载脂蛋白E基因多态性与路易体痴呆关系的Meta分析

目的探讨载脂蛋白E (APOE)基因多态性与路易体痴呆(DLB)的相关性。方法检索PubMed、EMBASE、Cochrane图书馆以及CNKI数据库截止至2018年4月发表的相关文献,确定文献纳入和排除标准,并采用Newcastle-Ottawa(NOS)进行文献质量评估,提取高质量文献的有用部分,应用Rev Man 5.3软件进行统计分析。结果共纳入21篇文献,包括DLB患者1 178例,健康对照6 272例,Meta分析结果显示APOEε4是DLB的危险因素,其中ε4 vs.ε3 (OR=2.51,95%CI:1.87～3.38,P 0.001)、ε4 vs.ε2 (OR=2.71,95%CI:1.73～4.26,P=0.007),APOEε2与DLB无显著相关性(P 0.05)。在高加索人群的亚组分析中,也得出一致结果。结论 APOE基因多态性与DLB具有相关性,APOEε4是DLB发病的危险因素,APOEε2与DLB易感性无明显相关性。     

载脂蛋白E基因多态性与血管性痴呆的关系

目的 探讨载脂蛋白E（ApoE)基因多态性与血管性痴呆（VD）的关系。方法 采用PCR－RFLP方法对VD组47例，脑梗死组（CI）46例，正常对照组60人进行ApoE基因型测定。结果 VD组，CI组与正常对照组ApoE基因型频率分布，以3／3型所占比率最高。VD组4／3占第2位（27．7％），与正常对照组（18．33％）比较有显著差异（P＜0．05）。各组ApoE等位基因频率比较，VD组ApoEε4高于对照组（P＜0．05）。C1组与正常对照组之间ApoE基因型频率及等位基因频率比较无显著差异。结论 ApoEε4等位基因可能是VD发生的遗传危险因素这一。本研究不支持ApoEε4等位基因可以增加发生CI的危险性。     

载脂蛋白E基因多态性与动脉粥样硬化、痴呆的关系

<正> 载脂蛋白E(ApoE)不仅参与脂类代谢,而且与脑内有多种生理和病理功能有关,ApoE基因多态性与动脉粥样硬化关系密切,从而引起心脑血管疾病。同时ApoE基因多态性与痴呆的发生有关,本文仅对ApoE基因多态性与动脉粥样硬化及痴呆关系综述如下。     

血管性痴呆患者载脂蛋白E基因多态性分析

目的：探讨载脂蛋白E（ApoE)基因多态性与血管性痴呆的关系。方法：应用免疫银光比色法分析17例VD患者及22例非痴呆患者的ApoE基因型,结果：VD组ε4基因频率明显高于对照组（P＜0．01）,ε3频率降低（P＜0．05,且ε4与血清TC,LDL－C呈正相关。与HDL－C负相关。结论：ε4可能是VD的危险因子,其机制可能与大脑血管的变性和损害有关。ε     

中国人载脂蛋白E基因多态性与脑出血关系的Meta分析

目的 探讨中国人群载脂蛋白E(ApoE)基因多态性与脑出血的相关性.方法 通过文献检索收集脑出血组和对照组的病例对照研究,剔除不符合要求的文献,以漏斗图检验人选文献的发表偏倚,并根据各入选文献结果的同质性检验结果进行数据合并,计算总OR值,Meta分析采用Review Manager 4.2版统计软件.结果 共有10篇符合条件的文献纳入分析,Meta分析结果表明,以野生型E3/3基因型为参照,携带E2/2,E2/3,E2/4,E3/4,E4/4基因型的个体发生脑出血的危险性的OR值和95%可信区间分别为1.25(0.61～2.58)、1.35(0.86～2.11)、1.89(1.08～3.29)、1.79(1.44～2.23)和1.97(0.91～4.28),携带E4的个体OR值和95%可信区间为1.01(1.40～2.22)(P＜0.01),携带E2的个体OR值和95%可信区间为1.45(0.99～2.14)(P＞0.05).结论 E4等位基因携带者可能是脑出血的遗传危险因素.     

中国人ApoE基因多态性与血管性痴呆关系的Meta分析

目的评价我国人群ApoE基因多态性与血管性痴呆的关系。方法对1996年1月至2011年5月公开发表的关于中国人血管性痴呆ApoE基因多态性的病例对照研究进行Meta分析。结果共纳入20个病例对照研究。Meta分析结果表明,中国人携带ε4等位基因的个体发生血管性痴呆的危险性的合并OR值为2.20[95%CI(1.81,2.66)];中国汉族人携带ε4等位基因的个体发生血管性痴呆的危险性的合并OR值为3.11[95%CI(2.06,4.69)]。结论载脂蛋白E基因多态性与中国人血管性痴呆相关,携带ε4等位基因的个体有发生血管性痴呆的倾向。     

载脂蛋白E基因多态性与血管性痴呆的相关性研究

目的 探讨载脂蛋白E(apolipoproteinE,apoE)基因多态性与血管性痴呆(vascular Dementia,VD)的相关性。方法 应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术,检测35例VD患者、36例脑梗死(cerebral Infarction,CI)患者以及40名健康人的apoE基因型,同时检测其血脂及载脂蛋白的含量。结果 VD组和CI组患者ε4频率均升高(P<0.01),ε3频率均降低(P<0.05),而两组患者间各等位基因频率差异无统计学意义(P>0.05);apoEε4等位基因携带者总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、apoB水平均较apoEε2、ε3携带者高(P<0.05)。结论 apoE基因多态性与血管性痴呆的发病有关,ε4基因可能为该病的危险因子,且可能与其在脑梗死中的作用机制相似。     

载脂蛋白E基因多态性与Alzheimer病和血管性痴呆的关系

目的 探讨载脂蛋白E(ApoE)基因多态性与Alzheimer病(AD)和血管性痴呆(VD)的关系.方法 用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测79例AD患者(AD组)、85例VD患者(VD组)及156名健康老年人(正常对照组)ApoE基因型和等位基因频率.结果 ApoEε3/ε4基因型及ε4等位基因频率AD组分别为25.3%及17.7%,VD组分别为25.9%及20.5%,正常对照组分别为10.9%及5.7%;AD组及VD组ApoEε3/ε4基因型及ε4等位基因频率显著高于正常对照组(均P＜0.01).结论 ApoEε4等位基因可能是AD和VD共同的危险因素.     

载脂蛋白E基因多态性与脑出血关系的Meta分析

OBJECTIVE： To evaluate the relationship between apolipoprotein E （ApoE） gene polymorphism and susceptibility to intracerebral hemorrhage （ICH） in Chinese population by a meta-analysis.
METHODS： Related literature regarding control analysis between ICH and control groups was collected. Independent case-control studies published between 1989 and 2007 that had complete data were included; and articles not closely related to the topic were excluded. The meta-analysis software, RevMan 4.2, was applied to analyze the odds ratio （OR） value in those studies included in the analysis to assess the relationship between susceptibility to ICH and ApoE polymorphism.
RESULTS： Eight papers which were in accordance with the inclusion criteria were selected, and a total of 1 249 ICH cases and 1 329 controls were involved. Meta-analysis results showed that with the wildtype E3/3 as a reference, the OR values （95% confidence interval） of intracerebral hemorrhage for subjects carrying E2/2, E3/2, E4/2, E4/3, and E4/4 were 1.15 （0.60–2.21）, 1.00 （0.79–1.28）, 3.01 （1.73–5.23）, 1.78 （1.41–2.24） and 1.94 （1.03–3.65）, respectively. The combined OR values （95% confidence interval） of intracerebral hemorrhage for ε4 and ε2 carriers were 1.53 （1.16–2.01）, and 0.93 （0.69–1.25）.
CONCLUSION： The results suggest that ApoE polymorphism is significantly associated with susceptibility to intracerebral hemorrhage and that ε4 carriers have a higher risk for intracerebral hemorrhage than others.     

Levodopa use and sleep in patients with dementia with Lewy bodies

Sleep disturbance and excessive daytime somnolence (EDS) are features of Parkinson's disease (PD) and dementia with Lewy bodies (DLB) that may be influenced by dopamine replacement therapy. The effect of levodopa on sleep and EDS in DLB is unknown and unclear in PD. The aim of this study is to determine if levodopa treatment alters sleep symptoms and EDS in DLB. Dopamine naïve patients with DLB (n = 15; mean mini mental state examination (MMSE) score 17.7(4.6)) and PD (n = 9; mean MMSE 25.5(2.2)) were assessed using the Epworth sleep scale, Parkinson's disease sleep scale, and the neuropsychiatric inventory prior to initiating treatment with levodopa. All measures were repeated after 3 and 6 months of levodopa therapy. The median final daily levodopa dose was 300 mg in both groups. Baseline sleep measures were comparable between groups. Levodopa treatment did not affect sleep or lead to increased EDS in DLB patients. The use of levodopa does not appear to adversely affect subjective sleep measures or increase EDS in DLB patients. © 2009 Movement Disorder Society     

Administration of zonisamide in three cases of dementia with Lewy bodies

Zonisamide (ZNS) add‐on administration was used to treat parkinsonian symptoms in three cases of dementia with Lewy bodies (DLB). ZNS was added after doses of the anti‐Parkinson's disease drugs were fixed for at least 4 weeks. A total of 25 mg of ZNS produced mild–moderate improvement of parkinsonian symptoms in two cases, but it did not affect the cognitive functions and behavioral or psychological symptoms. Caregiver burdens were decreased in two cases. Although dizziness and drowsiness were detected, these were improved by decreasing the dose. ZNS may be useful for the treatment of motor symptoms in DLB patients.     

Differences in clinical course between dementia with Lewy bodies and Alzheimer's disease

Background and purpose:  To investigate whether there may be differences in the clinical course and changes in cognitive progression between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD).
Methods:  We compared the time from the first visit to endpoints (discontinuation of visits because of admission, death, or institutionalization) between 56 patients with DLB and 111 patients with AD. Mini-Mental State Examination (MMSE) scores of patients were every 12 months examined up to 60 months.
Results:  Dementia with Lewy bodies had a significantly shorter time to reaching endpoints than those with AD (median time; 40 months vs. 52 months, P  < 0.0001). The proportion of admission (or death) was significantly higher in DLB than in AD (30% vs. 14%, P  < 0.05), while the difference in institutionalization in nursing homes did not reach statistical significance (25% vs. 17%). Rates of longitudinal MMSE score decline for DLB and AD groups were equivalent.
Conclusion:  Dementia with Lewy bodies had a greater risk of admission (or death) because of most commonly fall-related injuries and bronchopneumonia than AD, but the two groups did not differ in rate of cognitive decline.     

Autonomic dysfunctions in dementia with Lewy bodies

Twenty-nine cases of both clinically and neuropathologically diagnosed dementia with Lewy bodies (DLB) were retrospectively examined for autonomic symptoms. Twenty-eight cases showed some kind of autonomic dysfunction. Urinary incontinence (97 %) and constipation (83 %) were the two most common. Although urinary retention and episodic hypotension causing syncopal attacks were less common, the frequency was still high (28 % each). There were 18 cases (62 %) with severe autonomic failure. These 28 cases showed similar tendencies, with no significant differences between the subtypes of DLB (brainstem, limbic, and neocortical types or common and pure forms). We found that DLB of all pathological subtypes exhibits some kind and level of autonomic symptoms. Received: 20 August 2002, Received in revised form: 12 November 2002, Accepted: 18 November 2002 Correspondence to Y. Horimoto     

Increased incidence of dementia with Lewy bodies in patients carrying the ɛ4-allele of apolipoprotein E

Background: The apolipoprotein ∈4 (APOE4) allele is a risk factor for Alzheimer's disease, but it remains undetermined whether this allele is related to the pathological development of neurofibrillary tangles (NFT) and the formation of Lewy bodies. Methods: In the present study, we examined the relationship between these changes and the APOE4 allele in 255 consecutive neuropathologically diagnosed cases. APOE genotyping was carried out by the polymerase chain reaction–restriction fragment length polymorphism method. Results: Nearly all our cases of dementia with Lewy bodies (DLB) showed the common form, having numerous senile plaques in the cerebral cortex and NFT in the parahippocampal and hippocampal regions and were also associated with the APOE4 allele. Limbic neurofibrillary tangle dementia (LNTD), characterized by the presence of NFT in limbic areas as well as the absence of senile plaques, did not appear to be associated with the APOE4 allele. Conclusions: The APOE4 allele is a risk factor for DLB as well as Alzheimer's disease and cerebral amyloid angiopathy, but not for LNTD.     

Clinicopathological multiplicity of dementia with Lewy bodies

‘Dementia with Lewy bodies (DLB)’ is a generic clinicopathological concept characterized by progressive dementia and Lewy bodies (LB). We examined 23 autopsied DLB cases clinicopathologically and immunohistochemically. These cases were classified into the neocortical type (10 cases), the limbic type (seven cases), the cerebral type (one case) and the brainstem type (none) according to our pathological criteria, which were based on the regional incidence of LB and the degree of neuronal loss in the substantia nigra. Each subtype of DLB was further divided into the common form and the pure form on the basis of the degree of Alzheimer pathology. The remaining five cases were not classified by our pathological criteria, and were designated ‘the senile dementia of Alzheimer type (SDAT) or Alzheimer's disease (AD) type of DLB with neocortical or limbic LB’. We examined how each subtype was correlated with various clinical features, such as the age of disease onset, the clinical duration, the degree of dementia, and the presence or absence of parkinsonism, fluctuating cognition and visual hallucination. The results of this study indicate that DLB can be clinicopathologically divided into a number of subtypes, that each subtype is preferentially correlated with some clinical feature, and that the neocortical type, common form, is the major type of DLB.     

The progression of cognitive impairment in dementia with Lewy bodies, vascular dementia and Alzheimer's disease

BACKGROUND: Little is known about the rate of progression or associations of cognitive impairment in dementia with Lewy bodies (DLB), or the associations of accelerated decline. METHOD: Dementia patients from a case register were evaluated at baseline and 1 year follow-up using the Cambridge Assessment for Mental Disorders in the Elderly, section B (CAMCOG) and the Mini-Mental State Examination (MMSE) to determine the rate of cognitive decline. Operationalized clinical diagnoses were applied (NINCDS ADRDA for Alzheimer's disease (AD), NINCDS AIRENS for vascular dementia (VaD) and consensus criteria for DLB). RESULTS: One hundred and ninety-three patients completed annual MMSE schedules (AD, 101; DLB, 64; VaD, 38), of whom 154 completed the CAMCOG. The magnitude of cognitive decline (MMSE, 4-5 points; CAMCOG, 12-14 points) was similar in each of the dementias. The strongest predictor of accelerated cognitive decline in DLB was the apolipoprotein E4 allele (17.5 vs 8.3 points decline on the CAMCOG). CONCLUSION: Over 1 year, DLB, VaD and AD patients had similar rates of cognitive decline overall. Apolipoprotein E4 may be an important predictor of more rapid decline in DLB.     

Neuropsychological profile of dementia with Lewy bodies

Dementia with Lewy bodies (DLB) accounts for 10–25% of all dementia cases in clinical populations and is considered to be the second most common degenerative dementia in elderly people after Alzheimer's disease (AD). Dementia with Lewy bodies is characterized by the presence of cognitive, psychiatric, and motor symptoms. Although the neuropsychological profiles of patients with DLB often differ from those of patients with AD, the diagnostic sensitivity, specificity, and predictive values of these profiles remain largely unknown. The present paper reviews the neuropsychological profiling of DLB and attempts the neuropsychological differentiation of DLB from AD.