银杏叶制剂联合盐酸多奈哌齐对老年轻度认知功能障碍的疗效

目的探讨银杏叶制剂联合盐酸多奈哌齐对老年轻度认知功能障碍疗效的影响。方法采用随机数字表法将2011年3月-2013年3月在日照市精神卫生中心治疗的112例符合2006年中国防治认知功能障碍专家共识诊断标准的轻度认知功能障碍的老年患者分为对照组和实验组各56例。对照组给予银杏叶制剂治疗,每次口服19.2g,每日3次,12个月为一个疗程。实验组给予银杏叶制剂联合盐酸多奈哌齐治疗,银杏叶制剂治疗方案同对照组,盐酸多奈哌齐每次口服5mg,每日服药1次,治疗一月后每次服药10mg。采用阿尔茨海默病评定量表认知分量表(ADAS-cog)、简易精神状态量表(MMSE)及脑电图(EEG)测评治疗效果、异常率、P300潜伏值和波幅变化。结果实验组总有效率85.72%,高于对照组67.86%,差异有统计学意义(P0.05)。实验组治疗前及治疗后1、3、6、12个月MMSE评分分别为(18.31±4.24)分、(19.95±3.81)分、(23.35±3.25)分、(25.46±2.92)分、(27.47±3.93)分,对照组分别为(18.53±4.92)分、(19.46±3.63)分、(19.97±3.63)分、(20.13±3.01)分、(22.01±3.35)分。治疗前及治疗后1个月两组MMSE评分差异无统计学意义(P0.05),治疗后3个月、6个月、12个月MMSE实验组评分高于对照组,差异有统计学意义(P0.05)。实验组P300潜伏期和波幅分别为(332.42±35.81)ms、(13.78±4.21)μV,对照组分别为(397.13±40.93)ms、(7.01±3.75)μV。实验组P300潜伏期较对照组短、波幅高,差异有统计学意义(P0.05)。结论银杏叶制剂联合盐酸多奈哌齐治疗老年轻度认知功能障碍的效果优于单用银杏叶制剂治疗。     

盐酸多奈哌齐治疗老年轻度认知功能障碍的临床疗效及脑电功能评价

目的 探讨盐酸多奈哌齐治疗老年轻度认知功能障碍(MCI)患者的临床疗效及脑电图(EEG)、事件相关电位(ERP)P300的变化. 方法 选取上海交通大学附属上海市第六人民医院老年科自2009年1月至2010年3月就诊的115例老年MCI患者,按完全随机数字表法分为盐酸多奈哌齐联合银杏叶制剂治疗组(治疗组,58例)和单用银杏叶制剂治疗组(对照组,57例),观察2组患者治疗前后简易精神状况检查量表(MMSE)评分以及EEG、P300的改变,评估临床疗效,并在组间进行比较. 结果 治疗后2组患者MMSE评分均较治疗前有所提高,但治疗组提高更为明显,与治疗前和对照组比较差异均有统计学意义(P＜0.05).治疗组的EEG异常率(25.86％)明显低于对照组(45.61％),差异有统计学意义(P＜0.05).治疗后2组患者P300潜伏期均有缩短、波幅增高,但治疗组变化更为明显,与治疗前及对照组比较差异均有统计学意义(P＜0.05).秩和检验发现治疗组临床疗效明显优于对照组,差异有统计学意义(P＜0.05). 结论 与单用银杏叶制剂比较,盐酸多奈哌齐联合银杏叶制剂治疗能显著改善老年MCI患者认知功能及脑电活动状态,提示盐酸多奈哌齐在老年MCI治疗中有一定价值.     

盐酸多奈哌齐对MCI患者MoCA评分和认知功能的影响

目的 探讨盐酸多奈哌齐对轻度认知障碍(MCI)患者蒙特利尔认知评估量表(MoCA)评分和认知功能的影响. 方法 哈尔滨医科大学附属第一医院神经内科自2010年9月至2011年3月共收治MCI患者50例,其中给予盐酸多奈哌齐治疗30例(盐酸多奈哌齐组),银杏叶片治疗20例(对照组),分析并比较2组患者治疗前、治疗12周、24周后MoCA评分的变化. 结果 盐酸多奈哌齐组患者治疗12、24周时MoCA评分高于治疗前,差异有统计学意义(P＜0.05).治疗12周、24周时盐酸多奈哌齐组MoCA评分均高于对照组,差异有统计学意义(P＜0.05);治疗12周时盐酸多奈哌齐组患者在数字广度、词语流畅性和延迟记忆方面的分项得分高于治疗前,差异有统计学意义(P＜0.05). 结论 MoCA量表能够对MCI患者进行早期诊断,盐酸多奈哌齐对MCI患者进行早期治疗能延缓其进入AD的病程.     

认知功能训练与盐酸多奈哌齐治疗脑卒中认知功能障碍的疗效

目的观察盐酸多奈哌齐联合认知功能训练治疗脑卒中后认知功能障碍的疗效。方法 42例脑卒中后认知功能异常患者随机分为2组,治疗组21例,在常规治疗的基础上给予盐酸多奈哌齐5mg,1次/d,每天下午进行2h的认识功能训练;对照组21例给予盐酸多奈哌齐5mg,1次/d,结合常规治疗。疗程1个月,疗程结束后由专业康复评定师对治疗前后患者认知功能及日常生活能力（ADL）进行终末评定。结果治疗组精神检查状态量表（MMSE）、功能独立性评定量表（FIM）和Barthel指数评分有明显改善（P〈0.01）,与对照组比较,MMSE、FIM及Barthel指数评分差异均有统计学意义（P〈0.05）。结论认知功能训练结合盐酸多奈哌齐治疗脑卒中后认知功能障碍疗效较好,且方便易行,值得临床推广。     

多奈哌齐联合银杏叶提取物治疗老年认知功能障碍临床效果分析

目的观察多奈哌齐联合银杏叶提取物治疗老年认知功能障碍的临床疗效及安全性。方法将80例认知功能障碍的老年患者随机分为治疗组和对照组各40例,对照组给予盐酸多奈哌齐片,每次5~10mg,每天1次,口服;治疗组在对照组基础上加用银杏叶提取物口服,每日40 mg,每天2次,疗程均为24周。治疗前后用MMSE量表、Mo CA和ADL量表各对患者进行评估。结果治疗后与治疗前相比,两组患者的Mo CA评分及MMSE量表评分均增高,差异有统计学意义(P0.05);两组患者的ADL评分降低,差异有统计学意义(P0.05)。治疗组疗效优于对照组,有统计学意义(P0.05)。结论盐酸多奈哌齐联合银杏叶提取物治疗老年认知功能障碍的临床疗效优于盐酸多奈哌齐单独给药,是治疗老年认知功能障碍的一种安全有效临床方法。     

天智颗粒联合多奈哌齐治疗血管性痴呆临床观察

目的：探讨天智颗粒联合多奈哌齐在血管性痴呆中的治疗效果。方法选择我院82例血管性痴呆患者,随机分为观察组和对照组。对照组给予盐酸多奈哌齐治疗,观察组给予天智颗粒联合多奈哌齐治疗。评定2组治疗前后认知改善情况。结果观察组治疗后简易智能精神状态检查表及Blessed行为量表评分与对照组治疗后比较,差异有统计学意义（ P＜0.05）。观察组治疗后总有效率95.1％,对照组为78.0％,差异有统计学意义（ P＜0.05）。结论天智颗粒联合多奈哌齐治疗血管性痴呆临床效果显著,能够改善患者认知功能。     

盐酸多奈哌齐联合高压氧治疗血管性认知障碍疗效观察

目的探讨盐酸多奈哌齐联合高压氧治疗血管性认知障碍临床疗效。方法将存在血管性认知障碍的90例患者随机分为治疗组(n=47例)和对照组(n=43例),对照组给予多奈哌齐及脑血管病基础治疗,治疗组在对照组基础上联合高压氧物理治疗,观察治疗前后MMSE及MoCA评分变化。结果治疗前存在不同程度认知障碍,但MMSE及MoCA评分比较差异无统计学意义,治疗后2组认知功能均改善,MMSE及MoCA评分均提高,与对照组比较治疗组评分显著提高,2组比较差异有统计学意义(P0.05)。结论血管性认知障碍患者在常规血管病及多奈哌齐治疗基础上联合高压氧物理治疗,能显著改善患者认知障碍,且无明特殊不良反应,安全有效,实用范围广。     

养血清脑颗粒联合奥拉西坦对脑梗死认知功能障碍的疗效

目的探讨联合用药治疗脑梗死认知功能障碍患者的临床效果。方法选择2014-03-2016-03漯河医学高等专科学校第二附属医院收治的脑梗死认知功能障碍患者80例。对照组40例给予奥拉西坦单药治疗,观察组40例在对照组基础上给予养血清脑颗粒治疗。比较2组认知功能改善情况。结果治疗前2组MMSE各项评分比较差异无统计学意义(P0.05);治疗后2组MMSE各项评分均有改善,其中观察组各项评分显著高于对照组(P0.05)。治疗后,对照组和观察组治疗有效率分别为75.0%和95.0%,差异有统计学意义(P0.05)。结论脑梗死认知功能障碍患者采用奥拉西坦联合养血清脑颗粒治疗效果显著,认知功能障碍可得到有效改善,促进患者恢复,值得在临床中推广应用。     

养血清脑颗粒联合多奈哌齐对血管性认知障碍患者事件相关电位的影响

目的：观察养血清脑颗粒联合多奈哌齐对血管性认知功能障碍（VCI）患者的事件相关电位（ERP）的影响。方法：将76例患者随机分为观察组（40例）和对照组（36例）,观察组采用多奈哌齐加养血清脑颗粒,共服药12周;对照组采用多奈哌齐,服药12周。分别对观察组和对照组治疗前后进行ERP检测。结果：ERP结果显示观察组和对照组治疗前后N2、P3波潜伏期比较差异有显著意义（P〈0.01）;治疗前,观察组和对照组之间N2、P3波潜伏期和N2-P3波峰间期比较差异无显著意义（P〉0．05）;治疗后,观察组和对照组之间N2波和N2-P3波峰间期差异也无显著意义（P〉0．05）,但P3波潜伏期差异有显著意义（P〈0.05）。临床观察结果显示服药后对肝功能、肾功能、血常规、尿常规、凝血常规及心电图等无明显影响。治疗过程中未见明显不良反应。结论：养血清脑颗粒联合多奈哌齐治疗对VCI患者认知功能改善具有明确的疗效。     

阳极经颅直流电刺激联合多奈哌齐治疗卒中后认知障碍的疗效观察

目的 探讨阳极经颅直流电刺激(transcranial direct current stimulation,tDCS)联合多奈哌齐治疗卒中后认知障碍(post-stroke cognitive impairment,PSCI)的临床疗效.方法 前瞻性连续纳入2019年10月-2020年9月在河南大学附属南石医院康复医...     

The effect of folate and VitB12 in the treatment of MCI patients with hyperhomocysteinemia

ObjectiveThis study aims to investigate the effect of folate combined with VitB₁₂ on serum total homocysteine (tHcy) levels and cognitive function in patients with mild cognitive impairment (MCI) complicated by hyperhomocysteinemia (HHcy).Methods(1) A total of 92 MCI patients with HHcy were enrolled in this study and randomly divided into two groups: the intervention group (46 cases) and the control group (46 cases). (2) The patients in both groups received the routine treatment for their condition, but patients in the intervention group were also given 5 mg/day of folate and 500 μg × 3/day of VitB₁₂. (3) The changes in levels of folate, VitB₁₂, and tHcy, the Montreal Cognitive Assessment (MoCA) score and the event-related potential (P300) were observed before and after treatment.Results(1) There were no statistically significant differences in folate, VitB₁₂, and tHcy levels, the MoCA score and the P300 between the two groups before treatment. (2) At the 4th, 12th and 24th week, folate and VitB₁₂ levels in the intervention group were higher than those in the same group before treatment and those in the control group at the same time points, while tHcy levels were lower than those in the same group before treatment and those in the control group at the same time points. (3) At the 24th week, the MoCA score in the control group was lower than before treatment, and the MoCA score in the intervention group was higher than in the same group before treatment and in the control group at the same time point. The P300 latency was shorter than it was in the same group before treatment and in the control group at the same time point.ConclusionFolate and VitB₁₂ can effectively reduce levels of tHcy in patients with MCI and improve cognitive function.     

轻度认知障碍患者的脑血流动力学临床研究

目的通过经颅多普勒(Transcranial Doppler,TCD)结合事件相关电位(Event-related potentials,ERP)对轻度认知障碍(Mild cognitive impairment,MCI)患者的脑血流动力学特点进行综合评价。方法180例受试者根据ERP和TCD检测结果,编入正常对照组、MCI组及痴呆组,统计分析不同认知功能状态下脑血流动力学的特点。结果各组别受试者脑动脉硬化及血管狭窄检出率有差异,正常组与MCI组及痴呆组比较,Vp、Vm、S/D及PI有统计学意义(P<0.01);MCI组与痴呆组比较,Vp和S/D均有统计学意义(P<0.05);TCD的Vp及S/D对ERP中P3潜伏期影响较大(P<0.01)。结论脑血流动力学的改变对MCI患者的认知功能有明显影响,脑血流动力学TCD检测结果可以作为评判MCI患者认知状态的客观指标。     

事件相关电位在轻度认知功能障碍诊断中的意义

目的探讨轻度认知功能障碍和阿尓茨篋〉氖录喙氐缥?ERP:N100、P300)变化。方法根据Peterson制订的MCI诊断标准,筛选出21例MCI患者(MCI组),22例正常对照者(NC组)以及20例阿尓茨篋?AD)组患者,分别用英国OXFORD脑电生理仪记录事件相关电位(ERP:N100,P300)和视觉诱发电位(VEP)情况。结果(1)AD组MMSE评分(16.52±2.17分)及MCI组(24.33±1.34分)低于正常对照组[(26.57±1.43)分,P<0.01]。(2)AD组与MCI组靶波幅P3和非靶波幅P2均见降低,与NC组比较也有显著性差异(P<0.05、P<0.01)。(3)N100潜伏期、波幅变化不是很大(P>0.05)。(4)AD组P300靶刺激中的P2、P3波潜伏期与MMSE分值呈负相关(P<0.05、P<0.01)。结论AD和MCI患者的P300有多项指标异常对于临床诊断AD和MCI患者有一定价值。事件相关电位与认知功能存在明显相关性,提示事件相关电位可以客观反映AD和MCI患者的认知功能障碍。     

Self-awareness of cognitive efficiency: Differences between healthy elderly and patients with mild cognitive impairment (MCI)

Introduction: Self-estimation of performance implies the ability to understand one’s own performance with relatively objective terms. Up to date, few studies have addressed this topic in mild cognitive impairment (MCI) patients. The aim of the present study was to compare objective measures of performance with subjective perception of specific performance on cognitive tests and investigate differences in assessment between MCI patients and healthy elderly. Method: Thirty-five participants diagnosed with MCI (women = 16, men = 19, mean age = 65.09 years ±SD = 7.81, mean education = 12.83 years ±SD = 4.32) and 35 control subjects similar in terms of age and education (women = 20, men = 15, mean age = 62.46 years ± SD = 9.35, mean education = 14.26 ± SD = 2.84) were examined with an extended battery of neuropsychological tests. After every test they were asked to self-evaluate their performance by comparing it to what they considered as average for people of their age and educational level. This self-evaluation was reported on a scale ranging from –100 to +100. Results: Significant differences were found in the self-assessment patterns of the two groups in memory measures of verbal and visual delayed recall, visuospatial perception, and tests of attention. MCI patients overestimated their performance on every cognitive domain while control participants underestimated their performance on measures of verbal memory. Conclusions: The present results indicate that accuracy of self-report is not uniform across groups and functional areas. The discrepancies in the MCI patients indicate unawareness of their memory deficits, which is contradictory to subjective memory complaints as being an important component for clinical diagnosis.     

Prefrontal Compensatory Mechanism May Enable Normal Semantic Memory Performance in Mild Cognitive Impairment (MCI)

Mild cognitive impairment (MCI) is considered as a potential transitional state between normal aging and dementia. Studies addressing semantic memory in patients with incipient dementia and MCI show inconsistent results. In the current report we focused on MCI and examined memory performance (semantic, episodic, and working memory) in addition to structural and functional magnetic resonance imaging (fMRI) measurements. We studied 6 MCI, 6 normal controls, and 4 Alzheimer disease (AD) patients. MCI participants demonstrated normal semantic memory performance while fMRI examination revealed distinct patterns of activations between MCI and normal aged subjects. According to our previous study, time courses were taken from parietal, dorsolateral‐prefrontal‐cortex (DLPFC), hippocampal formation, and fusiform gyri. A small number of activated voxels in parietal regions were depicted in MCI participants and were correlated with structural changes in this region. In contrast, significantly higher activation (intensity and number of voxels) was observed in DLPFC of MCI subjects. The overactivity seen in DLPFC of MCI may represent a compensatory mechanism that enables them to perform normally. These preliminary results suggest that functional imaging may be useful for early diagnosis of dementia and call to develop reliable tests and criteria that will enable using such methods clinically.     

轻度认知功能障碍患者的神经心理学测试

目的探讨轻度认知功能障碍(MCI)患者是否有神经心理方面的损害及损害的特点,以期为早期筛查出MCI患者提供参考指标。方法采用数字颜色连线测验(CTT)、数字广度测试(DS)、词汇流畅性测试(VFT)、中文听觉词汇(CALT)、线段方向判断(JLOT)和Stroop测验对30名MCI患者和30名性别、年龄和教育程度相匹配的正常对照组进行评定。结果MCI患者的CTT、VFT、数字广度倒背和CALT与正常对照组相比差异均有显著性。JLOT、Stroop测验和数字广度顺背成绩虽有所下降,但差异均无显著性。结论MCI患者的神经心理方面有损害。对MCI危险人群进行神经心理学测试能早期筛选出MCI患者。     

Memory Support System training in mild cognitive impairment: Predictors of learning and adherence

ABSTRACT

This study aimed to identify predictors of learning and adherence to a previously validated compensatory calendar and note-taking system (Memory Support System; MSS) in persons with amnestic mild cognitive impairment (aMCI). Age, education, global cognition, depression, and memory-related self-efficacy were studied as predictors of individuals’ ability to learn the use of the MSS during the two-week training and of their adherence to the MSS 6, 12, and 18 months after training. How well an individual was able to learn the use of the MSS was itself examined as a predictor of adherence. Two-hundred-and-fifteen older adults with aMCI and their study partners (e.g., spouse, adult child) received MSS training one-hour daily for 10 days. Ordinal logistic regression analyses indicated that (1) global cognition predicted MSS learning at end of training, and (2) MSS learning at end of trainng predicted MSS adherence at 6, 12, and 18 months post-training. The current study suggests that offering compensatory strategies as early as possible for those with MCI might be of most benefit, and might have implications for long-term adherence.     

蒙特利尔认知评估量表识别首次卒中后轻度血管性认知障碍的作用

目的 探讨蒙特利尔认知评估量表(MoCA)识别首次卒中后轻度血管性认知障碍(mVCI-FS)的作用,并与简易智能精神状态量表(MMSE)比较. 方法 选取mVCI-FS患者60例.首次卒中后非血管性认知障碍(nVCI-FS)25例,于发病后(12+1)周由不知情的神经科医师进行MoCA及MMSE评估. 结果 MoCA总平均分为(19.78±4.573)分,MMSE为(25.48±3.148)分,偏相关分析间.r=9,P=0.000.MoCA除计算力和言语流畅性外,其余各项在mVCI-FS和nVCI-FS间差异均有统计学意义(P<0.05);MMSE的即刻记忆、计算力、命名和阅读理解在2组间差异无统计学意义(P>0.05).应用ROC曲线和Youden指数最大值初步确定MoCA识别mVCI-FS与nVCI-FS的最佳分界值为21分.以21分为分界值.MoCA筛查mVCI-FS的敏感度和特异度分别为84.6%和76.0%,明显优于MMSE(敏感度59.6%和特异度57.7%),差异有统计学意义(P<0.05). 结论 初步确定MoCA识别mVCI-FS与nVCI-FS的最佳分界值为21分.MoCA筛查mVCI-FS的敏感度和特异度均高,是一种有效的mVCI.FS筛查量表;MMSE对mVCI.FS的敏感度低,识别mVCI-FS的作用有限.