老年静止性腔隙性脑梗死患者认知功能研究

目的探讨静止性腔隙性脑梗死（SLI）老年患者认知功能障碍的特点. 方法临床收集128名患者和38名对照者,根据MRI影像按照SLI梗死数的多少将患者进一步分为单个SLI组和多发SLI组,分别进行简明精神状态量表（MMSE）测验、积木测验和画钟测验. 结果 （1） 单个SLI组患者的MMSE、积木测验和画钟测验评分与对照组相比无明显差异（P＞0.05）,而多发SLI组患者MMSE、积木测验和画钟测验评分较对照组显著降低（P＜0.01）;（2） 与对照组相比,单个SLI组MMSE各分值评分均无显著降低（P＞0.05）,而多发SLI组MMSE时间定向、地点定向、短程记忆、注意力、计算力、图形描画分值评分显著降低（P＜0.05）. 结论多发SLI与认知功能下降密切相关,主要影响记忆、注意力、计算力和视空间、执行等认知功能.     

Contributing factors to intellectual impairment in patients with multiple lacunar infarctions]

The author investigated factors leading to intellectual impairment in patients with multiple lacunar infarctions. The subjects consisted of 40 patients with multi-infarct dementia (MID) and 17 nondemented patients with multiple infarctions (MI) who showed multiple lacunar infarctions in the deep penetrating arterial territory on CT. MID patients showed more marked and extensive periventricular lucency (PVL), a higher degree of ventricular index (VI) measured on CT, and were of a higher age, and had poorer activity of daily living (ADL) compared with MI patients. There were significant correlations between the PVL score, VI, ADL score, age and Hasegawa's dementia rating score (HDS). However, no significant differences in sex, site of infarct, and the count of low density areas reflected lacunar infarction on CT, and vascular risk factors were shown between MID and MI patients. Multiple regression analysis demonstrated that the PVL score and VI showed the highest partial correlations for HDS, and that the ADL score and age were also independently contributing factors. Our results suggest that deep white matter lesions observed as PVL on CT and ventricular enlargement were the most important factors contributing to intellectual impairment in patients with multiple lacunar infarcts, and that physical factors such as ADL and age can be considered to be related to the development of dementia.     

Pathology and treatment of anemia in the elderly]

An important background characteristic of anemia in the elderly is decrease in hematopoiesis due to aging. Factors influencing hematopoiesis in the elderly include changes in the distribution of hematopoietic tissue, changes in hematopoietic stem cell density and changes in the hematopoietic inductive microenvironment. In the present study, in order to assess changes in the bone marrow with aging, the fat tissue area, uncleated cell-count and cellularity in the bone marrow, in addition to changes in the diameter of the vascular lumen which result primarily from sclerotic changes in the dorsomedial artery of the bone marrow were determined in different age groups. The results revealed that all of the aforementioned factors changed significantly with aging. We also describe on the results of assays of inflammatory cytokines (IL-1, IL-6, TNF-alpha), lactoferrin and transferrin receptors in cases of anemia of chronic disorders (ACD) which own secondary to chronic inflammatory diseases and is known to frequently afflict the elderly.     

Cerebral complications of hypertension in the elderly]

PURPOSE: This review focuses on cerebral complications of hypertension, which include stroke, impairment of cognitive function, dementia, and possibly depression and anxiety. These conditions are major causes of morbidity and mortality in the elderly. CURRENT KNOWLEDGE AND KEY POINTS: Not only elevated diastolic blood pressure, but also isolated systolic hypertension and elevated pulse pressure play an important role in the development of brain complications. Randomised placebo-controlled trials have provided evidence that reduction of hypertension decreases safely and effectively morbidity and mortality rates in the elderly. The new classes of drugs, in particular calcium-channels blockers and angiotensin-converting enzyme inhibitors, have been shown to be as effective as the originally used diuretics and beta-blockers. FUTURE PROSPECTS AND PROJECTS: Several trials are currently in progress and should provide more information on the benefit of antihypertensive treatment in very elderly persons (Hypertension in the Very Elderly Trial, HYVET) and secondary prevention of stroke (PROGRESS). The importance of assessing new dosages of the presently used antihypertensive drugs as well as the benefit of new classes of drugs is emphasised. Further trials specifically focusing on the prevention of dementia by antihypertensive drugs are needed to confirm the results of the Syst-Eur Vascular Dementia Project. The benefit of calcium antagonists in the prevention of dementia in elderly hypertensive patients should be assessed in the Dementia Prevention in Hypertension trial (DEPHY).     

Late fate of patients with pernicious anemia]

In a retrospective study is reported on 271 cases of pernicious anaemia which were observed for 30 years. 2 groups of patients could be significantly differed. In the first group the disease appears familiarly and/or is combined with a diabetes mellitus or a disease of the thyroid gland. Its manifestation is 7 years earlier than in the 2nd group, in individual cases without genetic relation. In this a heterologous etiology of the pernicious anaemia is to be seen. On principle in therapy was treated only parenterally and relatively small quantities of vitamin B12 were given. In these cases the results were good. Recidivations appeared only quite infrequently. The life expectancy obtained is altogether high, but it is, however, somewhat under the average of a healthy population of the same age. Despite careful control and early operation the gastric carcinoma more frequently appeared as cause of death than in the average population of the same age, whereas all other tumours were more rarely found.     

Cerebral white matter lesions predict both ischemic strokes and myocardial infarctions in patients with established atherosclerotic disease

BACKGROUND: Cerebral white matter lesions (WML) are regarded as manifestations of small vessel disease, but have also been associated with large vessel atherosclerosis. We investigated whether WML have a predictive value for future ischemic events. METHODS AND RESULTS: Two-hundred-thirty patients with proven atherosclerotic disease, recent ischemic stroke (IS, n=70), recent myocardial infarction (MI, n=71), or peripheral arterial disease (PAD, n=89) were included. The presence of periventricular lesions (PVL) and deep white matter lesions (DWML) on MRI at entry and ischemic events during follow-up were registered. During follow-up with a mean duration of 3.5+/-1.4 years 22 patients had a MI, 21 patients suffered an IS and 2 patients died suddenly. The frequency of ischemic events during follow-up was higher among patients with PVL than in those without PVL (IS: 18% versus 5%, p=0.001; MI: 15% versus 7%, p=0.03; any ischemic event: 36% versus 11%, p<0.001). DWML was associated only with the combined outcome any ischemic event (p=0.04). In multivariate regression analysis the presence of PVL was independently associated with IS (HR 3.2 (95%CI 1.3-8.4) and MI (HR 3.4 (95%CI 1.4-8.0)). CONCLUSION: We observed an association between WML, especially PVL, and future ischemic strokes and myocardial infarctions in patients with established atherosclerotic disease.     

老年腔隙性脑梗死患者认知功能障碍特点及其相关因素研究

目的探讨老年腔隙性脑梗死（LI）患者的认知功能特点及其相关因素。方法收集64例LI患者病史,并按照CT/MRI分为左侧病灶组、右侧病灶组及双侧病灶组,每例均应用蒙特利尔认知评估量表（MoCA）进行认知评估,并和79例无LI者进行对照。结果 LI患者的MoCA得分与患者年龄呈负相关,与受教育年限呈正相关,而与LI的病程无显著相关。LI组在MoCA总分、视空间/执行功能及注意力上与对照组相比有显著性差异（P〈0.05）。左侧病灶组的MoCA总分及在注意力、语言功能方面分数均低于右侧病灶组（P〈0.05）;双侧病灶组的MoCA总分及延迟回忆低于右侧病灶组（P〈0.05）。结论 LI患者存在高龄、低教育年限时更易出现认知功能障碍;LI患者认知功能障碍主要表现在视空间/执行功能及注意力方面;病灶位于大脑左侧和双侧的LI患者更易出现认知功能的损害。     

Cerebral infarctions and transient neurologic deficits associated with acquired immunodeficiency syndrome

PURPOSE: Little information is available concerning the clinical importance of cerebral infarction in patients with acquired immunodeficiency syndrome (AIDS). The purpose of this retrospective study was two-fold: (1) to determine the frequency and clinical characteristics of cerebral infarction and transient neurologic deficits (TNDs) among patients with AIDS; and (2) to identify specific patient subgroups at risk for such complications and whether there were underlying associated diseases requiring specific therapy. PATIENTS AND METHODS: Neurology inpatient and consult service records, neuropathology reports, and the University of California, San Francisco, AIDS computerized registry were used in identifying study cases. Information on demographic background, associated clinical diagnoses, presenting neurologic symptoms and signs, laboratory results, pathologic findings, and clinical follow-up was obtained from each patient's medical record. RESULTS: Twenty-five patients with AIDS (mean age, 38) having clinical or pathologic findings suggestive of focal cerebral ischemia or infarction were identified. Ten patients had non-hemorrhagic cerebral infarctions, 13 had acute TNDs, and two had both. Cerebral infarction was associated with central nervous system (CNS) infections (cryptococcus, four; tuberculosis, one; zoster vasculitis, one) and cardiogenic embolism (one). TNDs were associated with toxoplasmosis (four), cerebral infarction (two), cryptococcal meningitis (one), vasculitis (one), and CNS Kaposi's sarcoma (one). A presumptive cause was absent in five cases of cerebral infarction and eight of TND. All five patients with pathologically proven macroscopic cerebral infarcts were diagnosed clinically before death. CONCLUSIONS: We conclude the following: (1) AIDS patients, especially given their young age, appear to be increased risk for cerebral infarction and TND. (2) Cerebral infarction and TND may be the initial presentation of AIDS. (3) TND and cerebral infarction often signify treatable CNS infection among AIDS patients. (4) The causes of AIDS-related cerebral infarction and TND are unknown in many cases.     

老年人多发性脑梗死危险因素分析

目的探讨与老年多发性脑梗死发生相关的危险因素,为该病的防治提供客观依据。方法对2000年1月至2008年1月所收治的1416例脑梗死患者,根据临床观察确定老年多发性脑梗死的相关因素,采用非条件Logistic回归确定危险因素。结果引起老年多发性脑梗死的主要危险因素按其影响大小而排列的顺序为：心房纤颤、颈动脉斑块形成、糖尿病、高血压病,为独立危险因素,结果有显著性差异。结论心房纤颤、颈动脉粥样硬化、糖尿病、高血压病是引起老年多发性脑梗死的4个最重要危险因素,根据存在的危险因素制订不同的防治方案对降低该病的发生具有积极意义。     

Sympathico-adrenal system in elderly patients with systolic hypertension]

A study of the catecholamines passage with urine in patients of advanced age with systolic hypertension has revealed features specific for the activity of their sympathico-adrenal-system by comparison with that in patients with hypertensive disease (with systolic-diastolic pressure rise) and in persons of the same age with normal pressure. In systolic hypertension an inhibition of the mediatory link finding its expression in a decreased noradrenaline excretion, was noted, while that of adrenalin remained normal which led to a fall in the ration noradrenaline/adrenalin. Inasmuch as adrenalin causes chiefly the rise of systolic pressure and noradrenaline -- that of diastolic it may be presumed that the established features of the sympathico-adrenalin activity appear to be a factor contributing to the systolic nature of the hypertension under review, which stems primarily from other major pathogenetic factors. At the same time in subjects of advanced age the reactivity of the mediatory link in systolic hypertension remains intact, this manifesting itself in a significantly increased noradrenaline passage, as compared to a low initial level following administration of insulin.     

老年心脑血管疾病患者的认知功能随访与脑血流灌注改变

目的 本研究通过随访了解老年缺血性心脑血管疾病患者认知功能改变及其与脑血流灌注关系,同时观察心脑血管疾病患者临床事件和预后情况。方法 选取因冠心病和／或缺血性脑血管疾病住院治疗的老年人37例,进行认知功能测试,并作SPECT检查明确脑血流灌注情况,12～18个月后随访认知功能和严重心脑血管不良事件。结果 随访前后中国成人智力量表（CISA）测验中B因素、D因素、言语商、拼图、词义分辨、找错和背数成绩的降低（P〈0．05）;简易精神状态量表（MMSE）、临床记忆量表测试成绩无统计学意义;认知功能下降者的左脑血流灌注较差（P〈0．05）;各组都有心脑血管不良事件发生,冠心病合并脑血管病组死亡率升高（21．43％,P〈0．05）。结论 老年缺血性心脑血管疾病患者的认知功能随增龄呈下降趋势,有关言语和抽象思维方面的认知功能更易下降;认知功能下降者的左脑血流灌注较差。     

Prevalence and causes of anemia in elderly hospitalized patients.

The prevalence and causes of anemia have been studied in 104 patients over 60 years of age admitted to a general medical ward in Jerusalem. In males and females, mean hemoglobin levels were about 1 g less than in the corresponding groups of healthy younger controls. A primary nutritional anemia could not be implicated in any of the 15 patients with hemoglobins below 11 g/dl. The most important causes of anemia were chronic renal failure, metastatic carcinoma, gastrointestinal bleeding, and infection. Conversely, in diseases with no adverse effect on erythropoiesis such as chronic ischemic heart disease, hypertension and diabetes, hemoglobin levels were equal to those of the younger controls. These findings indicate that although diminished serum iron and RBC folate levels may occasionally be found in elderly subjects, nutritional deficiency is seldom responsible for anemia in this age group in Israel- and anemia when present is often the manifestation of a chronic underlying disease.