降糖药物对认知功能障碍的治疗作用研究进展

认知障碍和2型糖尿病是常见的老年慢性疾病.越来越多研究表明2型糖尿病与认知功能障碍(包括阿尔茨海默病、血管性痴呆、轻度认知功能障碍等)具有相关性,特别是在老年人群中.部分治疗2型糖尿病的药物在分子层面被证明具有神经保护作用.许多动物模型和临床研究的试验结果也提示这些降糖药物具有改善认知功能的作用.因此使用降糖药物治疗认...     

脑卒中高危人群认知功能障碍血管性危险因素筛查

目的通过对社区脑卒中高危人群进行认知功能评价,筛查脑卒中高危人群认知功能障碍的血管性危险因素。方法对2012年8-12月在陕西省西安市雁塔区筛查出的541例脑卒中高危人群进行翔实的基线资料采集和血管性危险因素评价,并采用简易智能状态检查量表评价认知功能。单因素和多因素逐步法Logistic回归分析筛查脑卒中高危人群认知功能障碍的血管性危险因素。结果541例脑卒中高危人群中90例(16.64%)符合认知功能障碍标准,单因素和多因素逐步法Logistic回归分析显示,仅糖尿病是脑卒中高危人群认知功能障碍的独立血管性危险因素(OR=1.871,95%CI:1.132~3.151;P=0.015)。结论血管性危险因素可以增加认知功能障碍的发病风险,尤其糖尿病是脑卒中高危人群认知功能障碍的独立危险因素。     

精神分裂症老年患者认知功能障碍研究进展

精神分裂症是一种常见的精神疾病，老年患者在疾病和年龄的双重作用下认知功能障碍更加突出。本文梳理了近5年有关精神分裂症老年患者认知功能的研究进展，包括认知功能障碍的临床表现、评估方法、影响因素及干预措施等方面，旨在为提高患者的生活质量提供依据。     

帕金森病痴呆的诊断和治疗

<正> 帕金森病(Parkinson disease,PD)是一种常见的中老年期中枢神经系统变性疾病,以运动障碍为主要临床特征。近年来,随着PD临床研究工作的深入开展,PD的非运动障碍症状,包括精神症状、自主神经功能异常、认知功能障碍等备受重视,其中,PD伴随的认知功能障碍得到了更密切的关注。PD相关的认知障碍和痴呆增加了PD患者的致残率和病死率,也明显降低了PD患者的社会功     

非痴呆型血管性认知功能障碍病因及防治的研究进展

随着人口老龄化的加剧,非痴呆型血管性认知功能障碍已成为一种影响生活质量并给社会经济和情感带来负担的疾病。非痴呆型血管性认知功能障碍是血管性认知功能障碍的早期阶段,尽早进行干预可以延缓甚至逆转认知功能的衰退,改善生活质量,节省医疗资源。本文从现代医学和中医学角度分别对非痴呆型血管性认知功能障碍的病因及其发病机制进行阐述,同时对非痴呆型血管性认知功能障碍的防治进展进行综述,以期为临床和科研实践提供理论依据。     

痴呆的诊断与鉴别诊断

<正> 痴呆的定义 痴呆(Dementia)是由于脑功能障碍而产生的获得性智能障碍综合症,从临床角度可将痴呆下定义为:因脑功能障碍致获得性,持续性智能损害,并在记忆、认知(概括、计算、判断等)、语言、视空间功能和人格中,至少三项受损。此定义以床边检查的障碍结果为基础。获得性是为区别先天精神发育迟滞,持续性是为排除常见的急性脑外伤、代谢障碍和中毒疾病引起的意识错乱状态。     

奥拉西坦胶囊治疗血管性痴呆患者50例疗效分析

血管性痴呆（vascular dementia ,VD）是由于各种脑血管疾病所导致的认知功能障碍综合征,是痴呆的常见类型之一。随着我国人民生活方式的改变和人口老龄化的进展,脑血管疾病的发病率逐年提高,血管性痴呆的发病率也随之增高,给患者及其家庭和社会带来沉重负担,目前尚无特别有效的治疗。我科2012-01-2013-10采用奥拉西坦胶囊治疗血管性痴呆患者50例,取得较好效果,现报告如下。     

高龄老年认知功能障碍人群精神和行为异常症状的临床分析

目的研究高龄老年认知障碍人群精神和行为症状的发生率和严重程度。方法采用横断面研究方法,应用神经精神科问卷知情者版(neuropsychiatric inventory-questionnaire,NPI-Q)量表对作者医院住院和记忆门诊收治的80岁以上有记忆力障碍主诉的高龄老年人群进行调查,比较认知功能正常者和痴呆患者间精神和行为症状的发生率和严重程度。结果共纳入535例病例,其中认知功能正常组159例,痴呆组376例。NPI-Q检查结果显示,在过去1个月内高达86.7%的痴呆患者出现过至少一种精神和行为症状,而对照组的发生率为72.3%,显著低于痴呆组(P0.01)。在痴呆组,情感淡漠/漠不关心(59.8%)、夜间行为与睡眠障碍(47.3%)和易激惹/情绪不稳(46.8%)是最常见和最严重的3种表现,其中情感淡漠/漠不关心和易激惹/情绪不稳症状均显著高于认知功能正常组(P0.01)。痴呆患者组NPI-Q总分显著高于对照组(P0.01)。结论在高龄老年痴呆人群中精神和行为异常症状的发生率和严重程度均显著高于认知功能正常者,正确认识和治疗这些症状有利于提高高龄老年痴呆患者的生存质量。     

微梗死与认知功能障碍的研究进展

微梗死被定义为由缺血导致的细胞或组织的缺失伴或不伴胶质细胞增生的微观区域。微梗死在老年人群中常见,且与年龄相关的认知功能障碍密切相关。微梗死病理表现及影像学表现多样,随着超高场强磁共振技术的发明及应用,使脑微梗死在体内外的检测成为可能,微梗死的病理分布及数量与认知功能损害的类型及进展速度密切相关。因此,通过对微梗死与认知功能障碍关系及其相关机制的研究可能对认知功能障碍的防治至关重要。     

环磷酸腺苷反应元件结合蛋白与认知功能障碍相关疾病研究进展

环磷酸腺苷反应元件结合蛋白（CREB）是一种重要的核内转录因子，参与多种信号通路， CREB 表达异常可参与认知功能障碍疾病。术后认知功能障碍、血管性痴呆和癫痫是 3 种典型认知功能 障碍相关疾病。现就对 CREB 和其形成的信号通路在这三种疾病中的作用进行总结。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.