路易体痴呆与帕金森病伴认知功能损害患者分子影像特点研究

目的探讨路易体痴呆与帕金森病伴认知功能损害(Parkinson's disease with cognitive impairment,PD-CI)患者分子影像特点。方法选择2014年2月~2016年12月解放军总医院南楼神经内科诊治的可能路易体痴呆患者6例及PD-CI患者15例,回顾分析临床病史、神经心理学特点以及~(11)C-甲基-N-2β-甲基酯-3β-(4-氟苯基)托烷(~(11)C-β-CFT)、~(11)C-匹兹堡复合物B(~(11)C-PIB)、~(11)C-雷氯必利(~(11)C-RAC)和18F-氟脱氧葡萄糖(18F-FDG)正电子发射断层显像特点。结果路易体痴呆患者双侧壳核~(11)C-β-CFT摄取对称性减低比例、皮质~(11)C-PIB摄取增高比例以及顶枕连接区18F-FDG下降比例明显高于PD-CI患者(50.0%vs 13.3%,80.0%vs 16.7%,100.0%vs 40.0%,P0.05);而双侧壳核~(11)C-β-CFT摄取不对称性减低比例明显低于PD-CI患者(33.3%vs 86.7%,P0.05)。3例行~(11)C-RAC显像的路易体痴呆患者中,双侧摄取减低1例(33.3%),双侧摄取增高2例(66.7%);15例(100.0%)PD-CI患者均呈现双侧摄取增高。结论路易体痴呆与PD-CI的分子影像特征性改变,有助于两者的鉴别诊断。     

轻度认知障碍与非痴呆型血管性认知功能障碍患者屏气指数的研究

目的评价轻度认知障碍（McI）患者与非痴呆型血管性认知功能障碍（VICND）患者的屏气指数（BHI）与认知功能的关系。方法 150例受试者分为正常对照组、MCI组及VICND组,应用经颅多普勒（TCD）屏气试验计算BHI,并应用蒙特利尔认知评估量表（MoCA）进行认知功能评分,分析BHI与认知功能的关系。结果MCI组和VCIND组高血压、高血糖、高血脂的患病率均显著高于对照组（P〈0．05）,MCI组与VCIND组间比较无显著差异。MCI组和VCIND组BHI,分别为（0．90±0．16）％／s、（0．87±0．19）％／s,均明显低于对照组的（1．37±0．22）％／s。MoCA评分与BHI呈正相关（r=0．803,P〈0．01）结论高血压、糖尿病及高血脂可能与MCI患者及VCIND患者的认知功能下降有关,BHI与认知功能具有一定的相关性。     

Mild cognitive impairment: epidemiology and dementia risk in an elderly Italian population

OBJECTIVES: To investigate prevalence and incidence of mild cognitive impairment (MCI) and its risk of progression to dementia in an elderly Italian population.
DESIGN: Longitudinal.
SETTING: Population-based cohort aged 65 and older resident in an Italian municipality.
PARTICIPANTS: A total of 1,016 subjects underwent baseline evaluation in 1999/2000. In 2003/04, information about cognitive outcome was collected for 745 participants who were free of dementia at baseline.
MEASUREMENTS: MCI (classified as with or without impairment of the memory domain), dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) diagnosed according to current international criteria.
RESULTS: Overall prevalence of MCI was 7.7% (95% confidence interval (CI)=6.1–9.7 %) and was greater with older age and poor education. During 4 years of follow-up, 155 incident MCI cases were diagnosed, with an incidence rate of 76.8 (95% CI=66.8–88.4) per 1,000 person-years. Approximately half of prevalent and incident MCI cases had memory impairment. Compared with normal cognition, multivariable-adjusted risk for progression from MCI with memory impairment to dementia was 4.78 (95% CI=2.78–8.07) for any dementia, 5.92 (95% CI=3.20–10.91) for AD, and 1.61 (95% CI=0.37–7.00) for VaD. No association with dementia risk was found for MCI without memory impairment. Approximately one-third of MCI cases with memory impairment did not progress to dementia.
CONCLUSION: MCI occurs often in this elderly Italian cohort and is associated with greater risk of AD, but only when the impairment involves the memory domain. However, a substantial proportion of MCI cases with memory impairment do not progress to dementia.     

Predictors of cognitive impairment and dementia in older people with diabetes

Aims/hypothesis Diabetes is associated with an increased risk of dementia but the reasons for this association are unclear because there are many potential mechanisms. We explored the relative contribution of diabetes-related variables as predictors of dementia in older individuals with diabetes. Methods Survivors, aged ≥70 or more, were recruited from an existing observational cohort study 7.6 ± 1.0 years after baseline, when they underwent a comprehensive assessment of diabetes, complications and cardiovascular risk factors. Dementia, probable Alzheimer’s disease and cognitive impairment without dementia were diagnosed clinically. Logistic regression modelling determined independent predictors of cognitive diagnoses. Results Of 302 participants, aged 75.7 ± 4.6 years, 28 (9.3%) had dementia (16 with probable Alzheimer’s disease) and 60 (19.9%) had cognitive impairment without dementia. The major independent longitudinal predictors of dementia were older age (per decade; odds ratio 4.0, 95% CI 1.59–10.10), diabetes duration (for each 5 years; odds ratio 1.69, 95% CI 1.24–2.32), peripheral arterial disease (odds ratio 5.35, 95% CI 2.08–13.72) and exercise (which was protective; odds ratio 0.26, 95% CI 0.09–0.73). For Alzheimer’s disease, diabetes duration was an independent predictor in addition to age and diastolic blood pressure. The results of the cross-sectional analyses were similar with respect to diabetes duration and peripheral arterial disease. Conclusions/interpretation Peripheral arterial disease is a strong independent risk factor for dementia in diabetes. After adjustment for a wide range of potential risk factors, diabetes duration remains independently associated with dementia and probable Alzheimer’s disease, indicating that factors not measured in this study may be important in the pathogenesis of dementia in diabetes.     

老年帕金森病患者的神经心理学特点及其相关因素

目的分析帕金森病（Parkinson’s Disease,PD）患者的认知功能状况及其相关因素。方法利用简易精神状态检查（Mini—Mentalstate,MMSE）、日常生活活动能力量表（Activities of Daily Living Scale,ADL）、韦氏记忆量表（Wechsler Memory Scale,WMS）,对PD患者及正常老人（NormalAged,NA）各30例进行认知功能评估。PD组的认知状况与其病程,运动功能障碍（Webster评分）,受教育年限等因素进行相关性分析。结果（1）PD组的认知功能损害的发生率为53．3％;（2）与对照组相比PD患者的认知功能损害主要表现在与短时记忆（P〈0．01）和瞬时记忆（P〈0.05）相关的测验;长时记忆、计算能力相关的测验分数差异无显著性（P〉0．05）。（3）PD组患者病程与WMS各分测验无相关关系（P〉0．05）。Webster评分与各分测验均有负相关关系（P〈0．05）,尤其与触摸测验分数呈明显负相关（P〈0．01）。患者受教育年限与各分测验亦有相关关系（P〈0．05）。结论PD患者存在不同程度的认知功能障碍,特别是短时记忆、瞬时记忆和执行功能的下降;认知障碍与其受教育程度和运动功能障碍具有相关性。     

Mild cognitive impairment subtypes and vascular dementia in community-dwelling elderly people: a 3-year follow-up study

OBJECTIVES: To investigate whether mild cognitive impairment (MCI) with multiple impaired cognitive domains (mcd-MCI) is a prodromal manifestation of vascular dementia (VaD). DESIGN: Prospective cohort study. SETTING: Geriatric unit of the Ospedale Maggiore Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy. PARTICIPANTS: Four hundred community-dwelling subjects aged 65 and older who came freely to the geriatric unit as part of a comprehensive geriatric assessment program were evaluated for memory impairment or other cognitive disorders. Subjects with MCI were kept under observation for 3 years. MEASUREMENTS: Subjects with MCI were studied by applying a standardized clinical evaluation and a conducting a computed tomography brain scan. Cognitive performance was assessed using the Mini-Mental State Examination, the Clock Drawing Test, and a comprehensive battery of neuropsychological tests. Cardiovascular comorbidity was assessed on the basis of medical history and using electrocardiography, echocardiography, and carotid color Doppler ultrasound. RESULTS: MCI was found in 65 of the 400 community-dwelling subjects; 31 were classified with amnestic MCI (a-MCI) and 34 with mcd-MCI. A dysexecutive syndrome characterized people with mcd-MCI, who had significantly more vascular comorbidity and signs of vascular disease on brain imaging as well as a higher prevalence of extra pyramidal features, mood disorders, and behavioral symptoms than people with a-MCI. Twenty of the 65 subjects with MCI (31%) progressed to dementia within 3 years of follow-up: 11 subjects with Alzheimer's disease (AD) and nine with VaD. All patients who evolved to AD had been classified with a-MCI at baseline, whereas all patients who evolved to subcortical VaD had been classified with mcd-MCI at baseline. CONCLUSION: All subjects who converted to subcortical VaD had been classified with mcd-MCI, suggesting that mcd-MCI might be an early stage of subcortical VaD.     

Effects of reminiscence group in elderly people with Alzheimer disease and vascular dementia in a community setting

This study reports the effects of a reminiscence group program on elderly people with two major types of dementia, Alzheimer's disease and vascular dementia, in a randomized controlled clinical trial with a 6-month follow up. The subjects were 24 participants with Alzheimer's disease and 36 with vascular dementia, and were randomly assigned to an intervention group or a control group. The intervention group followed a reminiscence group program in a geriatric health facility for 8 weeks; the control group followed a routine daycare program. The primary outcome was level of daily life activities (i.e. self-care, disorientation, depression, irritability and withdrawal) measured by the Multi-dimensional Observation Scale for Elderly Subjects. The second outcome was level of cognitive function measured by the Mini-Mental State Examination. For participants with Alzheimer's disease, the intervention group exhibited significant improvement of withdrawal compared with the control group immediately after intervention ( P  < 0.05). For participants with vascular dementia, the intervention group exhibited significant improvement of withdrawal and cognitive function compared with the control group immediately after intervention (withdrawal, P  < 0.05; cognitive function, P  < 0.05) and after 6-month follow up (withdrawal, P  < 0.05; cognitive function, P  < 0.05). The reminiscence group program is an effective means of enhancing the remaining capacity and the adaptation to a daily life in elderly people with Alzheimer's disease and vascular dementia. However, it is also suggested that sustained intervention may be necessary to maintain the effect over time, especially in elderly people with Alzheimer's disease.     

帕金森病痴呆与阿尔茨海默病认知障碍特点分析

目的 分析帕金森病痴呆(PDD)与阿尔茨海默病(AD)患者的认知障碍特点.方法 采用语义流畅性、语音流畅性、动作流畅性测验与物品和动作命名测验评定PDD组(30例)、AD组(30例)与对照组(60例)患者临床情况.结果 PDD组语义流畅性测验总分(9.33±2.78)分、语音流畅性测验总分(6.17±1.67)分、动作流畅性测验总分(7.03±2.34)分,AD组分别为(6.90±2.47)分、(7.87±2.01)分、(8.30±3.17)分;PDD组物件命名测验总分(36.33±3.39)分、动作命名测验总分(17.63±2.17)分,AD组分别为(33.23±3.56)分与(22.33±2.37)分.与对照组比较,PDD与AD患者三项言语流畅性与物品和动作命名均受损(P＜0.01).其中,PDD患者以语音流畅性、动作流畅性与动作命名损害为重,而AD患者以语义流畅性与物件损害为重(P＜0.01).结论 PDD与AD患者均存在执行功能障碍与命名损害,PDD是一种伴有皮质功能损害以额叶皮质下功能障碍为主要特点的认知损害性疾病,而AD亦存在皮质下功能障碍.

Abstract：

Objective To analyze the characterization of cognitive function in Parkinson's disease with dementia and Alzheimer's disease. Methods Cognitive function was examined in Parkinson's disease with dementia (PDD) patients ( n = 30) , Alzheimer's disease (AD) patients ( n = 30) and healthy elderly control subjects ( n = 60) . Neuropsychological evaluation contained semantic fluency test, phonemic fluency test, action fluency test, objective and action naming tests. Results In PDD group , the score of semantic fluency test is 9. 33 ±2. 78, 6. 17 ± 1.67 of phonemic fluency test and 7.03 ±2. 34 of action fluency test,it is 6.90 ±2.47, 7.87±2.01,8.30±3. 17 of AD group. The score of objective and action naming tests is 36.33 ±3.39, 17.63 ±2. 17 in PDD group,while AD patients is 33.23 ±3.56 and 22.33 ±2.37. The verbal fluency tests and naming tests were impaired in PDD and AD patients compared with the healthy elderly control group (P ＜ 0. 01 ), phonemic fluency, action fluency and action naming were more impaired in PDD patients compared with the AD group , while semantic fluency and objective naming were more impaired in AD patients (P ＜ 0. 01 ). Conclusions Executive function deficit and naming impairment are found in PDD and AD patients, it shows that PDD is characterized by the addition of cortical dysfunction upon a predominant and progressive fronto-subcortical impairment. There is subcortical dysfunction in AD patients.     

The EASI: a self-administered screening test for cognitive impairment in the elderly

The Early Assessment Self Inventory (EASI), a rapid self-administered screening test for cognitive impairment in the elderly, was constructed to permit individuals to be assessed in a group or singly without examiner intervention. This paper-and-pencil device requires a fourth-grade reading level and makes minimal demands on literacy while assessing orientation, recent and remote memory, language, visual-construction, calculation, and attention. In the present study, the EASI was group-administered to 146 elderly persons attending senior centers and completed individually without examiner intervention by 19 outpatients at a memory disorders clinic. Participants were 60 to 95 years old with 5 to 18 years of education. The EASI demonstrated good internal consistency and test-retest reliability and was significantly correlated with the Mini-Mental State Exam and the Mattis Dementia Rating Scale, both widely used screening instruments. Neuropsychological measures of memory, attention, and verbal fluency correlated as well with the EASI as with the examiner-administered screening instruments, suggesting that the EASI may provide an efficient method of screening for cognitive impairment.     

Mortality and blood pressure in elderly people with and without cognitive impairment

BACKGROUND: Controversial data are available on the association between mortality, blood pressure and cognitive impairment in the elderly. Objective: To verify the role of blood pressure on mortality in an elderly population with and without cognitive impairment. METHODS: A cross-sectional survey with a 6-year mortality evaluation was conducted in a region of southern Italy in elderly subjects with and without cognitive impairment. Subjects were divided into 4 groups on the basis of systolic, diastolic, mean and pulse blood pressure values. RESULTS: Mortality shows a linear relationship with pulse blood pressure and a U-curve shape for diastolic blood pressure. This phenomenon was more evident in subjects with cognitive impairment showing the greatest risk of mortality at the lowest and highest levels of diastolic blood pressure. CONCLUSION: The study shows that mortality increases linearly with increasing blood pressure in the elderly. In contrast, mortality shows a U-shape curve for diastolic blood pressure; cognitively impaired patients with the lowest and highest diastolic blood pressures show the greatest relative risk of mortality.     

帕金森病轻度认知功能障碍患者的事件相关电位研究

目的探讨事件相关电位在评估帕金森病轻度认知功能障碍(PD-MCI)中的价值。方法选择PD患者110例,根据神经心理学测验评估结果分为PD-MCI组45例和认知正常组(PD-CN组)65例。另选择同期健康体检者66例(对照组)。比较各组事件相关电位成分的变化,并分析P3和N2潜伏期及波幅与神经心理学测验成绩的相关性。结果与PD-CN组比较,PD-MCI组P3和N2潜伏期明显延长,差异有统计学意义(P<0.05);与对照组比较,PD-CN组P3潜伏期延长(P<0.05)。3组间P3和N2潜伏期比较,差异有统计学意义(P=0.001,P=0.000,P=0.004,P=0.000);3组间P3波幅比较,差异无统计学意义。P3潜伏期与视觉再认、图片排列及MMSE评分呈负相关(P<0.05),N2潜伏期与视觉再认、图片排列评分呈负相关,差异有统计学意义(P<0.05)。结论事件相关电位能较客观反映认知功能,其中N2潜伏期可作为PD-MCI客观评估的指标。     

Instrumental activities of daily living as a screening tool for cognitive impairment and dementia in elderly community dwellers.

OBJECTIVE: To identify which Instrumental Activities of Daily Living (IADL) are related to cognitive impairment, independent of age, sex, and education; to assess the performance of an IADL score using these items in screening for cognitive impairment and dementia in elderly community dwellers. DESIGN: Survey based on the baseline interview of the PAQUID study on functional and cerebral aging. SETTING: Community survey in 37 randomly selected parishes in Gironde, France. SUBJECTS: Random sample of 2,792 community dwellers aged 65 and over (participation rate: 69%). MEASUREMENTS: Two-phase screening: (1) functional assessment, Mini-Mental State Examination (MMSE) and DSM-III criteria for dementia; (2) in DSM-III-positive patients, NINCDS-ADRDA criteria applied by a neurologist. Functional assessment: IADL scale of Lawton and Brody. Criterion standards: cognitive impairment: MMSE score lower than 24; dementia: DSM-III and NINCDS-ADRDA criteria. RESULTS: Four IADL items are correlated with cognitive impairment independent of age, sex, and education: telephone use, use of means of transportation, responsibility for medication intake, and handling finances. A score adding the number of IADL dependencies has a sensitivity of 0.62 and a specificity of 0.80 at the lowest cut-off point (score > 0) for the diagnosis of cognitive impairment. The same score at the same cut-off has a sensitivity of 0.94 and a specificity of 0.71 for the diagnosis of dementia. The prevalence of dementia (2.4%) is reduced by a factor of 12 in subjects independent for the four IADL. CONCLUSION: The four IADL score could be incorporated into the screening procedure for dementia in elderly community dwellers.     

Daytime sleepiness and cognitive impairment in the elderly population.

BACKGROUND: Recent findings suggest that there may be a relationship between excessive daytime sleepiness (EDS) and cognitive deficits. This study aims to determine to what extent EDS is predictive of cognitive impairment in an elderly population. METHODS: A total of 1026 individuals 60 years or older representative of the general population living in the metropolitan area of Paris, France, were interviewed by telephone using the Sleep-EVAL expert system. To find these individuals, 7010 randomly selected households were called: 1269 had at least 1 household member in this age range (participation rate, 80.9%). In addition to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and International Classification of Sleep Disorders diagnoses, the system administered to participants the Psychological General Well-being Schedule, the Cognitive Difficulties Scale (MacNair-R), and an independent living scale. RESULTS: Excessive daytime sleepiness was reported by 13.6% of the sample, with no significant difference among age groups. Compared with nonsleepy participants, those with EDS were at increased risk of cognitive impairment on all the dimensions of the MacNair-R scale after controlling for age, sex, physical activity, occupation, organic diseases, use of sleep or anxiety medication, sleep duration, and psychological well-being. The odd ratios were 2.1 for attention-concentration deficits, 1.7 for praxis, 2.0 for delayed recall, 2.5 for difficulties in orientation for persons, 2.2 for difficulties in temporal orientation, and 1.8 for prospective memory. CONCLUSIONS: Among elderly individuals in the general population, EDS is an important risk factor for cognitive impairment. A complaint of EDS by an elderly patient should signal the possibility of an underlying cognitive impairment in need of evaluation.     

Refining memory assessment of elderly people with cognitive impairment: Insights from the short-term memory binding test

Alzheimer's disease (AD) affects temporary memory for bound features more remarkably than for individual features. Such selective impairments manifest from presymptomatic through dementia stages via titration procedures. A recent study suggested that without titration and with high memory load the binding selectivity may disappear in people at risk of AD such as those with Mild Cognitive Impairment (MCI). We compared data from two studies on temporary binding which assessed people with MCI and controls using different memory loads (2 or 3 items). Selective binding impairments were found in MCI, but relative to controls, such selectivity was contingent upon memory load (i.e., present with 2 items). Further analysis with MCI people who tested positive to neuroimaging biomarkers (i.e., hippocampal atrophy) confirmed that this specific binding impairments are a feature of prodromal AD. The temporary binding task has been recently suggested by consensus papers as a potential screening tool for AD. The results presented here inform on task properties that can maximize the reliability of this new assessment tool for the detection of memory impairments in prodromal cases of AD.     

社区老年人轻度认知功能障碍患病调查

目的了解社区老年人轻度认知功能障碍（MCI）的患病率及危险因素。方法采用整群随机抽样的方法对上海市黄浦区年龄≥60岁的老年人进行现况问卷调查及临床医师评定。调查问卷包括一般人口学资料、简易精神状况量表（MMSE）、蒙特利尔认知评估表（MoCA）;临床医师评定包括照料者询问、现病史、既往史、体检、日常生活量表（ADL）、总体退化量表（GDS）、临床痴呆评定量表（CDR）、Hachinski缺血指数量表测评,并由精神科医师进行最后诊断。结果调查300人,确诊为MCI者67例,患病率为22．3％;不同性别、年龄段、文化程度、职业及运动与否、有无业余爱好、饮茶与否的老年人,其MCI患病率差异均有统计学意义（P〈0.01）。结论女性、高龄、低文化水平、不运动等患MCI的危险性增加。     

阿尔茨海默病和轻度认知功能障碍的神经心理学研究

目的探讨阿尔茨海默病(AD)与轻度认知功能障碍(MCI)的神经心理学特点。方法52例AD、26例MCI患者及24例正常认知者分别接受临床评估和多项神经心理学检查,包括简易精神状态检查法(MMSE)、临床痴呆评定量表(CDR)、日常生活能力量表(ADL)、临床记忆量表(CMS)。结果AD组、MCI组、正常认知组总成绩MMSE分别为(18．9±5．1)分、(26．9±2．1)分、(29．0±1．1)分;ADL分别为(48．3±17．7)分、(26．7±9．3)分、(22．1±4．1)分;MQ分别为(52．5±26．7)分、(811．3±10．8)分、(101．8±11．6)分;CMS分别为(52．5±26．7)分、(81．3±10．8)分、(101．8±11．6)分。与正常认知组比较,MCI除ADL成绩外,其余各量表值均显著降低;与AD组比较,MCI组MMSE、ADL、记忆商(MQ)和CMS中各项成绩均优于AD(P<0．05)。CMS测验中的图像自由回忆分随痴呆程度加重而明显下降,各组比较,差异均有统计学意义(P<0．05)。结论以本研究设立的诊断标准所确立的MCI,其认知功能介于痴呆和正常认知老年人之间,并与早期AD具有相似的认知功能改变。神经心理学检查对于MCI、痴呆的早期诊断和客观反映痴呆严重程度具有重要价值,图像自由回忆是筛选MCI、早期诊断痴呆、评定痴呆程度的敏感指标。     

Relationship between arterial stiffness and cognitive function in outpatients with dementia and mild cognitive impairment compared with community residents without dementia

BACKGROUND It is unclear whether the dementia patients with Alzheimer’s disease(AD) and vascular dementia(VaD) and mixed dementia(MIX, including AD and VaD) would have more developed arterial stiffness as compared with local residents without dementia. The aim of this study was to assess arterial stiffness and cognitive function in different types of dementia patients [AD, VaD, MIX and mild cognitive impairment(MCI)] and community residents without dementia.METHODS This was a single-center, cros...