老年房颤患者认知功能障碍分析

目的探讨老年房颤(AF)患者认知功能障碍特点。方法回顾性分析2016年1月至2017年12月首都医科大学附属北京友谊医院医疗保健中心心血管内科住院的老年患者165例,根据是否患有AF分为AF组83例和非AF组82例。通过蒙特利尔认知评估量表(Mo CA)和简易智能状态检查量表(MMSE)评估2组患者的认知功能。采用SPSS 24.0统计软件对数据进行分析。组间比较采用t检验、非参数秩和检验或χ2检验。结果 Mo CA评估结果表明AF组患者71.1%(59/83)存在认知功能障碍,非AF组患者56.10%(46/82)存在认知功能障碍,差异有统计学意义(P0.05)。与非AF组患者相比,AF组患者视空间与执行功能[(3.17±1.64)vs(3.96±1.23)分]、言语功能[(1.98±1.00)vs(2.34±0.95)分]、抽象思维[(1.27±0.75)vs(1.56±0.67)分]、定向力[(5.20±0.85)vs(5.50±1.10)分]得分以及总分[(20.27±6.83)vs(23.16±5.78)分]均低,差异有统计学意义(P0.05)。MMSE评估结果表明AF组患者31.3%(26/83)存在认知功能障碍,非AF组患者18.3%(15/82)存在认知功能障碍,差异有统计学意义(P0.05)。AF组相比非AF组患者时间定向[(3.92±1.60)vs(4.40±1.20)分]、地点定向[(4.66±0.89)vs(4.89±0.45)分]、注意和计算力[(3.39±1.80)vs(3.94±1.40)分]、物体命名[(1.98±0.15)vs(2.35±0.78)分]、图形描绘得分[(0.73±0.44)vs(0.90±0.30)分]以及总分[(24.90±5.87)vs(26.79±4.20)分]均低,差异有统计学意义(P0.05)。结论 AF患者认知功能障碍主要表现在视空间与执行功能、言语功能、抽象思维、时间和方向定向、注意和计算力、物体命名和图形描绘方面,极大影响老年人的日常生活,积极转复或维持AF患者窦房结节律,可提高患者的生活质量。     

多系统萎缩P型与帕金森病认知功能特点的临床研究

目的探讨多系统萎缩(MSA)-P型与帕金森病(PD)的临床特征和认知功能损害的异同。方法连续选择MSA-P型和PD患者共55例,根据诊断分为MSA-P组19例和PD组36例。详细收集年龄、病程、教育年限、统一PD评分量表第3部分(UPDRS-Ⅲ)及日常生活活动能力量表(ADL)评分等,用简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、韦氏智力及记忆力等进行神经心理评估,并进行比较分析。结果 MSA-P组的ADL及UPDRS-Ⅲ评分均显著高于PD组[(31.74±10.56)分vs(16.39±4.18)分;(43.79±16.99)分vs(28.72±15.14)分,P<0.05]。2组MMSE、MoCA总分比较,无统计学差异[(26.32±3.13)分vs(27.50±2.52)分;(20.42±5.00)分vs(22.56±4.80)分,P>0.05]。MSA-P组操作量表分及韦氏记忆量表分低于PD组[(30.32±9.91)分vs(37.28±9.09)分;(54.53±23.14)分vs(76.28±22.97)分,P<0.05];图形排列、积木测试和理解记忆评分低于PD组[(5.79±2.12)分vs(7.22±1.69)分;(6.16±3.06)分vs(8.17±2.78)分;(5.53±2.74)分vs(7.75±2.99),P<0.05]。结论 MSA-P型患者运动功能及日常生活能力恶化较PD快;其总体认知功能受损与PD类似,但执行功能、视空间和记忆力等的认知损害较PD严重。     

缺血性脑卒中患者急性高血压反应与脑卒中后认知功能障碍的相关性研究

目的探讨首次缺血性脑卒中患者急性高血压反应(acute hypertensive response,AHR)与脑卒中后认知功能障碍(post-stroke cognitive impairment,PSCI)的相关性。方法连续纳入2015年1月~2017年12月在成都军区总医院神经内科住院的发病≤24h的首发急性缺血性脑卒中患者170例,根据AHR定义分为AHR组118例,非AHR组52例。根据患者简易智能状态检查量表(MMSE)评分分为PSCI组91例,非PSCI 79例。发病后3个月对患者进行认知功能评估。结果 AHR组认知功能障碍发生率明显高于非AHR组(64.4%vs 28.8%,P0.01)。AHR组MMSE总分[(20.23±4.87)分vs(24.29±4.78)分,P=0.000]、即刻回忆[(1.97±0.80)分vs(2.69±0.61)分,P=0.000]、注意力和计算力[(3.02±1.57)分vs(3.60±1.62)分,P=0.030]、延迟回忆[(1.19±0.91)分vs(1.87±0.93)分,P=0.000]、视空间能力[(0.31±0.46)分vs(0.54±0.50)分,P=0.005]明显低于非AHR组。与非PSCI组比较,PSCI组收缩压、平均动脉压、脉压差、脑卒中后肺部感染、AHR发生率、AHR持续时间、改良Rankin量表评分明显升高,差异有统计学意义(P0.05,P0.01)。logistic回归分析显示,AHR为PSCI发生的独立危险因素(OR=3.835,95%CI:1.844~7.976,P=0.000)。结论 AHR是PSCI的危险因素,早期监测和干预可能改善脑卒中后患者的认知功能。     

早期康复治疗对脑卒中患者认知功能障碍及日常生活活动能力的影响

目的探讨早期康复治疗对脑卒中患者认知功能障碍的发生及疗效,并观察对患者日常生活活动能力(ADL)作用。方法选择120例脑卒中患者,随机分为对照组和治疗组,每组60例。分别于治疗前24h及治疗4周后采用简易智能状态检查量表(MMSE)、神经功能缺损评分量表(NDS)及Barthel指数(BI)进行评定。结果治疗4周后,治疗组认知功能障碍的发生率是15.25%,对照组为40.35%,2组比较差异有统计学意义(P<0.05);与对照组比较,治疗组的MMSE[(19.58±6.68)分vs(23.58±5.32)分]、NDS[(18.20±7.39)分vs(11.58±6.28)分]和BI[(49.65±14.90)分vs(75.68±22.32)分]评分明显改善(P<0.05)。结论早期康复训练干预可减少脑卒中后认知功能障碍的发生,能改善脑卒中患者认知能力,提高ADL,促进患者神经功能康复。     

针刺联合丁基苯酞胶囊对血管性痴呆患者认知功能及MRI成像的影响

目的:探讨针刺联合丁基苯酞软胶囊对血管性痴呆患者认知功能及头颅磁共振(MRI)成像的影响。方法:选择我院收治的血管性痴呆患者94例作为研究对象,随机分为丁基苯酞组(丁基苯酞软胶囊治疗)和联合治疗组(在丁基苯酞组基础上配合针刺心包经穴位治疗),各47例,两组均给予控制血压、血脂、抗感染等基础干预,连续治疗8周。观察两组患者的临床疗效及不良反应发生情况,采用简易精神状态检查量表(MMSE)、临床痴呆量表(CDR)评定认知功能,测量头颅MRI相关指标并检测血浆生长抑素(SS)、精氨酸加压素(AVP)水平。结果:治疗后,与丁基苯酞组比较,联合治疗组临床有效率(78.72%比93.62%)显著提高(P=0.036);MMSE评分[(19.18±3.24)分比(21.15±4.11)分]显著增加,CDR评分[(1.51±0.26)分比(1.37±0.28)分]显著降低(P均0.05);MRI指标中三脑室宽度[(1.12±0.13)cm比(1.03±0.19)cm]显著减小,前角指数[(3.08±0.96)比(3.54±0.85)]、侧脑室体部宽度指数[(3.19±0.18)比(3.32±0.21)]显著增加(P0.05或0.01);血浆SS[(133.59±10.11) pg/ml比(139.14±10.56) pg/ml]、AVP[(35.37±9.12) pg/ml比(40.25±8.08) pg/ml]水平均显著升高(P0.05或0.01);两组均未出现严重不良反应。结论:针刺联合丁基苯酞软胶囊治疗可显著改善血管性痴呆患者认知功能及血浆SS、AVP水平,抑制脑室扩张,促进脑功能恢复,且安全性高。     

帕金森病患者伴发体位性低血压的特点及其对认知功能的影响北大核心CSCD

目的探讨帕金森病(PD)患者伴发体位性低血压(OH)的特点及其对认知功能的影响。方法连续收集北京天坛医院210例PD患者,记录人口学资料及临床特征。测量患者的立卧位血压,按照是否伴发OH分为PD伴发OH(PD-OH)组和PD不伴发OH(PD-NOH)组。采用简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评价患者的认知功能。结果在210例PD患者中,68例伴发OH,OH的发生率为32.4%。PD-OH组与PD-NOH组相比,年龄更大[(69.7±8.9)岁比(62.1±11.3)岁],病程更长[5.0(3.0~8.0)年比4.0(2.0~6.0)年],合并糖尿病的患者更多(30.9%比17.4%),空腹血糖更高[(5.3±1.1)mmol/L比(5.0±1.0)mmol/L],糖化血红蛋白水平更高[(6.1±0.9)%比(5.7±0.7)%],H-Y分期更高[2.5(2.0~3.0)期比2.0(1.5~2.5)期](P<0.05)。PD-OH组患者MMSE量表总分及MoCA量表总分均较PD-NOH组明显下降[(25.1±4.9)分比(26.8±4.0)分;(19.4±5.4)分比(21.4±5.3)分](P<0.05)。两组患者MMSE量表各分项评分比较,PD-OH组患者注意力和计算力[(3.7±1.7)分比(4.2±1.3)分]、延迟回忆[(2.1±1.0)分比(2.5±0.8)分]及图形复制评分[(0.6±0.5)分比(0.7±0.5)分]均明显下降(P<0.05)。MoCA量表各分项评分比较,PD-OH组患者视空间和执行功能[(2.4±1.6)分比(2.9±1.7)分]、延迟回忆力评分[(1.3±1.4)分比(2.3±1.6)分]较PD-NOH组明显下降(P<0.05)。Logistic回归分析显示,年龄(OR=1.061,95%CI:1.022~1.102,P=0.002)和MoCA量表的延迟回忆评分(OR=0.690,95%CI:0.498~0.955,P=0.025)是PD-OH的独立相关因素。结论PD-OH患者年龄更大,病程更长,病情更重,合并糖尿病更多、程度更重,高龄是PD-OH的独立相关因素。PD-OH患者认知功能明显受损,延迟回忆下降是PD-OH的独立相关因素。     

园艺疗法对轻-中度阿尔茨海默病患者认知功能和生活质量的影响

目的评价园艺疗法(HT)对轻-中度阿尔茨海默病(AD)患者认知功能和生活质量的影响。方法选取2014年12月至2016年12月北京老年医院住院部及门诊部轻-中度AD患者130例,随机分为对照组65例和HT组65例。对照组给予常规多奈哌齐联合尼麦角林口服治疗,HT组患者在常规治疗基础上,进行HT。分别于治疗前、治疗3个月和6个月时,使用简易精神状态评价量表(MMSE)和生活质量综合评定问卷(GQOL-74)对患者进行评估。采用SPSS 19.0软件对数据进行统计分析。根据数据类型,组间比较采用独立样本t检验或χ~2检验,组内比较采用重复测量方差分析。结果对照组治疗6个月MMSE总评分较治疗前显著升高,差异有统计学意义(P0.05);HT组患者治疗3、6个月语言功能、记忆力、回忆力及MMSE总评分较治疗前均显著升高,差异有统计学意义(P0.05)。与对照组比较,HT组患者3、6个月语言功能[(6.89±1.46)vs(5.21±2.36)分,(8.82±1.22)vs(6.80±1.49)分]、记忆力[(3.47±0.48)vs(2.04±0.65)分,(4.02±1.06)vs(2.92±0.86)分]、回忆力[(2.73±0.59)vs(1.03±0.78)分,(3.24±0.72)vs(2.24±0.92)分]及MMSE总评分[(20.82±1.35)vs(16.78±1.46)分,(24.02±2.20)vs(18.92±2.15)分]显著提高,差异有统计学意义(P0.05)。HT患者治疗3、6个月社会功能、心理功能、躯体功能及GQOL-74总评分较治疗前均显著升高,差异有统计学意义(P0.05);与对照组比较,HT组患者治疗3个月社会功能评分显著提高,差异有统计学意义[(67.02±7.51)vs(63.28±9.52)分,P0.05],治疗6个月社会功能[(69.33±6.94)vs(64.19±11.25)分]、心理功能[(57.12±13.07)vs(52.12±9.08)分]、躯体功能[(72.38±8.32)vs(66.85±10.08)分]及GQOL-74总评分[(68.46±9.34)vs(63.95±10.11)分]均明显升高,差异有统计学意义(P0.05)。结论 HT联合常规药物治疗可能改善轻-中度AD患者认知功能,提高生活质量,具有重要的临床推广意义。     

外翻式颈内动脉内膜斑块切除术对老年颈动脉狭窄患者认知功能的影响

目的 探讨外翻式颈内动脉内膜斑块切除术(eCEA)对不同年龄段老年颈动脉狭窄患者认知功能的影响。方法 选取2019年5月至2022年5月解放军联勤保障部队第九二〇医院血管外科行eCEA的老年患者56例,根据年龄分为60～69岁组31例,70～80岁组25例。采用简易智能状态检查量表(MMSE)评分对2组患者术前1周内、术后1个月、6个月进行分析。结果 60～69岁组术后1个月、6个月MMSE评分较术前明显增高[(24.71±3.67)分vs(23.52±3.70)分,P<0.05;(25.48±3.19)分vs(23.52±3.70)分,P<0.01]。70～80岁组术后6个月MMSE评分较术前、术后1个月明显增高[(25.44±3.42)分vs(23.76±3.81)分,P<0.01;(25.44±3.42)分vs(23.90±3.65)分,P<0.01]。60～69岁组术后1个月-术前MMSE评分改善程度较70～80岁组明显增高,术后6个月-术后1个月MMSE评分改善程度较70～80岁组明显降低,差异有统计学意义(P<0.05)。结论 老年颈动脉狭窄患...     

2型糖尿病对老年人群认知功能的影响

目的了解T2DM对老年人群认知功能的影响。方法选取T2DM患者(T2DM组)69例与非糖尿病者(N-DM组)73例,分析蒙特利尔认知评估(MoCA)量表和简明智能精神状态检查(MMSE)量表的检测结果,比较认知功能障碍合并或未合并T2DM的认知检查差异。结果两组MoCA量表检查中,短时记忆[(2.8±1.6)vs(3.3±1.3)分,P0.05]和画钟试验[(3.1±1.2)vs(3.4±1.0)分,P=0.054]较差。认知功能障碍患者中T2DM组认知功能损害范围更广。MoCA量表的延迟记忆以3分为界时,诊断认知功能障碍Kappa值0.831。结论 T2DM对老年人群认知功能的影响主要表现在记忆力上,并对认知能力造成广泛损害。MoCA量表的延迟记忆可作为简易筛查认知功能障碍的方法。     

老年血脂异常患者轻度认知功能障碍与Klotho蛋白的相关性研究

目的探讨老年血脂异常患者轻度认知功能障碍(MCI)与血浆Klotho蛋白浓度的关系。方法选取我院健康查体老年人300例,根据血脂水平分为血脂正常组79例和血脂异常组221例,患者根据简易智能状态检查量表(MMSE)评分,血脂异常组中MCI 156例和认知正常65例,血脂正常组中MCI 53例和认知正常26例。所有入选者检测血浆Klotho蛋白,分析MMSE评分与Klotho蛋白的相关性。结果血脂异常组中的MCI患者TC[(4.58±1.09)mmol/L vs(4.35±1.17)mmol/L]、TG[(2.18±1.38)mmol/L vs(1.91±1.09)mmol/L]、LDL[(3.25±0.55)mmol/L vs(2.95±0.32)mmol/L]较认知正常者均升高,HDL[(1.08±0.36)mmol/L vs(1.38±0.59)mmol/L]较认知正常者降低,差异有统计学意义(P0.05)。血脂异常组患者MMSE评分[(25.5±3.2)分vs(27.3±1.2)分,P=0.032]和Klotho蛋白浓度明显低于血脂正常组,差异有统计学意义[(1.8±1.4)μg/L vs(3.3±1.2)μg/L,P=0.019]。MMSE评分与TC、LDL、Klotho蛋白浓度呈负相关(r=-0.235,-0.176,-0.167),与HDL呈正相关(r=0.152,P0.05,P0.01)。结论血脂异常患者Klotho蛋白浓度明显降低,并且与MCI存在相关性,Klotho可能为早期预防及干预MCI的发生发展提供新的治疗手段。     

蒙特利尔认知评估量表在军队离退休人员轻度认知功能障碍中的应用

目的应用蒙特利尔认知评估（MOCA）量表对西安地区军队离退休人员进行轻度认知功能障碍（MCI）的筛查。方法随机、整群抽样选取西安市9个干休所304名离退休干部,同时进行个人信息、患病情况、MOCA量表、简易智能状态检查（MMSE）量表、日常活动能力（ADL）量表、抑郁自评（CES-D）量表、匹兹堡睡眠质量（PSQI）量表调查。结果西安干休所离退休干部MCI发生率为64．8％;80岁以上老年人MCI的发生率高于70岁组（P〈0．05）;教育年限小于6年者MCI的发生率高于7～12年及12年以上者（P〈0．05）;不参加体育锻炼者MCI的发生率高于经常参加体育锻炼者（P〈0．01）;有脑卒中者MCI的发生率高于无脑卒中者（P〈0．05）;MOCA量表得分与MMSE量表得分呈正相关（r=0．81）,与ADL量表、CES-D量表得分呈负相关,与PSQI量表得分无显著相关。结论MOCA量表与相关评估量表具有相关性,测量方便,可行性好,能够用于军队离退休干部人群中MCI的筛查。     

Characteristics of cognitive function in early and late stages of amnestic mild cognitive impairment

Aim: The detection of the early stages in amnesic mild cognitive impairment (aMCI) is considered important in diagnosing progression to Alzheimer's disease. The current study sought to investigate differences in cognitive function between control subjects with no memory loss (control), and subjects in the early stage of aMCI (EMCI) and late stage of aMCI (LMCI). Methods: A total of 100 community‐dwelling older adults aged 65 years and over were recruited from 1543 potential subjects. Subjects were classified into three groups based on the degree of objective memory impairment; control (n = 29), EMCI (n = 34) and LMCI (n = 37). Multiple neuropsychological tests were carried out to examine cognitive function. Results: The EMCI individuals showed lower cognitive function relative to controls; not only in logical memory, but also in letter fluency (P < 0.05). There were no significant differences in neuropsychological scores between the EMCI and LMCI groups, except for category fluency and logical memory. In addition, the EMCI subjects' logical memory score showed a significant relationship with letter fluency, category fluency and digit span backward test performance (P < 0.05). Conclusions: These results suggest that the application of multiple neuropsychological tests might be useful in diagnosing older adults with EMCI and LMCI. Geriatr Gerontol Int 2013; 13: 83–89 .     

The association between blood pressure components and cognitive functions and cognitive reserve

Objective: Hypertension exerts a subtle impact on the brain that is revealed by diminished cognitive function. This study aimed at evaluating the association between blood pressure components and cognitive functions and cognitive reserve. Methods: In this cross-sectional study, 500 subjects from general population were evaluated. All neuropsychological tests were negatively associated with age; memory and executive function were also positively related with education. Results: The hypertensives (HT) were less efficient than the normotensives (NT) in the test of memory with interference at 10?s (MI-10) (?32%, p?=?0.043), clock drawing test (CLOX) (?26%, p?<?0.001), and mini-mental state examination (MMSE) (?7.4%, p?=?0.02). Lower MMSE, MI-10, and CLOX were predicted by higher systolic (OR, 0.94, p?=?0.032; OR 0.96, p?<?0.001; OR 0.94, p?<?0.001) and higher pulse pressure (BP) (OR 0.95, p?=?0.04; OR 0.97, p?<?0.001; and OR 0.92, p?<?0.001). The cognitive reserve index (CRI) was 8% lower in the HT (p?=?0.04) and was predicted by higher pulse BP (OR 0.86, p?<?0.001). The BP vectors of lower MMSE, MI-10, and CLOX were directed towards higher values of systolic and diastolic BP, that of low CRI towards higher systolic and lower diastolic. Conclusion: This study contributes to the belief that a link exists between BP and cognition, higher values of systolic BP being associated to impaired cognitive function.     

Comparison of cognitive performance in mild cognitive impairment and dementia patients with that in normal children and adults

Background: It is well known that there is rapid cognitive development in childhood and cognitive decline during aging, but the volume of these changes using the same clinical tool is not well documented in the literature. The aim of our study was to investigate and compare the cognitive performance of mild cognitive impairment (MCI) and dementia patients with that of children, adolescents and adults, using a worldwide screening tool, the Mini Mental State Examination (MMSE), and considering the age, educational level and mental status of the participants. Methods: Our sample included 1364 Greek participants and consisted of normal children, adolescents, adults and non‐demented, MCI and demented elderly participants. Results: The variables of age, education and mental status influenced the participant's performance in the MMSE, but sex did not. The smallest variance of the MMSE score was found in 16–18‐year‐old adolescents, a big variance was found in 7–8‐year‐old children, while the biggest was in 71–90‐year‐olds. Alzheimer's disease (AD) participants performed poorer than the 7–8 years old children, though MCI participants showed similar cognitive performance to that age‐group. The participants with 7–9 years of schooling and those with more than 9 years had no significant difference in their MMSE performance. Conclusion: Comparing cognitive performance between subgroups, our results indicated that MCI patients have a similar cognitive performance to that of 7–8‐year‐old children and AD patients' a poorer one than that group. The significant years of cognitive decline in aging are the 56^th year, the 66 quinquennium, and the 7^th and 8^th decades. Geriatr Gerontol Int 2012; 12: 336–344.     

Self-reported driving,cognitive status,and physician awareness of cognitive impairment

OBJECTIVES: To assess self-reported driving rates in older people and correlate these data with cognitive status and physician recognition of cognitive impairment. DESIGN: Cross-sectional study. SETTING: A multiphysician private practice clinic in a primarily Asian-American community of Honolulu, Hawaii. PARTICIPANTS: Two hundred ninety-seven ambulatory patients aged 65 and older. MEASUREMENTS: Cognitive function was assessed by physician interview using the Cognitive Abilities Screening Instrument (CASI) and proxy informant data. Subjects' self-reported driving status. Outpatient medical records were reviewed. RESULTS: Sixty percent of the studied population reported that they currently drove. This rate decreased from 73.3% (148/202) for subjects with good CASI performance (CASI 282) to 37.5% (21/56) for subjects with intermediate CASI performance (CASI 74-81.9) and further to 23.7% (9/38)for subjects with poor CASI performance (CASI <74). Further analysis of drivers with intermediate and poor CASI performance scores revealed that almost none of their physicians recognized that these drivers had cognitive problems(4.8% (1/21) of drivers with intermediate CASI performance and 11.1% (1/9) of drivers with poor CASI performance). CONCLUSION: In this convenience sample of older drivers, driving rates dropped precipitously with poorer performance on cognitive tests, yet a significant percentage of individuals with intermediate or poor cognitive test performance reported that they currently drove. This poor performance was often unrecognized by their physicians. Low recognition rates could affect physicians' interventions to curb unsafe driving.     

Apolipoprotein e genotypes: relationship to cognitive functioning, cognitive decline, and survival in nonagenarians

OBJECTIVES: To evaluate the extent to which relationships between apolipoprotein E, cognitive functioning, and survival in people aged 60 to 80 persist into advanced old age. DESIGN: Examine the effect of apolipoprotein E genotypes on baseline cognitive functioning, cognitive decline over 5 years, and survival in a cohort of 1,551 nonagenarians. SETTING: The Danish 1905 birth cohort. PARTICIPANTS: One thousand five hundred fifty-one nonagenarians from the Danish 1905 birth cohort. MEASUREMENTS: Cognitive functioning was assessed using the Mini-Mental State Examination (MMSE) and five brief cognitive tests (cognitive composite). RESULTS: The subjects were stratified into four groups by occurrence of a protective (epsilon2) or a risk (epsilon4) apo E allele (epsilon22 and epsilon23, epsilon33, epsilon24 and epsilon34, epsilon44). At intake, the mean scores for the three genotype groups were 22.1, 21.8, 21.4, and 21.0 for MMSE and 0.10, 0.07, -0.02, and 0.30 for the cognitive composite, respectively. Growth-curve analyses showed that, although individuals carrying at least one epsilon4 allele had slightly lower MMSE scores and declined slightly more rapidly over time, this effect was not statistically significant and was not apparent in scores on the cognitive composite. In subjects whose functioning was relatively well preserved (those still living and able to participate in the assessment, and whose cognitive functioning had declined less than 4 points on the MMSE), epsilon4 frequencies tended to decline at subsequent waves (P=.03, chi-square test for trend), but epsilon4 had no significant survival disadvantage (hazard ratio=1.11 (95% confidence interval=0.99-1.25; P=.07). CONCLUSION: Apo E genotype has a small effect on the probability of remaining a well-functioning nonagenarian but no separately detectable effect on cognitive functioning, cognitive decline, or survival.     

Hypoglycaemia and cognitive function

Acute hypoglycaemia impairs cerebral function, and available data indicate that cognitive performance becomes impaired at a blood glucose level of 2.6-3.0 mmol/l in healthy subjects. Methodological problems limit comparisons between studies, but in general complex tasks are more sensitive to hypoglycaemia than simple tasks, and some cognitive abilities are completely abolished. The onset of hypoglycaemic cognitive dysfunction is immediate, but recovery may be considerably delayed. There is persuasive evidence of adaptation to hypoglycaemia, partly due to increased brain glucose uptake capacity, although other mechanisms may exist. Patients who are exposed to chronic or recurrent hypoglycaemia become remarkably tolerant to the state, but this is insufficient to prevent severe hypoglycaemia with neuroglycopenic decompensation, probably because symptomatic and counterregulatory responses adapt even more. During experimental hypoglycaemia, administration of non-glucose cerebral fuels preserves cognitive function. However, little progress has been made as yet towards protecting cognitive function during hypoglycaemia in clinical practice. The chronic effects of recurrent hypoglycaemia remain contentious. There are numerous case reports of hypoglycaemic brain damage and of cognitive deterioration attributed to repeated severe hypoglycaemia. The major prospective studies, including the Diabetes Control and Complications Trial, did not report cognitive declines in intensively treated patients, but had unrepresentative study populations and may have been too short to detect such effects. Structural and functional brain changes are not only associated with recurrent severe hypoglycaemia, but also with hyperglycaemia and early disease onset and may in part be due to hyperglycaemic microvascular disease. Children may be more prone to acute metabolic insults, and there is evidence of developmental disadvantage associated with hypoglycaemic episodes.     

血管性认知障碍的诊断

血管性认知障碍(vascular cognitive inpairment,VCI)是由脑血管危险因素(如高血压、糖尿病和高脂血症等)、明显(如脑梗死和脑出血等)或不明显的脑血管病(如白质疏松症和慢性脑缺血)引起的从轻度认知障碍到痴呆的一大类综合征.准确的早期诊断町提供最佳的治疗机会,并延缓病情的发展.近年来,对VCI的研究取得了很大进展.文章对VCI从病因、临床表现、神经心理学、影像学、神经电生理、生物学标志物和诊断标准等方面做了综述.