可疑痴呆人群中阿尔茨海默氏病临床前的认识损害特征及其与中医证候的关系

1背景可疑痴呆（Questionabledementia,QD）概念被用来描述那些有认知障碍而又不符合痴呆诊断标准的患者群，由美国老年病学家D．P．Devand博士等于1996年在第45期《美国老年病学杂志》首次提出1]。有关健康与衰老的大量研究显示，65岁以上人群中约30％的人有认知障碍但尚未达到痴呆诊断标准2]。平均2．5年随访研究发现，41．3％的QD个体进展为痴呆，44％的QD不能确定是痴呆，14．7％的人仍是QD1]。Bowen等3]报告QD转化成痴呆的数量随着随访时间的延长而增加，在18、36、54个月后随访时转化率分别为24％、44％和55％。有证据表明…

The correlation of characters of cognitive impairment preceding Alzheimer s dementia in individuals with questionable dementia to Chinese medical syndrome

To look for predictive markers preceding Alzheimer s dementia. Methods: This study involved multitudinal assessment of individuals in whom there was cognitive impairment that was insufficient to warrant a diagnosis of dementia, which were followed up for mean 11 months. Results: A diagnosis of probable AD was made in 58% of cases, VD in 21%, FLD in 5% and dementia of uncertain aetiology in the remainder. 42% subjects with memory loss are as result of ageassociated cognitive decline, 25% subjects are due to cerebralvascular accident, 1.8% subjects due to menopausal symptoms. 30.4% are of memory loss of unknown aetiology. Cognitive markers preceding dementia found within this study actually have discriminant function of the earliest changes of AD from age-associated cognitive decline. The group that developed dementia on follow-up does not differ significantly from the memory loss group on the WAIS-R total scores or on the digit forward, digit backward and picture completion. However, the subtest score for similarities on the WAIS-R is significantly lower in patients who became demented comparing with the rest of sample. Verbal memory such as story recall immediate and story recall delayed, verbal learning discriminant index, verbal fluency raw score showed significant lower in patients who became dementia. Moreover digit copy transformedscore on the SSRS also is very significantly lower in patients who became demented than those who were stable memory loss. The kidney deficiency syndrome of Chinese medicine was most common in QD, and the phlegm syndrome and the blood stasis syndrome were more common. The scores of the picture completion subtest and the story recall immediate subtest were significantly correlated to the score of the phlegm syndrome respectively. The scores of the picture completion subtest and the similarities subtest were significantly correlated with the score of the kidney deficiency syndrome respectively. Suggestion: Often a significantly long interval, well in excess of the mean follow up of 11 months in our study, is required before one can be certain that a person with no dementia but with significant memory impairment ,is or is not going on to develop a dementia. Folstein MMSE scores are significantly predictive for the outcome of cognitive impairment. The digit copy transformed score and the similarities were more significantly predictive for the outcome than the above four measures of verbal memory. The scores of neuropsychological test were correlated to the scores of syndrome of Chinese medicine.