阿尔茨海默病患者脑电图与听觉认知电位P300的相关性研究

目的：观察阿尔茨海默病（AD）患者脑电图（EEG）与听觉认知电位P300的变化,并与神经心理学及痴呆程度进行相关性分析,探讨对老年性痴呆进行综合评价的有效方法。方法：对AD患者36例及正常对照者36名采用EEG和P300检查,结合神经心理学测试[简易智能精神状态量表（MMSE）]进行相关性分析。结果：AD组患者的P300潜伏期明显延长,波幅明显降低,与正常对照组比较差异有显著统计学意义（P〈0.01,P〈0.05）;EEG异常率AD组为84%,正常对照组为21 %,两组比较差异有显著统计学意义（P〈0.01）。MMSE总分AD组为19.77±5.22,明显低于对照组（27.66±5.13）,差异有统计学意义（P〈0.05）。AD组MMSE评分与P300 PL呈负相关（r=-0.57,P〈0.05）,与P300 AMP呈正相关（r=0.37,P〉0.05）。结论：利用EEG和P300结合MMSE量表可对老年性痴呆患者作出确切评价,是早期发现AD的有效手段之一。     

阿尔茨海默病患者认知功能与相关脑区血流量的关系

目的探讨不同程度阿尔茨海默病（Alzheimer disease,AD）患者额、颞、基底节、海马区CT血流灌注水平及其与认知功能损害的相关性。方法随机选择60例AD患者及30名健康老人,用简易智能状态量表（Mini-Mental State Exam,MMSE）及韦氏记忆量表（Wechsler Memory Scale,WMS）进行认知功能检查,并选取海马区层面进行CT血流灌注扫描,获得感兴趣区的血流灌注值。采用临床痴呆量表将AD组分为轻、中、重度痴呆3组。结果轻、中、重度AD组与健康组MMSE总分、长时、短时及瞬时记忆测验量表分比较的差异均有统计学意义。比较4组患者的双侧额、颞、基底节、海马区血流灌注参数,发现右额叶、右颞叶及左基底节脑血容量（cerebral blood volume,CBV）的差异有统计学意义,中度AD组较轻度组、对照组CBV明显升高;重度AD组与各组比较均无统计学差异。逐步回归分析显示认知功能与左海马、右基底节CBV呈显著正相关。结论 AD患者局部脑区的CBV变化,反映了不同程度痴呆患者的大脑认知储备能力。     

老年期痴呆104例的临床研究

为研究老年期痴呆三种主要类型的诊断特点，对104例住院患者进行神经心理测试，脑CT扫描定量分析，部分患者经单光子发射计算机体层摄影术（SPECT）定量检查，并以健康老年人为对照组，统计分析组间均值比用t检验或F检验，计数资料用x2检验，结果显示：老年期痴呆患者中常见类型为血管性痴呆（VD），老年性痴呆（AD）及混合痴呆（MIX），VD多有卒中史，急性起病，阶梯样进展，伴有神经功能损害，Hackinski评分＞7分，脑CT扫描显示局灶性病灶，脑SPECT示局灶性血流减少。（2）AD常缓慢起病，逐渐进展，神经功能缺损轻，Hackinski评分＜4分，脑CT扫描显著波层萎缩明显，脑SPECT表现为双侧颞顶枕区（TPO）皮层对称性血流减少，（3）MIX兼有VD和AD二者类型的特征，老年期痴呆的诊断首先应确定有无痴呆，然后根据不同类型临床类型的特点确定痴呆的类型，尽可能包括其类型诊断以利于治疗。     

阿尔茨海默病患者经颅多普勒分析

目的探讨阿尔茨海默病（Alzheimer‘s disease,AD）患者经颅多普勒（transcranial Doppler,TCD）的异常特征及与患者痴呆之间的关系。方法分析26例AD患者TCD的检测结果,并与其MMSE评分进行相关分析。结果 26例TCD显示脑供血动脉血流速度均减慢,且血流速度的减慢程度与MMSE评分有相关性。结论 TCD检测可有效反映AD患者认知功能损害程度,TCD技术对AD患者的认知障碍评估具有一定临床价值。     

Alzheimer‘s病患者认知功能与脑电活动及脑萎缩的相关性研究

目的 研究Alzheimer‘s病（AD）患者认知功能、脑电活动及脑萎缩的相关性。方法 对20例AD患者及21例正常老年人进行成套神经心理学评估（MMSE.FOM.DST.BNT RVR画钟试验）,BEAM频谱分析及脑CT线性测量的结果进行比较,采用逐步多元回归方法进行相关分析。结果 AD组的神经心理学评估分值明显降低,慢波功率（δθ）明显增高,快波功率（α3、β）明显下降,额叶、颞叶的萎缩程度明显增加,其认知缺损与脑沟宽度,侧裂池宽度,侧脑室体部宽度及δ波功率相关。结论 AD患者认知功能与颞额叶萎缩程度及δ波功率呈负相关。     

阿尔茨海默病患者血清脑源性神经营养因子水平研究

目的 探讨阿尔茨海默病（AD）与血清脑源性神经营养因子（BDNF）水平的关系。方法 采用酶联免疫吸附法对46例AD患者（研究组）和44例正常对照者（对照组）的外周血清进行BDNF水平检测。所有受试者均进行简易精神状态量表（MMSE）、Hachinski缺血指数（HIS）及汉密尔顿抑郁量表（HAMD）评定,AD患者用临床痴呆评定量表（CDR）进行痴呆严重程度分级。结果 研究组血清BDNF水平低于对照组（P〈0.01）。研究组轻度、中度与重度AD患者血清BDNF水平均低于对照组（P〈0.01）,重度AD血清BDNF水平低于轻度AD（P〈0.05）。研究组血清BDNF水平与年龄、病程呈负相关（P〈0.01）,与MMSE评分呈正相关（P〈0.01）。结论 AD患者存在血清BDNF水平降低,且与其年龄、病程及痴呆程度显著相关。     

Alzheimer病的嗅觉功能障碍

目的 探讨Alzheimer病（AD）的嗅觉功能障碍特点及其在AD早期诊断中的作用。方法 对24例可能AD患者和正常老年人分别行简易智能状态检查（MMSE）、日常生活活动量表（ADL）评定、气味感知阈值测定和图片介导的气味识别试验检查。结果 可能AD患者气味感知能力低于正常老年人（t=5.38,P＜0．001）;确诊的气味数目少于正常老年人（t=15.54,P＜0．001）,可能AD患者的识别和气味感知能力与MMSE得分呈正相关（r分别为0．646与0．467,P＜0．01）。结论 可能AD患者存在嗅觉功能损害,缺损程度与痴呆严重程度有关。嗅觉功能检查可用于早期AD的诊断。     

轻度认知障碍和阿尔茨海默病患者认知功能和MRI对照研究

目的探讨轻度认知障碍（MCI）和阿尔茨海默病（AD）的认知功能及影像学特点。方法回顾性分析经临床确诊的21例MCI和24例AD患者的临床资料。所有实验对象均用简易智力量表（MMSE）和蒙特利尔认知评估（MoCA）测定。结果MCI与AD的认知功能损害相比较：除了MMSE的记忆力组间无统计学意义（P＝0．28）,其余均有统计学差异（P〈0．05）。MoCA比MMSE具有更好的敏感性。AD的MRI表现：脑萎缩,特别是海马存在不同程度的萎缩;老年性脑改变;MCI的MRI主要表现为脑白质脱髓鞘病变,少数提示轻度脑萎缩或未见明显异常。结论MCI和AD患者早期均表现为记忆力下降,对记忆力减退人群进行MMSE、MoCA量表筛查有助于AD的早期诊断。AD患者到中晚期治疗较困难,因此早期诊断及干预对延缓病程起积极作用。     

静息态脑电在阿尔茨海默病诊断中的价值

背景 阿尔茨海默病（AD）诊断仍面临很大挑战,脑电图检查具有便携、无创的优势,脑电诊断AD是目前的研究热点。目的 探讨静息态脑电用于AD诊断的价值,为临床上AD的早期识别提供参考。方法 回顾性分析2019年5月-2022年5月在深圳市康宁医院老年精神障碍科住院的AD患者（n=59）临床资料,以同期在该院门诊检查的健康老年人作为对照组（n=54）。收集8通道静息态脑电数据,使用快速傅里叶变换（FFT）计算患者在α、β、θ、δ频段脑电的绝对功率值和α/θ绝对功率比值。采用简易精神状态评价量表（MMSE）和蒙特利尔认知评估量表（MoCA）评定患者的认知功能。采用Spearman相关分析考查患者脑电变量与MMSE和MoCA评分的相关性。基于选定的脑电及临床资料,建立预测AD的Logistic回归模型,采用受试者工作特征（ROC）曲线下面积（AUC）评估模型性能。结果 AD患者右额极（F4）、左右侧额极（F7、F8）θ绝对功率均高于健康对照组,差异均有统计学意义（t=-2.844、-2.825、-3.014,P<0.05或0.01）;AD患者左右前额极（Fp1、Fp2）、左右额极（F3、F...     

脑器质性神经病智力状况及其与脑CT异常的关系

目的 探讨脑器质性精神病智力状况与其脑结构异常的关系。方法 采用单螺旋CT机，对先后住院的脑器质性精神病患者72例，进行各脑区不同层面扫描，尤其观察第4、5、6层的变化，同时临床采用MMSE量表（简易智力筛查表）进行逐一评分.并与72例对照组（慢性分裂症）进行比较.结果 脑器质性精神病患者72例中，脑腔梗32例占44.4%，透明膈变异20例占27.7%，高血压、糖尿病24例，占33.3%与临床MMSE量表分进行比较具有显著相关，r=6.11。两组病人MMSE得分比较脑器质性精神病患者回忆力，语言表达能力与对照组（慢性分裂症）比较具有显著差异P＜0.01。两组病人的性别年龄、病程及受教育年龄均无显著差异P＞0.05。结论 脑器质性精神病患者智力状况与脑血管及组织损伤程度密彻相关，尤其对脑血管性痴呆与脑变性更为严重的智力损伤患者，与慢性分裂症比较有显著差异.加强脑器质精神病智力测验、治疗与康复措施至关重要。     

Cognitive and functional neuroimaging correlate for anosognosia in mild cognitive impairment and Alzheimer's disease

OBJECTIVES: To investigate the correlation between anosognosia and behavioural symptoms, performance on executive tests, and frontal cortex regional cerebral blood flow (rCBF) in patients with 'amnestic mild cognitive impairment' (MCI) and mild Alzheimer's disease (AD). METHODS: From a prospective Memory Clinic cohort including consecutively referred patients, age 60 years or above, and with MMSE score 20 or above, 36 patients with AD and 30 with MCI were included in this study. Anosognosia was assessed using a categorical scale and discrepancy scores between patients' and relatives' reports on a 20-item Memory Questionnaire (MQ). Behavioural symptoms were assessed with Frontal Behavioural Inventory (FBI). Executive functions were examined with a range of neuropsychological tests. Tc99m-HMPAO SPECT was obtained in an unselected sample of 55 of the 66 patients, and rCBF was analysed in six cortical frontal regions. RESULTS: Insight was equally impaired in the two patient groups. A significant correlation was found between impaired awareness and dementia severity (MMSE). Discrepancy-scores on the MQ were significantly correlated to scores on FBI and to rCBF in the right inferior frontal gyrus, but not to executive tests. The groups classified by the categorical ratings 'full', 'shallow' and 'no' awareness were not characterized by differences in behavioural symptoms, executive performance or frontal rCBF. CONCLUSIONS: Impaired awareness is associated with behavioural symptoms and may reflect functional impairment in the right inferior frontal cortex.     

Regional cerebral blood flow patterns and response to donepezil treatment in patients with Alzheimer's disease

We attempted to identify the characteristic patterns in regional cerebral blood flow (rCBF) of patients with Alzheimer's disease who responded to donepezil therapy. Sixty-one patients treated with donepezil were divided into two groups (responders and nonresponders) on the basis of changes in their Mini Mental State Examination (MMSE) scores from baseline to study endpoint. We analyzed single-photon emission computed tomography data (SPECT) at baseline using three-dimensional stereotactic surface projections and compared differences in rCBF between the two groups. Statistical maps showed a significantly lower rCBF of the lateral and medial frontal lobes in the nonresponders than in the responders. There was a significant inverse correlation between the relative rCBF reduction in the frontal lobe and the MMSE change. These results suggest that frontal function, as assessed by SPECT, affects the patient's response to treatment with donepezil. Measuring rCBF may aid in the selection of possible treatment responders.     

石杉碱甲治疗脑器质性疾病的记忆和认知功能的疗效观察

目的探讨石杉碱甲治疗脑器质性疾病的记忆和认知功能的疗效.方法用石杉碱甲治疗脑器质性疾病64例,疗程八周.其中阿尔采木氏病(AD)23例,血管性痴呆(VD)41例.采用韦氏记忆商数(WMQ)、简易智能状态量表(MMSE)评定疗效.结果治疗后,AD、VD两组的(WMQ)与MMSE得分均较治疗前有明显改善(P＜0.05～0.1).结论石杉碱甲对治疗脑器质性疾病的记忆和认知功能有效.     

Ouabain binding in the human brain. Effects of Alzheimer's disease and aging

We studied Na+,K+-adenosine triphosphatase by assaying specific tritiated ouabain binding in the frontal cortex, temporal cortex, hippocampus, putamen, cerebellum, and cerebral microvessels in subjects with Alzheimer's disease and control subjects. Ouabain binds specifically, in a saturable manner, and with a high affinity to a single class of binding sites in all the tissues studied. The density of ouabain binding sites was highest in cerebellum and frontal cortex (approximately 40 pmol/mg of protein); intermediate in temporal cortex, hippocampus, and putamen; and lowest in brain microvessels (approximately 8 pmol/mg of protein). The dissociation constant of binding was about 30 nmol/L in all tissues. In control subjects, there were no age-related alterations in ouabain binding, nor was there any correlation between ouabain binding and postmortem delay. However, there was a marked decrease in brain ouabain binding in subjects with Alzheimer's disease when compared with age-matched controls, especially in the cerebral cortex. Ouabain binding was also significantly decreased in the cerebellum and putamen of subjects with Alzheimer's disease even though these brain regions are not particularly affected in this disease. Ouabain binding to brain microvessels, which constitute the blood-brain barrier, was not significantly decreased in subjects with Alzheimer's disease. The decreased specific ouabain binding in the brain of subjects with Alzheimer's disease probably reflects the loss of neuronal membranes.     

Intercorrelations of regional cerebral glucose metabolic rates in Alzheimer''s disease

Patterns of cerebral metabolic correlations were compared between 21 Alzheimer's disease patients and 21 healthy age-matched controls in the resting state. Cerebral metabolic rates for glucose were determined by positron emission tomography using [18F]2-fluoro-2-deoxy-D-glucose. Partial correlation coefficients, controlling for whole brain glucose metabolism, were evaluated between pairs of regional glucose metabolic rates in 59 brain regions. Reliable correlation coefficients were obtained with the 'jackknife' and 'bootstrap' statistical procedures. Compared with healthy controls, the Alzheimer patients had significantly fewer reliable partial correlation coefficients between frontal and parietal lobe regions, and more reliable correlations between the cerebellum and temporal lobe. The number of reliable correlations between many bilaterally symmetric brain regions was reduced in the Alzheimer patients, as compared with controls. These results suggest that in the early stages of Alzheimer's disease there is a breakdown of the organized functional activity between the two cerebral hemispheres, and between parietal and frontal lobe structures.     

Altered circadian cortisol secretion in Alzheimer's disease: clinical and neuroradiological aspects

We determined circadian salivary cortisol levels in 18 outpatients affected by probable Alzheimer's disease (AD) and looked for a possible correlation with both cognitive impairment and brain CT scan findings. The diagnosis of probable AD was made according to the NINCDS-ADRDA criteria. The severity of cognitive impairment was quantified using the Mini Mental State Examination (MMSE) and the Global Deterioration Scale (GDS). Cortisol levels were measured on saliva samples collected at 08:00 AM and 08:00 PM. For each sample, a duplicate cortisol measurement was performed on 50 microl of saliva by means of a modified commercial radioimmunoassay kit. At the same time, 11 of the 18 AD patients enrolled also underwent a brain CT scan to estimate cerebral atrophy by using linear indexes. The mean value of cortisol levels was significantly higher in AD patients than in controls at both the morning and the evening measurements, and the circadian fluctuation of cortisol was less marked in AD patients than in controls, although this difference did not reach statistical significance. Morning cortisol levels were significantly correlated to both the MMSE and the GDS scores. A significant correlation was also found between morning cortisol levels and all the cerebral atrophy indexes. By contrast, no correlation was observed between evening cortisol levels or cortisol circadian fluctuations and either cognitive impairment or cerebral atrophy. In conclusion, despite the potential biases deriving from the small sample and the limitations of the CT scan study, our results suggest that, in AD patients, hypercortisolemia is correlated with severity of the disease.     

Cerebral blood flow and cerebral oxygen metabolism in patients with dementia of frontal lobe type

This study was designed to investigate the differences in cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) between patients with dementia of frontal lobe type and patients with Alzheimer's disease. Positron emission tomography (PET) using 15O steady state inhalation technique was carried out in 5 patients with a clinical diagnosis of dementia of frontal lobe type and 7 patients with a clinical diagnosis of Alzheimer's disease. CBF and CMRO2 were significantly decreased in the frontal cortex except for precentral region in patients with dementia of frontal lobe type in comparison to those values in patients with Alzheimer's disease. However, in patients with dementia of frontal lobe type CBF and CMRO2 in the parietal cortex and the occipital cortex were relatively preserved when compared with patients with Alzheimer's disease. In comparison with values for CBF and CMRO2 in the posterior part of brain [frontal or temporal/(parietal + occipital)/2 ratio], both values in the frontal cortex were markedly decreased in all 5 patients with dementia of frontal lobe type, but there was no marked reduction in the frontal cortex in patients with Alzheimer's disease. In addition, in 2 patients with dementia of frontal lobe type whose duration of the disease was more than 7 years, CBF and CMRO2 in the temporal cortex were markedly reduced in comparison with values in the posterior part of brain. These results suggested that PET findings of marked reduction in CBF and CMRO2 in the frontal cortex are useful to distinguish dementia of frontal lobe type from Alzheimer's disease.     

Patterns of brain activity during a semantic task differentiate normal aging from early Alzheimer's disease

In a study of the effects of normal and pathological aging on semantic-related brain activity, 29 patients with Alzheimer's disease (AD) and 19 controls subjects (10 young and 9 older controls) performed a version of the Pyramids and Palm Trees Test that had been adapted for use during functional magnetic resonance imaging (fMRI). Young and older controls activated the left inferior and middle frontal gyri, precuneus and superior parietal lobule. Right frontal and left temporal cortices were activated only in the young. The AD group activated only the left prefrontal and cingulate cortex. Separate analyses of high- and low-performing AD subgroups showed a similar pattern of activation in the left frontal lobe, although activiation was more widespread in low performers. High performers significantly deactivated anterior midline frontal structures, however, while low performers did not. When the older adult and AD groups were combined, there was a significant positive correlation between left frontal and parietal activation and Mini-Mental State Examination (MMSE) score (covarying for age), suggesting a disease effect. A significant negative correlation between activation in the left temporal cortex and age (covarying for MMSE score) reflected a possible age effect. These differential effects suggest that semantic activation paradigms might aid diagnosis in those cases for whom conventional assessments lack the necessary sensitivity to detect subtle changes.     

Widespread reduction of somatostatin-like immunoreactivity in the cerebral cortex in Alzheimer's disease

Although several studies have documented reduced concentrations of somatostatin-like immunoreactivity (SLI) in the cerebral cortex in Alzheimer's disease, there is controversy concerning the extent and importance of these changes. We measured SLI in brains obtained post mortem from 12 patients with pathologically confirmed Alzheimer's disease and from 13 neurologically normal controls. All major cortical and subcortical regions were examined. Widespread reductions of SLI in Alzheimer's disease cerebral cortex were found, with the most profound changes seen in temporal lobe; but there also were major reductions in both the frontal and occipital cortex. There were no significant reductions in subcortical regions. Characterization of SLI by high-pressure liquid chromatography showed no significant difference in profiles between Alzheimer's disease and control frontal cortex. These results suggest that the reduction in somatostatin immunoreactivity in Alzheimer's disease may be caused by degeneration of intrinsic somatostatin cortical neurons.