医患对减肥的心理认识

当病人有某种疼痛．或某种症状．或某种不良的习惯（如吸烟等）的话．要想清除这些事情所带来的影响．或痛苦．那么医生办公室就是一个非常理想的、而且不错的地方。然而．当医生们面对的是肥胖病人时．这样的效果就不是那么非常理想的地方了．     

2型糖尿病患者注射利拉鲁肽后出现房室传导阻滞一例报道

本文报道1例T2DM患者注射利拉鲁肽后心电图显示房室传导阻滞。提示临床医生在使用利拉鲁肽的同时,应密切关注其心电图变化,尤其当患者合并心脏疾病或使用一些可能影响房室传导的药物时。     

患有心脏病征求治疗意见时,你应该注意什么?

<正>你刚发现心脏的几条动脉几乎被完全堵塞了。医生认为搭桥手术是最好的治疗方案,但你想知道是否有非侵入性手术治疗的可能。又或者你的心脏瓣膜不能正常工作了,应该修复还是完全更换?这是两个与心脏相关的例子,经常要求人们对于不同的治疗方案作出选择。医生在提出做手术或行某种操作建议的时候,咨询一下其他医生是有意义的,特别是如果你有一些问题没有得到合理的解释时。在许多情况下,参考其他医生对     

失用症及其相关综合征

1引言 1．1背景 失用症是最重要但同时也是了解最少的主要行为神经病学综合征之一。与失语症不同,失用症通常被许多医学院的神经科教程忽略,甚至有资质的执业神经科医生可能也没有很好地理解失用症。尽管不受重视,但失用症是精神状态检查中最佳的定位体征之一,也能预测卒中或者痴呆患者的残疾（与失语症不同）。失用症患者不会使用工具;因此,他们不太可能胜任日常生活活动。在不伴失用症时,失语症患者可以独立生活,如乘坐公车或地铁,可以过着相对正常的生活;伴有严重肢体失用的患者则很可能遗留生活不能自理。     

糖尿病治疗药物导致的皮肤问题

糖尿病患者服用某些药物,也可能出现皮肤、黏膜的皮肤问题。患者朋友对此应有了解,当出现皮肤反应的时候,要注意是否为药物导致,就诊时主动汇报给医生,并在医生指导下进行调整。     

由于未被认识的夜间低血糖引起短暂性轻偏瘫发作

低血糖时可有局灶性神经体征,很少有偏瘫。近来强调,由于低血糖可能继以“反跳性高血糖”(rebound hyperglycemia),故很多夜间低血糖发作,可能未被识别,木文报告1例未被患者或医生认识的低血糖导致轻偏瘫复发,发生短哲性脑缺血发作(TIA)。 患者男性,40岁,1977年某日凌晨2点30分醒来时,发现右侧)短暂性轻偏瘫后入院,但4小时内自     

吞咽障碍患者的病史询问和临床检查

0引言病史询问和临床物理检查是对患者作出有无吞咽障碍的第一步,也是最基础的一步.在此基础上,才能进行吞咽障碍的分类和分度,考虑应由哪些专科进行检查和治疗[1].1吞咽障碍患者行为的异常表现如表1所列,临床医师应直接或通过家属和同事等有关人员注意观察了解患者的各种情况.表1可能患有吞咽障碍的提示因素灵敏性或认知性失常●迟钝、昏迷、服用大量镇静剂、谵妄、痴呆●进食时摆弄食品、咬下食物块的大小不适当、试图吞咽时有情绪变化进食环境和选择食物的变化●不愿在公众餐厅用餐●偏食,不吃某种质地较硬或较软的食品●进食的时间很长…     

你服用的药物会使你情绪低落吗?

<正>在开始服用某些药物时要注意监测情绪波动、失眠和焦虑等情况。我们每个人都会有情绪不佳的时候。但如果出现长时间的无助或注意力难以集中、好像无所适从等情绪低落的现象,其原因可能是出自于你的治疗方案。哈佛大学附属马萨诸塞州总医院的药剂师劳拉·卡尔博士说:"我认为大多数患者没有意识到服用一些药物可能会导致情绪低落。这些副作用有时可能因为病人的犹豫没有告诉医生而导致医生忽视了这些症状"。     

常用疫苗联合接种及丙种球蛋白的正确应用

众所周知,疫苗具有抗原性,是大分子的异体物质,接种于人体后,除产生有益的免疫反应以外,自身还可能因疫苗本身如疫苗的生物学特性,生产工艺(如培养基的某些营养素、动物血清、动物组织、细胞残片等)和附加物质(如佐剂、防腐剂)等,或极少数人处于某种特定的病理生理状态及特有的遗传因素的情况下,可能产生有损于机体的不良反应,这就要求在接种疫苗时,接种医生要全面,准确的了解疫苗的性状、主要成分、用法用量、不良反应、禁忌、注意事项、药物的相互作用以及受种者的过敏史、机体的健康状况等有关信息.     

减肥秘密武器应该怎么用

不管是出于个人健康考虑。还是为了追求个人形象,很多人都在想方设法减肥。糖尿病患者可能更多的是被医生要求减肥以便更好的控制病情。糖耐量异常的患者也被医生建议减掉超标的体重,以避免或延缓糖尿病的发生。其实,每个人都有一个非常简单,便宜的减肥秘密武器,您知道吗？     

Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer's disease

OBJECTIVE: To examine changes in equilibrium and limb coordination in normal aging, mild cognitive impairment, and moderate cognitive impairment associated with early probable Alzheimer's disease (AD), by means of parametric clinical measures. DESIGN: Case series SETTING: Out-patient clinic. PARTICIPANTS: A consecutive sample of 365 community-residing ambulatory volunteers (137 men, 228 women; mean age 70.4 +/- 9.4 years; mean educational attainment 14.6 +/- 3.1 years), who were followed in an ongoing longitudinal study of aging and AD, comprising cognitively intact individuals, persons with mild cognitive impairment, and patients with mild AD. MEASUREMENTS: For general magnitude of cognitive function, the Global Deterioration Scale (GDS). For cognition, the Mini-Mental State Examination (MMSE). Equilibrium was assessed with parametric measurements of single leg stance (SLS) and tandem walking (TW). Limb coordination was assessed with parametric measurements of foot tapping (FT), alternating pronation and supination (PS), and sequential finger to thumb tapping (FTH). MAIN RESULTS: After adjustment for age, persons with mild cognitive impairment or mild AD had significantly poorer performance on parametric clinical tests of equilibrium and limb coordination compared with cognitively intact individuals (P < .05). CONCLUSIONS: Changes in equilibrium and limb coordination are clinically demonstrable in persons with mild cognitive impairment and mild AD using simple parametric tests. Such tests could potentially identify individuals with increased risk of falling. Early diagnosis and treatment of conditions that can jeopardize equilibrium and limb coordination, as well as balance and coordination training, might help cognitively impaired older people to maintain optimal function and may decrease the risk of falls and injuries.     

Early identification of cognitive deficits: preclinical Alzheimer's disease and mild cognitive impairment

With the projected dramatic increase in the number of people who will be diagnosed with Alzheimer's disease (AD) in the coming years, interest is growing in identifying and treating adults at high risk for developing the disorder. Recent research suggests that individuals who will go on to receive a diagnosis of AD exhibit deficits in cognitive performance years beforehand. Those with mild cognitive impairment (MCI), for example, have characteristic cognitive deficits, such as memory loss, and convert to a diagnosis of AD at a faster rate than cognitively healthy controls. MCI has thus become a focus of research because it may help identify high-risk individuals for whom prophylactic treatments designed to slow the progress toward AD can be prescribed. After describing the diagnostic criteria and dementia outcomes associated with MCI, this article discusses several challenges to the study of cognitive impairment before the diagnosis of AD.     

序列位置效应联合延迟回忆识别不同认知障碍水平患者的研究

目的 探索序列位置效应联合延迟回忆在区分不同认知障碍水平人群的诊断价值.方法 共纳入310例受试,其中认知正常(NC)组128例,轻度认知功能障碍(MCI)组133例,轻度阿尔茨海默病(AD)组49例.3组性别、年龄、受教育程度无显著性差异.所有受试进行成套神经心理学测验,使用听觉词语学习测验量表华山版(AVLT-H)...     

早发和晚发遗忘型轻度认知损害与阿尔茨海默病的神经心理学比较研究

目的:比较早发性与晚发性阿尔茨海默病(AD)、早发性和晚发性遗忘型轻度认知损害(aMCI)的神经心理学表现。方法:记忆障碍门诊患者根据首诊年龄分组,70岁为晚发组。接受简明精神状态量表(MMSE)、听觉词语学习测验(AVMT)、逻辑记忆测验(LM)、斯特鲁普(Stroop)色词测验(CWT)、Rey-Osterrich复杂图形测验(CFT)、言语流畅性测验(VFT)、连线测验(TMT)、画钟测验(CDT)等。结果:共257例患者,分为4组,分别为早发AD34例,晚发AD78例,早发aMCI58例,晚发aMCI87例;早发、晚发AD间大部分神经心理学表现相似;早发aMCI患者在大部分测验上的表现优于晚发患者,听觉词语延迟回忆、言语流畅性、TMTB耗时等项目的差异最为显著(P<0.01)。晚发aMCI患者逻辑记忆即刻、延迟回忆更佳。结论:早发与晚发AD认知损害较为相似,晚发aMCI患者的认知损害较早发aMCI患者更为弥漫。     

Practical recommendations for timely,accurate diagnosis of symptomatic Alzheimer’s disease (MCI and dementia) in primary care: a review and synthesis

The critical role of primary care clinicians (PCCs) in Alzheimer’s disease (AD) prevention, diagnosis and management must evolve as new treatment paradigms and disease-modifying therapies (DMTs) emerge. Our understanding of AD has grown substantially: no longer conceptualized as a late-in-life syndrome of cognitive and functional impairments, we now recognize that AD pathology builds silently for decades before cognitive impairment is detectable. Clinically, AD first manifests subtly as mild cognitive impairment (MCI) due to AD before progressing to dementia. Emerging optimism for improved outcomes in AD stems from a focus on preventive interventions in midlife and timely, biomarker-confirmed diagnosis at early signs of cognitive deficits (i.e. MCI due to AD and mild AD dementia). A timely AD diagnosis is particularly important for optimizing patient care and enabling the appropriate use of anticipated DMTs. An accelerating challenge for PCCs and AD specialists will be to respond to innovations in diagnostics and therapy for AD in a system that is not currently well positioned to do so. To overcome these challenges, PCCs and AD specialists must collaborate closely to navigate and optimize dynamically evolving AD care in the face of new opportunities. In the spirit of this collaboration, we summarize here some prominent and influential models that inform our current understanding of AD. We also advocate for timely and accurate (i.e. biomarker-defined) diagnosis of early AD. In doing so, we consider evolving issues related to prevention, detecting emerging cognitive impairment and the role of biomarkers in the clinic.     

2013年第1期中文目录

随着人口老龄化的到来,老年性相关疾病的发生越来越突出,轻度老年认知功能障碍是老年性痴呆的高危人群,是介于正常认知老化与轻度痴呆之间的一种临床状态。然而,在临床常规工作对轻度老年认知功能障碍认识严重不足,故加强对老年早期认知功能障碍的认识水平,提高对老年人早期认知功能障碍的评估与筛查,是尽早干预和预防老年性痴呆发生的重要保障。     

遗忘型轻度认知障碍和轻度阿尔茨海默病的认知损害特征研究

目的明确遗忘型轻度认知障碍（amnesia-mild cognitive impairment,a-MCI）患者和轻度阿尔茨海默病（alzheimer＇s disease,AD）患者的认知损害特征。方法对13例a-MCI患者、22例轻度AD患者和37例正常对照进行全面的认知测查,除简易精神状态检查（mini-mental state examination,MMSE）外,测验可覆盖4个认知域：记忆力、信息处理速度、执行功能、视空间结构能力,进行组间比较。结果 3组患者在年龄、受教育程度及性别组成上匹配。轻度AD组的所有认知测验成绩都差于正常对照组,而且多数测验较a-MCI组也有减退。a-MCI组的MMSE、记忆相关测验以及多个执行功能相关测验结果都差于正常对照组,信息处理速度和视空间结构能力相关测验与对照组间无统计学差异。结论轻度AD患者表现为全面的认知功能减退。a-MCI患者除存在显著的记忆障碍外,还存在执行功能的异常,信息处理速度和视空间结构能力尚正常。     

Sleep spindles,K-complexes,limb movements and sleep stage proportions may be biomarkers for amnestic mild cognitive impairment and Alzheimer’s disease

Sleep and Breathing - Sleep disturbances are common in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) patients. Non-rapid eye movement stage 3 (N3), rapid eye movement stage...     

血清睾酮对老年男性轻度认知损伤和轻度痴呆患者认知功能的影响

目的　探讨认知损伤的老年男性患者中血清睾酮水平与认知功能的关系。方法　对 15例轻度认知损伤(MCI组 )、17例轻度阿尔茨海默病 (AD组 )、7例轻度血管性痴呆 (VaD组 )患者进行详细的认知功能检查。应用放射免疫法检测血清睾酮浓度。应用多元线性回归分析各项认知功能成绩与血清睾酮的关系 ,对年龄和文化水平进行调整。结果　MCI组睾酮与结构性检查的成绩呈正相关。轻度AD组睾酮与词表学习 3、复杂图形回忆和延迟回忆、领悟力、词语流畅性均呈正相关。轻度VaD组睾酮与词表学习 1的成绩呈负相关。当轻度AD和轻度VaD合并后 ,睾酮与词表学习 3、复杂图形复制和回忆及延迟回忆、领悟力、词语流畅性、简易智力状态检查表、地点定向、符号数字呈正相关关系 (P <0 .0 5 )。结论　血清睾酮水平与MCI和轻度痴呆患者的视空间技能有选择性关系 ,并可能与词语和图形记忆以及执行功能有关 ,这对于雄激素替代治疗痴呆的研究有重要意义。     

Evaluation of the slopes of cognitive impairment and disability in Alzheimer's disease (AD) patients treated with acetylcholinesterase inhibitors (AChEl)

AD is characterized by a widespread cognitive impairment and deficit in functional competency to perform activities of daily living (ADL). The longitudinal reliability of cognitive and functional performance indices and the strength of relationship between patients cognitive impairment and their functional competence are still open issues. The aim of this study has been to evaluate, in a selected sample of patients with AD treated with AChEl, the slopes of cognitive impairment and disability. Among 249 AD patients, according to DSM-IV criteria, with presence/absence of associated vascular lesions (AD+VD), eligible for AChEl treatment, we selected subjects with mild to moderate cognitive impairment, without high comorbidity and severe psychiatric disease, with caregiver who resided with, or had frequent contact with the patient. Patients that changed treatment shifting from one AChEl to another, that didn't tolerate inhibitors (drop-out), and that presented behavioral and psychological symptoms of dementia (BPSD) requiring neuroleptic treatment during the study period were excluded from the final analysis. A sample of 99 subjects (30 males, 69 females; mean age of 79.4+/-5.0 years), completing a 15 months follow-up was considered. Cognitive performance remained stable after 15 months of treatment, but disability increased. No difference was found due to the AChEl compound used. The same hold true for the subgroups with presence/absence of a vascular components, whereas subgroup with mild cognitive performance showed a cognitive decline, parallel to the functional one. Our data underline the efficacy of AChEl in the treatment of AD with presence/absence of vascular component. Nevertheless, the judgement on the level of efficacy of AChEl could be biased by the level of reliability of the indices considered.