Dietary fatty acids, age-related cognitive decline, and mild cognitive impairment

Currently available epidemiological evidence suggested that an increase of saturated fatty acids (SFA) could have negative effects on cognitive functions, while increased polyunsaturated fatty acids (PUFA) and monounsaturated fatty acids (MUFA) may be protective against cognitive decline. In a Southern Italian elderly population from the Italian Longitudinal Study on Aging (ILSA), a clear reduction of risk of age-related cognitive decline (ARCD) has been found with elevated intake of PUFA and MUFA. Furthermore, in the ILSA, while dietary fatty acids intakes were not associated with incident mild cognitive impairment (MCI), high PUFA intake appeared to have borderline non-significant trend for a protective effect against the development of MCI. These epidemiological findings on predementia syndromes, i.e. MCI or ARCD, together with a recent randomised controlled trial on a possible effect on cognitive and depressive symptoms of ω-3 PUFA supplementation in patients with very mild AD, suggested a possible role of fatty acids intake in maintaining adequate cognitive functioning and possibly in preventing or delaying the onset of dementia.     

中文版De Jong Gierveld孤独量表的信效度研究

调查上海市社区老年人轻度认知功能障碍（MCI）现状,探究相关影响因素。

采用蒙特利尔认知评估基础量表对≥65岁社区老年人进行MCI筛查,对影响因素进行logistic回归分析。

在629位社区老年人中筛查出MCI 226位（35.90%）。更大的年龄（OR=1.04,95%CI：1.01~0.07）、更差的家庭收入（一般OR=2.20,95%CI：1.01~4.80;较差OR=2.59,95%CI：1.03~6.50）、听力状况影响生活（OR=1.86,95%CI：1.19~2.91）、有焦虑症状（OR=1.58,95%CI：1.02~2.44）的社区老年人更可能筛查出MCI。居住中心城区（OR=0.57,95%CI：0.37~0.89）和更高的社会支持（OR=0.97,95%CI：0.94~1.00）是筛查出MCI的保护因素。

上海市社区老年人MCI现状不容乐观,建立老年认知障碍友好型社区是十分重要且必要的。

     

Progression and improvement after mild cognitive impairment

Objective

We studied progression to dementia and improvement rates of mild cognitive impairment (MCI) to help clinicians decide whether or not to screen older people for MCI.

Method

Prospective cohort study in which 156 vulnerable patients with (n = 24) and without (n = 132) MCI are followed and reassessed after two years with MMSE and Camdex.

Results

Nine (38%) out of 24 patients initially diagnosed with MCI and 20 (15%) out of 132 considered normal or depressed progressed to dementia within two years. This results in a relative risk of progression of 2.48 (95% confidence interval = 1.29-4.77), a sensitivity of 31%(95%CI = 16-51) and a predictive value of 38% (95%CI = 20-59). Out of 24 people with MCI at baseline, 8 (33%; 95%CI = 16-55) had improved at follow-up.

Conclusion

The low sensitivity of MCI for subsequent occurrence of dementia and the high improvement rate found in our study as well as by others, and the absence of a proven therapy, provide cumulative evidence against screening for MCI.

     

老年人高血压、抑郁与认知功能减退的相关性研究

目的分析老年人高血压、抑郁患者认知功能状况及其相关性。方法共收集207例患者,分为单纯高血压组、单纯抑郁组、高血压合并抑郁组和正常对照组。采用简易精神状况检查表（MMSE）进行认知功能检查,采用汉密顿抑郁量表（HAMD）进行抑郁程度的评定,并收集相关资料。结果抑郁老人中独居比例较大。与正常对照组比较,单纯高血压组的注意力和计算力明显下降（P〈0．01）,单纯抑郁组的MMSE总分、定向力、注意力和计算力、语言能力明显下降（P〈0．05）;与单纯高血压组比较,高血压合并抑郁组的MMSE总分、定向力、回忆力、语言能力明显降低（P〈0．05）;与单纯抑郁组比较,高血压合并抑郁组的注意力和计算力明显降低（P〈0．05）。抑郁患者的MMSE得分与HAMD得分呈负相关（r=一0．706,P〈0．01）。Logistic回归结果显示抑郁及高血压合并抑郁均为认知功能减退的影响因素（P〈0．01）。结论老年人高血压和抑郁均会引起认知功能的减退,高血压合并抑郁者认知功能减退更为严重,抑郁的严重程度与认知功能减退有关。有效的控制高龄老人的血压和抑郁状态,可能有助于降低其认知功能减退发生的危险。     

轻度认知损害诊断及干预

轻度认知损害(mild cognitive impairment,MCI)是目前在痴呆领域里研究的热点,轻度认知损害定义了一种正常老化与痴呆的交替阶段,反映一种有记忆主诉和客观认知损伤证据但又不能诊断为痴呆的临床状况。轻度认知损害这一概念在识别老年人的记忆下降和高痴呆风险的个体以及对其积极实施干预起重要作用。 1.诊断标准:MCI研究领域的焦点问题之一是诊断标准。加拿大CSHA研究使用标准为“有认知损伤而无痴     

阿尔茨海默病和轻度认知障碍注意功能研究

目的研究阿尔茨海默病(Alzheimer's disease,AD)与轻度认知障碍(mild cognitive impairment,MCI)注意功能变化,进一步揭示AD认知功能减退规律。方法选取济南军区总医院干部病房神经内科病房和门诊的患者43例,其中AD患者16例,MCI患者12例,正常对照15例。采用改良注意网络测试(ANT)范式进行注意功能测试,分别对人脑警觉能力、定向能力与执行控制能力反应时进行测试,通过方差分析进行组间行为效应比较。结果三组间警觉、定向与执行控制3个子系统效应反应时均表现出显著差异,具有统计学意义(P<0.05)。统计检验两两比较显示,AD组相对于正常对照组与MCI组3个子系统效应均表现为反应时延长;而MCI组相对正常对照组表现为选择性的注意功能受损,其中警觉效应(P=0.26)与定向效应(P=0.11)未发生显著性变化,而执行控制效应发生显著退化(P<0.01)。结论 AD与MCI患者认知功能退变进程存在差异性,AD患者已出现全面注意功能减退,而MCI患者表现为选择性注意功能减退。     

老年人认知功能对不同亚型MCI预测作用

目的了解老年人认知功能领域在轻度认知功能损害(mild cognitive impairment,MCI)发生过程中的变化特点,探索不同认知功能领域对不同亚型MCI的预测价值。方法于2008年7-10月对2004-2005年在贵州省贵阳市城区采用分层整群抽样方法抽取的26个社区居委会的2 197名≥60岁认知正常老年人进行随访调查,按照随访结局分为正常对照组及不同亚型MCI组,分析认知功能领域在MCI发生过程中的变化特点及不同认知领域对不同亚型MCI发生的预测作用。结果本次调查完成随访者1 409人,随访率为64.13%;其中认知正常者1 279人,遗忘型轻度认知功能损害(aMCI)72例,非遗忘型轻度认知功能损害(naMCI)34例,痴呆24例;aMCI组老年人基线语言词汇运用力得分为(3.65±0.56)分,低于正常对照组老年人的(3.78±0.46)分(t=-2.196,P=0.022);naMCI组老年人基线记忆力、计算力、视空间能力和总体认知功能得分分别为(7.97±1.66)、(3.15±1.46)、(0.41±0.49)和(25.32±2.67)分,均低于正常对照组老年人的(9.08±1.89)、(4.01±1.39)、(0.71±0.45)和(27.21±2.65)分(P<0.05);aMCI组老年人记忆力、计算力、视空间能力和总体认知功能得分分别下降(3.33±2.17)、(2.26±1.56)、(0.27±0.63)和(3.97±2.98)分,naMCI组老年人定向力、语言词汇运用力、语言词汇理解力和总体认知功能得分分别下降(1.59±1.81)、(0.41±0.70)、(0.62±1.18)和(3.82±2.61)分,与正常对照组老年人比较,差异均有统计学意义(P<0.05);在控制年龄、文化程度、职业后,记忆力和语言词汇运用力对aMCI组老年人的发生有预测意义(P=0.000);计算力和视空间能力对naMCI的发生有意义(P<0.05)。结论不同亚型MCI老年人认知功能领域变化不同,对早期区别不同亚型MCI有预测作用。     

Variability of epidemiological measures in mild cognitive impairment and dementia

Variability in occurrence estimates is one of the basic features of the epidemiology of dementia and mild cognitive impairment (MCI). This review will cover two levels of variability that affect epidemiological research on dementia and MCI: the conceptual and the operational level. More specifically, it is highlighted how the lack of a precise definition of MCI leads to a greater variability in the occurrence estimates of this condition, when compared to dementia. Variability will decrease only when more precise criteria and aims of the concept "MCI" will be specified.     

老年人轻度认知功能障碍患病调查

  目的  探讨社区老年人居住方式与认知功能障碍的关系。  方法  采用现况研究、系统抽样方法,于2014年8月 — 2016年8月在湖北省武汉市武昌区4个社区共调查了1 818名老年人,以蒙特利尔认知评估量表评分作为认知功能的评价指标,数据分析采用χ²检验、方差分析、SNK检验和多因素非条件logistic回归。  结果  仅与配偶居住、与配偶/子女居住是老年人认知功能的保护因素（OR = 0.57,95 % CI = 0.41～0.79;OR = 0.66,95 % CI =0.45～0.98）。调整年龄、性别、教育程度、职业、锻炼、吸烟饮酒、社会网络（规模、复杂性）后,OR = 0.62,95 % CI = 0.45～0.88;OR = 0.73,95 % CI = 0.46～0.98。  结论  老年人的认知功能与居住方式有关,与配偶居住能减缓认知功能的损伤。     

老年轻度认知功能障碍者人格特征分析

目的探讨老年轻度认知功解障碍者人格特征,为采取有效的预防措施提供科学依据。方法2008年,采用整群随机抽样方法在山西省太原市选取9个社区的老年人群中轻度认知功能障碍者(MCI)232例,按年龄、性别、文化程度进行1∶1配对的病例对照研究。采用Epi-Data和SPSS13.0软件进行单因素和多因素条件Logistic回归分析。结果单因素条件Logistic回归分析发现,卡特尔16种人格因素问卷(16PF)中的乐群(A)(χ2=2.826,P=0.003)、恃强(E)(χ2=11.581,P=0.000)、忧虑(O)(χ2=2.409,P=0.001)、独立(Q2)(χ2=0.351,P=0.046)、自律(Q3)(χ2=0.173,P=0.001)在MCI组与对照组之间差异有统计学意义。多因素条件Logistic回归分析结果显示,16PF中恃强(E)(χ2=34.920,P=0.000)、独立(Q2)(χ2=4.168,P=0.041)、自律(Q3)(χ2=6.560,P=0.010)在MCI组与对照组之间差异有统计学意义,并且16PF中的独立(Q2)(OR=0.050,95%CI=0.005~0.515)、自律(Q3)(OR=0.057,95%CI=0.009~0.407)是MCI的保护性因素,且独立并自律是轻度认知功能障碍的保护性因素(OR=0.059,95%CI=0.011~0.298)。结论16PF中恃强性是MCI的危险性因素。高独立性及高自律性为MCI的保护性因素,且高独立性并高自律性对MCI的影响分别存在主效应及联合作用效应。     

外周炎性因子水平与老年人轻度认知功能障碍认知表现的关联分析

目的 探讨多种外周炎性因子水平对老年人轻度认知功能障碍（mild cognitive impairment,MCI）不同认知表现的影响。方法 采用病例对照研究,纳入MCI患者150例,正常对照101例。应用韦氏成人智力量表评定认知水平;采用酶联免疫吸附实验试剂盒和多因子检测试剂盒测定血清白介素-6（interleukin-6,IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、β-淀粉样蛋白（amyloid β-protein,Aβ）中的Aβ40和Aβ42水平。结果 MCI患者血清IL-6、Aβ42水平高于正常对照,差异均有统计学意义（均有P<0.05）。在MCI人群中,言语智商随Aβ42水平的增加而降低（β=-0.285,P<0.001）;操作智商、总智商随IL-6和TNF-α水平的升高而降低（均有P<0.05）。结论 MCI患者血清IL-6、Aβ42水平升高;血清IL-6和TNF-α水平可以作为评估MCI操作智商和总智商的参考指标;Aβ42水平可以作为MCI言语智力损伤的参考指标。     

老年人轻度认知功能障碍患病调查

目的 了解浙江省宁波市社区老年人轻度认知功能障碍(MCI)的流行病学特征.方法 采用随机整群分层分阶段抽样的方法对宁波市6个社区,年龄≥60岁的老年人进行现况调查及筛查,完成调查问卷及简易精神状况量表;临床诊断,对有明显记忆障碍者及简易精神状态量表(MMSE)分数低于界值者进一步进行临床检查,并由2名精神科医师进行最后诊断;同时进行总体衰退量表、Hachinski缺血指数量表、临床痴呆评定量表等评定.结果 调查1 227人,男性536人,女691人,MMSE阳性者131例,占10.68％,确诊为MCI者107例,患病率为8.72％;不同年龄段、文化程度、职业,居住及文化生活情况的老年人,其MCI患病率差异均有统计学意义(P＜0.05).结论 高龄、低文化水平、嗜烟、不喝酒或嗜酒、少吃鱼及海产品、单独居住以及少阅读等患MCI的危险性增加.     

轻度认知功能障碍及其影响因素的研究进展

目前,早期发现和干预仍是控制老年期痴呆的主要措施。随着对治疗方法的深入研究,正常衰老和痴呆中间的病理状态—轻度认知功能障碍(mild cognitive impairment,MCI)的提出为老年期痴呆的早期治疗和干预提供了新的靶点,其影响因素的研究也得到研究者的重视。大量研究发现,心血管疾病、吸烟、中年期肥胖、中年期高胆固醇血症、糖尿病及代谢综合征等是该疾病的主要影响因素。本文通过文献复习,对这些因素进行了综述。以期为后续研究提供参考借鉴。     

Enhanced neural activation with blueberry supplementation in mild cognitive impairment

Objectives: Preclinical studies have shown that blueberry supplementation can improve cognitive performance and neural function in aged animals and have identified associations between anthocyanins and such benefits. Preliminary human trials also suggest cognitive improvement in older adults, although direct evidence of enhancement of brain function has not been demonstrated. In this study, we investigated the effect of blueberry supplementation on regional brain activation in older adults at risk for dementia.

Methods: In a randomized, double-blind, placebo-controlled trial we performed pre- and post-intervention functional magnetic resonance imaging during a working memory (WM) task to assess the effect of blueberry supplementation on blood oxygen level-dependent (BOLD) signal in older adults with mild cognitive impairment, a risk condition for dementia.

Results: Following daily supplementation for 16 weeks, blueberry-treated participants exhibited increased BOLD activation in the left pre-central gyrus, left middle frontal gyrus, and left inferior parietal lobe during WM load conditions (corrected P?Discussion: These data demonstrate, for the first time, enhanced neural response during WM challenge in blueberry-treated older adults with cognitive decline and are consistent with prior trials showing neurocognitive benefit with blueberry supplementation in this at-risk population.     

轻度认知功能损害的转归及其影响因素

轻度认知功能损害是介于正常老化和轻度痴呆之间的中间过渡状态。目前的研究证实轻度认知功能损害不仅只是进展为痴呆或死亡,也能保持轻度认知功能损害状态或向正常逆转,而且将轻度认知功能损害进行分型后,其转归不尽相同。本研究主要讨论轻度认知功能损害的分型、转归及影响其转归的因素。     

社区老年人体智锻炼与轻度认知障碍患病关联性的城乡差异

目的  调查社区老年人体智锻炼与轻度认知障碍(mild cognitive impairment, MCI)患病关联性及城乡差异。方法  基于湖北老年记忆队列(Hubei Memory and Aging Cohort Study, HMACS),根据体智锻炼参与情况将社区老人分为：无锻炼(no exercise, NE)、仅体育锻炼(physical exercise only, PE)、仅智力练习(cognitive activity only, CA)和体智锻炼(physical exercise and cognitive activity, PE+CA)组。采用多因素logistic回归分析模型分析体智锻炼与MCI患病的关联性及其城乡差异。结果  共纳入8 365人,平均年龄为(71.67±5.52)岁,MCI患病率为23.22%(95% CI: 22.31%~24.12%),且农村(41.00%) 高于城市(13.61%)。PE、CA、PE+CA组人群MCI的患病风险均低于NE组(均P < 0.05)。进一步分析发现,农村PE组(OR=0.646,95% CI: 0.542~0.771)、城市CA组(OR=0.684, 95% CI: 0.487~0.961)会降低MCI的患病风险(均P < 0.05)。结论  农村MCI患病率高于城市;体智锻炼会降低MCI患病风险;城乡间单一锻炼与MCI患病的关联存在不同,在制定健康老年化认知障碍类疾病干预策略时,应考虑文化背景和城乡差异。     

Impaired cognitive function and mental performance in mild dehydration

Dehydration is a reliable predictor of impaired cognitive status. Objective data, using tests of cortical function, support the deterioration of mental performance in mildly dehydrated younger adults. Dehydration frequently results in delirium as a manifestation of cognitive dysfunction. Although, the occurrence of delirium suggests transient acute global cerebral dysfunction, cognitive impairment may not be completely reversible. Animal studies have identified neuronal mitochondrial damage and glutamate hypertransmission in dehydrated rats. Additional studies have identified an increase in cerebral nicotinamide adenine dinucleotide phosphate-diaphorase activity (nitric oxide synthase, NOS) with dehydration. Available evidence also implicates NOS as a neurotransmitter in long-term potentiation, rendering this a critical enzyme in facilitating learning and memory. With ageing, a reduction of NOS activity has been identified in the cortex and striatum of rats. The reduction of NOs synthase activity that occurs with ageing may blunt the rise that occurs with dehydration, and possibly interfere with memory processing and cognitive function. Dehydration has been shown to be a reliable predictor of increasing frailty, deteriorating mental performance and poor quality of life. Intervention models directed toward improving outcomes in dehydration must incorporate strategies to enhance prompt recognition of cognitive dysfunction.     

社区老年人社会经济地位与轻度认知功能障碍的相关性研究

目的  探讨老年人社会经济地位(socioeconomic status,SES)与轻度认知功能障碍(mild cognitive impairment,MCI)患病的关联。方法  数据来源于湖北老年记忆队列(the Hubei Memory and Aging Cohort Study,HMACS);共纳入7 887名≥65岁老年人,他们完成了3全套神经心理评估和临床体格检查。SES通过受教育程度、职业性质和家庭人均月收入综合评定;MCI由专家组根据Petersen标准和中国痴呆与认知障碍诊治指南进行诊断;多因素logistic回归分析模型分析老年人SES与MCI患病的关联。结果  共纳入7 887名调查对象,平均年龄(71.74±5.58)岁,MCI检出率为23.00%(95% CI: 22.07%~23.93%);低SES组MCI检出率(44.65%)高于中SES组MCI检出率(16.89%)和高SES组MCI检出率(9.18%);女性高于男性;农村高于城市。分层分析发现：城市男性低SES组MCI患病风险为高SES组的6.276倍(OR=6.276, 95% CI: 4.017~9.805),城市女性低SES组MCI患病风险为高SES组的3.978倍(OR=3.978, 95% CI: 2.943~5.376);依据现有SES标准,农村女性老年人SES分布不均匀。结论  低SES组老年人MCI检出率较高,认知功能障碍的防控要密切关注低SES组老年人,特别是社区低收入、低教育程度的老年人。     

Homocysteine, folate, and vitamin B-12 in mild cognitive impairment, Alzheimer disease, and vascular dementia

BACKGROUND: Evidence supports an independent association between plasma total homocysteine concentrations and the risk of vascular disease. Recent epidemiologic studies reappraised the possibility that vascular risk factors might play a role in the pathogenesis not only of vascular dementia (VaD) but also of Alzheimer disease (AD). OBJECTIVE: The objective was to investigate the relations of mild cognitive impairment, AD, and VaD with blood homocysteine, folate, and vitamin B-12. DESIGN: The study population consisted of 314 consecutive subjects, 228 of whom were eligible for analyses. Plasma total homocysteine, serum folate, and serum vitamin B-12 concentrations were measured in 55 nondemented elderly control subjects, 81 mildly cognitively impaired subjects (Clinical Dementia Rating: 0.5), and 92 demented patients prevalently in a mild disease stage and with a clinical diagnosis of AD (n = 74) or VaD (n = 18). RESULTS: Subjects in the lowest folate tertile had significantly higher adjusted odds ratios (ORs) for mild cognitive impairment (OR: 3.1; 95% CI: 1.2, 8.1) and dementia (3.8; 1.3, 11.2). Hyperhomocysteinemia was significantly associated with dementia (adjusted OR: 4.3; 1.3, 14.7) and AD (adjusted OR: 3.7; 1.1, 13.1). In subjects with a Clinical Dementia Rating of 0.5, the mean (+/- SE) Mini-Mental State Examination score was significantly lower (P < 0.05) in the highest homocysteine tertile (24.5 +/- 0.5) than in the lowest tertile (26.6 +/- 0.5). No significant associations were found between minimum medial temporal lobe thickness or leukoaraiosis and any biochemical measure in the dementia and AD groups. CONCLUSIONS: These findings suggest that relative folate deficiency may precede AD and VaD onset. Hyperhomocysteinemia might also be an early risk factor for cognitive decline in the elderly, but its role in dementia development must be addressed in future longitudinal studies.