唐山市社区老年轻度认知障碍患者的调查分析

目的 了解唐山市老年轻度认知障碍（MCI）患者发病率并分析其影响因素.方法 采用简短认知筛查量表、日常生活能力量表（ADL）等对2532例社区老人进行MCI的筛查和医学诊断,筛选确诊了200例患者,对其状况进行调查.并进一步探讨其影响因素.结果 老年MCI患者的发病率为12.7％,男性患病率为5.67％,女性患病率10.75％,男女患病率有明显性别差异（x2=8.3,P＜0.01）;各年龄段患病率有明显差异（x2 =29.53,P＜0.01）;不同文明水平患病率有明显差异（x2=13.52,P＜0.01）;分居者MCI发病率为22.2％;与配偶住在一起发病率为5.65％;未与配偶住在一起者发病率为23.5％,三者之间有明显差异（x2=9.56,P＜0.01）;饮酒与不饮酒及不同饮酒量之间的发病率无明显差异（x2=5.59,P＞0.05）;常参加体育锻炼者发病率为6.04％,偶尔或无规律体育锻炼者发病率为9.34％,没有体育锻炼者发病率为12.4％,3组之间有明显差异（x2=10.77,P＜0.01）;睡眠时间的影响显然导致MCI的发病率高（x2=9.36,P＜0.01）.结论 认知功能、性别、年龄、文化程度、日常活动能力和婚姻状况是MCI患病的重要影响因素.     

北京市老年人抑郁症状的调查

目的:分析北京市老年人抑郁症状的现状和影响因素.方法:在2000年对一个流行病学队列研究人群的55岁以上初老年和老年人的样本2660例,采用自评量表CES-D评定抑郁症状的有无,并和人口学因素(年龄、性别、地区)、慢性病患病情况及日常生活自理能力进行对比分析.结果:不同年龄组抑郁症状的检出率无明显差别(P>0.05).分层分析显示,女性(17.4%)和农村老年人(20.9%)抑郁症状的检出率高于男性(9.6%,χ2=34.6,P<0.01)和城市居民(7.4%,χ2=102.5,P<0.01).抑郁症状与日常生活能力(ADL)(χ2=96,P<0.01)、慢性病患病情况(χ2=39,P<0.01)密切相关.结论:女性、居住于山区、低教育水平并患有慢性病及日常生活能力差的老年人更易出现抑郁情绪.     

体外受精-胚胎移植妇女的焦虑、抑郁情绪

目的:了解体外受精-胚胎移植(IVF-ET)妇女的焦虑、抑郁情绪及相关因素。方法:2009年4月-2010年3月,在湖南省妇幼保健院生殖中心选取来自全国各地符合本研究筛选标准的妇女连续入组,共入组IVF-ET妇女538例,采取现场询问的方式,在胚胎移植术后2小时内进行问卷调查,内容包括社会人口学特征、生育情况、治疗情况、社会心理因素及情绪症状的评定。结果:焦虑评分(39.6±3.1)分,焦虑症状检出率38.5%;抑郁评分(35.8±4.5)分,抑郁症状检出率12.3%。居住在城市(OR=1.66)、不孕年限长(OR=1.34)、夫妻交流少(OR=2.25)、积极应对评分低(OR=4.30)、生理健康(OR=3.24)评分低、心理健康(OR=5.36)评分低的IVF-ET妇女焦虑倾向危险比高;既往治疗费用多(OR=3.02),取卵个数少(OR=2.24)及性生活(OR=1.13)、积极应对(OR=6.08)评分低,应激性生活事件评分高(OR=1.83)的IVF-ET妇女抑郁倾向危险比高。结论:体外受精-胚胎移植妇女存在不同程度的焦虑、抑郁情绪,社会心理变量是其主要相关因素。     

初一学生抑郁情绪影响因素调查

目的:探讨初一学生抑郁症状及与之相关的心理和环境因素。方法:用自陈问卷调查300名样本的抑郁症状及自尊、生活事件、社会支持、家庭亲密度和矛盾性,分析这些因素与抑郁症状之间以及生活事件各因子与自尊之间的相关性。结果:抑郁症状发生率为11%;逐步回归分析发现,自尊、社会支持与抑郁症状负相关(标化回归系数分别为-0·59和-0·14),生活事件与之正相关(标化回归系数0·26);在生活事件6个因子中,学习压力及相关因子与自尊负相关(标化回归系数分别为-0·14和-0·13)。结论:抑郁症状在初一学生中相当常见;自尊水平低下、缺乏社会支持以及不良生活事件的影响与抑郁症状的发生有关;在各种生活事件中,来自学习过程的压力和挫败对自尊的影响最为突出。     

综合医院内科住院病人抑郁状况调查

综合医院内科住院病人的抑郁情绪引起了包括精神科在内的临床各科医师的关注 ,因此本调查用抑郁自评量表 (SDS) [1] 对 2 5 2例内科住院病人进行评定 ,以了解抑郁情绪在内科住院病人中的发生率及其相关因素。1　研究对象与方法1.1　研究对象2 5 2例患者均为马鞍山钢铁公司总医院的内科住院病人 ,排除既往有功能性精神病和器质性疾病引起的抑郁障碍患者。男性 134例 ,女性 118例 ;年龄范围 16～ 83岁 ,平均 5 1.32± 16 .17岁 ,文化程度 :文盲 2 5例 ,小学 4 6例 ,中学 (含初中、高中和中专 )98例 ,大学 (大专以上 ) 83例。1.2　研究方法1.…     

乳腺癌患者术后应对方式及焦虑抑郁情绪调查

我国妇女乳腺癌的患病率占全身恶性肿瘤的7%~10%,并有逐渐上升的趋势[1].国内研究显示,乳腺癌患者普遍存在疾病不确定感与焦虑、抑郁,术后患者中有87.3%疾病不确定感处于中等水平,焦虑、抑郁发生率分别为84.1%与89.5%,且焦虑、抑郁与疾病不确定感呈正相关[2].     

老年人抑郁症状与情绪调节策略的横断面研究

目的:考察老年人抑郁症状与情绪调节策略的关系及老年人抑郁症状的相关因素,为老年人抑郁症状的干预提供理论指导。方法:选取北京市某社区60~80岁老年人335名,用流调中心用抑郁量表(CES-D,得分≥16分为"有抑郁症状")来评估老年人抑郁症状,用Gross情绪调节问卷(ERQ,包括认知重评和表达抑制两个分量表)来评估老年人认知重评和表达抑制策略的使用情况,用沉思量表(RRS)来测量老年人沉思策略的使用情况,并用logistic回归分析方法对老年人抑郁症状的相关因素进行分析。结果:有抑郁症状的老年人的比例为19.9%(61/306)。CES-D总分与ERQ的认知重评得分呈负相关(r=-0.21,P<0.01),与ERQ的表达抑制得分的相关无统计学意义(r=0.08,P>0.05),与RRS总分呈正相关(r=0.58,P<0.01)。Logistic回归分析表明,男性(OR=0.42,P<0.05)、健康状况好(OR=0.29,P<0.001)、生活方式好(OR=0.09,P<0.01)、经济状况好(OR=0.05~0.23,P<0.01)和ERQ认知重评得分较高(OR=0.93,P<0.05)的老年人,CES-D得分较低;而高龄(OR=1.04,P<0.05)和RRS总分较高(OR=1.19,P<0.01)的老年人,CES-D得分较高。结论:女性、高龄、经济状况差、健康水平低、无子女或子女在外地或国外、越多使用沉思策略和越少使用认知重评策略的老年人,越可能出现抑郁症状。     

安徽省农村老年人抑郁的现况调查

老年人抑郁症状严重危害老年人的心身健康,影响老年人的生活质量[1]。本研究探讨安徽农村老年人抑郁症状及相关因素。1对象与方法1.1对象2009年12月-2010年3月,在安徽省16个地市41个县,每个县随机选取2个乡镇,每个乡镇随机选取2~3个自然村,调查10~15户老年人家庭(入选条件为家庭内有至少1名60岁以上老人,且有子女健在),每个家庭调查1名60岁以上老人,共调查了992户家庭,其中有17户家庭老     

综合医院老年和成年住院患者精神科会诊的特点比较

目的: 探讨综合医院老年住院患者精神科会诊的特点.方法: 对一年内本院记录在案的所有精神科会诊的292例老年患者(年龄≥65岁)的人口学资料、会诊科室和原因、主要躯体疾病、精神障碍的诊断、会诊原因和精神科诊断之间的一致性进行分析,并与232例成年患者(18-64岁)进行比较.结果: 老年患者会诊的性别比例相当(男性50%,女性50%),会诊时精神障碍的病程≤1周占30.2%,并多于成年组(21.7%,P＜0.05);老年患者会诊的主要科室依次为内科、外科、急诊科和重症监护病房;会诊的主要原因为精神病发作(36.1%)、行为紊乱(14.4%)、抑郁障碍(14.4%)和焦虑障碍(10.3%);多系统疾病(27.0%)和循环系统疾病(17.1%)是导致人院的主要躯体疾病.谵妄(24.5%)、抑郁障碍(21.6%)和焦虑障碍(11.5%)是老年患者主要的精神障碍诊断.老年患者谵妄、痴呆的比例高于成年组(老年组分别为24.5%和14.9%,成年组分别为11.1%和1.8%,P＜0.01),而精神分裂症和其他精神病性障碍、物质相关的障碍的比例低于成年组(老年组分别为6.5%和2.2%,成年组分别为15.1%和6.7%,P＜0.05).结论: 谵妄、抑郁障碍和焦虑障碍是综合医院老年住院患者主要的精神障碍,提示有必要加强联络会诊培训中对这些障碍的正确识别和处理.     

老年人轻度认知障碍部分定向相干脑网络分析

近年的研究表明,轻度认知障碍(MCI)患者的认知加工呈现脑连通性缺失特征,但各脑区间如何影响,因果特性不明。本研究的目的在于分析MCI患者在认知任务下的有向脑网络特征。采集了30位老人在信息冲突颜色认知作业下的头皮脑电,包括21位正常人和9位MCI患者。选取刺激呈现后的脑电计算其部分定向相干值,依此构建脑网络,并着重分析了不同脑区的入度差异。研究发现：在beta段,MCI患者右前额区信息流入缺失,左中央区的信息流入异常增强;在患者组和正常组中前脑区的入度要远高于后脑区;正常人在匹配和不匹配刺激下右脑区的入度要高于左脑区;但是在患者组中左右脑区的入度却没有明显差别。在特定阈值下：正常人在匹配刺激下左脑区（阈值0.14）的入度要低于MCI患者（F=3.780,P=0.040）;正常人在不匹配刺激下左脑区（阈值0.26）的入度要低于MCI患者（F=3.780,P=0.040）;正常人在匹配刺激下右脑区（阈值0.18）的入度要高于MCI患者（F=3.941,P=0.021）。文章从入度为脑网络特征验证了MCI患者在颜色认知任务下右脑的功能缺损。     

Longitudinal change in cognitive performance among individuals with mild cognitive impairment

The authors used mixed-effects growth models to examine longitudinal change in neuropsychological performance over a 4-year period among 197 individuals who were either normal or had mild cognitive impairment (MCI) at baseline. At follow-up, the participants were divided into 4 groups: (a) controls: participants who were normal at both baseline and follow-up (n = 33), (b) stables: participants with MCI whose Clinical Dementia Rating-Sum of Boxes (CDR-SB) score did not differ between the first and last evaluations (n = 22), (c) decliners: participants with MCI whose CDR-SB score declined between the first and last evaluations (n = 95), and (d) converters: participants who received a clinical diagnosis of Alzheimer's disease during the follow-up period (n = 47). Only the Episodic Memory factor showed a significantly greater rate of decline over the follow-up period among the converters. Two other factors were significantly lower in converters at baseline in comparison with other groups (the executive function factor and the general knowledge factor), but the rate of decline over time did not differ. Individuals with an APOE epsilon4 allele scored lower on the episodic memory and executive function factors at baseline.     

Associations between sleep duration and cognitive impairment in mild cognitive impairment

The prevalence of mild cognitive impairment (MCI) increases among elderly people and is associated with a high risk of dementia. Identifying factors that may contribute to the progress of MCI to dementia is critical. The objective of this study was to examine the association of objective sleep with cognitive performance in MCI patients. A subsample of 271 participants with a diagnosis of probable Alzheimer's disease (AD; N = 50) or mild cognitive impairment (MCI; N = 121) and 100 persons who were not cognitively impaired (NI) were recruited from a large population‐based cohort in the island of Crete, Greece (3140 older adults aged >60 years). All participants underwent extensive neuropsychiatric/neuropsychological evaluation and a 3‐day 24‐hr actigraphy. Objective sleep variables and their association with neuropsychological performance were examined across the three groups, controlling for demographics, body mass index, depression, sleep apnea symptoms and psychotropic medications. Patients with AD had significantly longer 24‐hr total sleep time (TST) compared to the MCI and NI groups. Long 24‐hr TST was associated with reduced performance on tasks that placed significant demands on attention and processing speed in the MCI group and the AD group. Elderly patients with MCI have similar objective sleep duration to normal controls, whereas AD patients sleep longer. Long sleep duration in patients with multidomain subtypes of MCI is associated with critical non‐memory cognitive domains. It appears that within the MCI group those that sleep longer have more severe cognitive impairment.     

Structural correlates of mild cognitive impairment

The structural correlates of mild cognitive impairment (MCI) were examined in 105 elderly subjects whose cognitive function ranged from intact to demented, including 38 subjects with MCI. Hippocampal volumes (left and right HcV), brain volume (BV), and grey matter volume (GMV) and white matter volume (WMV) were segmented from high resolution magnetic resonance data sets and normalised to intracranial volume (ICV). Hippocampal volume reductions, but not global brain, white or grey matter atrophy, were associated with MCI. White matter lesion severity did not differ over cognitive states. In multiple logistic regression models, normalised HcV and ICV (indicating premorbid brain volume) were significant predictors of MCI versus normality. Normalised BV and ICV significantly predicted dementia versus MCI. Absolute volumetric measures of HcV and BV yielded comparable classification accuracies. Hippocampal atrophy may be the crucial step for the transition from normality to MCI. Widespread brain atrophy may be the step to determine the transition from MCI to dementia. Brain volume reserve effects appear to be involved in both of these steps.     

轻度认知功能障碍、轻度阿尔茨海默病和正常对照老人的ADAS-Cog中文版评分比较

目的:比较阿尔茨海默病评定量表认知分量表(Alzheimer's Disease Assessment Scale-cognitive subscale,ADAS-Cog)中文版在轻度认知功能损害(Mild Cognitive Impairment,MCI)、正常对照、轻度阿尔茨海默病(Alzheimer's disease,AD)三组老人的评分,分析ADAS-Cog中文版对MCI的区分能力。方法:选择轻度AD患者(n=40)、MCI患者(n=40)、正常对照(NC,n=50)三组老人,采用ADAS-Cog进行评估。结果:不同性别、年龄、受教育年限对ADAS-Cog总分的影响无统计学意义。MCI组的单词回忆、意向性练习、定向力、单词辨认、语言表达、找词能力、语言理解项与ADAS-Cog总分均低于轻度AD组[如ADAS-Cog总分(9.85±8.70)vs.(11.83±5.31),均P0.05]。MCI组测验指令回忆与ADAS-Cog总分均高于正常对照组[(1.05±0.88)vs.(0.40±0.61),(11.83±5.31)vs.(7.94±3.80);均P0.01]。轻度AD组除物体命名项外,其他各项与ADAS-Cog总分均高于正常对照组[如ADAS-Cog总分(11.83±5.31)vs.(7.94±3.80),P0.01]。ADAS-Cog总分区分MCI与轻度AD的曲线下面积(AUC)为0.781,敏感度为85.0%,特异度为60.0%。ADAS-Cog总分区分MCI与正常对照的AUC值为0.719,敏感度为70.0%,特异度为66.0%。结论:轻度认知功能损害的阿尔茨海默病评定量表认知分量表中文版总评分与12子项目评分范围都在轻度阿尔茨海默病与正常对照之间,总评分与部分子项目三组差异较明显。该量表对轻度认知功能损害的区分度一般。     

Dual task performance in early Alzheimer's disease, amnestic mild cognitive impairment and depression

BACKGROUND: The dual task paradigm (Baddeley et al. 1986; Della Sala et al. 1995) has been proposed as a sensitive measure of Alzheimer's dementia, early in the disease process. METHOD: We investigated this claim by administering the modified dual task paradigm (utilising a pencil-and-paper version of a tracking task) to 33 patients with amnestic mild cognitive impairment (aMCI) and 10 with very early Alzheimer's disease, as well as 21 healthy elderly subjects and 17 controls with depressive symptoms. All groups were closely matched for age and pre-morbid intellectual ability. RESULTS: There were no group differences in dual task performance, despite poor performance in episodic memory tests of the aMCI and early Alzheimer's disease groups. In contrast, the Alzheimer patients were specifically impaired in the trail-making test B, another commonly used test of divided attention. CONCLUSIONS: The dual task paradigm lacks sensitivity for use in the early differential diagnosis of Alzheimer's disease.     

Reduced interhemispheric inhibition in mild cognitive impairment

In mild cognitive impairment (MCI), the corpus callosum is known to be affected structurally. We evaluated callosal function by interhemispheric inhibition (IHI) using transcranial magnetic stimulation (TMS) in MCI patients. We investigated 12 amnestic MCI patients and 16 healthy age-matched control subjects. The IHI was studied with a paired-pulse TMS technique. The conditioning TMS was given over the right primary motor cortex (M1) and the test TMS over the left M1. Motor evoked potentials were recorded from the relaxed first dorsal interosseous muscle. We also studied other motor cortical circuit functions; short-latency afferent inhibition (SAI), short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). Both the amount of IHI and SAI were significantly reduced in MCI patients as compared with control subjects, whereas SICI or ICF did not differ between them. The degree of IHI significantly correlated with neither the mini-mental state examination score nor the degree of SAI. Our results suggest that transcallosal connection between bilateral M1 is primarily involved in MCI, regardless of SAI dysfunction.     

Geriatric depression and cognitive impairment

Cognitive impairment is common in geriatric depression, and depressed individuals with co-morbid cognitive impairment are at increased risk for a number of adverse medical, psychiatric and cognitive outcomes. This review focuses on clinical issues surrounding the co-occurrence of these two conditions within the context of current research. We (1) review the clinical criteria and prevalence of depression, as well as co-morbid cognitive impairment, (2) discuss factors associated with persistent cognitive impairment in depression, including dementia, and (3) review research relevant to the assessment and treatment of cognitive impairment and dementia in the context of depression. We conclude that current research on depression and cognition can inform clinical decisions that reduce the occurrence of adverse outcomes. Clinicians are encouraged to develop proactive approaches for treatment, which may include combinations of pharmacological and psychotherapeutic interventions.     

Cognitive estimation impairment in Alzheimer disease and mild cognitive impairment

Intact executive functioning is believed to be required for performance on tasks requiring cognitive estimations. This study used a revised version of a cognitive estimations test (CET) to investigate whether patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) were impaired on the CET compared with normal elderly controls (NECs). Neuropsychological tests were administered to determine the relationship between CET performance and other cognitive domains. AD patients displayed impaired CET performance when compared with NECs but MCI patients did not. Negative correlations between tests of working memory (WM) and semantic memory and the CET were found in NECs and AD patients, indicating that these cognitive domains were important for CET performance. Regression analysis suggests that AD patients were unable to maintain semantic information in WM to perform the task. The authors conclude that AD patients display deficits in working memory, semantic memory, and executive function, which are required for adequate CET performance.