早期Alzheimer病的扩瞳反应及其认知功能研究

目的为了探讨扩瞳反应对Alzheimer病的诊断价值及其与认知功能之间的关系. 方法我们对20例早期Alzheimer病患者进行了3个月的观察,作了扩瞳试验及认知功能评估,并与20例多发性梗塞性痴呆及20例正常老年人进行比较.结果 Alzheimer病患者在滴注扩瞳药液后15～25分钟时间内的瞳孔扩大倍数显著高于血管性痴呆和正常对照组,但这种瞳孔对扩瞳液的敏感性改变与认知功能缺损之间尚无显著相关性.结论扩瞳反应可以作为Alzheimer病早期诊断的辅助指标之一.     

稀释托品卡胺散瞳试验对诊断阿尔采木病的潜在价值

目的：探讨稀释托品卡胺散瞳试验对诊断阿尔采木病潜在的临床意义。方法：１０９例老人按ＨＤＳ测查评分等级分为四组，进行０．０１％托品卡胺散瞳试验，观察瞳孔的改变。结果：各组胺试者对托品卡胺散瞳呈现不同的敏感性反应，痴呆组和痴呆前期组瞳孔直径变化百分率之间关系密切，几乎呈相同形式，相反，痴呆组与正常组间扩瞳反应有显著性差异。结论：稀释托品卡胺散瞳试验对高危人群中阿尔采木病人的筛查具有参考价值。     

轻度认知功能障碍早期诊断与治疗进展

轻度认知功能障碍是介于正常老化和痴呆之间的一种过渡状态,是老年性痴呆的高危人群,对其进行早期诊断和早期干预是防治痴呆的关键。近年来轻度认知功能障碍的神经影像学及神经生物学研究取得了新的进展,现综述如下。     

中医药对轻度认知功能障碍的研究进展

轻度认知功能障碍(Mild Cognitive Impairment,MIC)是介于正常老化和阿尔兹海默病(Alzheimer disease,AD)的过渡状态,许多研究者都将MCI看作AD的极早期阶端,其转化为痴呆的比率明显高于正常人。中医药在改善轻度认知功能障碍方面具有一定的优势。本文将目前中医药对轻度认知功能障碍的研究进展进行综述。     

老年轻度认知功能损害的临床神经生物学标志

老年轻度认知功能损害（mild cognitive impairment，MCI）是介于正常衰老和痴呆之间的一种认知功能损害状态，是老年期痴呆的临床前期，平均每年有10％-15％的MCI发展为痴呆，其中绝大部分为阿尔茨海默病（Alzheimer’s disease，AD）。近年来MCI的生物学诊断标志研究取得了较多的进展。     

Alzheimer病胼胝体萎缩的MRI定量研究

目的：评价胼胝体面积测量对诊断Alzheimer病（Alzheimer disease,AD)的价值。方法：14名AD患者和20名年龄，性别，受教育程度相匹配的正常对照。进行MRI扫描并全部行简易精神状态量表（MMSE）检查。结果：AD组胼胝体面积区域性减少，胼胝体萎缩与AD的认知功能损害显著相关。结论：胼胝体面积的测量可以有助于AD的明确诊断。     

尼莫地平联合茴拉西坦治疗血管性痴呆60例分析

血管性痴呆是脑血管疾病导致的认知功能障碍临床综合征，是痴呆常见病因，在我国仅次于Alzheimer病，约占痴呆症的20％。2001年9月～2006年6月，我们采用尼莫地平联合茴拉西坦治疗脑血管性痴呆60例，报告如下。     

路易体痴呆的临床特征及鉴别诊断

路易体痴呆(DLB)是指一组在临床和病理表现上重叠于帕金森病和Alzheimer病之间，以波动性认知功能障碍、持久的注意障碍、视空间障碍以及视幻觉和帕金森综合征为临床特点，以路易体为病理特征的神经变性疾病。病因及发病机制不清。包括弥漫性路易体病、路易体痴呆和Alzheimer病路易体型3种。     

弹性虹膜拉钩在小瞳孔白内障超声乳化术中的应用

在白内障超声乳化术中,由葡萄膜炎及抗青光眼术等各种原因引起的虹膜后粘连、术前瞳孔不能散大的患者并不少见,这给手术带来相当的难度。由于手术操作困难,术后炎症反应往往较重,目前有多种方法可以采用〔1〕。而术中应用虹膜拉钩则可减少由传统扩瞳法造成的虹膜损伤,最大限度地保持瞳孔的形态和功能,减少手术并发症,提高术后视力〔2〕。现比较虹膜拉钩扩瞳33例(35只眼)与传统扩瞳37例(38只眼)的疗效。报告如下。1资料与方法1.1一般资料观察组:2002年1月至2005年2月在我院行白内障超声乳化术的小瞳孔白内障患者33例(35只眼)。其中男17例(17…     

老年糖尿病与认知功能障碍的相关性分析

目的评价老年糖尿病与认知功能障碍的关系及其影响因素。方法以我院近3年收治的符合2型糖尿病诊断标准的60岁以上的108例糖尿病患者为研究组,随机抽取同年龄段的健康志愿者116例作为对照组,两组进行简易智能状态量表(MMSE)测查,结合DSM-Ⅳ痴呆诊断标准及轻度认知功能障碍(MCI)诊断标准将所有被调查者分为认知功能正常组、MCI组及痴呆组。结果老年糖尿病组MMSE评分低于健康对照组,糖尿病患者痴呆患病率明显高于对照组。结论老年糖尿病与认知功能障碍之间存在相关性,糖尿病是认知功能障碍的危险因素。     

ApoE alleles and tau markers in patients with different levels of cognitive impairment

BACKGROUND: The presence of brain hyperphosphorylated tau constitutes a hallmark of neurodegenerative disorders of the Alzheimer's type. This report describes the relationships between tau markers in the cerebrospinal fluid (CSF), the degree of cognitive impairment and the predictive value of genetic markers such the alleles of apolipoprotein E, namely, the presence of Apo-epsilon4, as part of a longitudinal study. METHODS: Three major groups of patients with ages ranging from 65-73 years were evaluated in this study (n=72): Alzheimer's disease patients (AD), a group with mild cognitive impairment (MCI) and normal senile patients (NS). Hyperphosphorylated tau and tau dephosphorylated species at the Alzheimer-type epitopes in CSF samples were analyzed by ELISA assays using a battery of different monoclonal antibodies. ApoE was analyzed by PCR in blood samples. RESULTS: The levels of hyperphosphorylated tau were significantly higher in AD patients, but no statistical differences were found between the MCI and NS groups. However, the analysis of tau markers and cognitive impairment indicated the existence of two main subgroups within this population: MCI patients with a higher cognitive impairment as revealed by the total box score (TBS) >1.5 who exhibited phosphorylated tau patterns similar to the AD group, and patients with a mild impairment (TBS <1.5) with tau patterns similar to normal patients. In regard to ApoE, epsilon4/epsilon4 genotype was absent in the Chilean population analyzed, and only the epsilon2/epsilon4 genotype was significantly increased in both MCI and AD patients. A detailed analysis of the ApoE alleles, particularly epsilon3 and epsilon4, indicated a tendency to increase the epsilon4 allele in the MCI group with higher cognitive impairment and in AD patients. CONCLUSIONS: Studies indicate that hyperphosphorylated tau is a good indicator of the degree of cognitive disorders in early stages of AD and that no clear correlation exists with the epsilon4/epsilon4 and epsilon3/epsilon4 genotypes, even though a higher proportion of epsilon4 allele in the MCI group with a more significant level of impairment and in AD patients was evidenced.     

华山命名测验的编制与效度分析

目的 为研制适合中国文化背景的命名检测方法,编制了"华山命名测验(Huashan Naming Test,HNT)",并通过对遗忘型轻度认知损伤(aMCI)和轻度阿尔茨海默病(AD)记忆力下降差异的检测,来分析其试用效度.方法 100名来自社区的正常老人组、100名aMCI组和95名轻度AD组(受教育程度均在初中及以上)被试完成包括MMSE、听觉词语学习测验和华山命名测验在内的8种神经心理测验.人组MCI和AD患者均完成大脑核磁共振检查.HNT的图片包括动物20张、蔬菜10张、水果10张、工具20张、家庭用品20张、交通工具10张、文具10张,共100张.结果 1.HNT项目的 确定:第1步:删除3组比较没有显著差异的项目22个;第2步:删除8个在正常中老年人组中完成率低于75%的项目;第3步:根据方差分析的F值大小,删除10个F值最小的项目;第4步,在余下的60个项目中,进行完成率大小排列,按照奇偶数分割为2个版本,分别为HNT-1和HNT-Ⅱ.2.HNT的特点:正常老人组HNT-Ⅰ和HNT-Ⅱ的得分与年龄、性别没有显著相关性,但与受教育程度、MMSE得分显著相关(P＜0.05).以自发命名正确数≤26分作为划界分,HNT-Ⅰ识别aMCI的敏感性为44%,识别轻度AD的敏感性为84%,特异性均为84%;HNT-Ⅱ识别aMCI的敏感性为56%,识别轻度AD的敏感性为83%,特异性均为80%.结论 HNT是一种符合我国文化背景的、耗时短、效度好的命名测验,值得进一步推广应用.

Abstract：

Objective To present the development of the Naming test tool ( Huashan Naming Test, HNT)for Chinese cultural and by amnestic mild cognitive impairment ( aMCI ) and mild Alzheimer' s disease (AD) between the detection of memory decline,and to analyze the validity of its trial.Methods 100 normal elders from communities in Shanghai, 100 patients with amnestic mild cognitive impairment (aMCI), and 95 patients with mild Alzheimer's disease (AD) who received an education of junior high school or above and were evaluated by neuropsychological tests including mini mental state examination ( MMSE), auditory verbal memory test, Huashan Naming tests etc.8 cognitive tests.The groups of MCI and AD patients finished cranial MRI.100 items with HNT including 20 animals,10 vegetables,10 fruits ,20 tools ,20 household , 10 vehicles, 10 stationery.Results 1.HNT items to determine: 22 items were excluded due to the completion of the three groups were not significantly different; 8 items were excluded due to the completion of the normal elderly group was lower than 75%; 10 items were excluded from the analysis of variance Fvalue of the minimum value.The remaining 60 items,according to the size of the arrangement and completion rates were divided into two versions of odd and even, respectively HNT-Ⅰ and HNT-Ⅱ.2.HNT characteristics:in normal elderly group age, sex were found to had no significant factors affecting overall scores of HNT-Ⅰ and HNT-Ⅱ but level of education, MMSE score was significantly correlated (P ＜0.05).As cut-off score ≤ 26 for spontaneous naming of HNT,the sensitivities of HNT-Ⅰ for aMCI ,mild AD were 44%, 84% respectively, specificities were all around 84%; the sensitivities of HNT-Ⅱ for aMCI , mild AD were 56% ,83% respectively,specificities were all around 80%.Conclusion HNT is a Chinese cultural background,time-consuming short and good name validity test,and it is worth further promoting the application.     

边缘区损伤与认知功能下降关系的临床分析(附20例报告)

目的探讨脑边缘区损伤与认知功能下降的关系。方法搜集20例因各种原因造成脑边缘区损伤在我院住院的病例,男14例,女6例;全部病例均行常规MRI检查,对每病例进行认知功能测定,并与MRI表现对比分析;同时,还与10例老年性痴呆患者进行MRI改变及认知功能下降程度的对比研究。结果(1)边缘区损伤的原因多以缺血性损伤为主,MRI表现为长T1长T2异常信号灶,而对照组主要表现为颞叶、海马及大脑皮层的萎缩;(2)20例患者的MMSE评分介于13~25分之间,平均19.7分,以记忆力及计算力下降为主;对照组的MMSE评分为6~15分,平均11分,定向力、记忆力、注意力和计算力、回忆力及语言能力的评分全面下降;(3)单纯边缘区损伤组的认知障碍程度与边缘区合并了豆状核其它部位损伤组无明显差异。结论边缘区是人脑与学习及记忆功能相关的一个新区,脑边缘区的损伤可引起认知功能的下降。     

男性轻度阿尔茨海默与老年精神分裂症患者认知功能损害的差异及雄激素相关机制

目的比较轻度阿尔茨海默(AD)患者与老年精神分裂症患者认知功能损害的异同,并从雄激素角度探讨二者差异的原因。方法采用词汇测验、木块图测验、逻辑记忆测验、视觉再生测验、Benton线方向判断测验等评估认知功能,检测血清睾酮评估雄激素水平。结果1.在词汇[(7.78±2.46)分Vs(9.13±2.76)分]、木块图[(7.43±2.31)分Vs(8.67±2.65)分]测验中老年精神分裂症组损伤较轻度AD组更严重,差异有显著性。在逻辑记忆[(8.32±3.53)分(11.58±3.82)分]、视觉再生[(6.32±2.43)分Vs(8.13±2.31)分]、线方向判断测验中[(17.36±4.35)分Vs(21.08±5.49)分],轻度AD组损伤较老年精神分裂症组更严重,差异有显著性。2组睾酮比较,轻度AD组明显减少,差异有显著性。2.除线方向判断测验外,轻度AD组认知功能测验的成绩与睾酮的水平明显正相关,而老年精神分裂症组所有认知功能测验的成绩与睾酮的水平不相关。结论轻度AD和老年精神分裂症患者在认知功能受损的形式上是不同的,雄激素的下降可能是AD患者认知功能受损的原因之一,而雄激素的下降可能与老年精神分裂症患者认知功能受损无关。     

白藜芦醇诱导沉默信息调节因子1改善阿尔茨海默病记忆能力的研究进展

阿尔茨海默病（AD）以进行性认知功能障碍和记忆能力损伤为主,是一种中枢神经系统退行性疾病。由于AD的病因以及发病机制未明,所以尚无有效治疗药物。近年来相关研究表明白藜芦醇可有效预防AD的发生及发展。白藜芦醇具有神经保护作用,可改善AD动物模型记忆能力,但具体机制未明。白藜芦醇可以诱导沉默信息调节因子1（SIRT1）,而且SIRT1具有调节记忆能力的作用,故白藜芦醇可能通过激活SIRT1来提高AD患者记忆能力。本文综述白藜芦醇诱导SIRT1改善AD记忆能力的研究进展,为白藜芦醇防治AD提供参考依据。     

阿尔茨海默病与嗅觉功能障碍：一项Meta分析

 目的 通过比较不同程度认知损害者[健康对照、轻度认知损害者和阿尔茨海默病（Alzheimer’s disease，AD）患者]的嗅觉识别能力，探究AD与嗅觉功能障碍的关系。方法 系统检索数据库Web of science、PubMed、EMBASE以及中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、中文科技期刊数据库（VIP）和万方数字化期刊全文数据库，获取2010年1月—2021年11月期间发表的病例对照研究或横断面研究文献。由2名研究员分别进行文献筛选、质量评价（使用Newcastle-Ottawa Scale）及数据提取。使用Cohen’s d法计算单个研究组间嗅觉分数的标准化均数差（standardized mean difference，SMD），并根据研究间异质性大小选用随机效应模型或固定效应模型进行Meta分析。结果 共纳入20篇文献，均为高质量。文献涉及9个国家地区，总计1 717名轻度认知损害者以及1 322名AD患者。Meta分析显示，轻度认知损害患者组的嗅觉识别能力评分显著低于健康对照组（SMD=-0.80，95%CI：-0.94~-0.67）；AD患者组的嗅觉识别能力评分显著低于轻度认知损害患者组（SMD=-0.74，95%CI：-0.94~-0.54）。将纳入研究按照东亚地区与欧美地区分层后，Meta分析结果并无显著差异。结论 嗅觉识别能力随认知损害程度的加深而减退，这表明嗅觉减退可能与AD患者的认知功能的下降有关。     

血脑屏障损伤与阿尔茨海默病关系的研究

阿尔茨海默病(AD)是老年人认知障碍最重要的病因,严重危害老年人健康,最终可以导致患者丧失生活能力及多种并发症的发生。但目前为止其发病机制尚未研究清楚,仍缺乏有效的治愈及预防手段。因此,研究其发病机制是为其提供行之有效的治疗方法的关键。近期,血脑屏障破坏成为AD研究的热点之一。现就血脑屏障损伤与AD关系的相关研究进行综述。     

Differential acetylcholine and choline concentrations in the cerebrospinal fluid of patients with Alzheimer’s disease and vascular dementia

Background An important aspect of Alzheimer’s disease (AD) is loss or impairment of cholinergic neurons. It is controversial whether there is a similar cholinergic impairment and cerebral deficit of acetylcholine (ACh) in the case of vascular dementia (VD). The purpose of this study was to explore the levels of ACh and choline (Ch) in the cerebrospinal fluid (CSF) of patients with AD and VD, and their possible relationship with cognitive impairment.Methods Twenty-two AD patients, twenty-two VD patients, and twenty normal controls were recruited and scored with a Mini-Mental State Examination (MMSE). CSF concentrations of ACh and Ch were measured using high-performance liquid chromatography with an electrochemical detector (HPLC-ECD) and the results were then compared to cognitive status.Results ACh concentrations in CSF of AD patients ［(10.7±5.1） nmol/L］ and VD patients ［(16.8±7.4） nmol/L］ were both significantly lower than in controls ［(34.5±9.0） nmol/L, t=10.67, P&lt;0.001; t=6.91, P&lt;0.001］. Both results correlated positively with MMSE scores (rs=0.88 and rs=0.85, respectively, P&lt;0.01). The CSF concentration of Ch was significantly higher in VD patients ［(887.4±187.4） nmol/L］ compared to AD patients ［(627.6±145.1） nmol/L, t=6.4, P&lt;0.001］ and controls ［(716.0±159.4） nmol/L, t=4.2, P=0.002］. CSF Ch concentration showed no difference between AD patients and normal controls, nor did it correlate with MMSE score in any of the three groups. Conclusions The positive correlation between ACh deficit and cognitive impairment suggests that ACh is an important neurotransmitter for memory. The similar decrease in ACh concentration in AD and VD patients may imply a similar pathogenesis for the process of cognitive impairment involved in these two disorders. The elevated CSF levels of Ch in VD patients compared to AD patients may be useful diagnostically. Cholinesterase inhibitors may be helpful not only for AD patients, but also for VD patients.     

老年人血清维生素A含量与老年性痴呆的相关性研究

目的:通过检测老年人血清中维生素A含量及与老年痴呆的相关性分析,为老年痴呆预防和治疗提供理论指导。方法:用高效液相检测152名老年人血清维生素A及类胡萝卜素水平。结果:老年人血清中维生素A含量接近,但老年性痴呆患者(AD)和轻度认知功能障碍者(MCI)血清中类胡萝卜素含量偏低。结论:富含类胡萝卜素的饮食可能降低AD、MCI的发生率,延缓MCI发展为AD进程。     

海马与阿尔茨海默病

阿尔茨海默病（Alzheimer＇s disease,AD）是一种病因尚不明确的进行性神经退变性疾病,以近记忆障碍为最早的症状和最突出的认知障碍。而海马是中枢神经系统中参与学习和记忆贮存的重要器官,因此在对阿尔茨海默病的研究过程中,海马区成为了众多学者关注的重点之一。通过长期的研究发现：在阿尔茨海默病中以海马的病理表现及生化改变尤为突出。本综述分别就海马的生理功能、病理学改变以及分子生物学改变与阿尔茨海默病的联系进行回顾与总结。