基底核出血和梗死后认知功能的随访研究

目的探讨基底核出血和梗死急性期及恢复期的认知损害特点和差异。方法观察组共91例患者,其中基底核出血48例,基底核梗死43例。观察组在卒中后急性期（卒中后3周内）及卒中后恢复期（卒中后6～9个月）各完成一次神经心理学测验。健康对照组77名,完成一次神经心理学测验。结果基底核出血组和梗死组在急性期的各个认知域评分与对照组比较,差异均有统计学意义（P〈0．05）。除执行功能（语义分类流畅性）外,基底核出血组恢复期的神经心理学测验评分与急性期比较,差异均有统计学意义（P〈0．05）。恢复期基底核出血组的记忆力、执行功能（语义分类流畅性）、信息处理速度（数字符号测验）、视空间结构能力（积木测验和画钟测验）评分与健康对照组比较,差异亦有统计学意义（P〈0．05）,而简易精神状态检查量表（MMSE）、注意力、执行功能（Stroop测验C）和信息处理速度（Stroop测验A）评分与健康对照组比较,差异无统计学意义（P〉0．05）。除注意力（数字广度顺背测验）、记忆力（再认）和执行功能（语义分类流畅性测验）外,基底核梗死组恢复期的神经心理学测验评分与急性期比较,差异均有统计学意义（P〈0．05）。基底核梗死组恢复期记忆力、信息处理速度（数字符号测验）、视空间结构能力（积木测验和画钟测验）评分与健康对照组比较,差异具有统计学意义（P〈0．05）,而MMSE、执行功能（Stroop测验C）和信息处理速度（Stroop测验A）评分与健康对照组比较,差异无统计学意义（P〉0．05）。结论基底核卒中急性期出现多个认知领域的损害,恢复期大部分认知域得到改善,其中部分认知域可基本达到健康对照水平。     

初发急性基底核出血与梗死患者的认知改变

目的探讨初次发病的急性基底核出血和梗死急性期患者认知变化的特点和差异。方法观察组共91例患者,其中基底核出血48例,基底核梗死43例。观察组卒中患者均在发病3周内,人组当日就完成一次神经心理学测验。健康对照组77名,完成一次神经心理学测验。结果基底核出血组和梗死组在各个认知域的评分均低于健康对照组（P〈0.05）。除数字符号、Stroop测验A部分和积木测验外,基底核出血组的认知域评分均低于基底核梗死组（P〈0.05）。左侧半球基底核出血组简易精神状态检查量表（Mini-Mental State Examination,MMSE）、注意力、记忆力、执行功能、信息处理速度和视空间结构能力的认知域评分均低于同侧基底核梗死组（P〈0.05）。右侧半球基底核出血组的MMSE、记忆力和视空间结构能力评分低于同侧基底核梗死组（P〈0.05）。左侧基底核出血组的MMSE、记忆力、执行功能和信息处理速度评分均低于右侧出血组,左侧基底核梗死组记忆力和执行功能评分也低于右侧半球（P〈0.05）。结论基底核卒中急性期可以出现多个认知领域的损害,基底核出血较梗死受损严重,左侧较右侧受损严重。应早期进行神经心理学评估,以期进行针对性的康复治疗。     

老年期抑郁症和轻度Alzheimer病的认知功能研究

目的 了解老年期抑郁症（SD）和轻度Alzheimer病（AD）的认知功能差异。方法 使用汉密顿抑郁量表（HAMD）、简易智能状态检查（MMSE）和Et常生活能力量表（ADL）、韦氏成人记忆量表（WAIS-RC）和中国临床记忆量表对60例SD患者、30例轻度AD患者和30例正常老年人进行评定。同时在治疗前对他们进行P300测量。结果 SD和轻度AD患者的MMSE、WAIS-RC和记忆量表评分均显著低于正常对照组，而ADL总分均显著高于正常对照组，但轻度AD患者的前3个量表总分又均显著低于SD患者，而ADL总分又均显著高于SD患者（P〈0．05或P〈0．01）。SD和轻度AD患者的P300的N1、P2、N2、P3潜伏期均显著长于正常对照组，SD患者的P3波幅显著低于轻度AD患者；但轻度AD患者的P300的N1、N2、P3潜伏期均显著长于SD患者；并且轻度AD患者的P300的P2波幅显著高于正常对照组（P〈0．05或P〈0．01），而SD的P2波幅与正常对照组无显著性差异。结论 SD和轻度AD患者均存在认知功能障碍，但轻度AD患者较SD患者重。     

阿尔茨海默病与遗忘型轻度认知功能障碍患者的记忆损害

目的分析阿尔茨海默病(AD)及遗忘型轻度认知功能障碍(a MCI)患者的记忆损害。方法对25例AD患者和28例遗忘型轻度认知功能障碍患者和25例健康对照者进行多项神经心理学检查,包括简明精神状态量(MMSE)、蒙特利尔认知评估量表(Mo CA)、WMS-RC(韦氏记忆量表中文修订版)。结果 AD组MMSE、Mo CA总分明显低于a MCI组(P0.05),a MCI组MMSE、Mo CA评分明显低于正常对照组(P0.05);AD组与a MCI组及正常对照组相比,记忆商降低(P0.05)。除经历、定向外,各分测验分数降低;a MCI与对照组相比记忆商降低,短时记忆中(视觉再生、联想学习)分数明显降低,长时记忆和瞬间记忆无明显差异。结论 AD患者与a MCI患者均出现不同程度记忆损害,AD患者瞬时记忆、短时记忆、长时记忆损害明显,a MCI患者短时记忆出现损害,瞬时记忆、长时记忆无显著变化。     

老年静止性腔隙性脑梗死患者认知功能研究

目的探讨静止性腔隙性脑梗死（SLI）老年患者认知功能障碍的特点. 方法临床收集128名患者和38名对照者,根据MRI影像按照SLI梗死数的多少将患者进一步分为单个SLI组和多发SLI组,分别进行简明精神状态量表（MMSE）测验、积木测验和画钟测验. 结果 （1） 单个SLI组患者的MMSE、积木测验和画钟测验评分与对照组相比无明显差异（P＞0.05）,而多发SLI组患者MMSE、积木测验和画钟测验评分较对照组显著降低（P＜0.01）;（2） 与对照组相比,单个SLI组MMSE各分值评分均无显著降低（P＞0.05）,而多发SLI组MMSE时间定向、地点定向、短程记忆、注意力、计算力、图形描画分值评分显著降低（P＜0.05）. 结论多发SLI与认知功能下降密切相关,主要影响记忆、注意力、计算力和视空间、执行等认知功能.     

不同病因所致轻度认知功能损害的神经心理检测比较

轻度认知功能损害(mild cognitive impairment,MCI)是介于正常衰老与痴呆之间的一种过渡状态,是一组认知障碍综合征。与年龄和教育程度匹配的正常老年人相比,患者存在轻度认知功能减退,但日常生活能力没有受到明显影响,保持功能独立,认知障碍尚未达到痴呆程度。MCI的核心症状是认知功能的减退,根据病因或大脑损害部位的不同,可以累及记忆、执行功能、注意力、语言、视空     

老年高血压患者昼夜血压节律变化与轻度认知功能障碍的关系

目的：分析老年原发性高血压患者血压昼夜节律改变与轻度认知功能障碍的关系。方法对998例老年原发高血压患者进行动态血压监测,并采用蒙特利尔认知评估量表（ MoCA）进行认知功能评价;依据夜间血压下降率分为杓型血压组、非杓型血压组、超杓型血压组和反杓型血压组,比较各组认知功能障碍的差异,分析动态血压参数与轻度认知功能损害的关系。结果非杓型、超杓型、反杓型血压组MoCA评分均小于杓型血压组,轻度认知功能障碍发病率高于杓型血压组,P均＜0．05;非杓型及超杓型血压组视空间/执行功能、记忆功能减退较杓型血压组更明显（P均＜0．05）;轻度认知功能障碍与24 h平均收缩压、日间平均收缩压、夜间平均收缩压呈负相关（P均＜0．01）。结论昼夜血压节律异常的高血压患者较血压节律正常的杓型高血压患者更易发生轻度认知功能损害,其对认知功能的影响主要表现在视空间/执行功能、记忆功能和注意功能。     

三种轻度认知功能障碍患者的病情转归

目的：观察三种轻度认知功能障碍（ MCI ）患者的病情转归情况。方法76例MCI患者,根据认知功能障碍程度分为单纯记忆损害（SMI）21例（SMI组）、多领域认知功能损害（MD-MCI）43例（MD-MCI组）、单纯非记忆功能认知受损（NMI）12例（NMI组）,观察随访3 a后,比较三组患者的认知功能及病情转归情况。结果3 a后MCI患者认知功能减退明显,MD-MCI组MMSE评分、词语延迟回忆评分、数字广度倒数评分、言语流畅性评分、画钟实验评分、本顿视觉保持正确评分均明显低于SMI组、NMI组（P均＜0．05）;MD-MCI组进展为阿尔茨海默病（AD）19例,其他类型痴呆4例,AD及痴呆发病率为53．5％;SMI组AD发病率为19．0％（4/21）;NMI组痴呆发病率为25％;MD-MCI组AD及痴呆发病率与SMI组、NMI组相比,P均＜0．05。 SMI组2例、NMI组3例认知状态恢复正常。结论不同类型的MCI转归不同,MD-MCI型较SMI型、NMI型认知功能损害重,3 a后AD及痴呆发病率高。     

快速认知筛查测验识别老年轻度认知功能障碍的效果

目的评价老年人快速认知筛查测验识别轻度认知功能障碍(MCI)和早期痴呆(AD)的效能。方法 60岁及以上的轻度AD患者84例、MCI患者112例、正常老人(NC)196例,采用老年人快速认知筛查测验(QCST-E)、简易精神状态检查量表(MMSE)、日常生活能力(ADL)量表、临床痴呆评定量表(CDR)、华文认知能力量表(CCAS)进行认知功能评估。QCST-E分别测量12个认知领域:即刻记忆、实物命名、视觉空间、言语流畅性、数字广度、抽象能力、听觉模仿、视觉模仿、动作指令、延迟记忆、简单计算、时空定向,最高总分83分,得分越低,认知功能损害越严重。结果轻度AD组、MCI组、NC组QCST-E总分分别为(51.47±3.91)分、(61.47±2.96)分、(72.60±3.01)分,差异显著(P<0.01)。QCST-E各领域和总分与年龄、受教育年限及MMSE、ADL、CCAS得分显著相关(均P<0.01)。根据不同文化程度制定QCST-E的划界分,其中QCST-E总分识别MCI与正常老人的总体敏感度为89.6%、特异度为94.5%,曲线下面积(AUC)为0.903(95%CI:0.857~0.963);识别MCI与轻度AD的总体敏感度为81.7%、特异度为88.6%,AUC值为0.898(95%CI:0.845~0.940)。结论老年人快速认知筛查测验内容全面、简便易行,识别MCI的敏感度和特异度良好。     

养血清脑颗粒对轻度血管性认知功能障碍病人认知功能减退疗效的临床研究

目的观察养血清脑颗粒对轻度血管性认知功能障碍病人的认知功能的影响。方法将45例轻度血管性认知功能障碍病人随机分为对照组及治疗组，其中治疗组24例，对照组21例，两组病人均接受控制脑血管病危险因素的基础治疗。治疗组加服养血清脑颗粒，每次4g，每日3次，冲服，共服用16周；对照组接受控制脑血管病危险因素的基础治疗（如阿司匹林、他汀类、降压药物等）疗程16周，治疗前和治疗后分别测定简易智力状态量表（MMSE）总分和各个亚项评分及成人韦氏记忆测验记忆商（MQ）总分及各个亚项的评分。结果治疗前两组在MMSE的各个亚项目无统计学意义（P〉0．05）；治疗后治疗组在MMSE的亚项如记忆力、注意力及计算力和回忆力上有统计学意义（P〈0．05），在定向力与语言能力上无明显差异；在成人韦氏记忆量表记忆商方面治疗后的病人主要表现图片回忆、背数、理解力3项上前后的差异性表现显著。对照组治疗前后虽有提高但是无统计学意义。结论养血清脑颗粒对轻度血管性认知功能障碍病人的认知功能减退有所改善，尤其表现在MMSE的主要亚项如记忆力、注意力及计算力和回忆力的评分较治疗前有明显提高。     

Impaired cognitive performance in asymptomatic peripheral arterial disease: relation to C-reactive protein and D-dimer levels

BACKGROUND AND PURPOSE: asymptomatic peripheral arterial disease (APAD), a highly prevalent condition in the general older population, is associated with an increased risk of cerebrovascular events because of co-existing clinical or subclinical cerebral atherosclerosis. The purpose of this study was to investigate whether cognitive function is impaired in stroke- and transient ischaemic attack-free patients with APAD, and whether inflammatory and haemostatic markers are associated independently with neuropsychological performance. METHODS: cognitive performances of 164 well-functioning, community-dwelling patients with APAD were compared with those of 164 age-, gender- and education-matched healthy control subjects on six neuropsychological tests. Levels of C-reactive protein (CRP), D-dimer and fibrinogen were also analysed in all participants. RESULTS: patients with APAD scored significantly worse (P < 0.0001) than control subjects on five cognitive tests assessing domains of verbal working memory, attention, perceptuomotor speed, mental flexibility, visuoconstructive skills and visual memory. Multiple linear regression analyses showed that CRP and D-dimer were significant, independent predictors of poorer performances on four and three cognitive tests, respectively, within patients with APAD. CONCLUSIONS: patients with APAD show cognitive impairment in a range of psychometric tests, and CRP and D-dimer appear to be independent negative predictors of some cognitive performances. These findings suggest the need for screening for APAD among at-risk subjects in order to identify patients to be treated for prevention of functional decline and dementia. They also support the hypothesis that inflammation and hypercoagulability are implicated in the pathophysiology of cognitive dysfunction associated with APAD.     

Characteristics of neuropsychological functions in inpatients with poorly‐controlled type 2 diabetes mellitus

Aims/Introduction: It has been suggested that type 2 diabetes is associated with cognitive impairment. We investigated the neuropsychological profile of inpatients with poorly controlled type 2 diabetes and assessed the effects of clinical factors on neuropsychological functions. Materials and Methods: Forty‐two patients with type 2 diabetes and 32 non diabetic control subjects were matched for age, sex ratio, and level of education. Attention & working memory, processing speed, verbal memory, visuospatial memory, visuoconstruction, and executive function were tested. Information about physical function, alcohol use, hypertension, dyslipidemia, and myocardial infarction was retrieved from personal interviews and medical records. Results: Diabetic patients demonstrated mild cognitive deterioration in attention & working memory, processing speed, verbal memory, and executive function. In particular, neuropsychological decline became prominent when tasks related with speed and verbal stimuli became unstructured and complex. Age was significantly associated with the majority of neuropsychological tests, whereas tasks dealing with working memory and executive function were associated with age only in the diabetic group. Duration of diabetes was associated with Backward Digit Span. Conclusions: Accelerated aging had a major influence on cognitive decline in the diabetic group, whereas diminished performance in working memory and executive function might have been more related to diabetes‐related cognitive impairment. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00170.x, 2011)     

Cognitive effects of treating obstructive sleep apnea in Alzheimer's disease: a randomized controlled study

OBJECTIVES: To examine whether treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) in patients with Alzheimer's disease (AD) results in better cognitive function. DESIGN: Randomized double‐blind placebo‐controlled trial. Participants were randomized to therapeutic CPAP for 6 weeks or placebo CPAP for 3 weeks followed by therapeutic CPAP for 3 weeks. SETTING: General clinical research center. PARTICIPANTS: Fifty‐two men and women with mild to moderate AD and OSA. INTERVENTION: CPAP. MEASUREMENTS: A complete neuropsychological test battery was administered before treatment and at 3 and at 6 weeks. RESULTS: A comparison of subjects randomized to 3 weeks of therapeutic versus placebo CPAP suggested no significant improvements in cognition. A comparison of pre‐ and posttreatment neuropsychological test scores after 3 weeks of therapeutic CPAP in both groups showed a significant improvement in cognition. The study was underpowered to make definitive statements about improvements within specific cognitive constructs, although exploratory post hoc examination of change scores for individual tests suggested improvements in episodic verbal learning and memory and some aspects of executive functioning such as cognitive flexibility and mental processing speed. CONCLUSION: OSA may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in patients with AD. OSA treatment seems to improve some cognitive functioning. Clinicians who care for patients with AD should consider implementing CPAP treatment when OSA is present.     

PIN-1 promoter polymorphisms in mild cognitive impairment and susceptibility to Alzheimer's disease: a preliminary report

BACKGROUND AND AIMS: Peptydil prolyl cis-trans isomerase (PIN-1), which specifically regulates the conformational changes following phosphorylation of several proteins, targets the inactive hyper-phosphorylated tau on the Thr231-Pro motif and directly restores its biological function. Interestingly, PIN-1 is oxidatively inhibited not only in Alzheimer's disease brain but also in the hippocampi of mild cognitive impairment (MCI) subjects. The PIN-1 gene is characterized by two single nucleotide polymorphisms (SNPs) in the promoter region which are associated with the risk of Alzheimer's disease. The aim of this study was to analyse the genotype and allele distributions of these PIN-1 SNPs in MCI subjects diagnosed respectively as amnestic MCI (a-MCI) and multiple impaired cognitive domains (mcd-MCI) on the basis of cognitive features. METHODS: -667 T/C and -842 C/G SNPs were genotyped by polymerase chain reaction (PCR) amplification and direct sequencing in 43 MCI subjects, with the intention of comparing -667 and -842 SNP frequencies with those previously described in 111 Alzheimer's disease patients (AD) and 73 healthy controls (HC). RESULTS: The allele frequencies of the -842 C/G SNP in a-MCI subjects are similar to those of AD subjects, while those of mcd-MCI are comparable to HC (G allele 83% in both a-MCI and AD; 95% and 94% in mcd-MCI and HC, respectively). A similar trend is also observed in -842 C/G genotypes. CONCLUSIONS: Since a-MCI is thought to be the preclinical form of AD, the similar genotype distribution of -842 SNP in AD and a-MCI, but not in mcd-MCI, suggests that it is potentially involved in the conversion of a-MCI to AD. In conclusion, these findings support the theory that polymorphisms of the PIN-1 gene can affect neurodegeneration and its clinical progression.     

Donepezil provides greater benefits in mild compared to moderate Alzheimer's disease: Implications for early diagnosis and treatment

We assessed the cognitive and functional outcomes of donepezil treatment in mild versus moderate Alzheimer's disease (AD) patients. We performed a 6-month prospective, observational, multicenter study of the progression of cognitive and functionality abilities in a large sample patients with AD who initiated treatment with donepezil in monotherapy. According to baseline mini mental state examination (MMSE), patients were divided in two groups: mild AD (MMSE ≥ 21) and moderate AD (MMSE < 21). Patients were evaluated with the memory alteration test (M@T) and the Alzheimer's disease functional assessment and change scale (ADFACS) at baseline and at 6 months. A total of 403 patients finished the study (mild AD = 152; moderate AD = 251). The MMSE total score and M@T score remained stable at 6 months in the whole sample, with MMSE memory domain and M@T free and cued recall domains improving significantly from baseline. Total ADFACS, instrumental (IADL) and basic activities of daily living (BADL) got significantly worse, with the worsening being significantly greater in the moderate AD group. Significant differences between the groups favoring mild AD were observed for MMSE memory, orientation and language domains, M@T temporal orientation and semantic memory domains, and for IADL. We concluded that in AD patients on donepezil, cognition remains stable at 6 months. The beneficial effect of donepezil treatment, in terms of cognition and functionality, is greater for mild than for moderate AD.     

初次发病的腔隙性脑梗死患者急性期的认知改变

目的研究初次发病的腔隙性脑梗死患者在急性期的认知障碍特点。方法对91例初次发病的腔隙性脑梗死患者于发病1周内进行神经心理学测验,并与78名健康志愿者进行比较,观察不同认知域的变化特点。神经心理学测验包括简易精神状态检查量表、汉化的韦氏成人智力量表（数字广度、图片排列、数字符号和积木测验）、世界卫生组织一加利福尼亚洛杉矶大学听觉词语学习测验、简化的Rey复杂图形测验、Stroop测验、语义分类流畅性测验、加利福尼亚卡片分类测验和画钟测验。结果腔隙性脑梗死急性期患者在注意力、记忆力、执行能力和视空间结构能力等认知域评分均低于对照组,差异有统计学意义,P〈0．05;信息处理速度的评分与对照组比较,差异无统计学意义。结论初次发病的腔隙性脑梗死急性期的患者认知障碍广泛。腔隙性脑梗死后的认知障碍应作为临床特征,进行早期重视和干预。     

Profile of cognitive impairment in chronic heart failure

OBJECTIVES: To determine the frequency and pattern of cognitive dysfunction in outpatients with chronic congestive heart failure (CHF) and to identify the corresponding demographic and clinical correlates.
DESIGN: Case-control study.
SETTING: Outpatient clinic in a community hospital.
PARTICIPANTS: Sixty-two outpatients with CHF, 53 controls diagnosed with cardiovascular disease uncomplicated by CHF (cardiac controls), and 42 healthy controls were investigated.
MEASUREMENTS: Neuropsychological assessment included tests of mental speed, executive function, memory, language, and visuospatial function. Composite z -scores for five cognitive domains and mean z -score for overall cognitive performance were computed. The cutoff score to indicate cognitive impairment was defined as the overall healthy participants' cognitive z -score minus 2 standard deviations. Independent demographic and clinical predictors of cognitive impairment were identified using linear regression analysis.
RESULTS: Patients with CHF showed a pattern of general cognitive impairment, including impairment of executive function, memory, language, mental speed, and attention. Twenty-five percent ( P =.04) of patients with CHF were classified as cognitively impaired, compared with 15% of the cardiac controls and 4% of the healthy controls. Independent predictors of cognitive impairment in patients with CHF were estimated intelligence, New York Heart Association class, and presence of the apolipoprotein (Apo)E ɛ4 allele.
CONCLUSION: Cognitive dysfunction is relatively common in patients with CHF, with deficits being most prominent in the domains of executive function, memory, language, and mental speed. Disease severity and ApoE genotype are likely to be important determinants for cognitive impairment in patients with chronic CHF.     

词语记忆量表在老年人认知功能损害中的应用

目的评估词语记忆量表在区分正常老年人、轻度认知功能损害(MCI)及轻度阿尔茨海默病(AD)患者中的应用。方法选择认知功能正常者108例(对照组),MCI患者105例(MCI组)及轻度AD患者57例(轻度AD组),进行简易智能状态检查量表及词语记忆量表检查,量表内容包括词语即刻回忆、延迟回忆、原词再认和新词再认,并分析各组的词语记忆得分及组间比较。结果与对照组比较,MCI组及轻度AD组的词语记忆量表各项得分均降低,且延迟回忆得分降低显著,差异有统计学意义(P=0.000);3组间各项得分比较,差异有统计学意义(P=0.000),MCI组与轻度AD组比较,延迟回忆、原词再认和新词再认差异有统计学意义(P<0.05);多因素分析对年龄和教育程度进行调整后,年龄影响第1次即刻回忆、第2次即刻回忆、延迟回忆;临床诊断影响词语记忆量表的各项得分,差异有统计学意义(P=0.000)。结论词语记忆量表中的延迟回忆及延迟再认有助于MCI的早期识别以及MCI与轻度AD的鉴别。