快速认知筛查测验识别老年轻度认知功能障碍的效果

目的评价老年人快速认知筛查测验识别轻度认知功能障碍(MCI)和早期痴呆(AD)的效能。方法 60岁及以上的轻度AD患者84例、MCI患者112例、正常老人(NC)196例,采用老年人快速认知筛查测验(QCST-E)、简易精神状态检查量表(MMSE)、日常生活能力(ADL)量表、临床痴呆评定量表(CDR)、华文认知能力量表(CCAS)进行认知功能评估。QCST-E分别测量12个认知领域:即刻记忆、实物命名、视觉空间、言语流畅性、数字广度、抽象能力、听觉模仿、视觉模仿、动作指令、延迟记忆、简单计算、时空定向,最高总分83分,得分越低,认知功能损害越严重。结果轻度AD组、MCI组、NC组QCST-E总分分别为(51.47±3.91)分、(61.47±2.96)分、(72.60±3.01)分,差异显著(P<0.01)。QCST-E各领域和总分与年龄、受教育年限及MMSE、ADL、CCAS得分显著相关(均P<0.01)。根据不同文化程度制定QCST-E的划界分,其中QCST-E总分识别MCI与正常老人的总体敏感度为89.6%、特异度为94.5%,曲线下面积(AUC)为0.903(95%CI:0.857~0.963);识别MCI与轻度AD的总体敏感度为81.7%、特异度为88.6%,AUC值为0.898(95%CI:0.845~0.940)。结论老年人快速认知筛查测验内容全面、简便易行,识别MCI的敏感度和特异度良好。     

海南版简易智能状态检查量表和蒙特利尔认知评估量表界值划分的初步研究

目的初步探讨中文海南版(琼北闽语版)简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分在本地人群认知筛查中的可行性及界值的划分。方法选取2019年1~9月海口市养老院和海南省人民医院门诊及住院的本地被试者217例,根据临床诊断分为正常组45例,轻度认知功能障碍(MCI)组54例,轻度痴呆组62例,中度以上痴呆组56例,同时进行MMSE及MoCA评分评估,进行两种量表评分相关性及界值。结果与正常组比较,MCI组、轻度痴呆组和中度以上痴呆组MMSE及MoCA评分明显降低,差异有统计学意义(P<0.05)。正常组、MCI组、轻度痴呆组和中度以上痴呆组MMSE评分明显高于MoCA评分(P<0.01)。Person相关分析显示,MMSE评分与MoCA评分呈正相关(r=0.940,P<0.01)。MCI组、轻度痴呆组和中度以上痴呆组ROC曲线界值为:MCI组MMSE评分低于27分,MoCA评分低于22分;轻度痴呆组MMSE评分低于23分,MoCA评分低于16分;中度以上痴呆组MMSE评分低于15分,MoCA评分低于11分。结论海南版(琼北闽语版)MMSE与MoCA评分有较好的一致性,联合应用对认知障碍及痴呆患者有较好的筛查应用价值。     

阿尔茨海默病与遗忘型轻度认知功能障碍患者的记忆损害

目的分析阿尔茨海默病(AD)及遗忘型轻度认知功能障碍(a MCI)患者的记忆损害。方法对25例AD患者和28例遗忘型轻度认知功能障碍患者和25例健康对照者进行多项神经心理学检查,包括简明精神状态量(MMSE)、蒙特利尔认知评估量表(Mo CA)、WMS-RC(韦氏记忆量表中文修订版)。结果 AD组MMSE、Mo CA总分明显低于a MCI组(P0.05),a MCI组MMSE、Mo CA评分明显低于正常对照组(P0.05);AD组与a MCI组及正常对照组相比,记忆商降低(P0.05)。除经历、定向外,各分测验分数降低;a MCI与对照组相比记忆商降低,短时记忆中(视觉再生、联想学习)分数明显降低,长时记忆和瞬间记忆无明显差异。结论 AD患者与a MCI患者均出现不同程度记忆损害,AD患者瞬时记忆、短时记忆、长时记忆损害明显,a MCI患者短时记忆出现损害,瞬时记忆、长时记忆无显著变化。     

加兰他敏双盲治疗增龄相关记忆障碍及阿尔茨海默病

目的观察加兰他敏对增龄相关记忆障碍(AAMI)及阿尔茨海默病(AD)疗效及副反应。方法双盲法治疗增龄相关记忆障碍(MQ<90,MMSE≥24分)36例及20例阿尔茨海默病,加兰他敏与安慰剂对照组均为每次2片10毫克,每日3次,疗程2个月。以韦氏记忆量表(WMS)、MMSE、及HDS评定疗效。结果①AAMI:11例治疗组与25例对照组治后MQ增值分别为8.00±5.37及1.64±5.51(P<0.01)。治疗组2例恶心呕吐、胃部不适。②AD:加兰他敏与对照组治后MQ增值,治疗组MMSE为2.90±1.85,显著高于对照组0.50±0.97(P<0.01);治疗组HDS为3.19±2.91,显著高于对照组0.50±1.63(P<0.05);治疗组MQ为5.10±7.03,显著高于对照组0.20±4.91(t=1.95,P<0.1)。治疗组胃部不适2例,1例窦性心动过缓。结论加兰他敏对改善AAMI及AD记忆及认知功能有一定疗效且可耐受。     

老年及高龄老人记忆及认知功能生理增龄性及整体增龄性动态改变的研究

目的研究老年记忆及认知功能生理增龄性及整体增龄性动态改变。方法共调查两个群体3 234例各年龄组对象(其中≥75岁高龄老人1 741例),检测记忆商及MMSE,并定记忆商(MQ;WMS)≥100分,MMSE为28~30为认知正常;MQ<100分,MMSE为28~30为AAM I;MQ<100分,MMSE为24~27分为MC I;MQ<100分,MMSE≤23分为痴呆。研究记忆及认知功能生理性(除外MC I及痴呆)及整体性(排除痴呆,而仍包括MC I)增龄性动态改变。全组中2 666例老年人(≥65岁)除外MC I 782例,痴呆157例后,余1 727例作为生理性增龄改变观察组。而将包括认知正常、AAM I及MC I各867、860及782例共2 509例作为整体性增龄改变观察对象。检测方法用WMS及MMSE。结果①WMS:生理性增龄改变组老年及高龄组量表分平均值介于83.54±15.04~82.12±13.74;MQ计算结果介于99.01±13.05~98.05±12.64.②WMS:整体性增龄改变组观察结果显示老年组量表平均值低于生理性增龄改变组7.5分。③MMSE生理性增龄改变组65~74、75~84、85~98岁组MMSE总分中位值均为29分,高于整体性增龄改变组中位值28分。④MMSE按各年龄组异常标准推算式为“该年龄组MMSE总分x-1.5s”计算,则作为与认知正常区别的切点为≤27分。结论①记忆及认知功能均呈现显著增龄性减退改变。②本文“生理增龄性”组测定结果可作为对一般高龄、长寿老人各年龄组临床判断WMS检测结果意义时的参考(正常参考值)。可将老年人及高龄老人AAM I异常标准定为MQ<100分及量表分<83.0。③MMSE总分≤27分可作为与正常值区别的异常标准。将MMSE总分与痴呆的分界值切点定为≤23分。     

老年人认知功能减退知情者问卷检测老年人认知功能损害

目的评价老年人认知功能减退知情者问卷在中国老年人群中应用的信效度,以及在认知功能损害筛查中的有效性。方法认知功能损害患者93例,应用简短版本的老年人认知功能减退知情者问卷(IQCODE)对其知情者进行问卷调查。对128名60岁以上来自于社区的健康老年人的知情者进行调查,作问卷的信效度检验。结果 IQCODE 内部一致性系数达0.83。重测信度Pearson 相关系数为0.86。与简短精神状态量表(MMSE)、日常生活活动能力量表(ADL)的效度系数分别为-0.78和0.71。IQCODE 得分在轻度认知障碍和轻、中、重度痴呆患者中分别为(3.5±0.4)分和、(4.2±0.4)分、(4.7±0.2)分和(4.9±0.2)分,差异有统计学意义,但在阿尔茨海默病(AD)和血管性痴呆(VaD)等不同痴呆病因组间差异无统计学意义。结论 IQCODE 信效度良好。得分与病情严重程度密切相关,此问卷能将痴呆和轻度认知功能损害患者与健康人群很好地区分开来,可用于认知功能损害的检测。但对 AD、VaD 等痴呆类型的鉴别作用有限。     

痴呆患者行为和精神症状的相关因素

目的探讨痴呆患者行为和精神症状(BPSD)的相关因素。方法采用简易智力状态检查表(MMSE)、日常生活功能量表(ADL)、Hachinski缺血指数量表和简明神经精神量表(NPI-Q)对102例痴呆患者进行测评。结果 1痴呆患者的妄想、幻觉、抑郁、焦虑、易激惹症状评分与MMSE量表总分、ADL量表总分有显著相关(P<0.05),妄想症状评分与病程呈负相关(P<0.05),行为紊乱评分与病程呈正相关(P<0.05);NPI-Q量表总分与MMSE量表总分、ADL量表总分有显著相关(P<0.05),与病程的无显著相关;2女性阿尔茨海默病(AD)组的抑郁症状评分显著高于男性AD组(P<0.05),女性AD组的妄想、幻觉症状评分和量表总分显著高于男性血管性痴呆组(P<0.05);3回归分析MMSE评分和痴呆类型进入回归方程。结论痴呆患者BPSD的发生及表现出的严重程度,受到较多因素的影响。认知功能水平相对较好和痴呆类型为AD的患者,总体上BPSD更为严重。     

Addenbrooke改良认知评估量表对老年人认知障碍诊断效力的研究

目的探讨Addenbrooke改良认知评估量表(ACE-R)对老年人群认知功能障碍(cognitive impairment,CI)的诊断效力。方法选择2013年9月至2016年7月在江苏省老年医院就诊的老年人269例,其中认知正常者139例(正常对照组),轻度认知功能障碍者63例(MCI组),痴呆者67例(痴呆组)。所有研究对象均完成ACE-R量表及简明精神状态量表(MMSE)测评,比较3组的ACE-R总分及各个子项目评分,并绘制ROC曲线,通过计算ROC曲线下面积的方法观察ACE-R对MCI及痴呆诊断的敏感性及特异性。结果 (1)正常组ACE-R总分及MMSE评分分别为(83.94±7.41)分,(28.40±1.29)分,MCI组评分为(67.76±10.97)分和(23.78±1.62)分,痴呆组评分为:(36.09±15.66)分和(14.64±4.74)分。3组间ACE-R总分、MMSE评分及各子项目评分差异均有统计学意义。(2)ACE-R量表以74/75作为分界值时筛查MCI灵敏度达93.5%,特异度达到65.1%,以65/66作为分界值时筛查痴呆灵敏度达98.6%,特异度达到98.3%。(3)ACE-R量表和MMSE量表呈显著正相关(r=0.926,P0.01)。(4)年龄及性别对ACE-R分值有影响,教育年限对ACE-R分值无影响。结论 ACE-R量表可以很好地反映CI病人相关认知域受损情况,可有效筛查MCI及痴呆病人。     

轻度认知损害和阿尔茨海默病患者的血脂变化

目的探讨轻度认知损害(mild cognitive impairment,MCI)和阿尔茨海默病(Alzheimer′s disease,AD)患者血脂代谢改变。方法受试者来自北京中医药大学东直门医院老年病科记忆门诊及附近社区居民。依据中文版简易精神状态检查(mini-mental state examination-Chinese revised,MMSE-CR)测试成绩、临床记忆量表(clinical memory scale,CMS)之记忆商(MQ)、Petersen等MCI标准、NINCDS-ADRDA很可能AD标准以及Hachinski缺血评分(HIS)将129名受试者分为4组遗忘型轻度认知损害(amnestic-mild cognitive impairment,aMCI)患者37例、年龄相关的记忆损害(age-associated memory mpairment,AAMI)患者48例、AD患者15例和认知正常(normal cognitive state,NCS)者29名。4组患者的血脂指标由OLYM-PUSAU640全自动生化仪直接测定。结果AD组、aMCI组与认知正常组比较,血清脂蛋白(a)〔LP(a)〕水平存在显著性差异(分别为P<0.01和P<0.05);AD组与AAMI组比较,LP(a)水平存在显著性差异(P<0.05)。以LP(a)>300mg/L为高水平,高LP(a)组之MMSE总分和定向分测验分显著低于LP(a)正常组(P<0.01)。LP(a)水平随认知损害程度的加重而呈现出逐渐上升趋势。相关分析结果提示LP(a)水平与MMSE总分、MQ等存在一定相关关系(分别为r=-0.2937,P=0.001;r=-0.2718,P=0.005)。而总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)在4组中均无显著性差异(P>0.05)。结论血清高LP(a)水平可能是aMCI和AD患者的危险因素之一。     

社区老年认知功能和生活功能的变化模式

目的 分析正常老化与痴呆在认知功能和生活功能变化模式的区别.方法 对社区正常老人(NC)、AD、VD三组共131例,入组和随访24个月后进行 MMSE及ADL评估.结果 ①随访前后三组病例的MMSE评分均有显著下降.②三组MMSE量表中个因子分的变化情况各不相同.③AD组和VD组ADL评分上升显著,正常对照组ADL评分上升不显著.④AD患者女性认知功能下降快,饮酒后VD患者认知功能下降快.结论 ①正常老年人认知功能的减退与AD、VD患者认知功能的衰退存在着不同的模式.②性别和饮酒可能分别是AD和VD患者认知功能下降的危险因素.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.