血管性认知障碍的概念及危险因素

随着人口老龄化的提高,如果不采取干预性措施,1/3 的人将来会患卒中和(或)痴呆,卒中后,高达64%的患者存在不同程度的认知障碍,1/3 会发展为明显的痴呆[1].本文就血管性认知障碍(vascular cognitive impairment,VCI)概念及危险因素一综述.     

轻度血管性认知障碍的结构影像学研究

血管性认知障碍(vascular cognitive impairment,VCI)包括无痴呆型血管性认知障碍(vascular cognitive impairment no dementia,VCIND)、血管性痴呆(vascular dementia,VaD)及混合性痴呆这一过程[1].神经影像学是VCI研究和诊...     

血管性认知障碍的影像学研究

正随着老龄化社会的到来,脑血管病的发病率日益增高,脑血管病伴发的认知障碍随之增多。脑血管病伴发的认知障碍首先由Bowler等~([1])在1995年提出,称之为血管性认知障碍(vascular cognitive impairment,VCI)。VCI是指由于颅内血管本身的病变、心脏病变或颅外大血管病变引起的脑部血流异常及其危险因素导致的认知功能损害的综合征~([2])。2011年《中国血管性认知障碍诊治指南》中指出,根据病程可以将VCI分为非痴呆性血管性认知障碍     

血管性痴呆和2型糖尿病关系的研究进展

血管性痴呆(vascular dementia,VaD)是影响老年人的常见认知障碍性疾病,其认知障碍主要归因于脑血管病变.2型糖尿病(diabetes mellitus type 2,T2DM)是最常见的代谢相关疾病之一,是脑血管病的危险因素.VaD的发生机制目前仍不清楚,但是大量研究数据表明,T2DM与VaD之间存在...     

皮层下缺血性血管性痴呆

皮层下缺血性血管性痴呆（subcortical ischemic vascular dementia, SIVD）是血管性认知障碍（Vascular cognitive impairment, VCI）的一个亚型,具有认知障碍和皮层下脑缺血病灶的证据。其包括腔隙状态、关键部位梗死性痴呆和Binswanger综合征等3个类型。认知障碍的特征是显著的执行功能障碍和相对轻微的工作记忆减退。对脑血管病危险因素的干预有助于皮层下缺血性血管性痴呆的防治。     

卡巴拉汀治疗血管性认知障碍的研究现状

血管性认知障碍(vascualr cognitive impairment,VCI)是指由脑血管病危险因素(如高血压病、糖尿病和高脂血症等)、显性(如脑梗死和脑出血等)或非显性脑血管病(如白质疏松和慢性脑缺血)引起的从轻度认知损害到痴呆的一大类综合征[1].该病包括了血管性的认知功能障碍从轻到重的完整的发病病程,依据严重程度可分为非痴呆性血管性认知障碍(vascular cognitive impairment not dementia,VCIND)和血管性痴呆(vascular dementia,VaD)[2].根据国际阿尔茨海默病协会2018年公布的数据[3],全球有5000万人罹患痴呆症,其中VCI占所有痴呆类型的20%~30%,为仅次于阿尔茨海默病(Alzheimer's disease,AD)的第二常见的痴呆类型,给家庭和社会造成较大的经济压力.然而VCI具有可防可治性,因此逐渐成为人们研究热点之一.目前推荐用于治疗VaD的药物有胆碱酯酶抑制剂(主要有多奈哌齐、加兰他敏、卡巴拉汀、石杉碱甲)、美金刚、银杏叶制剂、奥拉西坦等,但部分药物疗效尚存争议[1].     

轻度认知障碍与无痴呆型血管性认知障碍患者的神经心理学特征

阿尔茨海默病（AD）和血管性痴呆（vascular dementia，VD）是临床常见的老年期痴呆类型。虽然长期以来受到广泛关注．但对其治疗收效甚微．近年逐渐将研究重点转向对其早期阶段的干预治疗。在这一临床需要下，针对阿尔茨海默病和血管性痴呆分别提出了轻度认知障碍（mild cognitive impairment，MCI）和血管性认知障碍（vascular cognitive impairment，VCI）的概念，力求对患者进行早期识别和干预，以延缓甚至阻止痴呆的发生、发展。     

啮齿类血管性痴呆动物模型

<正>由脑血管因素引起脑组织血液供应障碍导致的脑功能衰退,表现为认知功能缺损,统称为血管性痴呆(vascular dementia,VD)[1],亦称血管性认知障碍(vascular cognitive impairment,VCI)[2]。VD不是一个单一的疾病,而是一类综合征,大、小动脉病变,弥漫性缺血性白质病变,心脏脱落栓子的栓塞,血流动力学改变,出血,血液学因素和遗传性疾病等不同的血管病理变化均可引起VD症状。流行病学研究显示在欧洲和北美,VD是继老年性痴呆(Alzheimer’s disease,AD)之后引起老     

皮质下缺血性血管病患者认知功能的弥散张量磁共振研究

目的明确弥散张量成像(diffusion tensor imaging,DTI)对皮质下型血管性认知障碍的识别作用。方法42例皮质下缺血性血管病(subcortical ischemic vascular desease,SIVD)患者经过认知测试,被分为无认知障碍(no cognitive impairment,NCI)组,血管性认知障碍非痴呆(vascular cognitive impairment no dementia,VCIND)组和血管性痴呆(vascular dementia,VaD)组。分析其认知测试指标与DTI参数之间的关系。结果VCIND组、VaD组全脑白质平均弥散度(mean diffusivity,MD)分别为(0.89±0.05)×10-9m2.s-1和(0.93±0.05)×10-9m2.s-1,与NCI组(0.84±0.03)×10-9m2.s-1相比,有统计学差异(均P<0.01),VCIND组、VaD组各向异性分数(fractional anisotropy,FA)分别为(0.35±0.02)和(0.34±0.02),与NCI组(0.37±0.02)相比,亦有统计学差异(均P<0.01)。全脑白质MD与注意执行功能和记忆功能测验评分的相关系数分别为-0.538和-0.500,均P<0.01;FA值与注意执行功能和记忆功能测验评分的相关系数分别是0.439和0.411,均P<0.01。排除VaD患者后,MD与注意执行功能的相关系数为-0.401,P<0.05。结论 VCIND和VaD组的MD和FA值与NCI组有统计学差异,SIVD患者的注意执行与记忆功能与白质完整性独立相关。     

低灌注性血管性认知障碍的研究进展

血管性认知障碍（vascular cognitive impairment,VCI）是导致认知障碍和痴呆的常见原因。 低灌注性VCI作为一个重要亚型由于其可干预性和可预防性,成为认知障碍领域研究的热点。本文根 据近些年来对于低灌注性VCI的相关研究,对其概念、病理生理、临床特征、影像学检查及治疗方法 加以阐述。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.