急性一氧化碳中毒后迟发性脑病的诱发电位、CT和脑电图研究

目的：研究急性一氧化碳中毒后迟发性脑病（ＤＥＡＣＭＰ）患者的诱发电位（ＥＰ）、ＣＴ和脑电图（ＥＥＧ）。方法：对４６例ＤＥＡＣＭＰ患者进行ＥＰ、ＣＴ和ＥＥＧ检查。结果：异常率体感诱发电位（ＳＥＰ）８３％、视觉诱发电位（ＶＥＰ）６３％，脑干听觉诱发电位（ＢＡＥＰ）３０％，ＣＴ７１％，ＥＥＧ１００％。ＳＥＰ中的Ｐ４０、Ｎ５０、Ｐ６０和Ｎ７５峰潜伏期（ＰＬ）比正常对照组显著延长。ＶＥＰ的Ｐ１００ＰＬ较对照组明显延长。ＢＡＥＰ的Ⅰ、Ⅲ和Ⅴ波ＰＬ及Ⅰ—Ⅲ、Ⅲ—Ⅴ和Ⅰ—Ⅴ峰间期（ＩＰＬ）与对照组比较无显著性差异。结论：ＥＰ、ＣＴ和ＥＥＧ结合临床观察，对ＤＥＡＣＭＰ的定位诊断、病情判断与预后评估均有意义。     

68例脑基底节区梗塞的脑电地形图分析

报告经ＣＴ、磁共振成像（ＭＲＩ）证实的６８例脑基底节区梗塞患者的脑电地形图（ＢＥＡＭ），并与５０例正常对照组的ＢＥＡＭ作对照，结果梗塞组ＢＥＡＭ３６例（５３％）异常：其中３３例以θ波频带能量增高为主要表现（２９例位于大脑前半部，４例位于大脑后半部）；３例（８％）为δ波频带能量增高，均在后半部。对照组ＢＥＡＭ异常４例（８％），表现在额、颞区θ波频带能量稍有增高。脑梗塞组与正常对照组比较，ＢＥＡＭ异常率有明显差异。     

腔隙性脑梗死患者早期EEG、BEAN和CT、MRI检测报告

目的：用脑电图（ＥＥＧ）脑电地形图（ＢＥＡＭ）对早期（３天内）腔隙性脑梗死（腔梗实施监测,观察其敏感性、变化特点以及对临床诊断的指导价值、方法：对６５例早期腔梗的患者作ＥＥＧ和ＢＥＡＭ监测,同期做计算机断层扫描（ＣＴ）或磁共振成像（ＭＲＩ）对照,并设正常组对比分析。结果：腔梗组发病３天内阳性率分别为：ＥＥＧ６６％和ＢＥＡＭ８９％（Ｐ＜０．０５）,ＣＴ、ＭＲＩ２２％（Ｐ＜０．００１）。ＢＥＡＭ主要改变为局限性异常,多在颞额,中央区以　频带功率增高为主,部分病变侧颞区较对侧功率降低,ａ频带功率减弱。与ＣＴ比较,ＢＥＡＭ具有较高的敏感性。结论：ＢＥＡＭ检查早期腔梗优于ＣＴ,起到了指导临床诊断及时治疗的作用。     

急性脑梗死患者BAEP与脑血流量相关性研究

目的：探讨脑干听觉诱发电位与脑血流量在急性脑梗死病人中的相关性,方法：对１２０例急性脑梗死患者和８０例上常人进行脑干听觉诱发电位（ＢＡＥＰ）及脑血流量（ＣＢＦ）检测。结果：脑梗死患者ＲＡＥＰ和ＣＢＦ异常率分别为７７％和６８％,病情愈重异常愈明显．脑梗死患者ＢＡＥＰ异常表现为主波潜伏期和波间期均比正常对照组延长（Ｐ＜０．０５～０．０１）,且病情愈重延长明显,ＢＡＥＰ延长患者ＣＢＦ明显低于正常患者（Ｐ＜０．０５～０．０１）。结论：ＢＡＥＰ是初步评价脑梗死患者脑功能和ＣＢＦ的有效手段。     

氯氮平脑电改变预测精神分裂症的疗效

目的：利用氯氮平引起脑电明显改变预测精神分裂症临床疗效。方法：采用病人自身对照方法，将３９例病人服药两周时是否引起脑电明显改变，分为脑电改变组（Ａ组）与脑电无改变组（Ｂ组），比较两组临床疗效。结果：氯氮平服药后Ａ组ＥＥＧ主要表现为额、中央、顶部慢波的明显增多，有的病人甚至枕部也出现较多慢波；脑电地形图δ、θ频段功率明显增强。Ｂ组脑电图、脑电地形图无明显变化。两组疗效比较，经统计学处理有非常显著性差异（Ｐ＜０００１）；脑电改变组与脑电无改变组两周时氯氮平剂量和血浓度比较，无显著性差异（Ｐ＞００５）。结论：服用氯氮平时是否引起脑电慢波增多可用为对该病人是否有治疗意义的一种判定指标     

癫癎病人δ、θ活动地形图研究

目的：利用脑电地形图（ＢＥＡＭ） 分析技术,判断不对称性δ、θ活动在癫癎患者中的临床意义。方法：用Ｚ 值概率差异ＢＥＡＭ 进行分析,并与其它检查结果比较。结果：在８３ 例癫癎病人中,ＢＥＡＭ 对不对称性δ、θ的检出率高达７２ ％ ,较脑电图（ＥＥＧ） 目测分析敏感,其显示的异常区与ＥＥＧ 目测分析、ＣＴ、单光子发射ＣＴ（ＳＰＥＣＴ） 大多符合。结论：背景脑电的不对称性δ、θ活动对癫癎的辅助诊断与癎灶定位有重要价值。     

颅脑外伤病人脑电地形图的观察与分析

目的：探讨脑外伤病人意识状况与脑电活动慢波频域的关系。方法：对４４例脑外伤病人意识状态进行格拉斯哥昏迷量表（ＧＣＳ）评分，并在伤后不同时期作三次脑电地形图（ＢＥＡＭ）的相关分析。结果：ＧＣＳ评分越低，脑电活动频域就低，ＧＣＳ评分越高，脑电活动频域就高，两者关系密切。结论：ＢＥＡＭ是及时评估病情的有效检查方法     

多梗塞痴呆和Alzheimer型痴呆认知功能与局部脑血流的关系

目的：探讨多梗塞痴呆和Ａｌｚｈｅｉｍｅｒ型痴呆患者神经心理功能与局部脑血流的关系。方法：对３３例多梗塞痴呆（ＭＩＤ）、２１例Ａｌｚｈｅｉｍｅｒ型痴呆（ＤＡＴ）病人和２４例健康对照组作了单光子发射计算机断层显像（ＳＰＥＣＴ）检查，采用相对定量法测定局部脑血流（ｒＣＢＦ）。并作神经心理学测验。结果：ＭＩＤ病人左额颞叶ｒＣＢＦ与言语智商（ＶＩＱ）相关显著；左额、右顶、丘脑ｒＣＢＦ与总智商（ＦＩＱ）明显相关；左颞、右顶叶ｒＣＢＦ与脑损伤指数（ＤＱ）相关明显。ＤＡＴ病人左颞、右额叶ｒＣＢＦ与ＶＩＱ，右顶枕叶ｒＣＢＦ与操作智商（ＰＩＱ），左额颞、右顶叶ｒＣＢＦ与ＤＱ相关明显。ＭＩＤ、ＤＡＴ病人左颞叶ｒＣＢＦ与记忆商数（ＭＱ）相关显著。结论：提示ＭＩＤ、ＤＡＴ病人智能减退与脑血流降低有关。     

脑白质疏松症患者的诱发电位研究

对２４例经颅脑ＣＴ证实的脑白质疏松症患者进行脑干听觉诱发电位（ＢＡＥＰ）和短潜伏期体感觉诱发电位（ＳＥＰ）检查，结果ＢＥＡＰ总异常率７９％，ＳＥＰ总异常率８３％，两种诱发电位均以时间参数的异常率明显比波幅度参数的异常率高。结论：在脑白质疏松症的临床早期，虽然还未出现典型的临床表现，但脑电生理已出现异常，诱发电位的检测可以作为早期诊断该病的一个敏感的辅助检测方法。     

脑梗死患者的运动及体感诱发电位研究

目的：研究脑梗死患者的运动诱发电位（ＭＥＰ）及体感诱发电位（ＳＥＰ）改变。方法：对３０便脑梗死患者在急性期行经颅磁刺激ＭＥＰ检测,对其中２０例同时行电刺激ＳＥＰ检测,１０例患者２月后复查ＭＥＰ,并以３０例健康者作为正常对照组。结果：急性期ＭＥＰ的异常率为９３％,主要表现为皮层ＭＥＰ消失,中枢运动传导时间（ＣＭＣＴ）延长,波形异常及阈刺激强度增高。ＳＥＰ的异常率为３０％,表现为皮层波的缺失及中枢传导时间延长。复查ＭＥＰ有９例明显改善。结论：对于脑梗死的诊断,ＭＥＰ较ＳＥＰ敏感,但将ＭＥＰ与ＳＥＰ联合应用,可从不同的两个侧面反映运动及感觉功能受损的情况,弥补了ＣＴ仅能提供颅内解剖学改变而不能反映功能状态的不足。     

Depression with late onset is associated with right frontal lobe atrophy

BACKGROUND: The objective of this study was to determine whether older adults with first-ever onset of depression after age 60 years (late onset depression, LOD) have smaller frontal lobes than elderly patients with early-onset depression (EOD) and aged controls. METHOD: Twenty-seven subjects with LOD, 24 with EOD and 37 controls underwent volumetric MRI to determine right and left frontal lobe volumes and total brain volume. RESULTS: The right frontal volume of subjects with LOD was 8.0% and 5.6% smaller than that of patients with EOD (P < 0.01) and controls (NS) respectively. Volume of the left frontal lobe was not significantly different from EOD or controls. All analyses were adjusted for age, gender and total brain volume. Unlike controls and those with EOD, patients with LOD did not display a significant positive correlation between cognitive scores and total brain, left frontal or right frontal volumes. CONCLUSION: LOD is associated with right frontal lobe atrophy and loss of the correlation between cognitive performance and brain volume. This adds support to the fronto-striatal hypothesis of depression and suggests that structural brain changes have a particular role in cases of LOD.     

Relative contributions of the cerebellar vermis and prefrontal lobe volumes on cognitive function across the adult lifespan

Recent research has revealed significant relationships between the vermian regions of the cerebellum and cognitive functions typically associated with prefrontal lobe function. These relationships are believed to be supported by anatomical connections between the distant brain regions. Recent evidence also suggests that age-related reductions in the posterior vermis are associated with age-related decline in frontal lobe cognitive functions, but these studies did not consider concomitant age-related atrophy of the prefrontal lobes. In the present study we addressed this issue by examining cognitive and structural MRI data obtained from 251 adults ranging in age from 18 to 79. Cognition was examined with a computerized cognitive battery and volumes of the cerebellar vermian regions and the prefrontal lobes were determined using quantitative morphometry. Results of the study revealed that both prefrontal and vermian volumes were smaller in older adults compared to younger adults, and both volumes correlated with cognitive performances in the older individuals. However, after controlling for prefrontal volume, the relationships between cognitive function and vermian volumes were eliminated, whereas prefrontal lobe volume remained significantly related to cognitive function after controlling for vermian volumes. These results suggest that while a reduction in cerebellar vermian volume does not significantly relate to normal age-related cognitive decline, prefrontal volume is significantly related to cognitive aging. Our results are consistent with the frontal aging hypothesis.     

Alzheimer病CT测量值及BEAM各频域功率值的左右侧比较研究

目的:了解阿耳采木病脑CT测量与脑电地形图测量左右两侧的对称性。方法:对43例符合DSM—Ⅲ—R诊断标准的Alzheimer病患者与41名年龄、性别匹配的正常老年人(NC)行脑CT摄片与脑电地形图检查,并加以统计分析。结果:(1)患者组与NC组在CT摄片各项测量值上两侧比较无显著差异:(2)NC组BEAM检查结果两侧对照,右侧前额区的β、δ功能显著增高;(3)患者组BEAM两侧比较,右侧前、中颞区θ、δ功率明显增高;右额区θ功能率明显增高。结论:根据BEAM检测,AD患者与正常老人是有不同的一测化特征。     

Medial temporal lobe volume of nondemented elderly individuals with poor cognitive functions

Poor cognitive performance of elderly individuals with low educational attainment is often difficult to interpret in dementia evaluation. Lack of education, as well as dementia, is often associated with poor cognitive test performance. To elucidate the underlying structural change of low cognitive performance in elderly individuals with low educational attainment, this study examined the relationship between low cognitive performance (LCP) and brain volumes, especially regions vulnerable to Alzheimer's disease, in nondemented elderly Koreans. Individuals with LCP (n=14) were matched on age and education with individuals with normal cognitive performance (n=14). The two groups were compared on the MR-based volumetric measures in the hippocampus, the entorhinal cortex, the amygdala, the temporal lobe, the frontal lobe, the cerebrum, and the intracranial cavity. Intracranial volume (p<.05) and absolute hippocampus (p<.05) and frontal lobe volumes (p<.05) were significantly reduced in individuals with LCP. Normalized volumes of the hippocampus and the frontal lobe did not differ in the two cognitive performance groups. ICV was associated with the K-DRS scores. General cognitive functioning of the LCP individuals, measured with the Korean version of the DRS, did not deteriorate in the 1- or 2-year follow-up cognitive tests. LCP in a nondemented elderly population with limited education appears to be associated with stable lower intelligence rather than increased risk for dementia of the Alzheimer's type.     

Diabetes mellitus and brain atrophy: A computed tomography study in an elderly population

Previous studies have suggested that noninsulin dependent diabetes mellitus (NIDDM) could lead to learning and memory deficits. We studied cognitive performance and computed tomography (CT) findings of the brain in elderly subjects with drug treated NIDDM (n = 12), with diet treated NIDDM (n = 13), and in nondiabetic individuals (ND, n = 59). The cognitive performance (orientation and uptodate knowledge, praxic functions, understanding of speech, expressive speech, memory, general reasoning) did not differ between the groups. The drug treated diabetics had more pronounced central temporal atrophy compared to that in the ND subjects as evidenced by wider right temporal horn (ANCOVA adjusted for age, p = 0.011). The drug treated diabetics (all women) also had wider frontal horns than did the ND women. The CT measures of diet treated diabetics were comparable with those of the ND group. The fasting glucose level was positively correlated with the width of the right temporal horn but not with other CT measures in diabetic subjects. The results suggest that NIDDM and poor glucose control may carry a risk for accelarated brain atrophy in the elderly.     

左额叶CT值在偏执型精神分裂症患者中的变化及临床意义

目的:探讨左额叶CT值在偏执型精神分裂症患者中的变化及临床意义。方法:选取2014年6月—2016年6月于我院就诊的偏执型首发精神分裂症患者共120例作为观察组,取120例正常的头部CT患者作为正常组,测量其脑部CT图像上大脑左侧额叶CT值,分析偏执型精神分裂症患者患者大脑左侧额叶CT值与临床资料的关系。结果:观察组患者的平均左额叶CT值低于正常组(t=17.286,P0.05),PANSS评分阴性症状的CT值与阳性症状的CT值差异无统计学意义(t=0.309,P=0.758),不同的教育程度和是否具有职业的患者的CT值比较差异无统计学意义。左额叶CT值与PANSS评分呈负相关(r=-0.455,P=0.024),左额叶CT值与病程时间分评分呈负相关(r=-0.406,P=0.035)。结论:偏执型精神分裂症患者的左侧额叶CT值显著降低,与精神分裂症状的程度和病程时间呈负相关,左侧额叶CT值降低是偏执型精神分裂症的重要影像依据。     

社区老人神经心理功能的5年随访观察

目的：调查分析社区老人同一组神经心理测验５年随访结果。方法：应用Ｆｕｌｄ物品记忆测验（ＦＯＭ）、言语流畅性测验（ＲＶＲ）、积木测验（ＢＤ）和数字广度测验（ＤＳ）评定１２１名社区老人５年前后的认知功能变化。结果：ＮＰＴ变化幅度是：正常老人组：ＢＤ＞ＲＶＲ＞ＤＳ＝ＲＥＣ１３。痴呆老人组：ＢＤ＞ＲＶＲ＝ＲＥＣ１３＞ＤＳ。正常衰老与病理衰老在物品短时记忆与语义长时记忆的减退速率上有显著的差异。结论：正常衰老与病理衰老具有不同的神经心理学变化特点，这些特点有助于痴呆的诊断与预测。     

The fat mass and obesity gene is linked to reduced verbal fluency in overweight and obese elderly men

Humans carrying the prevalent rs9939609 A allele of the fat mass and obesity-associated (FTO) gene are more susceptible to developing obesity than noncarries. Recently, polymorphisms in the FTO gene of elderly subjects have also been linked to a reduced volume in the frontal lobe as well as increased risk for incident Alzheimer disease. However, so far there is no evidence directly linking the FTO gene to functional cognitive processes. Here we examined whether the FTO rs9939609 A allele is associated with verbal fluency performance in 355 elderly men at the age of 82 years who have no clinically apparent cognitive impairment. Retrieval of verbal memory is a good surrogate measure reflecting frontal lobe functioning. Here we found that obese and overweight but not normal weight FTO A allele carriers showed a lower performance on verbal fluency than non-carriers (homozygous for rs9939609 T allele). This effect was not observed for a measure of general cognitive performance (i.e., Mini-Mental State Examination score), thereby indicating that the FTO gene primarily affects frontal lobe-dependent cognitive processes in elderly men.     

Atrophy of the medial occipitotemporal, inferior, and middle temporal gyri in non-demented elderly predict decline to Alzheimer's disease

Our goal was to ascertain, among normal elderly and individuals with mild cognitive impairment, which temporal lobe neocortical regions predicted decline to dementia of the Alzheimer's type (DAT). Individuals received an MRI at baseline and a clinical and cognitive evaluation at baseline and follow-up. By using the baseline MRI we assessed the anatomical subdivisions of the temporal lobe: anteromedial temporal lobe (hippocampus and parahippocampal gyrus), medial occipitotemporal (fusiform) gyrus, middle and inferior temporal gyri, and superior temporal gyrus. We studied two groups of carefully screened age- and education-matched elderly individuals: 26 normal elderly (NL) and 20 individuals with mild cognitive impairment (MCI). Fourteen individuals (12 from the MCI group and two from the NL group) declined to DAT within the 3.2-year follow-up interval. We used logistic regression analyses to ascertain whether the baseline brain volumes were useful predictors of decline to DAT at follow-up after accounting for age, gender, individual differences in brain size, and other variables known to predict DAT. After accounting for age, gender, and head size, adding the volume of the anteromedial temporal lobe (the aggregate of hippocampus and parahippocampal gyrus) and an index of global atrophy raised the accuracy of overall classification to 80.4%. However, the ability to detect those individuals who declined (sensitivity) was low at 57%. When baseline medial occipitotemporal and the combined middle and inferior temporal gyri were added to the logistic model, the overall classification accuracy reached 95.6% and, most importantly, the sensitivity rose to 92.8%. These data indicate that the medial occipitotemporal and the combined middle and inferior temporal gyri may be the first temporal lobe neocortical sites affected in AD; atrophy in these areas may herald the presence of future AD among nondemented individuals. No other clinical baseline variables examined predicted decline with sensitivities above 71%. The apolipoprotein APOE epsilon4 genotype was not associated with decline.     

颈椎病患者经颅多普勒检查与头颅CT和脑电图的关系

应用多普勒技术对50例确诊为椎动脉型颈椎病的患者进行了检查,结果30例异常。其中25例主要表现为不同程度的双侧颈动脉血流量对称性偏低,管径及头颅CT无异常,脑电图部分改变,主要表现为低幅慢波,经治疗后症状改善,多普勒复查正常,说明CT正常不能否定脑缺性血管病的存在,CT不能代替多普勒检查,另5例主要表现为双侧颈动脉血流量不对称,其中3例为双侧血管经狭窄,CT提示全脑萎缩,脑电图呈低幅慢波;另2例CT提示左颞后顶区,右枕外侧区梗塞,脑电图及脑电地形图表现相应部位慢波灶达6～7级。CT异常者,临床治疗效果欠佳,多普勒检查和脑电图及临床症状变化不大,故多普勒检查对监测脑动力循环有一定意义。