老年人轻度帕金森病样体征与轻度认知功能损害的关系

目的:比较轻度帕金森病样体征(mild parkinsonian signs,MPS)和无MPS老人的轻度认知功能损害(mildcognitive impairment,MCI)患病情况,探讨MPS与MCI间的关系。方法:以506名大于70岁老年人为研究对象,使用国际通用帕金森病统一评分量表(The unified Parkinson's disease rating scale,UPDRS)第Ⅲ部分缩写版本评定MPS。将研究对象分为MPS组和无MPS组,分析MPS患病的危险因素及MCI患病情况。结果:MPS组较无MPS组的年龄大,患糖尿病及MCI比例高。结论:MPS与MCI的关系密切,不同类型的MPS对MCI的发病影响不同。     

帕金森病认知损害的神经影像学研究进展

帕金森病(PD)是一种常见的中枢神经系统变性疾病,认知损害是PD常见的非运动症状之一,其机制目前尚不完全清楚。神经影像学技术可以显示疾病特异性的结构和功能特征,是研究PD认知损害发生发展机制的强大工具。文中将从神经影像技术中的磁共振成像和正电子发射计算机断层扫描两个方面,对近年来PD认知损害的神经影像学研究进展予以综述。     

非痴呆帕金森病患者认知功能状态分析

目的 分析非痴呆帕金森病(PD)患者认知功能的特点及其影响因素,为早期诊断和干预PD认知功能损害提供依据. 方法 选择广州军区广州总医院神经内科自2010年1月至201 1年10月收治的PD患者56例,采用简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评定其认知功能,Logistic逐步回归分析PD患者认知功能损害的影响因素. 结果 以MMSE为评估标准时,6例(7.14％)PD患者存在轻度认知功能损害(MCI);而以MoCA为标准时,40例(71.43％)PD患者存在MCI.MMSE和MoCA评分均与患者文化程度呈正相关关系(r=0.483,P=0.007;r=0.503,P=0.000).MMSE各认知域中评分下降幅度较大的是视空间、计算及注意力、复述和延迟记忆.认知域评分低于相应认知域总分患者例数较多的为延迟记忆、视空间、即刻记忆和复述.MoCA各认知域评分下降幅度较大的为复述、延迟记忆、抽象、视空间与执行;认知域评分低于相应认知域总分患者例数较多的为延迟记忆、复述、注意和视空间与执行.Logistic逐步回归分析显示文化程度和临床分型是影响PD认知功能损害的主要因素,即文化程度较低,少动强直型和混合型的PD患者认知功能损害风险增高. 结论 认知功能损害在PD患者中常见,以延迟记忆、视空间与执行、计算及注意力、抽象和复述等认知域为主.文化程度和临床分型是PD认知功能损害的主要影响因素.     

非痴呆非抑郁帕金森病患者额叶认知功能变化的研究靠

目的探讨帕金森病(PD)患者认知功能变化的特点,以及额叶认知测试对PD患者认知障碍评价的意义.方法采用对额叶认知障碍比较敏感的神经心理方法词语流畅性、连线测验、Stroop字色干扰测验对31例非痴呆非抑郁PD患者和25名年龄、性别、受教育程度相匹配的正常对照进行测试.结果非痴呆非抑郁PD患者与对照组比较额叶认知功能评分较差(词语流畅性P＜0.05、连线试验P＜0.01、Stroop字色干扰测试P＜0.01).结论非痴呆非抑郁的PD患者额叶认知功能显著降低,其机制可能与额叶-纹状体多巴胺环路中递质紊乱有关.     

MoCA量表在评估帕金森病患者认知功能中的应用

目的 采用蒙特利尔认知评估量表(MoCA)分析帕金森病(PD)患者的认知功能损害的特点,并探讨MoCA在评估PD认知功能方面的应用价值.方法 采用MoCA对35例PD患者进行认知功能评估,并进行各认知域的分析.结果 (1)本组研究对象的MoCA评分为20.51±5.767,其中7例患者MoCA≤26分,占20.0%;(2)PD患者各认知域障碍的发生率不一致,依次为语言(34例,97.1%)、延迟记忆(32例,91.4%)、视空间与执行能力(30例,85.7%)、抽象思维(27例,77.1%)、注意(23例,68.6%)、命名(13例,37.1%)和定向力(12例,34.3%):(3)MoCA的各认知域与总分的相关系数都大于0.50,P＜0.01.结论 (1)MoCA是评估PD患者认知功能的高效快捷的工具;(2)PD患者常见的认知功能损害包括语言、延迟记忆、视空间与执行能力、抽象思维和注意,而命名和定向力相对损害较轻.     

从血管性痴呆到血管性认知功能损害

本文通过回顾血管性痴呆的提出及争议，引出血管性认知功能损害提出的背景及其必要性，阐述了其诊断标准目前存在的问题及新近的研究进展，旨在通过比较血管性痴呆到血管性认知功能损害定义的演变说明血管性认知功能损害这一定义的重要性，指出寻找血管性认知功能损害特异性的神经心理学表现、影像学特点、生物学标记以及病理学特点将是今后。     

帕金森病的认知功能改变特征

帕金森病（Parkinson disease,PD）是一种中老年常见的神经系统变性疾病,其病因及发病机制尚不完全清楚,目前认为可能是遗传与环境因素共同作用的结果。其主要病理特征是黑质多巴胺能神经元的变性死亡和残存神经元内路易小体（Levy body）形成。60岁以上人群其发病率为1％。最初认为PD患者没有认知功能方面的改变,20世纪80年代以来有关PD认知功能改变方面的报道逐渐增多,人们逐渐认识到PD可以出现认知方面的变化,部分患者在疾病晚期会出现痴呆的表现,称之为帕金森痴呆（PDD）。然而,目前尚不清楚是PD本身导致痴呆还是痴呆作为另外一种疾病发生在PD患者身上。本文试对PD患者的认知功能改变特征及相关因素作一综述。     

帕金森病患者主观性认知减退的临床研究

目的探讨伴有主观性认知减退(SCD)的帕金森病(PD)患者(PD-SCD~+)和不伴有SCD的PD患者(PD-SCD~-)各领域的认知功能是否有差异。方法将40例PD患者按照是否有SCD主诉分为PD-SCD~+(n=22)和PD-SCD~-(n=18)两组。用相关测试评价患者各个领域的认知功能(包括注意力、执行功能、语言功能、记忆力功能、视空间功能),比较两组之间各领域的认知测试分数的差异。结果(1)PD-SCD~+与PD-SCD~-两组患者的临床基线资料(P0.05);(2)PD-SCD~+与PD-SCD~-两组在记忆力(即刻与延迟回忆2,P=0.0477)上的差异有统计学意义;在注意力(数字广度试验,P=0.7697;100连续减7,P=0.8696)、执行功能(连线试验,P=1.0000)、语言功能(语言流畅性,P=0.3596;命名和复述,P=0.9140)、记忆力(即刻与延迟回忆1:P=1.0000;定向:P=0.7686)、视空间功能(画钟试验,P=1.0000;五边形交叉,P=0.5597)的差异无统计学意义。结论 PD-SCD~+与PD-SCD~-两组患者的临床基线资料没有差异。PD-SCD~+组的记忆力(即刻与延迟回忆2)较PD-SCD~-组差。     

画钟测验检测认知功能损害

目的　比较画钟测验 (CDT) 4种不同评分方法检测认知功能损害时的信度和效度。方法　认知功能损害组病人 71例 ,对照组为社区健康老人 70名。采用三分制方法、Watson方法、Sunderland方法和CDIS方法 ,由 2名神经科医师独立、盲法检查CDT ,2周后随机抽取 2 0名研究对象由同一名检查者做 2次访问 ,并与简易精神状况检查法 (MMSE)等进行相关性分析。结果　不同评定员之间的重测信度Spearmen相关系数在 0 88～ 0 98之间 ,同一评定员 2次测查的重测信度相关系数在 0 91～ 0 98之间。不同测查方法测查认知功能损害的敏感性、特异性和准确性在 0 80左右 ,而对早期认知功能损害 (MCI)的诊断效度较低 ,敏感性仅为 0 2 0～ 0 60。与MMSE和临床痴呆评定量表 (CDR)的Spearmen相关系数较高 ,分别为 0 85左右和 0 90左右。结论　CDT具有很好的重测信度和诊断效度 ,可用于痴呆的临床和流行病学调查。而对于MCI和正常人群的识别能力有限。     

非痴呆非抑郁帕金森病患者额叶认知功能变化的研究

目的　探讨帕金森病 (PD)患者认知功能变化的特点 ,以及额叶认知测试对PD患者认知障碍评价的意义。方法　采用对额叶认知障碍比较敏感的神经心理方法 :词语流畅性、连线测验、Stroop字色干扰测验对 3 1例非痴呆非抑郁PD患者和 2 5名年龄、性别、受教育程度相匹配的正常对照进行测试。结果　非痴呆非抑郁PD患者与对照组比较额叶认知功能评分较差 (词语流畅性P <0 0 5、连线试验P <0 0 1、Stroop字色干扰测试P <0 0 1)。结论　非痴呆非抑郁的PD患者额叶认知功能显著降低 ,其机制可能与额叶 纹状体多巴胺环路中递质紊乱有关。     

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.     

Vascular Cognitive Impairment: Disease Mechanisms and Therapeutic Implications

The prevalence of vascular cognitive impairment (VCI) is likely to increase as the population ages and cardiovascular disease survival improves. We provide an overview of the definition and disease mechanisms of VCI and present a systematic literature review of the current evidence for the pharmacologic and nonpharmacologic therapies used to treat the VCI symptoms of cognitive dysfunction or to modify VCI through primary and secondary prevention. The Cochrane Database of Systematic Reviews was searched from 2005 to October 2010 using the keywords “vascular dementia” or “vascular cognitive impairment and therapy.” MEDLINE was searched for English-language articles published within the last 10 years using the combined Medical Subject Headings (MeSH) “therapeutics and dementia,” “vascular” or “vascular cognitive impairment.” Although cholinesterase inhibitors and memantine produce small cognitive improvements in patients with VCI, these drugs do not improve global clinical outcomes and have adverse effects and costs. Selective serotonin reuptake inhibitors and dihydropyridine calcium channel blockers may improve short-term cognitive function in patients with VCI. Anti-hypertensive therapy with an ACE inhibitor-based regimen and statins may prevent the major subtype of VCI known as poststroke cognitive decline. Clinical and effectiveness studies with long-term follow-up are needed to determine the benefits and risks of pharmacologic and nonpharmacologic therapies to prevent and treat VCI. Given its growing health, social, and economic burden, the prevention and treatment of VCI are critical priorities for clinical care and research.

Electronic supplementary material

The online version of this article (doi:10.1007/s13311-011-0047-z) contains supplementary material, which is available to authorized users.     

Patterns of Word-List Generation in Mild Cognitive Impairment and Alzheimer's Disease

Patients with amnestic mild cognitive impairment (aMCI) have been described as exhibiting greater impairment on tests of category fluency than letter fluency. This has been offered as evidence that this condition represents pre-clinical Alzheimer's disease (AD). We hypothesized that this pattern of differential impairment is dependent on the specific semantic categories and initial letters selected, and is not specific to AD and aMCI. A total of 40 cognitively normal older adults, 74 MCI patients—25 “amnestic single domain” (aMCI), 27 “amnestic multiple domain”, and 22 non-amnestic—and 29 AD patients were tested with multiple forms of semantic-category and initial-letter fluency tasks. The pattern of deficits within and across groups was highly dependent on the specific categories and letters chosen. Overall, aMCI patients did not demonstrate greater impairment in category than letter fluency. In fact, the level and pattern of their performance resembled that of cognitively normal older adults much more than AD patients. MCI patients with deficits in multiple cognitive domains performed most like AD patients. These findings indicate that verbal fluency performance is highly influenced by the specific tasks used, and impairment on semantic fluency is not characteristic of pure amnestic MCI.     

Sleep Disturbances and Predictive Factors in Caregivers of Patients with Mild Cognitive Impairment and Dementia

Background and Purpose

We examined the characteristics of sleep disturbances and sleep patterns in the caregivers of patients with amnestic mild cognitive impairment (aMCI) and dementia.

Methods

We prospectively studied 132 patients (60 with aMCI and 72 with dementia) and their caregivers, and 52 noncaregiver controls. All caregivers and controls completed several sleep questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). The patients were administered neuropsychological tests and the neuropsychiatric inventory to evaluate their behavioral and neuropsychiatric symptoms of dementia (BPSD).

Results

The PSQI global score was 6.25±3.88 (mean±SD) for the dementia caregivers and 5.47±3.53 for the aMCI caregivers. The Insomnia Severity Index (ISI) and short form of the Geriatric Depression Scale (GDS-S) predicted higher PSQI global scores in aMCI caregivers, and higher scores for the ISI, Epworth Sleepiness Scale (ESS), and GDS-S in dementia caregivers. BPSD, including not only agitation, depression, and appetite change in dementia patients, but also depression, apathy, and disinhibition in aMCI patients, was related to impaired sleep quality of caregivers, but nighttime behavior was not. Age and gender were not risk factors for disturbed sleep quality.

Conclusions

Dementia and aMCI caregivers exhibit impaired quality of sleep versus non-caregivers. ISI, GDS-S, and ESS scores are strong indicators of poor sleep in dementia caregivers. In addition, some BPSD and parts of the neuropsychological tests may be predictive factors of sleep disturbance in dementia caregivers.     

Vascular Cognitive Impairment

Abstract: The term vascular cognitive impairment (VCI) is now employed to capture the spectrum of illness and disability arising from impaired cognitive function of vascular origin. As such, it supplants the more narrowly focussed terms "Vascular dementia (VaD)" and "multi-infarct dementia". It is meant to include both those whose cognitive impairment is different from that assumed by the usual criteria for dementia. Traditionally, dementia criteria have been modelled on AD, a disorder with more characteristic neuropathological and clinical disease expression than is seen in VaD, which can occur in many forms. VCI is common, and is associated with many adverse outcomes, including worse cognition, institutionalization, and death.
One form of VCI is coincident AD and VaD, a category which, although it has been comparatively neglected, may be amongst the most common forms of dementia. Another common form of VCI has a predilection for subcortical ischemic lesions, and for a clinical presentation which reflects frontal and subcortical involvement.
At present, there is no specific treatment for VCI, although several agents appear to offer the hope of both treatment and prevention. Further research on the clinical, pathological and mechanistic underpinnings of this important syndrome is needed. For a long time, VaD has been recognized as the second most common cause of dementia.^1,2) More recently, however, the concept of cognitive impairment in relation to cerebrovascular disease has been expanded. This paper will review the notion of "vascular cognitive impairment" (VCI) as it relates to clinical practice, and to our understanding of disease mechanisms in dementia and related disorders. It will propose that while the expanded concept has merit, within it are to be found distinct subgroups, including some of particular importance as targets for clinical trials of therapeutic and even preventive interventions.     

血管性认知障碍研究进展

血管性认知功能障碍（VCI）包括血管性非痴呆认知功能障碍、血管性痴呆（VaD）以及伴有血管因素的阿尔茨海默病。这种理解扩大了VaD的范围，有利于认知功能障碍的早期诊断，从而为痴呆的预防提供了可能。本文从概念、分类、流行病学、病因、危险因素、神经影像学、神经病理学、诊断及治疗方面对最近几年VCI的研究进展进行综述。     

中文修订版智能筛查检测在阿尔茨海默病和轻度认知损害评估中的作用

目的:探讨智能筛查测验(CASI)在不同严重度的阿尔茨海默病(AD)患者中的表现及与MMSE总分的关系。方法:使用2.0版本的CASI、MMSE及临床痴呆量表等对30名正常中老年人、20例轻度认知损害(MCI)和53例不同严重度的AD患者(20例轻度、19例中度、14例重度)进行评估。结果:根据CASI因子分分析发现,MCI组新记忆和概念判断受损、完成测验的耗时数延长,AD组在从轻至重度组中依次出现定向障碍、心算障碍,直到所有因子分均显著减退。除"概判"因子外,其余因子分都随着病情严重度而逐渐降低。除了重度AD组以外,MCI组、轻度AD组和中度AD组均较前一组下降约10分。CASI总分以≤85分为界:识别MCI的敏感度为70.6%;识别轻度AD的敏感度为82.7%;特异度均为73.9%。对于大学及以上文化者,CASI难度过低,容易出现假阴性。结论:CASI可有效判断AD认知损害的严重度,并能从组成项目中获得MMSE总分。