CISA在老年痴呆患者中的应用

目的：探讨中国成人智力量表（ＣＩＳＡ）在老年痴呆患者中的临床应用价值。方法：采用ＣＩＳＡ、韦氏记忆量表（ＷＭＳ）、简易智力状态检查（ＭＭＳＥ）、老年抑郁量表（ＧＤＳ）、长谷川痴呆量表（ＨＤＳ）和日常生活能力量表（ＡＤＬ）等分别用于测验老年痴呆组和正常老年组。结果：两组被试在ＣＩＳＡ各量表分、智商和因素商均有明显差异,老年痴呆组的ＣＩＳＡ各量表分与ＷＭＳ的ＭＱ、ＧＤＳ、ＨＤＳ和ＡＤＬ均有明显相关。结论：ＣＩＳＡ在应用于老年痴呆患者中具有较高的效度,能够反映患者的智力状部和智力因素的各个方面,他们学习新知识和解决问题的能力下降速度较快。     

茴拉西坦治疗62例Alzheimer′s病的临床疗效

目的 观察茴拉西坦片剂治疗６２例Ａｌｚｅｉｍｅｒ′ｓ病的临床疗效，方法 茴拉西坦２００ｍｇ～３００ｍｇ，ｐｏ，ｔｉｄ疗程２日。结果 总有效率７２．５８％，其中轻度痴呆９０％，中度痴呆为６６．２９％，各量表治疗前后平均分值均有显著差异，（Ｐ〈０．０１），其中ＨＤＳ－Ｒ，ＭＭＳＥ，ＡＤＬ治疗前事各提高约４．５分ＷＡＩＳ和ＷＭＳ分别提高５．８分和１０分。治疗中仅有轻度口干，便泌，嗜睡副反应，能自行消失，     

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．     

对97例脑梗塞后痴呆的危险因素分析

目的 探讨脑梗塞后血管性痴呆（ＶＤ）的发生率及其危险因素。方法 采用简易智力状态检查表（ＭＭＳＥ）和流调用抑郁自评量表（ＣＥＳ－Ｄ）;对９７例住院脑便塞病人进行筛选与检测。对其中认知受损者则采用日常生活能力量表（ＡＤＬ）和Ｈａｃｈｉｎｃｋｉ缺血指数量表（ＨＩＳ）进上步检测。并对痴呆组５和非痴呆组病人的临床资料进行统计分析。结果 （１）２７例确诊为ＶＤ,ＶＤ发生率为２７．８４％,≥６５岁为３４．３３     

腔隙梗塞脑白质疏松非痴呆患者血浆生长抑素含量的初步研究

分别对２６例多发性腔隙梗塞（ＭＬＩ）并存脑白质疏松（ＬＡ），２６例ＭＬＩ无ＬＡ患者及２０名健康人的认知功能和血浆ＳＳ含量进行了测定。结果显示：ＬＡ组得分和血浆ＳＳ含量比ＭＬＩ组和对照组明显降低（Ｐ＜０．０５）。提示这种与脑血管疾病相关的ＬＡ患者，存在着认识障碍，在诊断痴呆之前，体内ＳＳ含量就已出现降低。     

慢性疼痛与器质性疼痛心理学特征的对照研究

目的 旨在探讨慢性疼痛与器质性疼痛心理学特征的差异。方法 采用ＳＣＬ－９０、ＬＥＳ、ＳＳＲＳ、ＤＳＱ、ＨＡＭＤ、ＨＡＭＡ等尽理学量表对５９例慢性疼痛（ＣＰ）与５０例器质性疼痛（ＯＰ）患者进行对照研究,并用ｔ检验对数据进行统计分析。结果 与ＯＰ组相比较,ＣＰ组有较多的生活支持相对缺乏,较易动用不成熟防御方式,有明显的抑郁、焦虑情绪。结论 慢性疼痛与心理社会因素密切相关。     

Parkinson病患者载脂蛋白E基因多态性分布的研究

部分帕金森病(ＰＤ)患者在病程中出现痴呆,而阿尔茨海默病(ＡＤ)是否存在共同的发病机制或有某种内在的联系?为探讨这一问题,我们用聚合酶链反应限制片段长度多态性(ＰＣＲＲＦＬＰ)方法检测了ＰＤ77例、ＡＤ68例及正常老年人73名的载脂蛋白Ｅ(ａｐｏＥ)基因的多态性分布。现将结果报道如下。资料:　ＡＤ组68例,男22例,女46例,平均年龄(79.6±8.1)岁。全部病例从广州市老人院中筛选,。应用细微精神状态检查(ＭＭＳＥ)、汉密尔顿忧郁量表(ＨＤＳＲ)、日常生活活动量表(ＡＤＬ)初筛有痴呆,Ｈａｃｈｉｎｓｋｉ缺血指数<4分,采用ＡＤＲＤＡＮＩ…     

阿欠茨海默病的Aβ表达与APOE,PS1基因的相关分析

目的 研究阿尔茨海默病的ＡＰＰ基因中Ａβ表达量与载脂蛋白Ｅ（ＡＰＯＥ）基因和早老素１（ＰＳ１）基因间相互关系。方法 应用竞争ＲＴ－ＰＣＲ技术,测定５２例ＡＤ患者,２８例血管性痴呆（ＶＤ）患者及６０名健康老人的外周单核血细胞中Ａβ相对半定量表达量,以及采用ＰＣＲ－ＲＦＬＰ方法检测所有研究对象的ＡＰＯＥ基因和ＰＳ１基因的多态性分布。疾病诊断按ＤＳＭⅢ－Ｒ标准。结果 ＡＰＯＥε４等位基因和ＰＳ１的各种     

痴呆患者423例MMSE和BBS测试结果分析

为了深入探讨智能的亚项及其影响因素，对临床诊断为痴呆的４２３例患者进行了简易精神状态检查表（ＭＭＳＥ）和Ｂｌｅｓｅｄ行为量表（ＢＢＳ）的测试，应用多元回归分析、相关分析及ｔ检验对测试结果进行了智能亚项及其影响因素的深入分析。结果显示：文化程度与ＭＭＳＥ总分及其４个智能亚项（认知、记忆、语言、运用和视空间技能）和ＢＢＳ总分均有密切关系（Ｐ＜０．００１）；ＭＭＳＥ总分及其４个智能亚项和ＢＢＳ总分各项之间均密切相关（Ｐ＜０．００１）；轻度和中度痴呆患者两组间各智能亚项差异显著（Ｐ＜０．００１）。结论：ＭＭＳＥ和ＢＢＳ结合使用是评价痴呆的好方法。各智能亚项均能反映痴呆的程度。文化程度为影响痴呆患者智能的最主要的和独立的因素。     

社区老人Blessed痴呆量表5年随访分析

目的 分析社区老人５年间Ｂｌｅｓｓｅｄ痴呆量表（ＢＤＳ）总分的变化情况及其影响因素。方法 ８１０名初检时正常的社区老人５年后再次完成ＢＤＳ测验。按ＤＳＭ－Ⅲ－Ｒ诊断痴呆。结果 （１）痴呆组平均每年下降３．３分；非痴呆组每年下降０．３６分；（２）痴呆组在不同年龄、教育程度、性别的认知减退速度均高于非痴呆组；（３）ＢＤＳ可以分成以下４个因子：时间定向、地点定向、记忆能力。结论 ＢＤＳ在老人的认知损害评     

Activities of daily living performance in dementia

OBJECTIVE: To explore the activities of daily living ADL performance profile of community-living people with dementia and to investigate its relationship with dementia severity. MATERIALS & METHODS: ADL performance of 86 subjects were evaluated using Barthel Index (BI), Lawton and Brody's Instrumental Activities Daily Living (IADL) and Assessment of Motor and Process Skills (AMPS). Dementia severity was measured by Clinical Dementia Rating (CDR). RESULTS: Subjects were able to perform most basic ADL (BI mean = 16.4) and some IADL (Lawton and Brody's IADL mean = 4.3). The AMPS process ability measure and the Lawton and Brody's IADL were significantly correlated with CDR (P < 0.01). CONCLUSIONS: Subjects with mild dementia were able to perform mostly all basic ADL and some IADL. The AMPS process ability measure and the Lawton and Brody's IADL could provide useful information on their ability to live independently in the community.     

Clinical experience with the nosger (nurses' observation scale for geriatric patients): Tentative normative data and sensitivity to change

The NOSGER is an assessment instrument used in psychogeriatrics, consisting of 30 observable items of behaviour and measuring impairments in six areas: memory, IADL (instrumental activities of daily living), ADL (activities of daily living), mood, social behaviour and disturbing behaviour. Data collected in the course of validation studies were reanalysed to calculate tentative normative scores and to assess the scale's sensitivity to change. Cutoff scores for elderly normal subjects living in the community are estimated around 10 for ADL and around 15 for memory and IADL disturbances. Cutoff values for the three non-cognitive NOSGER dimensions are not yet available. Sensitivity to change (over 3 months) was shown to be relatively highest for memory, IADL and disturbing behaviour and lowest for ADL in a group of patients with mild to moderate dementia. Correlations between NOSGER change scores and physicians- overall assessments of treatment efficacy in a drug study were highest for social behaviour, IADL and mood, suggesting that non-cognitive factors were at least as important to determine doctors- assessments of change as changes in cognitive areas of behaviour. Further studies are on their way to supplement the present data set.     

Perturbations of activities of daily living in Alzheimer's disease. A study of 172 patients with the using a questionnaire completed by caregivers

Functional decline was studied retrospectively in 172 patients with Alzheimer's disease, AD, using a questionnaire completed by the caregiver. Ninety-nine of these patients had a second assessment after a follow-up of 22.1 +/- 13.8 months. The questionnaire included French versions of the Physical Self-Maintenance Activities, ADL, and of the Instrumental Activities of Daily Living, IADL (Lawton and Brody, 1969). A third part assessing social activities, SADL, was derived from Katz and Lyerly (1963). The earliest and most frequent perturbations in early AD involved SADL, mainly a reduction in social and leisure activities, appearing in subjects with a MMSE score > 26. The earliest decline in IADL involved the ability for handling finances, odd jobs-sewing, and shopping, which were more frequently perturbed than ability to use telephone, traveling or handling medication. The most interesting results of our study were as follows. Functional decline did not allow to distinguish patients with early AD (MMSE score > or = 24) from those with mild dementia (MMSE score 20-23). Mild perturbations of ADL, mainly dressing and walking, were observed in early AD. There was a good correlation, but no parallelism, between functional decline and cognitive decline. Disturbances in ADL and SADL significantly differed only between patients with severe dementia (MMSE < 10) and those of the three other groups. Apathy appeared to be a stronger predictor of functional decline than the score on the MMSE in the early stages of AD. There was a great variability among the patients regarding the type of functional decline as well as the rate of decline. Functional decline is very useful for detecting early AD. However, its specificity seems to be low and the diagnosis should be supported by cognitive assessment.     

An examination of instrumental activities of daily living assessment in older adults and mild cognitive impairment

Basic activities of daily living (ADL) are self-maintenance abilities such as dressing or bathing. Instrumental ADL (IADL) are more complex everyday tasks, such as preparing a meal or managing finances (Lawton & Brody, 1969). IADL questionnaires play an important role in assessing the functional abilities of older adults and evaluating the impact of cognitive impairment on routine activities. This paper examined the cognitive processes that underlie IADL performance and concluded that the accurate and reliable execution of IADL likely draws upon the integrity of a wide range of cognitive processes. This review examined IADL in mild cognitive impairment (MCI) because of the controversial nature of distinguishing a significant decline in functional abilities in those with MCI versus dementia or MCI versus cognitively normal aging. The challenges of investigating IADL empirically were explored, as well as some of the reasons for the inconsistent findings in the literature. A review of questionnaire-based assessments of IADL indicated that: MCI can be distinguished statistically from healthy older adults and dementia, individuals with multiple domain MCI are more impaired on IADL than those with single domain MCI, mild IADL changes can be predictive of future cognitive decline, and the ability to manage finances may be among the earliest IADL changes in MCI and a strong predictor of conversion to dementia. This paper concluded with recommendations for more sensitive and reliable IADL questionnaires.     

Clock drawing test in mild and moderate dementia of the Alzheimer's type: a comparative and correlation study

OBJECTIVES: (a) To compare two different clock drawing tests (CDTs) in mild and moderate dementia of the Alzheimer's type (DAT); (b) To examine presumed correlation between these CDTs and some demographic, cognitive and activities of daily living (ADL) variables in mild and moderate DAT. METHODS: Cross-sectional study. Psychogeriatric outpatient clinic. 49 DAT patients, total; 26-mild, 23-moderate, mean age 77.8 and 80.6, respectively.Evaluations included the Mini-Mental State Examination (MMSE), the Cambridge Cognitive Examination (CAMCOG), the Instrumental Activities of Daily Living Scale (IADL), and a Basic Activities of Daily Living (BADL)-dressing subscale. Severity of dementia was determined with the Clinical Dementia Rating (CDR). Each clock was blindly scored by the same investigator, according to Shulman's and Freedman's methods. RESULTS: Mild and moderate DAT groups were similar in age, gender and education. Performance on Shulman's clock was similar between groups while moderate DAT subjects performed significantly worse on Freedman's clock compared to mild DAT patients. Both clocks correlated highly in mild and moderate DAT. CDT scores correlated significantly with age and education only in mild DAT. Neither clock correlated with ADLs in either stage of dementia severity. CDTs correlated with the MMSE score, and the CAMCOG score in mild DAT, and only with the CAMCOG score in moderate DAT. These correlations were still significant after controlling for age and education. CONCLUSIONS: Different aspects of cognition and dementia severity are reflected depending on how a clock drawing is scored. Some scoring systems may have greater sensitivity than others in monitoring progression of cognitive deterioration. Correlation between different CDTs and the variables studied (demographic, cognitive, ADLs), when present, is not ubiqitous and changes with the dementia severity.     

Instrumental activities of daily living: a stepping-stone towards Alzheimer's disease diagnosis in subjects with mild cognitive impairment?

This paper challenges the requirements of normal activities of daily living/instrumental activities of daily living (ADL/IADL) functioning in mild cognitive impairment and stresses the need for further research and assessment refinement. Although people who develop dementia seem to experience subtle changes in complex IADLs long before the disease onset, studies that compare cognitively mildly impaired subjects with demented and nondemented subjects present no clear consensus regarding differentiation according to IADL ability. The traditional ADL/IADL assessment instruments and techniques seem to present a major problem when the purpose is to predict or differentiate between diagnoses. It is therefore argued that the diagnosis of MCI should include rather than exclude observed or experienced changes in complex everyday life activities.     

Detailed assessment of activities of daily living in moderate to severe Alzheimer's disease.

Patients with Alzheimer's Disease (AD) who have reached a stage of moderate to severe dementia are capable of completing a restricted range of cognitive tests and performing a limited range of activities of daily living (ADL). As part of an initiative to develop instruments to evaluate AD, we analyzed data describing the performance of a large number of ADL and scores on cognitive and global assessment measures in a cohort of patients with AD with moderate to severe cognitive impairment, defined as a Mini-Mental State Examination score ranging from 0-15 (out of 30). From the large pool of ADL, 19 met criteria of applicability, reliability, good scaling, concordant validity, and sensitivity to detect change in performance over 6-12 months. A total score derived from these 19 ADL ratings, comprising a scale termed the Alzheimer Disease Cooperative Study ADL-sev, correlated strongly with measures of cognition and of global dementia severity. Patients with moderate to severe AD showed a decline on the ADL-sev and cognitive measures over 6 and 12 months, consistent with the progression of AD. Detailed evaluation of ADL may provide a useful index to evaluate patients with moderate to severe AD and may complement cognitive assessment, especially for characterizing change in interventional or therapeutic studies.     

Neuropsychiatric symptoms and functional status in Alzheimer's disease and vascular dementia patients

Neuropsychiatric symptoms (NPS) are increasingly recognized as common in patients with dementia, both of degenerative (Alzheimer's disease, AD) or vascular origin (vascular dementia, VaD). In this study, 302 demented patients, 166 with AD and 136 with VaD, were evaluated for NPS according to the Neuropsychiatric Inventory (NPI) score at the Alzheimer's Evaluation Unit of Casa Sollievo della Sofferenza Hospital-IRCCS, San Giovanni Rotondo, Italy. A comprehensive geriatric assessment was also performed in all demented patients. The means of NPI scores did not differ in two groups. The overall prevalence of NPS was similar in both groups of patients (69.7% vs. 69.4%). Patients with AD had higher frequency in agitation/aggression and irritability/lability than VaD patients. Logistic analysis demonstrated a significant association between severity of the cognitive impairment and depression and eating disorders in both AD and VaD patients. The association with agitation/aggression, irritability/lability, and aberrant motor activity was found in AD only, and with apathy in VaD patients only. In both AD and VaD patients, there was a significant association between the impairment in activities of daily living (ADL) and the majority of NPI domains. A significant association was also found between the impairment of the instrumental activities of daily living (IADL) and agitation/aggression, anxiety, aberrant motor activity in AD and depression, apathy, irritability/lability, sleep disturbance and eating disorders in both AD and VaD patients. In particular, a causal mediation analysis was performed to better understand whether the relationship of NPS to functional impairment was direct or mediated by severity of cognitive dysfunction, i.e., Clinical dementia rating scale (CDR) score. Only agitation/aggression was mediated by the CDR score in affecting ADL status in VaD patients (OR: 1.12, 95% CI: 1.01-1.27). The NPI-Distress scores showed a significantly higher levels of distress in caregivers of AD than VaD. There were significant differences between AD and VaD patients with NPS, and these symptoms varied according to dementia subtype and severity and induced marked disability in ADL and IADL, increasing, prevalently, the distress of the caregivers of AD patients.     

An 18-month prospective cohort study of functional outcome of delirium in elderly patients: activities of daily living

OBJECTIVES: To examine delirium, chronic medical problems and sociodemographic factors as predictors of activities of daily living (ADL), basic ADL (BADL) and instrumental ADL (IADL). METHODS: A prospective cohort study of four groups of elderly patients examined in the emergency department (ED): those with delirium, dementia, neither, and both. All were aged 66 years or older and living at home. Delirium was assessed with the Confusion Assessment Method and dementia with the Informant Questionnaire on Cognitive Decline in the Elderly. Demographic variables and chronic medical problems were ascertained with questionnaires. Outcome was ADL at 6, 12 and 18 months, measured with the ADL subscale of the Older Americans Resources and Services instrument. RESULTS: Univariate analyses suggested significantly poorer ADL, particularly IADL, at 18 months in the delirium versus the non-delirium group, in the absence of dementia only. Statistically significant independent predictors of poorer ADL at 18 months in the non-dementia groups were poorer initial ADL, stroke, Parkinson's disease, hypertension and female sex. Independent predictors of poorer BADL at 18 months in the non-dementia groups were poorer initial BADL, Parkinson's disease, stroke, cancer, colds/sinusitis/laryngitis, female sex and hypertension. Independent predictors of poorer IADL at 18 months in the non-dementia groups were poorer initial IADL, stroke, never-married status, colds/sinusitis/laryngitis, arthritis and hypertension, with Parkinson's disease showing a non-significant but numerically large regression coefficient. CONCLUSION: Rather than finding delirium to be a predictor of poorer functional outcome among survivors, we found an interaction between delirium and dementia and several plausible confounders, primarily chronic medical problems, although we cannot rule out the effect of misclassification or survivor bias.     

Limitations in activities of daily living and instrumental activities of daily living capacity in a representative sample: disentangling dementia- and mobility-related effects

A representative sample of the Leipzig population aged 75 years and older showed 61.8% of the participants with relevant deficits in their capacity for independent living, according to a combined activities of daily living/instrumental activities of daily living (ADL/IADL) scale. The quantity and quality of care needed almost exponentially increases above 85 years of age. Looking at potential reasons for ADL/IADL limitations, 44% of variance in single ADL/IADL activities and 75% of the combined ADL/IADL sum score could come from a minimal set of predictor variables. Most important are dementia- or mobility-related declines, but living conditions also explain small but significant amounts of variance. These seem initially impressive, yet analyses showed about half the explained variances shared among the mobility and dementia indicators, limiting the use not only of ADL/IADL sum scores but of many single ADL/IADL items as well. Before deriving specific conclusions from variations in ADL/IADL instruments, one must note that the data suggest that interpretations of covariations--whether for health/mobility or dementia--are useful and substantial only if both indicators/predictors are verified. The information given captures the mobility- and dementia-related variance if ADL/IADL items, facilitating more specific scale developments.