker in aMCI.     

驻京部队干休所居家痴呆照料者需求与身心负担的相关性研究

目的 探讨驻京部队干休所痴呆照料者需求现况及与其身心负担的相关性.方法 采用问卷调查方法,调查者通过发放问卷,对81位痴呆患者的主要照料者进行调查.结果 照料者总体需求呈中等程度,标化得分为(56.08±20.79)分;知识技能需求标化得分为(58.63±21.63)分;社会支持需求得分为(49.66±26.28)分.焦虑(32.47±8.25)分、抑郁(35.04±9.47)分、负担总分(18.91±11.47)分,其中社会支持需求得分与身心负担呈正相关.结论 驻京部队干休所痴呆照料者广泛存在中等程度的需求,满足照料者的需求,有助于减轻其身心负担.     

窦性心动过缓致皮质下分水岭脑梗死一例

临床资料 患者男性，84岁，主因“发作性右侧下肢力弱7d”入院。患者于入院前7d无明显诱因出现右侧下肢无力，不能独自站起，症状持续约15min后白行缓解，发作间期行走如常，此后上述症状反复出现，每日发作约1-2次。既往有冠心病、老年性痴呆病史。体格检查：血压145／80mmHg（1mmHg=0．133kPa），心率56次／min，心律齐。神经系统检查：意识清楚，记忆力、计算力、定向力减退，四肢肌力V级，右侧Babinski征偶可引出，左侧Babinski征阴性。入院后查头颅MRI：左侧额叶及枕叶多发亚急性梗死灶；超声心动图未见附壁血栓。入院后患者右侧肢体力弱症状逐渐加重，入院第6天痛刺激后左侧肢体肌力V级，右侧肢体肌力Ⅳ级，床旁重症监护仪连续监测患者心率、血压，心率为43-64次／min，血压波动于正常范围。给予缓释茶碱片口服，患者心率可维持在60次／min以上，神经系统症状体征逐渐平稳，入院后3周复查头颅MRI＋弥散提示：左侧侧脑室前后角、基底节区、枕叶大片新发梗死灶。患者发病前10个月曾查颈部血管超声：双侧颈总、颈内、右侧锁骨下动脉起始部内壁增厚，但未见显著管腔狭窄，彩色多普勒血流显像提示上述动脉血流通畅，双侧椎动脉血流通畅，未见充盈缺损。     

脑微出血与脑白质病变及腔隙性梗死关系研究

目的 探讨脑微出血（cerebral microbleeds,CMBs）与脑白质病变（white matter lesions,WML）及腔隙性 梗死（lacunar infarcts,LI）的关系。 方法 连续纳入2010年2月至2012年2月解放军总医院南楼神经内科病房根据病史及头颅影像学检 查确诊患有脑血管病或具有高血压、糖尿病、高脂血症等脑血管病危险因素者217例。采用GE公司 1.5T磁共振成像行头颅常规序列及T2 *血管加权成像（T2 star weighted angiography,SWAN）序列扫 描。记录深部及皮层部位CMBs病灶数,按照Fazekas评分和Scheltens改良量表将脑室旁白质高信号 （peri-ventricular hyperintensities,PVH）和深部白质高信号（deep white m atter hyperintensities,DWMH） 分别评分,根据病灶数量评估LI的严重程度分析CMBs与PVH、DWMH及LI的关系。 结果 随着PVH和DWMH评分的升高,CMBs的检出率分别由41.8%（PVH=1）及40.8%（DWMH=1）升高 至68.8%（PVH=3）及76.9%（DWMH=3）;随着LI数量的增加,CMBs的检出率由46.3%升高至75%。深 部CMBs与PVH及DWMH的严重程度有较强相关性（rs =0.345,P＜0.001;rs =0.346,P＜0.001）,与LI 亦显 著相关（r s =0.281,P＜0.001）;而皮层CMBs与PVH及DWMH严重程度仅呈弱相关（r s =0.219,P =0.001; rs =0.189,P =0.005）,与LI无显著相关性。 结论 深部CMBs与脑室旁及深部脑白质病变、LI相关。     

痴呆患者照料者积极感受现状的调查研究

目的 探讨痴呆患者照料者积极感受的现况.方法 采用问卷调查法对76例痴呆患者主要照料者(痴呆组)及76例非痴呆患者的主要照料者(对照组)的积极感受进行调查.结果 痴呆组主要照料者的积极感受总分及各维度得分均显著低于对照组.结论 痴呆患者照料者体验到较高的积极感受,但与非痴呆患者照料者相比,痴呆患者照料者体验的积极感受较低.     

认知训练治疗阿尔茨海默病的疗效观察

目的 观察认知训练治疗早中期阿尔茨海默病(AD)的临床疗效.方法 采用单盲随机对照方法.入选的32例早中期AD患者中,16例(认知训练组)进行认知训练联合药物治疗,16例(对照组)进行沟通对照联合药物治疗,治疗期为10周.在治疗前及治疗10周后,运用简易精神状态筛查量表(MMSE)、Fuld物体记忆测验(FOM)、词语流畅性测验(RVR)、画钟测验(CDT)、连线测验A(TMT-A)、数字广度测验(WAIS-DS)、积木测验(WISC-BD)、日常生活活动(ADL)能力量表、神经精神科问卷(NPI)等对患者进行评定.结果 治疗10周后,认知训练组的MMSE、TMT-A和NPI的改善均优于对照组,差异具有统计学意义(P＜0.05,P＜0.01).结论 认知训练治疗可稳定和改善早中期AD患者的认知功能和精神行为症状.

Abstract：

Objective To determine the efficacy of individual cognitive training (CT) in the treatment of cognitive and neuropsychiatric symptoms in patients with mild to moderate Alzheimer disease ( AD). Methods A randomized, controlled, rater-blind clinical trial recruited 32 AD patients. AH patients were assigned to a CT group (n = 16) or a control group (a time and attention control, n = 16) for 10 weeks. All outcome measures were administered at baseline and follow-up. The cognitive status was evaluated using the Mini Mental State examination (MMSE) , a clock-drawing test (CDT) , Fuld's object memory evaluation (FOME) , a rapid verbal retrieval (RVR) , digit span assessments (DS) , block designing (BD), and the A version of the trail making test (TMTA). The patients' functional status was evaluated using an activities of daily living (ADL) scale. Any psychological and behavioural disorders were evaluated with the Neuropsychiatry Inventory ( NPI). Results Patients receiving CT showed greater average improvements in NPI total score, TMT-A score and MMSE total score than the controis at week 10. There was no statistically significant benefit for CT-treated patients in terms of ADL score. Conclusions Cognitive training can raise the NPI total scores and MMSE total scores of patients with mild to moderate AD.     

轻度认知功能障碍的磁共振弥散张量成像研究

目的 应用磁共振弥散张量成像技术以及自动化影像分析工具研究遗忘型轻度认知功能障碍(aMCI)大脑白质结构的变化.方法 对受试者进行临床和神经心理评估,31例受试者(aMCI组15例,对照组16例)接受磁共振弥散张量成像技术扫描.所有影像资料经与标准模板配准后,采用基于像素的图像分析法确定两组各向异性分数有差异的脑区.结果 aMCI组简易智力状态检查量表(MMSE)(26.93±1.49)分,蒙特利尔认知评估量表(MoCA)(22.73±1.91)分,对照组MMSE(29.44±0.81)分,MoCA(26.50±1.17)分,差异有统计学意义(P<0.05).在aMCI组双侧额叶部分白质区域异性分数值低于对照组(P<0.1301).结论 额叶白质损伤可能参与了aMCI的病理生理过程的变化.     

老年人脑干梗死与椎-基底动脉供血不足的病例回顾研究

目的探讨老年人脑干梗死与椎基底动脉供血不足(VB I)临床特点的异同。方法回顾分析14例老年脑干梗死患者以及95例老年VB I患者的症状、体征、化验结果、影像学等临床资料。结果脑干梗死组运动障碍、感觉障碍、饮水呛咳、构音障碍以及颅神经体征、浅感觉障碍、下肢病理征、肌力减退和共济失调的发生率(71.4%、57.1%、50.0%、71.4%、92.9%、35.7%、100.0%、78.6%、42.9%)显著高于VB I组(19.0%、16.4%、3.2%、3.2%、18.9%、14.7%、36.8%、20.0%、15.8%)。脑干梗死组高血压的患病率(85.7%)显著高于VB I组(50.5%)。脑干梗死组入院后血糖均值(5.05±0.77)mmol/L低于VB I组(6.00±1.14)mmol/L。结论对于有后循环系统缺血临床表现的老年患者,应更加重视症状、体征的特征性变化,而高血压等心脑血管病的危险因素以及发病时血糖的水平有助于我们做出准确的判断。     

第427例——双手不自主抖动10年,行动迟缓5年,伴智能减退4年

病历摘要 患者男,90岁.因"双手不自主抖动8年,动作缓慢3年,智能减退2年"于2009年6月10日入院.患者于2001年9月开始出现双手不自主抖动,在紧张及肢体活动时明显,但自觉不影响日常生活.曾到神经科门诊就诊,当时神经系统检查:四肢肌力正常,肌张力不高,认知心理测试:简易精神状态评价量表(MMSE) 28分.临床考虑为"老年性震颤",但"帕金森病"不除外,在门诊试服金刚烷胺和安坦,剂量不详,自觉服药后效果不明显,于2个月后自行停药.此后双手不自主抖动持续存在,但并无妨碍日常活动而未到神经科就诊随访.2005年6月,单位健康体检再次来神经科检查,发现患者表情呆板,动作迟缓,行走小步态.2006年1月开始经常出现头昏眼花及行走不稳,其头晕以站立时明显,平躺时减轻,伴行走时身体前倾.此时神经系统检查记录:双上肢张力增高,可引出齿轮征,但下肢肌张力不高.2007年8月3日,因"精神萎靡1个月"在神经科住院,急诊头颅CT检查发现双侧亚急性硬膜下血肿.     

他汀类药物与老年痴呆的防治

痴呆是老年人群的常见疾病，随着老龄社会的来临，痴呆已经成为包括我国在内的许多国家主要的保健和社会问题之一。最常见的痴呆类型是阿尔茨海默病（Alzheimer’s disease AD），它是一种涉及多种发病因素、以进行性痴呆为特征的大脑变性性疾病，主要临床表现为进行性记忆力和认知力减退、精神运动异常等症状。最显著的神经组织学病理特征是神经细胞之间大量的老年斑和神经细胞内存在的神经元纤维缠结。