Alzheimer′s病和血管性痴呆特征的比较研究

目的 :旨在通过对AD和VaD临床特征、流行特征和认知功能三方面的对比分析 ,为两者的病因学研究、鉴别诊断、治疗和预防提供依据。方法 :选取 1997～ 1998年上海地区流行病学调查中的确诊AD和VaD病人。结果 :在四项心理测验FOM ,RVR ,DS和BD项中 ,只有BD项表现为AD高于VaD(P <0 0 5 )。AD女性患病率是男性的 2倍 ,VaD患病率男性高于女性 ;AD患病率自 75～ 90岁以上呈倍数上升 ,而VaD 90岁以后的患病率反而下降。AD有文化程度的差别 ,VaD的患病率和文化程度的关系不明显。结论 :AD和VaD在临床特征、流行特征和认知功能方面都有差别     

男性痴呆患者血清性激素的变化

目的:观察阿尔茨海默病(AD)和血管性痴呆(VD)男性患者血清性激素及促性腺激素的变化。方法:老年男性共114人,其中AD 3 2例;VD 3 0例;无痴呆正常老年人5 2名。采用化学发光法测定血中黄体生成素(LH )、促卵泡成熟素(FSH)、雌二醇(E2 )、催乳素(PRL)、睾酮(T)的含量,并计算E2 /T的比值。结果:AD组及VD组患者血清T水平较正常对照组低,差别有显著意义(P <0 .0 5 ,P <0 .0 1)。VD组患者血清E2 /T较正常对照组显著升高;也较AD组明显升高(P <0 .0 1,P <0 .0 5 )。AD、VD组患者血清E2 、LH、FSH、PRL与正常对照组比较,差别均无显著意义(P >0 .0 5 )。结论:老年男性AD及VD患者血清T水平降低。     

血管性痴呆与事件相关电位

目的探讨血管性痴呆的事件相关电位(P300)特点,及P300用于鉴别血管性痴呆和阿尔茨海默病的可能性。方法选用听觉oddball诱发范式对24例血管性痴呆(VD)、25例阿尔茨海默病(AD)和22例正常老年人(NC)进行P300测试。结果VD的P300特点为靶P3潜伏期延长,靶N2潜伏期延长并与认知障碍程度密切相关。VD与AD相比,AD的靶P2及靶P3波幅明显下降。结论靶N2潜伏期是VD的P300研究中一项重要指标,靶P2、P3波幅在VD与AD的鉴别诊断中有一定意义。     

Dementia with cerebrovascular disease: the benefits of early treatment

Patients with vascular dementia (VaD) and Alzheimer's disease with cerebrovascular disease (AD + CVD) have dementia associated with underlying CVD. Although diagnosis of VaD is challenging, VaD is typically characterized by a stepwise progression of dementia that is closely associated with stroke and focal neurological findings, and a symptom profile that often includes executive dysfunction leading to decreased ability to perform instrumental activities of daily living (IADL). In contrast, AD + CVD patients typically present with progressive deterioration of cognition/memory that may also be influenced by concurrent cerebrovascular events. Early diagnosis and intervention are desirable to prevent further decline due to subsequent vascular events. Management of CVD can limit deterioration of cognitive symptoms in VaD patients, and treatment benefits with cholinesterase inhibitors may be realized as improvement above baseline levels in dementia symptoms. Results from a combined analysis of two 24-week, placebo-controlled clinical trials show that donepezil-treated VaD patients improve in cognition, global function, and performance of IADL. In contrast, AD + CVD patients may continue to decline despite management of CVD, and treatment benefits should be recognized as initial improvements followed by stabilization or slowed decline of dementia symptoms over time. In post-marketing studies, donepezil-treated AD and AD + CVD patients show similar benefits in cognition, global function, and quality of life. The results of these studies support the use of donepezil in treatment of patients with VaD or AD + CVD.     

Evaluation of 110 consecutive patients with dementias: a prospective study

We prospectively investigated 131 consecutive cases (both in- and outpatients) of suspected dementia to evaluate the relative frequency of different types of dementia in Chinese patients. Dementia was confirmed in 110 cases (84.0%). In contrast to the Western series, vascular dementia (39.1%) was slightly more frequent than the Alzheimer's disease (36.4%). Twelve cases (10.9%) of potentially treatable dementia were found. Careful clinical observation was the most useful part of the evaluation. CT scan of brain was the most useful laboratory test.     

Cognitive and behavioural predictors of progression rates in Alzheimer's disease

Cognitive and functional decline in Alzheimer's disease (AD) may show different, yet correlated, rates of progression. Over a 2-year period we investigated the predictive role of neuropsychological and behavioural variables on the cognitive and functional decline of 43 patients with AD. Slow and fast decliners were defined on the basis of cognitive and functional indexes of disease progression. We found that cognitive decline was predicted by diffuse cognitive impairment and functional progression by visuospatial deficits. Psychotic symptoms predicted faster disease progression in both cognitive and functional dimensions.     

Event-Related Potentials in Senile Dementia of Alzheimer's Type, Multiinfarct Dementia and Parkinson's Disease

Abstract: We investigated event-related potentials (P300) in three types of demented patients. Fourteen patients with senile dementia of Alzheimer's type (SDAT), 15 with multiinfarct dementia (MID), 8 with Parkinson's disease with dementia and 29 normal controls participated in this study. We measured the latencies of N100 and P300 at Pz after odd-ball paradigm stimulation. N100 peaks were within the normal range in all patients. However, P300 peaks were significantly delayed in all demented patients. There were no statistical differences in the mean latencies of P300 in each demented group. P300 latencies were found to be negatively correlated with Hasegawa's dementia scale. These results suggest that regardless of its cause dementia has similar influences on the P300 latency and P300 may be a useful means to assess the degree of dementia.     

Pacing Rhythms of Wanderers with Dementia

Background : As wandering in the demented is difficult to define qualitatively, we tride to define it quantitatively. We investigated the relationship between wandering and rhythm abnormalities.
Methods : In order to study the pacing rhythms of wanderers observed in a subgroup of demented inpatients (dementia due to Alzheimer's disease and vascular dementia), we assessed 115 inpatients in terms of steps during four parts of a day and total daily steps using a pedometer.
As the mean+2 S.D. of total daily steps in the nondemented was 9,979, we defined 10,000 steps in a day as the cut off for defining demented wanderers versus nonwanderers. Then, the pacing rhythms (nadir part and amplitude) were compared among demented wanderers, demented nonwanderers and nondemented subjects.
Results : That there were no statistically significant differences among the three groups. But wandering groups defined by pedometer exhibited many of the same characteristics in wanderers observed in other studies.
Conclusion : The quantification of steps might provide a good hallmark of wandering behaviors in the demented, and these results might indicate hyperpacing rather than rhythm dysfunctions to be essential to wandering behavior.     

Incidence And Course Of Dementia In People With Down's Syndrome: Findings From A Population-Based Study

The prevalence rate of Alzheimer's disease (AD) in people with down's syndrome (DS) increases significantly with age. However, the nature of the early clinical presentation, course and incidence rates of dementia are uncertain. The aims of the present study were to investigate the characteristics of age-related clinical changes and incidence rates for dementia in a population-based sample of people with DS aged 30 years and older at the age of risk for dementia. A modified version of the cambridge examination for mental disorders of the elderly informant interview was used to determine the extent and nature of changes in memory, personality, general mental functioning and daily living skill 18 months after a similar assessment. At the time of the first assessment, the initial changes reported were predominately in behaviour and personality. At the second assessment, overall estimated incidence rates for frontal-like dementia were high (0.24), mainly in the younger groups, with incidence rates of AD, meeting both ICD-10 and DSM-IV criteria, of 0.04 predominately in the older groups. The present authors have hypothesized that the observed personality changes and the high estimated incidence rates of frontal-like dementia in the younger groups may indicate that functions served by the frontal lobes are the first to be compromised with the progressive development of Alzheimer-like neuropathology in people with DS.     

Dementia Poststroke

Abstract : The frequency of dementia poststroke is high, and stroke considerably increases the risk of dementia. The risk factors for dementia related to stroke are still incompletely understood. In addition to age and low level of education, different combinations of vascular risk factors and stroke features have been associated with poststroke dementia. A single explanation for poststroke dementia is not adequate; rather, multiple factors including stroke features (dysphasia, major dominant stroke syndrome), infarct features (type, side, site, number, and volume), extent and type of white matter lesions (WMLs), degree and site of atrophy, host characteristics (e.g. age, educational level), and risk factors for stroke (e.g. prior cerebrovascular disease, diabetes) each contribute to the risk of dementia poststroke.
Dementia after first ever clinical stroke is also frequent. Cognitive decline is present prior to stroke in up to one-third of patients developing post-stroke dementia. Medial temporal lobe atrophy, a marker of an increased risk of Alzheimer's disease (AD), is more frequent in stroke patients who have preexisting dementia or cognitive decline, as well as poststroke dementia. This may be explained by co-existing AD and cerebrovascular disease (CVD). The magnitude of this mixed dementia (AD with CVD/Vascular Dementia (VaD)) group has been previously underestimated, and it is a diagnostic challenge in the older population.
Dementia due to CVD is a rather advanced stage of is chemic brain changes, and outcome of treatment and prevention may be limited. Accordingly, the focus should be placed on the entire spectrum of cognitive impairment related to CVD, focusing especially the early cognitive changes.     

石杉碱甲治疗血管性痴呆的临床研究

目的：观察石杉碱甲治疗轻、中度血管性痴呆（VaD）的临床疗效和安全性。方法：78例轻、中度VaD患者随机分为两组。石杉碱甲组39例：男性24例,女性15例,年龄（71．8±7．2）岁;对照组39例：男性26例,女性13例,年龄（72．3±6．9）岁。石杉碱甲组给予石杉碱甲0．1mg,bid,口服;对照组给予维生素C100mg,bid,口服。两组总疗程为12周。采用简易精神状态检查表（MMSE）、临床痴呆程度量表（CDR）和日常生活能力量表（ADL）作为评价指标。结果：石杉碱甲治疗12周后MMSE、CDR及ADL分数分别较对照组和治疗前明显改善（P〈0．01）。结论：石杉碱甲可显著改善VaD患者的认知功能,且安全性良好。     

Low Levels of Serum Apolipoprotein AI and AII in Senile Dementia

Abstract: We studied the serum lipoprotein and apolipoprotein profiles in 44 patients with sporadic late-onset Alzheimer's dementia and 43 patients with vascular dementia. The levels of high-density lipoprotein (HDL) cholesterol were lower in both patient groups than in a control group. Apolipoprotein A I and A II levels have decreased in both the patient groups, especially in the vascular dementia group. The HDL-cholesterol levels correlated positively with the level of apolipoprotein A I, but not with the level of apolipoprotein A II. The ratios of apolipoprotein A I/A II have increased in both the patient groups. The apolipoprotein A II levels have disproportionally decreased in the patient groups. The serum apolipoprotein A II may involve the pathological process in the patients with senile dementia.     

Frontal Behavioural Inventory in the differential diagnosis of dementia

Objective –  To evaluate diagnostic properties of the Frontal Behavioural Inventory (FBI) in patients suffering from different forms of dementia.
Methods –  The FBI was administered with other psychometric tests investigating cognitive performances and behavioral scales to the caregivers of 35 patients with the frontal variant of frontotemporal dementia (fv-FTD), 22 patients with Alzheimer's disease (AD) and 15 with vascular dementia (VaD). All patients were comparable for degree of dementia severity and level of executive impairment.
Results –  The FBI showed high concurrent validity, internal consistency and good inter-rater and test–retest reliability. The discriminant validity was also very high. A new FBI cut-off score of 23 gave 97% sensitivity and 95% specificity in distinguishing fv-FTD from non-FTD patients. Conversely, the Neuropsychiatic Inventory (NPI) score was unable to differentiate fv-FTD from AD.
Conclusions –  The FBI is a neurobehavioral tool suitable to distinguish fv-FTD from other forms of dementia also when data from cognitive testing or other behavioral scales fail to support the differential diagnosis.     

Oligoclonal immunoglobulin bands in cerebrospinal fluid of patients with Alzheimer''s disease and vascular dementia

We examined serum and cerebrospinal fluid (CSF) of 16 patients with Alzheimer's disease (AD), 28 patients with vascular dementia (VD), their age-matched controls and multiple sclerosis (MS) patients in order to evaluate the humoral immune response within the central nervous system both quantitatively and qualitatively. Intra-blood-brain barrier (BBB) protein synthesis was calculated by CSF IgG index. The presence of oligoclonal banding (OCB) was investigated with agarose isoelectric focusing (IEF) followed by immunoblotting with antihuman IgG. No patient with AD and only 4 patients with VD had slightly elevated IgG indexes, and no statistically significant differences in the indexes were found between the two groups. No bands were found in the CSF of AD patients but 3 VD patients had OCB in both serum and CSF. One VD patient had bands in serum but no bands in CSF. No kappa or lambda free light chains were found in those demented patients with demonstrable bands in the CSF and serum. No OCB were found in control sera and CSF. For comparison, the majority of patients with MS had OCB in CSF. Thus, no consistent increase of intrathecal protein synthesis was found in patients with AD and VD. Methodological differences explain at least part of the conflicting results published earlier.     

Longitudinal changes in the prevalence of dementia in a Japanese rural area

Background: The increasing number of patients with dementia in Japan, together with the rapid aging of society, is currently considered to have a substantial impact on Japan's medical, economic and sociological systems. Therefore, the longitudinal estimation of changes in the prevalence of dementia based on accurate diagnostic evaluation has important implications. Methods: We undertook three separate epidemiological studies on long‐term changes, 10 years apart (1980, 1990 and 2000), in the prevalence of dementia in an elderly population using identical methods (DSM‐III and Hachinski's ischemic score) for the same rural area in Japan (Daisen‐cho). Results: The percentage of the population that was elderly (over 65 years of age) increased steadily from 16.0% in 1980 to 21.7% in 1990 and 27.1% in 2000. The prevalence of dementia (cases/100 people aged 65 years or older, adjusted to the population structure of 1980) in 1980, 1990 and 2000 was 4.4, 4.5 and 5.9, respectively, for all types of dementia, 1.9, 2.5 and 3.6, respectively, for Alzheimer‐type dementia (DAT) and 2.0, 1.7 and 2.2, respectively, for vascular dementia (VaD). Conclusions: These findings of an increase in the number of cases and prevalence of DAT and VaD in a Japanese rural community have important implications for interventional medicine.     

Alzheimer's disease and brain infarcts in the elderly. Agreement with neuropathology

Clarifying the etiology of dementia is one of the most difficult diagnostic challenges, especially in the elderly. We examined the accuracy of clinical criteria to distinguish Alzheimer's disease (AD) and dementia associated with infarcts of the brain, either isolated (vascular dementia) or associated with degenerative lesions (mixed dementia). We carried out a prospective clinico-neuropathological study in a selected series of hospitalized patients. We evaluated the clinical aspects of 33 patients aged over 75 years by use of the criteria and scores of DSMIII, NINCDS-ADRDA, Loeb and Gandolfo, ADDTC and NINDS-AIREN and the Hachinski Ischemic Score. The neuropathological diagnosis was considered to be the gold standard. When comparing clinical criteria and neuropathology, the agreement was moderate for Hachinski's score (0.50) and Loeb's score (0.43) and substantial for the ADDTC (0.63) and the NINDS-AIREN (0.67). When mixed dementias were excluded, the agreement between all clinical criteria and scores and the pathological diagnosis rose to 0.88. Hachinski's score was the most sensitive (0.89) and the NINDS-AIREN the most specific (0.86) for the diagnosis of vascular dementia. In conclusion, all sets of clinical criteria distinguished pure AD from vascular dementia with a high accuracy whereas mixed dementia was clinically under-recognized. The NINDS-AIREN criteria were the most discriminating for the accurate identification of patients with mixed dementia. Received: 17 November 2001, Received in revised form: 14 May 2002, Accepted: 22 May 2002 Correspondence to Pr. Jean-Jacques Hauw     

Cause of death in patients with dementia disorders

Background:  Investigations on cause of death may provide valuable information about life expectancy and on conditions of terminal dementia care, which perhaps can be ameliorated.
Methods:  The autopsy reports were studied on all patients ( n  = 524; 55.3% females; median age 80 years) with a clinically and neuropathologically diagnosed dementia disorder who underwent a complete autopsy at the University Hospital in Lund, Sweden, during 1974–2004.
Results:  The two most common causes of death were bronchopneumonia (38.4%) and ischaemic heart disease (23.1%), whilst neoplastic diseases were uncommon (3.8%). In a general population of elderly studied for comparison, bronchopneumonia accounted for 2.8%, ischaemic heart disease for 22.0%, and neoplasm for 21.3% of the deaths. Amongst the demented patients, circulatory and respiratory system diseases were the causes of death in 23.2% and 55.5% of the Alzheimer patients, respectively, whilst the corresponding figures were 54.8% and 33.1% for the patients with vascular dementia.
Conclusions:  In patients with dementia, pneumonia as the immediate cause of death may reflect a terminal stage in which patient care and feeding is difficult to manage well. Knowledge about what actually causes death is of value in the terminal care of patients with dementia disorders.     

新疆石河子城区血管性痴呆和老年性痴呆的流行病学调查

目的探讨新疆石河子城区老年人血管性痴呆及老年性痴呆的发病情况。方法于1995年1～3月对石河子城区50岁以上老年人群进行随机抽样调查。共调查6个住宅小区计2687人，其中尼佳1380人，女性1307人。结果发现血管性痴呆的患病率为1．38％（37／2687），老年性痴呆患病率为0．41％（11／2687），老年性痴呆无性别及职业差异。血管性痴呆男性患病率（1．88％，26／1380）明显高于女性（0．84％，11／1307）（x2=4．6310，P＜0．05），无职业差异。随年龄增长，两种痴呆患病率均有明显增加，且两者均有显著性意义（P＜0．01）。调查结果还表明，无论哪种痴呆，文化程度低的人群患病率高。结论降低痴呆的重要措施是提高人群的教育、文化水平。