世界卫生组织老年认知功能评价成套神经心理测验的临床初步应用

目的 验证世界卫生组织老年认知功能评价成套神经心理测验（ＷＨＯ－ＢＣＡＩ）并探讨阿尔茨海默病（ＡＤ）早期认知功能改变的特点。方法 采用ＷＨＯ－ＢＣＡＩ对２６例轻中度,ＡＤ患者（ＡＤ组）２７例轻度认知功能损害的老年人（ＭＣＩ组）和８３名认知功能正常的老年人（ＮＣ组）进行测试,结果 在全部（２５项）测验中３例组间比较差异均有非常显著性（Ｐ〈０．０１）,两两比较,ＡＤ组与ＭＣＩ组（除１项（视觉再认）外和     

成功老龄化机制的系列研究:随访部分

目的探索成功老龄（SA）化的可能机制。，方法（1）样本来源于社区≥65岁老年人。共完成随访156例，其中成功老龄（SA）组73例，常态老龄（uA）组57例，轻度认知功能损害（MCI）组26例。（2）研究工具采用中国老年成套神经心理测验和上海市社区老年人群健康问卷SA2004等。结果（1）SA组老年人在即刻记忆、延迟记忆、长时记忆提取相关测验成绩随访前后差异无统计学意义（P〉0．05），执行功能、序列学习和逻辑推理相关测验成绩随访前后差异有统计学意义（P〈0．05）；UA组老年人在工作记忆、执行功能方面的下降有统计学意义（P〈0．05）；MCI组老年人成绩的下降项目仅4项。（2）按年龄分组后，神经心理项目测验成绩随访前后比较，差异有统计学意义（P〈0．05）的分量表有10项，其中有9项在71—75岁组下降数值相对最大。（3）躯体活动能力、心理状况及认知功能等基线指标与随访结局指标（健康状况调查问卷各分量表评分）的差异有统计学意义（P〈0．05）。结论（1）SA老年人的高认知水平与大脑的整合功能及有效代偿相关，认知老化过程中执行功能可能属于易感领域，而71—75岁则可能是老年人认知老化的敏感时期。（2）UA、MCI老年人的认知功能仍具一定的可塑性，SA化干预具有现实意义。     

轻度认知功能损害的老年成套神经心理测验的特点

目的 观察轻度认知功能损害者（MCI）老年成套神经心理测验（NTBE）的特点。方法 采用横断面研究,在上海,北京和江苏等地区取样;样本分为MCI组,正常老人组和阿尔茨海默病（AD）组。结果 NTBE可判断上述3组,准确率高。MCI组与正常组之间：NTBE的绝大多数单项测验成绩有非常显著的差异;MCI组与AD组之间：NTBE的多数单项测绘有显著差异。MCI组的NTBE成绩介于正常组与AD组之间。结论 MCI组有多方面认知功能损害,包括语言,执行,学习和空间结构等。     

老年轻度认知损害患者抑郁情绪与认知功能相关性分析

目的 探讨轻度认知损害（MCI）患者抑郁情绪与认知功能之间的相关性。方法 纳入2020年12月至2021年12月浙江大学医学院附属第一医院收治的106例轻度认知损害患者,根据老年抑郁量表（GDS）评分分为伴抑郁MCI组（53例）和无抑郁MCI组（53例）,以及同期就诊的53例认知功能正常的抑郁患者（抑郁组）和53例无认知功能障碍且无抑郁的对照者（对照组）。采用简易智能状态检查量表（MMSE）和蒙特利尔认知评价量表（MoCA）评价整体认知功能,Rey-Osterrieth复杂图形测验（ROCFT）和画钟测验（CDT）评价视空间能力,逻辑记忆测验（LMT）和听觉词汇学习测验（AVLT）评价记忆力,Stroop色词测验（SCWT）和连线测验（TMT）评价注意力和执行功能,词语流畅性测验（VFT）和Boston命名测验（BNT）评价语言功能,日常生活活动能力量表（ADL）评价日常生活活动能力。Pearson相关分析和偏相关分析探讨抑郁情绪与认知功能之间的相关性。结果 4组受试者各项神经心理学测验差异具有统计学意义（均P <0.05）,其中,伴抑郁MCI组MMSE和MoCA评分低于对照组（...     

晚发型抑郁障碍与轻度认知功能损害患者的认知功能差异研究

目的 探讨晚发型抑郁障碍患者与轻度认知功能损害患者的认知功能损害的差异.方法 研究对象为2012年7月～2013年8月上海市精神卫生中心老年科住院与门诊就诊符合DSM—Ⅳ诊断标准且起病年龄≥60岁的抑郁障碍患者,共26例为晚发型抑郁障碍组（LOD组）,另选择26例轻度认知功能损害的患者（MCI组）与26例正常老年人（NC组）.认知功能评估采用简明精神状态量表（MMSE）、蒙特利尔量表（MoCA）.结果 MMSE总分、MMSE分测验中计算力与注意力及MoCA总分、MoCA分测验中连线、注意、持续注意、计算、复述、延迟回忆在LOD组与MCI组差比较异无统计学意义（P＞0.05）,两组与NC组比较差异有统计学意义（P＜0.05）.三组在MMSE分测验的时间定向、延迟回忆、三步指令、书写书面指令及MoCA分测验的复制图、画钟、命名比较,MCI组均值最低,与NC组比较差异有统计学意义（P＜0.05）,与LOD组比较差异无统计学意义（P＞0.05）.结论 LOD组认知功能在注意力、延迟回忆、连线测验方面与MCI组损害程度相当.MCI组认知功能受损范围较LOD组广泛.     

慢性老年精神分裂症患者与Alzheimer病的认知功能及脑CT比较

目的分析正常老年人（ＮＣ）与认知功能相对保存的慢性老年精神分裂症（Ｓ１）、认知功能缺损的慢性老年精神分裂症（Ｓ２）及Ａｌｚｈｅｉｍｅｒ病（ＡＤ）、Ｓ１与Ｓ２之间认知和脑萎缩情况的异同，探索慢性分裂症认知功能减退的本质及器质性基础。方法应用一组神经心理测验与头颅ＣＴ扫描检测４１例ＮＣ、１９例Ｓ１、１９例Ｓ２及３８例ＡＤ患者。结果４组样本以认知功能评定成绩好坏依次排序：ＮＣ为最好；其次为Ｓ１，Ｓ２和ＡＤ最差。Ｓ２的认知损害模式与ＡＤ有所不同。脑ＣＴ测量显示的脑萎缩程度：ＡＤ最重，其后的是顺序为Ｓ２，Ｓ１，ＮＣ。Ｓ１与ＮＣ相比，存在以颞叶萎缩为主的局灶性损害，Ｓ２组脑萎缩较Ｓ１组弥漫且严重，但较ＡＤ轻。结论提示Ｓ２组认知功能损害是精神分裂症的自然结果，而不是因为合并了ＡＤ；精神分裂症有可能是一种异质性疾病。     

社区正常老年人和轻度认知功能损害老年人的随访研究

目的了解社区正常和轻度认知功能损害（MCI）老年人的认知功能变化特点和转归。方法分别于2000年5月和2004年6月（时隔4年）对杭州市186名≥60岁老年人采用分层、分段、随机抽取方法进行调查。两次调查的程序和使用工具相同，采用美国精神障碍诊断与统计手册第4版进行诊断，用世界卫生组织老年认知功能评价成套神经心理测验（WHO-BCAI）进行测查。结果（1）在2000年调查时诊断为正常的127例中，4年后有97例（76．4％）正常（NC组），16例（12．6％）为MCI（MCI组），14例（11．0％）为痴呆（痴呆组）；而2000年诊断为MCI的18例，4年后全部发展为痴呆。（2）与NC组比较，除性别外，MCI组的年龄大、教育水平低、从事体力劳动和不良婚姻事件多（P〈0．05和P〈0．01），痴呆组的年龄大和男性比例高（均P〈0．05和P〈0．01）。（3）WHO-BCAI测验，2004年与2000年比较，三组各项测验的成绩均有所下降（P〈0．01或P〈0．05），其中以痴呆组为著；而MCI组在听觉词汇学习第4次测验、语言能力测验（小标记测验）、视觉辨认测验（语义联系、视觉推理）、连线测验、注销测验（注销测验2和3）、运动测验和空间结构等项下降明显。结论老年期MCI患者的认知功能损害和功能下降呈进行性加重，主要表现为学习、近记忆能力、记忆再现、语义记忆、抽象思维能力、空间感知及执行功能受损。     

轻度认知功能损害——AD的极早期阶段?

轻度认知功能损害 (ｍｉｌｄｃｏｇｎｉｔｉｖｅｉｍｐａｉｒｍｅｎｔ,ＭＣＩ)是介于正常老年和痴呆之间的一种认知功能损害状态 ,为正常老年和Ａｌｚｈｅｉｍｅｒ病 (Ａｌｚｈｅｉｍｅｒｄｉｓｅａｓｅ,ＡＤ)的分界线 ,有其相应的神经影像及神经病理改变形式 ,认知损害亦有一定特点。有人认为ＭＣＩ是正常老年与ＡＤ的过渡阶段 ,也有人认为ＭＣＩ就是临床前的ＡＤ ,最新报道认为它代表ＡＤ的极早期阶段。因而ＭＣＩ群体的研究对ＡＤ的早期诊断和早期干预有着重要的意义 ,是近年来老年痴呆研究的热点。文献中关于ＭＣＩ曾有多种描述的术语。…     

首发精神分裂症利培酮治疗前后认知功能的比较研究

目的探讨首发精神分裂症患者利培酮治疗前后认知功能的变化。方法采用认知评估工具连线测验、简单视觉空间记忆测验（BVMT-R）、WMS-III空间广度测验、霍普金斯词语学习测验（HVLT-R）、定步调听觉连续加法测验（PASAT）和威斯康星卡片分类测验（WCST-64）对经利培酮治疗8周前后的89例首发精神分裂症患者和62例健康对照者进行神经心理测试。结果首发精神分裂症患者治疗前的神经心理测验成绩显著差于治疗后和健康对照组（P〈0.05）;经利培酮治疗8周后达到临床痊愈标准患者的神经心理测验成绩除WMS-III空间广度测验外,其它大部分测验测验成绩仍显著差于健康对照组（P〈0.05）。结论首发精神分裂症患者存在处理速度、工作记忆、言语记忆、空间记忆、注意警觉和执行功能广泛的认知功能损害,利培酮治疗可部分改善认知缺陷,但精神症状达到临床痊愈的患者仍然存在多个领域认知缺陷,提示认知缺陷是精神分裂症的内表型。     

H·R神经心理测验在弱智儿童中的初步研究

本对27名中、轻度弱智儿童在H·R 神经心理测验中所表现出来的神经心理功能特点进行了初步分析，结果表明：弱智儿童神经功能的损害是广泛而全面性的，而感知觉缺陷及神经过程的不充分的灵活性为其比较突出的问题。《修订HooR 神经心理成套测验（幼儿本）》对弱智儿童的鉴别作用明显，能较系统地提示其神经心理功能的特点。     

Clinical correlates of functional performance in community-dwelling Chinese older persons with mild cognitive impairment

ABSTRACTBackground: Increasing evidence suggests that functional impairment can be detected in older persons with mild cognitive impairment (MCI). This study explores the functional profiles and the clinical correlates of a population-based sample of Chinese older persons with MCI in Hong Kong.Methods: A random sample of 765 Chinese elderly subjects without dementia was recruited, of which 389 were elderly normal controls (Clinical Dementia Rating = 0), and 376 had questionable dementia (CDR = 0.5). The latter were categorized into an MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Their functional performances were measured and compared with the normal controls (NC). Multiple regression analyses investigated the associations between functional scores (Disability Assessment in Dementia) and clinical correlates (cognitive test scores, neuropsychiatric symptoms and motor signs) in the NC subjects and cognitively impaired subjects.Results: Subjects with MCI had intermediate functional performance between the NC and those with VMD. Regression analyses revealed that lower scores of cognitive tests (delayed recall and categorical verbal fluency tests), apathy, aberrant motor symptoms and parkinsonism features were associated with lower functional scores in clinically non-demented subjects. Functional scores had no correlation with age, education and medical illness burden.Conclusion: Neuropsychiatric symptoms and parkinsonism features were associated with functional impairment in the clinically non-demented elderly in the community. Assessment of these should be incorporated in the evaluation of older persons for early cognitive impairment.     

Nonepisodic memory deficits in amnestic MCI.

OBJECTIVE: To (a) compare patients with amnestic Mild Cognitive Impairment (MCI), mild Alzheimer disease (AD), and a group of healthy elderly persons on nonepisodic memory measures; (b) examine which measures are independent of level of education in the groups studied. BACKGROUND: Episodic memory impairment is a cardinal feature of preclinical AD. However, a number of other cognitive measures are also sensitive to the preclinical stage of AD and deficits in multiple domains characterize AD several years before clinical diagnosis. MATERIALS AND METHODS: Patients with amnestic MCI (N=31), patients with mild probable AD (N=15), and healthy elderly controls (N=27) were compared on nonepisodic memory tasks measuring fluid intelligence, working memory, processing speed, verbal fluency, and visual-perceptual and motor functions. Amnestic MCI patients were selected based on clinical criteria and a subgroup was also selected based on psychometric criteria. RESULTS: Multivariate analyses of covariance, controlling for the effects of age, education, and sex, showed that fluid intelligence, working memory, processing speed, semantic fluency, visual-perceptual function, and complex motor function were significantly worse in the MCI than the elderly control group. Working memory, processing speed, semantic fluency, and complex motor tasks were significantly worse in the mild probable AD than the MCI group. The analyses were corroborated using the psychometrically derived MCI group. CONCLUSIONS: (a) Performance on multiple nonepisodic memory measures is affected in the preclinical stage of AD, indicating that broad cognitive impairment characterizes that stage. (b) Complex motor tasks were independent of level of education in our sample, and may have practical utility in the early detection of dementia.     

Neurofibrillary tangles,amyloid, and memory in aging and mild cognitive impairment

BACKGROUND: Large numbers of neurofibrillary tangles (NFTs) and amyloid plaques are diagnostic markers for Alzheimer disease (AD), but lesser numbers of these lesions are also seen in nondemented elderly individuals. Much of the existing literature suggests that the NFTs of AD have a closer correlation with cognitive function than do amyloid plaques. Whether a similar relationship exists in normal aging and mild cognitive impairment (MCI), a condition that frequently reflects a preclinical stage of AD, remains unknown. OBJECTIVE: To determine the distribution patterns of beta-amyloid plaques and NFTs and the association of these lesions with memory performance in nondemented individuals. METHODS: We investigated regional distributions and neuropsychological correlates of NFTs and amyloid plaques in cognitively normal elderly persons and subjects with MCI who received neuropsychological testing before death.Subjects Eight nondemented subjects who volunteered to receive annual neuropsychological testing and agreed to brain donation were studied. Five subjects showed no cognitive impairment, and 3 were diagnosed with MCI. RESULTS: Distribution of NFTs followed a rigorous and hierarchical pattern, but distribution of amyloid plaques varied among individuals. Subjects with MCI displayed higher NFT densities than did nonimpaired subjects. In addition, NFT density in the temporal lobe correlated with memory scores, whereas density of amyloid plaques did not. CONCLUSIONS: Neurofibrillary tangles are more numerous in medial temporal lobe regions associated with memory function and show a relationship to performance on memory tests in nondemented individuals. These results suggest that NFTs may constitute a pathological substrate for memory loss not only in AD but also in normal aging and MCI.     

Clinical correlates of Parkinsonian signs in community- dwelling Chinese older persons: a population based study

BACKGROUND AND OBJECTIVE: This study examined the clinical correlates of parkinsonian signs including neuropsychiatric symptoms, cognitive impairment and medical illness burden in the community-dwelling non-demented Chinese elderly. METHODS: A random sample of 765 Chinese elderly subjects from a thematic household survey was recruited. There were 389 normal elderly controls (Clinical Dementia Rating [CDR] 0) (NC) and 376 subjects with questionable dementia (CDR 0.5). The subjects with questionable dementia (CDR 0.5) were categorized into two groups: a MCI group (n = 291) and a very mild dementia (VMD) group (n = 85). Parkinsonian signs were measured by Unified Parkinson Disease Rating Scale- motor scale (UPDRS). The clinical correlates were investigated in each group. RESULTS: UPDRS motor score was associated with age, cumulative medical illness burden and cerebrovascular accidents in the normal control and MCI groups. It correlated negatively with MMSE scores in the NC group. It was associated with presence of soft signs in the NC and MCI groups; and apathy in the VMD group. CONCLUSION: Neuropsychiatric symptoms, cognitive impairment and vascular risk factors had different patterns of associations with parkinsonian signs in the older persons with different degree of cognitive impairment.     

老年遗忘型轻度认知损害患者语言工作记忆损害特点

目的 探讨老年遗忘型轻度认知损害(aMCI)患者语言工作记忆损害的特点及机制.方法 采用语言工作记忆检查软件对30例老年aMCI患者进行视觉语言工作记忆及词语流畅性和数字广度测试等神经心理学检查,并选择30名健康老人作对照.结果 aMCI患者的视觉语义工作记忆测试成绩正确率低于对照组,差异具有统计学意义(79.83%±3.22%与87.00%±1.93%,t=-1.03,P=0.002);视觉语音工作记忆测试成绩也低于对照组,但差异无统计学意义(78.92%±8.60%与86.80%±2.14%,t=-2.34,P=0.060);逆序数字广度测试(1.53±0.86与3.63±0.56,t=-1.23,P=0.027)和词语流畅性测试分值均低于对照组(22.96±2.31与31.53±3.72,t=-1.08,P=0.004),差异具有统计学意义.结论 老年aMCI患者的视觉语义性语言工作记忆受损,语音性语言工作记忆相对保留;逆序数字广度和词语流畅性测试成绩亦显著降低.     

老年轻度认知功能损害的脑磁共振显像三维测量研究

目的 研究老年轻度认知功能损害者的脑形态结构变化特点。方法 于1999年1月至2000年6月用脑磁共振显像（MRI）三维测量法组织分割和体积测量分析技术,检查有轻度认知功能损害的老年人21例（MCI组）和认知功能正常的老年人29名（NC组）。结果 （1）MRI测量：与NC组相比,MCI组的颅内总体积少5．2％,灰质体积少8．8％,灰质百分比少3．9％,总脑脊液多12．3％,两组差异有显著或非显著性（P＜0．05或P＜0．01）。（2）多元逐步判别分析：脑灰质和侧脑室体积具有非常显著性判别意义（P＜0．01）,两组判别总正确率为74．5％。结论 MRI三维测量有助于了解老年轻度认知功能损害者的脑部形态结构的改变。     

Greater memory impairment in dementing females than males relative to sex-matched healthy controls

Previously we demonstrated sex differences in episodic memory in healthy elderly and suggested that normative data be separated by sex. The present study extended the exploration of sex differences on memory measures into two clinical populations, mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Seventy-six subjects with MCI and 101 subjects with AD diagnosed by a multidisciplinary team were included. These two groups were also compared to a group of 177 healthy elderly control participants. Sex differences on the Rey Auditory Verbal Learning Test (RAVLT; total and delayed recall) raw scores and Brief Visuospatial Memory Test–Revised (BVMT–R) were demonstrated within the healthy but not the MCI or AD groups. Calculating z scores by sex for both dementing groups based on the healthy controls suggested a larger performance gap between healthy and dementing women than between healthy and dementing men. MCI females were on average 0.48 standard deviations lower for total verbal learning compared to healthy female controls than were MCI males when compared to healthy male controls. For verbal delayed recall the gap was even larger (SD = 1.09). Similarly, on the BVMT–R, a measure of visual memory, the difference was 0.60 standard deviations for total visual learning and 0.99 standard deviations for delayed recall. This same sex difference, with females showing greater impairment compared to the controls group than did the males, was also present within the AD group. The greater memory impairment in dementing females rather than males when compared to sex-matched healthy controls was unlikely to be due to more severe illness since females performed equivalently to males on the Clinical Dementia Rating Scale, Mini-Mental Status Examination, and Dementia Rating Scale, and were also similar for age, education, and apolipoprotein status. The present study suggested relatively greater memory impairment in females with MCI or AD than in controls.     

Using different memory cutoffs to assess mild cognitive impairment.

OBJECTIVE: Although mild cognitive impairment (MCI) is characterized by performance on memory and other measures below expected normative values, neither a scientific rationale nor a consensus exists regarding which measures have the most use or the optimal cutoffs to use to establish impairment. METHODS: Different memory measures were administered to 80 normal community-dwelling subjects divided into two age groups. This provided conormed data on eight different memory indices by which to compare 23 nondemented clinically diagnosed patients with MCI who met all other criteria for Alzheimer disease (AD). RESULTS: On immediate memory for passages, delayed visual reproduction, object memory, and a measure sensitive to semantic interference, 70%-78% of patients with MCI were identified as impaired at 1.5 standard deviations or greater below expected levels. Conditional logistical regression for age-matched samples indicated that consideration of raw scores for these neuropsychologic tests in combination did not significantly change the odds of MCI diagnosis. When impairment relative to the total normal elderly sample was calculated based on one or more impairments at a 1.5 or greater cutoff, specificity fell below acceptable levels when more than three memory measures were considered. CONCLUSION: An array of widely used neuropsychologic measures demonstrated utility in distinguishing patients with MCI-AD from cognitively normal community-dwelling elders. The appropriateness of more or less stringent cutoffs was highly influenced by the number of measures considered. These findings have important implications regarding the choice of cut points for impairment used for the diagnosis of MCI in both research and clinical settings.     

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.     

The nature of lexico-semantic processing deficits in mild cognitive impairment

Lexico-semantic impairments in Alzheimer disease (AD) have been attributed to abnormalities in both intentional and automatic access to semantic memory. However, the order in which these impairments appear during the course of the disease is unclear. We sought to answer this question by documenting lexico-semantic impairments in 61 subjects with mild cognitive impairment (MCI), a pre-AD stage, and by comparing them to those of 39 AD and 60 normal elderly (NE) subjects. All subjects were tested with intentional access tasks (picture naming and semantic probes), automatic access tasks (lexical decision and priming), and executive function tasks (Stroop and Stroop-Picture naming). Results indicated that the MCI group was only impaired on tasks of intentional access relative to the AD group who was impaired on both types of tasks. Because most MCI subjects eventually develop AD, these results suggest that intentional access to semantic memory is impaired before automatic access. Further, impairments on the Stroop-Picture naming task but not on the Stroop task, suggest that lexico-semantic impairments in the MCI group may be related to inhibition deficits during semantic search. Findings are discussed in light of executive dysfunctions within the framework of semantic memory theories.