帕金森病的认知障碍及康复治疗

帕金森病是一个运动系统的疾病,但也有认知功能的障碍,研究发现帕金森病患的认知障碍主要表现为：言语流畅性障碍、视空间障碍、额叶功能记忆障碍、智能障碍等。其中最引起人们关注和最引起病人人生活能力的是智能障碍,即痴呆,病人的认知功能障碍尤其是痴呆对其生活造成了极大的影响,因此有必要对帕金森病患的认知障碍进行复合治疗。本在总结了国内外的献的基础上,对帕金森病的认知障碍及其康复治疗做一简单综述。     

尼莫通与调心方改善帕金森病认知功能障碍的疗效分析

目的分析尼莫通与调心方对帕金森病认知功能障碍改善的临床疗效。方法80例帕金森病患者,随机分为2组。临床康复组采用尼莫通及中药调心方治疗。对照组采用脑康复治疗。治疗前后分别进行韦氏记忆量表测查和Webster功能评分。结果两组都改善帕金森病人认知障碍,使韦氏记忆量表分数提高,但临床康复治疗组优于对照组(P<0.01)。结论尼莫通配合调心方能有效地改善帕金森病人的认知障碍。     

脑梗死后血管性认知障碍的临床观察

认知障碍是急性脑梗死（Cerebral irifarction，CI）最常见的症状，不但影响病人的社会适应能力，而且影响脑血管病的全面康复，不少脑梗死病人因认知障碍得不到及时诊断治疗，最终发展成血管性痴呆（Vascular dementia，VD），脑梗死后患者出现血管性痴呆，目前尚无确切有效的治疗方法，为使患者的认知功能在发展为VD之前即能被发现，     

虚拟现实训练对脑卒中恢复期患者认知功能和P300的影响

正随着人口老龄化,脑卒中的发病率逐渐增高。脑卒中后有35%的患者发生认知障碍~([1])。血管性认知功能障碍可分为:血管性认知损害非痴呆、血管性痴呆和混合型认知障碍。认知训练可以改善血管性认知损害非痴呆患者的认知功能状况~([2])。虚拟现实(virtual reality, VR)技术近年来开始应用于脑卒中、脑外伤的认知康复~([3—4])。基于Kinect体感交     

卒中后患者认知功能障碍相关影响因素及早期康复模式的研究现况

认知功能障碍主要包括记忆障碍、失语、失用、失认、失读、视空间障碍等。据相关调查显示：脑卒中后有50%-70%的患者有认知功能障碍,其中脑卒中患者发生认知功能障碍的几率是未发生卒中患者的6 ～ 9 倍［1］。据冀战一研究显示脑卒中患者中有半数以上伴有认知功能障碍,近1/3发生痴呆,不同类型的脑卒中发生痴呆的发生率相近,脑梗死的痴呆发生率约30.1％,而脑出血的痴呆发生率约为27.5％,尤其是卒中后12个月内发生认知功能障碍的风险更大,而且可能持续到数年之后[２]。因此脑卒中后认知障碍是影响患者康复质量和导致血管性痴呆的重要原因,其对于日常生活活动能力的影响甚至远远超过了躯体功能障碍的影响。认知功能障碍不但影响患者的社会适应能力,而且影响脑卒中的全面康复[3]。早期进行认知训练不仅能够改善脑卒中后患者的认知功能障碍,而且还能促进患者日常生活能力的恢复 [４]。因此,针对脑卒中患者认知功能障碍的危害性及国内外早期康复锻炼模式进行综述,为下一步构建适合我国国情的卒中后患者认知功能障碍早期康复模式奠定基础。     

帕金森病病人的智能障碍与评定

1引言 从大量的临床研究资料看,帕金森病病人不仅有严重的运动功能障碍,同时伴有突出的认知功能障碍,临床上主要表现为不同程度的智能障碍即痴呆.1922年Patrick报告,帕金森病患者痴呆的发生率为5%,1970年Mindham的研究资料显示痴呆患者占帕金森病病人的1/3,Colesia等(1972)的报告为40%,而PirozzoLo(1982年)的报告为93%.国内邸晓兰等(1988年)调查结果:帕金森病伴发痴呆者44%,李飞等(1999年)用长谷川简易智能评分表检测76例帕金森病病人,29例存在智能障碍,发生率38%.     

轻度认知障碍的认知训练研究进展

轻度认知障碍是介于正常衰老导致的认知功能障碍和痴呆之间的一种认知能力受损状态,早期识别轻度认知障碍并尽早干预对延缓认知功能进一步受损是非常必要的,以避免患者发展成痴呆。目前,改善认知功能药物治疗的疗效有限,且鉴于药物治疗的不良影响及用量等存在很大争议。本综述旨在通过回顾轻度认知障碍认知训练方法,为临床轻度认知障碍患者的认知训练提供参考。     

老年期痴呆的诊断与鉴别

老年期痴呆是指发生在老年期的智能障碍,最常见的是阿尔茨海默病(AD)和血管性痴呆(VD)。AD患者的核心症状是记忆障碍,认知障碍,语言和视空间功能障碍,失认,失用等;多梗死性痴呆(MID)是VD中最常见的类型,患者有多次缺血性脑血管病事件;具有脑梗死局灶定位体征,认知功能障碍表现近记忆力、计算力减退,表情淡漠,焦虑,少语,抑郁或欣快,不能胜任以往熟悉的工作和进行正常交往。可急性起病和阶段性进展,智能损害往往呈斑片状缺损,与血管病变的部位及大小有直接的关系。     

影像学技术、计算机技术在血管性认知障碍诊断及康复治疗中的应用

目的:综述血管性认知障碍的研究进展,以便预防和治疗血管性认知障碍,提高血管性认知障碍患者的生活质量。资料来源:应用计算检索万方数据库2002-01/2007-01与血管性认知障碍相关的文章,检索词“血管性认知障碍、轻度认知障碍、血管性痴呆、虚拟现实技术、无错性学习、远程康复”,限定语种为中文;同时应用计算机检索Pubmed 1998-01/2007-01的相关文章,检索词为vascular cognitive impairment,virtual reality,errorless learning,telerehabilitation,并限定文章语言种类为English。资料选择:就检索到的100余篇文献进行筛选,选取与血管性认知障碍相关的文章。资料提炼:共收集到相关文章34篇,将筛选到的文献分类,其中认知障碍诊断进展的22篇,康复治疗的12篇。资料综合:血管性认知障碍患者通过磁共振血流灌注加权成像、磁共振波谱成像、弥散加权成像、放射性核素功能显像等影像学检查都会呈现不同程度的异常。神经心理学测验、虚拟现实技术以及计算机辅助技术的应用能够探测到非常细微的认知功能损害,使这部分患者得到早期的诊断,加以治疗,可阻止或延缓痴呆的发生。无错性学习的应用和远程认知康复治疗可使患者的认知功能障碍和功能性活动得到良好的改善。结论:血管性认知障碍对日常生活活动能力影响很大,应对其进行早期的预防、诊断和相应的康复治疗以提高患者的生活质量。     

针刺治疗血管性认知功能障碍研究进展

正血管性认知功能障碍(VCI)是由脑血管病危险因素(如高血压、心脏病、糖尿病和高血脂等)、明显(如脑梗死和脑出血等)或不明显的脑血管病(如白质疏松和慢性脑缺血等)引起的从轻度认知障碍到痴呆的一大类综合征[1]。VCI的发生率达37.1%,不同形式、不同程度的认知功能障碍使患者生活能力受限,生活质量降低[2]。目前,国内外治疗脑卒中后患者认知功能障碍的     

Autobiographical memory and future thinking impairments in multiple sclerosis: Cognitive and neural mechanisms,functional impact and rehabilitation

Learning and memory impairments are common in individuals with multiple sclerosis (MS) and have pervasive effects on everyday life functioning. Hence, memory and learning have received particular attention in the cognitive rehabilitation literature in MS. The effectiveness of memory rehabilitation on memory performance is supported by several studies, but the generalisability of the benefits to daily life and memory for real-life events has rarely been examined. Recently, a new line of research focusing on memory for personal life events (i.e., autobiographical memory) has emerged in the MS literature. This approach is complementary to classical learning and memory paradigms and also allows for approaching memory in a broader context, one that considers memory as the ability to remember past episodes and imagine events that may occur in one's personal future (i.e. future thinking). This review provides an overview of the findings in this line of work. The first part summarises current evidence regarding the cognitive and neural mechanisms underlying autobiographical memory and future thinking impairments in MS. It points out that these domains are frequently and early impaired in individuals with MS because of an executive/frontal-related deficit. Individuals with MS are generally aware of these deficits and their negative impact on everyday life, so the development of strategies to alleviate such deficits seems of paramount importance. Thus, in the second part, I present the main outcomes of a cognitive intervention developed by our research group, which has been specifically designed to alleviate autobiographical memory and future thinking impairments in individuals with MS. The implications of these findings for neuropsychological care and well-being of individuals with MS are discussed in the final section, with an emphasis on the functional role of autobiographical memory and future thinking in various domains, including personal identity.     

Frontal impairment and confabulation after herpes simplex encephalitis: A case report

We describe the rehabilitation training of a 53-year-old woman with severe confabulatory and dysexecutive syndrome, as well as memory impairment, after herpes simplex encephalitis (HSE). Secondary narcolepsy was also present. Neuropsychologic deficits were detailed through an extensive examination, and specific techniques were used to improve performances in each defective cognitive domain. Improvement of vigilance and attention was reached through appropriate and timed periods of rest, along with attentional tasks of growing difficulty. Different external aids were used to reduce temporal disorientation, to contrast confabulation and inertia, and to overcome memory deficits in everyday life. Their independent use by the patient was implemented through cues that were progressively reduced. Treatment also focused on planning, categorization, and topographic orientation. The patient's family gave constant support during rehabilitation and provided informal training after discharge. The patient was able to regain independence in everyday life at home.     

The cognitive dysfunction in Parkinson's disease

Parkinson's disease (PD) is a slowly progressive disorder which begins with motor symptoms. Several cognitive deficits can be observed in nondemented patients with PD during their history. The core symptom in the cognitive deficits in PD is the executive dysfunction. Neuropsychological tests such as Wisconsin Card Sorting Test, Trail Making Test are used to measure the degree of this dysfunction. Executive dysfunction is thought related to abnormalities in the dorsolateral prefrontal circuit which largely passes through the caudate nucleus. The dysfunction emerges as the pathology spreads to the nigrocaudate project corresponding to Hoehn & Yahr stage II-III. Effective therapy for cognitive dysfunction in PD remains elusive, however donepezil, Attention Process Training, Music therapy and Transcranial magnetic stimulation have been reported to have partial efficacy.     

Cognitive functions among Hong Kong Chinese people with schizophrenia

Persons with schizophrenia show deficits in a variety of cognitive domains including executive function, attention, memory and language. Similar interest in studying the impact of cognitive deficits on the everyday functioning of people with schizophrenia has been documented. This study examined the cognitive functioning among Hong Kong Chinese schizophrenic patients compared with other patient groups, and its relationship with functional outcome, especially in the social aspect. Results indicated that schizophrenic patients presented with mild cognitive problems compared with neurosurgical and demented patients. Initial support was found in relating cognitive functions, as measured by Neurobehavioral Cognitive Status Examination, with functional outcome as measured by Functional Independence Measures. The implication for community rehabilitation is also discussed.     

帕金森病患者50例运动功能康复的护理

目的探讨康复运动训练方法对帕金森病患者运动功能康复的作用。方法对50例帕金森病患者进行康复训练,将训练前后运动功能的恢复进行对比分析。结果通过康复训练,帕金森病Ⅱ、Ⅲ、Ⅳ期患者运动功能明显提高（P〈0．05）。结论运动康复训练可提高患者日常生活自理能力。提高生活质量,从而减轻家庭、社会负担。     

Lecithin treatment of cognitively impaired Parkinson's patients

Abstract. To test the effects of lecithin on cognitive deficits associated with Parkinson's disease, sixteen elderly and mentally-impaired outpatients with Parkinson's disease participated in a 9-week double-blind placebo-controlled study. Each patient took a daily dose of approximately 32 g of a commercial lecithin preparation containing 25% phosphatidylcholine, or an equivalent amount of powdered skim milk placebo. Marked clinical improvement was not observed, but some indications of a positive treatment effect were obtained on memory, cognition, and motility tests.     

Cognitive dysfunction in Parkinson's disease

The neuropsychological impairments associated with Parkinson's disease(PD) have been often documented. However, the pathological mechanisms underlying cognitive dysfunction are hardly solved, as compared with motor dysfunction. Moreover, the precise relationships between the two dysfunctions have remained aloof. This paper attempts to clarify three specific domains of isolated cognitive impairments: dysexecutive syndrome, memory disturbance, and bradyphrenia, which are specifically observed in PD. It especially discusses the neuropsychological relationships between these impairments and the stages of illness. Several neuropsychological experiments to examine these three domains of cognitive impairments were conducted. Significant results were obtained in the following: set-shifting and divergent thinking were significantly impaired in both the early group and the advanced group; while set-maintaining, procedural learning, and cognitive speed, were only significantly disturbed in the advanced group. The failure to acquire procedural skills and the slowing of cognitive speed, were correlated with decreased attention of working memory in the advanced group. These results indicate that the shifting of cognitive sets maybe disturbed in the embryonic stage of the disease. The results also indicated that other cognitive dysfunctions might manifest themselves during the advanced stages due to attentional deficits. In conclusion, it is possible that other neurotransmitters maybe involved in the progressive degeneration of other systems in addition to the dopaminergic system. For example: serotoninergic, noradrenergic and cholinergic systems. Therefore, further research is required to establish which neurotransmitters are involved in their corresponding cognitive impairments in PD.     

The effect of physical therapy on balance of patients with Parkinson's disease

Physical therapy can improve performance of balance tests in patients with Parkinson's disease. Parkinson's disease is a chronic progressive neurological disturbance with significant effect on movements, cognitive functions, autonomous systems and psychosocial activities. The effects of physical therapy are rarely reported and not sufficiently studied. This prospective study comprised 40 persons with stage III Parkinson's disease, according to aged over 50 years and 20 healthy controls of the same age. Patients were medically stable and had no other neurological deficits, postural hypotensia, visual disturbances or musculo-skeletal deficits. Balance tests before and after physical therapy were analysed according to. Balance tests in patients with Parkinson's disease resulted in significant differences of values for tandem stance, one leg stance, step test and external perturbation when compared to the controls, and between groups with and without falling tendency. Tandem stance, one leg stance, step test and external perturbation can be used for differentiation between groups with and without a tendency to fall. Physical therapy resulted in significant improvement of these tests in both the groups analysed. Systematic application of physical therapy, as part of team treatment, improves the balance of patients with Parkinson's disease.     

记忆障碍的康复

记忆障碍是脑外伤、脑卒中、老年性痴呆等患者最普遍的认知功能损害。目前国内外学者采用不同方法针对脑损伤患者的记忆障碍进行康复训练,取得了一定的进展。本文对近年有关记忆障碍康复的方法及疗效做一综述,初步探讨最佳的康复治疗方案。