美金刚与奥氮平治疗老年期痴呆的行为和精神症状对照研究

目的 探讨美金刚与奥氮平治疗老年期痴呆的行为和精神症状(BPSD)的疗效及不良反应.方法 将86例老年期BPSD患者分为美金刚组与奥氮平组,治疗8周.在治疗前、治疗2周末、4周末和8周末,采用痴呆病理行为评定量表(BEHAVE-AD)评定疗效,简易精神状况检查量表(MMSE)评定患者认知功能,日常生活能力量表(ADL)评定患者生活质量,治疗中需处理的不良反应症状量表(TESS)评定不良反应.结果 美金刚组在治疗后第2、4、8周末BEHAVE-AD评分较奥氮平组显著下降(t=2.12、t=2.23、t=2.28,P＜0.05).美金刚组在治疗后第8周末MMSE评分较治疗前显著升高(t=2.33,P＜0.05),奥氮平组治疗前后MMSE评分差异无显著性(t=0.42,P＞0.05),两组比较差异有显著性(t=2.04,P＜0.05).两组治疗后第8周末ADL评分显著下降(t1=2.35,t2=2.49,P＜0.05),两组比较差异无显著性(t=0.45,P＞0.05).美金刚组不良反应少于奥氮平组(x2=5.09,P＜0.05),两组在锥体外系反应(EPS)、口干、嗜睡、体质量增加方面差异有显著性(x2=4.62～6.86,P＜0.05).结论 美金刚对老年期痴呆患者的认知功能及行为和精神症状的改善均有效,且安全可靠.     

多奈哌齐联合奥氮平治疗老年痴呆精神行为障碍的随机对照研究

目的探讨多奈哌齐联合奥氮平治疗老年痴呆精神行为症状的疗效。方法 100例伴精神行为症状的痴呆患者随机分为治疗组与对照组,比较治疗前后痴呆病理行为评定量表(BEHAVE-AD)评分、简易智力状态检查(MMSE)评分、日常生活能力量表(ADL)评分等。结果治疗组在改善BEHAVE-AD量表评分方面优于对照组(P0.05);两组MMSE、ADL评分差异无统计意义(P0.05)。结论奥氮平联合多奈哌齐治疗老年痴呆精神行为症状有效。     

利培酮与奋乃静治疗老年期痴呆精神症状的对照研究

目的　比较利培酮与奋乃静治疗老年期痴呆患者精神症状的疗效、不良反应及对认知功能的影响。方法　将符合条件的60例老年期痴呆患者随机分为利培酮组和奋乃静组(各30例)。治疗8周。采用一般情况调查表(自编)、临床疗效评定量表(CGI)、阿尔茨海默病病理行为评分表(BEHAVE AD)、简易智力状态检查(MMSE)及药物不良反应量表(TESS)分别进行疗效、不良反应和认知功能评估。结果　两组临床总体疗效比较:有效率分别为86. 67%和83 .33%,无显著性差异(P>0 .05)。两组BEHAVE AD评分治疗前后比较均有非常显著差异(P<0. 05,P<0 .01),治疗结束后两组间BEHAVE AD评分无显著差异(P>0 .05)。治疗结束后MMSE评分利培酮组较奋乃静组高,有显著差异(t=2 .26,P<0 .05 )。两组不良反应发生率无显著性差异(χ2 =0 .28,P>0 .05)。结论　利培酮与奋乃静对老年期痴呆的精神症状疗效、不良反应相近,但对认知功能的影响优于奋乃静,故利培酮更适合于伴有精神症状的老年期痴呆患者的治疗。     

喹硫平和利培酮治疗老年痴呆精神行为障碍的疗效研究

目的观察喹硫平和利培酮治疗老年痴呆精神行为症状的疗效和安全性。方法将60例老年期痴呆患者随机分为喹硫平组30例,利培酮组30例,共观察8周。治疗前及治疗后第2,4,8周分别采用AD病理行为评定量表（BEHAVE-AD）评定疗效;采用TESS量表评定不良反应。结果治疗前后两药的疗效相似（P〉0.05）。但治疗2周,4周时攻击行为和昼夜节律紊乱因子,喹硫平组疗效优于利培酮组,且存在显著差异（分别是P〈0.01,P〈0.05）。喹硫平组不良反应较利培酮组少。结论喹硫平治疗老年期痴呆精神行为障碍疗效与利培酮相当,但不良反应较利培酮少,更适用于老年患者。     

加兰他敏和利培酮对老年期痴呆患者激越症状的影响

目的评估加兰他敏和利培酮对老年期痴呆患者激越症状的影响。方法将41例老年期痴呆合并激越症状患者进行为期12w随机接受加兰他敏或利培酮治疗的研究,参与最后评估者加兰他敏组18例、利培酮组19例,分别于第5周、12周通过科恩-曼斯菲尔德激越问卷(CMAI)评估对激越症状的影响,简易精神状况检查量表(MMSE)评估对认知功能的影响。结果加兰他敏组和利培酮组各时间点CMAI总分均下降。加兰他敏组在第5周及第12周CMAI总分较基线相比差异有统计学意义(P0.05);利培酮组在第5周及第12周CMAI总分较基线相比差异有统计学意义(P0.01)。加兰他敏组MMSE评分在第12周时与基线相比差异有统计学意义(P0.05);利培酮组在各时间点MMSE评分与基线相比差异无统计学意义(P0.05)。结论加兰他敏和利培酮对老年期痴呆患者激越症状均有改善,利培酮组的改善更明显,但加兰他敏组对认知亦有改善且不良反应小。     

喹硫平与奋乃静治疗老年期痴呆精神症状的对照研究

目的 比较喹硫平与奋乃静治疗老年期痴呆患者精神症状的疗效、副反应及对认知功能的影响.方法 将符合条件的60例老年期痴呆患者随机分为喹硫平组和奋乃静组(各30例),治疗2个月,采用一般情况调查表(自编)、临床疗效评定量表(CGI)、阿尔茨海默病病理行为评分表(BEHAVE-AD)、简易智力状态检查(MMSE)、药物副反应量表(TESS)进行疗效、副反应和认知功能评估.结果 两组临床总体疗效比较:有效率分别为85.67%和83.33%,无显著性差异(P>0.05).两组BEHAVE-AD评分治疗前后比较均有显著差异(P<0.05,P<0.01),治疗结束后两组间BEHAVE-AD评分无显著(P<0.05).治疗结束后MMSE评分喹硫平组较奋乃静组高,有显著差异(t=2.26,P<0.05).两组锥体外系副反应发生率比较有显著性差异(X2=4.812,P<0.05).结论 喹硫平与奋乃静对老年期痴呆精神症状疗效、副反应相似,但喹硫平对认知功能的影响优于奋乃静,故更适合于伴有精神症状的老年期痴呆患者的治疗.     

美金刚与喹硫平治疗痴呆的行为和精神症状对照研究

目的探讨美金刚与喹硫平治疗痴呆的行为和精神症状(BPSD)的疗效及安全性。方法将78例BPSD患者随机分为美金刚组与喹硫平组,每组39例,观察8周,于治疗前后采用痴呆病理行为评定量表(BEHAVE-AD)评定疗效,简易精神状况检查量表(MMSE)评定认知功能,日常生活能力量表(ADL)评定生活质量,副反应症状量表(TESS)评定不良反应。结果美金刚组BEHAVE-AD评分、MMSE评分、ADL评分、不良反应、锥体外系反应及嗜睡方面均优于喹硫平组,差异有统计学意义(P0.05)。结论美金刚可有效控制BPSD患者的行为和精神症状,改善其认知功能,提高其日常生活能力,且安全性好。     

阿立哌唑与利培酮口服液治疗门诊老年期痴呆精神行为症状的对照研究

目的 探讨阿立哌唑和利培酮口服液治疗门诊老年期痴呆精神行为症状(BPSD)的疗效和安全性.方法 将68例老年期痴呆伴BPSD患者随机分成阿立哌唑组35例,利培酮口服液组33例,疗程8周,采用痴呆病理行为评定量表(BEHAVE-AD)及激越性问卷(CMAI)评定疗效,采用治疗中需处理的不良反应症状量表(TESS)评定副反应.结果 两组治疗后第6、8周末BEHAVE-AD和CMAI评分与治疗前比较均显著下降(P＜0.01),两组之间比较治疗前及治疗后各时间点比较BEHAVE-AD评分差异无统计学意义(P＞0.05).两组不良反应比较,阿立哌唑组不良发生率明显低于利培酮口服液组,差异有统计学意义(P＜0.01).结论 阿立哌唑和利培酮口服液治疗老年期痴呆伴发BPSD均有较好疗效,两者总体疗效、起效时间相当,而阿立哌唑的安全性优于利培酮口服液.     

奥氮平和利醅酮治疗老年痴呆精神行为症状的比较研究

目的 探讨奥氮平治疗老年痴呆精神行为症状的疗效和安全性.方法 将80例老年痴呆患者随机分为两组,奥氮平组40例,利培酮组40例,分别给予两药治疗8周.采用阳性症状和阴性症状量表(PANSS)评定临床疗效,不良反应量表(TESS)及有关实验室检查评定不良反应.结果 治疗8周后两药的疗效近似(P＞0.05).利培酮组锥体外系、兴奋或激惹和失眠不良反应的发生率明显高于奥氮平组(P＜0.05).结论 奥氮平治疗老年痴呆精神行为障碍疗效与利培酮相当,但起效时间比较快、不良反应较利培酮少,更适用于老年患者.     

阿尔茨海默病伴精神行为异常临床研究

目的分析比较美金刚、喹硫平、氟哌啶醇治疗阿尔茨海默病(Alzheimer′s disease,AD)患者精神行为症状(BPSD)的疗效、不良反应及对认知功能的影响。方法将90例伴有精神行为异常的AD患者随机分配到美金刚组、喹硫平组、氟哌啶醇组,各组在基础治疗上分别加用美金刚、喹硫平、氟哌啶醇治疗。观察12周。采用痴呆行为量表(BEHAVE-AD)评价精神行为症状,简易智能状态检查(MMSE)判定认知功能,副反应量表(TESS)评估患者的药物不良反应。结果治疗后3组间BEHAVE-AD评分差异无统计学意义(P>0.05);美金刚组MMSE评分优于其他2组,差异有统计学意义(P<0.05);不良反应方面:氟哌啶醇组>喹硫平组>美金刚组。结论美金刚治疗AD患者的精神行为异常方面与喹硫平、氟哌啶醇相当,在一定程度上改善患者认知,不良反应少,在临床选药方面,有一定的参考价值。     

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.