阿尔茨海默病和遗忘型轻度认知障碍患者海马血管周围间隙扩大的对比观察

目的比较阿尔茨海默病(AD)与遗忘型轻度认知障碍(aMCI)患者海马血管周围间隙扩大(EPVS)发生率和数量,并探讨海马EPVS与海马萎缩的相关性。方法选择2016年10月～2018年12月在北京大学人民医院神经内科记忆门诊诊断的AD患者105例为AD组,aMCI患者55例为aMCI组,同期在门诊进行体检的认知正常的健康老年人(HC)50例为HC组。在MRI 3DBRAVO成像斜冠状位上观察海马EPVS数量,用内侧颞叶萎缩评定量表(MTA)评分判断海马萎缩程度,比较3组海马EPVS数量差异,Spearman相关性分析海马EPVS与MTA评分的相关性。结果 AD组、aMCI组和HC组海马EPVS发生率分别是87.62%、83.64%和76.00%,且严重的海马EPVS(4个)的比例分别为40.00%、23.64%和12.00%;AD组、aMCI组和HC组海马EPVS总数比较,差异有统计学意义[4.00(2.00,6.00)个vs 3.00(2.00,4.00)个vs 2.50(0.75,3.25)个,P=0.001];与aMCI组和HC组比较,AD组海马EPVS总数明显增多,差异有统计学意义(P=0.025,P=0.003);aMCI组与HC组海马EPVS总数比较,差异无统计学意义(P=0.131)。海马EPVS与海马萎缩的MTA评分呈正相关(r=0.328,P=0.000)。结论AD患者海马EPVS数量高于aMCI患者和HC,其可能与海马萎缩程度相关。     

伴抑郁与不伴抑郁的轻度认知功能障碍患者神经心理测验表现比较

目的比较伴抑郁的遗忘型轻度认知功能障碍(aMCI)与不伴抑郁的aMCI患者神经心理特点。方法根据流行病学调查用抑郁自评量表和老年抑郁量表选择符合伴抑郁的aMCI患者43例(伴抑郁组),随机选择不伴抑郁的aMCI患者43例(不伴抑郁组),社区正常老年人43例(对照组),通过一系列神经心理测试,比较3组受试者的认知缺损特点。结果伴抑郁组和不伴抑郁组认知筛查总分、记忆测试评分、语言测试评分、部分注意功能评分、部分执行功能评分明显高于对照组,差异有统计学意义(P0.05,P0.01);伴抑郁组患者部分注意功能评分、部分执行功能评分、Boston命名测验、结构评分与对照组比较,差异有统计学意义(P0.05,P0.01);伴抑郁组Mattis痴呆评估量表评分明显低于不伴抑郁组[(123.83±9.81)分vs(129.91±6.99)分,P0.01],日常生活能力评分明显高于不伴抑郁组[(2.58±2.23)分vs(1.25±1.70)分,P0.01]。其余测试伴抑郁组与不伴抑郁组差异无统计学意义(P0.05)。结论伴抑郁的aMCI患者认知功能障碍较不伴抑郁aMCI患者严重且弥漫,抑郁使aMCI患者的注意能力减退更严重。     

遗忘型轻度认知障碍的记忆力与fMRI度中心性的相关性

目的应用度中心性(DC)的分析方法,探讨遗忘型轻度认知障碍(aMCI)患者静息态功能核磁共振(RS-fMRI)脑网络的变化及其与aMCI患者记忆力减退的相关性。方法招募aMCI患者与正常老年人(HC组)各25例,采用简易精神状态检查量表(MMSE)和韦氏记忆量表(WMS-RC)评估参与者的整体认知功能和记忆力,同时采集RS-fMRI数据。使用DPABI软件进行数据预处理,严格质控,对两组DC值做两样本t检验,比较组间差异,找出差异脑区;并提取两组有显著差异的脑区DC值,与WMS-RC评分结果做相关分析。结果 aMCI患者右侧额中回、右侧角回、颞上回、双侧后扣带回、右侧扣带旁回等脑区DC值显著低于HC组;而在右侧舌回、左侧尾状核等脑区的DC值明显高于HC组。右侧额中回区DC值与WMS-RC图片记忆部分评分有中等强度的正相关(r=0.536 7)。结论 aMCI与正常老年人的脑功能节点DC存在差异,这种差异可能与情景记忆能力的下降有密切关系。     

认知功能与1H-MRS波谱功能成像的关系

目的 探讨正常老年人的认知功能同脑1H-MRS波谱代谢变化的相关性.方法 采用德国SIEMENS公司生产的Novus 1.5 T磁共振成像系统,对入选的研究对象行相应的常规MRI扫描,对双内侧颞叶及左后扣带回的1 H-MRS采集,比较正常对照(NC)、遗忘型轻度认知功能障碍(aMCI)和阿尔茨海默病(AD)各组间NAA/Cr,NAA/mI,Cho/Cr,mI/Cr比值的差别,并分析各代谢物比值与认知功能的相关性.结果 aMCI、AD组的MMSE评分与1H-MRS相关性:aMCI组与左后扣带回NAA/Cr呈负相关(r=-0.709,P＜0.05),而与其他代谢物比值无明显相关；aMCI和AD组的延迟故事回忆(DSR)评分与1H-MRS相关性:aMCI组与左内侧颞叶NAA／Cr呈正相关(r=0.648,P＜0.05),AD组与左后扣带回的NAA/mI呈正相关(r =0.637,P ＜0.05)；aMCI和AD组的即刻故事回忆(ISR)评分与1H-MRS相关性:aMCI组与左内侧颞叶NAA/Cr无明显相关(r=0.629,P=0.051),与Cho/Cr正相关(r=0.660,P＜0.05),AD组与左后扣带回的NAA/mI呈正相关(r=0.658,P＜0.05).结论 DSR与脑影像学检查结合可作为aMCI和AD早期诊断及鉴别的重要辅助工具,左后扣带回的NAA/mI,及NAA/Cr与AD关联密切,可作为AD诊断的参考依据.     

血清可溶性人基质裂解素水平与2型糖尿病患者心血管风险因素的相关性

目的 探讨血清可溶性人基质裂解素（sST2）水平与T2DM患者患心血管疾病风险的相关性. 方法 根据Framingham十年心血管风险评分将239例研究对象分为4组,收集临床资料,并检测血脂、FPG、2 hPG、HbA1c及纤维蛋白原（FIB）等.ELISA检测sST2水平. 结果 随心血管风险的升高,血清sST2水平呈升高趋势,4组浓度比较,差异有统计学意义（P＜0.01）.除第2组和第3组比较差异无统计学意义,其余各组两两比较,差异均有统计学意义（P＜0.05）.血清sST2水平与年龄、血浆FIB呈正相关（r=0.372、0.201,P=0.000、0.009）.血清sST2水平在既往有无血压异常的患者间比较,差异有统计学意义（P＜0.05）. 结论 血清sST2水平与T2DM患者心血管风险因素年龄、血浆FIB、Framingham十年心血管风险分层呈正相关.     

老年人轻度认知损害危险因素的调查分析

目的 调查北京老年人轻度认知损害(MCD)与年龄、性别、体质指数等的关系.方法 应用简易精神状态检查,对北京东直门社区招募的129例老年人进行认知功能评估.结果 检出记忆型轻度认知损害(aMCI)37例(28.7%),阿尔茨海默病(AD)36例(27.9%),认知正常者56例(43.4%).aMCI和AD患者年龄高于认知正常者,分别为(67.6±7.5)岁、(66.6±8.2)岁和(62.5±7.9)岁,两两比较差异均有统计学意义(t值分别为2.847、-1.747和-2.429,P>0.05、P<0.01和P<0.01);aMCI和AD患者受教育年限低(P<0.05);aMCI和AD患者的血压较认知正常者高(P<0.05);aMCI体质指数高于其他两组(P<0.05),不同性别老年人aMCI和AD患病率差异无统计学意义(P>0.05);不同月份出生aMCI和AD患病率差异无统计学意义(P>0.05).结论 aMCI患病率与年龄、教育程度、高血压和体质指数等因素有关,与性别、出生月份无关.     

遗忘型轻度认知障碍与非痴呆性血管性认知障碍的认知损害及睡眠障碍特点

目的分析遗忘型轻度认知障碍(aMCI)与非痴呆性血管性认知障碍(VCIND)在认知损害及睡眠障碍的特点。方法纳入认知障碍专科门诊就诊的aMCI(aMCI组)和VCIND(VCIND组)患者各50例,同时选取36例正常老年人作为对照组(NC组)。对3组受试者进行神经心理学测评和睡眠评估。比较3组人群认知功能及睡眠状况的特点。结果与aMCI组比较,VCIND组定步调听觉连续加法测验、数字符号编码测验和Benton线方向判定评分显著降低(P<0.05),连线A、连线B评分、威斯康星卡片分类测验64及延迟回忆和再认评分显著升高(P<0.05)。与NC组比较,aMCI组和VCIND组爱泼沃斯嗜睡量表、匹滋堡睡眠质量指数量表评分显著升高(P<0.05);VCIND组失眠严重程度指数得分明显升高(P<0.05)。结论 aMCI延迟记忆和再认能力较VCIND受损严重,而VCIND的注意力、信息处理速度、视空间加工能力和执行功能较aMCI受损更为严重。VCIND的睡眠障碍表现较aMCI突出。     

118例老年人的认知功能改变与载脂蛋白E基因型的关系

目的 了解认知功能正常的老年人认知功能变化与不同载脂蛋白E（APOE）基因型及血管性风险因子的关系。方法 对118例认知功能正常的老年人进行随访，观察简易智能状态检查（MMSE）评分的改变和痴呆发生率与APOE基因型以及血管性风险因子的关系。结果 有APOE4基因型的老人与没有APOE4基因型的老人相比，每年的MMSE评分降低速度快、冠心病的患病率高、痴呆发病率高。结论 APOE4基因型不仅是痴呆的独立风险因子，也与多种血管性风险因子的作用相关。     

同型半胱氨酸及尿酸水平与社区人群中国动脉粥样硬化性心血管疾病风险预测关系的研究

目的：基于中国动脉粥样硬化性心血管疾病风险预测[prediction for atherosclerotic cardio-vascular disease(ASCVD)risk in China, China-PAR]模型,探讨血同型半胱氨酸（homocysteine,HCY）及UA水平与社区人群心血管病10年风险的关系。方法：以2023年3月至5月,在我中心体检的1 699例50～85岁参检者作为对象,收集年龄、性别等基本临床特征,检测HCY、UA等生化指标,采用China-PAR模型进行心血管10年风险评分。按照血HCY及UA是否升高,分为四组：HCY及UA正常组,单纯高HCY组,单纯高UA组,HCY及UA升高组,比较四组间China-PAR评分的差异。结果：HCY及UA正常组,单纯高HCY组,单纯高UA组,HCY及UA升高组的心血管10年风险值中位数分别为：7.6%,11.1%,9.5%,12.9%;各组心血管10年风险高危分布情况分别为：484例（37.8%）,78例（54.9%）,97例（45.8%）,39例（60.0%）。HCY及UA升高组心血管10年风险值中位数、高危占...     

皮质下缺血性血管病影像学特点与老年人认知功能相关性研究

目的 研究皮质下缺血性血管病影像学特点与老年人认知功能的相关性。方法 收集2014年9月至2015年1月哈尔滨医科大学附属第二医院神经内科住院部99例皮质下缺血性血管病患者的临床资料,分析头部磁共振成像（MRI）的检查结果,根据基底节和丘脑区腔隙性脑梗死（LI）数目及脑白质病变（WML）患者的胆碱能通路高信号评分量表（CHIPS）的评分进行分组;采用蒙特利尔认知功能评估量表（MoCA,北京版）和阿尔茨海默病评定量表认知分量表（ADAS-Cog）作为认知评估工具,分析WML和LI病变程度与认知功能障碍是否存在相关性。结果 根据MoCA和ADAS-Cog评分,LI和WML的中度组与轻度组比较认知功能均没有受到影响（P＞0.05）;重度组与轻度组比较,认知功能障碍均显著受到影响（P＜0.05）。基底节和丘脑区多发性LI数目＜7时,轻、中度WML组与对照组相比,认知功能没有受到影响（P＞0.05）;基底节和丘脑区多发性LI数目≥7时,轻中度WML组与对照组相比认知功能显著受到影响（P＜0.05）。结论 严重WML或基底节和丘脑区多发性LI可引起认知功能下降;轻、中度WML同时伴有基底节和丘脑区多发性LI的老年人认知功能也会下降。     

老年高血压患者心血管危险因素分层与认知功能障碍的相关性

目的探讨老年高血压患者心血管危险因素分层与认知功能障碍的关系。方法通过随机整群抽样的方法,选择西安地区老年高血压患者329例,根据心血管危险因素分层分为低危组62例,中危组77例,高危组108例,极高危组82例,又按简易智能状态检查量表(MMSE)评分分为认知功能正常组283例及认知功能障碍组46例。对不同分层及不同认知功能进行单因素及多因素分析。结果随着心血管危险程度的增加,低危组、中危组、高危组和极高危组的MMSE总分及各分项定向力、记忆力、回忆力、注意力、语言能力得分依次递减,差异有统计学意义;认知功能正常组与认知功能障碍组在年龄、职业、体育锻炼、做家务、参加社会活动、脑卒中及TG方面比较,差异有统计学意义(P<0.05,P<0.01);多因素回归分析显示,高龄、不参加体育锻炼、不做家务、不参加社会活动在2组间差异有统计学意义(P<0.05,P<0.01)。结论老年高血压患者随着心血管危险因素分层越高,认知功能障碍越重。高龄、不参加体育锻炼、不做家务、不参加社会活动是其认知功能障碍的重要危险因素。     

低血压对老年人认知功能的影响

目的探讨低血压对老年人认知功能的影响。方法选择因头晕、头昏、乏力就诊的患者141例,通过问诊了解既往血压>5年的老年低血压患者(低血压组)67例,老年正常血压者(正常血压组)74例,所有受试者行蒙特利尔认知评估量表(MoCA)和简易智能状态检查量表(MMSE)检测,以及头颅MRI和颈部血管超声检查。结果多因素logistic回归分析显示,低血压是认知功能障碍的危险因素(P=0.020)。与正常血压组比较,低血压组的MoCA、MMSE评分明显降低(P=0.000),MoCA的视空间与执行功能、注意、语言、抽象、延迟回忆评分明显降低,差异有统计学意义,MoCA和MMSE评分呈正相关(r=0.922,P<0.05)。与正常血压组比较,低血压组脑白质损害分级显著升高(P<0.01)。两组颈部血管超声比较差异无统计学意义(P>0.05)。结论低血压是认知功能障碍的危险因素,老年低血压患者认知功能较正常血压者下降。     

Specific saccade deficits in patients with Alzheimer’s disease at mild to moderate stage and in patients with amnestic mild cognitive impairment

Saccadic impairment in Alzheimer’s disease (AD) was found in horizontal saccades. The present study extends investigation to vertical saccades in a large number of subjects, including AD and amnestic mild cognitive impairment (aMCI). We examined both horizontal and vertical saccades in 30 healthy elderly, 18 aMCI, and 25 AD. Two tasks were used: gap (fixation target extinguishes prior to target onset) and overlap (fixation stays on after target onset). Eye movements were recorded with the Eyeseecam system. (1) Robust gap effect (shorter latencies in gap than in overlap) exists for AD and aMCI patients as for healthy elderly; (2) abnormal long latency of saccades in gap and overlap tasks for AD relative to healthy elderly and aMCI patients; (3) longer latency for aMCI patients than for healthy elderly for the overlap task; (4) significant correlation between scores of Mini-Mental State Examination (MMSE) and latencies of saccades considering the AD group only; (5) higher coefficient of variation in latency for AD patients than for healthy elderly and for aMCI patients; (6) variability of accuracy and speed is abnormally higher in AD patients than in aMCI and healthy elderly. Abnormalities of latency and latency–accuracy–speed variability reflect deficits of cerebral areas involved in the triggering and execution of saccades; latency of saccades can be used as follow-up test for aMCI and AD patients with its significant correlation with the changes of MMSE scores.     

老年阻塞性睡眠呼吸暂停低通气综合征患者冠心病发病风险的调查

目的对老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者冠心病的发病风险进行调查。方法选择2015年5月~2018年5月海南省人民医院经整夜多导睡眠监测诊断为OSAHS患者60例,根据患者病情严重程度分为轻度组19例,中度组18例,重度组23例。按2︰1原则选择同期我院健康体检中心进行体检的非OSAHS患者30例(对照组)。采集各组患者基本信息,通过多导睡眠监测仪监测呼吸暂停低通气指数(AHI),根据AHI评估患者病情,进一步采用Framingham危险评分及欧洲心脏外科手术风险评估系统(EuroSCORE)对研究对象进行评估。结果与对照组比较,中度组和重度组Framingham危险评分和EuroSCORE明显升高[(7.94±3.49)分、(10.30±3.01)分vs(2.82±1.39)分,(2.25±0.86)分、(3.25±0.85)分vs(1.31±0.48)分,P<0.05)]。相关性分析显示,OSAHS患者AHI分别与Framingham危险评分及EuroSCORE呈正相关(r=0.709,P=0.028;r=0.726,P=0.019)。结论老年OSAHS患者随着病情的加重,冠心病相关事件发生风险明显升高。     

Framingham cardiovascular disease risk scores and incident frailty: the English longitudinal study of ageing

Cross-sectional studies show that frailty is common in older people with cardiovascular disease. Whether older people at higher risk of developing cardiovascular disease are more likely to become frail is unclear. We used multinomial logistic regression to examine the prospective relation between Framingham cardiovascular disease risk scores and incidence of physical frailty or pre-frailty, defined according to the Fried criteria, in 1,726 men and women aged 60 to over 90 years from the English Longitudinal Study of Ageing who had no history of cardiovascular disease at baseline. Men and women with higher Framingham cardiovascular risk scores were more likely to become frail over the 4-year follow-up period. For a standard deviation higher score at baseline, the relative risk ratio (95 % confidence interval) for incident frailty, adjusted for sex and baseline frailty status, was 2.76 (2.18, 3.49). There was a significant association between Framingham cardiovascular risk score and risk of pre-frailty: 1.69 (1.46, 1.95). After further adjustment for other potential confounding factors, the relative risk ratios for frailty and pre-frailty were 2.15 (1.68, 2.75) and 1.50 (1.29, 1.74), respectively. The associations were unchanged after excluding incident cases of cardiovascular disease. Separate adjustment for each component of the risk score suggested that no single component was driving the associations between cardiovascular risk score and incident pre-frailty or frailty. Framingham cardiovascular risk scores may be useful for predicting the development of physical frailty in older people. We now need to understand the biological mechanisms whereby cardiovascular risk increases the risk of frailty.     

入院营养状况对老年社区获得性肺炎严重程度及预后的影响

目的探讨入院营养状况对老年社区获得性肺炎(CAP)严重程度及临床预后的影响。方法选取2018年1月至2018年9月在首都医科大学附属北京友谊医院医疗保健中心内科住院的老年CAP患者150例为研究对象。入院24 h内应用肺炎严重指数(PSI)量表进行肺炎严重程度评估,根据肺炎严重程度分为非高危肺炎组(99例)与高危肺炎组(51例)。72 h内应用营养风险筛查2002(NRS2002)量表进行营养状况调查。记录并比较2组患者基本资料、实验室数据及临床预后等情况。应用SPSS 22.0软件进行统计分析。根据数据类型,组间比较采用t检验、秩和检验或卡方检验。多因素logistic逐步回归分析探讨CAP患者发生高危肺炎的影响因素。结果多因素logistic回归分析显示,营养风险评分增高(OR=0.481,95%CI 0.231~0.999;P=0.049)、红细胞体积分布宽度(RDW)增加(OR=2.400,95%CI 1.302~4.425;P=0.005)、心力衰竭(OR=7.854,95%CI 1.086~56.784;P=0.041)、口腔缺齿/义齿(OR=19.84,95%CI 1.366~288.219;P=0.029)、血尿素氮增高(OR=2.050,95%CI 1.219~3.446;P=0.007)和日常生活能力评分减低(OR=0.452,95%CI 0.237~0.862;P=0.016)是老年CAP患者发生高危肺炎的影响因素(P<0.05)。在所有患者中,合并营养风险者与营养正常者30 d临床预后(P=0.016)及出院转归(P=0.012)比较,差异有统计学意义,其中合并营养风险的患者预后较差。结论老年CAP住院患者高危肺炎发生率高,预后差,临床上需注意营养风险、心功能不全、口腔卫生以及日常生活能力降低等情况的发生。     

上海社区老年人抑郁与认知状况的相关性研究

目的 研究社区居家养老老年人抑郁状况及其与认知障碍的关系.方法 本研究于2020年4月9日-6月15日间,选取842例上海某社区健康体检老年人为研究对象,用老年抑郁量表(GDS)评估其抑郁状态,用简易智力状态检查量表(MMSE)评估其认知功能.结果 分析发现,抑郁组的MMSE得分下降(P=0.005),表明抑郁与认知功...     

Conversion pattern and predictive factor of mild cognitive impairment in elderly Koreans

ObjectiveWe aimed to understand conversion characteristics of mild cognitive impairment (MCI) in elderly Koreans.MethodsWe analyzed clinical data of 760 individuals who participated in a two-year follow-up study. Neuropsychological assessments and clinical examination were conducted in the follow-ups. Logistic regression model was used to estimate predictive risk factors of MCI conversion.ResultThe participants at baseline (n = 760) represented 462 cognitively normal individuals (60.8%), 286 individuals with MCI (37.6%), and 12 individuals with dementia (1.6%). Among the cognitively normal individuals (n = 462), 108 (23.4%) progressed to MCI during the two-year follow-up period, including 92 with amnestic mild cognitive impairment (aMCI; 19.9%) and 16 with non-amnestic mild cognitive impairment (non-aMCI; 3.5%). Interestingly, 3.7% of participants with aMCI converted to non-aMCI, while 45.5% of participants with non-aMCI converted to aMCI. Moreover, a higher proportion of non-aMCI (27.3%) reverted to a cognitively normal state, compared to aMCI participants (18.6%), indicating that non-amnestic cognitive impairment is more unstable than amnestic cognitive impairment, and probably converges toward aMCI. Additionally, we found that weight loss was associated with incident MCI and future MCI. Weight loss was negatively correlated with Clinical Dementia Rating (p = 0.005), and significantly associated with a higher risk of MCI conversion from a cognitively normal state (OR = 1.10, 95% CI: 1.00–1.21, p = 0.042).ConclusionThis study supports that non-amnestic MCI is prone to converge toward amnestic MCI, and the elderly people with weight loss are at risk for developing cognitive decline.     

How much might cardiovascular disease risk be reduced by intensive therapy in people with screen‐detected diabetes?

Aims To assess the cardiovascular disease (CVD) risk of people with screen‐detected Type 2 diabetes and to estimate the risk reduction achievable through early intensive pharmacological intervention. Methods In ADDITION‐Cambridge, diabetic patients were identified among people aged 40–69 years through a stepwise screening procedure including a risk score, random and fasting capillary blood glucose, HbA_1c and oral glucose tolerance test. In those without prior macrovascular disease, 10‐year CVD risk was computed using UK Prospective Diabetes Study (UKPDS) and Framingham engines. The absolute risk reduction achievable and its plausible range were predicted using relative risk reductions for individual therapies from published trials and sensitivity analysis. Results Of the 867 individuals with undiagnosed diabetes, 19% had pre‐existing CVD, 97% were overweight or obese, 86% had hypertension, 75% had dyslipidaemia, 20% had microalbuminuria and 18% were smokers. Of those with hypertension, 35% were not prescribed drugs and 42% were suboptimally treated. Of participants with dyslipidaemia, 68% were not prescribed medications and 22% were poorly controlled. Median 10‐year CVD risk was 34.0%[interquartile range (IQR) 26.2–44.6] in men and 21.5% (IQR 15.7–28.7) in women using the UKPDS engine; 38.6% (IQR 27.8–53.0) in men and 24.6% (IQR 17.2–32.9) in women using Framingham equations. In the most conservative scenario (no additive effect of therapies), the absolute risk reduction achievable through multifactorial therapy ranged from 4.9 to 9.5% (UKPDS) and from 5.4 to 10.5% (Framingham). The corresponding ranges of numbers needed to treat were 11–20 and 10–19. Conclusions People with screen‐detected diabetes have an adverse cardiovascular risk profile, which is potentially modifiable through application of existing treatment recommendations.