两种轻度认知损害患者的神经心理学功能比较

背景区别轻度认知损害（mildcognitiveimpairment,MCI）的两种亚型,即遗忘型轻度认知损害（alTlnesticmildcogni—tiveimpairment,aMCI）和小血管型轻度认知损害（MCIassociatedwithsmallvesseldiseases,sv-MCI）将有利于延缓和预防MCI进展为阿尔茨海默病性痴呆和血管性痴呆。目的识别并区分区aMCI与sv-MCI的神经心理学特征。方法从宣武医院神经科门诊就诊患者或在北京社区进行的一项入户调查中选择符合入组标准的被试。根据Pe—tersen诊断标准筛选aMCI患者50例,根据Hachinski诊断标准筛选sv-MCI患者65例。以上两组患者和49名55岁以上没有认知障碍的社区被试一同接受简明精神状态量表（MiniMentalStateExamination,MMSE）检查及画钟测验（ClockDrawingTest,CDT）与听觉词语学习测验（AuditoryVerbalLearningTest,AVLT,评定即刻记忆、延迟回忆和延迟再认能力）。采用单因素方差分析法比较3组被试各项测验的平均得分,如果结果存在明显差异,再进行多个样本两两比较的Tukey法检验。结果aMCI组和SV．MCI组5项测验平均得分均明显低于健康对照组。aMCI组AVLT即刻记忆、延迟回忆和延迟再认测验得分均低于SV．MCI组。在校正了年龄、性别、受教育年限后,上述差异仍旧存在。结论实验结果与既往结果一致,与SV—MCI患者相比,aMCI患者记忆损害更加明显。记忆相关的评估测验,尤其是AVLT,或将有助于区别这两种MCI亚型。     

部分前循环脑梗死与遗忘型轻度认知功能损害患者认知功能的对比研究

目的 比较部分前循环脑梗死(partial anterior circulation infact,PACI)和遗忘型轻度认知损害(amnesic mild cognitive impairment,aMCI)患者的认知损害的特点.方法 选择29例符合牛津社区卒中项目(Oxford Community Stroke Droject,OCSP)分型的PACI患者,35例符合Petersen 诊断标准的aMCI患者,以及60例健康老年人为对照组,采用认知功能筛选测验-C2.1(Cognitive Ability Screening Instrument-C2.1,CASI)评定认知功能.结果 PACI组(86.28±12.04)和aMCI组(89.86±6.03)的CASI总分均比正常对照组(95.57±3.44)低,差异具有统计学意义[F(2)=8.547,P<0.05],而PACI组与aMCI组间无统计学差异.在CASI分领域方面,与对照组相比,PACI组在心算力(P=0.000)和定向力(P=0.021)两方面均较差;与aMCI组比较,PACI组的心算力(P=0.000)较aMCI组差,而短时记忆(P=0.016)和思维流畅性(P=0.005)方面则较好.aMCI组与对照组相比,在短时记忆(P=0.000)、抽象与判断能力(P=0.013)和思维流畅性(P=0.001)方面均较差.结论 PACI患者存在认知损害,尤其在心算力和定向力方面,与aMCI患者相比,可能更好地保留了执行功能,推测缺血性脑卒中与神经退行性变引起的认知损害可能涉及不同认知领域.     

中文版MoCA和MMSE在诊断遗忘型轻度认知功能障碍中的应用

目的 研究中文版蒙特利尔认知评估量表(MoCA)在遗忘型轻度认知障碍(aMCI)诊断筛查中的作用. 方法 以2009-05-2010-03在卫生部北京医院神经内科门诊就诊的患者为检查对象,筛选出aMCI患者31例及健康对照者30名,分别进行简易精神状态量表(MMSE)、MoCA等量表检测,计算两量表诊断aMCI的敏感性和特异性并进行比较,分析MoCA在诊断aMCI中的作用和特点. 结果 以26分作为分界值时,MMSE和MoCA诊断aMCI的敏感性分别为9.68%和87.10%,特异性分别为93.33%和73.33%.MoCA的敏感性显著高于MMSE. 结论与MMSE 相比,MoCA以其较高的敏感性在筛查aMCI中具有较大作用,而且可对多个认知领域的功能进行检测,有望在多个认知损害类型的研究中起到重要作用.     

上海社区老年抑郁障碍与遗忘型轻度认知功能损害患者的认知功能对照研究

目的:探讨上海社区老年抑郁障碍与遗忘型轻度认知功能损害(aMCI)患者之间认知功能的神经心理学差异。方法:1 068例社区老人中符合美国精神障碍诊断与统计手册第4版临床定式检查(SCID)的老年抑郁障碍患者13例及亚临床抑郁患者7例,共20例作为抑郁障碍组(DD组),并选取性别、年龄、教育程度均匹配的aMCI患者20例(aMCI组)及正常老人20名(NC组)作为对照,采用简明精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)进行认知功能的测评。结果:3组在MMSE总分及地点定向力、计算与注意力、三步指令评分,以及MoCA总分、复制图、注意、计算、延迟回忆、时间定向评分差异有统计学意义(P0.05或P0.001)。DD组MMSE总分(P=0.034)、计算力与注意力(P=0.009)以及MoCA总分(P=0.002)、计算(P=0.006)、抽象思维(P=0.030)、时间定向(P=0.044)评分明显好于aMCI组。结论:社区老年抑郁障碍患者认知功能受损程度较老年aMCI患者轻。     

Rey-Osterriche复杂图形测验在轻度阿尔茨海默病和轻度认知损害患者中的应用研究

目的:研究Rey-Osterrich复杂图形测验(CFT)对轻度阿尔茨海默病(AD)和遗忘型轻度认知损害(MCI)的诊断价值。方法:应用CFT、简明精神状态量表(MMSE)对45例轻度AD患者、73例遗忘型MCI和66名正常老年人进行检测,MMSE总得分分别为(20.2±2.5)分、(26.9±1.8)和(28.2±1.6)分。结果:对照组,CFT结构模仿和延迟回忆得分与教育程度有显著正相关性,与年龄、性别无相关性。MCI组的结构模仿得分为(32.4±6.2)分,轻度AD组为(26.1±10.9)分,对照组为(33.6±3.1)分。AD组与对照组及MCI组比差异有显著意义,延迟记忆对于识别MCI有一定作用,协助AD诊断有较好的敏感性(P<0.01);MCI组的延迟回忆得分与对照组比差异有显著统计学意义(P<0.01),轻度AD组下降更为明显,与MCI组比差异有显著统计学意义(P<0.01)。结论:CFT延迟记忆对于识别MCI有一定作用,协助AD诊断有较好的敏感性。CFT结构模仿不能识别MCI,对轻度AD,其敏感性亦不理想。     

轻度认知损害研究进展

因为在老年性痴呆 (Ａｌｚｈｅｉｍｅｒｄｉｓｅａｓｅ,ＡＤ)的治疗方面 ,已开始出现很有希望的苗头 ,有关研究的注意力已经开始转向如何尽早识别其智能衰退的早期症候 ,以期预防、减缓或逆转痴呆的脑功能损害。轻度认知损害 (ｍｉｌｄｃｏｇｎｉｔｉｏｎｉｍｐａｉｒｍｅｎｔ,ＭＣＩ) ,即常发生在老年性痴呆临床前期的一种综合征 ,可能是老年性痴呆发病的早期信号 ,它有助于发现最需要早期干预的个体[1] 。我们就ＭＣＩ的概念、诊断标准、神经影像、外周标志及其与早期ＡＤ的关系等进行综述。一、ＭＣＩ的沿革及概念1.沿革 :老年人中常见未…     

轻度认知功能障碍患者的神经心理学研究

目的 探讨轻度认知功能障碍(MCI)患者神经心理学的特点. 方法 对42例MCI患者和55例健康对照者进行多项神经心理学检查,包括简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、临床痴呆评定量表(CDR)、语言流畅性测验(RVR)、韦氏智力测验(WAIS-RC)[包括数字广度测验(DS)、积木测验(BD)、相似性测验]、韦氏记忆测验(WMS-R)(包括逻辑记忆、联想学习、视觉再认、图片回忆)、日常生活能力量表(ADL),比较2组患者上述量表评分和MMSE、MoCA量表各亚项评分的差异.结果 与对照者比较,MCI患者MMSE、MoCA总分和RVR、WAIS-RC、WMS-R分测验,MoCA量表各亚项(地点定向力除外),MMSE量表中计算与注意、延迟回忆两亚项评分较低,差异均有统计学意义(P<0.05).结论 MCI患者不仅记忆受损,其计算与注意力、命名、视空间结构能力、执行功能也可受损,尤以延迟回忆、计算与注意力受损明显.MoCA涵盖了重要的认知领域,能较全面评估MCI患者的认知功能,值的临床推广应用.     

游离脂肪酸与老年2型糖尿病患者轻度认知功能障碍的研究

目的探讨游离脂肪酸(FFA)与老年2型糖尿病(T2DM)患者轻度认知功能障碍(MCI)的关系。方法选择85例老年T2DM患者,应用蒙特利尔认知评估(MoCA)量表评定认知功能,分为T2DM认知功能正常组(T2DM-NC)45例和T2DM认知功能障碍组(T2DM-MCI)40例,另选择糖耐量正常且认知功能正常者35例为对照组(NC)。测定3组FFA、糖化血红蛋白(HbA1c)、血脂等。结果 T2DM-MCI组FFA水平(7.45±0.13)mmol/L高于T2DM-NC组(6.32±0.13)mmol/L及NC组(4.56±0.11)mmol/L。T2DM-MCI患者的MoCA评分与糖尿病病程(r=-0.507,P=0.001)、FPG(r=-0.581,P0.001)、HOMA-IR(r=-0.360,P=0.022)、HbA1c(r=-0.533,P0.001)、TC(r=-0.358,P=0.023)、TG(r=-0.408,P=0.009)、LDL-C(r=-0.377,P=0.016)、FFA水平(r=-0.566,P0.001)呈负相关,与HDL-C(r=0.365,P=0.021)呈正相关。多重线性回归分析结果示,FPG(β=-0.290,P=0.015)、HbA1c(β=-0.272,P=0.019)、FFA(β=-0.375,P=0.001)、病程(β=-0.248,P=0.037)是MoCA评分的危险因素。结论血清FFA是T2DM患者MCI的危险因素。     

高龄人群轻度认知功能损害的影响因素分析

目的探讨高龄人群轻度认知功能损害的影响因素。方法我院于2010-02—2013-11对高龄人群较为集中的多个社区老年人进行蒙特利尔认知功能量表(MocA)评定,并对评分符合轻度认知功能损害的245例患者进行一般情况调查,对相关影响因素进行统计分析。结果 2组年龄、性别、文化程度、经济收入、性格特征、饮食状况、参加社区活动情况以及有无业余爱好差异有统计学意义(P0.05)。进一步Logistic回归分析显示,性别、年龄、文化程度以及基础病是老年MIC的独立危险因素(P0.05)。结论老年女性、年龄增长、文化程度低下是影响高龄人群并发轻度认知功能损害的独立危险因素,临床可以此作为制定相应防治措施的依据。     

SORLl基因rs2070045单核苷酸多态性与遗忘型轻度认知功能障碍的关联分析

目的分析北京地区汉族人群分拣蛋白相关受体1（sortilin-relatedreceptorl,SORL1,又称sorl1或LR11）rs2070045单核苷酸多态性与遗忘型轻度认知功能障碍（amnesticmildcognitiveimpairment,aMCI）是否存在关联。方法采用病例对照的关联分析方法,提取139例aMCI（病例组）和213例非认知障碍健康人（对照组）外周血中基因组DNA,应用聚合酶链反应-高分辨溶解曲线（PCR-HRM）技术结合测序验证法检测SORLl基因rs2070045位点单核苷酸多态性的分布情况,分析SORL1基因多态性与aMCI的相关性。结果aMCI组中GG,GT,TT基因型分别为54例（38．8）,65例（46．8）,20例（14．4）;对照组中GG,GT,TT基因型分别为59例（27．7）,103例（48．4）,51例（23．9）。aMCI组与对照组SORL1基因rs2070045单核苷酸多态性的基因型及等位基因频率分布差异明显（X2=7．109,P=0．029;X2=7．315,P=0．007）,男性aMCI组与对照组基因型及等位基因频率分布差异不明显（X2=3．068,P=0．216;X2=2．357,P=0．125）,女性aMCI组与对照组基因型频率分布差异也不明显（X2=4．229,P=0．121）,等位基因频率分布差异明显（x。=4：438,P=0．035）。结论SORL1基因rs2070045位点单核苷酸多态性与北京地区汉族人群aMCI的发生明显相关,G等位基因为危险等位基因。     

Neuropsychiatric predictors of conversion to dementia both in patients with amnestic mild cognitive impairment and those with subcortical vascular MCI

Objective

The aim of this study was to investigate whether specific neuropsychiatric domains could predict a conversion to dementia in those patients either with amnestic subtype of mild MCI (aMCI) or subcortical vascular MCI (svMCI).

Methods

At baseline, all subjects underwent neuropsychological tests, Neuropsychiatric Inventory (NPI), and MRI. We compared the baseline NPI scores between converters (CV) and non-converters (NCV) both in the aMCI and svMCI groups.

Results

The mean follow-up duration was 16.74 ± 8.02 months (range: 4.2–43.9). At the second time point, about 30% of aMCI and svMCI patients converted to dementia with 7.5% of aMCI patients exhibiting improvement to normal cognitive state. In female aMCI patients, those who later improved to normal cognition exhibited higher baseline depression scores than the CV group. However, baseline depression scores were higher in the CV group than the NCV group in svMCI patients, and this difference was significant only in males.

Conclusion

Our results suggest that depression might serve as a predictive marker of conversion to dementia in patients with svMCI, albeit only in males. On the other hand, patients who later improved to normal cognition showed higher scores of depression at baseline in female aMCI patients, suggesting that longer follow-ups are warranted in female patients with aMCI and depression.     

Measuring mild cognitive impairment in patients with Parkinson's disease

We examined the frequency of Parkinson disease with mild cognitive impairment (PD‐MCI) and its subtypes and the accuracy of 3 cognitive scales for detecting PD‐MCI using the new criteria for PD‐MCI proposed by the Movement Disorders Society. Nondemented patients with Parkinson's disease completed a clinical visit with the 3 screening tests followed 1 to 3 weeks later by neuropsychological testing. Of 139 patients, 46 met Level 2 Task Force criteria for PD‐MCI when impaired performance was based on comparisons with normative scores. Forty‐two patients (93%) had multi‐domain MCI. At the lowest cutoff levels that provided at least 80% sensitivity, specificity was 44% for the Montreal Cognitive Assessment and 33% for the Scales for Outcomes in Parkinson's Disease‐Cognition. The Mini‐Mental State Examination could not achieve 80% sensitivity at any cutoff score. At the highest cutoff levels that provided specificity of at least 80%, sensitivities were low (≤44%) for all tests. When decline from estimated premorbid levels was considered evidence of cognitive impairment, 110 of 139 patients were classified with PD‐MCI, and 103 (94%) had multi‐domain MCI. We observed dramatic differences in the proportion of patients who had PD‐MCI using the new Level 2 criteria, depending on whether or not decline from premorbid level of intellectual function was considered. Recommendations for methods of operationalizing decline from premorbid levels constitute an unmet need. Among the 3 screening tests examined, none of the instruments provided good combined sensitivity and specificity for PD‐MCI. Other tests recommended by the Task Force Level 1 criteria may represent better choices, and these should be the subject of future research. © 2013 Movement Disorder Society     

轻度认知障碍和阿尔茨海默病患者认知功能和MRI对照研究

目的探讨轻度认知障碍（MCI）和阿尔茨海默病（AD）的认知功能及影像学特点。方法回顾性分析经临床确诊的21例MCI和24例AD患者的临床资料。所有实验对象均用简易智力量表（MMSE）和蒙特利尔认知评估（MoCA）测定。结果MCI与AD的认知功能损害相比较：除了MMSE的记忆力组间无统计学意义（P＝0．28）,其余均有统计学差异（P〈0．05）。MoCA比MMSE具有更好的敏感性。AD的MRI表现：脑萎缩,特别是海马存在不同程度的萎缩;老年性脑改变;MCI的MRI主要表现为脑白质脱髓鞘病变,少数提示轻度脑萎缩或未见明显异常。结论MCI和AD患者早期均表现为记忆力下降,对记忆力减退人群进行MMSE、MoCA量表筛查有助于AD的早期诊断。AD患者到中晚期治疗较困难,因此早期诊断及干预对延缓病程起积极作用。     

Mindfulness and psychoeducation to manage stress in amnestic mild cognitive impairment: A pilot study

Objectives: Amnestic mild cognitive impairment (aMCI) often corresponds to the prodromal stage of Alzheimer disease (AD). The aMCI stage represents a crucial time window to apply preventive interventions in an attempt to delay cognitive decline. Stress, one of AD’s modifiable risk factors frequently co-occurring with aMCI, stands out as a key intervention target. The goal of this study was to assess the impacts of two non-pharmacological interventions, mindfulness and psychoeducation, on stress at the psychological and physiological levels among aMCI older adults.

Methods: Forty-eight aMCI participants were randomized between a mindfulness-based intervention (MBI) and a psychoeducation-based intervention (PBI) for eight weekly sessions. Anxiety symptoms, perceived stress levels, cortisol awakening response (CAR), and coping strategies were assessed pre- and post-intervention. Mindfulness attitudes and time dedicated to at-home meditative practices were evaluated in the MBI group.

Results: The main results revealed a slight reduction of the CAR among MBI participants who practiced meditation at home the most and a decrease in perceived stress levels in the PBI group. Both interventions enhanced problem-focused coping strategies.

Conclusion: In sum, this pilot study supports the potential of MBI and PBI to reduce stress at the physiological and psychological level, respectively, and increase coping strategies in older adults at risk for AD.     

Cognitive reserve modulates attention processes in healthy elderly and amnestic mild cognitive impairment: An event-related potential study

Objectives

The study aimed to investigate and compare the effect of cognitive reserve (CR) on brain activation in healthy controls (HC) and amnestic mild cognitive impairment (aMCI) patients during 0-back and 1-back tasks measured by event-related potential (ERP).

Spontaneous K-Complexes may be biomarkers of the progression of amnestic mild cognitive impairment

ObjectiveSpontaneous K-complexes (SKCs), a hallmark of stage 2 sleep, have been reported to decrease in density in Alzheimer's disease (AD) patients. However, few former studies have explored the alterations in SKC characteristics in the pre-clinical phase of AD—amnestic mild cognitive impairment (aMCI). The aim of our prospective cohort study was to investigate the changing trend in SKC characteristics during the progression of aMCI.MethodsSKC density, amplitude and duration were measured in aMCI subjects and normal controls (NC) at two-year follow-up assessments by polysomnography (PSG). In sum, 22 NCs, 25 stable aMCI (sMCI) subjects and 20 progressive aMCI (pMCI) subjects finished the four follow-up PSG assessments, and their data were used for analysis.ResultsSKC density and amplitude, but not duration, decreased during the follow-up assessments in both NCs and aMCI subjects, but the rate of decrease of these parameters was greater in aMCI subjects. With the progression of aMCI, significant differences in SKC density and amplitude among the three groups were observed, whereas SKC density showed no difference at the early stage of aMCI. The receiver operating characteristic (ROC) curve results demonstrated that SKC density and amplitude could distinguish aMCI subjects from NCs with high specificity and sensitivity.ConclusionOur results suggest that SKCs decrease with ageing and the progression of aMCI, and SKC characteristics may be potential biomarkers for diagnosing aMCI.     

The role of neuroimaging in mild cognitive impairment

The main purposes of neuroimaging in Alzheimer's disease (AD) have been moved from diagnosis of advanced AD to diagnosis of very early AD at a prodromal stage of mild cognitive impairment, prediction of conversion from mild cognitive impairment (MCI) to AD, and differential diagnosis from other diseases causing dementia. Structural MRI studies and functional studies using F‐18 fluorodeoxyglucose‐positron emission tomography (FDG‐PET) and brain perfusion single‐photon emission computed tomography (SPECT) are widely used in diagnosis of AD. Outstanding progress in diagnostic accuracy of these neuroimaging modalities has been obtained using statistical analysis on a voxel‐by‐voxel basis after spatial normalization of individual scans to a standardized brain‐volume template instead of visual inspection or a conventional region of interest technique. In a very early stage of AD, this statistical approach revealed gray matter loss in the entorhinal and hippocampal areas and hypometabolism or hypoperfusion in the posterior cingulate cortex and precuneus. These two findings might be related in view of anatomical knowledge that the regions are linked through the circuit of Papez. This statistical approach also offers prediction of conversion from MCI to AD. Presence of hypometabolism or hypoperfusion in parietal association areas and entorhinal atrophy at the MCI stage has been reported to predict rapid conversion to AD.