术侧上肢功能锻炼对开胸术后患者心理状态的影响

目的探讨手指操训练延缓老年轻度认知障碍的效果。方法将30例轻度认知障碍的老年人进行基本匹配分为干预组和对照组各15例，对照组不作任何干预，干预组每天9：30～10：00，在保健师的带领下做手指操，持续3个月．用MMSE、MOCA、ADL评价干预效果。结果3个月后，对照组MMSE、MOCA评分显著低于干预前，而ADL评分显著高于干预前（均P〈0．01）；干预组干预前后MMSE评分差异无显著性意义（P〉0．05），但显著高于对照组干预后（P〈0．05）．MOCA、ADL评分显著优于干预前及对照组干预后（P〈0．05．P〈0．01）。结论轻度认知障碍患者的认知水平随时间的推移呈下降趋势，手指操训练可延缓老年轻度认知障碍的进程。     

全程护理干预对早中期老年性痴呆患者生活质量的影响

目的探讨早、中期老年性痴呆（AD）患者的全程护理方法。方法将确诊为早、中期AD的80例患者随机均分为观察组和时照组。对照组采用一般住院护理指导；观察组实施住院-社区-家庭全程护理干预，即在科学组织管理的基础上进行全程护理干预，实施心理护理以厦记忆、智能、逻辑思维、日常生活能力等训练，并进行安全护理指导。结果两组干预后简易精神状态检查量表（MMSE）、日常生活能力量表（ADL）评分均显著高于干预前（均P〈0．05），干预后评分观察组与对照组比较，差异有显著性意义（P〈0．05．P〈0．01）。结论全程护理干预可提高AD患者生活质量，延缓病情进展。     

创伤性脑损伤后认知功能障碍的临床治疗研究

目的探讨盐酸多奈哌齐对创伤性脑损伤（TBI）后认知功能障碍的干预作用及其对TBI临床预后的影响。方法将TBI后合并认知障碍患者86例，随机分成治疗组和对照组，治疗组应用盐酸多奈哌齐10mg，每日一次服用；对照组应用吡拉西坦0．8g，每日三次服用。两组的治疗周期为12周。治疗前及治疗后，分别应用简明精神状态检测量表（MMSE）、国人修订成人韦氏智利量表（WAIS—RC）和格拉斯哥预后评分（GOS）来评价疗效。结果治疗后12周两组MMSE和WAIS—RC评分均较治疗前提高（P〈0．05）。治疗后12周，治疗组MMSE和WAIS—RC评分较对照组高（P〈0．05），治疗组预后优良率优于对照组（P〈0．05）。结论盐酸多奈哌齐对TBI后认知障碍有积极治疗作用，并能改善其预后。     

认知式自助疗法对神经症患者焦虑抑郁情绪的影响

目的探讨认知式自助疗法对神经症患者焦虑抑郁情绪的影响。方法将60例神经症患者随机分为对照组和观察组各30例,对照组进行常规治疗及心理护理,观察组在常规治疗的基础上采用认知式自助疗法进行心理干预;分别在住院第2天及住院后1个月对患者进行SAS、SDS评定。结果干预后两组患者SAS、SDS评分较干预前显著下降（均P〈0．05）,观察组SAS、SDS评分较对照组下降更显著（均P〈0．05）。结论认知式自助疗法能改善神经症患者的焦虑抑郁情绪,帮助患者矫正不良认知,重塑健康行为。促进疾病的康复。     

综合性护理干预对耐多药结核病患者生活质量及疗效的影响

目的提高耐多药结核病患者的疗效及生活质量。方法将60例耐多药结核病患者随机分成观察组和对照组各30例，对照组采用规则抗结核治疗和常规护理，观察组增加针对性综合护理干预，疗程均为12个月。结果两组干预前后生活质量中的物质生活评分比较，差异无显著性意义（均P〉0．05），干预后观察组躯体功能、心理功能评分显著高于对照组（均P〈0．01），观察组干预后社会功能评分显著高于干预前（P〈0．01）；接受12个月化疗后痰菌转阴及空洞闭合率显著高于对照组（均P〈0．01）。结论采用综合性护理干预能提高耐多药结核病患者的疗效，改善其生活质量。     

专科护理模式在血管性痴呆患者护理中的应用

目的 探讨对血管性痴呆患者施行专科护理的临床效果。方法 将56例患者随机分为观察组（30例）和对照组（26例）．对照组予常规护理．观察组实施以自护理论为依据．3R护理法为主要内容及心理护理贯穿始终的专科护理模式．比较护理干预前及干预8周后两组简易精神状态检查表（MMSER）、长谷川智能量表（HDS-R）及社会功能活动调查表（FAQ）的评分结果。结果 观察组护理干预后MMSE-R总分、HDS-R评分显著高于对照组（均P〈0．05）．FAQ评分显著低于对照组（P〈0．05）。结论 专科护理模式有利于血管性痴呆患者的康复。     

对精神分裂症患者陪护亲属实施认知教育的研究

目的探讨对精神分裂症患者陪护亲属实施认知教育的效果。方法将100名精神分裂症患者陪护亲属随机分为观察组和对照组各50名，对照组进行常规安全护理教育，观察纽在此基础上进行认知教育。采用自行设计的患者住院观察表记录患者自杀、外走、自伤、伤人行为；并于患者出院前1d对陪护亲属进行疾病认知调查。结果干预后，观察纽陪护亲属对疾病的概念、疾病的治疗、疾病的转归评分显著高于对照组（均P〈0．01）；观察组患者自杀未遂、外走、自伤、伤人发生率显著低于对照组（P〈0．05，P〈0．01）。结论认知疗法能提高陪护亲属对精神疾病的认知度及监护能力，减少患者自杀、外走、自伤、伤人的发生，从而提高监护质量，并为预防医患纠纷提供了证据。     

护理干预对情感障碍患者认知行为的影响

目的 探讨护理干预对情感障碍患者认知行为的影响。方法 将62例情感障碍患者随机分为观察组（30例）和对照组（32例）。两组均给予常规药物治疗及情感支持；观察组在此基础上予以认知行为护理干预。6周后运用症状自评量表（SCL-90）、抑郁自评量表（SDS）评定疗效。结果 观察组干预后SCL-90评分中。强迫、人际关系、抑郁、焦虑、恐怖、躯体化、精神病性各因子分显著低于对照组（P〈0．05。P〈0．01）；SDS评分显著低于对照组（P〈0．01）。结论 护理干预可降低情感障碍患者抑郁、焦虑情绪及躯体症状。促进疾病康复。     

银杏叶提取物联合尼莫地平治疗血管性痴呆的疗效及安全性

目的探讨银杏叶提取物联合尼莫地平对血管性痴呆患者认知功能和行为能力的临床疗效及安全性。方法将82例血管性痴呆患者随机分为两组,在治疗前和治疗12周后进行简易精神状态量表（MMSE）和13常生活活动能力量表（ADL）的评分并比较两组的评分结果。结果联合用药组MMSE评分为（21．7±4．8）分,ADL评分为（26．4±10．3）分;对照组分别为（17．8±4．5）分和（30．1±12．4）分,差异有统计学意义（P〈0．05）。结论银杏叶提取物能有效改善血管性痴呆患者的认知功能及日常生活能力,与尼莫地平联合治疗的效果优于单独使用,且安全性较高。     

日记式认知干预对原发性高血压患者心理及血压的影响

目的探讨日记式认知干预方法对原发性高血压患者心理及血压的影响,为良好控制该人群的情绪及血压提供参考。方法将54例原发性高血压住院患者随机分为观察组与对照组各27例。观察组采用日记式认知干预,即用日记记录负性情绪、每日的饮食及用药等,责任护士阅读患者日记并针对问题采取干预。对照组采用常规护理。结果干预后观察组除敌对性和精神病性因子外,其它7个因子（躯体化症状、强迫、人际关系敏感、焦虑、抑郁、恐怖和偏执）的评分显著低于对照组（P〈0．05,P〈0．01）。干预后观察组患者血压下降幅度显著（P〈0．05）。结论日记式认知干预可以使原发性高血压患者的负性情绪得到明显的改善,使血压趋于平稳。     

Cognitive side-effects of adjuvant treatments

Symptoms associated with cognitive dysfunction-difficulties with memory, concentration, and language-are frequent among breast cancer survivors after chemotherapy. The true incidence, functional significance, and causes of these symptoms remain unclear. Models of cognitive dysfunction suggest multiple possible contributors including changes in hormonal milieu, direct effects of chemotherapy, medications given as supportive care, psychiatric changes including depression and anxiety, and mediators of inflammation. Novel neuro-cognitive testing and imaging methods are being evaluated in breast cancer survivors to better understand cognitive side-effects of therapy.     

Treatment of Post-Traumatic Cognitive Impairments

OPINION STATEMENT: ? Cognitive impairment is a common consequence of traumatic brain injury (TBI) and a substantial source of disability. Across all levels of TBI severity, attention, processing speed, episodic memory, and executive function are most commonly affected.? The differential diagnosis for post-traumatic cognitive impairments is broad, and includes emotional, behavioral, and physical problems as well as substance use disorders, medical conditions, prescribed and self-administered medications, and symptom elaboration. Thorough neuropsychiatric assessment for such problems is a prerequisite to treatments specifically targeting cognitive impairments.? First-line treatments for post-traumatic cognitive impairments are nonpharmacologic, including education, realistic expectation setting, environmental and lifestyle modifications, and cognitive rehabilitation.? Pharmacotherapies for post-traumatic cognitive impairments include uncompetitive N-methyl-D-aspartate receptor (NMDA) antagonists, medications that directly or indirectly augment cerebral catecholaminergic or acetylcholinergic function, or agents with combinations of these properties.? In the immediate post-injury period, treatment with uncompetitive NMDA receptor antagonists reduces duration of unconsciousness. The mechanism for this effect may involve attenuation of neurotrauma-induced glutamate-mediated excitotoxicity and/or stabilization of glutamate signaling in the injured brain.? During the subacute or late post-injury periods, medications that augment cerebral acetylcholinergic function may improve declarative memory. Among responders to this treatment, secondary benefits on attention, processing speed, and executive function impairments as well as neuropsychiatric disturbances may be observed. During these post-injury periods, medications that augment cerebral catecholaminergic function may improve hypoarousal, processing speed, attention, and/or executive function as well as comorbid depression or apathy.? When medications are used, a "start-low, go-slow, but go" approach is encouraged, coupled with frequent reassessment of benefits and side effects as well as monitoring for drug-drug interactions. Titration to either beneficial effect or medication intolerance should be completed before discontinuing a treatment or augmenting partial responses with additional medications.     

术后认知功能紊乱的防治

认知的定义是感知、记忆、处理信息的心理过程。人们通过认知可以获得知识、处理问题、计划未来。术后认知功能紊乱（postoperative cognitive disorders）是指术前无认知功能紊乱的病人在术后出现认知过程的损害^[1,2],包括谵妄（delirium）和术后认知功能障碍（postoperative cognitive dysfunction POCD）。Dijkstra等发现术后认知功能紊乱可持续存在数年甚至永久性存在^[3,4]。     

Cognitive retraining in epilepsy

Epilepsy is the commonest neurological disorder, so there is a need to establish more effective remedial programmes for the deficits in cognitive functioning associated with epilepsy. The present paper studies the relative change in the targeted skill areas as a consequence of cognitive retraining. For this purpose, a pre- and post-multiple baseline design was adopted with the intention of treating specific deficient skill. The measures of neuropsychological functioning adopted were a composite of tests/tasks, with specific emphasis on attention, memory and emotional status. The subject was targeted to a special neuro-rehabilitation programme comprised of cognitive retraining, supportive therapy and a deep breathing relaxation exercise. A regular home intervention programme was conducted simultaneously. Cognitive retraining included both paper and pencil tasks and real life activities. The training programme covered a 6-week period and each weekly session lasted ~1 hour. The results showed an overall improvement in cognitive performance across sessions, and the regular home intervention sessions were found to have enhanced the subject's performance. In conclusion, it was noted that by identifying cognitive deficits, effective training programmes can be devised that will be of substantial benefit to patients with epilepsy