同型半胱氨酸与高血压患者轻度认知障碍的相关性

目的 探讨同型半胱氨酸（homocysteine,Hcy）与高血压患者轻度认知障碍的相关性。方法 回顾性纳入2017年1月-2018年2月邯郸市第一医院神经内科连续收治的原发性高血压患者,根据其血浆Hcy水平,将患者分为单纯型高血压组（Hcy<15 μm m ol/L）与H型高血压组（Hcy≥15 μmmol/L）,采用Spearman秩相关分析Hcy与MMSE和MoCA评分的相关性,并采用Logistic回归分析高血压患者轻度认知功能障碍的影响因素。结果 共纳入原发性高血压患者113例,其中单纯型高血压组49例,H型高血压组64例。H型高血压组患者的MMSE和MoCA评分均低于单纯型高血压组（分别为24.94±1.83 vs 27.96±1.54和23.45±2.47vs 27.24±1.80,均P <0.001）。相关分析显示,Hcy水平与MMSE和MoCA评分存在负相关性（分别为r =-0.513和r =-0.500,均P＜0.001）。多因素Logistic回归分析显示,高龄（OR 1.236,95%CI 1.124～1.361）、H型高血压（OR 22.218,95%CI 8.243～59.654）是高血压患者轻度认知功能障碍的独立危险因素。结论 Hcy水平升高是高血压患者轻度认知功能障碍发生的独立危险因素。     

老年轻度认知功能障碍与同型半胱氨酸 血脂的相关性分析

正轻度认知功能障碍(mild cognitive impairment,MCI)是近年来提出的新概念,介于正常衰老与极早期痴呆间的一种以认知功能损害为主要特征的中间状态。随着社会老龄化,老年人的发病率明显高于年轻人。研究表明,MCI患者进展为痴呆的发病率为正常人的10倍,故MCI人群将成为痴呆的高危人群,但存在异质性~([1])。心脑血管损害的重要危险因素之一的高同型半胱氨酸血症已被广泛认可。多数学者认为高同型半胱氨酸血症是痴呆的危险因素之一。McCully     

脑梗死患者轻度认知功能障碍与同型半胱氨酸的关系

目的探讨脑梗死患者轻度认知功能障碍与血清中同型半胱氨酸(Hcy)的关系,为预防痴呆提供依据。方法依据简易智能精神状态量表(MMSE),将我院收治的230例脑梗死患者分为2组:轻度认知功能障碍患者86例(MCI组)和认知功能正常患者144例(对照组)。取患者外周空腹血,测定血浆Hcy的水平,进行组间比较。应用非条件Logistic回归分析法分析血浆Hcy水平与MoCA总评分及其各项认知功能以及病灶部位的关系。结果 (1)MCI组测得的血浆Hcy水平均比对照组明显高,差异有统计学意义(P<0.05)。(2)血浆Hcy水平对MoCA总评分、视空间与执行功能、语言功能、基底节病灶、额部病灶、颞部病灶有独立的危险性。结论脑梗死后轻度认知功能障碍(MCI)与血浆Hcy水平呈正相关。     

高同型半胱氨酸血症与轻度血管性认知损害关系的临床研究

目的探讨高同型半胱氨酸血症（Hhcy）与轻度血管性认知损害（mild vascular cognitive impairment,MVCI）的关系,为MVCI患者的治疗及预后判断提供理论依据。方法选114例MVCI患者为MVCI组,同期选择年龄性别相匹配的认知功能正常者51例为对照组。所有研究对象均测定血浆同型半胱氨酸（homocysteine,HCY）水平,评价二者之间的关系。结果MVCI组患者的HCY水平高于对照组,差异有统计学意义（P〈0．05）。结论Hhcy是导致MVCI患者认知功能损害的重要危险因素。     

同型半胱氨酸与血管性轻度认知功能障碍的相关性

轻度认知功能障碍(mild cognitive impairment,MCI)是介于正常老化与痴呆之间的一种过渡状态,是痴呆的前期阶段.血管性轻度认知功能障碍(vascular mild cognitive impairment,VMCI)是MCI的一个亚型,系病因分型,是血管性痴呆(Vascular dementia,VD)的前期阶段.目前VMCI的危险因素及发病机制尚不清楚.本研究的目的 在于探讨同型半胱氨酸(homocysteine,Hey)水平与VMCI的相关性,研究与VMCI相关的危险因素,为预防VD提供依据.     

轻度认知障碍患者认知水平与血清淀粉样蛋白42磷酸化Tau同型半胱氨酸水平相关性分析

目的探讨轻度认知障碍患者认知水平与血清淀粉样蛋白42、磷酸化Tau、同型半胱氨酸水平的相关性。方法选择2008-2011年济宁各社区近1 100例50~80岁的中老年人,筛选出MCI患者36例,并选取年龄、学历相匹配的健康对照组36例。检测MCI组与对照组的认知功能水平与血清Aβ-42、p-tan、Hcy水平,使用相关性分析MMSE水平与血清指标的关系。结果 2组患者性别比例、平均年龄、受教育年限方面比较差异无统计学意义(P0.05),对照组平均MMSE明显高于MCI组,差异有统计学意义(P≤0.05),MCI组平均Aβ-42、p-tan、Hcy水平明显高于对照组,差异有统计学意义(P≤0.05),MCI组及对照组的Aβ-42、p-tan、Hcy均与患者的MMSE得分呈相关性(P≤0.05),其中MMSE得分与Aβ-42、p-tan、Hcy为负相关。结论血清Aβ-42、p-tan、Hcy可指示认知功能水平。     

血浆同型半胱氨酸与认知障碍关系的研究进展

血浆同型半胱氨酸(Hcy)是人体内含硫基氨基酸的一个重要代谢中间产物。越来越多的研究发现,高Hcy血症与认知功能减退密切相关。现就血浆Hcy升高的原因、引起认知障碍可能的发病机制,以及其在不同认知障碍性疾病中作用的研究进展进行综述。     

叶酸对同型半胱氨酸升高型高血压的疗效观察

目的观察叶酸对同型半胱氨酸（Homocysteine,Hcy）升高型高血压（称H型高血压）患者血浆Hcy、NO水平和脑血管事件的影响。方法纳入我院神经内科收治的高Hcy的H型高血压患者100例,随机分为观察组和对照组各50例,对照组采用常规降压治疗（包括改变生活习惯、饮食及口服药物治疗）,观察组在对照组基础上口服叶酸5mg,1次/d。随访用药后患者血浆Hcy、NO水平变化及脑血管事件发生率。结果随访期间观察组发生脑血管病9例（18.0%）,对照组18例（36.0%）,2组比较差异有统计学意义（P〈0.05）。观察组治疗后Hcy水平较前明显降低（P〈0.05）,与对照组比较差异有统计学意义（P〈0.01）,NO水平与治疗前比较升高（P〈0.05）。对照组Hcy及NO水平较治疗前好转,但治疗前后比较差异无统计学意义（P〉0.05）。结论叶酸辅助治疗H型高血压可以降低血浆Hcy水平,提高NO水平,有效降低脑血管事件的发生,值得临床推广应用。     

血浆同型半胱氨酸和血清神经元特异性烯醇化酶对轻度血管性认知障碍的预测价值

目的探讨血浆同型半胱氨酸(Hcy)和血清神经元特异性烯醇化酶(NSE)对轻度血管性认知障碍(VMCI)的预测价值。方法选取VMCI患者51例,正常对照组45例,完成神经心理学评估,头颅MRI或CT检查,测定血浆Hcy和血清NSE水平。结果 (1)两组间年龄、性别、受教育程度差异无统计学意义(P>0.05)。与正常对照组比较,VMCI患者Hcy和NSE水平明显升高,差异有统计学意义(P<0.05);(2)VMCI患者中,LA-VMCI(23例)和LI-VMCI(28例),两组间Hcy和NSE水平差异无统计学意义(P>0.05);(3)相关性分析显示,血浆Hcy与血清NSE呈正相关(r=0.657,P=0.008);(4)以Hcy来预测VMCI,其曲线下AUC为0.871(P=0.000,95%CI 0.753～0.948),OPP=15.89μmol.L-1,敏感性为86.5%,特异性为87.1%,阳性预测值86.7%,阴性预测值71.3%。以NSE来预测VMCI,其曲线下AUC为0.866(P=0.000,95%CI 0.756～0.930),OPP=17.82μg.L-1,敏感性为87.8%,特异性为85.3%,阳性预测值91.5%,阴性预测值为78.7%。结论血浆Hcy和血清NSE对VMCI有一定预测价值。     

高同型半胱氨酸血症与Alzheimer病的关系

目的 探讨高同型半胱氨酸血症与Alzheimer病(AD)的关系。方法 对38例AD患者及30例对照组老年人进行血浆同型半胱氨酸(Hcy)测定，并分析Hcy与认知功能障碍、痴呆严重程度、痴呆病程及精神症状的关系。结果 AD组血浆Hcy显著高于对照组IHcy水平与认知功能障碍、痴呆严重度密切相关，与痴呆病程和精神症状无关。结论 高同型半胱氨酸血症可能参与AD发病机制。     

轻度认知功能障碍患者认知损害与血清脑源性神经营养因子水平的相关性

目的 研究轻度认知功能障碍（mild cognitive impairment,MCI）患者认知损害与血清脑源性神经营养因子（brain derived neurotrophic factor,BDNF）水平的关系。 方法 从认知障碍门诊筛选MCI患者30例,正常对照老年人32例,采用酶联免疫吸附法（enzyme linked immunosorbent assay,ELISA）检测MCI患者的血清BDNF水平。 结果 MCI的血清BDNF水平较正常对照组显著升高（P=0.025）,MCI组中血清BDNF与简明精神状态量表（Mini-Mental State Examination Scale,MMSE）中的记忆力（r=-0.494,P=0.009）、语言能力（r=-0.399,P=0.039）呈负相关,与定向力、注意力和计算力、回忆能力无相关性;与临床痴呆量表（Clinical Dementia Rating Scale,CDR）总分呈正相关（r=0.476,P=0.012）;与MMSE总分、全面衰退量表（Global Deterioration Scale,GDS）总分无相关性。 结论 MCI患者的BDNF水平显著升高,提示BDNF可能参与MCI认知损害的病理生理过程     

皮质下血管性轻度认知障碍患者的多模式磁共振研究

目的 明确对皮质下缺血性血管病（subcortical ischemic vascular disease,SIVD）患者早期认知损害较 为敏感的磁共振成像（magnetic resonance imaging,MRI）指标。 方法 32例SIVD患者经过认知测试,被分为无认知障碍（no cognitive impairment,NCI）组18例,血管性 轻度认知障碍（vascular mild cognitive impairment,VaMCI）组14例,分析其认知测试指标与MRI参数之间 的关系。 结果 NCI组、VaMCI组全脑白质（whole brain white matter,WBWM）平均弥散度（mean diffusivity,MD） 分别为（0.84±0.03）×10-9·m2·s-1和（0.89±0.05）×10-9·m2·s-1,表观正常白质（normal appearing white matter,NAWM）的MD分别为（0.87±0.04）×10-9·m2·s-1和（0.92±0.05）×10-9·m2·s-1,差异 均有显著性（P均为0.003）;NCI组、VaMCI组WBWM各向异性分数（fractional anisotropy,FA）分别为 （0.37±0.02）和（0.35±0.02）,两组有显著差异（P =0.002）,两组NAWM的FA分别为（0.35±0.02）和 （0.33±0.02）,差异亦有显著性（P =0.001）。SIVD患者WBWM的MD值、NAWM的MD值和FA值与注意- 执行均相关,相关系数分别为－0.401（P =0.031）、－0.422（P =0.023）和0.409（P =0.027）,NAWM的 MD值与记忆相关,相关系数为－0.377（P =0.044）,多元逐步回归显示仅NAWM的MD值与注意-执行 （β=－0.453,P =0.009）、记忆（β=－0.414,P =0.019）和总体认知（β=－0.410,P =0.02）独立负相 关。而常规MRI参数未显示组间差异,与认知功能亦未见相关性。 结论 MRI弥散张量成像（diffusion tensor imaging,DTI）可以作为早期识别SIVD患者认知障碍的有效 手段。NAWM的MD值在认知障碍早期即下降,并与多项认知域独立相关,是较为敏感的DTI指标。     

Impairment of Instrumental Activities of Daily Living in Patients with Mild Cognitive Impairment

Objective

This study was conducted to examine the following: whether patients with mild cognitive impairment (MCI) show impairments in instrumental activities of daily living (IADL) as compared to controls; to identify the functional sub-domains of instrumental activities of daily living (IADL) that are affected in MCI and, finally, to identify the Seoul-Instrumental Activities of Daily Living (S-IADL) scale cut-off score that best differentiated between MCI and controls.

Methods

This study was carried out at the geropsychiatry clinic, university hospital. The study participants included 66 patients with MCI and 61 normal elderly. The S-IADL and Seoul-Activities of Daily Living (S-ADL) scales were administered to the main caregivers of all participants in order to assess everyday functioning.

Results

The total S-IADL score was significantly higher in the patients with MCI [mean (SD) score=4.47 (2.06)] than in the controls [mean (SD) score=1.44 (1.65)] (p<0.001). The patients with MCI performed significantly worse on IADLs, such as the ability to use the telephone, prepare meals, take medication, manage belongings, keep appointments, talk about recent events, and perform leisure activities/hobbies (p<0.05). The S-IADL scale discriminated well between patients with MCI and controls (Area Under Curve=87%).

Conclusion

The patients with MCI showed impairments in the ability to perform complex ADL in comparison to healthy controls. IADLs related to memory and frontal/executive functioning were particularly affected in MCI.     

Thalamic Shape and Cognitive Performance in Amnestic Mild Cognitive Impairment

ObjectiveThis study aimed to investigate thalamic shape alterations and their relationships with various episodic memory impairments in subjects with amnestic mild cognitive impairment (aMCI).MethodsWe compared volumes and morphological alterations of the thalamus between aMCI subjects and healthy controls. In addition, we investigated the correlation between thalamic deformations and various memory impairments in aMCI subjects using a comprehensive neuropsychological battery.ResultsThe normalized left thalamic volumes of the aMCI group were significantly smaller than those of the healthy control group (p<0.0001). aMCI subjects exhibited significant thalamic deformations in the left thalamic dorso-medial and antero-medial areas compared with healthy individuals. CERAD-K Word List Memory scores were significantly correlated with the left dorso-medial areas in aMCI subjects. There were no significant correlations between verbal fluency, Boston naming test, constructional praxis, Word List Recognition, and Visuospatial Recall scores and thalamic shape in aMCI subjects. Verbal delayed recall scores were also significantly correlated with the left dorso-medial areas in the aMCI group.ConclusionStructural alterations in the thalamic deformations in the left dorso-medial and antero-medial areas might be core underlying neurobiological mechanisms of thalamic dysfunction related to Word List Memory and delayed verbal recall in individuals with aMCI.     

记忆测试预测遗忘型轻度认知障碍患者海马形态改变的研究

目的 明确何种类型的记忆测试能更好地预测1年后遗忘型轻度认知障碍向阿尔茨海默病（Alzheimer’s disease,AD）转变相关的海马形态学改变。方法 用海马冠状位磁共振扫描T1像0～4分的视觉等级评分法,比较3组遗忘型轻度认知障碍患者的海马萎缩程度,分组为听觉记忆受损组（n =30）、视觉记忆受损组（n =28）、视觉与听觉记忆均受损组（n =44）。患者均接受了多奈哌齐、艾斯能或加兰他敏中的任一药物治疗。结果 基线资料显示听觉记忆受损组存在较高比例（80%）的海马萎缩,高于视觉记忆受损组海马萎缩的比例（43%）,视觉与听觉记忆均受损组海马萎缩的比例达91%,且萎缩的皮层更广泛。1年后,听觉记忆受损组、视觉记忆受损组和视觉听觉记忆均受损组向临床痴呆的转化率分别为20.0%、10.7%和31.8%。有极高比例的听觉记忆受损患者（50%）和视觉听觉记忆均受损者（68.2%）出现双侧海马萎缩或萎缩程度较前加重,而仅有较少比例（28.6%）的视觉记忆受损患者出现双侧海马的轻度萎缩。结论 听觉记忆受损和视觉听觉记忆均受损的遗忘型轻度认知障碍患者更可能是AD的前期状态,听觉记忆测试较视觉记忆测试更能敏感预测1年后遗忘型轻度认知障碍患者海马萎缩程度     

轻度认知功能障碍患者的步态障碍研究进展

对轻度认知功能障碍(MCI)患者的步态研究已有多年。认清MCI时期的步态异常对于诊断、鉴别诊断MCI是治疗干预的关键时期,但需要进一步阐明MCI步态障碍的临床表现,诊断思路。根据目前已有的国内外研究,提出了一个对于此概念性的框架和用于操作的研究标准。这些建议仅用于研究,目前不涉及临床应用。希望这些建议能够提供一个新的对于MCI诊断思路,最终推动更早期识别一些疾病,推进治疗干预MCI的进展。     

Effects of Virtual Reality-Based Cognitive Training in the Elderly with and without Mild Cognitive Impairment

ObjectiveThis study aimed to introduce a 4-week long fully immersive virtual reality-based cognitive training (VRCT) program that could be applied for both a cognitively normal elderly population and patients with mild cognitive impairment (MCI). In addition, we attempted to investigate the neuropsychological effects of the VRCT program in each group. MethodsA total of 56 participants, 31 in the MCI group and 25 in the cognitively normal elderly group, underwent eight sessions of VRCT for 4 weeks. In order to evaluate the effects of the VRCT, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet was administered before and after the program. The program’ s safety was assessed using a simulator sickness questionnaire (SSQ), and availability was assessed using the presence questionnaire. ResultsAfter the eighth session of the VRCT program, cognitive improvement was observed in the ability to learn new information, visuospatial constructional ability, and frontal lobe function in both groups. At the baseline evaluation, based on the SSQ, the MCI group complained of disorientation and nausea significantly more than the cognitively normal elderly group did. However, both groups showed a reduction in discomfort as the VRCT program progressed. ConclusionWe conclude that our VRCT program helps improve cognition in both the MCI group and cognitively normal elderly group. Therefore, the VRCT is expected to help improve cognitive function in elderly populations with and without MCI.     

轻度认知障碍患者情感图片再认的研究

目的　探讨轻度认知障碍 (MCI)患者情感记忆受损的特点 ,为极早发现MCI和干预治疗前移评估提供理论依据。方法　入选MCI组 34例 ,选取 30例健康老年人作为对照组 ,所有受试者均进行情感图片再认测试。结果　MCI组情感图片记住数 (RET) (2 1 .32± 7.2 9) %明显低于对照组(2 6 .0 0± 9.5 7) % (P <0 .0 5 ) ,MCI组情感图片靶片提取率 (85 .4 4± 4 .94 ) %与对照组 (96 .76±2 .1 8) %比较有极显著差异 (P<0 .0 1 ) 。MCI组IPreci与 (PP +UP)reci比较无显著性差异 (t=1 .4 1 ,P >0 .0 5 ) ,对照组IPreci与 (PP +UP)reci比较有显著性差异 (t=1 5 .2 4 ,P <0 .0 5 ) 。两组间IPreci比较无显著性差异 (t=1 .2 8,P >0 .0 5 ) 、(PP +UP)reci比较有极显著性差异 (t=2 5 .4 9,P <0 .0 1 )。结论　MCI患者存在情感记忆受损 ,载有情感内容的图片不能增强MCI患者情感记忆提取 ,情感图片再认测试为极早发现MCI有效工具之一。