Computed tomography in the investigation of dementia

To assess the value of computed tomography in investigating patients with dementia, 500 consecutive patients presenting with a provisional clinical diagnosis of dementia of recent onset were reviewed and the results analysed in a computer. Most patients had either cerebral atrophy or infarction, but 82 patients had a normal scan and 42 others had tumours. More than 10% of all patients, including 5% with no other symptoms or signs, had a treatable lesion. Various associated symptoms and signs were useful pointers to such a treatable lesion and clearly indicated computed tomography. Accurate diagnosis is the cornerstone of proper management, and if a few patients with treatable lesions can be identified then the benefits to all concerned may be incalculable.     

阿尔茨海默病外周血早期生物标志物的研究进展

阿尔茨海默病发病隐匿,在痴呆症状出现前数十年,体内已产生一系列病理变化,一旦进入痴呆期,目前尚无理想的药物和疗法可缓解病情。其与衰老呈正相关,年龄越大,患病风险越高。筛选合适的生物标志物进行早期诊断、早预防、早发现、早治疗,对预防和延缓阿尔茨海默病的发展有着重要意义。外周血生物标志物易采集、易检测、可重复,是最理想的生物标志物来源。本文根据阿尔茨海默病经典的β淀粉样蛋白（Aβ）和Tau蛋白机制,梳理了部分外周血中潜在的生物标志物。     

A community survey of Parkinson's disease.

In a rural community of 80,000 people 69 patients were identified as having a diagnosis of Parkinson's disease. After interview and examination we found that 55 met the generally accepted diagnostic criteria for Parkinson's disease, 4 had possible Parkinson's disease, 6 had essential tremor, 2 had dementia and 2 had other conditions. The patients with Parkinson's disease had clinical and epidemiologic characteristics similar to those of patients in previous, mainly hospital-based, studies. These characteristics included mean age at onset (63 years), frequency rate of dementia (20%) and presence of postural tremor (11%). The pattern of treatment varied, some patients receiving more medication than is usual for the severity of their illness, and some patients receiving less than is usual. Parkinson's disease can be difficult to diagnose and manage because of the clinical variation between patients in presentation and response to treatment.     

不同快速眼动睡眠行为障碍发生时间的帕金森病患者临床特征差异性分析

背景　快速眼动睡眠行为障碍（RBD）不仅是帕金森病（PD）重要的临床前期症状之一,也是帕金森病病情进展的促进因素。然而,RBD的不同出现时间与PD临床特征是否存在相关性目前尚不清楚。目的　研究不同RBD 发生时间帕金森病患者的临床特征。方法　选取2013年10月-2018年5月大连市友谊医院神经内科收治的PD患者136例。同期选取本院体检中心体检健康志愿者30例为对照组,根据是否发生RBD将PD患者分为伴RBD组和不伴RBD组,根据RBD发生时间分为先发RBD亚组和后发RBD亚组。比较各组患者年龄、性别、多巴胺药物用量（左旋多巴剂量当量LEDs）、PD病程、Hoehn-Yahr分级、有无震颤、帕金森病症状偏重侧、简易智能精神状态检查量表（MMSE）评分、有无直立性低血压（OH）、是否存在幻觉、是否痴呆。结果　伴RBD组47例,不伴RBD组89例;先发RBD亚组9例,后发RBD亚组38例。伴RBD组较不伴RBD组PD病程长,Hoehn-Yahr分级高,LEDs剂量大,幻觉、OH和痴呆发生率高,MMSE评分低（P<0.05）。伴RBD和不伴RBD组幻觉、OH、痴呆发生率高于对照组（P<0.05）。后发RBD亚组较先发RBD组的MMSE评分下降、痴呆发生率高（P<0.05）。与对照组相比,先发RBD亚组与后发RBD亚组MMSE评分低,痴呆发生率高（P<0.05）。结论　PD运动症状后出现RBD可能是加重认知功能损伤的重要因素。     

阿尔茨海默病性痴呆与其他常见老年性痴呆的精神行为症状比较

老年性痴呆是老年期疾病中常见病,大部分的老年性痴呆患者有明显的痴呆行为和心理症状,伴有精神症状时往往给痴呆类型的诊断增加困难或误诊。阿尔茨海默病性痴呆为老年性痴呆中最常见的类型,故本文就近几年阿尔茨海默病性痴呆与其他类型的老年性痴呆所伴发痴呆行为和心理症状进行比较,希望对临床诊断起到一定的参考作用。     

Occam's razor cuts out the mind-body dichotomy

Psychiatric symptoms are among the most common manifestations of endocrine disorders. We present a case of Schmidt's syndrome, or polyglandular type II failure. Due to a florid psychiatric presentation, the initial endocrine diagnosis was missed, and a diagnosis of a nonorganic psychotic illness was made. This impacted on the treatment and appropriate placement of the patient. This case is presented to illustrate the importance of the organic work-up and follow-up on abnormal laboratory results in patients with dementia. In the elderly, a new onset of psychosis is usually associated with an organic cause. Furthermore, the presence of either a fixed or intermittent change in cognitive function suggests a strong likelihood of organicity. These features were present, but not noted, leading to management problems that are described here to illustrate the need for careful clinical scrutiny.     

加强基层医务工作者对痴呆的识别与诊治是中国痴呆防控的关键

随着人口老龄化进程加剧，近年来我国痴呆患者数量呈现快速增多趋势，但目前我国痴呆诊治相关医疗资源主要集中在大型综合医院，远不能满足广大痴呆患者需求。目前仍存在基层医务工作者由于缺乏痴呆识别和诊治经验、不能区分痴呆与正常老化而导致多数痴呆患者得不到及时救治，进而贻误病情、导致患者错过早期治疗的最佳时间等问题。提高广大基层医务工作者对痴呆的识别和诊治能力、建立基层医务工作者与三甲医院记忆门诊的上下联动机制并进行连续性管理是中国痴呆防控的必要措施。本文主要就我国痴呆流行病学特征、诊治现状及困境、提高痴呆规范化管理水平的有效改进措施等进行了分析。     

重视痴呆的诊断和生活质量提高——2018 NICE《痴呆的评估和管理指南》解读

随着人口老龄化的到来,痴呆已经成为威胁老年人健康的重要疾病之一。如何对痴呆做到早诊断、早治疗及提高患者生活质量是世界各国政府、医务工作者及公众面临的重大难题。本文对英国国家卫生与临床优化研究所（NICE）2018年发布的《痴呆的评估和管理指南》进行分析解读,总结指南中痴呆的诊断、治疗及护理要点,旨在为痴呆的早期分类诊断提供科学根据,为针对痴呆的药物、非药物干预措施提供参考依据,为痴呆的照料者及护理机构提供指导方针。     

进行性核上性麻痹2例临床分析

目的通过对进行性核上性麻痹的临床特点、病因病理、诊断及治疗的了解,提高进行性核上性麻痹诊断的准确性。方法分析我院近3年的2例进行性核上性麻痹患者的临床资料,并复习相关文献。结果2例患者均于60岁后缓慢起病,临床表现为姿势不稳、帕金森综合征、垂直性核上性眼肌麻痹、假性球麻痹和痴呆等症状。2例头颅MRI未见异常。结论进行性核上性麻痹是一种误诊率很高的疾病,临床医生应予重视。     

血管性痴呆和阿尔茨海默病患者脑MRI对比分析

目的血管性痴呆和阿尔茨海默病患者脑MRI对比分析。方法本文选取我院于2014年01月-2015年05月收治的各35例血管性痴呆和阿尔茨海默病患者,对所有患者全部实施脑部MRI扫描诊断,进一步对其扫描诊断的MRI图像加以分析探讨,对比两组患者的海马体积测量值大小、LA分级情况以及影像学结果。结果血管性痴呆组患者的海马体积平均为(4.80±0.27)立方厘米,阿尔茨海默病组患者的海马体积平均为(4.44±0.24)立方厘米,两组结果对比存在显著性差异(P0.05),具有统计学意义。两组LA分级情况结果对比存在显著性差异(P0.05),具有统计学意义。结论血管性痴呆和阿尔茨海默病患者的脑部MRI图像存在较大的差异,需要结合临床治疗和诊断过程加以有效鉴别和诊断。     

Major trauma in West Virginia dementia patients injury patterns, discharge dispositions and implications for treatment and injury prevention

Our study examines injury patterns, treatment implications, discharge disposition, and injury prevention for trauma patients with dementia. It is a retrospective observational study of trauma patients at the Jon Michael Moore Trauma Center at West Virginia University Hospitals. Causes of injury, injuries sustained, and discharge disposition were examined in 286 trauma patients with a pre-existing diagnosis of dementia and 5,865 trauma patients without dementia. All patients included in this study were 40 years of age or older. Injury data were compiled for patients with dementia. Causes of injury and discharge disposition were compared for the two groups.     

Nature, incidence and prognosis of neurological involvement in the acquired immunodeficiency syndrome in central London

Clinical neurological involvement at various times throughout the illness was recorded in 52% of 122 patients seen in central London who died from acquired immunodeficiency syndrome (AIDS). Various metabolic encephalopathies, dementias, focal encephalopathies, retinopathies and peripheral nerve pathology were the most frequent manifestations. Seven of 9 patients with a neurological presentation had no other major systemic illness. The median time from diagnosis of AIDS to death was 9 months and from onset of neurological symptoms to death 4 months. Human immunodeficiency virus dementia, central nervous system opportunistic infections, presence of Kaposi sarcoma, neurological presentations and minor symptoms were not associated with major change in survival time.     

痴呆综合征60例临床和CT分析

目的研究分析痴呆综合征60例的临床和CT检查、诊断。方法回顾性分析2009年4月-2012年8月期间该院收的60例有痴呆表现患者的临床资料。结果研究中脑血管疾病引发的痴呆症最多，在脑血管性痴呆中，由于大面积多发脑梗死引起的最多，脑出血引起的较少，并且根据患者的病情来看，与痴呆的发生有关的是梗塞发生的多少、部位和大小。结论梗塞的大小、部位、多少和痴呆综合症的发生相关，且根据患者的生活习惯发现，有多年饮酒嗜好的人容易出现痴呆，并且有酒精中毒的症状，加强患者的临床检查诊断，以及保证其养成良好的生活习惯对于临床治疗十分重要。     

血管性痴呆的脑血流及代谢研究进展

目的；探讨脑血流及代谢异常在血管性痴呆（ＶＤ）诊治中的运用。方法：采用ＳＰＥＣＴ，ＰＥＴ等方法对ＶＤ脑血流及代谢的测定。结果：脑血流及代谢的测定是诊治ＶＤ的有效指标。结论：脑血流及代谢的测定与ＶＤ的诊治有一定的相关性。     

从卒中到VD的动态CT分析

目的 :研究血管性痴呆 (VD)的发病机制。方法 :选择首次发病的卒中患者 16 7例 ,分别在首次发病、每次复发及 5年时进行动态头颅CT扫描及智能测定。按 5年时是否痴呆分为血管性痴呆组 (VD组 ,95例 )及无痴呆血管病组 (对照组 ,72例 )。将两组资料进行对比分析 ,并行统计学处理。结果 :1年时VD发生率为 31.73% ,2年5 0 .17% ,5年 5 6 .89% ,VD组发作次数多、病灶体积增大、病灶数目增多、病变部位由单侧→双侧、左侧病变增大、皮层下病变增大多见 ,脑萎缩相关指标提示皮质下萎缩明显 ,但白质疏松面积改变两组差别无显著性。结论 :血管性痴呆多发于卒中首次发病后 1～ 2年内 ,VD发生率与发作次数、病灶体积、病灶数目增加及病变部位改变 (如单侧→双侧 ,左侧病变扩大 ,丘脑或角回病变等 )最相关 ,其次为皮层下脑萎缩的快速发展 ,而白质疏松改变与VD关系较小。首次卒中后 2年内积极有效防治有助于减少VD的发生。     

11: disorders of memory and intellect.

The clinical approach to the patient with a suspected disorder of memory and intellect is to establish whether it is dementia, which parts of the brain are affected, what is the cause, what is the prognosis, and what can be done about it. The diagnosis of dementia usually requires the involvement of memory and at least one other cognitive system. Delirium and depression are important differential diagnoses. Patients with dementia should usually have some simple investigations after a careful history-taking and examination to identify "reversible" causes. The commonest cause of dementia is Alzheimer's disease, in which short-term memory disturbance is usually prominent. Other causes of dementia include cerebrovascular disease, Lewy-body disease and Pick's disease. There is now hope for patients with Alzheimer's disease (which can be treated with some success with cholinesterase inhibitors) and patients with vascular dementia, in whom aggressive control of causal risk factors may retard progression.     

路易体痴呆33例临床及影像学特点

目的 总结路易体痴呆的临床及影像学特点,探讨早期诊治办法.方法 对2006年 2月至2011年1月于北京协和医院诊断的33例很可能的路易体痴呆患者的临床资料进行回顾性分析.结果 男性25例,确诊时平均病程3.3年.10例患者发病前经历1~10年不等的睡眠障碍、抑郁、焦虑及便秘.首发症状为记忆障碍(52%),帕金森样症状(21%)或二者同时.以记忆障碍首发的患者出现帕金森症状平均时间为17个月.帕金森样症状主要表现为轴性肌张力增高,可在2~3年累及言语、吞咽和行走功能.幻觉(70%)、睡眠障碍(63%)、淡漠(56%)、妄想(52%)是主要精神行为症状,幻觉平均在发病后15个月内出现.半数患者认知障碍进展迅速.轻度患者视空间能力受损显著重于记忆障碍,中重度患者认知功能全面受损.头颅核磁显示海马结构相对保留,PET表现为枕叶代谢减低.乙酰胆碱酯酶抑制剂治疗可以改善患者认知和精神症状.结论 路易体痴呆在发病前期就可出现神经功能异常.幻觉出现早、睡眠障碍发生率高、轴性肌张力增高为主和PET发现枕叶低代谢是有助于和其他痴呆鉴别的临床特征.

Abstract：

Objective To investigate the clinical, neuropsychological, neuroimaging features and treatment of dementia with Lewy bodies (DLB).Methods The clinical, neuropsychological, neuroimaging and therapeutic features of 33 DLB patients were retrospectively analyzed.Results There were 25 males and 8 females.The mean course from onset to diagnosis was 3.3 years.Sleep disorder, depression, anxiety and constipation were present at 1-10 years prior to DLB onset in 10 patients.Memory impairment (52%) and parkinsonism (21%) were initial symptoms.The mean duration from memory impairment to presence of parkinsonism was 17 months.Pattern of extrapyramidal signs showed bilateral, symmetry and axial muscles bias as postural instability and facial impassivity, tremor was less in DLB.Hallucination (70%), sleep disorder (63%), apathy (56%) and delusion (52%) were the major behavioral and psychological symptoms.Hallucination occurred within a mean of 15 months after presence of initial symptoms.Cognition impairment progressed rapidly in half of patients.Neuropsychological tests of mild patients revealed visuospatial dysfunction and relatively preservation of memory.Severe impairment of all domains of cognition was noticed in moderate-severe patients.MRI (magnetic resonance imaging) revealed the preservation of hippocampal structures.And PET (positron emission tomography) showed hypometabolism of occipital lobe.Cholinesterase inhibitors could improve cognitive impairment and behavioral symptoms in a large majority of patients.Conclusion Neuronal dysfunction may be present at an early stage of DLB. Early presence of hallucination, a high prevalence of sleep disorders, axial rigidity and hypometabolism of occipital lobe on PET may help to distinguish DLB from other types of dementia.     

守护"记忆之魂"的中国痴呆临床研究引领者——贾建平教授

他为了实现"守护记忆、留住人间美好"的梦想,面对痴呆顽症,带领团队克服了难以言述的重重困难,终于找到了能提前5~7年预测记忆丧失的标志物,为早期预防提供了宝贵和长足的时间;他为了拿出中国人痴呆治疗方案,持之以恒地探索中国人群痴呆发生发展、流行的发病规律,首次报道了中国人口老化导致记忆障碍人数出现"井喷现象"（4 000多万）,并提出控制危险因素可预防痴呆的观点;他一直潜心研究中国人痴呆的遗传规律和对携带有痴呆风险基因人群进行早期干预的可能性,首次报道了中国人13个致病基因新突变,提出了遗传干预策略;他为实现自主研发痴呆新药的载体工具,利用中国人特色基因构建了10种新的阿尔茨海默病动物模型,彰显了自力更生的研究精神;他为了规范中国的痴呆和认知障碍临床实践,主持制定《中国痴呆与认知障碍诊治指南》2010版和2015版,单篇发表相关论著23篇,极大地提高了我国临床诊治水平;为了推出痴呆新药,主持国内外临床试验20多项,证明中国新药丁苯酞和塞络通对血管性痴呆有明确疗效,报道于国际著名期刊,引起国内外同行关注;他和团队努力实践着构建防治痴呆的中国人方案,奠定了我国在痴呆领域研究的国际领先地位。他就是——贾建平教授。     

Net economic costs of dementia in Canada.

OBJECTIVE: To estimate the net economic costs of dementia in Canada in 1991 by comparing costs related to elderly patients with dementia with those related to elderly people without dementia. DESIGN: Cost-of-illness study. DATA SOURCES: Most of the data analysed in this study were from the Canadian Study of Health and Aging (CSHA), in which 10,263 Canadians aged 65 years and over were randomly selected, surveyed and, when appropriate, given clinical examinations. Data on patients with dementia and on people without cognitive impairment (control subjects) were used for this analysis. Data on activities of daily living (ADLs) were taken from a separate study under the CSHA, in which the principal caregivers of the subjects in the prevalence study were interviewed. SETTING: Community and institutional settings in Canada, excluding those in the territories. PATIENTS: All patients with dementia 65 years and older as determined from the CSHA. Patients with dementia under 65 were also considered. OUTCOME MEASURES: Costs of paid and unpaid services in the community, care in long-term care institutions, drugs, hospitalization, diagnosis and research. RESULTS: The total annual net cost of dementia was estimated to be over $3.9 billion. Costs associated with elderly patients in the community were estimated to be $1.25 billion ($615 million for paid services, $636 million for unpaid services), whereas costs for patients in long-term care institutions were $2.18 billion. Costs were about $74 million for drugs, hospitalization and diagnosis, $10 million for research and $389 million related to patients under age 65. CONCLUSION: The annual net economic cost of dementia in Canada is at least $3.9 billion. The most significant component of the total cost was for care in long-term care institutions and for assistance with ADLs by professionals, family and friends in the community. The economic burden of dementia is significant not only for patients, their families and friends, but also for society.     

Alzheimer氏病与多灶脑梗塞性痴呆的临床对照分析

对５１例ＡＤ及５０例ＭＩＤ进行了临床对照分析。结果显示ＭＩＤ９４．０％（４７／５０）有精神症状，而ＡＤ８０．４％（４１／５１）有精神症状，两组病人在发病年龄、性别、家族史、病程及住院时间相同的情况下ＭＩＤ的痴呆程度轻于ＡＤ。经治疗ＭＩＤ痴呆的好转率大于ＡＤ（Ｎ＜０．０１），精神症状则有不同程度减轻（Ｐ＞０．０５）。