脑囊虫病性痴呆：附8例报告

报告了８例以痴呆为主要表现的脑囊虫病，占同期住院脑囊虫病患者１３．７９％，其临床特征为皮质性痴呆和皮质下痴呆共存，常以记忆障碍首发表现，讨论了其发病机理和诊断，治疗。     

Alheimer病,血管性痴呆及正常老人的单光子发射计算机断层扫 …

目的 研究ＳＰＥＣＴ对诊断和鉴别Ａｌｚｈｅｉｍｅｒ病（ＡＤ）及血管性痴呆（ＶＤ）的价值。方法 对３７例正常老人，３６例ＡＤ作ＳＰＥＣＴ，比较三组脑血流灌注特点。结果 与对照组相比，ＡＤ除双侧枕叶外，其余各部位放射性计数比值均显著降低（Ｐ〈０．０５）；与ＶＤ相比，ＡＤ双侧额叶和左顶叶的放射性计数比值显著降低（Ｐ〈０．０５）。ＶＤ与对照组均表现为放射性计数比值双侧不对称，右侧大于左侧；ＶＤ还表现为单一     

多发性脑梗塞痴呆40例临床报告

本文报告了多发性脑梗塞痴呆（MID）40例，其中轻度24例占60％，中度13例占32．5％，重度3例占7．5％。头颅CT扫描发现梗塞灶112个，平均2.8个，梗塞部位以基底节、皮质下白质、丘脑、内囊多发性脑梗塞多见。基底节梗塞产生痴呆者病灶较皮质下梗塞者面积小。痴呆程度与梗塞数目、脑萎缩明显相关。     

不同类型痴呆脑代谢改变图型:~(18)F-FDG PET显像

目的探讨不同类型痴呆患者基于像素水平的脑代谢图型特点。方法对最终临床诊断为阿尔茨海默病(20例)、额颞叶痴呆(20例)、路易体痴呆(10例)、进行性核上性麻痹(7例)、原发性进行性失语(3例)、皮质基底节变性(1例)和多系统萎缩(1例)等认知功能障碍患者的18F-FDG PET显像资料进行回顾分析,描述各种神经变性疾病脑代谢降低区域和程度。结果 SPM分析表明,各种神经变性疾病引起的痴呆18F-FDG PET显像均表现为皮质代谢降低,但其代谢图型变化明显不同:阿尔茨海默病组以双侧颞顶叶和额叶皮质代谢降低为主,基本感觉运动皮质、枕叶、基底节和丘脑活性保留;额颞叶痴呆组额叶和颞叶皮质不对称性代谢降低,伴部分顶叶皮质和基底节、丘脑等皮质下核团不同程度代谢降低;路易体痴呆组枕叶、视皮质和双侧颞上回前部代谢降低;进行性核上性麻痹组双侧前额叶背外侧、颞叶前外侧、中脑和双侧尾状核代谢降低;原发性进行性失语组左侧额叶Broca区、左侧颞叶皮质(除左侧颞上回后部)和右侧颞叶内侧皮质代谢降低;皮质基底节变性组双侧中央沟周围额顶叶皮质(右侧显著)、右侧基底节代谢降低;多系统萎缩组双侧小脑背外侧皮质和左侧壳核代谢降低。结论神经变性疾病所致痴呆在18F-FDG PET显像中表现出各自特征性脑代谢降低图型,18F-FDG PET显像有可能成为痴呆鉴别诊断的一种辅助手段。     

帕金森病痴呆

帕金森病(Parkinson’s disease，PD)是最常见的神经变性疾病之一。最初认为认知障碍可能不是该病的常见表现，随着神经心理学的发展和人们对痴呆的重视，近来的研究显示在PD病人中可出现明显的痴呆，称为帕金森病痴呆(Parkinson’s disease with dementia，PDD)。病人可能产生某些认知功能的损害并发展为痴呆。本文回顾和PD相关的痴呆     

血管性痴呆的研究进展

血管性痴呆的研究进展王群，钱采韵老年期痴呆主要有血管性痴呆（ＶＤ）和Ａｌｚｈｅｉｍｅｒ病（ＡＤ）两大类。日本老年期痴呆中６０％～７０％属ＶＤ，ＡＤ只占３０％～４０％；而欧美相反，８５％～９０％为ＡＤ［１］。临床上区别ＶＤ和ＡＤ多采用Ｈａｃｈｉｎｓｋｉ...     

躯体疾病和药物与痴呆的危险因素

目的 探索躯体疾病和药物应用与痴呆发生的关系。方法 将５年前的疾病和用药为暴露因素，以Ｌｏｇｉｓｔｉｃ法分别计算Ａｌｚｈｅｉｍｅｒ病（ＡＤ）、血管性痴呆（ＶＤ）及各类痴呆的相对危险性（ＲＲ）和人群归因比率（ＰＡＲＰ）。结果 ３０２４名非痴呆老人中，５年后发生痴呆１４１例，内ＡＤ９２例，ＶＤ４１例。与ＡＤ有关的因素为：糖尿病（及其治疗）、降血糖药和视力缺损；ＲＲ和ＰＡＲＰ都不太高。ＶＤ的相关因素为：     

Alzheimer病和伴有痴呆Parkinson病的临床病理研究

研究Ａｌｚｈｅｉｍｅｒ病（ＡＤ）和伴有痴呆Ｐａｒｋｉｎｓｏｎ病（ＰＤ）以及年龄配对的对照组尸检病例各３例，主要观察额叶和颁叶皮质、黑质、蓝斑、Ｍｅｙｎｅｒｔ核的神经元数量和Ｌｅｗｙ小体的形成。从统计结果看，ＡＤ和ＰＤ与对照组比较，各部位的神经元数量均明显减少（Ｐ＜０．０１）。常见于ＰＤ的Ｌｅｗｙ小体，在两例ＡＤ患者的黑质和蓝斑色素神经元中也可见到，但其并非ＡＤ特有的病理改变。临床上诊断为特发性ＰＤ的３例和有强直表现的１例ＡＤ患者的黑质色素神经元减少均在５０％以上；而无锥体外系受累症状的两例ＡＤ患者，虽也有减少，但均未达到５０％。     

老年期痴呆事件相关电位内源性成分改变与认知障碍的相关研究

本研究对３２例老年期痴呆、１７例神经精神疾病患者及２０例正常老年人进行听觉事件相关电位、简易精神状态检查表、龚氏修订韦氏成人智力量表及临床记忆量的检测，结果发现痴呆组ＥＲＰ，内源性成分Ｎ２、Ｐ３ＰＬ比神经精神疾病组和正常老年组明显延长，推测与痴呆辩论和加工刺激信息速度明显减慢有关。多元逐眯回归分析表明痴呆病人认知功能障碍程度，随病程延长加重，Ｐ３ＰＬ延长更加明显，与该组ＭＭＳＥ、ＷＡＩＳ－ＲＣ及临     

痴呆的病因探讨

对１４４例痴呆病人的病因进行了探讨、大部份诊断有ＣＴ或ＭＲＩ，以及有关化验检查。并有１６例尸检，７例活检病理资料。病因多种多样、常见病因为血管性痴呆，Ａｌｚｈｅｉｍｅｒ病及神经梅毒。     

(99mTc)-HM-PAO SPECT and cognitive impairment in Parkinson''s disease: a comparison with dementia of the Alzheimer type.

Regional cerebral perfusion was evaluated by single photon emission tomography (SPECT) using (99mTc)-HM-PAO as a tracer, in thirty Parkinsonian patients with (n = 15) or without (n = 15) dementia, nineteen patients with dementia of the Alzheimer type (DAT) and thirteen control subjects. HM-PAO uptake was measured in the frontal, parietal, temporal and occipital cortex and tracer perfusion was expressed as cortical/cerebellar activity ratios. Regional HM-PAO ratios in nondemented Parkinsonian patients did not differ from controls, whereas in demented patients with Parkinson's disease (DPD) a significant reduction was found in the parietal, temporal and occipital cortex. Tracer uptake ratios were significantly reduced in all regions in the DAT group. Thus DPD and DAT shared a common pattern of marked posterior hypoperfusion, although the perfusion defect was greater and more extensive in the DAT patients.     

A study of regional cerebral blood flow and cognitive performance in Alzheimer''s disease.

Thirty five patients with dementia of the Alzheimer type (DAT) and 35 controls matched for age, sex and handedness were investigated using single photon emission computer tomography (SPECT) with 99m technetium HMPAO. Regional cerebral blood flow (rCBF) was assessed semi-quantitatively in 18 cortical and 4 subcortical areas by normalising mean information density in each region to cerebellar mean information density. Analysis revealed significantly reduced rCBF to temporal, parietal, frontal and left occipital cortex in the patients whilst blood flow to subcortical areas showed no differences between the 2 groups. In addition, significant left-sided cortical hypoperfusion was seen in the DAT group but not in controls. When patients were sub-divided on the basis of disease severity, those with mild disease showed temporal, parietal and left frontal changes with more severely affected patients also showing right frontal and left occipital involvement. rCBF patterns did not distinguish between presenile and senile onset cases once duration and severity of illness were controlled. Eight cortical areas were also rated visually for perfusion deficits on a simple 4 point scale. Perfusion deficits were detected in 34 of 35 patients but in only 4 of 35 controls. In the DAT group significant correlations were found between many of the neuropsychological tests used and rCBF. Memory correlated with left temporal activity, praxis, perception, object assembly and block design with right parietal activity and language with activity throughout the left hemisphere. Significant correlations were also seen between subcortical and cortical blood flow, possibly explaining the correlations observed between many of the neuropsychological tests and thalamic blood flow.     

Differentiation between Alzheimer's disease and multi-infarct dementia: Spect vs MR imaging

Single photon emission computed tomography (SPECT) and magnetic resonance (MR) imaging data were obtained in 11 patients with dementia of the Alzheimer type (DAT), 11 with multi-infarct dementia (MID) and nine elderly, healthy controls. All patients with dementia tolerated a 15-minute SPECT scan while six patients (27%) did not tolerate the MR examination due to the long acquisition times and/or claustrophobia. Blind qualitative rating of SPECT scans differentiated correctly between dementia and controls in 90% of cases (p < 0.0001; positive predicted value of 91%) and between clinically defined DAT and MID in 77% of cases (p < 0.01; positive predicted value of 80%). It correctly identified clinical group membership (control, DAT or MID) in 71% of cases (p <0.001; predicted positive value of 94%) but failed to differentiate between DAT and MID (positive predicted value of 50%). Overall, MR imaging correctly identified clinical group membership in 61% of cases (p < 0.01). Semiquantitative SPECT data demonstrated reduced regional cerebral blood flow (rCBF) in all regions of interest (ROI) except right frontal and right anterior parietal in both DAT and MID compared with controls (p < 0.05). There was no statistically significant difference between DAT and MID subjects in rCBF in any ROI. Several correlations between rCBF and cognitive variables were found in the MID but not the DAT group. Though the sample in this study is small, our findings suggest that Tc-99m HMPAO SPECT is a useful and practical tool in the assessment of patients with dementia. It enables the differential diagnosis of dementia and by using semiquantitative data it helps to establish the severity of disease.     

Cerebral blood flow and metabolism in multi-infarct dementia

Cerebral blood flow and oxygen metabolism were studied in three aged normal volunteers and 10 patients with multi-infarct dementia (MID) by Positron Emission Tomography using O-15. The diagnosis of MID was done according to the Loeb's modified ischemic score and X-ray CT findings. The MID patients, whose X-ray CT showed localized low density areas in the subcortical white matter and basal ganglia and thalamus, were studied. No occlusion was observed at anterior cerebral artery and/or middle cerebral artery on cerebral angiography. All cases of MID were mild dementias. Regional CBF, rOEF and rCMRO2 were measured by the steady state technique described by Terry Jones et al. The values of rCBF in MID patients were significantly low compared with those of aged normal subjects in frontal, temporal, occipital, parietal cortices and thalamus. The values of CMRO2 in MID were significantly low in frontal, temporal, occipital cortices and thalamus compared with normal subjects'. The OEF was 0.46 in aged normal subjects, and 0.52 in MID patients. The MID patients in the early stage of dementia showed the increased oxygen extraction fraction, and this fact suggests that ischemia is a significant pathogenic mechanism in the production and progression of multi-infarct dementia. The decrease of CBF and CMRO2 in MID compared from normal subjects' were most remarkable in frontal cortex. The impairment of mental functions in MID should be caused by the decreased neuronal activities in frontal association cortex.     

Brain perfusion SPECT in patients with mild cognitive impairment and Alzheimer’s disease: comparison of a semiquantitative and a visual evaluation

Summary. Due to the increasing importance of early recognition and differential diagnosis of dementias, cerebral perfusion scans using “single photon emission computed tomography” (SPECT) are increasingly integrated into the examination routine. The goal of this study was to check the diagnostic validity of SPECT scans of MCI- and DAT-patients, two subgroups out of 369 persons with etiologically unclear cognitive dysfunction, which underwent an assessment program for probable dementia including cognitive testing, cranial computed tomography, ultrasound, routine laboratory testing including vascular risk factors. After exclusion of patients with no or other forms of dementia we analyzed SPECT data of patients with mild cognitive impairment (MCI; n = 85) and dementia of the Alzheimer type (DAT; n = 78) in comparison with a healthy control group (n = 34). Visual assessment as well as a manual “regions of interest” (ROI) regionalization of the cortex were performed, whereby a ROI/cerebellum ratio was calculated as a semi-quantitative value. Association cortex areas were assessed regarding frontal, temporal, and parietal lobes of both hemispheres. When comparing the ratios of patients with DAT and controls, we found a statistically significant reduction of the cerebral perfusion in all measured cortex areas (p < 0.001). The comparison of patients with MCI with the selected control group also established a statistically significant difference in the cerebral perfusion for the evaluated cortex areas with the exception of the left hemispheric frontal and parietal cortex. A considerable number of the MCI patients showed an MMSE-score within the normal range, but with regard to the perfusion in the right hemispheric association cortex these patients also could be distinguished unambiguously from controls. Sensitivity levels found by visual assessment were at least as high as those found by the ROI method (pathological assessment: visual 49.4% vs. ROI 47.1% for MCI; visual 75.6% vs. ROI 73.1% for DAT). High experienced visual assessment of cerebral perfusion scans using SPECT provides an useful additional tool in diagnosis of cognitive impairment. The used semiquantitative ROI-method is nearly equivalent and does not depend on the experience of the investigator.     

Measurements of regional cerebral blood flow and cognitive performance in Alzheimer''s disease.

Single photon emission computed tomography (SPECT) with 99mTc-HMPAO was used to image 26 patients with dementia of the Alzheimer type (DAT) and 10 healthy controls. Regional cerebral blood flow (rCBF) data indicated a relative sparing of the occipital regions in DAT. Normalisation to occipital flow illustrated highly significant CBF deficits in a number of cortical regions, particularly in the left and right posterior--temporal cortex in DAT compared to controls. The cognitive performance of DAT patients was measured using a clinical cognitive assessment procedure (CAMCOG) and numerous correlations between these scores and rCBF were obtained. The implications and value of this investigative technique are discussed.     

CBF tomograms with [99mTc-HM-PAO in patients with dementia (Alzheimer type and HIV) and Parkinson's disease--initial results

We present preliminary data on the utility of functional brain imaging with [99mTc]-d,l-HM-PAO and single photon emission computed tomography (SPECT) in the study of patients with dementia of the Alzheimer type (DAT), HIV-related dementia syndrome, and the "on-off" syndrome of Parkinson's disease. In comparison with a group of age-matched controls, the DAT patients revealed distinctive bilateral temporal and posterior parietal deficits, which correlate with detailed psychometric evaluation. Patients with amnesia as the main symptom (group A) showed bilateral mesial temporal lobe perfusion deficits (p less than 0.02). More severely affected patients (group B) with significant apraxia, aphasia, or agnosia exhibited patterns compatible with bilateral reduced perfusion in the posterior parietal cortex, as well as reduced perfusion to both temporal lobes, different from the patients of the control group (p less than 0.05). SPECT studies of HIV patients with no evidence of intracraneal space occupying pathology showed marked perfusion deficits. Patients with Parkinson's disease and the "on-off" syndrome studied during an "on" phase (under levodopa therapy) and on another occasion after withdrawal of levodopa ("off") demonstrated a significant change in the uptake of [99mTc]-d,l-HM-PAO in the caudate nucleus (lower on "off") and thalamus (higher on "off"). These findings justify the present interest in the functional evaluation of the brain of patients with dementia. [99mTc]-d,l-HM-PAO and regional cerebral blood flow (rCBF)/SPECT appear useful and highlight individual disorders of flow in a variety of neuropsychiatric conditions.     

后部皮质萎缩的临床及影像学特点

目的后部皮质萎缩(posterior cortical atrophy,PCA)是以视觉障碍为突出表现,并伴进行性认知功能受损的神经系统退行性疾病。PCA的临床表现以视觉加工、计算力下降、阅读书写能力受损为主,患者的视觉认知损害突出,而情景记忆、语言能力和自知力相对保留。本文结合我院收治PCA病例,总结PCA的临床及影像学特征,以期为该病的早期诊治提供参考。方法收集2013年至2018年于宣武医院神经内科确诊的后部皮质萎缩8例患者的临床表现、神经心理学检查、影像学资料等各项检查结果并进行回顾性分析。结果8例PCA患者起病均为隐袭起病,病情进展缓慢,其中有5例符合背侧型后部皮质萎缩特点,临床表现为巴林特综合征、视空间功能障碍以及格茨曼综合征特点,头MRI显示顶枕叶皮质萎缩为主;另3例符合腹侧型后部皮质萎缩特点,临床表现主要为面孔失认、视觉忽视,头MRI显示双侧颞枕叶皮质萎缩为主,而内侧颞叶和海马萎缩程度相对较轻。8例患者均行SPECT检查,显示大脑后部包括顶叶、颞枕叶皮质血流低灌注现象。3例患者行18F FDG PET检查显示大脑后部枕叶、顶叶、颞叶皮质葡萄糖代谢降低。结论对于存在视觉障碍和后部皮质相关认知功能损害的患者,临床医生要考虑到PCA的诊断,特别注意进行视觉相关的全面的神经心理学评估及PET检查,以辅助进行PCA的诊断。     

MRI and SPECT studies of dural arteriovenous fistulas presenting as pure progressive dementia with leukoencephalopathy: a cause of treatable dementia

We report two patients with dural arteriovenous fistulas (DAVFs) who presented with pure progressive dementia. Both patients showed only slowly progressive dementia, without headache, papilledema and other neurologic signs associated with diffuse white matter changes in MRI. MR cerebral angiography showed sigmoid sinus DAVFs that were mainly supplied by the occipital artery, together with retrograde filling of the superior sagittal and straight sinus and dilated cortical veins. SPECT studies showed extensive blood flow reduction in the occipital and parieto-occipital areas and right temporal lobe in one patient. Selective embolization for treatment of the DAVF improved cognitive function associated with the abnormal white matter MRI signal. MRI and SPECT showed that severity of dementia correlated with diffuse white matter changes and regional cerebral blood flow. Our cases suggest that gradually impaired cerebral circulation due to venous hypertensive encephalopathy could be involved in slowly progressive dementia with leukoencephalopathy resulting from a DAVF. DAVFs may be particularly important for differential diagnosis in elderly patients with pure progressive dementia. Thus, early diagnosis of DAVFs and treatment by endovascular surgery is important as treatable or reversible dementia.     

Single-Photon Emission Computed Tomography Studies of Regional Cerebral Blood Flow in Multiple Infarct Dementia

Multiinfarct dementia (MID) and Alzheimer's disease (AD), both characterized by a decline in cognitive function, are often difficult to differentiate and may coexist. This study reports the findings of single-photon emission computed tomography (SPECT) using [²³¹]N-isopropyl-p-iodoamphetamine to determine cerebral blood flow patterns in patients with MID (n = 11 ), as compared with patients with AD (n = 22) and nondemented control subjects (n = 12). Data were acquired at two tomographic levels for dorsolateral frontal, parietal, orbitofrontal, and temporal areas of the cortex. Analyses of variance revealed that the blood flow pattern for the MID group was very similar to that in the AD patients, with both groups showing hypoperfusion in the temporal area, although blood flow in the left parietal region was lower for the patients with AD. When normal regional cerebral blood flow (rCBF) was defined as within 2 standard deviations of control values, most of the patients with MID had normal rCBF, while a few patients showed abnormal rCBF in all regions. In contrast, the majority of AD patients showed abnormal rCBF in the temporal part of the cortex. This suggests that while AD is characterized by hypoperfusion in the temporal and parietal areas, there is no characteristic rCBF pattern in MID. These findings emphasize the need to use multiple modalities when clinically evaluating patients with MID.