轻度认知功能损害患者视觉空间损害的研究

目的 了解轻度认知功能损害(MCI)患者视觉空间损害及其与认知损害之间的关系,揭示视觉功能损害是否可作为痴呆早期诊断的生物学指标.方法 采用横断面比较研究,对20例有轻度认知功能损害的老年人(MCI组)和20例认知功能正常的老年人(NC组)进行Benton视觉保持测验(BVRT)比较.结果 MCI组的BVRT正确得分明显低于对照组(P＜0.05),而总错误得分及各错误得分(特别是遗漏、持续、位置错误)均明显高于对照组(P＜0.05).结论 经BVRT测试后发现,MCI患者存在明显的视觉空间认知功能损害,这种认知功能损伤可能是阿尔茨海默病(AD)早期诊断的生物学指标之一.     

轻度认知功能障碍与阿尔茨海默病患者血管危险因素的研究

目的 探讨血管危险因素与轻度认知功能障碍（Mild cognitive impairment,MCI）及阿尔茨海默病（Alzheimer＇sdisease,AD）的关系,并进一步分析各因素与认知功能下降程度的相关性.方法 选择2012年6月至2014年6月于门诊及住院部诊断为MCI及AD的患者各35例,同期体检的性别、年龄、文化程度相匹配的健康老人35例为对照.所有研究对象均进行MMSE、ADAS-Cog量表评定,采集晨空腹血进行血脂、血糖检测,并分别记录性别、年龄、身高、体重、吸烟、饮酒等情况.采用最小显著性差异法（LSD）比较各组间血管危险因素的差异、Pearson＇s相关分析各因素与认知功能评分的相关性.结果 与对照组相比,MCI组、AD组体重指数、血胆固醇水平呈进行性下降,但仅AD组与对照组相比差异有统计学意义.收缩压水平MCI组、AD组与对照组相比均明显升高,MCI组与AD组比较差异亦有统计学意义.Pearson＇s分析可见各因素与认知功能下降程度之间呈线性相关.糖尿病、饮酒比率AD组与对照组相比亦明显升高.结论 血管危险因素在老年人认知功能下降过程中有重要的作用,并有可能指导AD早期诊断及治疗.     

脑梗死患者颈动脉粥样硬化与轻度认知功能损害的相关性

目的 探讨脑梗死患者颈动脉粥样硬化与轻度认知功能损害(MCI)的相关性.方法 采用蒙特利尔认知评估量表(MoCA)对380例脑梗死患者进行神经心理学测试,确诊MCI患者48例(MCI组).选择同时期认知功能正常的脑梗死患者48例作为对照组.测定颈总动脉内膜中膜厚度(IMT)、颈动脉软斑块数,收集人口学及痴呆危险因素等方面的指标.结果 MCI组高血压病及糖尿病比例、IMT、软斑块数高于对照组(P＜0.05),两组高血脂、吸烟比例无统计学差异(P＞0.05).校正了年龄、性别、受教育程度、既往病史、吸烟等因素后,颈动脉IMT的增加与MoCA分数的下降呈显著线性相关(P＜0.05).结论 颈动脉IMT增加与MCI的发生、发展关系密切,颈动脉IMT增加是引起早期认知功能损害的独立危险因素.     

不同认知功能水平对阿尔茨海默病患者外周血辅助性T细胞表达影响

目的观察不同认知功能水平对阿尔茨海默病(AD)患者外周血辅助性T细胞表达影响。方法连续选择近期就诊或住院治疗的AD患者39例,对照组选择同期在我院参加体检健康成人25名,2组入选对象均检测外周血辅助性T细胞(CD3+、CD4+、CD8+、CD4+/CD8+),AD组同时接受了AD评定量表认知部分(ADAS-Cog)评估。结果 AD组的外周血CD3+和CD4+表达水平及CD4+/CD8+比值显著高于对照组,而CD8+则显著低于后者(P均<0.05);中、重度认知损害重组(ADAS-Cog总分≥20分,17例)的外周血CD3+和CD4+表达水平及CD4+/CD8+比值也显著高于轻度认知损害组(ADAS-Cog总分<20分,22例),而前者CD8+则则明显低于后者(P均<0.05)。结论 AD患者存在明确的辅助性T细胞高水平表达,且伴随着认知损伤加深显著而进一步严重。     

上海市浦东新区轻度认知功能障碍老人的睡眠质量分析

目的 了解上海市浦东新区患有轻度认知功能障碍(mild cognitive impairment,MCI)老年人的睡眠质量,分析其与认知功能的关系.方法 采用PPS(Probability proportional to size)抽样法,对101例老年MCI患者(MCI组)和109例认知健康老年人(对照组)使用匹兹堡...     

太原市社区老年人轻度认知功能障碍的病例对照研究

<正>轻度认知功能障碍(MCI)是介于正常老化和阿尔茨海默病(AD)之间的一种认知损伤状态,系指老年人出现轻度记忆或某项认知功能障碍,但尚不足以诊断AD的临床现象。目前MCI虽不是明确的疾病实体,但被广泛地认为是一组临床实体或临床症状群。由于MCI干扰老年人正常生活、影响生活质量,并且较健康老年人群相比,MCI患者更易发展为AD     

认知功能训练改善轻度认知功能障碍的研究进展

阿尔茨海默病是最常见的神经系统退行性疾病之一,但其患者在达到痴呆症程度之前存在一定时期的轻度症状期,被称为阿尔茨海默病所致轻度认知功能障碍(mild cognitive impairment,MCI)阶段.不过,对MCI的治疗目前尚无统一的治疗原则或专家共识,且使用药物治疗MCI还存在一定的争议和风险.认知功能训练作为一种重要的非药物治疗手段,已逐渐成为早期干预认知功能减退的一种重要手段和研究热点.本文介绍对MCI患者进行认知功能训练的常用方式,具体论述了认知域和非认知域训练两种方法对MCI患者的认知功能和日常生活能力的影响,并讨论了认知功能训练效果的评估方法和训练设计的改良策略.     

认知功能障碍与同型半胱氨酸水平的关系研究

目的探讨老年人认知功能障碍与血浆同型半胱氨酸(Hcy)水平的关系。方法收集102例认知功能障碍老年患者为病例组,收集40例认知功能正常老年人为对照组;采用简易精神状态量表(MMSE)评分,将病例组分为轻度认知功能障碍(MCI)组52例和痴呆组50例,痴呆组其中老年性痴呆(AD)13例和血管性痴呆(VD)37例;各组均检测血浆Hcy水平,进行组间比较,血浆Hcy浓度与MMSE评分进行相关性分析。结果病例组血浆Hcy水平显著高于对照组(P<0.01),痴呆组血浆Hcy水平显著高于MCI组(P<0.01);痴呆组血浆Hcy水平与MMSE评分呈明显负相关(P<0.01)。结论老年人认知功能障碍与高Hcy有关,而且认知障碍程度与血浆Hcy水平增高程度密切相关,高Hcy是老年人认知功能障碍的一个危险因素。     

基于VBM-Dartel方法对阿兹海默症和轻度认知功能障碍患者的脑组织结构分析

目的:利用MRI图像研究轻度认知功能障碍(MCI)、轻度阿尔茨海默病(AD)患者和健康对照组(HC)两两组间灰质和白质体积改变的特点。方法:利用DARTEL算法对14例AD患者(AD组)、21例MCI患者(MCI组)及23例健康对照组(HC组)的MRI图像(数据均来于于ADNI数据库)进行预处理,再对MCI组、AD组和HC组的全脑灰质和白质体积进行基于体素的统计学比较分析。结果:灰质变化:与HC组比较,AD组的双侧海马、海马旁回、杏仁核、丘脑、颞中回、尾状核及右侧岛叶、梭状回、前扣带皮层、舌回、内嗅皮层、左侧豆状壳核和顶下小叶等结构灰质体积萎缩。MCI组右侧海马、海马旁回、杏仁核、楔前叶、额上回、双侧额中回和豆状壳核等结构的灰质体积萎缩。AD组相较于MCI组在右侧海马、丘脑、楔叶的灰质体积萎缩。白质变化:与HC组比较,AD组双侧Extra-Nuclear、Sub-Gyral、胼胝体、前扣带回和右侧海马旁回白质体积萎缩。MCI组双侧海马旁回、右侧丘脑、Extra-Nuclear和左侧梭状回白质体积萎缩。AD组相较于MCI组在双侧Sub-Gyral、右侧前扣带回、左侧中央后回白质体积萎缩。结论:基于体素的MRI形态学测量能够客观揭示MCI和AD早期阶段的脑灰质和白质结构萎缩,对于AD的早期诊断和监测MCI向AD的转变提供了很好的依据和方法。     

丁苯酞治疗老年轻度认知功能障碍患者的临床疗效及脑电功能评价

目的探讨丁苯酞治疗老年轻度认知功能障碍(MCI)患者的临床疗效及脑电功能评价。方法选取90例老年MCI患者。随机分为丁苯酞治疗组和对照组,观察2组患者治疗前后简易精神状况检查量表(MMSE)评分及事件相关电位P300的改变,评估临床疗效。结果治疗后治疗组患者与治疗前及对照组比较,MMSE分值提高(P<0.01),P300潜伏期均有缩短、波幅增高(P<0.05)。结论丁苯酞治疗能显著改善老年MCI患者认知功能及脑电活动状态。     

Neuropsychology of cognitive ageing, minimal cognitive impairment, Alzheimer's disease, and vascular cognitive impairment

In this review, the neuropsychological symptoms of different diseases in the elderly are described. After a brief explanation of relevant principles in the neuropsychological assessment of older individuals, a summary of the complex relation between ageing and cognition is presented. It may be concluded that cognitive decline is not an inevitable outcome of ageing, and may well be the result of unrecognised pathology. The term mild cognitive impairment is reserved for patients whose impairment is objectively demonstrable but is not pronounced in more than one domain of cognition and does not seriously affect activities of daily living. The initial phase of Alzheimer's disease is marked by a progressive deterioration of episodic memory. When the process advances, the impairment spreads to other functions, such as semantic memory, language and visuo-spatial ability. Vascular dementia is the second most common type of dementia; however, it is increasingly being recognised that vascular dementia is actually a heterogeneous syndrome and that several vascular pathologies can lead to cognitive deterioration. In contrast to the striking deficits produced by cortical infarcts, lesions of the subcortical white matter are mainly associated with a non-specific slowing of behaviour. Cerebrovascular disease also plays an important role in forms of cognitive decline other than dementia, and as such, it appears to be no less prevalent in old age than Alzheimer's disease. Neuropsychology is an important asset to the study and treatment of cognitive decline, but must be embedded in a multi-disciplinary context.     

认知护理干预对脑梗死轻度认知障碍患者认知功能的影响

目的对认知护理干预对脑梗死轻度认知障碍患者认知功能的影响进行初步研究。方法选取2017年1月～2018年10月我院收治的脑梗死轻度认知障碍患者90例,随机分两组,观察组45例和对照组45例。对照组采取常规治疗和护理,观察组在对照组的基础上给予认知护理干预。通过比较干预后两组患者的MMSE与ADL评分,比较两组的认知功能及精神状态的区别。结果观察组与对照组比较,干预前两组MMSE评分比较,差异无统计学意义(P 0.05),干预后观察组MMSE评分明显高于对照组,差异有统计学意义(P 0.05);观察组与对照组比较,干预前两组ADL评分比较,差异无统计学意义(P 0.05),干预后观察组ADL评分明显低于对照组,差异有统计学意义(P 0.05)。结论认知护理干预对脑梗死轻度认知障碍患者认知功能及精神状态有明显的改善,对于缓解脑梗死患者的认知障碍具有重要的临床参考价值,值得在医院推广应用。     

Non-pharmacological cognitive enhancement

The term "cognitive enhancement" usually characterizes interventions in humans that aim to improve mental functioning beyond what is necessary to sustain or restore good health. While the current bioethical debate mainly concentrates on pharmaceuticals, according to the given characterization, cognitive enhancement also by non-pharmacological means has to be regarded as enhancement proper. Here we summarize empirical data on approaches using nutrition, physical exercise, sleep, meditation, mnemonic strategies, computer training, and brain stimulation for enhancing cognitive capabilities. Several of these non-pharmacological enhancement strategies seem to be more efficacious compared to currently available pharmaceuticals usually coined as cognitive enhancers. While many ethical arguments of the cognitive enhancement debate apply to both pharmacological and non-pharmacological enhancers, some of them appear in new light when considered on the background of non-pharmacological enhancement. This article is part of a Special Issue entitled 'Cognitive Enhancers'.     

Emerging cognitive enhancing drugs

Background: Advances in health sciences during the last century have increased the average age in industrialized nations. Despite this progress, neurodegenerative diseases that affect higher order thinking and memory continue to increase in prevalence as they take a devastating toll on human productivity in the later years. There is an acute need for new drugs and therapeutic approaches for treating these severe diseases, and also for improving the quality of cognitive function associated with normal aging and in many other disorders and syndromes that present with cognitive dysfunction. Objective: The purpose of this review is to ascertain the pharmacological approaches being exploited to improve cognition and memory and to determine the most relevant and effective directions taken for new drug discovery. Limitations and difficulties encountered in this effort also are discussed. Methods: This review focuses primarily on compounds already undergoing clinical trials for improving cognition and memory with some discussion of rising new drug targets. Results/conclusion: Compounds that act on allosteric sites on neurotransmitter receptors are expected to lead the field with new levels of specificity and reduced side effects. New multi-functional compounds can be designed that can both improve cognition and slow the process of disease.     

GMP与思维科学

我国GMP是政府行政法规，思维科学是科学家钱学森创导的“研究思维活动规律和形式的科学”。两者貌似无直接关联，然而在GMP起草、审查、执行和研究过程中都离不开科学的思维。思维科学的植入，将会使我国GMP的修订更趋合理、科学，有助于GMP在我国的深入实施。     

Smoking and cognitive decline

The decline in cognitive functioning over a 7-year period in long-term regular smokers over the age of 50 was compared with that of lifelong non-smokers. The data comes from the Health and Lifestyle Survey, a longitudinal study of a representative sample of adults living in private households in England, Scotland and Wales. Four cognitive tests (memory, reasoning, simple reaction time and choice reaction time) were administered to participants in 1984–1985 and again in 1991–1992. Odds ratios for large falls in the respective scores of smokers relative to non-smokers, adjusted for age, education and lung function, and with or without adjustment for baseline score, were calculated, separately for males and females. There were no significant differences between smokers and non-smokers. For all adult smokers, change scores were not systematically related to time since they last smoked at the times of the tests. At baseline, cognitive scores of non-smokers who became regular smokers did not differ from those of non-smokers who remained non-smokers. Proportionally more regular smokers than non-smokers died in the 3 years following the second survey. © 1997 John Wiley & Sons, Ltd.     

PET network abnormalities and cognitive decline in patients with mild cognitive impairment.

Temporoparietal and posterior cingulate metabolism deficits characterize patients with Alzheimer's disease (AD). A H(2)(15)O resting PET scan covariance pattern, derived by using multivariate techniques, was previously shown to discriminate 17 mild AD patients from 16 healthy controls. This AD covariance pattern revealed hypoperfusion in bilateral inferior parietal lobule and cingulate; and left middle frontal, inferior frontal, precentral, and supramarginal gyri. The AD pattern also revealed hyperperfusion in bilateral insula, lingual gyri, and cuneus; left fusiform and superior occipital gyri; and right parahippocampal gyrus and pulvinar. In an independent sample of 23 outpatients with mild cognitive impairment (MCI) followed at 6-month intervals, the AD pattern score was evaluated as a predictor of cognitive decline. In this MCI sample, an H2(15)O resting PET scan was carried out at baseline. Mean duration of follow-up was 48.8 (SD 15.5) months, during which time six of 23 MCI patients converted to AD. In generalized estimating equations (GEE) analyses, controlling for age, sex, education, and baseline neuropsychological scores, increased AD pattern score was associated with greater decline in each neuropsychological test score over time (Mini Mental State Exam, Selective Reminding Test delayed recall, Animal Naming, WAIS-R digit symbol; Ps<0.01-0.001). In summary, a resting PET covariance pattern previously reported to discriminate AD patients from control subjects was applied prospectively to an independent sample of MCI patients and found to predict cognitive decline. Independent replication in larger samples is needed before clinical application can be considered.