轻度认知损害研究进展

因为在老年性痴呆 (Ａｌｚｈｅｉｍｅｒｄｉｓｅａｓｅ,ＡＤ)的治疗方面 ,已开始出现很有希望的苗头 ,有关研究的注意力已经开始转向如何尽早识别其智能衰退的早期症候 ,以期预防、减缓或逆转痴呆的脑功能损害。轻度认知损害 (ｍｉｌｄｃｏｇｎｉｔｉｏｎｉｍｐａｉｒｍｅｎｔ,ＭＣＩ) ,即常发生在老年性痴呆临床前期的一种综合征 ,可能是老年性痴呆发病的早期信号 ,它有助于发现最需要早期干预的个体[1] 。我们就ＭＣＩ的概念、诊断标准、神经影像、外周标志及其与早期ＡＤ的关系等进行综述。一、ＭＣＩ的沿革及概念1.沿革 :老年人中常见未…     

两种轻度认知损害患者的神经心理学功能比较

背景区别轻度认知损害（mildcognitiveimpairment,MCI）的两种亚型,即遗忘型轻度认知损害（alTlnesticmildcogni—tiveimpairment,aMCI）和小血管型轻度认知损害（MCIassociatedwithsmallvesseldiseases,sv-MCI）将有利于延缓和预防MCI进展为阿尔茨海默病性痴呆和血管性痴呆。目的识别并区分区aMCI与sv-MCI的神经心理学特征。方法从宣武医院神经科门诊就诊患者或在北京社区进行的一项入户调查中选择符合入组标准的被试。根据Pe—tersen诊断标准筛选aMCI患者50例,根据Hachinski诊断标准筛选sv-MCI患者65例。以上两组患者和49名55岁以上没有认知障碍的社区被试一同接受简明精神状态量表（MiniMentalStateExamination,MMSE）检查及画钟测验（ClockDrawingTest,CDT）与听觉词语学习测验（AuditoryVerbalLearningTest,AVLT,评定即刻记忆、延迟回忆和延迟再认能力）。采用单因素方差分析法比较3组被试各项测验的平均得分,如果结果存在明显差异,再进行多个样本两两比较的Tukey法检验。结果aMCI组和SV．MCI组5项测验平均得分均明显低于健康对照组。aMCI组AVLT即刻记忆、延迟回忆和延迟再认测验得分均低于SV．MCI组。在校正了年龄、性别、受教育年限后,上述差异仍旧存在。结论实验结果与既往结果一致,与SV—MCI患者相比,aMCI患者记忆损害更加明显。记忆相关的评估测验,尤其是AVLT,或将有助于区别这两种MCI亚型。     

离退休老人轻度认知功能损害研究

目的：探讨离退休老人轻度认知功能损害(MCI)的发生率及其影响因素。方法：采用哈金斯基缺血指数(HIS)、简易智能状态检查(中文版)(MMSE)、Reisberg总体衰退量表(GDS)、日常生活活动能力(20项版本)(ADL)等，对420名离退休老人MCI的发生情况及其影响因素进行调查，分析相互问关系。结果：离退休老人中MCI的发生率为8．6％，随年龄的增长而有升高趋势，但各年龄组之间差异无显著性。结论：离退休老人中MCI较常见，应对老年人群进行MCI的监测和干预，阻止和延缓MCI发展为痴呆，提高老年人的寿命和生活质量。     

快速认知筛查测验在检测轻度认知损害中的应用研究(英文)

目的轻度认知损害(mild cognitive impairment,MCI)可根据认知表现分为遗忘型MCI(aMCI)和非遗忘型MCI(naMCI)。本研究旨在编制快速认知筛查测验(quick cognitive screening test,QCST)便于快速全面地识别MCI,为进一步研究提供依据。方法符合MCI操作性诊断标准的MCI组121例、符合DSM-Ⅳ有关痴呆诊断标准的阿尔茨海默病(AD)组79例和正常老年人组186例,参与了QCST和标准化全套神经心理测验。参与者教育程度均在5年或以上,年龄55-85岁。QCST项目包括即刻记忆、延迟回忆、命名、动物流畅性、相似性、彩色连线B、画钟、手指结构、数字广度等9个分测验,每个分测验满分10分,总分90分,耗时10-15分钟。结果MCI组、AD组和正常老年人组QCST总分分别为(58.13±8.18)、(44.53±10.54)和(72.92±6.85)分。制定教育程度在5-8年、9-12年、高于13年3个组别的QCST总分的划界分分别为63、65和68分。QCST识别MCI的敏感性为87.6%,其中识别aMCI-s、aMCI-m和naMCI的敏感性分别...     

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。     

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。     

Rey-Osterriche复杂图形测验在轻度阿尔茨海默病和轻度认知损害患者中的应用研究

目的:研究Rey-Osterrich复杂图形测验(CFT)对轻度阿尔茨海默病(AD)和遗忘型轻度认知损害(MCI)的诊断价值。方法:应用CFT、简明精神状态量表(MMSE)对45例轻度AD患者、73例遗忘型MCI和66名正常老年人进行检测,MMSE总得分分别为(20.2±2.5)分、(26.9±1.8)和(28.2±1.6)分。结果:对照组,CFT结构模仿和延迟回忆得分与教育程度有显著正相关性,与年龄、性别无相关性。MCI组的结构模仿得分为(32.4±6.2)分,轻度AD组为(26.1±10.9)分,对照组为(33.6±3.1)分。AD组与对照组及MCI组比差异有显著意义,延迟记忆对于识别MCI有一定作用,协助AD诊断有较好的敏感性(P<0.01);MCI组的延迟回忆得分与对照组比差异有显著统计学意义(P<0.01),轻度AD组下降更为明显,与MCI组比差异有显著统计学意义(P<0.01)。结论:CFT延迟记忆对于识别MCI有一定作用,协助AD诊断有较好的敏感性。CFT结构模仿不能识别MCI,对轻度AD,其敏感性亦不理想。     

部分前循环脑梗死与遗忘型轻度认知功能损害患者认知功能的对比研究

目的 比较部分前循环脑梗死(partial anterior circulation infact,PACI)和遗忘型轻度认知损害(amnesic mild cognitive impairment,aMCI)患者的认知损害的特点.方法 选择29例符合牛津社区卒中项目(Oxford Community Stroke Droject,OCSP)分型的PACI患者,35例符合Petersen 诊断标准的aMCI患者,以及60例健康老年人为对照组,采用认知功能筛选测验-C2.1(Cognitive Ability Screening Instrument-C2.1,CASI)评定认知功能.结果 PACI组(86.28±12.04)和aMCI组(89.86±6.03)的CASI总分均比正常对照组(95.57±3.44)低,差异具有统计学意义[F(2)=8.547,P<0.05],而PACI组与aMCI组间无统计学差异.在CASI分领域方面,与对照组相比,PACI组在心算力(P=0.000)和定向力(P=0.021)两方面均较差;与aMCI组比较,PACI组的心算力(P=0.000)较aMCI组差,而短时记忆(P=0.016)和思维流畅性(P=0.005)方面则较好.aMCI组与对照组相比,在短时记忆(P=0.000)、抽象与判断能力(P=0.013)和思维流畅性(P=0.001)方面均较差.结论 PACI患者存在认知损害,尤其在心算力和定向力方面,与aMCI患者相比,可能更好地保留了执行功能,推测缺血性脑卒中与神经退行性变引起的认知损害可能涉及不同认知领域.     

轻度认知损害患者情节记忆的编码和提取

为了研究轻度认知损害患者情节记忆编码和提取的改变 ,采用神经心理学方法评定正常老年人和轻度认知损害患者 (MCI)情节记忆编码和提取。结果表明 :除存在记忆力损害以外 ,MCI组定向力、语言能力、执行等能力显著低于正常老年组 (P <0 .0 1) ;MCI组患者情节记忆编码正确率显著低于正常老年组 (P <0 .0 1) ,下降约2 2 .81% ;MCI组情节记忆提取正确率显著低于正常老年组 (P <0 .0 5 ) ,下降约 6 .84 %。提示轻度认知损害患者情节记忆编码和提取均存在不同程度的损害 ,而情节记忆编码的损害更明显。     

青中年轻度认知损害的危险因素分析

目的探讨轻度认知损害(MCI)的相关危险因素。方法对2003-10-2004-10北京大学医学部第三医院289例就诊患者进行神经心理测定,对存在睡眠呼吸暂停的患者进行多导睡眠仪(PSG)检查,确诊阻塞性睡眠呼吸暂停综合征(OSAS)患者171例,MCI患者31例;通过logistic回归分析法分析MCI患者患病的危险因素。结果单因素分析显示,文化程度、吸烟史、饮酒史、腔隙性脑梗死、TIA发作、OSAS史与MCI发生有关。多因素分析显示,文化程度(OR:0.270)、短暂性脑缺血发作(TIA)史(OR:3.462)、吸烟史(OR:2.963)、重度OSAS(OR:1.346)是青中年认知功能损害的主要影响因素。结论文化程度、吸烟史、TIA史、OSAS是青中年认知功能损害的可能影响因素。     

轻度认知功能障碍与血浆同型半胱氨酸水平的相关性研究

目的 探讨轻度认知功能障碍(MCI)与血浆同型半胱氨酸、维生素B12、叶酸水平的关系.方法 68例MCI患者测定血浆同型半胱氨酸、维生素B12、叶酸水平及简易精神量表评分等,并与70例健康老人作对照.结果 MCI患者血浆HCY明显高于对照组,而维生素B12、叶酸水平明显低于对照组(均P＜0.05);在轻度认知功能障碍组,当患者血浆HCY＞15umol/l时,其轻度认知功能障碍的优势比OR值为4.3,95%CI为1.89～7.43. MCI 患者HCY水平与维生素B12、叶酸水平及评分均称负相关关系.结论 血浆HCY升高是MCI的重要因素,体内叶酸、维生素B12缺乏是导致血浆HCY升高的原因.     

The detection of mild cognitive impairment in the general practice setting

Results from a general practice study of cognitive impairment are used to construct guidelines for the detection of mild cognitive impairment (MCI) in general practice. The role of the general practitioner in the diagnosis of MCI is discussed and the potential feasibility of general practice screening is evaluated with data from a two-year prospective study conducted in the Montpellier region of France. Neuropsychological tests with the highest predictive value for dementia conversion and suitable for use in general practice, were determined by logistic regression modelling. An examination comprising three tests (delayed auditory verbal recall, verbal fluency and visuospatial construction), were found to give a specificity of 99% and sensitivity of 73%. Reports from other research centres suggest that MCI detection should not be limited to cognitive performance alone. It is suggested that proxy observations of behavioural change and information relating to loss of ability to perform activities of daily living should also be used to improve sensitivity and also to provide information needed in patient management. It may be potentially feasible for the family practitioner to verify cognitive complaints and to screen for MCI with a high degree of accuracy using a brief test battery derived from empirical observations in population studies.     

The economics of mild cognitive impairment

Individuals with amnestic mild cognitive impairment (MCI) are at elevated risk of developing Alzheimer’s disease (AD). Although the economic burden of AD itself is well recognized, little is known about the direct and indirect costs associated with MCI before the onset of AD. Insufficient data on the economic impact of MCI as well as other gaps in the knowledge base (such as estimates of MCI progression rates and factors that drive MCI-related costs) present challenges to understanding the burden of MCI and to modeling the cost-effectiveness of potential MCI interventions. Initiating treatment and care management in the MCI phase could improve the health and well-being of patients and caregivers and possibly offset certain costs. Future economic analyses should incorporate new data, as they become available, from patient registries and linked administrative claims and electronic medical records to better characterize the cost consequences of MCI detection and management. Such analyses should help payers, providers, and policy makers make more informed decisions about the costs and benefits of new tests, treatments, and other management strategies for the condition.     

Early detection of cognitive disturbances in mild cognitive impairment: a systematic review of observational studies

Mild cognitive impairment (MCI) is an intermediate state between normal cognition and early dementia and is not considered as a typical outcome of brain aging. It has been estimated that 10% to 20% of individuals above 65 years of age will be diagnosed as having MCI. The increased rate of dementia and the importance of early detection of its forerunners have encouraged researchers to focus on detecting MCI and modifiable risk factors with the hope of developing better ways of managing dementia and its consequences. The main aim of this study was to systematically review the related literature concerning the cognitive changes in the spectrum of cognitive aging to cognitive impairment. Articles included in this review were identified through searching the databases of PubMed, Psych Info, Embase, ProQuest, and Scopus. Many domains like verbal memory, language, executive function, visual memory, attentional skills, and working memory showed acceptable predictive power. Testing subdomains such as executive function, speed of processing, working memory and semantic language are critical and others may indicate some suggestions for further clinical deteriorations in normal individuals. Although various cognitive instruments have been used for evaluation of impaired cognitive domains, it remains challenging to select the most appropriate ones having high‐level accuracy and their related cognitive subdomains. It also revealed that none of the identified cognitive domains solely fulfilled the criteria for MCI screening; in clinical settings, multiple neuropsychological batteries may be used for one single cognitive domain, while longitudinal studies prefer the use of at least two cognitive measures for each domain to improve accuracy and research settings might focus on only a single neuropsychological test. However, along with episodic memory, testing for amnestic MCI, executive function could increase the chance of early detection of MCI. Executive control has been found to deteriorate the earliest in MCI patients.     

Functional impairment in the diagnosis of mild cognitive impairment

The criterion on functional activity in the revised diagnostic criteria for mild cognitive impairment (MCI) seems to be conceptually and operationally problematic.We investigated the predictive validity for dementia of this criterion in 140 patients with MCI who participated in the baseline study of the Korean Longitudinal Study on Health and Aging and completed 18-month follow-up evaluation (mean duration of follow-up, 1.57±0.24 y). Annual conversion rates to dementia were compared between the patients who fulfilled the criterion on functional activity and those who did not. Annual conversion rates to dementia of the patients who fulfilled the criterion on functional activity was 4.76%, whereas that of the patients with MCI who did not was 33.07%, indicating that the criterion on functional activity was a significant negative predictor of dementia (odds ratio=0.12). Re-revision of the criterion on functional activity may be warranted to solve its conceptual and operational ambiguities.     

The role of neuroimaging in mild cognitive impairment

The main purposes of neuroimaging in Alzheimer's disease (AD) have been moved from diagnosis of advanced AD to diagnosis of very early AD at a prodromal stage of mild cognitive impairment, prediction of conversion from mild cognitive impairment (MCI) to AD, and differential diagnosis from other diseases causing dementia. Structural MRI studies and functional studies using F‐18 fluorodeoxyglucose‐positron emission tomography (FDG‐PET) and brain perfusion single‐photon emission computed tomography (SPECT) are widely used in diagnosis of AD. Outstanding progress in diagnostic accuracy of these neuroimaging modalities has been obtained using statistical analysis on a voxel‐by‐voxel basis after spatial normalization of individual scans to a standardized brain‐volume template instead of visual inspection or a conventional region of interest technique. In a very early stage of AD, this statistical approach revealed gray matter loss in the entorhinal and hippocampal areas and hypometabolism or hypoperfusion in the posterior cingulate cortex and precuneus. These two findings might be related in view of anatomical knowledge that the regions are linked through the circuit of Papez. This statistical approach also offers prediction of conversion from MCI to AD. Presence of hypometabolism or hypoperfusion in parietal association areas and entorhinal atrophy at the MCI stage has been reported to predict rapid conversion to AD.     

Pharmacoeconomics of mild cognitive impairment

There is little written about the pharmacoeconomics of mild cognitive impairment (MCI), particularly with regard to intervention. The aim of the paper is to highlight methodological issues and to present some results that are of importance when drug interventions of MCI are discussed. There is a relationship between severity of dementia and costs, but to what extent such results can be extrapolated to MCI is not known. Even if it is logical to consider a postponement of the shift from MCI to dementia as cost effective, this statement must be proven, particularly in light of the insufficient knowledge about the effects of antidementia drugs on survival. From the Kungsholmen project in Sweden, there are indications that the postponement between MCI and manifest dementia may result in short-term benefits (a few years) of about SEK50 000 (US$5300).     

Pharmacotherapy of mild cognitive impairment

Amnestic mild cognitive impairment (MCI) can be considered as a state with a high risk of developing Alzheimer's disease within 5 years, or as a prodromal stage of this condition. Randomized clinical trials comparing the acetylcholinesterase inhibitor donepezil with placebo have shown some symptomatic benefit on (i) cognition in one short-term (6-month) study; and (ii)conversion to dementia in one long-term (3-year) study, but not for the full duration of the study, except in subjects with the apolipoprotein E4 (APOE-4) mutation, in whoom the benefit was sustained throughout the 3 years. Results from studies on galantamine are still being analyzed; and a rivastigmine study will close in the fall of 2004. It is premature to recommend that acetylcholinesterase inhibitors be used systematically in amnestic MCI. However, important lessons have been learned from studies in this prodromal stage of AD, allowing the testing of hypotheses for disease modification.