Serum paraoxonase activity changes in patients with Alzheimer's disease and vascular dementia

The prevalence of Alzheimer's disease (AD) and vascular dementia (VAD) increases with aging of the population. The role of lipoproteins in the pathogenesis of AD is unclear: apoE₂ offers protection and apoE₃ is neutral, while apoE₄ promotes the development of the disease. Recently, several studies have confirmed the role of oxidative stress in the pathogenesis of AD and VAD. HDL-associated paraoxonase is one of the antioxidative enzymes that may reduce LDL oxidation. In our study, we investigated the lipid parameters of the sera and the serum paraoxonase activity in patients with AD and VAD. Lipid parameters were determined by an autoanalyzer in 30 AD patients, 40 VAD patients and 40 healthy, age-matched control (C) subjects. Paraoxonase activity was measured spectrophotometrically using paraoxon as the substrate. The phenotypic distribution of paraoxonase was determined by the dual substrate method, using paraoxon and phenylacetate as substrates. In our results, we found that most of the patients with AD had the apoE4 isoform, consistent with other studies. In the VAD and AD patients we found significantly higher total-cholesterol compared to the control group (C: 4.71 ± 0.89, VAD: 6.3 ± 0.8, AD: 6.52 ± 0.7 mmol/l; p < 0.01) and LDL-cholesterol levels (C: 2.6 ± 0.6, VAD: 3.96 ± 0.8, AD: 3.84 ± 0.6 mmol/l; p < 0.001). The HDL-associated antioxidant, paraoxonase activity did not differ significantly in the patient groups, but compared to the healthy control subjects, paraoxonase activity was significantly lower in both of the patient groups (C: 188 ± 55 U/l; AD: 131 ± 37, VAD: 151 ± 50 l; p < 0.05). Our results suggest that the defect in HDL-associated antioxidant capacity plays a role in the pathogenesis of Alzheimer's disease and vascular dementia. Received: 30 November 2001 / Accepted: 24 January 2002     

阿尔茨海默病和额颞叶痴呆徘徊行为的比较

目的 比较阿尔茨海默病和额颞叶痴呆徘徊者步行活动水平及活动节律的差异.方法 利用电子示踪监测系统对阿尔茨海默病(Alzheimer disease,AD)徘徊者27例及额颞叶痴呆(frontotemporal dementia,FTD)徘徊者7例进行连续30 d的24 h活动监测,比较两组日、夜活动水平(步行距离),以及活动节律的日间稳定性和日内变异性.结果 AD组和FTD组的年龄分别为 (73.89 ± 9.12)岁和(63.43 ± 14.93)岁,而发病年龄分别为 (70.16 ± 9.26)岁、(58.17 ± 15.16)岁.AD组的年龄较大而发病年龄较晚(P ＜ 0.05).AD组和FTD组在6:00 ～ 23:59的步行距离分别为(2119.39 ± 2535.59)m、(4842.44 ± 2617.94)m,后者较长(P ＜ 0.05),但两组在0:00 ～ 5:59的活动水平差异无统计学意义(P ＞ 0.05).FTD组活动节律更加稳定[(0.50 ± 0.11) vs (0.29 ± 0.15),P ＜ 0.01],日内活动变异片段数更少[(2.80 ± 0.74) vs (4.07 ± 0.95),P ＜ 0.01].结论 AD 和FTD 两类痴呆的徘徊行为特点不同,提示有必要建立痴呆亚型特异性徘徊行为的非药物干预策略.     

Effects of 2-deoxy-D-glucose on multi-unit activity of the hypothalamus in rats

Mutli-unit activity was recorded from the diencephalon of unanesthetized, immobilized female rats. Less than 50% of the recording sites in the hypothalamus showed changes in the level of multi-unit activity to changes in the level of glucose utilization induced by injection of 2-deoxy-D-glucose (2-DG). It was also not possible to specificy an area within the hypothalamus in which there was a concentration of recording sites which consistently responded to 2-DG. Relatively large amplitude, long duration changes in multi-unit activity levels were also observed in the optic tract, suggesting that 2-DG induced a widespread cellular metabolic response to glucoprivation which may not have been related to the regulation of feeding.     

No antibodies to HTLV-I and HIV in patients with dementia in Finland

Patients with human immunodeficiency virus (HIV) have often progressive dementia. Human T cell lymphotropic virus Type I (HTLV-I) infection has not been reported to cause dementia. We tested antibodies to HTLV-I and HIV in serum and cerebrospinal fluid in 69 Finnish patients referred because of dementia to an outpatient department of neurology. No antibodies to HTLV-I and HIV were detected in patients with the clinical diagnosis of Alzheimer's disease, vascular dementia, secondary dementia due to a specific cause, or in cases of atypical dementia.     

Association between the hydrogenase level and the occurrence of remote diffusion-weighted imaging lesions after spontaneous intracerebral hemorrhage

To explore the influence of serum lactate dehydrogenase (LDH) level on remote diffusion-weighted imaging lesions (rDWILs) after spontaneous intracerebral hemorrhage (ICH). A consecutive cohort of 160 patients with spontaneous ICH who had brain MRI within 4 weeks of ICH onset were collected and analyzed retrospectively. rDWILs showed high signal on diffusion-weighted image (DWI) while low signal on apparent diffusion coefficient (ADC), and at least 20 mm away from the hemorrhage focus. The blood samples were obtained within 24 h after ICH onset from all patients. Lactate dehydrogenase (LDH) levels in blood were collected from serum biochemical tests. We use multivariate logistic regression analyses to investigate the association between serum LDH level and rDWILs after ICH. The average serum LDH level was 186.5 ± 35.6 U/L. And this level was higher in patients who presented rDWILs than in those without rDWILs. With the best cut-off value of 191 by using receiver operating characteristic (ROC) analysis, elevated LDH was associated with the presence of rDWILs independently (OR = 1.024, 95%CI = 1.011–1.037, P < 0.001) in the bivariate logistic regression analysis with adjustment for age, sex, previous ischemic stroke/TIA, smoker, SBP on admission, hematoma volume, and intraventricular hemorrhage (IVH). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of LDH ≥ 191 U/L for rDWILs were 70.4%, 72.2%, 33.9%, 94.2%, respectively. Our study suggests serum LDH level has a significant correlation with rDWILs after spontaneous ICH. Patients with higher serum LDH level in 24 h after ICH onset may be a useful predictor for rDWILs occurrence.     

精神分裂症患者脑电地形图与CT扫描对比分析

对５５例首次入院的精神分裂症或分裂样精神病患者脑电地形图（ＢＥＡＭ）与ＣＴ扫描结果进行对比分析。结果发现，ＢＥＡＭ的阳性检出率显著高于ＣＴ，两者间经一致性检验，Ｋａｐｐａ系数值为０．０３４，说明所观察到的一致性完全是机遇造成。研究表明；两者在功能性和脑器质性精神障碍的辅助诊断研究上各有所长，二者有机结合，应用上才能恰到好处。     

CSF cholinesterase in early-onset and lateonset Alzheimer's disease and multi-infarct dementia of Chinese patients

Using Ellman spectrophotometric method we measured the total cholinesterase (ChE) activity in lumbar cerebrospinal fluid (CSF) of 13 persons without neurological disorder, 10 non-demented patients with cerebral infarcts, 17 patients with dementia of Alzheimer's type (DAT) (11 presenile, 6 senile cases), 10 patients with multi-infarct dementia (MID), 1 patient with Parkinson's disease associated with dementia. The ChE activity in CSF was significantly lower in the DAT group compared with age-matched control subjects (p<0.001). This paper also analyses the possibility of using CSF ChE activity as a marker of DAT, and the relationships between its level of activity and the age of the patient at onset, stage of illness and severity of dementia as well as discrepancies in the data published so far. Previous work has shown that ChE activity in the brain tissue and CSF of MID is normal: therefore, if low ChE activity is found in the CSF of MID patients, as was obtained in 8 out of 10 cases in our series, the diagnosis of mixed dementia should be considered.     

电针智三针对血管性痴呆患者认知功能和行为能力的影响

目的探讨电针智三针对血管性痴呆的疗效,为临床应用提供依据。方法采用随机数字表法将56例血管性痴呆(VD)患者随机分为电针组(电针治疗4周)和药物组(尼莫通,30mg,3次/d,治疗4周),治疗前后进行简易智能状态检查量表(MMSE)、长谷川痴呆修改量表(HDS)、日常生活能力(ADL)和P300等监测,观察2组治疗前后的变化。结果MMSE、HDS、ADL评分和P300监测均显示2组治疗后比治疗前明显改善,差异有统计学意义(P0.05);电针组的疗效优于药物治疗组(P0.01)。结论电针智三针可改善VD患者的认知功能和生活行为能力,疗效优于尼莫通。     

美金刚与奥氮平治疗老年期痴呆的行为和精神症状对照研究

目的 探讨美金刚与奥氮平治疗老年期痴呆的行为和精神症状(BPSD)的疗效及不良反应.方法 将86例老年期BPSD患者分为美金刚组与奥氮平组,治疗8周.在治疗前、治疗2周末、4周末和8周末,采用痴呆病理行为评定量表(BEHAVE-AD)评定疗效,简易精神状况检查量表(MMSE)评定患者认知功能,日常生活能力量表(ADL)评定患者生活质量,治疗中需处理的不良反应症状量表(TESS)评定不良反应.结果 美金刚组在治疗后第2、4、8周末BEHAVE-AD评分较奥氮平组显著下降(t=2.12、t=2.23、t=2.28,P＜0.05).美金刚组在治疗后第8周末MMSE评分较治疗前显著升高(t=2.33,P＜0.05),奥氮平组治疗前后MMSE评分差异无显著性(t=0.42,P＞0.05),两组比较差异有显著性(t=2.04,P＜0.05).两组治疗后第8周末ADL评分显著下降(t1=2.35,t2=2.49,P＜0.05),两组比较差异无显著性(t=0.45,P＞0.05).美金刚组不良反应少于奥氮平组(x2=5.09,P＜0.05),两组在锥体外系反应(EPS)、口干、嗜睡、体质量增加方面差异有显著性(x2=4.62～6.86,P＜0.05).结论 美金刚对老年期痴呆患者的认知功能及行为和精神症状的改善均有效,且安全可靠.     

The association between activity participation and time to discharge in the assisted living setting

OBJECTIVES: Given recent evidence that activity participation may reduce functional decline, the effect of activity on resident ability to remain in assisted living (AL) is of interest. This study examines the relationship between participation in activities and the length of time residents remain in AL. METHODS: The data reported here were gathered in the initial phase of the Maryland Assisted Living Study (MDAL), an epidemiologic study of psychiatric disorders in AL. A stratified, random sample of 198 residents of 22 AL facilities in central Maryland was evaluated using a number of cognitive, behavioral, general health, and functional assessments. The total amount of time each resident spent in group and solitary activity in the prior month was quantified. The dependent variable, time to discharge (TTD), was the number of days between the date of initial assessment by the study team and the date of death in AL, discharge, or administrative censoring. RESULTS: Greater levels of activity participation at baseline are associated with longer TTD in an univariate Cox proportional hazards model. After adjustment for global cognitive functioning, general medical health, and mobility, greater activity participation remained associated with longer TTD in AL (p=0.017). CONCLUSIONS: Higher levels of activity are associated with longer retention in the AL setting. This effect appeared to be independent of other potentially confounding factors such as general health, cognitive impairment, and mobility. This finding is consistent with the hypothesis that engagement in activities delays functional decline, but further longitudinal research is needed to understand this finding.     

Moderating effect of self-efficacy on the relation between behavior problems in persons with dementia and the distress they cause in caregivers

Introduction: Behavioral and psychological symptoms in dementia (BPSD) are the principal sources of stress in caregivers. The aim of the present work is to analyze the moderating effect of self-efficacy for managing BPSD on the distress these problems generate in family caregivers.

Method: The participants were 231 family caregivers of people with dementia. We assessed the frequency and caregiver distress associated with three dimensions of BPSD (depressive, disruptive and memory problems). In addition, we assessed the moderating effect of self-efficacy for dealing with BPSD in the relationship between the dementia patient's frequency of BPSD and caregiver distress through hierarchical regression analyses, one for each of the dimensions of BPSD.

Results: We found a moderating effect of self-efficacy on the relation between the frequency of BPSD and the distress in caregivers for the dimensions of depressive and disruptive behaviors. Caregivers having to deal with a high frequency of behavior problems but with high levels of self-efficacy presented significantly lower levels of distress associated with depressive and disruptive behavior problems compared to those caregivers with low levels of self-efficacy. No differences in the effects of self-efficacy were found for distress levels of caregivers who dealt with low frequency of BPSD. Also, we did not find a moderating effect of self-efficacy on the relation between the frequency of memory problems and caregivers’ distress.

Conclusions: The results suggest that self-efficacy for managing BPSD attenuates the relation between the frequency of behavior problems – both disruptive and depressive – and the distress they cause in caregivers.     

Association between activity level and situational factors in children with attention deficit/hyperactivity disorder in elementary school

The aim of this study was to determine whether the objective activity level of children with attention deficit/hyperactivity disorder (AD/HD) is associated with situational factors in elementary school. A total of 16 children with combined-type AD/HD (13 boys, 3 girls) and 20 controls matched for age and gender participated in the study. All the participants wore the objective measurement of activity level for 1 week while attending elementary school. The average activity levels were calculated for the morning and afternoon classes. The classes were categorized into four types: (i) in-seat classes, in which the participants were expected to learn quietly while sitting in their own seats; (ii) not-in-seat classes, in which the participants were not expected to sit in their seats; (iii) physical education classes; and (iv) lunch/recess periods. During the afternoon in-seat classes, the children with AD/HD were significantly more active than the controls. However, no significant differences based on the group (children with AD/HD or controls) were observed during the other morning or afternoon classes. These findings indicate that in naturalistic settings where the effects of situational demands involving inhibition and the effect of fatigue overlapped, the children with AD/HD exhibited an activity level that was different from that exhibited by the controls. Differences in the activity levels of children with AD/HD and normal controls were identified using an objective measurement of activity level when two situational factors overlapped.