早期帕金森病患者事件相关电位P300研究

目的研究早期帕金森病（PD）患者听觉事件相关电位P300的异常特征，为早期干预PD患者认知功能损害提供实验依据。方法早期PD患者83例（PD组），健康人58例（对照组）。肌电图诱发电位仪测定两组P300波群各成分（N1、P2、N2、P3）潜伏期和波幅、反应时，MMSE评定两组的认知功能。结果PD组N2、P3潜伏期延长（P〈0．05）；P300波群各成分中P3阳性率最高[PD痴呆组为53．3％，PD非痴呆（PD—D）组为29．4％]。结论早期PD患者P300外源性成分P2和内源性成分N2、P3的潜伏期均延长，提示其认知功能异常，还有警觉、选择、注意的障碍。P3潜伏期是识别早期PD伴发痴呆的敏感指标。     

轻度认知障碍老年病人事件相关电位P300和脑电图的研究

目的：探讨轻度认知功能障碍（MCI）老年病人事件相关电位（ERP）P300和脑电图（EEG）的特点,寻求对老年 MCI进行综合评估的有效方法,初步预测 MCI向早期阿尔茨海默病（AD）的转换。方法对35例 MCI病人（MCI组）、28例阿尔茨海默病（AD）病人（AD组）进行 P300、EEG检查,并与30名健康老年人（对照组）作比较。结果 P300显示,与对照组比较,MCI组与 AD组病人 ERP改变表现为 P300潜伏期逐渐异常延长,AD组较 MCI组的变化更为明显。MCI组与 AD组只在 P300潜伏期的顶部（Pz）点差异有统计学意义（P〈0.05）;MCI组与对照组的 P300潜伏期在中央（Cz）点比较差异有统计学意义（P〈0.05）。AD组与对照组比较 P300潜伏期的额部 Fz、Cz、Pz点差异有统计学意义（P〈0.01）,波幅 Cz点的差异有统计学意义（P〈0.01）。EEG显示, MCI组异常率为51.4%（18/35）,AD组为92.9%（26/28）,对照组为33.3%（10/30）,3组间差异有统计学意义（P〈0.01）。结论P300潜伏期 Pz点的改变可能有助于区分 MCI和 AD,EEG中θ波相关功率谱及平均频率增加是 MCI转为 AD的早期预测信号,联合使用 EEG和 P300可能有助于对老年性痴呆病人的综合评估,并可能成为预测 MCI向 AD的转化的有效方法。     

Alzheimer病患者的脑地形图和多项诱发电位变化

目的探讨Ａｌｚｈｅｉｍｅｒ病（ＡＤ）在自发和诱发脑电方面的特征。方法对３９例ＡＤ患者及４０例健康对照者应用ＳＥＥＧ－１６道脑地形图和诱发电位系统完成了脑电图（ＥＥＧ）、脑地形图（ＢＥＡＭ）、视觉和听觉诱发电位（ＶＥＰ和ＡＥＰ）、脑干听觉反应（ＡＢＲ）和Ｐ３００６种检测。结果ＡＤ患者ＥＥＧ异常率８７．５％。ＡＤ患者ＢＥＡＭ特征：δ和θ功率在主要记录点均增高，α功率在额、后颞、枕区降低。ＡＤ患者ＶＥＰ、ＡＥＰ主成分、Ｐ３００非靶潜伏期Ｐ２，以及ＡＥＰ、ＶＥＰ和Ｐ３００的Ｐ２、Ｐ３波幅均减低。另外，ＡＤ患者的ＡＢＲ绝对潜伏期（波Ⅰ）和绝对波幅（波Ⅰ、Ⅲ、Ⅴ和Ⅵ）也延迟或降低，与脑ＣＴ结果一致。结论短和长潜时、认知电位及地形图相结合的方法有可能作为ＡＤ辅助的电生理诊断方法。     

老年认知功能障碍患者的3种事件相关电位研究

目的：探讨老年认知功能障碍患者,包括轻度认知功能障碍（MCI）和阿尔茨海默病（AD）患者的3种事件相关电位P300,失匹配负波（MMN）和关联性负变（CNV）的改变,以了解三者在MCI中的诊断价值。方法2011年2月至2013年3月上海交通大学附属第六人民医院老年病科门诊或住院的患者及健康体检者120位,年龄≥60岁。测量轻度AD患者（AD组,n＝40）、MCI患者（MCI组,n＝40）、认知正常老人（NC组,n＝40）的事件相关电位（ERP,包括P300,MMN,CNVM1,CNVM2）的峰潜伏期（PL）与振幅（Amp）。结果 AD组ERP的PL均长于MCI组（P＜0.05）。MCI组中P300和MMN的PL[（380.94±37.55）,（188.63±31.63）ms]均长于NC组[（342.88±41.72）,（137.48±28.69）ms;P＜0.05],而MCI组中CNVM1及CNVM2的PL与NC组相比,差异无统计学意义（P＞0.05）。AD组与NC组相比,ERP的Amp明显降低（P＜0.05）。MCI组中MMN和CNVM2的Amp与NC组相比降低（P＜0.05）,MCI组与AD组相比,ERP的Amp差异无统计学意义（P＞0.05）。结论 P300,MMN和CNV对MCI的诊断有一定的参考价值,其中P300和MMN区分MCI患者与正常人的敏感性略高于CNV。     

老年糖尿病伴或不伴脑梗死患者P300诱发电位测定的临床意义

目的探讨老年糖尿病伴或不伴脑梗死患者听觉认知电位P300的变化特点及诊断价值.方法采用听觉Cond序列刺激的诱发电位方法对81例老年糖尿病患者(其中35例合并有多发性脑梗死)与30例健康老人进行测试.结果(1)糖尿病组与对照组健康老人比较,前者P300波潜伏期明显延长,P300波波幅显著降低.(2)糖尿病伴脑梗死组与不伴脑梗死组比较,前者P300波潜伏期明显延长,P300波波幅显著降低.(3)糖尿病组伴血管性痴呆亚组(VD)与多发性脑梗死亚组(MI)比较,前者P300波潜伏期更显著延长(P＜0.001),VD组P300潜伏期与简易智能化量表(MMSE)评分呈显著性负相关(P＜0.005).(4)糖尿病伴抑郁组与不伴抑郁组比较,前者P300波潜伏期明显延长,P300波波幅显著降低.结论老年糖尿病患者比正常健康组P300波潜伏期明显延长,P300波幅明显降低,老年糖尿病组中合并脑梗死时P300波改变更为显著.因此P300测试更利于血管性痴呆的早期诊断及疾病严重程度的观察.     

Alzheimer 病的脑诱发电位初步探讨

目的探讨Ａｌｚｈｅｉｍｅｒ病（ＡＤ）脑诱发电位变异及临床应用价值。方法记录３９例ＡＤ患者和４０例健康老年人的脑干听觉反应（ＡＢＲ）、听觉诱发电位（ＡＥＰ）、视觉诱发电位（Ｆ－ＶＥＰ）以及事件相关电位Ｐ３００。结果与健康对照组相比,ＡＤ组的脑诱发电位变异为：（１）波幅下降（ＡＢＲ－Ⅴ,ＡＥＰ－Ｐ２,Ｆ－ＶＥＰ－Ｐ２,靶Ｐ３００－Ｐ２、Ｐ３,非靶Ｐ３００－Ｐ２）;（２）潜伏期延长（ＡＢＲ－Ⅲ,ＡＥＰ－Ｐ１、Ｎ１、Ｐ２）;（３）部分潜伏期提前（靶和非靶Ｐ３００－Ｎ１）。相关分析提示：除靶Ｐ３００－Ｎ１潜伏期外,以上指标均与ＡＤ的认知功能评定（ＣＡＳＩ分）有显著线性相关,部分指标同时又与被试者的教育年限显著相关。Ｋ－Ｍｅａｎｓ聚类分析表明：与ＣＡＳＩ和教育年限皆相关的脑诱发电位指标（ＢＥＰｓ）区分两类被试者的特异性高（１００．０％）而敏感性低（５１．７％）;仅与ＣＡＳＩ评分相关的ＢＥＰｓ指标则敏感性高（９３．６％）而特异性低（５５．６％）。结论ＡＤ患者的脑诱发电位指标变异程度基本上与其认知功能受损程度相平行;根据不同临床应用目的可选择相应的ＢＥＰｓ指标     

社区正常老年人认知功能的随访和预测研究

目的 了解社区正常老年人的认知功能变化特点、转归和预测方法.方法 分别于2000年5月和2004年6月(间隔4年)对杭州市采用分层、分段、随机抽取方法,对158名≥60岁老年人进行调查.采用美国精神障碍诊断和统计手册(第4版)进行诊断,用世界卫生组织老年认知功能评价成套心理测验(WHO-BCAI)进行测查.结果 随访到127例(80.38%);其中有97例(76.4%)正常(NC组),16例(12.6%)为轻度认知功能损害(MCI组),14例(11.0%)为痴呆(痴呆组);60岁以上标准化年发病率MCI为2.46%,痴呆为1.34%.WHO-BCAI测验4年后减分率比较,MCI组与NC组比较在听觉词汇学习测验、语言能力测验、视觉辨认测验、连线测验、注销测验、运动测验和空间结构等项下降明显;痴呆组表现为全面下降.逐步判别分析预测正常认知能力准确率为74.2%、预测MCI准确率为68.8%、预测痴呆准确率为64.3%,预测总准确率为72.4%.结论 正常老年人的记忆老化与老年期MCI患者的认知功能改变是异质的,老年期痴呆的认知功能损害是在MCI基础上发展的全面性损害.年龄、受教育年限、WHO-BCAI测验(命名回忆、词汇流畅2和空间结构)对老年期认知功能改变有预测作用.     

有害气体中毒后迟发性脑病患者事件相关电位MMN、P300变化及其与认知功能的关系

目的 探讨有害气体中毒后迟发性脑病患者事件相关电位失匹配负波（MMN）、P300变化及其与认知功能的关系。方法 选择有害气体中毒后迟发性脑病患者92例（迟发脑病组）、单纯有害气体中毒患者87例（单纯中毒组），入组次日采用脑诱发电位仪检测事件相关电位MMN、P300潜伏期和波幅，采用简易智能精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）评估认知功能。比较两组MMN、P300潜伏期和波幅以及MMSE、MoCA评分；分析有害气体中毒后迟发性脑病患者MMN、P300潜伏期和波幅与MMSE、MoCA评分的关系。结果 迟发脑病组MMN、P300潜伏期均高于单纯中毒组，MMN、P300波幅均低于单纯中毒组（P均<0.05）。迟发脑病组MMSE、MoCA评分均低于单纯中毒组（P均<0.05）。Pearson相关分析显示，迟发脑病组MMN、P300潜伏期与MMSE、MoCA评分均呈负相关关系，而MMN、P300波幅与MMSE、MoCA评分均呈正相关关系（P均<0.05）。结论 有害气体中毒后迟发性脑病患者事件相关电位MMN和P300潜伏期显著延长、波幅显著降低，并且二者...     

腔隙性脑梗死伴脑白质疏松患者的认知功能研究

目的 探讨不同程度的缺血性脑白质病变对腔隙性脑梗死患者认知功能的影响.方法 连续收集腔隙性脑梗死患者112例,采用年龄相关的白质改变分级量表（ARWMCRs）,将患者分为轻度组（34例,0~3分）、中度组（43例,4~7分）和重度组（35例,8～24分）.采用美国国立卫生研究院卒中量表评分（NIHSS）和改良Rankin评分（mRS）评定患者的神经功能缺损程度,采用简易精神状况量表（MMSE）、蒙特利尔认知评估量表（MoCA）进行神经心理学测试,采用事件相关电位二音序列听觉P300（2t-P300）波进行神经电生理学检查,评价认知功能.比较各组间的认知功能.结果 ①3组MoCA评分比较,差异均有统计学意义,仅重度组患者的MMSE评分低于轻度组,差异有统计学意义,P〈0.05.②重度组患者P300波的潜伏期高于中度组和轻度组,中度组的潜伏期高于轻度组,差异有统计学意义,P〈0.05;重度组患者P300波的波幅低于中度组和轻度组,差异有统计学意义,P〈0.05.③缺血性脑白质病变患者的ARWMCRs评分与MMSE、MoCA评分、P300波的波幅呈负相关,与P300波的潜伏期和mRS评分呈正相关.结论 脑白质病变影响腔隙性脑梗死患者的认知功能.脑白质病变程度越重,认知功能下降越显著.     

老年慢性精神分裂症患者听觉脑干反应改变的意义

目的了解老年漫性精神分裂症（SCS）患者与正常老人在听觉脑干反应（ABR）检测中的不同表现。方法应用丹麦电生理仪和Click短声刺激，对40例正常老人和34例SCS患者的ABR作了检查。结果26．5％SCS患者波形带有切迹．ABR诸指标在Fz、Cz和Pz3个记录点上无差异（P＞0．05）。在中央区，SCS患者ABR绝对潜伏期波Ⅶ右侧长于左侧，绝对波幅波Ⅵ左侧低于右侧（P＜0．05）。与正常老人相比，SCS患者ABR绝对波幅波Ⅰ降低（P＜0．05）。结论本组SCS患者ABR异常在听神经区域，值得进一步随访．     

轻度认知障碍与非痴呆型血管性认知功能障碍患者屏气指数的研究

目的评价轻度认知障碍（McI）患者与非痴呆型血管性认知功能障碍（VICND）患者的屏气指数（BHI）与认知功能的关系。方法 150例受试者分为正常对照组、MCI组及VICND组,应用经颅多普勒（TCD）屏气试验计算BHI,并应用蒙特利尔认知评估量表（MoCA）进行认知功能评分,分析BHI与认知功能的关系。结果MCI组和VCIND组高血压、高血糖、高血脂的患病率均显著高于对照组（P〈0．05）,MCI组与VCIND组间比较无显著差异。MCI组和VCIND组BHI,分别为（0．90±0．16）％／s、（0．87±0．19）％／s,均明显低于对照组的（1．37±0．22）％／s。MoCA评分与BHI呈正相关（r=0．803,P〈0．01）结论高血压、糖尿病及高血脂可能与MCI患者及VCIND患者的认知功能下降有关,BHI与认知功能具有一定的相关性。     

部队老年人轻度认知损害的发生及向Alzheimer病的转化情况

目的调查部队老年人轻度认知损害（MCI）的发病率及向Alzheimer病（AD）的转化率，为进一步研究AD提供依据。方法以2001年石家庄市26个部队休干所MCI患病率调查的2674名60岁及以上的离退休干部为研究对象，对患病率调查时诊断为MCI的216例患者和2302名认知正常受试者进行为期3年的队列研究，比较MCI患者和认知正常受试者AD的平均年发病率。结果认知正常的老年人MCI的发病率为4．8％（人年），AD的平均年发病率为0．8％（人年）；MCI患者AD的平均年发病率为5．6％（人年）；男性和女性MCI患者AD的平均年发病率差别无统计学意义（P〉0．05）；随着文化程度的提高，MCI患者AD的平均年发病率有降低的趋势（P〈0．05）；而随着年龄的增长，MCI患者AD的平均年发病率有增高的趋势（P〈0．01）。MCI转化为AD的相对危险性为认知正常者的7．4倍。结论军队老年MCI患者转化为AD的危险性远远大于认知正常的老年人，应加强对老年MCI患者这一AD高危人群的监测。     

Characteristic Profiles of Activities of Daily Living and Relationship with Cognitive Performance in Thai Elderly with Different Stages from Normal Cognitive Function,Mild Cognitive Impairment to Dementia

ABSTRACT

Objective: The objectives were twofold—first, to evaluate the functional difference among normal cognitive elderly, mild cognitive impairment (MCI), and people with dementia; and second, to investigate the relationship between cognitive performance and functional abilities. Method: The Disability Assessment for Dementia (DAD) was administered to 90 participants: 20 normal controls (NC), 20 with MCI, 25 with mild dementia, 15 with moderate dementia and 10 with severe dementia patients. Results: The mean (SD) scores on instrumental activities of daily living (IADL) were 94.8 (6.4) for NC, 89.1 (9.9) for MCI, 33.6 (21.7) for mild dementia, 13 (12.2) for moderate dementia and 1.7 (4.2) for severe dementia. MCI participants presented slightly noticeable deficit in one IADL domain: ‘finance and correspondence’, whereas mild dementia presented deficit in all six IADL domains. Scores of basic activities of daily living (BADL) of the NC and MCI groups were equal at a perfect 100. The scores were slightly reduced in mild dementia patients (92.7 [12.3]) and were decreased in moderate (68.6 [26.4]) and severe dementia participants (10 [14.4]). Conclusions: Our studies demonstrated that IADL can be subtly impaired in people with MCI, but markedly impaired in those with mild dementia. BADL begin to decline in moderate dementia and then reach a level of severe impairment in severe dementia.     

Comparison of the quick mild cognitive impairment (Qmci) screen and the SMMSE in screening for mild cognitive impairment

Introduction: differentiating mild cognitive impairment (MCI) from normal cognition (NC) is difficult. The AB Cognitive Screen (ABCS) 135, sensitive in differentiating MCI from dementia, was modified to improve sensitivity and specificity, producing the quick mild cognitive impairment (Qmci) screen. Objective: this study compared the sensitivity and specificity of the Qmci with the Standardised MMSE and ABCS 135, to differentiate NC, MCI and dementia. Methods: weightings and subtests of the ABCS 135 were changed and a new section 'logical memory' added, creating the Qmci. From four memory clinics in Ontario, Canada, 335 subjects (154 with MCI, 181 with dementia) were recruited and underwent comprehensive assessment. Caregivers, attending with the subjects, without cognitive symptoms, were recruited as controls (n?=?630). Results: the Qmci was more sensitive than the SMMSE and ABCS 135, in differentiating MCI from NC, with an area under the curve (AUC) of 0.86 compared with 0.67 and 0.83, respectively, and in differentiating MCI from mild dementia, AUC of 0.92 versus 0.91 and 0.91. The ability of the Qmci to identify MCI was better for those over 75 years. Conclusion: the Qmci is more sensitive than the SMMSE in differentiating MCI and NC, making it a useful test, for MCI in clinical practice, especially for older adults.     

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)...     

Diagnostic Accuracy of the Chinese Version of the Trail‐Making Test for Screening Cognitive Impairment

Background/Objectives

The Trail‐Making Test (TMT), which is commonly used to measure executive function, consists of two components (TMT‐A and TMTB). There is a lack of normative TMT data for Chinese elderly adults. This study aimed to evaluate the validity of the TMT in screening for cognitive impairment.

Design

2,294 Chinese‐speaking adults aged 50 to 85: 1,026 with normal cognition (NC), 462 with mild cognitive impairment (MCI), 108 with Alzheimer's disease (AD), 113 with vascular mild cognitive impairment (VaMCI), 121 with vascular dementia (VaD), 282 with uncertain types of dementia, and 15 with mixed dementia. Receiver operating characteristic curve analysis was performed to test the ability of TMT scores to differentiate between NC and cognitive impairment.

Results

Age, education, and sex were significantly associated with TMT completion time. The TMT‐A exhibited sensitivity of 77.8% and specificity of 92.0% with cut‐off value of 98.5 seconds for discriminating AD from NC. The TMT‐B had sensitivity of 83.3% and specificity of 91.8% with a cut‐off value of 188.5 seconds for discriminating AD from NC. The TMT‐A had sensitivity of 85.7% and specificity of 81.6% for discriminating NC from VaD with a cut‐off value of 77.5 seconds, and the TMT‐s had sensitivity of 81.6% and specificity of 83.9% with a cut‐off value of 147.5 seconds. The TMT had less sensitivity distinguishing MCI from NC.

Conclusion

The Chinese version of the TMT is reliable for detecting AD or VaD but poor at distinguishing MCI from NC.     

颈动脉斑块与老年广泛性脑萎缩并发认知功能障碍的相关性研究

目的探讨颈动脉斑块与老年广泛性脑萎缩并发认知功能障碍的相关性。方法选择连云港市第二人民医院就诊或体检发现的中、重度广泛性脑萎缩的老年患者45例,按认知功能分为:正常组15例、轻度认知功能损害(MCI)组15例和阿尔茨海默病(AD)组15例。所有受试者均接受颈动脉斑块检测,并分析颈动脉斑块与简易智能状态检查量表(MMSE)评分的关系。结果与正常组比较,AD组和MCI组颈动脉内膜中层厚度[(IMT)(2.37±0.28)mm和(2.35±0.13)mmvs(1.76±0.09)mm]及高回声斑块[(17.71±2.30)mm2和(18.96±2.12)mm2 vs(14.25±2.29)mm2]明显增加(P<0.05),MMSE评分[(5.80±3.53)分和(17.40±3.92)分vs(25.73±3.08)分]明显降低(P<0.05);与MCI组比较,AD组MMSE评分明显降低(P<0.05)。3组低回声及混合回声斑块平均面积差异无统计学意义(P>0.05)。线性回归分析显示,IMT与MMSE评分呈负相关(P=0.000)。结论脑萎缩伴IMT或高回声斑块平均面积增多的患者易发生认知功能损害,IMT越高认知功能越低;颈部超声检查可视为老年脑萎缩患者并发认知功能损害的随访指标之一。     

Mild cognitive impairment: epidemiology and dementia risk in an elderly Italian population

OBJECTIVES: To investigate prevalence and incidence of mild cognitive impairment (MCI) and its risk of progression to dementia in an elderly Italian population.
DESIGN: Longitudinal.
SETTING: Population-based cohort aged 65 and older resident in an Italian municipality.
PARTICIPANTS: A total of 1,016 subjects underwent baseline evaluation in 1999/2000. In 2003/04, information about cognitive outcome was collected for 745 participants who were free of dementia at baseline.
MEASUREMENTS: MCI (classified as with or without impairment of the memory domain), dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) diagnosed according to current international criteria.
RESULTS: Overall prevalence of MCI was 7.7% (95% confidence interval (CI)=6.1–9.7 %) and was greater with older age and poor education. During 4 years of follow-up, 155 incident MCI cases were diagnosed, with an incidence rate of 76.8 (95% CI=66.8–88.4) per 1,000 person-years. Approximately half of prevalent and incident MCI cases had memory impairment. Compared with normal cognition, multivariable-adjusted risk for progression from MCI with memory impairment to dementia was 4.78 (95% CI=2.78–8.07) for any dementia, 5.92 (95% CI=3.20–10.91) for AD, and 1.61 (95% CI=0.37–7.00) for VaD. No association with dementia risk was found for MCI without memory impairment. Approximately one-third of MCI cases with memory impairment did not progress to dementia.
CONCLUSION: MCI occurs often in this elderly Italian cohort and is associated with greater risk of AD, but only when the impairment involves the memory domain. However, a substantial proportion of MCI cases with memory impairment do not progress to dementia.     

The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment

OBJECTIVES: To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. DESIGN: Validation study. SETTING: A community clinic and an academic center. PARTICIPANTS: Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). MEASUREMENTS: The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. RESULTS: Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). CONCLUSION: MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.