多发性梗塞性痴呆脑血流量变化

本文应用９９Ｍ、ＴＣ－ＥＣＤ和ＳＰＥＣＴ对３０例多发性梗塞性痴呆（ＭＩＤ）、３０例多发性梗塞（ＭＩ）进行局部脑血流断层显像，以灌注缺血容积（ＤＶ）指数为评价灌注减低范围的指标。结果表明：ＭＩＤ组的ＤＶ指数明显大于ＭＩ组（Ｐ＜０．００１），ＭＩＤ组的皮层下型与皮层型之间ＤＶ指数无明显差异（Ｐ＞０．０５）．提示痴呆组血流灌注减低范围较无痴呆组广泛。皮层血流灌注减低为皮层下型ＭＩＤ的一个重要原因。     

脑血管性痴呆局部脑血流的定量分析

目的探讨血管性痴呆的脑循环变化。方法采用单光子发射计算机断层显像（ＳＰＥＣＴ），９９ｍ－ＥＣＤ标记，定量测定血管性痴呆（ＶＤ）、多发性脑梗塞（ＭＩ）及正常老年人各１０例的局部脑血流量。结果ＶＤ组各脑叶及基底节区平均脑血流量均显著低于对照组（Ｐ＜０．０１）；ＶＤ组比ＭＩ组额颞叶皮质血流量明显减少（Ｐ＜０．０１，Ｐ＜０．０５）；ＶＤ额叶皮质脑血流量改变与神经心理测试ＭＭＳＥ呈正相关（ｒ＝０．６９２，Ｐ＜０．０５）。结论ＶＤ存在全脑广泛的脑血流灌注降低。额叶皮质血流灌注降低与痴呆的发生及痴呆的严重程度密切相关。ＳＰＥＣＴ局部脑血流定量测定对于ＶＤ的预测及早期发现有重要意义     

老年期痴呆患者脑血管储备功能的测定

目的 评价Ｄｉａｍｏｘ ＳＰＥＣＴ脑血流（ＣＢＦ）负荷显像对于老年期痴呆的诊断价值。方法 采用Ｄｉａｍｏｘ药物负荷＾９９ｍＴｃ－ＥＣＤ ＳＰＥＣＴ核素显像技术对Ａｌｚｈｅｉｍｅｒ型痴呆（ＤＡＴ）患者１０例,血管性痴呆（ＶＤ）患者２０例,正常对照者１５例进行脑血管储备功能测定。结果 安静状态下,两痴呆组平均脑血流量均显著低于对照组（Ｐ〈０．０１）,不同程度ＶＤ组间脑血流无统计学意义。Ｄｉａｍｏｘ负荷     

单纯栓塞治疗脑动静脉畸形结果分析

材料与方法 １．男性２５例：女性１５例,年龄９～６０岁,平均２７．２岁。采用 ＤＳＡ复查（２５例）及信访（１５例）二种方法。随访期１月～７年,平均２．３４年。栓塞材料为ＮＢＣＡ（氰丙烯酸正丁酯）与ＭＣｇｉｃ导管配用。 ２．首诊症状员现为,蛛网膜下腔出血及颅内血肿３０例．癫痫１０例,其它神经功能障碍９例。 ３．全部病人术前均ＣＴ或ＭＲＩ及ＤＳＡ检查．ＡＶＭ位于大脑皮层２１例．辟部（基底节）６例,胼胝体５例,脑干３例,小脑５例,其中ＡＶＭ的大小以ＤＢＡ片上的血管团的最长直径计算,小于３ｃｍ１１例,３ｃｍ…     

急性脑血管病多脏器功能失常综合征的临床分析

目的　探讨急性脑血管病（ＡＣＶＤ）并发多脏器功能失常综合征（ＭＯＤＳ）的发病机理、防治与预后。方法　对４７８ 例ＡＣＶＤ患者分为ＭＯＤＳ组１２４例，无ＭＯＤＳ组３５４ 例；进行对照分析。结果　ＭＯＤＳ发生率２５．９％ 。ＭＯＤＳ死亡率５８．５％ ，对照组死亡率６．５％ ，（Ｐ＜ ０．０５）。随着所累及器官越多，死亡率就越高，死亡的主要原因系脑损害，脑疝和继发呼吸道、泌尿系感染以及心肾功能衰竭等。结论　为降低ＭＯＤＳ的发生率，对ＡＣＶＤ患者应采取积极正确的治疗及严密的观察，一旦发生ＭＯＤＳ则应紧急措施加以控制。     

老人院内痴呆患病率及其主要原因的研究（附临床与病理对照资料）

对某老人院内３７６例老年人进行了痴呆患病率和痴呆病因调查，并在此基础上对其中１５例死亡患者进行了病理和临床对照研究。主要结果：（１）临床痴呆调查发现，３７６例中，痴呆及可疑痴呆者１２０例，占调查总数３１．９％；其中ＨＤＳ在１０分以下的肯定痴呆患者４４例，占调查总数１１．７％，占ＨＤＳ异常得分者总数３６．７％。不同年龄及文化背景各组中ＨＤＳ异常者的比率无显著异差．（２）对４４例肯定痴呆患者进行临床诊断分类，结果显示痴呆患者中可能为ＳＤＡＴ者２７例（６０％）；ＭＩＤ者８例（１７．５％）；ＭＩＸ者９例（２２．５％），ＳＤＡＴ比例大于ＭＩＤ和ＭＩＸ，Ｐ＜０．０１．（３）１５例脑病理检查结果表明，７例临床检查有痴呆症状的患者中，４例经病理组织学证实为ＳＤＡＴ，３例符合ＭＩＤ诊断．８例临床智力正常者，无１例发现ＳＤＡＴ改变．上述结果表明ＳＤＡＴ在我国老年人中的发病率可能高于ＭＩＤ．     

西比灵治疗血管性痴呆40例报告

本文拟在观察因脑血液循环障碍而致痴呆病人,服用西比灵胶囊后的智能改善情况。１对象与方法１．１对经我科１９９８年１２月－１９９９年５月住院的血管性痴呆患者（ＶＤ）６０例人：（１）符合美国精神病而会诊断和统计手册（ＤＳＭ－ Ｒ）痴呆的诊断标准［１］。（２）均做Ｈａｃｈｉｎ　ｓｋｉ缺血量表检查≥８分,随机分为治疗组４０例,对照组２０例。治疗组：男２３例,女１７例,平均５７±３．１岁,脑梗死３４例,脑出血６例;对照组：男１２例,女８例,平均５９± ２．８岁,其中脑梗死１７例,脑出血３例,两组比较年龄、性别…     

急性脑出血病多脏器功能失常综合征的临床分析

目的 探讨急性脑血管病（ＡＣＶＤ）并发多脏器功能失常综合征（ＭＯＤＳ）的发病机理,防治与预后。方法 对４７８例ＡＣＶＤ患者ＭＯＤＳ组１２４例,无ＭＯＤＳ组３５４例,进行对照分析。结果 ＭＯＤＳ发生率２５．９％,ＭＯＤＳ死亡率５８．５％,对照组死亡率６．５％（Ｐ〈０．０５）。随着所累及器官越多,死亡率就越高,死亡的主要系脑损害,脑疝和继发呼吸道,泌尿系感染以及心肾功能衰竭等。结论 为降低ＭＯＤＳ的发     

老年期痴呆患者的脑循环变化

目的 探讨老年期痴呆患者的脑循环变化。方法 采用单光子发射计算机断层显像（ＳＰＥＣＴ）,Ｅ＾９９ｍＴｃ－ＥＣＤ作为显像剂,定量测定１５例Ａｌｚｈｅｉｍｅｒ型痴呆（ＡＤＴ）、２４例血管性痴呆（ＶＤ）和１５名正常老年人的局部脑血流量（ｒＢＣＦ）。结果 ＤＮＴ、ＶＤ组大脑平均血流量（ｍＣＢＦ）均显著低于对照组（Ｐ〈０．０１）;ＤＡＴ组额、颞、顶叶皮质ｒＣＢＦ明显减少（Ｐ〈０．０１）;ＶＤ组各脑叶皮质及其     

多发性脑梗塞患者智能障碍初步研究

目的 探讨影响多发性脑梗塞患者智能障碍的因素。方法 采用ＭＭＳＥ和ＨＡＭＤ对７８例ＣＴ证实多发性脑梗塞患者进行智能和抑郁状态评定。将痴呆组（２４例）和非痴呆组（５４例）ＣＴ表现作比较,伴有抑郁的脑梗塞患者同不伴有抑郁的脑梗塞患者ＭＭＳＥ结果作比较。结果 痴呆组梗塞总容积明显大于非痴呆组,且优势半球梗塞发生率高,伴有抑郁的脑梗塞患者ＭＭＳＥ结果明显氏于不伴有抑郁的脑梗塞患者。结论 多发性脑梗塞患者智     

Hamilton Depression Scale in dementia

INTRODUCTION : Wide variations in frequency of depression in primary degenerative dementia (PDD) and in vascular dementia (VD) have been reported. This may perhaps be due to inadequacy of common diagnostic tools in detecting depression in the face of cognitive decline. We evaluated here the Hamilton Depression Rating Scale (HDRS) in demented patients with PDD and VD. METHODS : We examined 50 consecutive patients with PDD and 50 consecutive patients with VD. All patients underwent neurological examination and their depression was evaluated using DSM-III-R criteria and the HDRS. The data obtained were analysed for distribution of depression and pattern of responses obtained in the HDRS. Sensitivity, specificity and Youden's J-indices for different cut-off scores of the HDRS in its ability to detect depression in this population were calculated. RESULTS : Dementia was associated with depression in 38% of the patients (DSM-III-R criteria). HDRS scores were higher in depressed patients (z= -5.7, P < 0.0001) with an HDRS cut-off score of 10 being indicative of depression in demented patients. Symptoms related to 'affective' components of the HDRS (such as depressive mood and anxiety) were strongly associated with the diagnosis of depression (Mann-Whitney tests, P < 0.0001). CONCLUSION : Depression is frequent in demented patients. The HDRS has good criterion validity in the evaluation of depression in demented patients. (Int J Psych Clin Pract 2002; 6: 91-94)     

脑梗死恢复期抑郁及相关因素分析

目的探讨脑梗死恢复期抑郁的发生情况及相关因素.方法采用汉密尔顿抑郁量表(HAMD)将87例初发脑梗死恢复期患者分为抑郁组和非抑郁组,分别行脑卒中神经功能缺损评分(SSS)和日常生活能力评定(ADL).结果在87例脑梗死恢复期患者中抑郁发生率为41.4%,抑郁组SSS评分明显高于非抑郁组(P＜0.01),抑郁组ADL评分低于非抑郁组(P＜0.01),而病灶数量、部位在2组中无显著性差异.结论抑郁是脑梗死患者恢复期常见的并发症,其发生与神经功能缺损严重程度、日常生活能力依赖程度有关.     

Depression rating scales in Parkinson's disease: critique and recommendations.

Depression is a common comorbid condition in Parkinson's disease (PD) and a major contributor to poor quality of life and disability. However, depression can be difficult to assess in patients with PD due to overlapping symptoms and difficulties in the assessment of depression in cognitively impaired patients. As several rating scales have been used to assess depression in PD (dPD), the Movement Disorder Society commissioned a task force to assess their clinimetric properties and make clinical recommendations regarding their use. A systematic literature review was conducted to explore the use of depression scales in PD and determine which scales should be selected for this review. The scales reviewed were the Beck Depression Inventory (BDI), Hamilton Depression Scale (Ham-D), Hospital Anxiety and Depression Scale (HADS), Zung Self-Rating Depression Scale (SDS), Geriatric Depression Scale (GDS), Montgomery-Asberg Depression Rating Scale (MADRS), Unified Parkinson's Disease Rating Scale (UPDRS) Part I, Cornell Scale for the Assessment of Depression in Dementia (CSDD), and the Center for Epidemiologic Studies Depression Scale (CES-D). Seven clinical researchers with clinical and research experience in the assessment of dPD were assigned to review the scales using a structured format. The most appropriate scale is dependent on the clinical or research goal. However, observer-rated scales are preferred if the study or clinical situation permits. For screening purposes, the HAM-D, BDI, HADS, MADRS, and GDS are valid in dPD. The CES-D and CSDD are alternative instruments that need validation in dPD. For measurement of severity of depressive symptoms, the Ham-D, MADRS, BDI, and SDS scales are recommended. Further studies are needed to validate the CSDD, which could be particularly useful for the assessment of severity of dPD in patients with comorbid dementia. To account for overlapping motor and nonmotor symptoms of depression, adjusted instrument cutoff scores may be needed for dPD, and scales to assess severity of motor symptoms (e.g., UPDRS) should also be included to help adjust for confounding factors. The HADS and the GDS include limited motor symptom assessment and may, therefore, be most useful in rating depression severity across a range of PD severity; however, these scales appear insensitive in severe depression. The complex and time-consuming task of developing a new scale to measure depression specifically for patients with PD is currently not warranted.     

三个常用抑郁量表筛查癫痫患者伴抑郁的比较

目的比较贝克抑郁量表第2版(BDI-Ⅱ)、医院焦虑抑郁量表-抑郁分量表(HADS-D)、流调用抑郁自评量表(CES-D)用于对癫痫患者伴抑郁的筛查。方法采用BDI-Ⅱ、HADS-D、CES-D评价117例癫痫患者的抑郁情况,采用ROC曲线比较HADS-D、BDI-Ⅱ、CES-D的筛查性能。结果癫痫伴抑郁患者共33例。BDI-Ⅱ取临界值16,抑郁筛查的灵敏性和特异性大约都是90%,CES-D取临界值15时灵敏性大于80%,特异性72.6%。HADS-D在临界值9分时灵敏性和特异性均大于80%,而HADS-D临界值7分的敏感性91.3%,特异性76.8%。三个量表的阴性预测值都大于90%,ROC曲线下面积的比较没有统计学差异(均P0.05)。结论 HADS-D是一种对癫痫伴抑郁更简洁、方便有效的筛查工具。     

Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiologic Studies Depression Scale

This study examined the inter-observer reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a measure of depressive symptomatology in stroke patients, and its utility as a screening tool for depression in this population. The CES-D Scale is a brief questionnaire originally designed for use in community surveys. Twenty-seven non-aphasic patients enrolled in the Stroke Data Bank at the University of Maryland were interviewed by a research nurse using the CES-D. On the same day, each patient was independently evaluated by a research assistant using a psychiatric battery for depression and measures of cognitive, physical, and social functioning. Forty-one percent (11/27) of the patients were depressed according to clinical criteria for major or minor depression. With a cutpoint corresponding to the upper (most severe) 20% in community surveys, the CES-D Scale picked up 73% (8/11) of the depressed patients. In this sample no nondepressed patient scored over 16 on the CES-D (no false positives). The CES-D Scale scores correlated significantly with the other depression measures (r = .57 to r = .82, p less than .002) and did not correlate with the measures of cognitive, physical, or social functioning. Based on 24 patients who received a CES-D Scale score from both the nurse and the research assistant, inter-rater reliability was high (r = .76, p less than .001). Thus, the CES-D was found to be reliable and valid as a screening tool for assessing depression in stroke patients.     

Depressionshäufigkeit in Abhängigkeit von verschiedenen Erkrankungen bei geriatrischen Patienten

The higher prevalence of depression in specific diseases and older persons is discussed. This prevalence varies greatly according to the method used to collect data. A risk group can only be defined if information on diseases and other influencing factors are collected uniformly. The target diagnoses Parkinson's disease, stroke, myocardial infarction, cancer, diabetes mellitus, chronic pain, multiple infarct syndrome, Alzheimer's and other dementia were recorded from 1208 geriatric patients of the ZAGF municipal hospital in Munich, Germany. Logistic regression was used to identify chronic pain as the main cofactor for an association with depression (clinical diagnoses by ICD-10) and depressive symptoms (via GDS [Geriatric Depression Scale]). This association was also found for multimorbid patients with chronic pain. Impairment of the activities of daily living and the clinical setting were important additional cofactors. Pain patients are therefore at higher risk for depression.     

听觉P300对血管性痴呆早期诊断及鉴别诊断的价值

目的探讨P300对血管性痴呆(VD)的早期诊断及与Alzheimer病(AD)鉴别的价值.方法分别对20名正常人(NC)、20例VD患者、24例无痴呆脑梗死患者(CI)及20例AD患者进行神经心理学量表长谷川智力量表(HDS)评分,并选用听觉oddball序列分别对上述各组进行P300测试.结果 (1)VD组与CI组及NC组比较,N2、P3潜伏期(PL)明显延长(均P<0.05);P3PL与HDS评分呈负相关(r=-0.686,P＜0.01),且较HDS更为敏感;梗死部位与P300变化有一定关系,梗死位于颞叶、额叶的患者与其他梗死部位的患者相比,P3PL异常率明显增高(P＜0.05).(2)AD组与VD组相比,N1 PL更长,差异有显著性(P<0.05).结论 (1)P300对VD的早期诊断具有重要意义.(2)N1PL在VD与AD的鉴别诊断中有一定的意义.     

Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample

OBJECTIVE: Previous research has shown high prevalence rates of depression in multiple sclerosis patients seen in specialty clinics. The relationships among depressive symptoms and severity, duration, and course of multiple sclerosis are controversial. METHOD: A survey was mailed to members of the Multiple Sclerosis Association of King County (Wash.). Of the 1,374 eligible participants, 739 returned the survey, a response rate of 53.8%. Data about demographic characteristics, employment, and duration and course of multiple sclerosis were collected. Severity of multiple sclerosis was determined by the Expanded Disability Status Scale, self-report version. Severity of depressive symptoms was evaluated with the Center for Epidemiologic Studies Depression Scale (CES-D Scale). Analysis of covariance was used to compare mean CES-D Scale scores across categories of multiple sclerosis, and logistic regression was used to identify variables associated with clinically significant depression. RESULTS: Clinically significant depressive symptoms (CES-D Scale score > or =16) were found in 41.8% of the subjects, and 29.1% of the subjects had moderate to severe depression (score > or =21). Subjects with advanced multiple sclerosis were much more likely to experience clinically significant depressive symptoms than subjects with minimal disease. Shorter duration of multiple sclerosis was associated with a greater likelihood of significant depressive symptoms, but the pattern of illness progression was not. CONCLUSIONS: In this large community sample, the severity of multiple sclerosis was more strongly associated with depressive symptoms than was pattern of illness. Clinicians should evaluate depression in patients with recent diagnoses of multiple sclerosis, major changes in functioning, or limited social support.     

Prevalence of seasonal affective disorder in Alaska.

OBJECTIVE: The goals of this study are to provide estimates of the prevalence of seasonal affective disorder in Alaska, to examine sociodemographic correlates, and to evaluate the relation between seasonal affective disorder and general depression. METHOD: A random sample of 283 residents of Fairbanks who had lived in Alaska for 3 years or more were interviewed with the Seasonal Pattern Assessment Questionnaire and the Center for Epidemiologic Studies Depression Scale (CES-D Scale). RESULTS: Twenty-six (9.2%) of the subjects met diagnostic criteria for seasonal affective disorder, one of the highest figures yet reported. These cyclic winter affective disorders occurred more often in women than men (ratio = 3:2) and were less prevalent among residents who were older than 40 years of age. Assessment of depression with the CES-D Scale supported the diagnostic classification of respondents and the differentiation of seasonal affective disorder from other depression. CONCLUSIONS: This study supports the conclusions that seasonal affective disorder is prevalent in northern populations and that sex and age may represent the major risk factors that differentiate it from the general experience of depression in northern communities.     

阿尔茨海默氏病与血管性痴呆临床特点的对照研究

目的比较阿尔茨海默氏病（AD）与血管性痴呆（VD）的临床特点。方法对39例AD和38例VD患者的精神行为症状特点、伴随的躯体疾病、头颅CT检查以及脑电图检查进行比较。结果AD组与VD组在幻觉、妄想等精神病性症状方面无明显差异,在抑郁、焦虑等情绪障碍以及行为脱抑制方面有显著差异;AD组伴随的躯体疾病无明显特异性,VD组多伴发高血压、冠心病;AD组头颅CT多表现为脑萎缩,VD组多表现为脑梗塞;脑电图检查AD组无明显特异性,VD组界限脑电图居多。结论AD与VD患者的BPSD及所伴随的躯体疾病可有不同特点,CT和脑电图的检查等对痴呆的诊断与鉴别诊断均具有重要价值。