快速认知筛查测验识别老年轻度认知功能障碍的效果

目的评价老年人快速认知筛查测验识别轻度认知功能障碍(MCI)和早期痴呆(AD)的效能。方法 60岁及以上的轻度AD患者84例、MCI患者112例、正常老人(NC)196例,采用老年人快速认知筛查测验(QCST-E)、简易精神状态检查量表(MMSE)、日常生活能力(ADL)量表、临床痴呆评定量表(CDR)、华文认知能力量表(CCAS)进行认知功能评估。QCST-E分别测量12个认知领域:即刻记忆、实物命名、视觉空间、言语流畅性、数字广度、抽象能力、听觉模仿、视觉模仿、动作指令、延迟记忆、简单计算、时空定向,最高总分83分,得分越低,认知功能损害越严重。结果轻度AD组、MCI组、NC组QCST-E总分分别为(51.47±3.91)分、(61.47±2.96)分、(72.60±3.01)分,差异显著(P<0.01)。QCST-E各领域和总分与年龄、受教育年限及MMSE、ADL、CCAS得分显著相关(均P<0.01)。根据不同文化程度制定QCST-E的划界分,其中QCST-E总分识别MCI与正常老人的总体敏感度为89.6%、特异度为94.5%,曲线下面积(AUC)为0.903(95%CI:0.857~0.963);识别MCI与轻度AD的总体敏感度为81.7%、特异度为88.6%,AUC值为0.898(95%CI:0.845~0.940)。结论老年人快速认知筛查测验内容全面、简便易行,识别MCI的敏感度和特异度良好。     

"蒙特利尔认知评估量表"在轻度认知损伤患者筛查中的应用

老年性痴呆（Alzheimer＇s disease，AD）的发病率随着世界人口老龄化的加剧而迅速攀升。由于中晚期AD的治疗效果不佳，有关研究的注意力已经转向如何识别其智能减退的早期症状，以期预防、减缓甚至逆转痴呆的脑功能损害。轻度认知损伤（mild cognitive impairment，MCI）是发生在老年人群的认知功能减退综合征。据美国神经病学研究所（ANN）报道，每年MCI患者进展为AD的发生率达6％～25％，因而MCI患者是AD的高危人群。如能找到检测MCI的特异和敏感的筛查指标，建立客观、准确、便捷的早期诊断方法，及时干预防止其演化为AD，则可极大地减少AD的危害，减轻患者家庭的巨大精神压力和经济负担。因此，对于MCI患者的有效筛查是当前国内外认知领域研究的重点。     

军队体检人群应用两种量表筛查认知功能障碍的临床研究

目的探讨联合应用AD8和简易智力状态评估量表(Mini-Cog)在军队体检人群筛查认知功能障碍的特异性和敏感性。方法纳入我院常规健康体检军队人群1723例,对自愿接受认知功能测评者行AD8量表和Mini-Cog测评,最终同时接受AD8量表和Mini-Cog检测的体检者160例。采用ROC曲线分析量表评估的敏感性、特异性,计算ROC曲线下面积(AUC)。结果AD8量表和Mini-Cog测评提示认知功能障碍者分别为84例(52.5%)和71例(44.4%),两者联合检测提示双异常者为43例(26.9%)。160例受检者中临床诊断为认知功能障碍者66例(41.3%),其中AD8量表检出率为69.7%,Mini-Cog检出率为83.3%,两者联合检出率为56.1%。ROC曲线分析显示,两者联合检测特异性为93.6%,敏感性为56.1%。AD8(≥2分)量表、Mini-Cog及两者联合检测评估认知功能障碍的AUC比较,差异有统计学意义(P<0.01)。与认知正常者比较,双异常者年龄明显增高(P<0.01),在调整年龄的影响因素后,协方差分析显示,双异常者连线A完成时间明显延长,简易智能状态检查量表、延迟回忆、执行功能、工作记忆、词语流畅性评分明显降低(P<0.01)。结论AD8和Mini-Cog操作简单,测评所需时间短,两者联合检测可明显提高痴呆患者检出的特异性,适用于在初级医疗卫生保健机构筛查认知功能障碍患者。     

三种轻度认知功能障碍患者的病情转归

目的：观察三种轻度认知功能障碍（ MCI ）患者的病情转归情况。方法76例MCI患者,根据认知功能障碍程度分为单纯记忆损害（SMI）21例（SMI组）、多领域认知功能损害（MD-MCI）43例（MD-MCI组）、单纯非记忆功能认知受损（NMI）12例（NMI组）,观察随访3 a后,比较三组患者的认知功能及病情转归情况。结果3 a后MCI患者认知功能减退明显,MD-MCI组MMSE评分、词语延迟回忆评分、数字广度倒数评分、言语流畅性评分、画钟实验评分、本顿视觉保持正确评分均明显低于SMI组、NMI组（P均＜0．05）;MD-MCI组进展为阿尔茨海默病（AD）19例,其他类型痴呆4例,AD及痴呆发病率为53．5％;SMI组AD发病率为19．0％（4/21）;NMI组痴呆发病率为25％;MD-MCI组AD及痴呆发病率与SMI组、NMI组相比,P均＜0．05。 SMI组2例、NMI组3例认知状态恢复正常。结论不同类型的MCI转归不同,MD-MCI型较SMI型、NMI型认知功能损害重,3 a后AD及痴呆发病率高。     

从阿尔茨海默病新诊断指南看轻度认知功能损害概念的变化

阿尔茨海默病（AD）是以认知功能损害为突出表现的神经系统退变性疾病。轻度认知功能障碍（MCI）是认知功能低于同龄及文化背景的正常人但未达到痴呆程度的认知功能损害状态,被认为是痴呆、特别是AD的危险因素。临床及流行病学的研究表明MCI存在着异质性,有关MCI的概念及转归一直存在争论。随着对AD痴呆前阶段的关注,有必要了解MCI的含义及其变化。本文复习了MCI概念的提出、定义及其内容上发生的变化,并介绍了新的NIA—AD工作组AD诊断指南。     

简易老年人认知筛查问卷的编制和信效度

目的编制一个用于筛查老年人认知功能的简易问卷,检验问卷的难度、区分度以及信效度。方法在老年人痴呆问卷基础上编制一个以记忆障碍为核心,同时包含时空定向、做事效能、精神病理等4个功能领域的简易老年人认知筛查问卷(BECSI),共13个条目。在500名社区样本中检验该问卷的难度、区分度,150名重测样本和75名效度样本中检验问卷的重测信度、实证效度。结果问卷各条目的难度0.043~0.390,各条目与总分的相关系数(区分度)0.320~0.831;条目鉴别指数0.083~0.530,不同等级平均应答率依次为43.8%、41.4%、13.3%、1.5%。问卷总分的重测相关和α系数分别为0.998和0.908,分半信度为0.918。BECSI总分与年龄和教育的相关系数分别为0.449和-0.371,与MMSE、CCAS和DSI-E的相关分别为0.885、0.920和0.941。组间比较问卷总分和领域分存在显著差异(NCMCIAD)。ROC分析显示,问卷总分对筛查MCI或AD具有较高的敏感性和特异性。结论新编老年人快速认知筛查问卷条目的难度分布合理、区分度和信效度较理想,是一个可靠有效的简易认知损害筛查工具。     

城镇老年居民认知功能评估

随着对痴呆认识地深入,将治疗和干预转向早期以成为一种共识,而轻度认知功能损害(MCI)是介于认知功能正常衰老与痴呆之间的一种过渡阶段,是一种可干预的痴呆前状态,也是进行预防性干预的最佳阶段,因此凸显出早期筛查MCI的意义,发展快速、客观的MCI筛查工具也成为当务之急.蒙特利尔认知评估表(MoCA),其评估的认知领域全面,国内多项研究[1,2]均表明MoCA用于认知功能评估和筛查MCI,其敏感性要优于常用的简易精神状况量表(MMSE).本研究选用MoCA北京版对121例60～ 76岁城镇老年居民进行认知功能评估,以了解该群体的认知功能水平及其影响因素.     

老年人失眠与轻度认知功能障碍的临床研究进展

作为特发于老年期的原发性失眠,老年失眠症是困扰老年人的常见病症。阿尔茨海默病（ AD ）又称老年痴呆症,是一种神经退行性疾病,是痴呆病中最常见的类型。现有研究表明失眠症与认知功能障碍具有相关性。而轻度认知功能障碍（MCI）可能是痴呆的早期信号,是预防和治疗AD的关键阶段。鉴于MCI发病的隐匿性及其引发痴呆的危险性,早期识别MCI危险因素、早期诊断并进行有效的预防性干预具有重要临床意义。该文对老年人失眠与轻度认知功能改变之间关系的研究进展作一综述,以期为AD的早期防治提供新的研究思路。     

apoEε4等位基因轻度认知功能损害患者对认知功能的影响

研究和认识轻度认知功能损害（MCI）将有助于痴呆的早期诊断和干预.我们对30例MCI患者和30名健康老年人（对照组）的认知功能和载脂蛋白E（apoE）基因频率进行分析,旨在探寻MCI的认知损伤特点及apoEε4等位基因对认知功能的影响。     

轻度认知损害老年人认知支持的情节记忆特点

阿尔茨海默病（AD）前期，患者认知功能损害主要表现在记忆方面。Petersen等提出轻度认知损伤（MCI）的概念，即记忆力下降比同龄老年人严重，但总体认知功能相对完好，日常生活能力正常，尚未到AD的程度。流行病学研究表明，老年人群中MCI发病率高，并且MCI转化为AD的比率远高于同龄正常老年人。我们于2003年10月至2004年4月采用自由回忆、     

Mild cognitive impairment: epidemiology and dementia risk in an elderly Italian population

OBJECTIVES: To investigate prevalence and incidence of mild cognitive impairment (MCI) and its risk of progression to dementia in an elderly Italian population.
DESIGN: Longitudinal.
SETTING: Population-based cohort aged 65 and older resident in an Italian municipality.
PARTICIPANTS: A total of 1,016 subjects underwent baseline evaluation in 1999/2000. In 2003/04, information about cognitive outcome was collected for 745 participants who were free of dementia at baseline.
MEASUREMENTS: MCI (classified as with or without impairment of the memory domain), dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) diagnosed according to current international criteria.
RESULTS: Overall prevalence of MCI was 7.7% (95% confidence interval (CI)=6.1–9.7 %) and was greater with older age and poor education. During 4 years of follow-up, 155 incident MCI cases were diagnosed, with an incidence rate of 76.8 (95% CI=66.8–88.4) per 1,000 person-years. Approximately half of prevalent and incident MCI cases had memory impairment. Compared with normal cognition, multivariable-adjusted risk for progression from MCI with memory impairment to dementia was 4.78 (95% CI=2.78–8.07) for any dementia, 5.92 (95% CI=3.20–10.91) for AD, and 1.61 (95% CI=0.37–7.00) for VaD. No association with dementia risk was found for MCI without memory impairment. Approximately one-third of MCI cases with memory impairment did not progress to dementia.
CONCLUSION: MCI occurs often in this elderly Italian cohort and is associated with greater risk of AD, but only when the impairment involves the memory domain. However, a substantial proportion of MCI cases with memory impairment do not progress to dementia.     

Conversion of mild cognitive impairment to dementia in elderly subjects: a preliminary study in a memory and cognitive disorder unit

Prevalence and incidence of predementia syndromes vary as a result of different diagnostic criteria, as well as different sampling and assessment procedures. Mild cognitive impairment (MCI) is thought to be a prodromal phase of dementia and therefore highly predictive of subsequent conversion. The aim of our study was to investigate the risk of conversion to dementia for different MCI subtypes diagnosed according to standardized and recently revised criteria (amnestic; impairment of memory plus other cognitive domains; nonamnestic). Participants were recruited among the 2,866 patients referring to the Memory and Cognitive Disorders Unit of the Local Health Unit of Bologna, Maggiore Hospital, between October 2000 and February 2006. In this preliminary study we analyzed data from 52 elderly outpatients with a diagnosis of MCI and a mean follow-up of 1.21+/-0.61 years (range 0.23-3.10 years). Mean age was 72.8+/-6.6 years, males were 61.5%. Mean baseline mini mental state examination (MMSE) score was 27.1+/-1.5. There were 15 incident cases of dementia (28.8%), with Alzheimer's disease (AD) accounting for 53.3% of all cases, AD with cerebrovascular disease for 33.4% and fronto-temporal dementia for 13.3%. Overall rate of conversion was 23.8 per 100 person-years. During the same follow-up period, 53.8% of participants remained stable and 17.3% reverted to normal. Rates of conversion for the specific MCI subtypes were 38 per 100 person-years for amnestic MCI, 20 per 100 person- years for non-amnestic MCI, and 16 per 100 person-years for memory plus other cognitive domains MCI. With respect to non-converters, converters were generally older (76.1+/-4.2 vs. 71.5+/-7.0 years, p=0.021), had a lower MMSE score (26.4+/-1.66 vs. 27.4+/-1.4, p=0.035) and a higher prevalence of atrophy at neuroimaging (73.7% vs. 42.4%, p=0.047). Moreover, with respect to non-converters, converters tended to have higher serum high density lipoprotein (HDL) levels, and lower serum folate levels. No difference was observed for the other study variables, included MCI subtype. Our findings suggest that the current definitions for MCI subtypes, particularly those referring to individuals with multiple or non-amnestic cognitive impairment, include a substantial number of individuals who may not progress to dementia. The possible role of cortical atrophy and low folate in the conversion from MCI to dementia could have important implications, because both conditions are easily identifiable. Moreover, low folate status is potentially amenable to therapeutic options. Although discouraging with respect to the clinical usefulness of currently available MCI criteria, our results raise the possibility that defining a protocol of multiple clinical risk factors may be useful in identifying MCI individuals at increased risk of conversion.     

Simplifying detection of cognitive impairment: comparison of the Mini-Cog and Mini-Mental State Examination in a multiethnic sample

OBJECTIVES: To compare detection of cognitive impairment using the Mini-Cog and Mini-Mental State Examination (MMSE) and to identify sociodemographic variables that influence detection in an ethnoculturally diverse sample. DESIGN: Cross-sectional. SETTING: A registry of the University of Washington Alzheimer's Disease Research Center Satellite. PARTICIPANTS: A heterogeneous community sample (n=371) of predominantly ethnic minority elderly assessed using a standardized research protocol, 231 of whom met criteria for dementia or mild cognitive impairment (MCI). MEASUREMENTS: Demographic data, a standardized research protocol for cognitive assessment and dementia diagnosis, MMSE, and Mini-Cog. RESULTS: Both screens effectively detected cognitive impairment, the Mini-Cog slightly better than the MMSE (P<.01). Overall accuracy of classification was 83% for the Mini-Cog and 81% for the MMSE. The Mini-Cog was superior in recognizing patients with Alzheimer-type dementias (P=.05). Low education negatively affected detection using the MMSE (P<.001), whereas education did not affect the Mini-Cog, and low literacy minimally affected it. CONCLUSION: The Mini-Cog detects clinically significant cognitive impairment as well as or better than the MMSE in multiethnic elderly individuals, is easier to administer to non-English speakers, and is less biased by low education and literacy.     

Early identification of cognitive deficits: preclinical Alzheimer's disease and mild cognitive impairment

With the projected dramatic increase in the number of people who will be diagnosed with Alzheimer's disease (AD) in the coming years, interest is growing in identifying and treating adults at high risk for developing the disorder. Recent research suggests that individuals who will go on to receive a diagnosis of AD exhibit deficits in cognitive performance years beforehand. Those with mild cognitive impairment (MCI), for example, have characteristic cognitive deficits, such as memory loss, and convert to a diagnosis of AD at a faster rate than cognitively healthy controls. MCI has thus become a focus of research because it may help identify high-risk individuals for whom prophylactic treatments designed to slow the progress toward AD can be prescribed. After describing the diagnostic criteria and dementia outcomes associated with MCI, this article discusses several challenges to the study of cognitive impairment before the diagnosis of AD.     

Comparison of cognitive performance in mild cognitive impairment and dementia patients with that in normal children and adults

Background: It is well known that there is rapid cognitive development in childhood and cognitive decline during aging, but the volume of these changes using the same clinical tool is not well documented in the literature. The aim of our study was to investigate and compare the cognitive performance of mild cognitive impairment (MCI) and dementia patients with that of children, adolescents and adults, using a worldwide screening tool, the Mini Mental State Examination (MMSE), and considering the age, educational level and mental status of the participants. Methods: Our sample included 1364 Greek participants and consisted of normal children, adolescents, adults and non‐demented, MCI and demented elderly participants. Results: The variables of age, education and mental status influenced the participant's performance in the MMSE, but sex did not. The smallest variance of the MMSE score was found in 16–18‐year‐old adolescents, a big variance was found in 7–8‐year‐old children, while the biggest was in 71–90‐year‐olds. Alzheimer's disease (AD) participants performed poorer than the 7–8 years old children, though MCI participants showed similar cognitive performance to that age‐group. The participants with 7–9 years of schooling and those with more than 9 years had no significant difference in their MMSE performance. Conclusion: Comparing cognitive performance between subgroups, our results indicated that MCI patients have a similar cognitive performance to that of 7–8‐year‐old children and AD patients' a poorer one than that group. The significant years of cognitive decline in aging are the 56^th year, the 66 quinquennium, and the 7^th and 8^th decades. Geriatr Gerontol Int 2012; 12: 336–344.     

深圳市罗湖区老年人发生认知功能障碍的饮食习惯影响因素分析

目的探讨深圳市罗湖区老年人发生认知功能障碍的饮食习惯影响因素。方法采用自制调查问卷对深圳市罗湖区60岁及以上老年人进行调查,根据简易智力状态评估量表(Mini-Cog)和简易精神状态检查量表(MMSE)筛选出249例认知功能障碍患者作为病例组。按照年龄±3岁、性别相同原则进行1∶1匹配对照组249例。收集两组对象的饮食习惯,运用多因素条件logistic回归分析导致老年人认知功能障碍的饮食习惯影响因素。结果单因素分析发现,大米、新鲜蔬菜、新鲜水果的食用频次和是否食用海水鱼等饮食习惯是老年人认知功能障碍的影响因素(P均<0.05)。logistic回归分析结果显示,每月进食新鲜蔬菜>60次(OR=0.639,95%CI:0.465~0.879)、30~60次(OR=0.598,95%CI:0.412~0.790)、食用海水鱼(OR=0.634,95%CI:0.418~0.960)是老年人认知功能障碍的保护因素。结论经常进食新鲜蔬菜(≥30次/月)和食用海水鱼的饮食习惯是深圳市老年人认知功能障碍的保护因素。     

Implementing Routine Cognitive Screening of Older Adults in Primary Care: Process and Impact on Physician Behavior

Background Early detection of cognitive impairment is a goal of high-quality geriatric medical care, but new approaches are needed to reduce rates of missed cases. Objective To evaluate whether adding routine cognitive screening to primary care visits for older adults increases rates of dementia diagnosis, specialist referral, or prescribing of antidementia medications. Setting Four primary care clinics in a university-affiliated primary care network. Design A quality improvement screening project and quasiexperimental comparison of 2 intervention clinics and 2 control clinics. The Mini-Cog was administered by medical assistants to intervention clinic patients aged 65+ years. Rates of dementia diagnoses, referrals, and medication prescribing were tracked over time using computerized administrative data. Results Twenty-six medical assistants successfully screened 70% (n = 524) of all eligible patients who made at least 1 clinic visit during the intervention period; 18% screened positive. There were no complaints about workflow interruption. Relative to baseline rates and control clinics, Mini-Cog screening was associated with increased dementia diagnoses, specialist referrals, and prescribing of cognitive enhancing medications. Patients without previous dementia indicators who had a positive Mini-Cog were more likely than all other patients to receive a new dementia diagnosis, specialty referral, or cognitive enhancing medication. However, relevant physician action occurred in only 17% of screen-positive patients. Responses were most related to the lowest Mini-Cog score level (0/5) and advanced age. Conclusion Mini-Cog screening by office staff is feasible in primary care practice and has measurable effects on physician behavior. However, new physician action relevant to dementia was likely to occur only when impairment was severe, and additional efforts are needed to help primary care physicians follow up appropriately on information suggesting cognitive impairment in older patients. An erratum to this article can be found at     

部队老年人轻度认知损害的发生及向Alzheimer病的转化情况

目的调查部队老年人轻度认知损害（MCI）的发病率及向Alzheimer病（AD）的转化率，为进一步研究AD提供依据。方法以2001年石家庄市26个部队休干所MCI患病率调查的2674名60岁及以上的离退休干部为研究对象，对患病率调查时诊断为MCI的216例患者和2302名认知正常受试者进行为期3年的队列研究，比较MCI患者和认知正常受试者AD的平均年发病率。结果认知正常的老年人MCI的发病率为4．8％（人年），AD的平均年发病率为0．8％（人年）；MCI患者AD的平均年发病率为5．6％（人年）；男性和女性MCI患者AD的平均年发病率差别无统计学意义（P〉0．05）；随着文化程度的提高，MCI患者AD的平均年发病率有降低的趋势（P〈0．05）；而随着年龄的增长，MCI患者AD的平均年发病率有增高的趋势（P〈0．01）。MCI转化为AD的相对危险性为认知正常者的7．4倍。结论军队老年MCI患者转化为AD的危险性远远大于认知正常的老年人，应加强对老年MCI患者这一AD高危人群的监测。     

Injury-related hospitalisation in community-dwelling older people across the cognitive spectrum: A population based study

ObjectivesTo describe the injury profile, hospitalisation rates and health outcomes for older people with cognitive impairment and to determine whether these differ from those with normal cognition.MethodsParticipants were 867 community-dwelling 70–90 year olds enrolled in the population-based longitudinal Sydney Memory and Ageing Study (MAS). Participant’s cognitive status was classified as normal, mild cognitive impairment (MCI) and dementia at baseline, then 2, 4 and 6 years’ follow-up. MAS records were linked to hospital and death records to identify injury-related hospitalisations for the 2-year period following each assessment.ResultsThere were 335 injury-related hospitalisations for participants; 222 (25.6%) participants had at least one injury-related hospitalisation. The injury-related hospitalisation rate for participants with MCI (63.0 [95%CI 51.6–74.4] per 1000 person-years) was higher than for people with normal cognition (39.3 [95%CI 32.4–46.1] per 1000 person-years) but lower than people with dementia (137.1 [95%CI 87.2–186.9] per 1000 person-years).Upper limb fractures (22.1%) were the most common injuries for participants with normal cognition, and non-fracture head injuries for participants with MCI and dementia (25.9% and 23.3% respectively). Participants with dementia had a higher proportion of hip fractures (20.0%, p = 0.0483) than participants with normal cognition. There was no difference in 30-day mortality between participants with normal cognition, MCI and dementia (3.9%, 1.7%, 3.3% respectively).ConclusionOlder people with objectively defined MCI are at higher risk of injury-related hospitalisation than their cognitively intact peers, but lower risk than people with dementia. Falls-risk screening and fall prevention initiatives may be indicated for older people with MCI.