糖尿病对脑白质病变伴轻度认知功能障碍患者认知功能的影响

目的 探讨糖尿病与脑白质病变(WML)伴轻度认知功能障碍(MCI)患者认知功能减退的关系。方法 2012年1—12月在大坪医院神经内科住院病人中选择257例WML伴MCI患者进行前瞻性研究,随访时间为1年。收集患者血管危险因素(VRFs)及颅脑MRI检查结果,同时行神经心理学测试了解认知功能状态;根据1年内简易精神状态检查量表(MMSE)减少值分为认知功能下降组(≥3分)及无认知功能下降组(≤2分),并比较两组各种危险因素的差异。结果 257例中有246例(95.7%)患者完成了1年的观察随访过程,11例删失者中8例死亡、3例退出观察。246例中,认知功能下降组154例(62.6%),无认知功能下降组92例(37.4%);其中36例在观察期间发生卒中,余210例患者纳入线性回归分析。除受教育水平及血脂异常外,年龄、性别、高血压、糖尿病、短暂性脑缺血发作等各危险因素两组比较差异均有统计学意义 (P值均＜0.05)。糖尿病、基线WML程度及随访期间WML程度的加重与1年内MMSE减少值呈显著的线性关系,且对认知功能减退的影响由大至小依次为基线WML程度(β_j′=0.570)、随访期间WML加重程度(β_j′=0.244)、糖尿病(β_j′=0.171)。结论 糖尿病可使WML伴MCI患者认知功能进一步减退。重度WML伴MCI的糖尿病患者应作为痴呆的高危人群进行早期干预。     

蒙特利尔认知评估量表在成都市社区老年人轻度认知功能障碍筛查中的应用分析

目的:本文旨在研究蒙特利尔认知评估量表(MoCA)在成都市社区老年人轻度认知功能障碍(MCI)筛查中的价值,探讨该量表对社区老年人MCI筛查的最佳分界值。方法:采用简易精神状态量表(MMSE)和MoCA对成都市社区老年人进行MCI筛查,计算MoCA的信度、效度、敏感性、特异性和Youden指数,并计算适合本市老年人MCI患者的划界分。结果:参与此次社区调查并配合完成所有测试的人数为674人,其中MCI患者106人,MoCA量表的Cronbach’sα为0.852;其总分与MMSE相关系数为0.9392;MoCA以原版推荐26分为界,对MCI筛查的敏感性和特异性分别为98.11%和26.72%,Youden指数为0.2483。结论:用MoCA对成都市社区老年人认知功能的筛查是简便可行的,具有良好的信度、效度和敏感性。推荐以22分作为我市社区老年人的MCI分界值。     

轻度认知功能障碍患者动态脑电图的定量分析

探讨轻度认知功能障碍患者动态脑电图的量化指标,为认知功能障碍早期诊断预防提供依据。选取30例轻度认知功能障碍患者和30例正常老年人作为病例组和对照组,进行MMSE测试和动态脑电图监测,比较两组观察对象α、β、和慢波功率。病例组和对照组的双侧顶枕α功率及大脑各位点的θ和δ功率差别有统计学意义（P＜0．05）。病例组及对照组在睡眠2期纺锤波的时限、频率及密度差别有统计学意义（P＜0．05））。脑电图α功率下降,θ和δ功率增加可以提示认知功能下降,睡眠2期纺锤波的时限、频率及密度可以作为认知功能水平脑电图测试的参考指标。     

北京城乡老年人轻度认知障碍患病率调查

目的：调查北京地区老年人群轻度认知功能障碍（MCI）的患病率,分析患病的相关因素。方法：采用逐户访问方式,抽样调查了北京城乡社区60岁及以上老年人1865例,调查分为2个阶段,第1阶段筛查,由经过培训的调查员完成调查问卷及记忆量表、生活活动能力量表（ADL）及认知量表（MMSE）等测验。第2阶段临床诊断,由神经科专科医师对有主诉或家属诉其有明显记忆障碍者,及或有MMSE分数低于界值者进行病史收集、临床体格检查和神经心理测验,并由两名医师最后做出诊断。结果：1865例60岁及以上老年人中有MCI者217人,占11.6%,标化患病率为8.9%。患有MCI的老人中,22.6%为血管性因素所致（MCI-V）。MCI患病率在农村地区、低教育水平及体力劳动为主的老年人群中增加,随年龄增长,患病率增高。结论：与痴呆的患病特征相同,高龄、低教育水平、居住在农村的老年人是MCI的高发人群。     

太极拳对遗忘型轻度认知功能障碍患者认知功能影响的研究

目的 探讨太极拳对遗忘型轻度认知功能障碍（a-MCI）患者认知功能的影响。方法 将62例a-MCI患者随机分为对照组和观察组,每组31例。对照组患者接受常规健康教育,治疗组在此基础上接受太极拳干预治疗。两组患者分别在治疗前、治疗后6个月采用简明精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）以及事件相关电位P300对患者认知功能评价。结果 对照组治疗前后MMSE、MoCA评分分别比较,差异无统计学意义（P＞0.05）;治疗后观察组MMSE、MoCA评分分别为（25.12±4.17）分、     

电离辐射氧化应激致轻度认知功能障碍及其综合干预的研究

电离辐射氧化应激致机体细胞内水分子水解产生活性氧和自由基或直接损伤DNA等靶分子,脑组织细胞凋亡致海马体积缩小,并在脑膜、大脑皮层和海马的血管壁内可见β淀粉样蛋白沉积,神经组织的病理损伤,引起脑部认知功能障碍.神经功能发生改变轻度认知功能障碍成为当今研究的热点,本文系统阐述了电离辐射氧化应激致机体轻度认知功能障碍(MCI)的发生机制、临床表现与临床诊断,讨论了生物学标志物检测、影像学检查、综合干预对MCI的诊断和预防价值.     

蒙特利尔认知评估量表在轻度认知功能障碍诊断中的应用

目的：探讨蒙特利尔认知评估量表北京版（ Montreal cognitive assessment scale,MoCA）在轻度认知功能障碍（ mild cognitive impairment,MCI）诊断中应用的可行性。方法：选择MCI患者58例（ MCI组）,另选同期健康体检者51例（对照组）。分别给予MoCA和简易智能状态检查量表（ MMSE）评估,并分析评估结果。结果：MCI组Mo－CA总分及MMSE总分均低于对照组（t＝－10．544,－16．188;P＜0．01）。与对照组比较,MCI组MoCA总分及各亚项评分明显降低（ t＝－7．625,－4．614,－5．306,－7．505,－5．991,－7．405,－3．020;P＜0．01）。 MoCA诊断MCI的敏感性为96．55％,特异性为76．47％,MMSE诊断MCI的敏感性为55．17％,特异性为96．07％。结论：MoCA用于MCI诊断时敏感性优于MMSE,能全面评估MCI患者的认知功能。     

轻度认知功能损害的研究进展

轻度认知功能障碍(MCI)是一种发生在老年人群中的综合征,是介于正常衰老和痴呆之间的一种认知损伤状态,性质不稳定,具有转化为痴呆的高风险.本文将从一般情况、神经心理与生物学研究及目前研究中存在的问题三方面介绍其研究进展.     

SIVD患者认知功能障碍与HHcy的相关性

血管性认知功能障碍（VCI）是一组以脑血管病变为基础病因,临床表现为从轻度认知功能障碍到痴呆的综合征,具有异质性。近年来的一些研究表明,高同型半胱氨酸血症（HHcy）可能是血管性认知功能障碍的一个新的独立危险因素。     

阻塞性睡眠呼吸暂停综合征患者轻度认知功能障碍的MoCA评估

目的 探讨简易精神状态检查量表(MMSE)、蒙特列尔认知评估量表(MoCA)评估阻塞性睡眠呼吸暂停综合征(OSAS)患者轻度认知功能障碍(MCI)的可行性.方法 用便携式多导睡眠仪、MMSE及MoCA对51名OSAS患者和35名单纯鼾症者进行睡眠监测和认知功能的评价.结果 OSAS组MoCA评分结果为21.1 ±3.0,显著低于对照组的25.0 ±2.6(P＜0.01);MMSE评分结果在OSAS组与对照组中分别为27.8±1.8及28.1±1.7,无统计学意义.结论 MoCA对于OSAS患者MCI的早期诊断敏感性优于MMSE,对于MMSE测试结果正常但高度怀疑存在MCI者,MoCA是一种简便可行的筛查工具.     

MRI of hippocampus and entorhinal cortex in mild cognitive impairment: a follow-up study

The concept of mild cognitive impairment (MCI) has been proposed to represent a transitional stage between normal aging and dementia. We studied the predictive value of the MRI-derived volumes of medial temporal lobe (MTL) structures, white matter lesions (WML), neuropsychological tests, and Apolipoprotein E (APOE) genotype on conversion of MCI to dementia and AD. The study included 60 subjects with MCI identified from population cohorts. During the mean follow-up period of 34 months, 13 patients had progressed to dementia (9 to Alzheimer's disease (AD)). In Cox regression analysis the baseline volumes of the right hippocampus, the right entorhinal cortex and CDR sum of boxes predicted the progression of MCI to dementia during the follow-up. In a bivariate analysis, only the baseline volumes of entorhinal cortex predicted conversion of MCI to AD. The Mini-Mental State Examination (MMSE) score at baseline, WML load, or APOE genotype were not significant predictors of progression. The MTL volumetry helps in identifying among the MCI subjects a group, which is at high risk for developing AD.     

Sex differences in the prevalence and incidence of mild cognitive impairment: A meta-analysis

ObjectiveMore women have Alzheimer’s disease (AD) than men. Understanding sex differences in mild cognitive impairment (MCI) may further knowledge of AD etiology and prevention. We conducted a meta-analysis to examine sex differences in the prevalence and incidence of MCI, which included amnestic and non-amnestic subtypes.MethodSystematic searches were performed in July 2015 using MEDLINE/PubMed, Scopus, and PsycINFO for population-or community-based studies with MCI data for men and women. Random-effects model were used.ResultsFifty-six studies were included. There were no statistically significant sex differences in prevalence or incidence of amnestic MCI. There was a significantly higher prevalence (p = 0.038), but not incidence, of non-amnestic MCI among women. There were no sex differences in studies that combined both subtypes of MCI.ConclusionThe only statistically significant finding emerging from this study was that women have a higher prevalence of non-amnestic MCI. To better understand sex differences in the preclinical stages of dementia, studies must better characterize the etiology of the cognitive impairment.     

Prognosis of mild cognitive impairment syndrome: Data from a two-year clinical follow-up study

The psychopathological structure and prognostic significance of mild cognitive impairment syndrome (MCI) were studied in a two-year prospective study of randomized cohorts of elderly subjects whose mental state corresponded to the criteria for MCI. A total of 40 patients aged from 50 to 80 years were studied. Patients underwent clinical history-taking, neuropsychological, psychometric, and genetic investigations (genotyping for ApoE), as well as brain imaging studies. The psychopathological structure and psychometric characteristics of MCI syndrome are presented. Clinical and genetic factors with prognostic significance are identified. __________ Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 107, No. 1, pp. 4–10, January, 2007.     

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.     

Psychiatric impairment in rural communities

This household survey of 713 adults residing in nine rural Middle Tennessee counties was conducted to estimate the prevalence of psychiatric impairment in the rural population, to determine which groups in the population are characterized by higher levels of impairment, and to assess the validity of three indices of psychiatric impairment (HOS, CES-D, and GWB). The data indicate that approximately 12% of the rural population may be impaired and that impairment is most likely among females, the divorced, widowed, or separated, and those in lower socioeconomic strata. While depression was more common among the young, physical and psychosomatic complaints were more common among older respondents. Further, respondents classified as impaired by the indices tended to view themselves as having "substantial" or "major" problems and were likely to feel that they might require professional help. While the GWB appeared to discriminate between users and non-users of services, the other indices were less effective as predictors of service utilization.     

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.     

MicroRNAs and mild cognitive impairment: A systematic review

BackgroundMild cognitive impairment (MCI) is usually described as an intermediate phase between normal cognition and dementia. Identifying the subjects at a higher risk of progressing from MCI to AD is essential to manage this condition. The diagnosis of MCI is mainly clinical. Several biomarkers have been proposed, but mostly for research purposes, as they are based on an invasive procedure to obtain the sample, such as cerebrospinal fluid (CSF). As a consequence, rapid and non-invasive biomarkers are needed to improve diagnosis. The objective of this systematic review is to summarize available evidence on the use of miRNAs as biomarkers in subjects with MCI.MethodsRelevant literature published up to June 2018 was retrieved searching the databases PubMed, ISI Web of Knowledge and the Cochrane Database. Only studies considering microRNAs (miRNAs) and a diagnosis of MCI were included. Data were extracted using a specifically-designed standardized form, and their methodological quality was assessed using QUADAS-2 and QUIPS.ResultsTwenty-one studies of 153 retrieved articles met the predefined inclusion/exclusion criteria. Studies included participants ranging from 6 to 330. More than 40 miRNAs resulted as dysregulated, and miR-206 was the only miRNA that was found as differentially expressed in patients with MCI by more than two studies. However, these results have either not yet been confirmed in other independent cohorts, or data are still inconsistent. Inconsistencies among included studies could be due to several issues including the selection of participants, pre-analytical and analytical procedures, and statistical analyses.     

轻度认知障碍神经炎症机制的作用靶点

背景:临床上,轻度认知障碍是正常衰老认知下降与阿尔茨海默症早期之间的过渡状态,被认为是预防或改变阿尔茨海默症退行性变的最佳阶段.近年来,越来越多的研究表明,神经炎症是轻度认知障碍的核心发病机制和主要早期病理特征之一.目的:综述国内外神经炎症导致轻度认知障碍的机制研究进展.方法:英文检索词为neuroinflammat...