广州市城区75岁以上老年人痴呆患病率调查

目的 调查广州城区７５岁以上老年人的痴呆患病情况。方法 采用２阶段整群抽样方法。初级抽样单元为街道，次级抽样单元为居民小组，第１阶段采用系统抽样，第２阶段采用简单随机抽样方法，分人群筛选和病例诊断２个阶段进行调查，筛选阶段采用简易精神状态检查量表（ＭＭＳＥ）及日常活动功能量表（ＡＤＬ）等，诊断介段根据病史、精神科医师访问、神经心理测试、神经系统及一般体检结果作出评定，诊断采用ＤＳＭ－Ⅲ－Ｒ和ＮＮＣＤＳ－ＡＤＲＤＡ的标准。结果 筛选阶段中统及一般体检结果作出评定，诊断采用ＤＳＭ－Ⅲ－Ｒ和ＮＩＮＣＤＳ－ＡＤＲＤＡ的标准。结果 筛选阶段中ＭＭＳＥ作为筛选工具，其敏感度为７４．５１％、特异度为７４．９６％。７５岁以上老年人痴呆患病率为８．９０％，男、女患病率分别为２．９１％和１３．１１％。Ａｌｚｈｅｉｍｅｒ病（ＡＤ）患     

多发性骨髓瘤克隆起源的研究

为了解外周血中肿瘤克隆细胞的分化阶段，进一步研究ＭＭ（多发性骨髓瘤）发病机理，采用针对Ｂ细胞不同分化阶段抗原ＣＤ１０、ＣＤ１９、ＣＤ２０、ＣＤ４５ＲＡ、ＣＤ４５ＲＯ、ＣＤ３８的单克隆抗体，用ＡＰＡＡＰ法（碱性磷酸酶抗碱性磷酸酶法）同时检测１７例外周血中不含浆细胞的ＭＭ患者骨髓及外周血的免疫表型，其中１０例外周血表达浆细胞抗原增高（Ｐ＜０．００１）且与骨髓一致。９例外周血表达ＣＤ３８和ＣＤ４５ＲＯ，３例表达ＣＤ３８、ＣＤ４５ＲＡ、ＣＤ４５ＲＯ，１例表达ＣＤ３８、ＣＤ４５ＲＡ、ＣＤ４５ＲＡ和ＣＤ１０。此结果显示ＭＭ患者外周血的Ｂ系抗原表达既与骨髓具有一致性，又具多样性，提示ＭＭ的外周血中存在多分化阶段的肿瘤前体细胞，呈现自早期Ｂ细胞，经活化Ｂ细胞及晚期Ｂ细胞向前浆细胞的持续分化过程，并验证了文献关于ＭＭ发病途径的推测。     

血管性痴呆大鼠记忆障碍与海马胆碱能神经元关系的研究

目的探讨血管性痴呆（ＶＤ）记忆障碍的发病机理。方法采用改良的Ｐｕｌｓｉｎｅｌｉ４－血管阻断全脑缺血法，建立ＳＤ大鼠血管性痴呆模型，进行Ｙ－型迷宫和胆碱乙酰转移酶（ＣｈＡＴ）免疫组化测定。结果实验组在手术２周后出现严重的空间分辨学习记忆能力障碍，海马ＣＡ１区ＣｈＡＴ免疫反应阳性神经元分布及其数量较对照组显著减少，且与学习记忆障碍呈正相关。结论反复全脑缺血所致ＶＤ的学习记忆功能障碍，其原因可能为中枢胆碱能神经元受损致脑内学习记忆的神经生化基础海马环路损害。     

NIDDM患者心血管自主神经病变与红细胞山梨醇含量相关性及…

用Ｅｗｉｎｇ法和定量ＨＲＰＳ法同时测定９４级ＮＩＤＤＭ患者心血管自主神经病变（ＣＡＮＤ）程度，探讨其与红细胞山梨醇（ＲＢＣＳ）含量的关系。结果表明ＤＭ患者伴ＣＡＮＤ组的ＲＢＣＳ值显著高于无ＣＡＮＤ组，ＲＢＣＳ升高与ＣＡＮＤ严重程度，植物神经的改变，尤以副交感神经更易受影响，且与年龄、病程、ＦＢＧ、ＨｂＡ１Ｃ、血浆Ｆｇ、ＨＤＬ－Ｃ及亚类和血浆镁改变也显著相关；多元逐步回归分析显示ＲＢＣＳ是对ＣＡＮＤ     

氨力农对充血性心力衰竭患者左室舒张功能及肾素－血管紧张素系统的影响

应用氨力农治疗３５例严重充血性心力衰竭（ＣＨＦ），治疗前后测定左室舒张功能及血浆中肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＡⅡ）和醛固酮（ＡＬＤ）浓度。结果显示，氨力农可明显改善ＣＨＦ患者的左室舒张功能及降低血浆中ＡⅡ和ＡＬＤ浓度。其作用机理可能在一定程度上与神经体液因素有关。     

阿尔茨海默病的语言障碍研究

目的 为了研究阿尔茨海默病（Alzheimer Disease,AD)各阶段语言障碍的变化及特征,并为了找出阿尔茨海默病的早期诊断和鉴别诊断依据而作此研究。方法 使用汉语失语检查法（ABC）及多种神经心理测验,测试了符合国内外公证的疾呆诊断标准（NINCDS-ADRDA）的“很可能AD”的患,使用临床痴呆评定（CDR）确定疾呆严重程度。结果 疾呆严重程度是影响AD语言障碍的最主要因素。对CDR=0组（正常对照组）,CDR=1、2、3组（轻、中、重度AD组）比较AD各阶段语言障碍的特征,统计分析结果表明：AD早期即出现轻度词命名障碍,轻度复述障碍,听理解障碍及书写障碍（P<0.05）;AD中期AD语言障碍表现为流利型失语,类拟于经皮质感觉性失语;AD晚期由经皮质感觉性失语向Wemicke失语过渡,最终缄默不语。患的语言障碍有其自身的特征,与纯失语症不同,类拟于流利性失语。结论 疾呆严重程度是影响AD语言障碍的最主要因素,AD早期的语言变化可作其早期诊断与鉴别诊断依据之一。     

NIDDM 患者心血管自主神经病变与红细胞山梨醇含量相关性及其影响

用Ｅｗｉｎｇ法和定量ＨＲＰＳ法同时测定９４例ＮＩＤＤＭ患者心血管自主神经病变（ＣＡＮＤ）程度，探讨其与红细胞山梨醇（ＲＢＣＳ）含量的关系。结果表明ＤＭ患者伴ＣＡＮＤ组的ＲＢＣＳ值显著高于无ＣＡＮＤ组，ＲＢＣＳ升高与ＣＡＮＤ严重程度，植物神经的改变，尤以副交感神经更易受影响，且与年龄、病程、ＦＢＧ、ＨｂＡ１Ｃ、血浆Ｆｇ、ＨＤＬＣ及亚类和血浆镁改变也显著相关；多元逐步回归分析显示ＲＢＣＳ是对ＣＡＮＤ有显著影响的重要因素，提示ＤＭ患者ＣＡＮＤ是多因素共同作用结果，其中高血糖所致山梨醇通路活性增高在其发生发展中起重要作用。     

急性心肌梗塞后左室重构的超声心动图随访研究

目的：应用超声心动图对９２例急性心肌梗塞（ＡＭＩ）患者的左室重构（ＬＶＲ）进行随访研究,以探讨ＬＶＲ衍变规律。方法：分别于ＬＶＲ早期（３～６周）及后期（６～１２个月）应用彩色多普勒血流显像仪测定左室舒张末内径（ＬＶＤｄ）、左室收缩期圆周指数（ＬＶＳＣＩ）、左室舒张末及收缩末容积（ＥＤＶ,ＥＳＶ）、射血分数（ＥＦ）、心输出量（ＣＯ）、室壁应力指数（Ｅｄｂ,Ｅｓｂ,ｍｅａｎ服ｂ）、平均周边纤维缩短速率（ＭＶＣＦ）、二尖瓣舒张早期及晚期血流速度峰值（ＰＶＥ,ＰＶＡ）、左房张力（ＬＡＴ）、左房射血为（ＬＡＦ）及峰值充盈速度（ＰＦＲ）进行分析。结果：ＡＭＩ后ＬＶＲ早期可出现ＬＶＤｄ、ＥＤＶ、ＥＳＶ、Ｅｄｂ、Ｅｓｂ、ｍｅａｎｂ、ＰＶＡ、ＰＶＡ／ＰＶＥ、ＬＡＴ、ＬＡＦ显著增大（Ｐ＜０．０１－０．００１）,ＰＦＲ、ＥＦ、ＣＯ、ＬＶＳＣＩ、ＭＶＣＦ、ＰＶＥ显著降低（Ｐ＜０．０１—０．００１）;后期上述在室功能指标进一步减退,左房增力泵失代偿,左室畸形增加。结论：ＡＭＩ后ＬＶＲ的主要原因是梗塞区膨展、左室扩张、容量负荷及室壁应力增加,从而导致二尖瓣返流等并发症的出现。ＥＳＶ、ＥＤＶ及ＥＦ可作为了解远期预后的最佳指标。     

骨髓增生异常综合征和再生障碍性贫血等细胞遗传学…

为了探讨骨髓细胞遗传分析在鉴别诊断骨髓增生异常综合征（ＭＤＳ）和再生障碍性贫血（ＡＡ）等不同血液病中的意义，我们联合应用骨髓细胞Ｒ－带核型分析和组妹染色单体分化（ＳＣＤ）检测，对３３４例ＭＤＳ，ＡＡ等不同血液病进行分析并随访。结果表明：（１）ＲＡ／ＡＡ，ＲＡ／ＩＴＰ和ＲＡ／ＨＡ等可疑ＲＡ即为不典型ＲＡ或异早期ＲＡ；（２）骨髓细胞从ＳＣＤ阳性转为ＳＣＤ阴性是骨髓细胞癌变过程：（３）骨髓细胞ＳＣＤ检测     

强烈化疗治疗小儿急性淋巴细胞白血病临床研究

目的：观察强烈化疗治疗小儿急性淋巴细胞白血病（ＡＬＬ）的疗效。方法：８３ 例ＡＬＬ患儿用ＣＯＤＰＬ方案诱导治疗,缓解后用ＣＡＴ、ＨＤＭＴＸ、ＥＡ、ＶＰＤＬ方案早期巩固强化治疗,用ＭＴＸ、６－ＭＰ、ＶＰ、ＣＯＰ、Ａｒａ－Ｃ维持治疗,用ＣＯＡＰ、ＥＡ、ＶＰＤＬ方案定期加强治疗,用ＨＤＭＴＸ联合三联鞘注对庇护所白血病进行预防。结果：完全缓解（ＣＲ）率９６．４％ （８０／８３）;３ 例在诱导期死于败血症。６８例坚持治疗的患儿,中位随访３７（１８～１０８）个月,５ 年持续完全缓解（ＣＣＲ）率７６．２％ 。标危ＡＬＬ和高危ＡＬＬ的５ 年ＣＣＲ率分别为７９．６％ 和７２．９％ 。结论：强烈化疗及坚持治疗是提高小儿ＡＬＬ５年ＣＣＲ率的关键;严重感染仍是治疗失败的主要原因。     

Development of a scale to predict decline in patients with mild Alzheimer's disease

OBJECTIVES: To develop a scale that can assist in predicting likelihood of decline from mild dementia over 1 year in patients with Alzheimer's disease (AD). DESIGN: Retrospective cohort study. SETTING: University Memory and Aging Center. PARTICIPANTS: Patients with probable or possible AD and Clinical Dementia Rating (CDR) of 1 at baseline, divided into development and validation cohorts (n = 118 each). MEASUREMENTS: The CDR and neurological and neuropsychological assessments were given at baseline and 1 year later. RESULTS: In the development cohort, high education, low Mini-Mental State Examination score, poor insight, psychotic symptoms, and greater activity of daily living impairment predicted decline in CDR from 1 to 2 or 3. Receiver operating characteristics (ROC) curve analysis identified cutoff scores that maximized sensitivity and specificity for each significant predictor of decline. Based on the cutoff, raw scores were recoded to reflect risk for decline, weighted, and summed to create a final scale score. ROC curve analysis established a cutoff to indicate risk for decline on the final scale score. Sensitivity, specificity, and area under the ROC were 0.76, 0.74, and 0.83 in the development cohort and 0.77, 0.69, and 0.80 in the validation cohort, respectively. Positive and negative predictive values were 0.71 and 0.78 in the development cohort and 0.68 and 0.78 in the validation cohort, respectively. CONCLUSIONS: Decline from mild to moderate or severe impairment represents significant clinical change, with implications for patient and caregiver quality of life and treatment options. The clinical scale developed uses data to enhance prediction about change from mild to moderate or severe stages of AD.     

微型营养评价量表在老年阿尔茨海默病患者中的应用

目的 观察老年阿尔茨海默病（Alzheimer＇s disease,AD）患者营养状况及血叶酸、VitB12水平,并分析认知功能对老年患者营养状况影响.方法共纳入AD患者101例.以微型营养评价量表（MNA）和痴呆评定量表（CDR）为工具检查所有研究对象的营养状态和认知功能,分为轻度AD组（51例,CDR 1分）和中重度AD组（50例,CDR 2 ～3分）,根据患者量表得分及生化检测指标进行数据分析.结果与轻度AD组相比,中重度AD组患者MNA总得分（23.74±4.46） vs （26.86±3.13）、整体评估得分（6.32±0.67）vs（7.46±0.44）、膳食评估得分（6.68 ±0.17）vs （7.58±0.38）等降低（P＜0.05）,BMI降低[（21.33±4.08） kg/m2 vs （24.67±4.36） kg/m2,P＜0.01].多元回归逐步方程：MNA评分=30.860-0.215年龄-0.049CDR评分＋0.269血叶酸水平.结论MNA得分随CDR得分升高而降低.年龄、CDR评分与MNA评分呈负相关,血叶酸水平与MNA评分呈正相关.     

血浆重金属浓度与阿尔茨海默病和血管性痴呆的关系

目的 探讨重金属在阿尔茨海默病(Alzheimer's disease,AD)和血管性痴呆(vascular dementia,VaD)发病过程中的作用,分析AD患者认知功能障碍与血浆重金属含量的关系.方法 纳入50例AD患者、20例VaD患者和20例正常对照者,AD患者按临床痴呆分级量表(Clinical Dementia Rating,CDR)分为轻度痴呆组(CDR=1分)和中重度痴呆组(CDR=2～3分).所有观察对象均行简易智能状态量表(Mini-Mental State Examination,MMSE)、Hachinski缺血指数评分和CDR评分,同时抽取空腹静脉血检测重金属(Cu、Ca、Fe、Me、Zn、Hg、Cr、Co、Se和Pb)的浓度.结果 与对照组比较,轻度AD组和中重度AD组血浆Cu浓度显著增高[分别为(0.66±0.21)、(0.84±1.11)和(0.85±1.12)ng/g,P＜0.05],轻度AD组与中重度AD组之间无显著差异.对照组Pb浓度显著低于中重度AD组[(22.79±3.94)ng/g对(40.82±16.96)ng/g,P＜0.05],而对照组与轻度AD组以及轻度AD组与中重度AD组之间均无显著差异.AD组血浆Cu浓度[(0.84±1.25)ne/g对(0.66 ±0.21)ng/g,P＜0.05]和Pb浓度[(32.42±14.12)ne/g对(22.79±3.94)ng/g,P＜0.05]均显著高于对照组,而VaD组与对照组之间金属浓度均无显著差异,VaD组和AD组之间的金属浓度亦无显著差异.结论 部分重金属,如Cu和Pb可能参与了AD的发病过程,但重金属浓度与VaD的发病关系不大,AD患者的认知障碍程度与血浆金属浓度无显著相关性.     

Different MRI findings for normal elderly and very mild Alzheimer's disease in a community: implications for clinical practice the Tajiri Project

To investigate magnetic resonance imaging (MRI) findings of very mild dementia, 485 participants were randomly selected in a community. Three hundred and forty participants were of Clinical Dementia Rating (CDR) 0 (healthy), 113 were of CDR 0.5 (questionable dementia), and 32 were of CDR 1 and 2 (including 20 Alzheimer's disease, AD). Cortical atrophy, white matter lesion, etc., were visually assessed. We found that each part of the brain showed atrophy in older adults for CDR 0. For CDR 0.5, the relationships between MRI findings and age were weaker, and for AD, there were no such relationship. Atrophy related with dementia severity was found to be limited to the lateral and medial temporal lobes. For CDR 0.5, amygdala atrophy was the only finding indicating CDR effect but no age effect. The amygdala or anterior entorhinal atrophy is important for discriminating very mild dementia from normal elderly.     

血清睾酮及雌二醇与老年男性痴呆类型和严重程度的关系

目的探讨血清总睾酮(TT)、雌二醇(E2)与老年男性痴呆类型和严重程度的关系。方法选择111例男性老年人,将认知功能正常的老年人28例作为正常组,轻度认知损害(MCI)患者15例作为MCI组,阿尔茨海默病(AD)患者50例作为AD组(其中轻、中、重度分别为17、18和15例),血管性痴呆(VaD)患者18例作为VaD组,检测TT和E2浓度。痴呆严重程度根据通用的临床痴呆评价量表评分。应用协方差分析、相关分析和χ~2检验方法分析TT、E2与AD和VaD及其严重程度的关系。结果 MCI组、正常组和轻度AD患者的TT和F2水平差异均无统计学意义。AD组患者TT和E2水平明显低于正常组(P<0.05)。随着认知损伤程度的加重,AD组患者TT呈下降趋势(Spearman's ρ_s=-0.4709,P<0.001),且TT低下患者的比例增多。VaD组、AD组、正常组3组间比较,TT和E2水平以及TT和E2低下患者的比例差异均无统计学意义。结论 TT下降与AD及其严重程度相关,血清E2下降与AD相关,但与其严重程度无关,二者与VaD均无明显相关性。     

Clinical effect of cerebrovascular atherosclerosis on cognition in Alzheimer’s disease

BackgroundThe association between cerebrovascular atherosclerosis and Alzheimer’s disease (AD) has been examined in many cross-sectional studies; however, there are few data regarding the role of cerebrovascular atherosclerosis on the longitudinal course of cognitive decline in AD. The aim of this study was to examine the progression of cognitive function in AD patients with cerebrovascular atherosclerosis compared to those without atherosclerosis over a two-year period.MethodsForty-seven AD patients with cerebrovascular atherosclerosis and 81 AD patients without atherosclerosis were assessed for cognitive function at the time of diagnosis and again at follow-up after two years. The cognitive functions were evaluated by neuropsychological tests including mini-mental state examination (MMSE) and clinical dementia scale (CDR).ResultsRepeated-measures multivariate analyses showed that there was a significant group-by-time interactions for the temporal changes of the MMSE and CDR between the two groups. The group-by-time interactions remained significant when the atherosclerotic patients were sub-classified into either an extracranial stenosis (EC) group or an intracranial stenosis(IC) group. Comparing either the EC or IC group with the non-atherosclerosis group, there were no main effects by time or group alone, but there were significant group-by-time interactions for the MMSE and CDR.ConclusionsCognitive function worsened more in terms of progressive impairment in AD patients with cerebrovascular atherosclerosis compared to AD patients without cerebrovascular atherosclerosis, regardless of whether the atherosclerosis was extracranial or intracranial.     

Cognitive functional status of age-confirmed centenarians in a population-based study

The New England Centenarian Study is a population-based study of all centenarians in 8 towns near Boston, MA. Age was confirmed for 43 centenarians all alive on a designated date. To determine prevalence of dementia in centenarians, the authors analyzed neuropsychological, medical, and functional status data for 34 (79%) of the centenarians. Definition of dementia was based on the Consortium to Establish a Registry for Alzheimer's Disease criteria, and a Clinical Dementia Rating (CDR) score was formulated for each participant. Seven (21%) had no dementia (CDR score 0), and an additional 4 (12%) were assigned a CDR score of 0.5, uncertain or deferred diagnosis. The remaining 22 (64%) had at least some degree of dementia. The authors calculated Barthel Index scores to determine ability to perform activities of daily living. There was a statistically significant correlation between CDR scores and Barthel Index scores (r = -0.73). Correlation was strongest for those with no or severe dementia, with the greatest range of function measured among those with moderate dementia.     

The levels of recognition and hand functions of patients with Alzheimer's disease: a pilot study based on the simple test for evaluating hand function

AIM: The purpose of this study was to analyze the levels of recognition and hand functions of the patients with Alzheimer's disease (AD) based on the Simple Test for Evaluating Hand Function (STEF). METHODS: Forty subjects with AD (AD group) and 20 without AD (control group) in a facility for elderly health care services participated in this study. The AD group consisted of 20 subjects with Clinical Dementia Rating (CDR) 1 and 20 other subjects with CDR2. RESULTS: The results were as follows: Time required for full motion of right hand dexterity was significantly longer in both the CDR1 and CDR2 groups compared to the control group (p < 0.05, p < 0.01). Time required for the control group and CDR1 group were significantly shorter for motion of right hand dexterity compared to the left hand. No significant difference was observed between the times of right and left hand dexterity among subjects of CDR2. The disparity of right-left hand dexterity decreased in the order of control, CDR1 and CDR2. The correlations between the sub-items for CDR scale and the right-left hand disparity were significant in "memory" and "judgment". The right-left hand disparity decreased with the shortened time for left hand motion, as the "memory" or "judgment" scores increased. CONCLUSION: These findings suggest that right hand dexterity speed in patients in the mild AD stage was low when their dominant hand superiority declined. Moreover the decline of dominant hand superiority correlated with the recognition of memory and judgment.     

Effects of spaced retrieval training (SRT) on cognitive function in Alzheimer's disease (AD) patients

Among the non-pharmacological treatments of dementia, SRT is a good candidate strategy for rehabilitating the cognition of AD patients. This study investigates the efficacy of SRT on the cognition of AD patients with very mild to mild disease. We administered 24-session SRT to 13 very mild and 6 mild AD patients. To assess the change of the neuropsychological performance after SRT, we performed the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery (CERAD-K), the logical memory test (LMT), the Benton visual retention test A (BVRT-A), and the digit span test (DST). All tests were administered both before and after SRT. Retention spans were significantly increased up to 24 min after SRT in both very mild and mild AD patients (p < 0.05), and this improvement was maintained for different sets of target information. Retainable words were also significantly increased after SRT in the very mild AD patients (p = 0.007). However, we observed no changes in neuropsychological performance after SRT. Although we did not observe improvements in the neuropsychological tests following SRT, our results suggest that the treatment was an effective intervention for improving the memory of very mild to mild AD patients, and could potentially improve learning and retention outside the training session.