精神病

布犷万20041935 383例老年人尸植资料中痴呆的病因分析/下香宁…//中华内科杂志一2003,42(11)一789一792 回顾性分析383例)60岁有脑病理检查的患者进行临床和病理资料.结果:383例老年人)’检病例中,有临床病史和相关病理改变的痴呆患者78例,痴呆发生率为20.4%。其中血管性痴呆30例,占老年人痴呆病例的38.5%:变性病痴呆20例,占25.6%,其,},阿尔茨海默病11例.路易体痴呆、皮质基底竹变性、进行性核卜性麻痹、皮克病、帕金森病合并痴呆等非阿尔茨海默病型痴呆共9例;各种内科疾病包括肝性脑病、肺性脑病、低血糖反复发作引起认知功能障碍共16例,…     

老年人痴呆30例尸检分析

对３０例老年人痴呆及１３例非痴呆老年人的尸检材料进行临床和病理分析。发现老年人痴呆以血管性痴呆最多（１３例，占４３．３％），其次为阿茨哈默病（６例，占２０．０％）、混合型痴呆（６例，占２０．０％）及皮质下动脉硬化性脑病（５例，占１６．７％）。对不同类型的老年人痴呆的神经病理学特征进行了讨论。     

老年人痴呆30例尸剑分析

对３０例老年人痴呆及１３例非痴呆老年人的尸检材料进行临床和病理分析。发现老年人痴呆以血管性痴呆最多，其次为阿茨哈默病、混合型痴呆及皮质下动脉硬化性脑病。对不同类型的老年人痴呆的神经病理学特征进行了讨论。     

精神病

.医学文摘·内科学立995年第16卷第4期 953705p一受体阻滞剂在精神科的应用(综述)/陈国强//广州医药一1994,25(6)一1一3 ,53706老年人痴呆30例尸检分析/刘冬戈…刀中华老年医学杂志一1995,l性(1)一28一31 此组与13例非痴呆老年人尸检进行对照分析,老年人痴呆以血管性痴呆最多占昭.3%,其次为阿茨哈默病占20.0写,混合型痴呆占20.0写,皮质下动脉硬化脑病占1 6.7%。7例有帕金森病史,镜检均有帕金森病特有病理改变。对照组中9例在双侧脑室附近脑白质有呈灶状分布的轻度的脱随鞘变性,其余4例未发现明显的脑神经系流病变。对不同类型的老年人痴呆的…     

老年人脑出血的临床与病理研究

目的 探讨老年人自发性脑出血的临床特征与病理特点,以期为脑出血的预防提出建议.方法 将188例脑出血患者分为老年前期组、老年组和高龄组3组进行回顾性分析,比较老年人脑出血在性别,出血部位,发病前危险因素与其他组的异同;并对老年组、高龄组两组各争取到1例脑组织病理尸检,进行病理学研究,探讨老年脑出血的发病机制.结果 老年人脑出血病例男性多于女性;老年组出血部位以基底节区多见,但脑叶和小脑出血比老年前期明显增多;在高龄老年人脑叶出血最多见;其次为基底节区;老年组脑干出血低于老年前期;病前危险因素以高血压最多,老年组比老年前期组血胆固醇、甘油三酯水平明显减低;而痴呆病史明显增多;且随增龄痴呆有增加趋势;老年组尸检的1例有痴呆无高血压病史,病理发现以βA4阳性大量老年斑,小血管βA4免疫表达阳性,小血管结构消失,呈刚果红染色阳性,病理确诊阿尔茨海默病(AD),脑淀粉样血管病性脑出血;高龄组尸检的1例有高血压及痴呆病史,病理发现存在老年斑,动脉瘤破裂脑出血,脑淀粉样血管病.结论 老年人脑出血男性居多,以基底节、脑叶出血多见,病前常伴有高血压、痴呆,病理检查以老年斑,淀粉样血管病,或高血压脑动脉瘤出血常见;积极控制高血压,戒烟、酒,保持情绪稳定可减少脑出血的发生.     

海马神经细胞颗粒空泡变性的初步观察

对１４５例常规尸检脑及２例Ａｌｚｈｅｉｍｅｒ病脑的海马锥体细胞颗粒空泡变性进行观察。８０例０－５９岁尸检脑内仅１例出现颗粒空泡变性，发生率为１．２％；６５例６０－９２岁尸检脑内有２０例出现此种改变，发生率为３０．８％。８０岁以上老年人脑内７１．４％可见颗粒空泡变性。２例Ａｌｚｈｅｉｍｅｒ病海马部位可观大量颗粒空泡变性，占锥体细胞的２０％－３０％，累及Ｈ１，Ｈ２段，甚至Ｈ３段。结果表明，无痴呆记录…     

Alzheimer病的病理学所见

Alzheimer病(AD)也可称作Alzheimer型痴呆(DAT)或Alzheimer型老年期痴呆(SDAT),是一种神经变性疾病。在诊断中,仅病理诊断是确诊性的。事实上,Gearing等对106例临床诊断的AD痴呆患者进行病理检查。其结果证明,92例(87％)为AD痴呆;另14例为非AD患者:其中5例有帕金森病(PD)病理改变,3例有海马硬化,3例有各种各样神经变性疾患及其它疾病,3例无明显病理改变。     

Lewy体痴呆的研究进展

Lewy体痴只是继阿尔茨海默病之后致老年期痴呆的第二大类脑变性疾病，本文介绍了此病的发病机制、病理、临床特点、诊断标准、辅助检查和治疗方面的新进展。     

老年性痴呆和Alzheimer氏病的新观点

痴呆为大脑功能改变的一种状态,病因是多方面的,最常见的是Alzheimer氏病(A病)。与老年性痴呆相同的临床和病理,也可在老年前期和40岁以上的Down氏综合征患者的尸检中见到。这些观察都支持一种假说,即所发现的老年人脑组织变性可能是由一种疾病引起,而不是衰老的预期结果。既往人们误把这种病归于脑血管供血不全,但对脑组织病理学观察发现,只有20～30％老年血管粥样改变可解释痴呆的临床表现。而且有人证明,在一些病例中所见到的脑血流量减少可能是继发于脑组织萎缩;而且有60～70％具有痴呆临床表现的老年人都表现出A病的典型症状。过去A病一词仅代表老年前期痴呆,即患者发病年龄在60岁以下,但现在人们认识到老年前期痴呆和老年痴呆的Alzheimer型的病理是相同的,所以如今此病名不再受发病年龄的限制。     

路易体痴呆9例临床分析

本病最早由德国学者Lewy于1912年发现了路易小体（Lewy bodies ,LB ）,1961年日本学者Okazaki在痴呆患者的皮质神经元中也发现了路易小体,于是开始探讨其和痴呆间可能存在的关系［1,2］。路易体痴呆（dementia with Lewy bodies ,DLB ）是一种以波动性认知功能障碍（fluctuating cognition ,FC ）,持续存在的视幻觉和锥体外系运动功能障碍为临床特点的神经变性疾病［3］。是以路易小体和路易神经元为病理特征的神经变性疾病。近年来国外报道认为,阿尔茨海默病（AD ）在老年期痴呆中最常见,DLB位于第2位,占10％～15％［1］。神经病学家发现以前曾被诊断为AD、帕金森氏病（PD ）等的痴呆病人中,约有1／4为DLB。本病国内报道很少,原因可能由于我国尸检率低,对此病的特征性临床表现缺乏认识。本病与AD和PD极易误诊,但实际上两者特点不同。本文结合文献,回顾性分析近3年我们收治的9例临床诊断DLB患者的临床特征,以提高对本病早期诊断的准确性。     

Gallyas-Braak银染法在神经系统变性疾病中的应用

目的 评估Gallyas-Braak银染色方法在几种神经系统变性疾病病理诊断中的作用和价值。方法 采用修订Gallyas-Braak染色法,对经临床和常规病理方法诊断的22例神经系统变性病的脑和脊髓标本进行了回顾性研究。结果 Gallyas-Braak银染色可良好显示Alzheimer病（AD）,其他变性病痴呆,正常老年人的海马及额、颞叶皮层神经原纤维缠结,且较Bodian染色清楚。在4例有痴呆症状和明显锥体外体征患者的中脑,基底节观察到大量神经元球形团样缠结,同时在运动皮层,基底节,中脑观察到星形细胞丛状缠结,其中2例符合进行性核上性麻痹的病理诊断标准,另2例观察到运动皮层和基底节区星形细胞斑,加之皮层神经元气球样变,符合皮质基底节变性的病理特征。3例多系统萎缩的脑和脊髓白质显示广泛分布少突胶质细胞包涵体。1例AD病的颞叶和海马皮质2－3层神经毡内显示嗜银颗粒,而Bodian染色未观察到这些病理改变。结论 Gallyas-Braak染色除显示神经原纤维缠结外,还能较好显示胶质细胞变性和神经毡异常结构,因此对进行性核上性麻痹,皮质基底节变性,多系统萎缩,嗜银颗粒病的病理诊断有重要价值。     

Senile degenerative brain lesions and dementia.

In a study of senile degenerative lesions-including Alzheimer's neurofibrillary changes, senile plaques and amyloid angiopathy-the hippocampal area of the brain was examined by thioflavine T fluorescence microscopy in 146 consecutive autopsy patients over the age of 49. The incidence and quantity of neurofibrillary changes and senile plaques rose with age, and an approximate positive correlation in quantity was noted among the three kinds of degenerative change. The quantity of neurofibrillary lesions and senile plaques was significantly different between the demented and non-demented patients, but not between the severely and less severly demented patients. The cause of dementia was studied retrospectively, based on the extent of morphologic changes in the brain, thus classifying dementia into three types: degenerative, vascular, and mixed. Clinically, the mixed type resembled the vascular type with regard to major neurologic signs, and there was some similarity to the degenerative type with regard to mental features.     

Are vascular factors involved in Alzheimer's disease? Facts and theories

The hypothesis that vascular factors may contribute to the development of Alzheimer's disease (AD) is supported by epidemiologic and pathologic observations. Arterial hypertension and diabetes have been found to be associated not only with vascular dementia, but also with AD; in addition, the treatment of hypertension with calcium antagonists seems to prevent degenerative dementias. Hypertension and hyperinsulinemia favor the deposition of amyloid substance in the brain. The histopathology of AD is marked not only by neurofibrillary tangles and senile plaques, but also by macro and micro congophilic angiopathy and ischemic white matter rarefaction. The specific AD pathological lesions, if isolated, are not able to lead to an evident clinical picture of dementia, which, on the contrary, becomes evident when vascular, mainly subcortical, lesions are associated. These and other observations suggest that vascular factors may have a role in the development of AD. An aggressive approach to these factors could be of value in the prevention of AD.     

Differentiation of the dementias of old age by ultrasonic doppler flowmetry: a pilot study.

At the Bel-Air Psychiatric Clinic, Geneva, Switzerland, the technique of ultrasonic Doppler flowmetry was used to examine the internal carotid arteries of 30 aged patients - 10 with cerebral degenerative dementia, 10 with cerebrovascular dementia, and 10 without dementia. An index of cerebrovascular resistance was calculated. Apparently this index can distinguish a group of vascular dementias from a group of degenerative dementias.     

Distinguishing Alzheimer's disease from other dementias. Questionnaire responses of close relatives and autopsy results

Epidemiologic study of Alzheimer's disease by family history requires that Alzheimer's be distinguished from other dementias. Identification of demented family members is usually based on recall by relatives. This study examines the validity of the classification of Alzheimer's disease and other dementias based on relatives' reports. Close relatives of autopsy-confirmed dementia cases were asked to complete a questionnaire describing the patient's symptoms. These informants were familiar with the patient's disease and involved in his/her care prior to death. The questionnaire included the DSM-III criteria for Primary Degenerative Dementia and the Hachinski Ischemic Scale. A diagnosis derived from the close relatives' responses was compared to the neuropathologic diagnosis for thirty-six cases: 20 Alzheimer's disease, 9 mixed Alzheimer's disease, and 7 non-Alzheimer's disease dementias. The diagnosis of Primary Degenerative Dementia derived from questionnaire responses had a sensitivity of 0.93 and specificity of 0.43 for pathologic Alzheimer's disease. Few vascular dementias were included in the series, thereby precluding the study of so-called multi-infarct dementia. Hachinski scores based on relatives' responses classified 40% of pathologically pure Alzheimer's disease cases as multi-infarct dementia (HIS greater than 7). Thus, using these elevated Hachinski scores to rule out Alzheimer's disease would cause substantial misclassification. Diagnosis based on questionnaire Primary Degenerative Dementia criteria was quite sensitive but relatively nonspecific. When attempting to obtain a complete family history or pedigree that describes the occurrence of Alzheimer's disease and other dementias in all family members, the questionnaire approach should be supplemented with additional information from medical records, physicians, and other relatives.     

Focal degenerative dementia syndromes

Focal degenerative dementia syndromes are associated with a characteristic clinical picture, such as frontotemporal dementia, primary progressive aphasia, semantic dementia, corticobasal degeneration, and the Balint syndrome. A lobar approach may be used to classify the degenerative dementias. The underlying pathology of these various syndromes seems to be less heterogeneous than previously thought.     

老年人海绵状脑病一例报告及文献复习

目的：探讨老年期发病的海绵状脑病的临床特点并分析误诊原因。方法：报告1例79例老年海绵状脑病的临床病理诊断过程。并复习国内报道的经病理学证实的8例60岁以上老年海绵状脑病患者的持征及脑电图、MRI资料。结果：老年人海绵状脑病急性发病者病程短,但都有进行性痴呆、肌阵挛及各种不自主运动发作。6例脑电图有典型的周期性三相波,1例MRI发现双侧基底节区T2高信号。3例初诊为脑血管病,1例为单疱性脑炎。病理上有典型的空泡和海绵状改变。结论：急性发病的老年人海绵状脑病容易误诊为脑血管病,但根据患者典型的临床表现,结论动态脑电图特征,必要时脑活检,可尽早诊断,减少医源性传播。     

Frontal lobe degeneration of non-Alzheimer type. II. Clinical picture and differential diagnosis

In a longitudinal prospective study of dementia, 158 patients were investigated post mortem. Sixteen patients were classified as frontal lobe dementia (FLD) of non-Alzheimer type and four cases as Pick's disease. Positive heredity for dementia was reported in 50% of these cases compared to 30% in a reference group of patients with Alzheimer's disease (AD). The typical clinical picture in FLD and Pick's disease was that of a slowly progressive dementia, at an early stage dominated by personality change, lack of insight, disinhibition, and later on stereotypy and increased apathy. There was also a progressive dynamic aphasia ending in mutism and amimia. Memory and spatial functions were comparatively spared. Disinhibition, oral/dietary hyperactivity, and echolalia were more consistently found in Pick's disease compared to FLD. The differential diagnosis against AD, cerebrovascular dementia, and other degenerative dementias and against affective disorders and psychotic reactions are discussed.     

Morphological studies of the hippocampus of 100 elderly females in relation to age and grade of dementia

The number of the nerve cells, appearance of Alzheimer's neurofibrillary tangles and of senile plaques in the hippocampus of 100 female autopsy cases aged 56-101 were compared in relation to age and grade of dementia. The number of nerve cells of granular and pyramidal layers decreased significantly with age, however, the decrease in number did not necessarily correlate with the grade of dementia. Appearance of Alzheimer's neurofibrillary tangles was increased in grade with age and with grade of dementia of all types. Appearance of senile plaques increased in grade only in cases with dementia of Alzheimer's type, but not in case with cerebrovascular type of dementia.     

Wernicke encephalopathy in nonalcoholic patients

BACKGROUND: Wernicke encephalopathy is associated with patients that have a history of alcohol abuse and other malnourished states. However, clinicians may be less likely to recognize this condition in nonalcoholic patients. This study was undertaken to evaluate the cause, diagnosis, treatment, and outcome of nonalcoholic patients with Wernicke encephalopathy. METHODS: A retrospective review was conducted of all cases of Wernicke disease from 1984 to 1999 evaluated at a rural university hospital. Inclusion criteria consisted of patients diagnosed clinically with this disorder who improved after the administration of thiamin. Patients were also included in the series if they had classic pathologic findings of the disease on autopsy even without a prior clinical diagnosis. RESULTS: Twelve patients were identified. Alcohol abuse was noted in only 50%. The patients without a history of alcohol abuse had other malnourished states, such as end-stage cancer, intractable vomiting after gastric reduction procedure, and prolonged hospital courses on intravenous fluids without other sources of nutrition. The mortality rate was 4 of 12 (33%) but due to multiple causes. Autopsies were performed on all 4 patients. Three of these 4 patients had no history of alcohol abuse. Two of the nonalcoholic patients were not diagnosed until autopsy, whereas all the patients with a history of alcohol abuse were diagnosed clinically. DISCUSSION: Our study reveals that Wernicke encephalopathy continues to be a rare but life-threatening condition often overlooked in the nonalcoholic population, resulting in the further progression of an easily treatable condition.