脑白质疏松症

脑白质疏松症已作为神经影像学的术语。由于神经影像学的发展 ,在老年人群中发现越来越多的白质异常。文章对脑白质疏松症的临床表现、影像学特点、病理、发病机制、危险因素及临床意义作了综述     

脑白质异常的研究及意义

本文概述了脑白质异常的研究结果及意义，指出由于其发病因素众多及在病理与临床之间，目前对该病的名命仍不一致。并讨论了该病的研究方向。     

基于弥散张量成像的阿尔茨海默病患者脑白质结构网络改变的研究

目的通过弥散张量成像(DTI)技术探测阿尔茨海默病(AD)患者早期的结构脑网络变化。方法纳入AD患者13例为AD组,同期健康体检者5例为对照组,进行简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估。应用DTI数据构建脑白质网络,并计算各脑区间信息传递的概率,将AD组每人信息传递概率排名前10的脑区组成一个集合定义为B1,对照组每人信息传递概率排名前10的脑区组成一个集合定义为B2,比较B1和B2中信息分布的概率差异。结果 AD组MMSE及MoCA评分明显低于对照组,差异有统计学意义[(18.5±2.6)分、(13.8±3.7)分vs (27.0±2.1)分、(25.5±3.3)分,P0.01]。B1和B2中的第2,第67、第68脑区的出现概率差异明显(76.92%vs 0,15.38%vs 80.00%,23.08%vs 80.00%)。这3个脑区分别是右侧中央前回,左侧楔前叶和右侧楔前叶。结论 AD的脑网络结构与正常人群不同。右侧中央前回、左侧楔前叶和右侧楔前叶3个脑区在AD患者和正常人群中信息流动的概率差异最大。     

脑白质异常的研究及意义

概述了脑白质异常的研究结果及意义,指出了由于其发病因素众多及在病理与临床之间存在差距,目前对该病的命名仍不确切,并提出了今后的研究方向。     

对阿尔茨海默病与血管性痴呆的临床探讨

目的探讨阿尔茨海默病(AD)与血管性痴呆(VaD)的临床及影像学特点，旨在为基层医师提供诊治依据。方法根据DSM-IVAD及VaD的诊断标准以及CDR的临床痴呆分级标准，对神经内科12例AD及10例VaD患者的临床特点及影像学进行分析(主要为MRI)。结果AD与VaD的临床特点及影像学存在着明显差异。结论AD与VaD的临床特点及影像学明显不同，可以为基层医师提供诊断及治疗依据。     

海南岛阿尔茨海默病的流行病学调查

目的 全面了解海南岛≥55岁人群中阿尔茨海默病(AD)的现况,分析其危险因素.方法 采用人口学、健康史、长谷川痴呆量表( HDS)、哈金斯基缺血指数量表(HIS)、临床痴呆评定量表(CDR)等问卷和量表进行筛查.结果 海南岛55岁及人群AD的患病率为1.45%(中国发达地区平均发病率2.0%),西部、中部及南部地区的患病率分别较北部和东部地区高(P＜0.05);女性患病率比男性高(P＜0.05);随年龄的增长而升高(P＜0.01).单身、听力障碍是AD的危险因素(OR＞1),而脑力劳动、富含鱼饮食则是保护因素(OR＜1).结论 海南岛AD患病率较国内发达地区低,患病率有一定地区差异,高患病率与女性、高龄、单身及存在障碍损伤有密切关系.     

阿尔茨海默病的研究进展

阿尔茨海默病(Alzheimer’s disease,AD)是一种老年常见的神经系统退行性疾病,常隐匿起病,其临床特征为记忆及其他认知功能障碍。早期临床症状包括运动、感觉或协调功能缺陷[1]。世界卫生组织(WHO)报道在世界范围内,痴呆患者有3 560万例,每年新发770万例。AD是痴呆的最常见病因,60%~70%的痴呆可归因于AD[2],是美国人群的第六大死因,     

缺血性卒中患者的脑白质病变

脑白质病变(white matter lesion,WML)是一种常见的神经影像学改变.随着人口老龄化和成像技术的发展,WML在老年人中的检出率逐渐增高.WML与缺血性卒中关系密切.文章对WML的病理生理学机制、影像学评价、临床表现、与缺血性卒中的关系以及预防和治疗进行了综述.     

脑白质异常的研究及意义

概述了脑白质异常的研究结果及意义，指出了由于其发病因素众多及在病理与临床之间存在差距，目前对该病的命名仍不确切，并提出了今后的研究方向。     

血清金属元素含量与老年阿尔茨海默病的关系

目的探讨血清金属元素含量与老年阿尔茨海默病的关系。方法随机选择老年科住院的33例阿尔茨海默病（Alzheimer disease,AD）患者以及33例同期住院的认知功能正常的内科疾病患者,对两组人口学统计资料、认知功能及血清26种金属元素含量进行测定并进行比较。结果两组血清金属元素含量测定Zn、Cr、Co、Ni浓度AD组较对照组降低（正态分布元素值Zn0．75±0．20和0．92±0．40;非正态分布元素值Cr28．24和38．76;Co28．17和38．83;Ni27．79和39．21,P〈0．05）结论部分金属元素如Zn、Cr、Co、Ni等可能与AD的病理相关。     

不同程度脑白质损害老年患者认知评分与神经解剖指标的关系

目的分析不同程度脑白质损害(WML)老年患者认知评分及神经解剖指标的特点及其相互关系。方法根据Fazekas分级标准将151例老年患者分为WML0级组62例、WML1级组46例、WML 2级组43例,分析各组患者蒙特利尔认知评估量表(MoCA)和神经解剖结构的差异及其相互关系。结果与WML 0级组和WML1级组比较,WML 2级组患者各项MoCA评分明显降低(P<0.01)。控制各项脑神经解剖结构指标后,WML分级与MoCA总分显著相关(r=-0.448,P=0.000)。WML2级组与WML 0级组比较,尾状核指数扩大、海马沟回比扩大、腔隙性脑梗死数目增多为独立危险因素。执行功能与皮质下萎缩(P<0.01)、颞叶萎缩及腔隙性脑梗死数目增多(P<0.05)显著相关。结论轻度WML患者认知功能及脑解剖结构无明显改变,中、重度WML患者多领域认知功能出现明显损害同时伴有广泛的脑萎缩,且WML导致的认知障碍独立于脑萎缩,提示额叶皮质-皮质下环路的破坏及对执行功能的影响是中、重度WML患者的显著特征。     

Risk factor analysis of cerebral white matter hyperintensities in children with sickle cell disease

Sickle cell disease (SCD) is complicated by silent cerebral infarcts, visible as white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI). Both local vaso‐occlusion, elicited by endothelial dysfunction, and insufficiency of cerebral blood flow (CBF) have been proposed to be involved in the aetiology. We performed an explorative study to investigate the associations between WMHs and markers of endothelial dysfunction and CBF by quantifying WMH volume on 3·0 Tesla MRI. We included 40 children with HbSS or HbSβ⁰thalassaemia, with a mean age of 12·1 ± 2·6 years. Boys demonstrated an increased risk for WMHs (odds ratio 4·5, 95% confidence interval 1·2–17·4), unrelated to glucose‐6‐phosphate dehydrogenase deficiency. In patients with WMHs, lower fetal haemoglobin (HbF) was associated with a larger WMH volume (regression coefficient = ?0·62, R² = 0·25, P = 0·04). Lower ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) levels were associated with lower CBF in the white matter (regression coefficient = 0·07, R² = 0·15, P = 0·03), suggesting that endothelial dysfunction could potentially hamper CBF. The findings of our explorative study suggest that a high level of HbF may be protective for WMHs and that endothelial dysfunction may contribute to the development of WMHs by reducing CBF.     

Deletion/insertion polymorphism of the angiotensin-converting enzyme gene and white matter hyperintensities in dementia: A pilot study

OBJECTIVES: To examine the association between the angiotensin-converting enzyme (ACE) deletion/insertion (D/I) polymorphism and white matter hyperintensities (WMHs) in patients with dementia. DESIGN: Observational pilot study with adjustment for potential confounders using analysis of covariance. SETTING: Secondary care old-age psychiatry services in greater Manchester, United Kingdom. PARTICIPANTS: Ninety-seven patients with dementia: 49 with Alzheimer's disease (AD, National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria) and 48 with vascular dementia (VaD, National Institute of Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria). MEASUREMENTS: The ACE D/I polymorphism, WMHs (deep WMHs (DWMHs) and periventricular hyperintensities (PVHs)) on T2-weighted magnetic resonance imaging, and potential cardiovascular confounders. RESULTS: The D/D polymorphism of the ACE genotype was associated with severity of DWMH (P = .005) but not PVH (P = .34), corrected for age, cardiovascular risk factors, and type of dementia. Post hoc analyses were limited by statistical power but suggested an interaction with the apolipoprotein E epsilon4 allele. CONCLUSION: The results support previous observations that genetic factors influence the development of WMHs in dementia. The involvement of the ACE D/I polymorphism in the pathogenesis of DWMHs in dementia (AD and VaD), by a mechanism that is independent of its association with cardiovascular risk factors, should be confirmed in a large population-based sample.     

阿尔茨海默病相关概念研究进展

随着人口老龄化的加剧,阿尔茨海默病(AD)患病率正逐年攀升,产生了巨大的社会和经济负担,并已成为一个重要的公共卫生问题。目前针对痴呆期患者的治疗效果欠佳,因此研究的热点正逐渐前移,由痴呆期治疗转向痴呆临床前期轻度认知损害的防治,以期对痴呆的发生发展进行较早预防,由此也衍生了许多定义。本文就AD认知损害的不同阶段(无症状性临床前阶段、轻度认知损害阶段和痴呆阶段)的相关概念进行了梳理,并作一较全面介绍,使临床医师能更好地理解AD认知损害各时期的概念。     

High cortisol and the risk of Alzheimer disease: A protocol for systematic review and meta-analysis

Background:Morning cortisol levels have been reported to be elevated among patients with Alzheimer disease (AD). We perform a protocol for systematic review and meta-analysis to assess morning central or peripheral cortisol levels in AD patients as compared with cognitively normal individuals.Methods:Studies were identified through systematic searches in August 2021 with no restrictions on date and time, language, and publication status using the following bibliographic databases: Embase, Medline, PubMed, Web of Science, Science Direct, and the Cochrane Library. Studies were identified using search terms related to cortisol, Alzheimer disease, and cognitive impairment. The study quality of included papers was evaluated using the “National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies.” Statistical analyses were performed using Stata (version 14, StataCorp, College Station, TX).Results:The findings of this study will be submitted to peer-reviewed journals for publication.Conclusion:Morning cortisol was elevated in AD patients and may have diagnostic and prognostic values for AD.     

Headache: an important symptom possibly linked to white matter lesions in thalassaemia

Neurological manifestations are reported only occasionally in patients with thalassaemia and are given much less prominence than the complications related to anaemia and iron overload. White matter changes (WMCs) on magnetic resonance imaging (MRI) in patients with thalassaemia were first reported two decades ago but the significance of these lesions remains unclear. We studied the neurological and cognitive manifestations in 82 older patients with thalssaemia [25 Thalassaemia major (TM), 24 thalassaemia intermedia (TI) and 33 haemaglobin E β thalassaemia (EBT)] and 80 controls, and found that headaches were more common in thalassaemia patients (50/82, 61%) than in controls (18/80, 22·5%: P < 0·001). WMCs on MRI were found in 20/82 (24·3%) patients and 2/29 (6·9%) controls had (P = 0·078). WMC were more common among those with headaches (17/50: 34%) than in those without headache (3/32; 9·3%) (P = 0·023). WMCs were not associated with reduction of cognition. Nevertheless, cognition was lower in the TI and EBT groups compared with those with TM (P = 0·002). The association of headache with WMC in thalassaemia has not been reported before and warrants further study.     

Efficacy of Yukmijihwang-tang on symptoms of Alzheimer disease: A protocol for systematic review and meta-analysis

Background:Alzheimer disease (AD) is the most common cause of dementia, which may lead to severe memory loss and other cognitive disorders. Yukmijihwang-tang (YMJ), a type of Korean traditional herbal medicine, has been shown to be effective against neurodegenerative diseases. Although a meta-analysis on the efficacy of YMJ on AD exists, the study had some limitations, and there have been several newly published studies assessing the effect of YMJ. Therefore, the purpose of this study is to evaluate the efficacy and safety of YMJ as a treatment for AD through a meta-analysis.Methods:A systematic search of the following electronic databases will be conducted to identify eligible studies: MEDLINE (PubMed), Elsevier (EMBASE), The Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Korean Medical Database (KMBASE), Oriental Medicine Advanced Searching Integrated System (OASIS), Korean Traditional Knowledge Portal, Citation Information by NII (CiNii), China National Knowledge Infrastructure (CNKI). All randomized controlled trials assessing the efficacy and safety of YMJ on the symptoms of AD will be included. Two independent reviewers will perform article retrieval, deduplication, data screening, data extraction, quality evaluation, and data analyses using RevMan version 5.4. The Cochrane risk of bias tool will be used to assess the quality of the trials.Results:This study will provide synthesis of the cognitive function measured with neuropsychological tests, behavioral and psychological symptoms of dementia (BPSD), and activities of daily living (ADL) measured using validated scales. The clinical effective rate and adverse events will also be analyzed to assess the efficacy and safety of YMJ for treating AD.Conclusion:This systematic review will provide evidence for the efficacy and safety of YMJ in AD.Ethics and dissemination:Ethical approval is not required because individual patient data will not be included in this study. The study findings will be disseminated through conference presentations.