脑卒中患者认知障碍研究进展*

脑卒中是神经系统常见病和多发病,不仅引起偏瘫和各种神经定位症状和体征,而且还可以导致记忆障碍、失语、失认、失用、视觉空间障碍等认知功能障碍,甚至发生痴呆~([1]).认知障碍与偏瘫等症状一样,对脑卒中患者的预后都有重要影响.本文就脑卒中患者认知障碍的发生情况、发生机制、危险因素和防治作一综述.     

小血管性轻度认知障碍的研究进展

轻度认知障碍（mild cognitive impairment,MCI）是指患者有记忆或认知损害,但对日常能力无明显影响,未达到痴呆的程度,是介于正常衰老和痴呆之间的中间状态的一组临床综合征.最近关于轻度认知障碍发病率的文章提到[1],轻度认知障碍的发病率为每年51‰～77‰.同时还发现轻度认知障碍是痴呆的高危人群,发展成痴呆的危险性是正常老人的10陪,部分患者是痴呆的前期阶段.轻度认知障碍根据病因或转归可分为阿尔茨海默病源性轻度认知障碍也可称为遗忘型轻度认知障碍（amnestic mild cognitive impairment,aMCI）、小血管性轻度认知障碍（small vessel mild cognitive impairment,svMCI）和其他类型的认知障碍.而其中svMCI有可能发展为血管性痴呆（vascular dementia,VaD）.     

血管性认知功能障碍中医药研究进展

血管性认知功能障碍是指由血管因素导致的认知功能损害,可单独发生或与Alzheimer病(AD)伴发.对血管性疾病所致认知障碍患者的早期预防和治疗具有重大的社会和经济意义.西医目前尚没有有效的手段进行干预,而中医药在防治血管性认知功能障碍方面则凸显优势.该文从血管性认知功能障碍的病名研究、病因病机、药物治疗、针灸治疗等多方面进行了综述.     

植物雌激素对去卵巢血管性痴呆大鼠认知功能和海马胆碱乙酰转移酶表达的影响

目的:观察植物雌激素对去卵巢血管性痴呆(VD)大鼠海马胆碱能神经元表达的影响,探讨植物雌激素对去卵巢VD大鼠的脑保护作用及可能机制。方法:60只雌性Wistar大鼠经水迷宫筛选随机分为4组。Ⅰ组(sham组):VD大鼠,未去除卵巢;Ⅱ组(OVX组):VD大鼠,去除卵巢;Ⅲ组(OVX+est组):VD大鼠,去除卵巢,给予化学雌激素喂养;Ⅳ组(OVX+phy组):去除卵巢,给予植物雌激素喂养。4组大鼠VD手术前后分别应用Morris水迷宫检测法进行大鼠空间认知功能的评价。采用胆碱乙酰转移酶(ChAT)免疫组织化学ABC法,观察去卵巢VD大鼠各组海马胆碱能神经元的数目。结果:与OVX组相比,OVX+est组及OVX+phy组的大鼠海马胆碱能神经元数目明显升高(P<0.05),且在水迷宫中找到水下平台的时间、距离明显缩短(P<0.05),而与sham对照组差别不明显,且OVX+est组和OVX+phy组相比较,无显著性差异(P>0.05)。结论:植物雌激素具有雌激素样作用,能增强大鼠海马胆碱能神经元的ChAT表达,对血管性痴呆大鼠的记忆损害有一定程度的保护作用。     

轻度认知功能障碍及其危险因素的研究进展

随着人口老龄化进程,与年龄相关的老年认知功能障碍,特别是痴呆的发病率逐年增加。痴呆不仅严重影响老年人的生存质量,而且给家庭和社会带来沉重的负担。     

济南市社区老年人轻度认知功能障碍的调查

[目的]调查济南市社区老年人群轻度认知功能障碍(MCI)患病情况,分析患病的相关因素。[方法]采用入户调查的方式,抽样调查了济南市社区≥60岁老年人1 226人。调查由经过培训的调查员和社区医师进行,对有主诉或家属诉其有明显记忆障碍者及认知功能量表(MMSE)得分低于界值者进行病史收集、临床体格检查并作出诊断。[结果]社区老年人有MCI 115人,占9.4%。MCI患病情况在低教育水平的老年人群中增加,并且随着年龄增长,患病率增高。[结论]高龄、低教育水平的老年人是MCI的高发人群。     

血管性认知障碍的血液生物标志物研究进展

血管性认知障碍(VCI)涵盖血管性轻度认知障碍(VCIND)到血管性痴呆(VaD),在一定程度上具有可干预性,筛查VCI相关的生物标志物可为VCI的早期防治提供新的依据,本文对近年来的VCI血液标志物研究进展进行简要综述。     

老年轻度认知障碍患者睡眠障碍与认知功能的关系

目的 探讨老年轻度认知障碍(mild cognitive impairment,MCI)患者的睡眠障碍(sleep disorders, SD)情况及其与认知功能的关系。方法 纳入2018年11月至2019年1月在四川省南充市某社区筛查的MCI患者171例。采用匹兹堡睡眠指数量表(Pittsburgh sleep quality index, PSQI)评估患者的总体睡眠状况,根据评分结果,将入组患者分为MCI伴SD组(MCI-SD组)和MCI不伴SD组(MCI-NSD组)。采用蒙特利尔认知评估量表基础版(montreal cognitive assessment-basic, MoCA-B)、简明精神状态量表(mini-mental status examination, MMSE)、听觉词汇学习测验(auditory verbal learning test, AVLT)、波士顿命名测试(Boston naming test, BNT)、动物语言流畅性(animal verbal fluency test, AFT)、形状连线测试(trail making test,TMT)评估M...     

影响脑梗死患者从认知障碍转化为痴呆的血管性因素分析

目的:对影响脑梗死患者从认知障碍转化为痴呆的血管性因素进行分析。方法:对186例脑梗死患者进行6~24月的随访调查,根据血管性痴呆(VD)的诊断标准将患者分为VD组(42例)和非痴呆性血管性认知功能障碍组(VCIND)组(144例)。运用Cox回归模型对影响VCIND发展为VD的因素进行分析。结果:年龄、脑白质稀疏和丘脑、额区、基底核区的梗死灶数量均是促使VCIND患者发展为VD患者的危险因素(P=0.027,P0.001,P=0.046,P0.001,P=0.011)。脑白质稀疏评分和丘脑、额区、基底核区梗死灶的数量是相互独立的影响因素(P0.001,P=0.032,P=0.001,P=0.016)。结论:丘脑、额区、基底核区梗死灶数量及其部位分布特点对预测VCIND患者发展为VD患者的风险有重要意义。     

ASL技术基本原理及在血管性认知障碍中的研究进展

血管性认知障碍(vascular cognitive impairment,VCI)是从轻度认知功能障碍到痴呆的一组综合征。动脉自旋标记(arterial spin labeling,ASL)作为一种功能性磁共振成像(functional MRI,fMRI)技术,通过特定脉冲标记动脉血中的氢质子,在不依赖血脑屏障的情况下,能真实反映各个阶段VCI患者脑血流量(cerebral blood flow,CBF),具有良好时间分辨率,已成为诊断和随访VCI的重要影像学手段。作者就ASL技术基本原理及近年来在VCI中的研究进展进行综述。     

Mild Cognitive Impairment

Ohne Zusammenfassung

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Mild Cognitive Impairment and Mild Dementia: A Clinical Perspective

Mild cognitive impairment and mild dementia are common problems in the elderly. Primary care physicians are the first point of contact for most patients with these disorders and should be familiar with their diagnosis, prognosis, and management. Both mild cognitive impairment and mild dementia are characterized by objective evidence of cognitive impairment. The main distinctions between mild cognitive impairment and mild dementia are that in the latter, more than one cognitive domain is invariably involved and substantial interference with daily life is evident. The diagnosis of mild cognitive impairment and mild dementia is based mainly on the history and cognitive examination. The prognosis for mild cognitive impairment and mild dementia is an important motivation for diagnosis because in both, there is a heightened risk for further cognitive decline. The etiology of mild cognitive impairment and mild dementia can often be established through the clinical examination, although imaging and other laboratory tests may also contribute. Although Alzheimer disease is the most common cause of both, cerebrovascular disease and Lewy body disease make important contributions. Pharmacological treatments are of modest value in mild dementia due to Alzheimer disease, and there are no approved pharmacological treatments for mild cognitive impairment of any etiology. Nonetheless, new-onset cognitive impairment is a worrisome symptom to patients and families that demands answers and advice. If a patient is having difficulties managing medications, finances, or transportation independently, diagnosis and intervention are necessary to ensure the health and safety of the patient.     

脑白质疏松对轻度认知功能损害患者预后的影响

目的:探讨脑白质疏松(LA)对轻度认知功能损害(MCI)患者进展为痴呆的影响。方法:采用国际通用标准从门诊和住院患者中筛选MCI患者。通过MRI和CT扫描,确定这些患者是否存在LA。对MCI患者进行随访,用Kaplan-Meier生存分析法评定LA对MCI进展为痴呆的影响。结果:经临床和神经心理学评估,共有74例MCI患者入组。其中33例(44.6%)经影像学诊断为伴有LA,41例(55.4%)不伴LA。经6～24(13.2±6.8)个月随访,伴LA的患者有15例(45.5%)进展为痴呆,不伴LA的患者有9例(22.0%)进展为痴呆。随访期内伴有LA的MCI患者进展为痴呆的比例显著高于不伴LA的患者(P<0.05)。结论:伴有LA的MCI患者更容易进展为痴呆。这类MCI患者必须及早进行干预,去除可控危险因素,预防痴呆发生。     

Evidence-based Evaluation of Cholinesterase Inhibitors for Mild Cognitive Impairment

The purpose of this article is to critically appraise the evidence concerning the use of cholinesterase inhibitors compared to no treatment to prevent the progression from mild cognitive impairment (MCI) to Alzheimer disease. The objective was addressed through the development of a structured, critically appraised topic (CAT). This evidence-based methodology incorporated a clinical scenario, background information, structured question, literature search strategy, results, critical appraisal, commentary, and clinical bottom line.     

Deep Fusion of Brain Structure-Function in Mild Cognitive Impairment

Multimodal fusion of different types of neural image data provides an irreplaceable opportunity to take advantages of complementary cross-modal information that may only partially be contained in single modality. To jointly analyze multimodal data, deep neural networks can be especially useful because many studies have suggested that deep learning strategy is very efficient to reveal complex and non-linear relations buried in the data. However, most deep models, e.g., convolutional neural network and its numerous extensions, can only operate on regular Euclidean data like voxels in 3D MRI. The interrelated and hidden structures that beyond the grid neighbors, such as brain connectivity, may be overlooked. Moreover, how to effectively incorporate neuroscience knowledge into multimodal data fusion with a single deep framework is understudied. In this work, we developed a graph-based deep neural network to simultaneously model brain structure and function in Mild Cognitive Impairment (MCI): the topology of the graph is initialized using structural network (from diffusion MRI) and iteratively updated by incorporating functional information (from functional MRI) to maximize the capability of differentiating MCI patients from elderly normal controls. This resulted in a new connectome by exploring “deep relations” between brain structure and function in MCI patients and we named it as Deep Brain Connectome. Though deep brain connectome is learned individually, it shows consistent patterns of alteration comparing to structural network at group level. With deep brain connectome, our developed deep model can achieve 92.7% classification accuracy on ADNI dataset.     

The Effects of Self-Care Intervention Programs for Elderly with Mild Cognitive Impairment

This study examined the effects of a self-care intervention program on self-efficacy, dementia-preventive behavior, cognitive function, depression, and quality of life in elderly with mild cognitive impairment. The study employed a quasi-experimental study design using a nonequivalent control group pre-post. Data were analyzed using the chi-square test, independent t-test, and repeated-measures ANOVA. The results of the study showed that the program reduced dementia risk and strengthened self-care ability in older adults with MCI.     

轻度认知障碍患者的社区职业治疗

目的探讨社区职业治疗对轻度认知损害(MCI)患者的治疗作用。方法对南昌市某社区418例60岁以上老人进行认知筛查,有34例诊断为MCI。将这34例患者按随机数字表法分为2组,治疗组和对照组,每组17例。治疗组在治疗师指导下进行社区职业治疗;对照组则不做任何干预。治疗组每次治疗时间30~40 min,每周进行2次,连续进行6个月。治疗前后分别用简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MOCA)和日常生活活动能力量表(ADL)进行认知功能检查和状态评定,评价干预治疗效果。结果 6个月后,治疗组治疗前后MMSE评分差异无统计学意义(P>0.05),但显著高于对照组治疗后(P<0.05),治疗组治疗后MOCA,ADL评分显著优于治疗组治疗前及对照组治疗后(P<0.05或P<0.01);对照组MMSE,MOCA评分显著低于治疗前,而ADL评分高于治疗前(均P<0.01)。结论轻度认知损害患者的认知水平可能随时间的推移而呈下降趋势,社区职业治疗可以延缓老年轻度认知损害的进程。     

团体认知干预对社区MCI老人认知功能的影响

目的：探讨团体认知干预对社区轻度认知功能障碍（MCI）老人认知功能的影响。方法：将80例MCI老人随机分为干预组和对照组,干预组进行团体认知干预,每天60min,持续6个月,对照组不作任何干预。用蒙特利尔认知评估量表（MoCA）、简易精神状态量表（MMSE）、日常生活活动能力量表（ADL）评价干预效果。结果：干预后,干预组MoCA、MMSE评分高于干预前及对照组,ADL评分低于干预前及对照组（P〈0.05）;干预后,干预组MoCA量表分项目中记忆力、注意力、视空间执行能力方面的分值高于对照组（P〈0.05）。结论：团体认知干预可以改善社区MCI老人的认知功能状况。     

脑卒中轻度认知功能障碍的神经心理及神经影像学特点

【目的】探讨脑卒中轻度认知功能障碍（MCI）的神经心理及神经影像学特点。[方法]328例脑卒中患者,符合2005年中国防治认知功能障碍专家提出的标准者193例,从中筛检出31例脑卒中后合并MCl的患者;采用蒙特利尔认知量表对其评估。根据头颅CT或MRI确定病灶部位,并结合临床资料,分析脑卒中MCI的神经心理特点及影像学改变。【结果】193例脑卒中患者,MCI为31例,发生率16．06％。MCI患者临床表现为计算力下降,注意力受损,并以延迟记忆障碍和空间执行能力损害尤为明显,MCI与脑卒中的部位有关系。【结论】脑卒中患者MCI存在较高的发病率,且与病灶部位有一定的关系,脑叶卒中病灶更易引起MCI。     

轻度认知功能障碍患者的神经心理学特点初步探讨

目的 通过比较遗忘型轻度认知障碍(amnestic mild cognitive impairment,aMCI)和血管性认知障碍非痴呆型(vascular cognitive impairment-no dementia,VCFND)患者及正常老年人群在简易智能精神状态检查量表(mini mental state e...