Advances in structural and molecular neuroimaging in Alzheimer's disease

Longer life expectancies lead to increases in the prevalence of age-associated illnesses. The number of Australians with dementia is predicted to rise, from 234,000 in 2009 to over 1 million by 2050, as a result of the increased prevalence of Alzheimer's disease (AD), the leading cause of dementia in the elderly. Early diagnosis of AD will become more important as disease-modifying therapies emerge within the next decade. Advances in molecular neuroimaging with amyloid-β-specific radioligands for positron emission tomography, aided by magnetic resonance imaging techniques, allow detection of AD years before symptoms of dementia develop. Longitudinal prospective studies, such as the Australian Imaging Biomarkers and Lifestyle (AIBL) study of ageing, will determine the sensitivity and specificity of these analysis techniques for diagnosing AD and predicting cognitive decline.     

老年精神病人中痴呆流行病学调查

目的 调查老年精神病人中其痴呆的发病情况，探讨与发病有关的危险因素。方法 用简易智能量表(MMSE)和痴呆简易筛查量表(BSSD)作筛查工具，调查3930例55岁以上老年和亚老年精神病病人这一特殊群体；分析年龄、文化程度、精神病类型等18项与痴呆发病的相关性。结果 痴呆患病率1．53％；痴呆与高龄、女性、痴呆家族史、负性生活事件、脑外伤史、丧偶、体力劳动等密切相关，成为易患因素。结论 精神病人痴呆患病率均明显高于普通人群；精神症状复杂多变，认知功能下降和残疾程度严重。     

miRNA-210在痴呆中的调控作用及机制

目的:观察miRNA-210在痴呆或严重认知功能障碍老年患者血浆中的表达变化,探讨miRNA-210对老年痴呆患者的临床意义。方法:利用miRNA芯片检测老年患者(有无痴呆或严重认知功能障碍)血浆中miRNA-210水平变化。结果:痴呆或严重认知功能障碍的老年患者血浆中miRNA-210的表达水平明显高于无痴呆或严重认知功能障碍的老年患者。结论:miRNA-210在痴呆或严重认知功能障碍的发生发展过程中可能起着重要调控作用,可进一步深入研究其内在机制。     

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.     

Prevalence of undetected cognitive impairment and depression in residents of an elderly care home

The elderly population in Malaysia is growing rapidly. Some of the most vulnerable are in residential care. Research is needed into the characteristics of this population to aid clinicians and policy makers in addressing the needs of this group. This observational, cross-sectional study aims to determine prevalence of undetected cognitive impairment and depression in elderly care home residents in Malaysia. One hundred and sixty-seven people over 60 years of age living in a state run residential home were interviewed. Validated assessment tools were used to measure dependency, cognitive impairment and depression. The prevalence of probable dementia is 36.5%, with increasing prevalence with age and level of dependence. Prevalence of depression is 67.0% (major depression 13.2%), with more depression in males and in the Indian population. None of the identified cases had been previously investigated or treated for dementia or depression.     

老年轻度认知功能障碍323例住院患者的营养状况

目的:营养不良和轻度认知功能障碍的关系仍不清楚。本研究观察老年轻度认知功能障碍住院患者营养不良的患病率。方法:对323名老年住院患者进行详细的评估,包括躯体健康、认知功能、情感和社会功能;并用微型营养评估量表评定营养状况。根据神经心理学评估,认知功能分为三个水平:正常、轻度认知功能障碍和痴呆。结果:根据微型营养评估量表的评估,39.93%的研究对象营养状况为良好,34.98%为可疑营养不良,25.07%为营养不良。与认知功能正常的住院患者相比,轻度认知功能障碍和痴呆患者营养状况良好的比例明显降低,并且营养不良的风险明显升高。结论:在痴呆和轻度认知功能障碍者住院患者中营养不良的患病率明显增高。     

心房颤动与痴呆

心房颤动（以下简称房颤）和痴呆是老年人群常见疾病。越来越多的证据表明房颤可导致认知功能障碍和痴呆,通过对房颤患者进行抗凝、节律控制能改善认知功能和降低痴呆风险。该文就房颤导致认知功能障碍和痴呆的可能机制,通过对房颤的干预降低痴呆风险的研究进展作一综述。     

轻度认知功能障碍与抑郁、焦虑症状的相关性研究进展

轻度认知功能障碍（MCI）是介于正常衰老和痴呆之间的一种过渡状态，MCI作为痴呆的前驱阶段，进展为痴呆的风险是正常中老年人的10倍。本文通过对国内外MCI与抑郁、焦虑症状相关性的研究进展进行综述，发现MCI患者的抑郁、焦虑症状检出率高，抑郁、焦虑症状可促使MCI向痴呆转化。因此，重视MCI患者的抑郁、焦虑症状的评估及早期干预，对于防止MCI恶化、预防痴呆具有非常重要的意义。     

认知功能障碍患者无名质核的MRI测量

目的对正常认识功能老年人、轻度认知功能损害（MCI）和痴呆患者进行MRI检测,比较三者无名质核厚度的差异。方法对正常认知功能老龄者（11例）、MCI（13例）及痴呆患者（15例）,分别应用MMSE和MoCA量表进行评分,应用快速回波序列进行MR扫描,在平行于脑干长轴经白质前联合的冠状斜切面上测量无名质核的厚度。结果正常认知功能老龄对照组男6例,女5例,平均年龄（78.6±6.7）岁,无名质核厚度平均（0.27±0.06）cm;MCI组男7例,女6例,平均年龄（72.8±7.8）岁,无名质核厚度平均（0.23±0.04）cm;痴呆组男14例,女1例,平均年龄（78.5±5.8）岁,无名质核厚度平均（0.12±0.03）cm。3组无名质核厚度存在显著性差异（P〈0.01）,痴呆组较正常对照组及MCI组缩小（P〈0.01）,MCI组较正常对照组明显缩小（P〈0.05）。结论痴呆及MCI者无名质核较正常认知功能老龄者均存在明显萎缩,随着认知功能障碍的进展,无名质核的萎缩可能进一步加重。     

老年痴呆患者的营养状况分析

目的 了解不同痴呆类型、认知程度和日常生活能力老年（≥70岁）痴呆患者的营养状况,为临床医疗提供指导.方法 收集125例老年痴呆患者（其中阿尔茨海默病82例、血管性痴呆43例）的临床资料,根据简易智能状态检查表将患者分为轻度、中度、重度痴呆;根据基本日常生活能力量表将患者分为完全生活自理和轻度、中度和严重功能障碍.对痴呆患者进行微型营养评价精法（MNA-SF）测评和一些营养生化指标的检测,并以同期年龄匹配的因稳定期高血压、轻症冠心病及脑动脉硬化症等疾病住院治疗的老年患者作为对照,统计分析不同组别患者之间检测指标的差异.结果 痴呆患者血白蛋白水平明显低于对照组;重度痴呆患者血白蛋白水平低于轻度痴呆患者和对照组;重度痴呆患者MNA-SF值明显低于轻度痴呆患者;严重功能障碍痴呆患者血白蛋白水平和MNA-SF值明显低于轻、中度功能障碍痴呆患者和生活自理痴呆患者.结论 重度痴呆和严重功能障碍痴呆患者的营养状况较轻、中度痴呆患者明显恶化,临床上应作针对性治疗,以改善患者的病情.     

基于国际居民长期照护评估工具的养老机构老年人认知障碍现状及影响因素研究

背景　随着老龄化现象的加剧,老年人认知障碍的发生率逐步上升,通过研究相关影响因素对认知障碍进行早期筛查、诊断和干预,可以达到及时预防、延缓痴呆的效果。目的　调查养老机构老年人的认知障碍并探讨其影响因素。方法　于2018年4—6月采用方便抽样法,选取南京市江宁区某养老机构老年人（≥60岁,n=369）为调查对象。由经过专业培训获得资质的评估员依据国际居民长期照护评估工具（interRAI-LTCF）对老年人进行评估。根据其中的认知表现评分（CPS）判断老年人是否存在认知障碍,以老年人的基本情况及其他评估标尺得分为自变量,采用多因素Logistic逐步回归分析养老机构老年人发生认知障碍的影响因素。结果　共回收有效问卷338份,有效回收率为91.6%。138例老年人存在不同程度的认知障碍,认知障碍发生率为40.8%。多因素Logistic逐步回归分析结果显示,感觉受损情况、脑血管疾病患病情况、日常生活活动能力（ADL）评分、抑郁评分、疼痛评分、社会参与度评分是养老机构老年人是否发生认知障碍的影响因素（P<0.05）。结论　养老机构老年人的认知障碍发生率较高,感觉受损、患有脑血管疾病、ADL依赖、抑郁是其发生认知障碍的危险因素,社会参与度高是保护因素,应进行积极筛查并采取针对性的干预措施。     

基于老年健康综合评估探讨糖尿病与认知功能障碍的相关性研究

背景　目前糖尿病患者认知功能障碍被临床糖尿病治疗策略忽略，且尚未发现有效的治疗方法可以逆转痴呆的病程，因此，积极寻找痴呆的危险因素，从防治的角度预防痴呆的发生是改变目前在痴呆诊治中被动局面的一种有效方法。目的　探讨住院老年患者糖尿病与认知功能障碍的相关性。方法　选取2017年9月-2019年2月在成都市第一人民医院老年病科完成老年健康综合评估的住院老年患者为研究对象，采用简易精神状况量表（MMSE）、临床痴呆评定量表（CDR）、日常生活能力量表（ADL）进行评估。依据2型糖尿病诊断标准将患者分为正常组和糖尿病组。采用二分类Logistic回归分析探讨住院老年患者糖尿病与认知功能障碍的相关性。结果　共发放问卷610份，回收有效问卷606份，有效回收率99.3%。纳入研究的606例患者中，正常组428例，平均年龄（71.4±7.6）岁；男性180例（42.1%），女性248例（57.9%）。糖尿病组178例，平均年龄（72.3±6.4）岁；男性82例（46.7%），女性96例（53.9%）。两组患者MMSE、CDR、ADL评分及认知情况比较，差异有统计学意义（P<0.05）。二分类Logistic回归分析结果显示：糖尿病与住院老年患者认知功能障碍存在相关性（P<0.05）。结论　在住院老年患者中，糖尿病和认知功能障碍关系密切，临床上应关注两者共同的危险因素及影响因素，应注意筛查老年糖尿病患者的认知功能状况，及时发现认知功能障碍并进行有效的干预。     

阿尔茨海默病患者的视觉环路损害特征及其临床应用的研究进展

阿尔茨海默病（Alzheimer''s disease,AD）是老年人中最常见的痴呆类型,表现为进展性、不可逆转的多维度认知功能障碍。视觉功能障碍是AD及其高风险人群轻度认知功能障碍（mild cognitive impairment,MCI）的认知损害特征之一,视觉环路功能障碍是其视觉症状的主要机制。利用神经影像学可以揭示AD谱系患者视觉环路的损害模式,有助于早期识别并干预AD的进展。本文将对AD谱系患者的视觉环路损害特征及其临床应用的研究进展进行综述。     

轻度认知障碍的研究进展

轻度认知障碍是处于正常脑老化与痴呆之间的一种不稳定的认知损害的临床状态,大部分患者将转化为痴呆。故轻度认知障碍是痴呆的高危人群,研究轻度认知损害对痴呆的预防和治疗具有非常重大意义。文中对轻度认知障碍的临床流行病学、量表筛查、影像及实验室诊断、药物治疗的新进展和新特点作一综述。     

Ambient Particulate Matter Pollution and Hospital Visits for Cardiac Arrhythmia in Beijing,China

Cardiac arrhythmia is a serious public health problem in many countries[1]. Previous studies estimated that 33.5 million people are affected by cardiac arrhythmia worldwide, and this number will continue to grow as society ages[2]. Despite improvements in diagnostic and therapeutic interventions in electrophysiology, the disease burden, incidence and prevalence of cardiac arrhythmia continue to increase and have aroused public health concern. Increasing evidence has indicated that air pollution may be associated with cardiac autonomic nervous system[3]. Among air pollutants, particulate matter with an aerodynamic diameter of ≤ 2.5 μm (PM2.5) is considered exert more toxicity than other air pollutants, as it provides a larger surface area and absorbs or condenses more toxic substances per unit mass[4].     

社区老年轻度认知障碍患者抑郁焦虑状况及影响因素研究

背景　轻度认知障碍（MCI）是介于正常衰老和痴呆之间的一种临床过渡状态。抑郁和焦虑症状是MCI患者常见的神经精神症状,是MCI的危险因素,也是促使MCI向痴呆转化的危险因素。目的　了解上海市杨浦区某社区老年MCI患者抑郁、焦虑状况及影响因素。方法　于2018年4-7月,采用整群抽样法,选取上海市杨浦区定海街道所属居委会的60岁及以上老年人1 587例,利用蒙特利尔认知评估基础量表（MoCA-B）筛查并临床确诊MCI患者,采用老年抑郁量表（GDS）和汉密尔顿焦虑量表（HAMA）对MCI患者进行评估。采用二分类Logistic逐步回归分析MCI患者抑郁和焦虑症状的影响因素。结果　本次共调查1 587例社区老年人,诊断为MCI 342例（21.55%）,抑郁和焦虑症状的阳性检出率分别是38.9%（133/342）和34.2%（117/342）。单因素分析结果显示：不同年龄、月经济收入、经济满意度、饮酒、睡眠、MoCA-B评分MCI患者的抑郁症状阳性检出率比较,差异有统计学意义（P<0.05）;不同月经济收入、经济满意度、吸烟、饮酒、睡眠、慢性病种数MCI患者的焦虑症状阳性检出率比较,差异有统计学意义（P<0.05）。二分类Logistic逐步回归分析结果显示：年龄、月经济收入、经济满意度、饮酒、睡眠、MoCA-B评分6个变量是老年MCI患者抑郁症状的影响因素（P<0.05）;月经济收入、饮酒、睡眠3个变量是老年MCI患者焦虑症状的影响因素（P<0.05）。结论　社区老年MCI患者抑郁和焦虑症状检出率较高,老年MCI患者抑郁、焦虑症状的影响因素较多,今后需要针对相应危险因素行进一步的队列或干预研究。     

奥地利失智老人关怀照护对我国的启示

随着失智老人数量逐渐增多,其照护问题已成为社会关注的焦点。由于存在认知功能损害、行为精神异常,失智老人对关怀照顾有着更高的需求。本文在分析失智疾病特点及失智老人对人文关怀渴求的基础上,以奥地利阿尔伯特?史怀哲老年病健康中心失智老人关怀照护为例,从失智老人照护服务内容及方式、失智老人照护环境营造、多学科团队对失智老人的全方位关爱3方面进行介绍,得出失智老人关怀照护有利于提高失智老人照护的有效性及失智老人生活质量的结论。同时结合我国实际提出建议：为失智老人提供自主性、个性化、专业化的关怀照护;营造适合失智老人居住的人性化环境;提高失智照护人员的专业能力和关怀品质,为我国失智老人人性化整体照护提供参考和借鉴。     

TREM2: A Novel Potential Biomarker of Alzheimer's Disease

Alzheimer's disease (AD) is the most common type of neurodegenerative dementia worldwide[1]. Deposition of extracellular amyloid protein β (Aβ)-producing amyloid plaques and intracellular tau aggregation-comprising neurofibrillary tangles are two typical pathological features of this disease. Patients progress from mild cognitive impairment (MCI) to dementia of the Alzheimer type (DAT) typically within approximately five years[1]. There is a growing belief that AD is a heterogeneous disease affected by numerous factors, including age, genetic factors, and environmental factors. Although abundant research has been performed, effective prevention and treatment strategies for AD have yet to be developed[2]. Therefore, it is urgent to identify biomarkers of AD for early diagnosis.     

Cognitive impairment among the elderly Malays living in rural Malaysia

Cognitive impairment is a common psychiatric problem among the elderly. The objective of the study was to determine the prevalence of cognitive impairment among the elderly Malays living in a rural community in north Malaysia. A cross sectional study was conducted among the elderly population of 22 villages in north Malaysia. Elderly cognitive assessment questionnaire was used to determine the cognition status. Analysis was done using SPSS version 13. The prevalence of cognitive impairment among the older adults in these villages was 11% (n=46). There was an increasing prevalence of cognitive impairment with increasing age (p < 0.05). Being unmarried (OR 2.31), unemployed (OR 2.74) and living alone (OR 2.32) were significantly associated with the risk of being cognitively impairment. Being unemployed (OR 2.29) was a significant predictor variable for cognitive impairment. Similar to other studies conducted in Malaysia the prevalence of cognitive impairment was high.     

皮质下缺血性血管性痴呆

血管性痴呆是痴呆的第二种常见类型,皮质下缺血性血管性痴呆（SIVD）是血管性认知功能损害（VCI）最常见的亚型,是中老年认知功能损害和痴呆的常见原因。SIVD是由于脑部小血管疾病所致,包括小血管闭塞所致的多发性腔隙性梗塞（腔隙状态）和血管狭窄或/和低灌注所致的脑白质不完全性梗塞（脑白质疏松,Binswanger病）。本文就其发病机制、病理、分子生物学、神经生化、临床表现、诊断及治疗进行了综述。