血尿酸水平与非痴呆性血管性认知功能障碍的相关性研究

目的 旨在探讨血尿酸水平与非痴呆性血管性认知功能障碍（vascular cognitive impairment with no dementia,VCIND）的相关性。      

Low Levels of Serum Apolipoprotein AI and AII in Senile Dementia

Abstract: We studied the serum lipoprotein and apolipoprotein profiles in 44 patients with sporadic late-onset Alzheimer's dementia and 43 patients with vascular dementia. The levels of high-density lipoprotein (HDL) cholesterol were lower in both patient groups than in a control group. Apolipoprotein A I and A II levels have decreased in both the patient groups, especially in the vascular dementia group. The HDL-cholesterol levels correlated positively with the level of apolipoprotein A I, but not with the level of apolipoprotein A II. The ratios of apolipoprotein A I/A II have increased in both the patient groups. The apolipoprotein A II levels have disproportionally decreased in the patient groups. The serum apolipoprotein A II may involve the pathological process in the patients with senile dementia.     

Dementia studies in Chinese populations

Variations in the prevalence of dementia in different ethnic groups have been reported worldwide, and a number of reviews have provided a picture of epidemiological studies in dementia research. However, little is known about epidemiological studies in Chinese populations. In this review, we searched PubMed and the Web of Science for original research articles published in English up to July 2013 on the prevalence, incidence, risk factors, and prognosis of dementia in Chinese populations worldwide. Except for the prevalence, we included only population-based follow-up studies. We identified 25 studies in elderly Chinese residents in Mainland China, Hong Kong, Taiwan, and Singapore, and found a higher prevalence of dementia in Mainland China than in the other locations, which may be due to that the studies from Mainland China are more recent than those from other locations. A notable increase in incidence was observed when dementia cases were diagnosed using 10/66 diagnostic criteria compared to other criteria. Studies on risk factors for dementia were limited and mostly from Mainland China. Age, gender, education, smoking, and alcohol consumption were related to the risk of dementia in Chinese populations. Only two prognostic studies were identified, and age, gender, and residential area were related to the prognosis of dementia. In conclusion, the prevalence, incidence, and risk factors for dementia found in Chinese populations were comparable to other ethnic groups, but no conclusive results on prognosis were found. The differences in prevalence and incidence were influenced by the diagnostic criteria and the time of study. Longitudinal population-based studies on the incidence, risk factors, and prognosis of dementia in Chinese populations are required.     

Staff-rated ability to provide post-diagnosis support for patients with mild cognitive impairment and related factors

Background

Proactive interventions for patients with mild cognitive impairment (MCI) are required. We aimed to determine the staff-rated ability to provide post-diagnosis support for patients with MCI at a medical centre for dementia and the related factors.

Methods

We conducted a web-based survey on post-diagnosis support for patients with MCI among healthcare personnel, such as mental health social workers and public health nurses (hereafter referred to as ‘staff’), in consultation and support roles at medical centres for dementia nationwide. The latent characteristic value for ‘staff's self-rated ability to provide post-diagnosis support to patients with MCI’, which was estimated using the one-parameter logistic model of item response theory, was used as the dependent variable. Multivariate linear regression analysis was used to examine the factors associated with the dependent variable.

Results

We conducted the study at 482 medical centres for dementia. We received responses from 162 participants, 158 of which were valid. We applied item response theory to 45 staff-rated items regarding post-diagnosis support for patients with MCI and found that item difficulty ranged from −2.56 to 1.02; 40 items had negative values and were deemed relatively easy. The staff-rated ability to provide post-diagnosis support was significantly higher for ‘The role in assisting patients with MCI is clear’ (P < 0.005), ‘A reasonable number of personnel is available to assist immediately after MCI diagnosis’ (P = 0.001), and ‘Collaboration with family physician available immediately after MCI diagnosis’ (P < 0.001).

Conclusions

The results of this study showed that staff rated their ability to provide post-diagnosis support for patients with MCI as relatively easy. The staff-rated ability to provide post-diagnosis support to patients with MCI may be enhanced by increased availability of staff immediately after MCI diagnosis, clarification of staff roles, and collaboration with family doctors.     

ApoE基因多态性与血管性痴呆关系的实验研究

目的　探讨 Apo E基因多态性与血管性痴呆 ( Va D)的相互关系。方法　应用聚合酶链反应 -限制性片段长度多态性 ( PCR-RFLP)技术 ,检测脑卒中后 Va D组与未发生 Va D的对照组患者的 Apo E基因型分布及出现频率。结果　 Apo E基因的ε4 / 4基因型 ,在 Va D组的出现频率明显高于未发生 Va D的对照组 ( P<0 .0 5 ) ,其余各基因型的出现频率 ,两组间差异无显著性 ( P>0 .0 5 )。结论　Apo E基因的 ε4 / 4基因型与 Va D的发生密切相关 ;等位基因ε4可能是 Va D的一种遗传易感性因子。     

非痴呆性血管性认知障碍的研究进展

血管性认知障碍（vascular cognitive impairment,VCI）是由脑血管病危险因素（如高血压、 糖尿病、高脂血症和高同型半胱氨酸血症等）、显性脑血管病（出血性及缺血性卒中）及非显性脑血 管病（脑白质疏松和慢性脑缺血等）引起的一组从轻度认知功能损害到痴呆的临床综合征。非痴呆 性血管性认知障碍（vascular cognitive impairment-no dementia,VCIND）是VCI的早期阶段,其中约一半 患者会在5年内进展为痴呆。血管性痴呆（vascular dementia,VD）在治疗上尚未发现行之有效的方法, 但又是唯一可以预防的痴呆。发现VCIND危险因素并进行早期干预,对于寻求延缓痴呆进展的二级 预防策略至关重要。现从VCIND的概念、流行病学、诊断标准及影响因素等方面进行综述,以期能够 早期识别相关危险因素,防治VCI。     

Apolipoprotein E ε4 Allele Has No Effect on Age at Onset or Duration of Disease in Cases of Frontotemporal Dementia with Pick- or Microvacuolar-Type Histology

Frontotemporal dementia (FTD) is the second most common cause of presenile dementia. Here we have investigated the frequency of the ε4 allele of the Apolipoprotein (APOE) gene in FTD and in other non-Alzheimer forms of dementia related to FTD such as Motor Neurone disease dementia, semantic dementia, progressive aphasia, progressive supranuclear palsy, and corticobasal degeneration. In none of these diagnostic groups did we find a significant increase in the APOE ε4 allelic frequency, compared to population values. Neither did we observe any affects of the ε4 allele upon age at onset or duration of disease. We conclude therefore that polymorphic variations in the APOE gene do not modulate either the occurrence or progression of these non-Alzheimer forms of dementia.     

Dementia associated with disorders of the basal ganglia

Dementia is now the leading cause of death in the United Kingdom, accounting for over 12% of all deaths and is the fifth most common cause of death worldwide. As treatments for heart disease and cancers improve and the population ages, the number of sufferers will only increase, with the chance of developing dementia doubling every 5 years after the age of 65. Finding an effective treatment is ever more critical to avert this pandemic health (and economic) crisis. To date, most dementia-related research has focused on the cortex and the hippocampus; however, with dementia becoming more fully recognized as aspects of diseases historically categorized as motor disorders (e.g., Parkinson's and Huntington's diseases), the role of the basal ganglia in dementia is coming to the fore. Conversely, it is highly likely that neuronal pathways in these structures traditionally considered as spared in Alzheimer's disease are also affected, particularly in later stages of the disease. In this review, we examine some of the limited evidence linking the basal ganglia to dementia.     

Cognitive Impairment in Parkinson's Disease without Dementia: Subtypes and Influences of Age

Background and Purpose

Cognitive impairments are common in Parkinson''s disease (PD), although the severity of these impairments does not significantly impair the patient''s daily activities. The aim of this study was to determine the frequency of mild cognitive impairment (MCI) of Parkinson''s disease (PDMCI) and its subtypes in nondemented PD patients. We also evaluated the influence of age on the pattern of subtypes of PDMCI.

Methods

A total of 141 consecutive, nondemented PD patients underwent a comprehensive neuropsychological assessment covering the five cognitive domains: attention, language, visuospatial, memory, and executive functions. PDMCI was defined as impaired performance in at least one of these five cognitive domains. The influence of age on the distribution of subtypes of PDMCI was assessed by comparing patients in two groups dichotomized according to their age at assessment (younger vs. older).

Results

Fifty-seven (40.4%) of the nondemented PD patients had an impairment in at least one domain, and were therefore considered as having PDMCI. The age at assessment and age at disease onset were significantly higher in the PDMCI patients. The amnestic type of PDMCI was the most frequent, followed by the visuospatial, linguistic, executive, and attention types in that order. The frequency of PDMCI was higher for all subtypes in the older group; the domain that was influenced the most by age was executive function.

Conclusions

MCI was common in PD and the subtypes were diverse. Age was found to be an important risk factor for the development of PDMCI, particularly for the executive subtype. These results indicate that the concept of MCI should be introduced in PD.     

Apolipoprotein E genotypes and cognitive functions in healthy elderly persons

OBJECTIVES: We investigated whether apoE genotypes correlate with cognitive functions in clinically healthy persons. METHODS: In 1993 and 1995, we measured information processing speed, delayed free recall and semantic aspects of long-term memory in 227 men and 105 women aged 65 and over, a randomly selected subsample of the prospective Basel Study. Cardiovascular risk factors and education were assessed. RESULTS: E2 were more prevalent in old-old (>75 years, 23.5% vs. 15%) compared to E4 than in young-old (<75 years, 19.3% vs. 23.5%). Taking into account age and education, subjects with epsilon3/epsilon4 or epsilon4/epsilon4 alleles (E4) performed lowest in all 3 tests compared to those homozygous for epsilon3 (E3) or carriers of one or two epsilon2 alleles (E2) (reaction time P = 0.009, free recall P = 0.05, WAIS-R vocabulary P<0.05). In old-old there was a significant difference between E2 and E4 for reaction time (P = 0.02) and free recall (P<0.02) but not for vocabulary (P = 0.086). In all 3 groups there were no significant changes after 2 years. The subgroup with the genotype epsilon2/epsilon4 performed consistently best in the cognitive tests. Cholesterol was significantly increased in the E4 and E3 group compared to the E2 group. CONCLUSION: ApoE genotype correlates with cognitive performance. The increased prevalence of E2 in the old-old and the significantly lower plasma cholesterol levels suggest differential morbidity and mortality as important factors influencing the prevalence of cognitive disorders in late life.     

Apolipoprotein E phenotypes in demented and cognitively impaired patients with and without cerebrovascular disease

Controversy exists regarding the apolipoprotein E (ApoE) epsilon4 allele association with vascular dementia (VaD), ranging from increased epsilon4 frequency, similar to that found for Alzheimer's disease (AD), to no association between the epsilon4 allele and VaD. To clarify further the relationship between ApoE alleles polymorphism and cerebrovascular disease (CVD) in demented and cognitively impaired patients, we examined the ApoE phenotypes in a sample of 280 patients: 155 with AD, 21 with VaD, 32 with mixed dementia (MD), 45 with mild cognitive impairment (MCI) but without CVD, and 27 in which vascular disease was the most probable cause of cognitive decline [vascular mild cognitive impairment (VMCI)]. Our results show that the frequency of the ApoE epsilon4 allele in patients over 70 years old with clinically diagnosed VaD and VMCI does not differ significantly from that of controls. In contrast, ApoE epsilon4 allele-bearing individuals had greater risk of having late-onset AD (OR = 8.8; 95% CI 3.7-21.0), or non-vascular cognitive impairment (OR = 7.0; 95% CI 2.5-19.0).     

A Clinical Study on Premorbid Personality and Personality Change in Patients with Age Associated Dementia

Abstract: A survey was made on 502 elderly people living at home in Tokyo, and reliable data were obtained from 486 (96.8%) of them. A total of 198 persons who were judged to have dementia according to our clinical diagnostic criteria were subjected to the present study as the demented group (Group D). Other people who had no dementia or mental disorder were studied as controls (Group C); they were subdivided into two groups, i. e., a group of 83 persons who had a decline in ADL (Group C₁) and a group of 181 persons who had no decline in ADL (Group C_n). Their personalities were classified in terms of the personality trend and personality type according to SPI. 1. According to the classification by SPI, 28.2% of people who were syntonic in their younger days were in Group D. The corresponding rate was 11.6% for the nervous type, 45.3% for the immodithymic type, 1.7% for the viscous type, 5.5% for the autistic type, and 7.7% for the hysterical type. Thus, people who were syntonic, immodithymic or nervous in younger days were less likely to develop dementia, while those who were autistic or hysterical were more likely to develop dementia. The viscous type was associated with a low incidence of dementia in the present study. 2. Personality change was found more frequently in Group D (55.6%) than in Groups C_I and C_II (39.4%). 3. A personality change was either to nonadaptive personality (selfish, obstinate, suspicious or hot-tempered) or to adaptive personality (mellow or extroverted). In particular, the former four types of nonadaptive personality change were significantly more frequent in Group D. A change toward selfishness, obstinateness, suspi-ciousness or hot-tempcredness was closely related to the development of dementia rather than to ADL. There was no consistent relationship between the severity of dementia and nonadaptive personality change. Thus, among the personality in younger days, personality change and age associated dementia, we found a certain relationship between the personality in younger days and dementia. However, a relationship between the personality in younger days and later personality change was found in only a small group of subjects. However, the personality change toward selfishness, obstinateness, suspiciousness or hot-temperedness was closely related to the development of dementia.