~(11)C-PIBPET和~(18)F-FDGPET显像诊断阿尔茨海默病与遗忘型轻度认知损害的临床价值

目的应用11C-PIB PET和18F-FDG PET显像研究阿尔茨海默病和遗忘型轻度认知损害患者β-淀粉样蛋白(Aβ)沉积与葡萄糖代谢之间的关系,联合载脂蛋白E(ApoE)基因型进一步探讨遗忘型轻度认知损害与阿尔茨海默病的相关性。方法利用PET显像对阿尔茨海默病(14例)、遗忘型轻度认知损害(10例)和正常对照者(5例)脑组织Aβ沉积和葡萄糖代谢变化进行分析,采用聚合酶链反应-限制性片段长度多态性方法对ApoE基因型进行分析。结果阿尔茨海默病组患者11C-PIB标准化摄取比值在下顶叶、颞叶外侧、额叶、后扣带回皮质和楔前叶、枕叶和纹状体均高于正常对照组(P0.05);遗忘型轻度认知损害组患者脑组织11C-PIB结合水平呈双峰形。11C-PIB+aMCI亚组与阿尔茨海默病组、11C-PIB-aMCI亚组与正常对照组之间11C-PIB标准化摄取比值差异均无统计学意义(P0.05)。18F-FDG PET显像显示,3/5例11C-PIB+aMCI亚组患者双侧顶叶、颞叶和楔前叶代谢减低,其中2例ApoEε4等位基因携带者随访期间进展至阿尔茨海默病;3/5例11C-PIB-aMCI亚组患者双侧额叶和前扣带回代谢减低。结论11C-PIB PET显像是筛查具有阿尔茨海默病病理特点的遗忘型轻度认知损害患者的有效工具。具有阿尔茨海默病病理特征的遗忘型轻度认知损害患者可伴有顶叶、颞叶外侧皮质和楔前叶代谢减低,其中ApoEε4等位基因携带者更易进展至阿尔茨海默病痴呆。     

阿尔茨海默病颞干纤维束扩散张量成像研究

目的应用扩散张量成像(DTI)研究阿尔茨海默病和遗忘型轻度认知损害患者白质和颞干纤维束部分各向异性(FA)值变化特点,探讨颞干纤维束损伤机制及其对阿尔茨海默病和遗忘型轻度认知损害的诊断与鉴别诊断价值。方法应用常规MRI和DTI测量阿尔茨海默病(10例)、遗忘型轻度认知损害(10例)和正常对照者(10例)颞干纤维束(包括前连合、钩束、额枕下束)及前额叶、颞叶、顶叶、枕叶白质FA值,比较各组受试者左右侧对称部位白质和颞干纤维束FA值变化。结果各组受试者左右侧对称部位白质和颞干纤维束FA值差异无统计学意义(均P0.05),但其前连合、钩束、额枕下束及前额叶白质FA值差异具有统计学意义(均P0.05)。其中,阿尔茨海默病组前连合、钩束、额枕下束FA值低于遗忘型轻度认知损害组(均P0.05),前连合、钩束、额枕下束及前额叶、顶叶白质FA值低于正常对照组(均P0.05);而遗忘型轻度认知损害组与正常对照组前连合、钩束、额枕下束及前额叶白质FA值差异无统计学意义(均P0.05)。结论阿尔茨海默病和遗忘型轻度认知损害患者与正常老年人颞干纤维束FA值存在显著差异,提示颞干纤维束在阿尔茨海默病患者白质损伤中具有重要意义,DTI检查有助于阿尔茨海默病与遗忘型轻度认知损害和正常老龄化的鉴别诊断。阿尔茨海默病前连合、钩束、额枕下束及前额叶、顶叶白质FA值异常具有良好的临床诊断价值。     

米氮平治疗阿尔茨海默病所致抑郁对照研究

以米氮平和阿米替林分别治疗阿尔茨海默病(AD)所致抑郁患者,比较其疗效与安全性,报告如下。1对象和方法为2003年7月至2005年10月在我院的住院患者,符合中国精神障碍分类与诊断标准第3版诊断标准;汉密尔顿抑郁量表(HAMD,17项)≥18分;均为首发,未经抗抑郁剂治疗;排除严重躯体疾病,青光眼,前列腺肥大者。共60例,随机分为两组。米氮平组30例,男17例,女13例;年龄60~85岁,平均(63±5)岁。阿米替林组30例,男15例,女15例;年龄61~86岁,平均(64±6)岁,两组以上各项差异均无显著性(P均>0.05)。米氮平剂量15~30mg/d。阿米替林剂量50~100mg/d。疗程8周…     

阿尔茨海默病相关认知障碍患者营养不良影响因素初步分析

目的分析阿尔茨海默病相关认知障碍患者营养风险/不良的影响因素, 并进一步分析此类患者营养状况与痴呆精神行为症状(BPSD)严重程度的相关性。方法连续性收集2021年6月1日至2022年8月31日首都医科大学附属北京天坛医院阿尔茨海默病生物标志物与生活方式研究队列中的247例阿尔茨海默病相关认知障碍患者的临床资料。根据微型营养评定量表(MNA)评分将患者分为营养良好组(128例)和营养不良组(119例)。采用假设检验和单因素Logistic回归分析比较2组患者在性别、入组年龄、体重指数、腰臀比、受教育年限、是否有嗅觉减退、是否合并≥2种慢性疾病、胃肠道疾病史、是否有BPSD以及在简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、神经精神问卷(NPI)、日常生活活动能力评定量表(ADL)、照料者负担量表(CBI)评分和膳食多样化评分(DDS)得分上的差异。将单因素分析中差异有统计学意义的指标纳入多因素Logistic回归分析, 进一步分析阿尔茨海默病相关认知障碍患者营养不良的独立影响因素。采用Spearman相关分析检验NPI评分与MNA评分的相关性。结果与营养良好组相比...     

尿液β淀粉样蛋白寡聚体检测在阿尔茨海默病和轻度认知损害中临床意义的初步探索

目的 探索阿尔茨海默病(AD)患者尿液β淀粉样蛋白(Aβ)寡聚体水平及其临床意义.方法 收集60例病例组研究对象:包括轻度认知损害(MCI)组28例、AD组15例、主观认知下降(SCD)组17例;另选择上海市宝山区友谊街道社区认知正常健康者(对照组)19例.收集患者临床信息以及尿液,利用脑脊液Aβ寡聚体检测ELISA试...     

五边形复制测试在路易体痴呆和阿尔茨海默病鉴别诊断中的应用

目的 探讨简易精神评价量表(MMSE)五边形复制定性评分测试(QSPT)对路易体痴呆(DLB)与阿尔茨海默病(AD)的鉴别诊断价值.方法 选取符合纳入标准的2018年1月至2021年8月在首都医科大学宣武医院神经内科就诊的患者为研究对象,回顾性分析61例DLB患者与71例AD患者.比较两组患者性别、年龄、受教育年限、M...     

重度痴呆患者和血清维生素B_(12)、叶酸及同型半胱氨酸水平及其相关性研究

<正>本研究检测重度痴呆患者血清同型半胱氨酸(Hcy)、叶酸(FOL)及维生素B12(Vit B12)水平,分析重度痴呆与血清Hcy与B族维生素水平变化的相关性。1对象和方法为2011年4月至2013年4月期间于我院就诊的阿尔茨海默病(AD)和血管性痴呆(Va D)患者,入组者均符合国际疾病分类第10版(ICD-10)重度痴呆诊断标准[1],且简易精神状态检查(MMSE)评分≤5分。AD组:111例,男52例,女59例;平均年龄(78.5±7.4)岁。VaD组:131例,男     

住院老年期痴呆患者死亡原因分析

<正>对我院住院死亡的老年期痴呆患者临床资料分析如下。1对象和方法为2005年4月至2014年11月在本院老年科住院死亡的老年期痴呆患者46例,符合《国际疾病分类》第10版诊断标准;其中阿尔茨海默病(AD)22例,血管性痴呆(Va D)24例。对入组者的临床资料进行回顾性统计和分析。采用SPSS 19.0统计软件,正态分布资料用均数(x珋±s)     

艾司西酞普兰合并丙戊酸镁缓释片治疗难治性抑郁症的对照研究

本研究应用艾司西酞普兰合并丙戊酸镁缓释片治疗难治性抑郁症(TRD),现将结果报告如下. 1 对象和方法 2009年2月至2012年5月我院门诊或住院的TRD患者48例,符合中国精神障碍分类与诊断标准第3版(CCMD-3)诊断标准;汉密尔顿抑郁量表(HAMD) 17项≥18分.排除严重躯体疾病、精神活性物质依赖、妊娠及哺乳期、严重精神病性症状和自杀倾向者;均知情同意.随机分为两组:①研究组:28例,男13例,女15例;年龄21～62岁,平均(40.7 ±14.8)岁;病程1～12年,平均(5.1±4.7)年;HAMD(34.9±7.5)分;单相抑郁18例,双相抑郁10例.     

儿童少年期与青春期精神分裂症临床特征比较

正儿童青少年精神分裂症为18岁以前发病者[1],而17~18岁青春期是儿童少年向成人过渡的阶段。本研究采用回顾性调查方法,比较儿童少年期(17岁,少儿组)与青春期(17~18岁,青春期组)精神分裂症患者的临床特征。1对象和方法选择2010年1月至2015年12月在我院≤18岁首次住院、诊断符合《中国精神障碍分类与诊断标准》第3版或《国     

11C-匹兹堡复合物B正电子发射断层摄影术脑显像在阿尔茨海默病早期诊断中的临床应用

目的 探讨N-甲基[11C]2-(4'-甲基氨基苯基-6-羟基苯并噻唑){N-methyl[11C]2-(4'-methylaminophenyl-6-Hydroxybenzathiazole),11C-PIB}PET脑显像在阿尔茨海默病(AD)早期诊断中的价值.方法 分别对6例AD患者、7例轻度认知功能障碍(MCI)患者及6名智能正常的老年对照者(NC)进行临床诊断、资料收集及11C-PIB PET脑显像,并对5、25和45 min PET图像进行分析.结果 视觉分析:AD患者3个时段放射性清除情况与NC组有明显不同,药物注射45 min后脑内放射性清除较NC组明显减低;MCI组图像呈不均一改变,与AD、NC组均有重叠.统计分析:3组受试者各脑区与小脑45 min标准吸收值(SUV)比值示:AD组顶叶、额叶、颞叶、枕叶及海马比值分别为1.91±0.21、2.09±0.41、1.92±0.35、1.66±0.41、1.55±0.28,高于NC组的1.48±0.53、1.57±0.64、1.36±0.53、1.27±0.40、1.17±0.33,差异具有统计学意义(t值分别为8.114、5.620、5.705、3.650、2.866,P值分别为0.0001、0.0002、0.0002、0.0045和0.0170),MCI组顶叶、额叶、颞叶、枕叶及海马的比值分别为1.48±0.53、1.57±0.64、l_36±0.53、1.27±0.40、1.17±0.33,均高于相应NC组,但差异无统计学意义.结论 11C-PIB PET脑显像能够鉴别早期AD患者与Nc,并对MCI患者有一定预测价值.     

阿尔茨海默病与轻度认知障碍弥散张量成像研究

目的:应用磁共振弥散张量成像技术(DTI)研究阿尔茨海默病(AD)与轻度认知障碍患者(MCI)脑白质损伤情况。方法:对21例AD患者、15例MCI患者和20名健康志愿者进行脑部DTI扫描后,测量双脑区感兴趣区的各向异性分数值(FA)且进行比较。结果:AD患者额叶、顶叶、颞叶和胼胝体的FA值与MCI组和对照组均存在显著性差异,MCI患者仅颞叶和胼胝体的FA值与对照组均存在显著性差异。结论:AD患者与MCI患者存在脑白质结构的差异,DTI技术能够在一定程度上提供MCI的早期诊断指标。     

Diffusion tensor imaging based white matter changes and antioxidant enzymes status for early identification of mild cognitive impairment

Mild cognitive impairment (MCI) is an early stage of dementia. The changes in white matter integrity and antioxidant enzymes levels are crucial in onset and progression to Alzheimer’s disease (AD). To elucidate the changes in cognitive performance, white matter integrity, oxidative stress marker, for early detection of prodromal state of AD. Fifty cases of MCI and controls (55-75 years) were subjected to Mini Mental State Examination (MMSE), diffusion tensor imaging (DTI) followed by estimation of superoxide dismutase, glutathione peroxidase and lipid peroxidation in serum of MCI and control population. The MMSE scores of MCI subjects were (28±2 - 22.6±1) as compared with controls (28±1- 29±1). DTI metrics fractional anisotropy (FA) values in right and left frontal lobe, fornix, corpus callosum, while apparent diffusion coefficient (ADC) values in right temporal lobe, hippocampus head, corpus callosum right, and forcep major were significantly altered in MCI as compared with controls. Superoxide dismutase, glutathione peroxidase level were lower while lipid peroxidation marker malondialdehyde (MDA) was increased in patients with MCI as compared with controls. The study emphasized that changes in neuro-psychological performance, white matter integrity and antioxidant enzymes level provide early signature for diagnosis of MCI.     

Phenotypic regional functional imaging patterns during memory encoding in mild cognitive impairment and Alzheimer's disease

BackgroundReliable blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) phenotypic biomarkers of Alzheimer’s disease (AD) or mild cognitive impairment (MCI) are likely to emerge only from a systematic, quantitative, and aggregate examination of the functional neuroimaging research literature.MethodsA series of random-effects activation likelihood estimation (ALE) meta-analyses were conducted on studies of episodic memory encoding operations in AD and MCI samples relative to normal controls. ALE analyses were based on a thorough literature search for all task-based functional neuroimaging studies in AD and MCI published up to January 2010. Analyses covered 16 fMRI studies, which yielded 144 distinct foci for ALE meta-analysis.ResultsALE results indicated several regional task-based BOLD consistencies in MCI and AD patients relative to normal control subjects across the aggregate BOLD functional neuroimaging research literature. Patients with AD and those at significant risk (MCI) showed statistically significant consistent activation differences during episodic memory encoding in the medial temporal lobe, specifically parahippocampal gyrus, as well superior frontal gyrus, precuneus, and cuneus, relative to normal control subjects.ConclusionsALE consistencies broadly support the presence of frontal compensatory activity, medial temporal lobe activity alteration, and posterior midline “default mode” hyperactivation during episodic memory encoding attempts in the diseased or prospective predisease condition. Taken together, these robust commonalities may form the foundation for a task-based fMRI phenotype of memory encoding in AD.     

Assessing Visuoconstructional Performance in AD,MCI and Normal Elderly Using the Beery Visual-Motor Integration Test

This study evaluated the Beery Visual-Motor Integration Test (VMI) as a measure of construction ability in Alzheimer’s disease (AD) and mild cognitive impairment (MCI). Construction deficits are an early sign of Alzheimer’s disease. Commonly used tests of construction abilities are complex, often intimidating to impaired elders, and lack a range of items. The VMI has items ranging from very easy to difficult, allowing even impaired patients to enter task set, and elderly norms are available. It has not yet been validated for use in diagnosis of AD or MCI. Two patients groups (n =43 MCI and 40 AD) recruited from a memory clinic and a non-demented control group (n =43) recruited from the community were administered a battery of neuropsychological measures including the VMI. Results revealed that the VMI is useful for discriminating AD from MCI. Qualitative errors produced on the VMI provide additional information beyond the standard score about the patient’s cognitive status.     

A decade of pre-diagnostic assessment in a case of familial Alzheimer’s disease: tracking progression from asymptomatic to MCI and dementia

Detailed study of the very earliest phases of Alzheimer’s disease (AD) is seldom possible, especially those changes preceding the development of mild cognitive impairment (MCI), which may occur years before diagnosis. Knowledge of imaging and neuropsychological features of these early stages would add insight into this poorly understood phase of the disease. We present data from a subject who entered a longitudinal study of individuals at risk of familial Alzheimer’s disease (FAD), as a healthy volunteer with no memory complaints, undergoing 12 assessments between 1992 and 2003. Longitudinal MRI, neuropsychological and clinical data are presented over the decade preceding this man’s diagnosis, through the asymptomatic and prodromal preludes to his presentation with MCI and on to eventual conversion to AD.     

弥散张量成像与老年人认知功能的相关性

目的：研究老年人认知功能与MRI弥散张量成像（DTI）参数的相关性。方法：年龄〉60岁的老年人43例,按其认知功能量表评分[简易智能状态量表（MMSE）、临床痴呆量表（CDR）、总体衰退量表（GDS）和日常生活活动能力量表（ADL）]分为认知功能正常组、轻度认知功能障碍组和阿尔茨海默病3组,比较各组间头颅MRI部分各向异性（FA）和表观弥散系数（ADC）值是否具有差异,寻找与认知功能相关的颅内结构。结果：左侧颞叶、胼胝体膝部、压部的FA和ADC值,以及右侧额叶、双侧半卵圆中心的ADC值组间差异有统计学意义（P〈0.05）。FA值随认知功能减退而降低;而ADC值随认知功能减退而增高。额叶、颞叶、半卵圆中心和胼胝体等部位的DTI参数与常用的MMSE、CDR、GDS、ADL评分显著相关（P〈0.05）。结论：MRIDTI参数与老年人认知功能水平显著相关。     

FDG-PET measurement is more accurate than neuropsychological assessments to predict global cognitive deterioration in patients with mild cognitive impairment

The accurate prediction, at a pre-dementia stage of Alzheimer’s disease (AD), of the subsequent clinical evolution of patients would be a major breakthrough from both therapeutic and research standpoints. Amnestic mild cognitive impairment (MCI) is presently the most common reference to address the pre-dementia stage of AD. However, previous longitudinal studies on patients with MCI assessing neuropsychological and PET markers of future conversion to AD are sparse and yield discrepant findings, while a comprehensive comparison of the relative accuracy of these two categories of measure is still lacking. In the present study, we assessed the global cognitive decline as measured by the Mattis scale in 18 patients with amnestic MCI over an 18-month follow-up period, studying which subtest of this scale showed significant deterioration over time. Using baseline measurements from neuropsychological evaluation of memory and PET, we then assessed significant markers of global cognitive change, that is, percent annual change in the Mattis scale total score, and searched for the best predictor of this global cognitive decline. Altogether, our results revealed significant decline over the 18-month follow-up period in the total score and the verbal initiation and memory-recall subscores of the Mattis scale. The percent annual change in the total Mattis score significantly correlated with age and baseline performances in delayed episodic memory recall as well as semantic autobiographical and category word fluencies. Regarding functional imaging, significant correlations were also found with baseline PET values in the right temporo-parietal and medial frontal areas. Age and right temporo-parietal PET values were the most significant predictors of subsequent global cognitive decline, and the only ones to survive stepwise regression analyses. Our findings are consistent with previous works showing predominant delayed recall and semantic memory impairment at a pre-dementia stage of AD, as well as early metabolic defects in the temporo-parietal associative cortex. However, they suggest that only the latter predictor is specifically and accurately associated with subsequent cognitive decline in patients with MCI within 18 months of first assessment.     

Decreased Levels of Circulating Adiponectin in Mild Cognitive Impairment and Alzheimer’s Disease

Adiponectin, an adipocytokine released by the adipose tissue and has important roles in the metabolic regulation and inflammatory control, may play an important roles in the physiopathology of psychiatric and neurodegenerative disorders. The aim of the present work was to evaluate adiponectin serum levels in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) as compared to cognitively healthy elders and to correlate these levels with clinical and cognitive parameters. We further evaluated whether circulating adiponectin levels could predict progression from MCI to Alzheimer’s disease upon follow-up. We recruited 157 subjects (41 with AD, 65 with MCI and 51 elderly controls) in the baseline assessment. Follow-up data were available for 54 subjects with MCI and 43 controls in whom we ascertained the conversion to AD and the progression of cognitive impairment. Adiponectin was assayed by sandwich ELISA. Serum levels of adiponectin were significantly lower in MCI and AD as compared to controls (p < 0.001). After controlling for age, educational level and APOE genotype, adiponectin levels remained significantly reduced in these groups (p < 0.001). Circulating adiponectin levels did not predict cognitive decline in the elderly controls (i.e., progression from normal cognition to MCI) or progression to Alzheimer’s disease in subjects with MCI. We conclude that lower levels of adiponectin were associated with cognitive dysfunction, though it did not predict additional cognitive decline and conversion to dementia in this cohort of elderly subjects. Decreased adiponectin may be a surrogate marker of the pathological process in AD, linking clinical comorbidities, inflammation and cognitive dysfunction.     

Amyloid deposition and CBF patterns predict conversion of mild cognitive impairment to dementia

Mild cognitive impairment (MCI) can include the transition from a normal state to dementia. To explore biomarkers for the development of dementia, we performed an 18-month follow-up study in 28 patients with amnestic MCI. Amyloid deposition was examined using PiB PET, and cerebral blood flow (CBF) was examined using SPECT. Cognitive function was periodically assessed. The rate of conversion to dementia was higher in the PiB-positive/equivocal group (74%) than in the PiB-negative group (33%) (p?=?0.041). Perfusion SPECT was performed in 16 patients. MCI patients with an AD-characteristic pattern of reduced CBF had a higher PiB-positive/equivocal rate (82%) than those with a non-AD pattern (20%) (p?=?0.018), and patients with an AD pattern had a higher conversion rate (82%) than those with a non-AD pattern (40%) (p?=?0.094). Clinically, all PiB-positive converters were diagnosed as having Alzheimer’s disease (AD), whereas PiB-negative converters were thought to have some form of dementia other than AD. Amyloid PET is useful for predicting conversion to AD in MCI patients. A pattern analysis of perfusion SPECT findings might also be helpful for predicting conversion to AD, but with a lower specificity.