血管性痴呆患者神经精神症状的临床分析

目的 了解血管性痴呆患者的神经精神症状特点.方法 采用神经精神科问卷、简易智能状态检查量表和Hachinski缺血评分量表,分别评价血管性痴呆、脑卒中后非痴呆、阿尔茨海默病和正常老年人群的神经精神症状.结果 与正常对照组比较,血管性痴呆组患者在妄想、幻觉、激越、抑郁和(或)心境恶劣、情感淡漠、易激惹和(或)不稳定、迷乱的动作行为等调查内容和神经精神科问卷总评分,差异有统计学意义(P＜0.05或P＜0.01);阿尔茨海默病组伴妄想者多于血管性痴呆组,组间差异有统计学意义(P＜0.01).血管性痴呆不同严重程度组之间比较,幻觉、焦虑、情感淡漠、易激惹和(或)不稳定、迷乱的动作行为等调查项目达到统计学意义(P＜0.05或P＜0.01),且随病情的逐渐加重而症状更为明显.结论 血管性痴呆和阿尔茨海默病患者存在多种相似的神经精神症状,中至重度血管性痴呆患者表现为以情绪和情感障碍为主的神经精神症状.     

血管性痴呆与正常老人的CT,SPECT检查和神经心理学研究

目的 了解血管性痴呆和正常老人在ＣＴ、ＳＰＥＣＴ检查和神经心理学检查的不同表现，比较ＣＴ和ＳＰＥＣＴ的优劣，分析ＳＰＥＣＴ与神经心理学检查的相关性。方法 选择符合ＤＳＭ－Ⅳ有关血管性痴呆诊断标准的患者和正常老人各２０例，完成ＣＴ、ＳＰＥＣＴ检查和神经心理学检查。结果 与正常老人相比，血管性痴呆患者在认知功能缺损；ＳＰＥＣＴ放射性计数比值在左颞、顶、枕叶、左丘脑和双侧基底节显著一在神经心理学检查成绩     

轻度认知障碍与无痴呆型血管性认知障碍患者的神经心理学特征

阿尔茨海默病（AD）和血管性痴呆（vascular dementia，VD）是临床常见的老年期痴呆类型。虽然长期以来受到广泛关注．但对其治疗收效甚微．近年逐渐将研究重点转向对其早期阶段的干预治疗。在这一临床需要下，针对阿尔茨海默病和血管性痴呆分别提出了轻度认知障碍（mild cognitive impairment，MCI）和血管性认知障碍（vascular cognitive impairment，VCI）的概念，力求对患者进行早期识别和干预，以延缓甚至阻止痴呆的发生、发展。     

血管性痴呆

在过去的几十年中，血管性痴呆（ＶａｓｃｕｌａｒＤｅｍｅｎｔｉａ，ＶＤ）的概念有了长足发展。所有老年痴呆中９％～３９％具有血管性病因，另有１１％～４３％可能是混合性痴呆。ＶＤ发生率最典型的表述是６５岁以上老人中占３％～６％［１］。男性多于女性。加拿大健...     

不同类型的血管性认知损害的执行功能障碍

目的 分析不同类型的血管性认知功能损害(VCI)患者的执行功能损害特征.方法 经头颅MRI证实为皮质下缺血性小血管病(SIVD)患者64例,其中16例单一的执行功能损害(s-VCI-ND)、26例多个认知领域损害(m-VCI-ND)和22例血管性痴呆(VaD)患者,完成一系列神经心理测验,包括总体认知水平、记忆、语言、注意/执行功能、空间结构能力等各个认知领域.其中执行功能检查包括定势转移、优势抑制、工作记忆、概念形成和流畅性5个分因子,共15种独立的分测验.结果 汉诺塔测验、示踪排序测验、同步听觉连续加法测验等在非痴呆VCI(VCI-ND)患者中的完成率低于50%,不适合VCI-ND的检测;s-VCI-ND组与健康对照组比较,分别反映4种执行功能成分的连线测验B耗时数(216.5±69.3、137.4±37.9)、Stroop色词测验卡片C耗时数(115.4±30.1、72.9±17.5)、卡片分类测验(1.9±1.4、2.7±1.2)和范畴流畅性测验(列举动物14.2±2.3、17.7±4.4)差异具有统计学意义(t=4.73、5.72、2.04、3.53,均P<0.05);VCI-ND的认知表现介于健康老人组和VaD组之间,其中m-VCI-ND有比较严重的执行功能损害和情景与语义记忆障碍,其认知缺损模式接近VaD,很可能是VaD的前期状态.结论 SIVD所致VCI的执行功能损害缺乏选择性,部分执行功能测验可以作为早期检测VCI-ND的敏感工具.     

血管性痴呆神经心理学与事件相关电位的研究

目的 探讨血管性痴呆神经心理学与事件相关电位(P300)的变化规律及临床意义。方法 选取血管性痴呆患者30例，并以与其年龄、性别基本相似的体检健康者为对照组，用认知能力甄别检查法(OCSE)、老年性痴呆评定量表(ADAS)作神经心理学测试后，再用听觉Oddball序列研究血管性痴呆患者事件相关电位(ERPs)的P3成分。结果 血管性痴呆组CCSE、ADAS与对照组有显著差异(P＜0．05)。血管性痴呆组P3峰潜伏期(P3PL)、P3波幅(P3AMP)与对照组相比差异显著(P＜0．05)。CCSE与P3PL呈显著负相关(r＝-0．357，P＜0．05)，ADAS与P2PL呈显著正相关(r＝1．25，P＜0．05)。结论 血管性痴呆的认知功能评分与患者的巴潜伏期长短有明显相关性。     

轻度血管性痴呆患者的认知特征研究

目的　分析轻度血管性痴呆 (VaD)患者的认知特征。方法　符合美国国立神经疾病与脑卒中研究所(NINDS AIREN)编制的VaD诊断标准的 31例患者 ,与年龄、性别、教育程度等匹配的卒中后非痴呆患者和正常老人(各 31例 )均完成智能、记忆、语言、注意、结构、计算及执行功能的 16种神经心理测验。结果　VaD患者的认知损害是全面性的 ,最为显著的是总体智力、回忆策略、视觉空间能力及筹划执行功能指标 ,反映其额叶和皮质下功能损害。结论　VaD患者脑部额叶和皮质下功能障碍最为突出。     

阿尔茨海默病与血管性痴呆的临床特点

目的　观察比较阿尔茨海默氏病（ＡＤ） 与血管性痴呆（ＶＤ） 的临床特点,为临床上对老年期痴呆的诊断和鉴别诊断提供帮助。方法　根据ＤＳＭⅣ诊断标准,对２１ 例ＡＤ 患者、２５ 例ＶＤ 患者的临床特点进行对比研究,包括：疾病发展过程、认知功能、情感反应、行为变化和知觉异常。所有病人均为轻中度痴呆患者。结果　①ＡＤ 为缓慢起病;ＶＤ 多数起病较急。②ＡＤ 的认知功能减退常常累及多个方面;ＶＤ 以记忆力减退和计算力减退为主。③ＡＤ 的非认知功能常常受影响;ＶＤ的非认知功能较少受累。结论　ＡＤ 与ＶＤ 的临床特点不同,与两种疾病的病理机制不同有关。根据其不同的临床表现,有助于对这两种常见的老年期痴呆作出诊断及鉴别诊断。     

神经心理学测验评价痴呆的信度与效度问题

痴呆患者都存在学习、记忆、语言、思维等多种认知功能损害,同时伴有多种精神行为症状,认知和精神行为异常最终可导致患者社会活动能力减退或完全丧失.     

不同病因轻度认知障碍的神经心理学特征比较

目的 明确皮质下小血管病导致的轻度认知障碍(mild cognitive impairment due to subcortical small vessel disease,MCI-SSVD)和阿尔茨海默病源性MCI(mild cognitive impairment caused by Alzheimer's disease,MCI-AD)的神经心理学特征,并进行比较,筛选出有效鉴别两者盼认知测验.方法 对45例MCI-SSVD患者、30例MCI-AD患者和61名健康对照者的5个认知域进行广泛测查,结果进行组间比较,应用逻辑回归分析筛查对鉴别MCI-SSVD和MCI-AD作用显著的测验.结果 MCI-SSVD组和MCI-AD组患者多个认知域都差于健康对照组,以言语性记忆测查(正确回忆的单词个数)中的即刻回忆(健康对照组55.48±5.33;MCI-SSVD组38.55±8.04;MCI-AD组34.93±8.79;F=113.407,P=0.000)、短时延迟回忆(健康对照组13.34±1.38;MCI-SSVD组8.47±2.18;MCI-AD组4.06±2.87;F=216.284,P=0.000)和长时延迟回忆(健康对照组13.18±1.19;MCI-SSVD组8.58±2.02;MCI-AD组3.93±2.84;F=239.394,P=0.000)成绩下降最突出.与MCI-SSVD相比,MCI-AD组的记忆相关测验更差(P=0.000),信息处理速度和视空间结构能力相对好(P=0.000～0.023).2个与记忆和信息处理速度相关的测验能够正确区别93.3%的MCI-SSVD患者和93.3%的MCI-AD患者.结论 MCI-SSVD和MCI-AD都为多认知域损害,尤以记忆损害严重;两者间记忆力和信息处理速度有明显差别,相关测验对鉴别两者有临床应用价值.     

Cytokines in Alzheimer's Disease and Vascular Dementia

The levels of interleukin 1β, interleukin 6, and interleukin 10 were elevated in the serum of patients with dementia. No statistically significant correlation was recorded in the interleukin levels among patients with Alzheimer's disease and vascular dementia. Also, no significant correlation was observed in the interleukin levels in the serum and the severity of dementia. However, a significant correlation was found between IL-6 and tumor necrosis factor-α (TNF-α) levels and age. The levels of IL-1β and IL-6 were positively correlated with hypertension, and IL-2 levels were negatively correlated. No correlation was found between depressive symptoms and levels of cytokines in the serum.     

Yes/No Versus Forced-Choice Recognition Memory in Mild Cognitive Impairment and Alzheimer's Disease: Patterns of Impairment and Associations with Dementia Severity

Memory tests are sensitive to early identification of Alzheimer's disease (AD) but less useful as the disease advances. However, assessing particular types of recognition memory may better characterize dementia severity in later stages of AD. We sought to examine patterns of recognition memory deficits in individuals with AD and mild cognitive impairment (MCI). Memory performance and global cognition data were collected from participants with AD (n?=?37), MCI (n?=?37), and cognitively intact older adults (normal controls, NC; n?=?35). One-way analyses of variance (ANOVAs) examined differences between groups on yes/no and forced-choice recognition measures. Individuals with amnestic MCI performed worse than NC and nonamnestic MCI participants on yes/no recognition, but were comparable on forced-choice recognition. AD patients were more impaired across yes/no and forced-choice recognition tasks. Individuals with mild AD (≥120 Dementia Rating Scale, DRS) performed better than those with moderate-to-severe AD (<120 DRS) on forced-choice recognition, but were equally impaired on yes/no recognition. There were differences in the relationships between learning, recall, and recognition performance across groups. Although yes/no recognition testing may be sensitive to MCI, forced-choice procedures may provide utility in assessing severity of anterograde amnesia in later stages of AD. Implications for assessment of insufficient effort and malingering are also discussed.     

Neuropsychological differentiation of Alzheimer's disease from vascular dementia

The purpose of this study was to determine whether cognitive test performances alone could distinguish patients with probable Alzheimer's disease from those with probable vascular dementia. Sixty-eight outpatients with clinical diagnoses of either Alzheimer's disease or vascular dementia were administered a brief battery of neuropsychological tests. Scores from the Boston Naming Test and the Hopkins Verbal Learning Test were identified as most discriminating of the groups. Seventy-seven per cent of the sample was correctly classified by a stepwise discriminant function analysis. Results of this study indicate that selected neuropsychological tests have moderate concurrent utility in the differential diagnosis of dementia.     

Cognitive Impairment in Parkinson's Disease without Dementia: Subtypes and Influences of Age

Background and Purpose

Cognitive impairments are common in Parkinson''s disease (PD), although the severity of these impairments does not significantly impair the patient''s daily activities. The aim of this study was to determine the frequency of mild cognitive impairment (MCI) of Parkinson''s disease (PDMCI) and its subtypes in nondemented PD patients. We also evaluated the influence of age on the pattern of subtypes of PDMCI.

Methods

A total of 141 consecutive, nondemented PD patients underwent a comprehensive neuropsychological assessment covering the five cognitive domains: attention, language, visuospatial, memory, and executive functions. PDMCI was defined as impaired performance in at least one of these five cognitive domains. The influence of age on the distribution of subtypes of PDMCI was assessed by comparing patients in two groups dichotomized according to their age at assessment (younger vs. older).

Results

Fifty-seven (40.4%) of the nondemented PD patients had an impairment in at least one domain, and were therefore considered as having PDMCI. The age at assessment and age at disease onset were significantly higher in the PDMCI patients. The amnestic type of PDMCI was the most frequent, followed by the visuospatial, linguistic, executive, and attention types in that order. The frequency of PDMCI was higher for all subtypes in the older group; the domain that was influenced the most by age was executive function.

Conclusions

MCI was common in PD and the subtypes were diverse. Age was found to be an important risk factor for the development of PDMCI, particularly for the executive subtype. These results indicate that the concept of MCI should be introduced in PD.     

Education plays a different role in Frontotemporal Dementia and Alzheimer's disease

BACKGROUND: The role of modifiable and non-modifiable variables in Frontotemporal Dementia (FTD) as compared to Alzheimer's dDisease (AD) and to Progressive Supranuclear Palsy (PSP) or Corticobasal Degeneration Syndrome (CBDS) has not been extensively evaluated. In particular, low education levels have been reported to be a risk factor for AD, but their contribution in FTD is yet not known. OBJECTIVE: To investigate the role of education, other modifiable and non-modifiable factors in FTD as compared to AD, PSP and CBDS patients. METHODS: One hundred and seventeen FTD patients, 400 AD, 55 PSP, and 55 CBDS entered the study. Demographic and clinical characteristics were carefully recorded. Age, gender, family history for dementia and Apolipoprotein E (APOE) genotype were considered as non-modifiable factors; education and comorbidities were included as modifiable variables. Regression analyses were applied in order to identify differences among groups. RESULTS: FTD differed from AD patients in terms of younger age, positive family history and gender status. In regard to APOE genotype, no differences between FTD and AD were found, but FTD showed higher prevalence of epsilon 4 allele compared to both CBDS and PSP patients (p < 0.05). When modifiable factors were considered, FTD were higher educated than AD patients (p < 0.001). Regression analysis identified younger age, positive family history, and education levels as independently associated variables to FTD diagnosis compared to AD (F = 21.27, R(2) = 24.1, p = 0.036). CONCLUSION: Our results highlight that the contribution of education and non-modifiable factors is likely different in FTD and AD. Further work is needed to completely establish the role of this modifiable variable as a potential area of intervention for dementias.     

Sleep Disturbances and Predictive Factors in Caregivers of Patients with Mild Cognitive Impairment and Dementia

Background and Purpose

We examined the characteristics of sleep disturbances and sleep patterns in the caregivers of patients with amnestic mild cognitive impairment (aMCI) and dementia.

Methods

We prospectively studied 132 patients (60 with aMCI and 72 with dementia) and their caregivers, and 52 noncaregiver controls. All caregivers and controls completed several sleep questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). The patients were administered neuropsychological tests and the neuropsychiatric inventory to evaluate their behavioral and neuropsychiatric symptoms of dementia (BPSD).

Results

The PSQI global score was 6.25±3.88 (mean±SD) for the dementia caregivers and 5.47±3.53 for the aMCI caregivers. The Insomnia Severity Index (ISI) and short form of the Geriatric Depression Scale (GDS-S) predicted higher PSQI global scores in aMCI caregivers, and higher scores for the ISI, Epworth Sleepiness Scale (ESS), and GDS-S in dementia caregivers. BPSD, including not only agitation, depression, and appetite change in dementia patients, but also depression, apathy, and disinhibition in aMCI patients, was related to impaired sleep quality of caregivers, but nighttime behavior was not. Age and gender were not risk factors for disturbed sleep quality.

Conclusions

Dementia and aMCI caregivers exhibit impaired quality of sleep versus non-caregivers. ISI, GDS-S, and ESS scores are strong indicators of poor sleep in dementia caregivers. In addition, some BPSD and parts of the neuropsychological tests may be predictive factors of sleep disturbance in dementia caregivers.     

Patterns of Word-List Generation in Mild Cognitive Impairment and Alzheimer's Disease

Patients with amnestic mild cognitive impairment (aMCI) have been described as exhibiting greater impairment on tests of category fluency than letter fluency. This has been offered as evidence that this condition represents pre-clinical Alzheimer's disease (AD). We hypothesized that this pattern of differential impairment is dependent on the specific semantic categories and initial letters selected, and is not specific to AD and aMCI. A total of 40 cognitively normal older adults, 74 MCI patients—25 “amnestic single domain” (aMCI), 27 “amnestic multiple domain”, and 22 non-amnestic—and 29 AD patients were tested with multiple forms of semantic-category and initial-letter fluency tasks. The pattern of deficits within and across groups was highly dependent on the specific categories and letters chosen. Overall, aMCI patients did not demonstrate greater impairment in category than letter fluency. In fact, the level and pattern of their performance resembled that of cognitively normal older adults much more than AD patients. MCI patients with deficits in multiple cognitive domains performed most like AD patients. These findings indicate that verbal fluency performance is highly influenced by the specific tasks used, and impairment on semantic fluency is not characteristic of pure amnestic MCI.