阿尔茨海默病早期病理改变相关因素

就目前与阿尔茨海默病病理改变形成有关的遗传、病理、生理及生化等早期因素的研究进行综述。     

老年人脑出血并发肺部感染的相关因素分析

目的了解老年人脑出血并发肺部感染与某些因素的关系。方法对67例并发肺部感染患者出血部位、出血量、意识状态、血糖、慢性心肺疾患、感染发生时间、预后进行回顾性分析。结果67例中50％以上病人为大脑半球中线深部出血，出血量〉30ml，血糖高于10mmol／L，昏迷，有慢支、肺气肿痛史．大多在发病3d内出现肺部感染，46％以上的病人在1周内死亡。结论老年人脑出血部位在大脑中线深部，出血量大，血糖越高，昏迷越深，有慢性心肺疾患病史者，发生肺部感染的机会越高，而且发生的时间早，预后差。     

阿尔茨海默病的危险因素

痴呆是一种后天性、持续性的智能障碍。患者在意识清楚的情况下 ,出现记忆、思维、定向、理解、计算、学习能力、判断能力、语言和视空间能力的减退 ,情感人格的变化 ,并足以妨碍本人的社会生活和日常生活能力的综合征。可引起痴呆综合征的疾病多达百余种。可分为变性性、血管性、损伤、感染、中毒、肿瘤、代谢及其他等。在老年期痴呆 (发展中国家 >6 0岁 )中最常见的有两大类型痴呆 :(1)老年性痴呆 ,又称阿尔茨海默病 (AD) ;(2 )血管性痴呆 (VD)。这两大类型的痴呆占了老年期痴呆的绝大部分 ,大约 80 %左右。AD是一种大脑皮质的退行性、…     

阿尔茨海默病的发病机制与相关危险因素

随着社会人口老龄化的加剧,阿尔茨海默病（Alzheimer＇s Disease,AD）越来越引起人们的关注.AD的发病率随年龄的增高而呈增加趋势,据统计,65岁以后每增长5岁AD的发病率就增加一倍,65岁以上的发病率为1%~5%,85岁以上则高达20%~40%.     

中重度阿尔茨海默病患者生活质量相关因素分析

目的:探讨影响中重度阿尔茨海默病(AD)患者生活质量的相关因素。方法:采用AD生活质量量表(QOL-AD)及AD相关症状量表(ROSA),对103例中重度AD患者的生活质量及影响因素进行调查。结果:由配偶或子女看护的AD患者QOL-AD总分显著高于由他人看护的患者(P0.05)。QOL-AD总分与ROSA总分及各因子均相关(r=0.284~0.770)。多元逐步回归分析表明,影响中重度AD患者生活质量的主要因素为看护者负担、日常生活能力及认知功能(t=6.436,P=0.000,t=2.801,P=0.006,t=-3.265,P=0.002)。结论:症状严重程度和看护质量对AD患者生活质量有显著影响,病情严重程度与看护质量存在交互作用,亲属看护有助于提高生活质量。     

心血管危险因素对阿尔茨海默病的影响

目的 探讨心血管危险因素对社区老年人群阿尔茨海默病(AD)的影响.方法 采用多级整群抽样的方法抽取贵阳城区26个社区的3229名60岁以上老年人为调查对象,详细询问老年人一般资料、生活习惯、慢性病史等资料,并进行血压、身高、体重的测量,采用SPSS10.0软件进行单因素分析和多因素非条件Logistic回归分析.结果 长期服用抗高血压药物的高血压患者发生AD的危险性较低(OR=0.089,95% CI,0.012～0.650,P<0.05).收缩压水平≥180mmHg及舒张压水平≥110mmHg的老年人患AD的危险性较高(OR均>1,P<0.05).结论 长期服用抗高血压药物可能是AD的保护性因素,重度高血压与AD患病危险性有密切联系.     

阿尔茨海默病认知损害程度的相关影响因素分析

目的:探讨影响阿尔茨海默病(AD)认知损害程度的相关因素。方法:选择记忆障碍门诊就诊的不同严重程度的AD患者共229例,其中轻度101例,中重度128例,收集相关资料进行条件Logistic回归分析。结果:条件Logistic回归分析显示:病程长、低教育水平、低体重指数及伴发精神行为异常为AD病情严重的独立危险因素,OR值分别为1.729(5%CI:1.318～2.269)、0.854(95%CI:0.791～0.922)、0.853(95%CI:0.780～0.932)及2.865(95%CI:1.527～5.378)。结论:本研究提示病程、教育水平、体重指数及是否合并精神行为异常与AD病情的严重程度有明显相关性。     

轻度认知功能障碍老年人和阿尔茨海默病患者听觉事件相关电位P300比较

目的探讨轻度认知功能障碍老年人(MCI)和阿尔茨海默病(AD)在事件相关电位(ERP)P300检测中的不同表现.方法收集符合ICD-10诊断标准的36例MCI患者和30例AD,并以45例健康老人作对照组(NC).使用美国仪器以及"听觉靶-非靶刺激序列"为诱发事件,完成P300检测.结果 (1)3组和NC组在靶潜伏期Fz脑区N2以及在靶波幅Fz脑区P2P3和非靶波幅Fz脑区P2上均有显著差异(P＜0.01).(2)AD主成分N2表现为延迟,与NC组和MCI组有极显著性差异(P＜0.01).(3)MCI组和AD组靶波幅P3和非靶波幅P2均见降低,与NC组比较也有显著性差异(P＜0.05～＜0.01).结论提示作为反映MCI和AD认知功能障碍的客观生理指标,P300有可能作为MCI和AD辅助诊断的一个脑电生理学标志.P300检查可作为老年精神科的必查项目.     

阿尔茨海默病相关影响因素的病例对照研究

目的探讨阿尔茨海默病(AD)的发病影响因素,为AD的预防提供理论参考。方法以2013年2月²014年5月在吉林大学第一医院就诊的AD患者31例和同期在该院住院的认知功能正常患者35例为对象进行病例对照研究,经过统计学分析筛选出AD发病的影响因素。结果食用豆制品、喜好与朋友交往、负性生活事件、规律服用降血压药物的OR值及95%CI分别为0.067(0.0102014年5月在吉林大学第一医院就诊的AD患者31例和同期在该院住院的认知功能正常患者35例为对象进行病例对照研究,经过统计学分析筛选出AD发病的影响因素。结果食用豆制品、喜好与朋友交往、负性生活事件、规律服用降血压药物的OR值及95%CI分别为0.067(0.010⁰.443,P=0.005)、0.061(0.0120.443,P=0.005)、0.061(0.012⁰.296,P=0.001)、23.581(1.7510.296,P=0.001)、23.581(1.751³17.589,P=0.017)、0.145(0.029317.589,P=0.017)、0.145(0.029⁰.720,P=0.018)。病例组和对照组血清镁含量之间的差异有统计学意义(P<0.01),AD患者血清锌和叶酸含量低于正常水平。结论食用豆制品、喜好与朋友交往、规律服用降血压药物可能是AD发生的保护因素;负性生活事件可能是AD发生的危险因素。     

An efficacy and safety analysis of Exelon in Alzheimer's disease patients with concurrent vascular risk factors.

We evaluated the efficacy and safety of the centrally acting cholinesterase inhibitor, rivastigmine tartrate, for patients with mild to moderately severe Alzheimer's disease (AD) with or without concurrent vascular risk factors (VRF). Patients (45-90 years of age) were randomized to placebo (n = 235), low-dose rivastigmine (1-4 mg/day, n = 233), or high-dose rivastigmine (6-12 mg/day, n = 231) for 26 weeks. Efficacy measures included the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog), the Clinician's Interview Based Impression of Change (CIBIC-Plus), the Progressive Deterioration Scale (PDS), the Global Deterioration Scale (GDS), and the Mini-Mental State Examination (MMSE). For efficacy and safety analysis, patients were categorized by baseline Modified Hachinski Ischemic Score (MHIS) for the determination of VRF (MHIS > 0: presence of VRF; MHIS = 0: absence of VRF). As early as 12 weeks, the mean change from the baseline ADAS-Cog score was significantly different for those patients treated with high-dose rivastigmine compared with placebo controls in both MHIS categories. However, the treatment difference between high-dose rivastigmine and placebo at each time-point was larger for patients with MHIS > 0. The proportion of responders was significantly greater in the high-dose rivastigmine group for each level of improvement. No differences were noted between treatment groups regarding safety evaluations. Rivastigmine is effective in both categories of patients, and those with VRF experience greater clinical benefit (cognition, activities of daily living, and disease severity).     

老年抑郁症和阿尔茨海默症的听觉P300比较研究

目的比较老年抑郁症(SD)患者和阿尔茨海默症(AD)患者的听觉P300的特点。方法对36例SD患者、32例AD患者以及40名健康老人对照(NC组)进行P300检测。结果 SD组、AD组和NC组在靶潜伏期Cz脑区N2以及在靶波幅Cz脑区P3和非靶波幅Cz脑区P2上均有显著统计学差异(P<0.01)。AD主成份N2表现为延迟,与NC组和SD组有极显著统计学差异(P<0.01)。SD组和AD组靶波幅P3和非靶波幅P2均见降低,与NC组比较也有显著统计学差异(P<0.05或P<0.01)。结论作为反映SD和AD患者认知功能障碍的客观生理指标,P300有可能作为SD和AD辅助诊断的一个脑电波标志。     

Traumatic brain injury history is associated with earlier age of onset of Alzheimer disease

Objective: This study examined whether a history of traumatic brain injury (TBI) is associated with earlier onset of Alzheimer disease (AD), independent of apolipoprotein ε4 status (Apoe4) and gender.Method: Participants with a clinical diagnosis of AD (n = 7625) were obtained from the National Alzheimer’s Coordinating Center Uniform Data Set, and categorized based on self-reported lifetime TBI with loss of consciousness (LOC) (TBI+ vs. TBI?) and presence of Apoe4. ANCOVAs, controlling for gender, race, and education were used to examine the association between history of TBI, presence of Apoe4, and an interaction of both risk factors on estimated age of AD onset.Results: Estimated AD onset differed by TBI history and Apoe4 independently (p’s < .001). The TBI+ group had a mean age of onset 2.5 years earlier than the TBI? group. Likewise, Apoe4 carriers had a mean age of onset 2.3 years earlier than non-carriers. While the interaction was non-significant (p = .34), participants having both a history of TBI and Apoe4 had the earliest mean age of onset compared to those with a TBI history or Apoe4 alone (M_Difference = 2.8 and 2.7 years, respectively). These results remained unchanged when stratified by gender.Conclusions: History of self-reported TBI can be associated with an earlier onset of AD-related cognitive decline, regardless of Apoe4 status and gender. TBI may be related to an underlying neurodegenerative process in AD, but the implications of age at time of injury, severity, and repetitive injuries remain unclear.     

老年抑郁症和阿尔茨海默症的失配性负波比较

目的比较老年抑郁症(SD)和阿尔茨海默症(AD)患者的失配性负波(MMN)的特点。方法检测并比较36例SD患者、32例AD患者及40名正常老人(NC)的MMN。结果与NC组和SD组比较,AD组的MMN潜伏期延迟、波幅降低。SD组与NC组比较则无显著差异。结论 MMN技术可作为P300检测的一种补充手段用于临床鉴别SD和AD。     

阿尔茨海默病的相关睡眠障碍

阿尔茨海默病的睡眠障碍一直是困扰医患包括护理者的很棘手的问题,而对其临床判定和处理原则值得进一步探索,包括非药物的应用如光照和针灸等处理尚待总结。     

The clinical practice of risk reduction for Alzheimer's disease: A precision medicine approach

Like virtually all age-related chronic diseases, late-onset Alzheimer's disease (AD) develops over an extended preclinical period and is associated with modifiable lifestyle and environmental factors. We hypothesize that multimodal interventions that address many risk factors simultaneously and are individually tailored to patients may help reduce AD risk. We describe a novel clinical methodology used to evaluate and treat patients at two Alzheimer's Prevention Clinics. The framework applies evidence-based principles of clinical precision medicine to tailor individualized recommendations, follow patients longitudinally to continually refine the interventions, and evaluate N-of-1 effectiveness (trial registered at ClinicalTrials.gov NCT03687710). Prior preliminary results suggest that the clinical practice of AD risk reduction is feasible, with measurable improvements in cognition and biomarkers of AD risk. We propose using these early findings as a foundation to evaluate the comparative effectiveness of personalized risk management within an international network of clinician researchers in a cohort study possibly leading to a randomized controlled trial.     

天智颗粒治疗轻、中度阿尔茨海默病临床研究

目的评价天智颗粒治疗轻、中度阿尔茨海默病(alzheimer disease,AD)的有效性及安全性。方法选择简易智能状态量表(MMSE)轻、中度AD患者60例,随机分成治疗组和对照组各30例,治疗组给予天智颗粒联合吡拉西坦治疗,对照组给予吡拉西坦治疗,观察12周。治疗前后应用简易智能状态量表MMSE,日常生活能力量表(ADL)评价临床疗效;用不良反应量表(TESS)评定不良反应。结果观察12周,天智颗粒治疗组较对照组MMES、ADL评分明显改善(P<0.01)。治疗组天智颗粒治疗12周后较治疗前MMSE与ADL分数分别改善3.8分和8.0分(P<0.05,P<0.01)。天智颗粒治疗组不良反应轻,与吡拉西坦对照组比较2组差异无显著意义(P>0.05)。结论天智颗粒能有效治疗轻、中度AD患者,对患者的认知功能和日常生活自理能力均有改善,耐受性好,安全性高。     

Calcium channel blockers and Alzheimer’s disease

Alzheimer’s disease is characterized by two pathological hallmarks: amyloid plaques and neurofi-brillary tangles. In addition, calcium homeostasis is disrupted in the course of human aging. Recent research shows that dense plaques can cause functional alteration of calcium signals in mice with Alzheimer’s disease. Calcium channel blockers are effective therapeutics for treating Alzheimer’s disease. This review provides an overview of the current research of calcium channel blockers in-volved in Alzheimer’s disease therapy.     

美金刚联合多奈哌齐对阿尔茨海默病患者认知功能及神经递质的影响

目的 探讨美金刚联合多奈哌齐对阿尔茨海默病(AD)患者认知功能及神经递质的影响.方法 选取北京航天总医院收治的AD患者100例,随机分为试验组(n=50)、对照组(n=50),对照组予以多奈哌齐治疗,试验组在此基础上予以盐酸美金刚治疗,比较2组临床疗效、AD评定量表的认知分量表(ADAS-Cog)评分、神经精神科问卷(...