Rate of progression of Alzheimer's disease in younger versus older patients: A longitudinal single photon emission computed tomography study

Aim: Although several researchers have examined the effect of age on disease progression in patients with Alzheimer's disease (AD), the results are controversial. We investigated the effect of age on the rate of progression of cognitive impairment and on regional cerebral blood flow (rCBF) deficits using longitudinal single photon emission computed tomography (SPECT) studies. Methods: We divided 75 patients with AD who were followed up for 24–90 months into the younger AD group (n = 32, age at initial examination ≤75 years) and the older AD group (n = 43, age at initial examination >75 years). We assessed changes in Mini‐Mental State Examination (MMSE) scores and rCBF between initial and final examinations. Results: The change in the annual MMSE score was greater in the younger AD group than in the older AD group. The mean annual MMSE score changes correlated significantly with age at the initial examination. The initial and follow‐up SPECT studies showed more severe and extensive rCBF deficits in the younger AD group than in the older AD group. Conclusion: Our longitudinal SPECT study showed that the rate of progression of cognitive impairment and the rCBF deficits were higher in younger patients with AD than in older patients with AD. Therefore, age is an important factor to consider, not only in the diagnosis, but also in the treatment and prognosis of patients with AD. Geriatr Gerontol Int 2013; 13: 555–562.     

蒙特利尔认知评估量表在帕金森病认知功能损害筛查中的应用

目的探讨蒙特利尔认知评估量表(MoCA)和简易智能状态检查量表(MMSE)在帕金森病(PD)患者认知功能损害筛查中的应用。方法选取1 29例年龄≥60岁的PD患者,根据认知功能将其分为正常组(60例)、轻度认知功能障碍(MCI,37例)组和PD痴呆(PDD,32例)组,采用MoCA和MMSE对患者进行评估和分析。结果 3组MoCA得分差异有统计学意义(P<0.01)。与正常组比较,MCI组和PDD组患者在画立方体、复述、1 mm动物数、抽象能力、延迟回忆得分较低(P<0.01);与PDD组比较,正常组和MCI组患者在命名、数字广度和定向力得分较高(P<0.05)。此外,受试者ROC曲线结果显示,MMSE诊断MCI的曲线下面积为0.803;MoCA诊断MCI的曲线下面积为0.947。MMSE诊断PDD的曲线下面积为0.952;MoCA诊断PDD的曲线下面积为0.990。结论 MoCA可作为有效的PD患者认知功能损害的筛查工具,且随着PD患者病情的进展,MoCA得分逐渐降低。MoCA筛查MCI的最佳界值为≤23分,且MoCA在筛查PD患者MCI方面的敏感性较MMSE高。     

Is Mini‐Mental Score Examination Scoring a New Predictor of Uncontrolled Hypertension?

Essential hypertension is an important risk factor for target organ damage. The brain is among the target organs infrequently visited. The authors evaluated whether an abnormal Mini‐Mental Score Examination (MMSE) score predicts uncontrolled hypertension even if office blood pressure is normal. Seventy‐seven hypertensive patients were included. The cognitive function of each patient was assessed using MMSE and a customized brain magnetic resonance imaging study. Patients were classified into normal cognitive function group and mild, moderate, and severe cognitive impairment groups. A significance level of P=.05 was used. There was a higher percentage of uncontrolled BP in every cognitive impairment class. In patients older than 65 years, MMSE score had a sensitivity and specificity of 94% and 83%, respectively, in the prediction of uncontrolled hypertension. MMSE is a simple test to run in the clinic to predict whether patients have well‐controlled blood pressure.     

Montreal Cognitive Assessment Performance in Patients with Parkinson's Disease with "Normal" Global Cognition According to Mini-Mental State Examination Score

OBJECTIVES: To examine Montreal Cognitive Assessment (MoCA) performance in patients with Parkinson's disease (PD) with "normal" global cognition according to Mini-Mental State Examination (MMSE) score.
DESIGN: A cross-sectional comparison of the MoCA and the MMSE.
SETTING: Two movement disorders centers at the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center.
PARTICIPANTS: A convenience sample of 131 patients with idiopathic PD who were screened for cognitive and psychiatric complications.
MEASUREMENTS: Subjects were administered the MoCA and MMSE, and only subjects defined as having a normal age- and education-adjusted MMSE score were included in the analyses (N=100). As previously recommended in patients without PD, a MoCA score less than 26 was used to indicate the presence of at least mild cognitive impairment (MCI).
RESULTS: Mean MMSE and MoCA scores±standard deviation were 28.8±1.1 and 24.9±3.1, respectively. More than half (52.0%) of subjects with normal MMSE scores had cognitive impairment according to their MoCA score. Impairments were seen in numerous cognitive domains, including memory, visuospatial and executive abilities, attention, and language. Predictors of cognitive impairment on the MoCA using univariate analyses were male sex, older age, lower educational level, and greater disease severity; older age was the only predictor in a multivariate model.
CONCLUSION: Approximately half of patients with PD with a normal MMSE score have cognitive impairment based on the recommended MoCA cutoff score. These results suggest that MCI is common in PD and that the MoCA is a more sensitive instrument than the MMSE for its detection.     

Precuneus hypoperfusion plays an important role in memory impairment of patients with systemic lupus erythematosus

The present study was designed to identify regional cerebral blood flow (rCBF) abnormalities in systemic lupus erythematosus (SLE) patients with memory impairments. Nineteen SLE patients (mean age 36.1?±?8.6?years, range 17-47) with subjective memory complaints underwent brain single-photon emission computed tomography (SPECT). The Korean Wechsler Adult Intelligence Scale (K-WAIS) and the Rey-Kim Memory Test (RKMT) were used objectively to evaluate cognitive functions in these patients. On the basis of the Intelligence Quotient-Memory Quotient (IQ-MQ) difference score, patients were classified into two groups: those with below one standard deviation (SD) from the mean for normal subjects of comparable age and education (memory impairment, n?=?6) and those with without memory impairment (non-memory impairment, n?=?13). Their brain SPECT images were analyzed by statistical parametric mapping (SPM) for group comparisons. The group of SLE patients with memory impairment showed significant hypoperfusion in the right precuneus compared with those with non-memory impairment (p?相似文献   

Clinical analysis of cognitive function in diabetic patients by MMSE and SPECT

We examined the frequency of cognitive impairment using the mini-mental-status examination (MMSE), as well as cerebral perfusion using single photon emission computed tomography (SPECT) in elderly diabetic patients. Written consent was obtained from all patients prior to their inclusion in this study. An MMSE score of 26 or less was adopted as an indication of cognitive impairment. Following an initial study, a 3-month study incorporating the use of MMSE and SPECT was performed in subjects, some of whom were taking donepezil hydrochloride. Of the 92 subjects enrolled in this study, 38% exhibited cognitive functional impairment and 18% earned MMSE scores of 23 or lower that were indicative of dementia. With regard to their cerebral blood flow pattern as determined by SPECT 217, 31.4 and 34.2% of subjects showed parieto-temporal hypoperfusion, asymmetrical hypoperfusion and fronto-temporal hypoperfusion patterns of abnormalities, respectively; 11.4% displayed unclassifiable findings and 8.5% showed no detectable abnormalities. No significant differences were seen in patients that were taking donepezil hydrochloride compared to those who were not. The incidence of cognitive functional impairment in elderly, diabetic patients was significantly elevated and was accompanied by a reduction in cerebral blood flow in the fronto-temporal region, as determined by SPECT.     

Prediction of progression in patients with mild cognitive impairment using IMP-SPECT

To examine the difference in functional brain imaging between mild cognitive impairment (MCI) and normal aging, we measured rCBF on functional brain imaging using 123I-IMP single photon emission computed tomography (IMP-SPECT) in 19 MCI patients who progressed to develop AD on follow-up and 23 probable Alzheimer's disease (AD) patients as well as 15 age-matched normal subjects. Baseline MMSE score was 25.3 (SD 1.2) in the MCI group and 17.5 (SD 3.3) in the AD group. The regions of interest (ROI) in the posterior cingulate gyrus, frontal, temporal and parietal cortices were drawn on the image of IMP-SPECT with reference to an individual MRI image. The rCBF ratio was calculated using ROI value in the cerebellum as a reference. Voxel-based analysis was also preformed using statistical parametric mapping (SPM). The rCBF ratio in the posterior cingulate gyrus was significantly reduced in the MCI group (mean 0.956, SD 0.080) and the AD group (mean 0.833, SD 0.118) compared to that in the normal group (mean 1.083, SD 0.084). In the frontal, temporal and parietal cortices, the rCBF ratio was significantly reduced only in the AD group compared to the normal group. At a fixed specificity of 80%, the diagnostic sensitivity in the discrimination between MCI patients and normal subjects was 80.5% when using rCBF ratio in posterior cingulate gyrus. In the SPM analysis, significant reduction of the rCBF in MCI group was observed only in the posterior cingulate gyrus, compared with normal subject group. Our results suggest that MCI patients presenting with a posterior cingulate hypoperfusion are at higher risk for transition from MCI to clinically recognizable AD.     

蒙特利尔认知评估量表用于帕金森病认知评估的可行性研究

目的探讨蒙特利尔认知评估量表(MoCA)中文北京版用于帕金森病(PD)认知评估的可行性。方法分别用MoCA和简易智能状态检查量表(MMSE)对78例PD患者进行认知功能评估,分析评估结果。结果 PD患者MoCA与MMSE评分分别为(23.7±3.8)分和(27.7±2.3)分,MoCA评分明显低于MMSE,差异有统计学意义(P0.05);Pearson相关分析显示,MoCA与MMSE总分显著相关(r=0.89,P0.05)。在MMSE评定认知功能正常的患者中有50.7%MoCA评定有认知障碍。19例MMSE评分为30分患者的平均MoCA评分为(27.1±1.63)分,其中18例MoCA评分30分。MoCA延迟回忆下降发生率明显高于MMSE记忆和回忆能力下降发生率。结论 MoCA与MMSE总分上有较好的相关性,MoCA用作PD认知筛查时敏感性高于MMSE,较MMSE更适合用于PD患者的认知障碍筛查。     

Quality of Life and Emotional Distress in Peritoneal Dialysis and Hemodialysis Patients

Cardiovascular disease‐associated morbidity and mortality are reportedly higher in hemodialysis (HD) patients compared with peritoneal dialysis (PD) patients. However, few studies have estimated changes in state of depression and cognitive impairment in patients undergoing HD and PD. The present study evaluated the impact of HD or PD on patients' quality of life (QoL), cognitive impairment, and depression status over 2 years. This 24‐month observational, prospective study included 45 HD and 30 PD patients. Patients were assessed before and every 12 months after starting dialysis for 24 months. Measurements included QoL (36‐Item Short‐Form Health Survey [SF‐36]), cognitive impairment (Mini‐Mental State Examination [MMSE]), depressive state (Center for Epidemiologic Studies Depression Scale [CES‐D]), grip strength, and 24‐h urine volume (UV). Physical and social component scores of the SF‐36 significantly improved in PD patients at 24 months compared with those observed at baseline (42.8 vs. 39.4; P < 0.05 and 46.4 vs. 37.3; P < 0.05, respectively); however, scores remained unchanged in HD patients. MMSE scores were significantly decreased at 12 and 24 months in HD patients (29.0 vs. 26.0, 25.0; P < 0.05), but remained unchanged in PD patients. Moreover, CES‐D scores significantly worsened at 24 months in HD patients (12.8 vs. 16.5), but remained unchanged in PD. Preservation of UV and grip strength was associated with SF‐36, CES‐D, and MMSE scores. Our findings indicate that PD is associated with higher QoL and recovery from cognitive failure compared with HD.     

Malnutrition-inflammation is a risk factor for cerebral small vessel diseases and cognitive decline in peritoneal dialysis patients: a cross-sectional observational study

Background

Chronic kidney disease patients have an increased prevalence of subclinical cerebrovascular diseases. Dialysis patients have severe vascular diseases burden. The cerebral small vessel diseases (CSVD) are difficult to find by clinical assessment. The evaluation of CVSD needs MRI. Cognitive impairment is a consequence of CVSD which is diagnosed by cognitive testing. These limited the study of CVSD and cognitive function in dialysis patients. Peritoneal dialysis (PD) patients are minority of dialysis population. We know even fewer about the CVSD in this special population.

Methods

In this cross-sectional study, we enrolled 72 PD patients who received care at the Peking Union Medical College hospital peritoneal dialysis center. CSVD were assessed by brain MR images. Cognitive function was evaluated with the Chinese version of the MMSE and MoCA.

Results

In our PD patients, the brain MRI showed the prevalence different signs of CSVD were: lacunar infarcts 38.9%, microbleeds 36.1%, abnormal brain white matter hyperintensities (WMHs) 48.6%, and intracerebral hemorrhage 4.2%. 25% and 86.8%of our patients could be diagnosed as cognitive impairment, according to the MMSE and MoCA test, respectively. nPCR was lower in patients with a lacunar infarct or intracerebral hemorrhage, and relative to the MMSA/MoCA score; hsCRP was higher in patients with lacunar infarct or abnormal WMHs and negative relative to the MMSA/MoCA score. In logistic regression analyses, nPCR was an independent risk factor for lacunar infarcts and impaired cognitive function. The presence of lacunar infarct was an independent risk factor for cognitive function decline.

Conclusion

We demonstrated a high prevalence of CSVD and cognitive impairment in our PD patients. Lacunar infarct was the main kind of CVSD responsible for PD patients cognitive function decline. Our novel observation also revealed an association between malnutrition-inflammation and CSVD.

     

脑白质高信号对帕金森病运动症状和认知损害的影响

目的探讨脑白质高信号(WMH)对帕金森病(PD)运动症状和认知损害的影响。方法回顾性纳入315例PD患者,根据Fazekas量表评分分为轻度WMH组191例,中度WMH组74例,重度WMH组50例。收集脑血管病相关危险因素,Hoehn-Yahr(H-Y)分级、世界运动障碍协会统一帕金森病评定量表第三部分(MDS-UPDRSⅢ)总分及震颤、强直、运动迟缓、步态姿势异常评分评估运动症状,用简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能,用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估情绪,用3T MRI及Fazekas量表评估WMH程度,用Spearman相关和多元线性回归分析。结果 3组年龄、起病年龄、病程、MMSE和MoCA评分比较,有统计学差异(P<0.05,P<0.01)。3组H-Y分级、MDS-UPDRSⅢ总分、震颤、强直、运动迟缓、步态姿势异常、HAMA、HAMD评分及体位性低血压比例比较,无统计学差异(P>0.05)。多元线性回归分析校正年龄、病程、起病年龄、MoCA、同型半胱氨酸、缺血性脑卒中、高血压、吸烟、性别、体质量指数和心脏病等因素后,WMH与MMSE仍显著相关(β=-0.183,95%CI:-0.134^-0.007,P=0.029)。脑室旁WMH(r=-0.246,P=0.000;r=-0.235,P=0.000)和深部WMH(r=-0.192,P=0.001;r=-0.187,P=0.001)与MMSE和MoCA呈显著负相关。WMH与PD运动症状不相关(P>0.05)。结论 WMH对PD认知损害影响明显,临床需警惕PD伴发WMH,脑血管病二级预防可能对PD患者认知减退有潜在预防作用。     

Prevalence and characteristics of older community residents with mild cognitive decline

Background: Cognitive impairment is a major health issue, but epidemiological data on mild cognitive decline have been almost absent in Japan. Methods: Of all residents aged 65 years and over living in Yoita town, Niigata Prefecture, Japan in the year 2000 (n = 1673), 1544 participated in the interview survey held at community halls or at home (92.3% response). They underwent the Mini‐Mental State Examination (MMSE) for assessment of cognitive function and answered questionnaires comprising socio‐demographic, psychological, physical and medical, and social activity items. Higher‐level functional capacities were evaluated with the Tokyo Metropolitan Index of Competence (TMIG‐Index of Competence). According to subject’s age and MMSE score, all subjects were classified into 3 groups: control (MMSE > 1 SD below age‐specific means), mild cognitive decline (MMSE ≥ 21 and ≤ 1 SD below age‐specific means), and severe cognitive decline (MMSE ≤ 20), and compared various characteristics among these groups. Results: Mean MMSE score of the subjects showed a linear decline with advancing age. Among the participants, 232 (15.2%) were classified as mild cognitive decline. Compared with the controls, the subjects with mild cognitive decline reported poorer subjective health, more depressive moods, more history of stroke, more prevalence of basic activity of daily living (BADL) disability, and lower higher‐level functional capacity, even after controlling for possible confounding factors. They also reported a low level of social activities: both participating in group activities and enjoying hobbies were less frequent. Their food intake pattern tended to be monotonous. Conclusions: Older persons with mild cognitive decline comprised a substantial proportion (15.2%) of the community‐dwelling older population. In addition to lower cognitive function, they had lower levels of functional capacity and social activity.     

Olfaction and the 5-year incidence of cognitive impairment in an epidemiological study of older adults

OBJECTIVES: To determine whether odor identification ability is associated with the 5‐year incidence of cognitive impairment in a large population of older adults with normal cognition at baseline and whether olfactory impairment contributes to the prediction of cognitive decline. DESIGN: Population‐based longitudinal study. SETTING: Beaver Dam, Wisconsin. PARTICIPANTS: One thousand nine hundred twenty participants in the Epidemiology of Hearing Loss Study (mean age 66.9). MEASUREMENTS: Olfaction was measured using the San Diego Odor Identification Test (SDOIT). Incident cognitive impairment was defined as a Mini‐Mental State Examination (MMSE) score of less than 24 or reported diagnosis of dementia or Alzheimer's disease (AD) at follow‐up in participants with a MMSE score of 24 or greater and no diagnosis of dementia or AD at baseline. RESULTS: There was a significant association between olfactory impairment at baseline and 5‐year incidence of cognitive impairment (odds ratio (OR)=6.62, 95% confidence interval (CI)=4.36–10.05). The association remained significant after adjusting for possible confounders (OR=3.72, 95% CI=2.31–5.99). The positive predictive value of the SDOIT was 15.9%, the negative predictive value was 97.2%, the sensitivity was 55.1%, and the specificity was 84.4% for 5‐year incidence of cognitive impairment. CONCLUSION: Olfactory impairment at baseline was strongly associated with 5‐year incidence of cognitive impairment as measured using the MMSE. Odor identification testing may be useful in high‐risk settings, but not in the general population, to identify patients at risk for cognitive decline.     

Blood Pressure and All‐Cause Mortality by Level of Cognitive Function in the Elderly: Results From a Population‐Based Study in Rural Greece

This study aimed to investigate whether the effect of blood pressure (BP) on mortality differs by levels of cognitive function. The associations of brachial systolic BP, diastolic BP, mean arterial pressure (MAP), and pulse pressure with all‐cause mortality were prospectively explored (follow‐up 7.0±2.2 years) in 660 community‐dwelling individuals ( ≥ 60 years) using adjusted Cox models, stratified by cognitive impairment (Mini‐Mental State Examination [MMSE] <24). No association between brachial BP variables and mortality was shown for the total sample in quartiles analysis; however, MAP in the highest quartile, compared with the second, was associated with mortality (hazard ratio, 1.85; 95% confidence intervals, 1.09–3.12) among cognitively impaired individuals. The fractional‐polynomials approach for BP confirmed this finding and further showed, solely in the MMSE <24 subcohort, U‐shaped trends of MAP and systolic BP, with increased mortality risk in extremely low or high values; no such pattern was evident for patients with MMSE ≥24. Elderly individuals with cognitive impairment might be more susceptible to the detrimental effects of low and elevated MAP and systolic BP.     

Decrease of regional cerebral blood flow in liver cirrhosis

OBJECTIVE: Alterations of regional cerebral blood flow (rCBF) in subjects with liver cirrhosis have not been fully evaluated. We evaluated quantitative changes in rCBF using single photon emission computed tomography (SPECT). METHODS: Twenty-eight Japanese patients with liver cirrhosis were enrolled in this study. None of them exhibited advanced hepatic encephalopathy at the time of examination. The cause of liver cirrhosis was viral infection in 26 patients; the cause was unknown in two patients. Child-Pugh classification of the patients was as follows: Group A, 12 patients; Group B, 12 patients; and Group C, four patients. The control group consisted of 25 age-matched healthy subjects. Radionuclide angiography was performed by rapid injection of Tc-99m ethyl cysteinate dimer (ECD) (740 MBq) via the right cubital vein, and then SPECT brain images were taken. Using the Patlak graphical method, rCBF values (ml/100 g per min) were calculated in the frontal, parietal, temporal and occipital lobes and cerebellum on SPECT images. RESULTS: The rCBF values were lower in cirrhotic patients than in controls, i.e. by 15% in the frontal lobe, by 12% in the parietal lobe, by 10% in the temporal and occipital lobes, and by 7% in the cerebellum. They decreased concomitantly with the severity of liver disease. A significant negative correlation was noted between rCBF values and Child-Pugh score in the frontal (P<0.01), parietal (P<0.05) and occipital lobes (P<0.01). rCBF values of each region were not correlated with age or with results of neuropsychological test. The degree of association between rCBF values and results of laboratory examination was generally poor. CONCLUSION: Patients with liver cirrhosis without advanced encephalopathy showed widespread reduction in rCBF; this reduction was particularly evident in the frontal lobe. Tc-99m ECD SPECT may be useful for evaluating cerebral functional changes in patients with liver cirrhosis.     

A clinical study in elderly patients with Parkinson's disease using MRI and SPECT--Parkinson's disease and the lacunar state]

Parkinson's disease (PD) is often associated with dementia in elderly patients, and sometimes PD coexists with senile dementia of the Alzheimer type (SDAT) or cerebrovascular disease (CVD) in the elderly. However, since there are few previous clinical studies on the coincidence of, or relationship between PD and CVD, the authors evaluated these aspects in 34 elderly patients with PD using MRI and SPECT. All the patients were over 70 years old. The diagnosis of PD was based on the presence of three symptoms (resting tremor, cogwheel rigidity and bradikinesia) which are characteristic of PD, and the effectiveness of L-DOPA therapy. We therefore believe that patients with vascular Parkinsonism were excluded from our study. In 34 cases, 24 (71%) had MRI evidence of CVD (mainly the lacunar state). In the 10 cases who had no CVD, 2 (20%) had severe dementia and the decrease of regional cerebral blood flow (rCBF) in the temporal and parietal lobes bilaterally correlated with the SPECT findings commonly found in SDAT. A comparison of the rCBF and the results of Hasegawa's dementia score (HDS) (verbal intelligence score) was made between the patients with PD associated with CVD and the patients with PD who had no CVD and no SPECT findings which correlated with SDAT. The rCBF in the frontal lobes and the results of the HDS of the former group were significantly lower than those of the latter. As mentioned above, elderly patients with PD often had CVD, leading to dementia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Frontal Assessment Battery and brain perfusion images in amnestic mild cognitive impairment

Aim: Some patients with mild cognitive impairment (MCI) may have impaired frontal lobe function. To assess the frontal lobe functions of subjects with MCI using the Frontal Assessment Battery (FAB) and to identify the brain regions responsible for FAB performance. Methods: Based on the FAB score cut‐off of 12/13, 38 MCI subjects were divided into a high FAB group (n = 20) and a low FAB group (n = 18). They underwent single photon emission computed tomography (SPECT) and we analyzed the data by the 3‐D stereotactic surface projection method. Results: No significant differences in neuropsychological tests including memory, language and praxis, and depression scores were found between high and low FAB groups. Although both groups showed decreases in the regional cerebral blood flow (rCBF) of the parietotemporal and frontal regions, the low FAB group demonstrated significant decreases in the rCBF of the left lateral frontal and right medial frontal regions compared with the high FAB group. Conclusion: Our results indicate that some patients with amnestic MCI have frontal lobe dysfunction, assessed by the FAB. SPECT study suggests that the FAB mainly reflects the function of some regions of the left lateral frontal and right medial frontal areas. Geriatr Gerontol Int 2011; 11: 77–82.     

Increased iron and oxidative stress are separately related to cognitive decline in elderly

Aim: The aim of this study is to examine the relation between body iron, oxidative stress and cognitive function in elderly. Methods: Eighty‐seven elderly residents from nursing homes were the subjects of our study. Cognitive status was screened by the Mini‐Mental State Examination (MMSE). Of the 87 eligible subjects, 46 patients who obtained 24 or fewer points on the MMSE scale were considered as subjects with cognitive dysfunction. The control group consisted of 41 subjects who obtained more than 24 points on the MMSE. Routine biochemical analyses, parameters of iron metabolism, malondialdehyde (MDA) and glutathione peroxidase (GSH‐Px) were determined in all subjects. Results: There were statistically significant increases in serum iron, transferrin saturation, ferritin and MDA levels; whereas there was a statistically significant decrease in serum GSH‐Px enzyme activity and serum sodium levels in subjects with cognitive dysfunction. A significant negative correlation was found between serum iron, transferrin saturation, ferritin and MMSE score. There was a negative correlation between MMSE score and serum MDA; however, a positive significant correlation was found between MMSE score and both GSH‐Px enzyme activity and serum sodium. Conclusion: Our study provides evidence of increased markers of iron deposition and oxidative stress in patients with cognitive dysfunction. It seems likely that these markers negatively affect the MMSE score. Interestingly, we did not find any correlation between the markers of iron deposition and oxidative stress. Future studies will be required to demonstrate whether diminishing iron and oxidative stress will enhance MMSE score and thereby ameliorate cognitive impairment. Geriatr Gerontol Int 2011; 11: 504–509.     

颈动脉斑块与老年广泛性脑萎缩并发认知功能障碍的相关性研究

目的探讨颈动脉斑块与老年广泛性脑萎缩并发认知功能障碍的相关性。方法选择连云港市第二人民医院就诊或体检发现的中、重度广泛性脑萎缩的老年患者45例,按认知功能分为:正常组15例、轻度认知功能损害(MCI)组15例和阿尔茨海默病(AD)组15例。所有受试者均接受颈动脉斑块检测,并分析颈动脉斑块与简易智能状态检查量表(MMSE)评分的关系。结果与正常组比较,AD组和MCI组颈动脉内膜中层厚度[(IMT)(2.37±0.28)mm和(2.35±0.13)mmvs(1.76±0.09)mm]及高回声斑块[(17.71±2.30)mm2和(18.96±2.12)mm2 vs(14.25±2.29)mm2]明显增加(P<0.05),MMSE评分[(5.80±3.53)分和(17.40±3.92)分vs(25.73±3.08)分]明显降低(P<0.05);与MCI组比较,AD组MMSE评分明显降低(P<0.05)。3组低回声及混合回声斑块平均面积差异无统计学意义(P>0.05)。线性回归分析显示,IMT与MMSE评分呈负相关(P=0.000)。结论脑萎缩伴IMT或高回声斑块平均面积增多的患者易发生认知功能损害,IMT越高认知功能越低;颈部超声检查可视为老年脑萎缩患者并发认知功能损害的随访指标之一。     

高血压对社区老年人认知功能的影响

目的探讨贵阳市社区老年人血压、脉压及平均动脉压(MAP)与认知功能之间的关系。方法采用多级整群抽样法,抽取贵阳市城区年龄≥60岁的3229例老年人作为研究对象。通过问卷调查和体格检查相结合,收集相关资料,用简易智能状态检查量表(MMSE)进行认知功能评价。结果随着老年人收缩压水平的升高,MMSE呈下降趋势,差异有显著性意义(F=17.6,P<0.01),轻度认知障碍(MCI)患病率随着老年人收缩压水平的升高逐渐增高,差异有显著性意义(χ2趋势=4.76,P<0.05)。脉压越大,MMSE越低,差异有显著性意义(F=27.1,P<0.01)。随着脉压的增加,MCI患病率也逐渐增加(χ2趋势=5.63,P<0.05)。MAP与MMSE呈曲线关系,MAP在90～109mmHg(1mmHg=0.133kPa)时MMSE最高,≤70mmHg或≥110mmHg时MMSE逐渐降低。logistic回归分析显示,中、重度高血压老年人发生MCI的危险高于正常老年人。结论高血压、高脉压、过高或过低的MAP对MCI的发生有重要影响。