老年性痴呆和轻度认知障碍患者时间地点定向力受损情况探讨

目的:了解老年性痴呆(AD)患者和轻度认知障碍(MCI)患者的时间地点定向力的受损情况。方法:收集51例AD患者、9例MCI患者和26例正常老人,进行MMSE检查,针对MMSE的总分和时间地点定向10个分项进行分析。结果:MCI组和对照组之间时间定向分、地点定向分、定向力总分无显著差异。MCI患者和轻度AD的时间定向分有显著性差异。轻度与中度AD之间比较,年份、月份、星期、街道和楼层这几个分项的回答正确率有差异。中度与重度AD之间比较,季度、省市、区、街道层、所在地这几个分项的回答正确率有显著差异。结论:随着认知障碍的进展AD和MCI患者的定向力受损也是逐渐加重。在早期认知减退的情况下,个体的时间定向力受损会较地点定向力更为明显。对于认知下降的患者,时间定向力是一个敏感的指标。随着病情的进展,患者的地点定向受损越来越明显。未发现某些分项较其他分项更为敏感。     

Alzheimer's Disease

The medical recognizance of "Alzheimer's Disease" as a separate disorder signified progress for the medical and research world, but left the families of the victims of this disease as perplexed as ever. Only recently have the families of victims of Alzheimer's disease been able to receive the needed encouragement to confront their many problems. This bibliography brings together some of the materials written for the general public that may be of interest and aid to families of victims of this disease, as well as to other persons who may be interested in this disease in other than from a strictly medical point of view.     

Cognitive rehabilitation in Alzheimer's Disease

Non-pharmacological treatment in Alzheimer's Disease has gained great attention in recent years. The limited efficacy of drug therapy and the plasticity of human central nervous system are the two main reasons that explain this growing interest in rehabilitation. Different approaches have been developed. Here we discuss the efficacy of non-pharmacological therapy in the frame of two main approaches: Multistrategy Approaches (Reality Orientation, Reminiscence Therapy and Validation Therapy) and Cognitive Methods.     

Medial Temporal Lobe Atrophy,Apolipoprotein Genotype,and Plasma Homocysteine in Sri Lankan Patients with Alzheimer's Disease

ABSTRACT

The authors studied the association of Alzheimer's disease (AD) with total plasma homocysteine (tHcy) and apolipoprotein E (apoE) genotype, and the usefulness of measuring medial temporal lobe thickness (MTL) thickness for the diagnosis of AD in Sri Lankan patients. Using criteria of the NINCDS-ADRDA, 23 AD patients and 21 controls were recruited. All underwent MTL-oriented computed tomographic (CT) scans, measurement of plasma tHcy, and apoE genotyping. Mean plasma tHcy was significantly higher in AD patients than controls (p = .001). This association was independent of age, sex, body mass index (BMI), serum folate and vitamin B₁₂, and serum creatinine. The frequency of apoE4 allele was significantly higher (p = .003) in AD patients, and the adjusted odds ratio of AD for the presence of one or more apoE4 alleles compared with none was 10.39 (95% CI 1.77–61.10; p = .010). The mean minimum MTL thickness was significantly higher in control subjects compared to that of AD patients (p < .001). This first report of apoE4, plasma tHcy, MTL thickness, and AD from Sri Lanka shows that high plasma tHcy, the presence of apoE4 allele, and MTL atrophy are associated with AD.     

Pharmacological treatment of Alzheimer's Disease

BACKGROUND AND AIMS: The treatment of Alzheimer's disease (AD) is a challenge for physician, families, and patients. An individualized, multimodal treatment plan addressing the treatment of cognitive, behavioural and functional decline is essential. Aim of the paper is to describe the principal components of the treatment plan of AD patients. METHODS: A review of the recent literature was performed. RESULTS: Acetylcholinesterase inhibitors (AChEIs) play an important role in the improvement of cognitive decline in mild to moderate AD, even if the improvement is not permanent. Data obtained from the CRONOS project (involving about 500 Alzheimer Evaluation Units) replicate in the real world those obtained in controlled trials, confirming that AD patients may benefit from AChEI treatment. Treatment of behavioral and psychological symptoms of dementia (BPSD) requires education of caregivers, non pharmacological interventions, identification and treatment of medical illnesses or environmental precipitating conditions, specific pharmacological treatment. Traditional neuroleptics are widely used for BPSD treatment, but limited data support their use, and side-effects are frequent and severe. Atypical antipsychotics are effective in treating BPSD, and safer than traditional neuroleptics. However, the increased risk of cerebrovascular accident in patients taking risperidone or olanzapine limited currently their use in demented subjects. The use of antidepressant drugs, as well as behavioral approach, may improve depressive symptoms frequently accompanying AD. CONCLUSIONS: Although at present there is no cure for AD, several drug treatments and care strategies may improve or stabilize cognitive and behavioral symptoms, and improve the quality of life of patients and families.     

Estimation of short temporal intervals in Alzheimer's disease

This study investigated the estimation of short temporal intervals in Alzheimer's disease (AD). Eight patients with dementia of the Alzheimer type, and eight age-matched controls were evaluated in a time-estimation task. The task consisted in the production of three short empty intervals (5, 10, and 25 s). Results indicated that AD patients show deficits both in the accuracy and precision of time judgments: in the three intervals evaluated, the magnitude of absolute error and the variability in time judgments were significantly greater in AD patients than healthy respondents (p < .01). These findings are discussed taking into account the contribution of attentional processes during the performance of temporal tasks. It is concluded that the estimation of short temporal intervals could be useful as an objective indicator of cognitive decline in AD.     

Alzheimer's Disease Learning Enhancement Resources

Abstract

Long-term memory in people with memory impairment is facilitated when correct recall is followed by longer delays than incorrect recall (adjusted spaced retrieval training). Participants with Alzheimer's disease or alcohol-induced memory impairment practiced free recall of one pill name with adjusted spaced retrieval training and one with uniform short delays between practice trials (uniform retrieval training). No participant learned with uniform retrieval training. Most learned with adjusted spaced retrieval training despite leading to more errors during training than uniform retrieval training. This is the first demonstration that adjusted spaced retrieval training is effective for people with alcohol-induced memory impairment. In addition, the findings question the hypothesis that adjusted spaced retrieval training is effective because it limits errors during training.     

Alzheimer's Disease and Brain Reserve

Abstract. Alzheimer's disease has a long early phase in which limited pathological changes accumulate without apparent functional consequences. Once pathology exceeds a certain threshold, clinical features arise, but this threshold seems to differ from patient to patient, reflecting individual differences in ‘;brain reserve’. This review discusses the concept and possible determinants of brain reserve, and their implications for the diagnosis of Alzheimer's disease.     

Educating About Alzheimer's Disease:

The number of individuals with Alzheimer's Disease (AD) is expected to increase in the future. Health professionals must be prepared to meet the health care challenges associated with caring for this vulnerable group. Knowledge about AD and the complexities of caring for its victims are essential to providing appropriate care for patients and fmaily members. This paper examines knowledge about aging and AD among nursing and medical students and describes curricular implications for health professionals' education. Results show that: (1) both nursing and medical students performed poorly on a test of general knowledge about aging; (2) health professional students scored well on the Alzheimer's Disease Knowledge (ADK) Test compared to students and professionals whose scores have been previously reported; and (3) students' scores on the ADK reflected both their self-reported knowledge level and their type of educational preparation. This paper concludes by discussing four essential AD topics that must be addressed in the educational curricular plan for health professional students.     

血管紧张素转换酶与Alzheimer病

Alzheimer病(AD)是老年人群中的一种常见的神经系统变性疾病.近年来研究表明,血管紧张素转换酶(angiotensin converting enzyme,ACE)与AD的发病有关.ACE基因的第16内含子内存在插入/缺失(I/D)多态性,I等位基因可增高AD风险,而D等位基因能降低AD风险.ACE基因多态性影响AD发病的机制尚不清楚,可能与ACE对β-淀粉样蛋白(β-amyloid peptide,Aβ)的降解作用有关.目前,该领域的研究结果不尽相同,有些甚至完全相悖,表明其研究工作尚需不断完善和规范.文章对ACE基因的生物学特性及其与AD的相关性研究进展进行了综述.     

少突胶质细胞变性与Alzheimer病

Alzheimer病(AD)是一种重要的神经退行性疾病.最近的证据表明,髓鞘形成和随后的脱失与AD有关,因为晚期产生的少突胶质细胞的独特易损性使髓鞘脱失在AD早期改变中占据核心位置.髓鞘脱失破坏了高度依赖神经冲动同步化的大脑功能,最终导致皮质联合区域功能的断联和随后的神经元脱失.同时,在AD大脑中存在多种使少突胶质细胞变性的机制.因此,阐明其具体机制可帮助更好地了解AD,从而为其治疗提供一定的帮助.     

Drug Treatments for Alzheimer's Disease

Abstract. Alzheimer's disease (AD), the commonest cause of dementia, presents many challenges in pharmacological management. Newer cholinergic agents are modestly effective in improving or delaying decline in cognitive function, and should be considered for all with mild to moderate AD unless contra-indicated. Other cognitive agents with possible, but more modest, efficacy include Vitamin E, selegiline and ginkgo biloba. Potential new therapies, including anti-inflammatory agents, monoamine oxidase type B inhibitors and oestrogen are undergoing trials in Australia and New Zealand and may be available soon. Behavioural and psychological symptoms of dementia should be managed first by non-pharmacological approaches but antipsychotic agents may be needed - newer agents are better tolerated and likely to be as effective as older agents. Depression in those with AD is best managed with newer agents such as selective serotonin re-uptake inhibitors and moclobemide. Cost is a major consideration with cholinergic and newer antipsychotic therapies, and government subsidisation (eg. through the Australian Pharmaceutical Benefits Scheme) is yet to be provided.     

Alzheimer病的血管病因假设

Alzheimer病(AD)患者的血管和血流动力学改变逐渐成为研究的热点。越来越多的证据使人 们对AD患者的神经变性及其与脑血管病变的因果关系产生怀疑:脑血管损害究竟是神经变性的原 因还是结果?文章对血管因素在AD发病机制中的作用进行了综述。     

The Cholinergic Neuronal Phenotype in Alzheimer's Disease

The synthesis, storage and release of acetylcholine (ACh) requires the expression of several specialized proteins, including choline acetyltransferase (ChAT) and the vesicular ACh transporter (VAChT). The VAChT gene is located within the first intron of the ChAT gene. This unique genomic organization permits coordinated activation of expression of the two genes by extracellular factors. Much less is known about factors that reduce the expression of the cholinergic phenotype. A cholinergic deficit is one of the primary features of Alzheimer’s disease (AD), and AD brains are characterized by amyloid deposits composed primarily of Aβ peptides. Although Aβ peptides are neurotoxic, part of the cholinergic deficit in AD could be attributed to the suppression of cholinergic markers in the absence of cell death. Indeed, we and others demonstrated that synthetic Aβ peptides, at submicromolar concentrations that cause no cytotoxicity, reduce the expression of cholinergic markers in neuronal cells. Another feature of AD is abnormal phospholipid turnover, which might be related to the progressive accumulation of apolipoprotein E (apoE) within amyloid plaques, leading perhaps to the reduction of apoE content in the CSF of AD patients. ApoE is a component of very low density lipoproteins (VLDL). As a first step in investigating a potential neuroprotective function of apoE, we determined the effects of VLDL on ACh content in neuronal cells. We found that VLDL increases ACh levels, and that it can partially offset the anticholinergic actions of Aβ peptides.     

28/Drug Effects in Alzheimer's Disease

No abstract available for this article.