多领域认知训练对社区轻度认知障碍老年人影响的随机对照研究

目的 探索多领域认知训练对社区轻度认知障碍(MCI)老年人的干预效果.方法 将120例研究对象按照区组随机化方法分为干预组(60例)和对照组(60例),干预组进行12周多领域认知训练,2次/周,60 min/次;干预前后采用可重复的成套神经心理状态测量(RBANS)、视觉匹配与推理测验、stroop字色干扰测验(CWST)、彩色数字连线测验(TMT)评定2组的认知功能并进行比较.结果 (1)干预前:干预组RBANS注意力因子分[(81.3±15.5)分]与对照组[(74.3±12.1)分]比较,差异有统计学意义(t=-2.37,P=0.02);其他测评指标2组比较差异均无统计学意义.(2)干预后:干预组与对照组RBANS总分[(86.4±12.6)分:(78.6±9.3)分;t=3.07,P=0.00]、即刻记忆[(83.4±14.1)分:(74.6±11.5)分;t=3.03,P=0.00]、空间结构[(95.7±14.3)分:(89.1±12.9)分;t=2.16,P=0.03]、延迟记忆等因子分[(91.8±17.4)分:(83.7±13.0)分;t=2.32,P=0.02],视觉匹配与推理[(5.2±1.9)分:(3.9±1.9)分;t=3.11,P=0.00],TMT测验1完成时间[(110.0±44.4)s:(130.5±45.1)s;t=-2.07,P=0.04]比较,差异有统计学意义.结论 多领域认知训练干预效果明显,依从性好,对社区MCI老年人的认知功能具有促进或保持作用.     

遗忘型轻度认知功能障碍的执行功能损害

目的探讨遗忘型轻度认知功能障碍患者执行功能变化的特点。方法依据Miyake的执行功能三因素模型(工作记忆、任务转换、反应抑制),使用E-prime软件对这三种执行功能核心成分编写检测任务:利用2-back任务和Keep-track任务检测工作记忆,Stop-signal任务和Stroop任务检测反应抑制,More-odd shift-ing任务检测任务转换能力。在34例遗忘型轻度认知功能障碍(amnestic mild cognitive impairement,aMCI)患者和31例正常老年人中进行这些任务的检测,比较两组间执行功能差异的特点。结果 aMCI组的执行功能比对照组显著降低(Wilks′λ=0.567,P﹤0.01)。除Stroop任务的数据两组间没有明显差异之外,aMCI组的2-back任务、Keep-track任务、Stop-signal任务、More-odd shifting任务的成绩均显著低于对照组(P<0.05),但这4种任务成绩下降的程度彼此间没有显著差异。结论aMCI阶段已经出现了执行功能的全面损害,三种执行功能核心成分均有受损。     

Neural correlates of attentional deficits in Parkinson's disease patients with mild cognitive impairment

IntroductionDeficits in attentional processing observed in Parkinson's disease (PD) patients with mild cognitive impairment (MCI) increase risk of PD dementia. However, the neural basis of these attentional deficits are presently unknown. The present study aimed to explore the neural correlates of attention dysfunction in PD-MCI using the Attention Network Test (ANT) and functional Magnetic Resonance Imaging (fMRI).MethodFifteen (15) PD-MCI patients, 26 PD patients without MCI (PD-NC) and 22 healthy controls (HC) were scanned (3T Siemens PRISMA) whilst performing the ANT. Reaction time, accuracy and fMRI BOLD activation were compared between groups for the three attentional task components of 1) alerting, 2) orienting, and 3) executive control.ResultsPD-MCI patients showed an overall slower reaction time compared to PD-NC and HC, and showed less interference of reaction time in the orienting effect than HC. fMRI data demonstrated greater activation in the bilateral cerebellum crus 1 during the alerting attention condition in both PD-MCI and PD-NC compared to HC. However, activation was supressed in the left postcentral gyrus in PD-MCI compared to PD-NC and HC.DiscussionAlterations in the alerting attention functional network despite intact task performance in PD-MCI suggests that functional brain changes may precede cognitive changes in the attention domain. Furthermore, increased activation in the cerebellum may reflect an attentional compensatory mechanism unique to the PD pathology. Taken together, the findings suggest that PD has a complex effect on attentional ability that can, at least in part, be elucidated using functional neuroimaging.     

脑白质病变相关性轻度认知功能障碍患者神经心理学特征分析

目的观察脑白质病变(WML)对轻度认知功能损害(mild cognitive impairment,MCI)患者神经心理学的影响。方法 WML-MCI患者和健康对照者进行常规核磁共振及神经心理学检查,观察WML对MCI患者神经心理学的影响,并对其机制进行探讨。结果 WML-MCI组与对照组相比,高血压、糖尿病和冠心病比例明显增高;词语流畅性测验、积木测验和画钟测验评分均明显降低(P<0.05);而2组间MMSE、数字广度测验和词语延迟回忆测验评分无明显差异。结论 WML影响MCI患者的认知功能,主要表现为视空间及执行功能。血管危险因素是MCI发病的危险因素。     

轻度认知障碍增加老年人跌倒风险机制及认知康复 干预措施的研究进展

轻度认知障碍是老年人跌倒的高危因素之一,其主要表现在患者的记忆力、注意力、运动及执行功能和日常生活能力的下降,从而显著增加患者跌倒的风险.而通过早期的康复干预可以减缓甚至是逆转轻度认知障碍的恶化,其可能成为轻度认知障碍老年患者预防跌倒有效的干预措施.     

Task switching capacities in persons with Alzheimer's disease and mild cognitive impairment

Task switching is an executive capacity that relies on a set of separate components implicating a fronto-parietal network of brain areas. In the present study, different components implicated in task switching were assessed in persons with Alzheimer's disease (AD), persons with mild cognitive impairment (MCI), and their matched healthy controls. The procedure implicated presentation of a two-digit stimulus, and task switching involved either conceptual or spatial switching. Global switching was measured by comparing blocks that involved non-switch trials to blocks that included switch trials, whereas local switching was measured by comparing performance across single trials in the switch blocks. Furthermore, the paradigm measured practice effects. Persons with AD showed larger local and global switch cost than healthy controls suggesting that their deficits encompass both reconfiguration of new action sets and maintenance of potentially relevant tasks within working memory. Importantly, the deficit was large in spatial switching but negligible in the conceptual condition. Persons with MCI only showed global switching impairment, suggesting a deficit restricted to the concurrent maintenance of two relevant task sets, and as in AD, this impairment was limited to spatial switching. Interestingly, persons with MCI, but not AD patients, improved their switching capacities upon practice. These findings indicate that switching deficit is selective in both MCI and AD persons, and is thus supportive of the notion that different mechanisms are involved in task switching. The pattern across condition is coherent with a continuum between those two clinical groups.     

轻度认知功能障碍患者的神经心理学研究

目的 探讨轻度认知功能障碍(MCI)患者神经心理学的特点. 方法 对42例MCI患者和55例健康对照者进行多项神经心理学检查,包括简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、临床痴呆评定量表(CDR)、语言流畅性测验(RVR)、韦氏智力测验(WAIS-RC)[包括数字广度测验(DS)、积木测验(BD)、相似性测验]、韦氏记忆测验(WMS-R)(包括逻辑记忆、联想学习、视觉再认、图片回忆)、日常生活能力量表(ADL),比较2组患者上述量表评分和MMSE、MoCA量表各亚项评分的差异.结果 与对照者比较,MCI患者MMSE、MoCA总分和RVR、WAIS-RC、WMS-R分测验,MoCA量表各亚项(地点定向力除外),MMSE量表中计算与注意、延迟回忆两亚项评分较低,差异均有统计学意义(P<0.05).结论 MCI患者不仅记忆受损,其计算与注意力、命名、视空间结构能力、执行功能也可受损,尤以延迟回忆、计算与注意力受损明显.MoCA涵盖了重要的认知领域,能较全面评估MCI患者的认知功能,值的临床推广应用.     

离退休老人轻度认知功能损害研究

目的：探讨离退休老人轻度认知功能损害(MCI)的发生率及其影响因素。方法：采用哈金斯基缺血指数(HIS)、简易智能状态检查(中文版)(MMSE)、Reisberg总体衰退量表(GDS)、日常生活活动能力(20项版本)(ADL)等，对420名离退休老人MCI的发生情况及其影响因素进行调查，分析相互问关系。结果：离退休老人中MCI的发生率为8．6％，随年龄的增长而有升高趋势，但各年龄组之间差异无显著性。结论：离退休老人中MCI较常见，应对老年人群进行MCI的监测和干预，阻止和延缓MCI发展为痴呆，提高老年人的寿命和生活质量。     

尼麦角林对轻度认知损伤患者的干预治疗分析

目的 采用尼麦角林对轻度认知损伤(MCI)患者进行治疗,观察其服药后的认知功能的变化.方法 入选31例MCI患者,尼麦角林组16例,口服尼麦角林10mg,3次/d,连续用药3个月,对照组15例,用药前后均行认知功能评定.结果 与对照组相比,尼麦角林组用药后词语即刻回忆,符号数字转换以及简易智力状态测查的成绩显著提高(P＜0.05).结论 服用尼麦角林对MCI患者的记忆力、注意力有一定改善,进而使MCI患者总体认知功能也有提高.     

Dissociation between top-down attentional control and the time course of visual attention as measured by attentional dwell time in patients with mild cognitive impairment

Studies of the time course of visual attention have identified a temporary functional blindness to the second of sequentially presented stimuli in that the attentional cost of attending to one visual stimulus may lead to impairments in identifying a second stimulus presented within 500 ms of the first. This phenomenon is known as the attentional blink or attentional dwell time. The neural correlates of the attentional blink and its relationship to mechanisms that control attention are unknown. To examine this relationship we tested healthy controls and subjects in the preclinical stage of Alzheimer's disease, known as mild cognitive impairment (MCI), on a paradigm which affords quantification of both the attentional blink and the top-down control of attention. When subjects were asked to identify both a number and a letter that were rapidly and sequentially presented on a visual display, the detrimental effect that identifying the first stimulus had on the ability to identify the second served as a measure of the attentional blink. When asked to identify only one of the two stimuli, the ability to ignore the first stimulus was a function of their top-down attentional control. The MCI subjects demonstrated a normal attentional dwell time but in contrast they showed impaired top-down attentional control within the same paradigm. This dissociation suggests that these two aspects of visual attention are subserved by different neural systems. The possible neural correlates of these two attentional functions are discussed.     

社区老年轻度认知损害者自我效能的研究

目的探索社区老年轻度认知损害者的自我效能特点及其与躯体状况、个性的关系。方法调查对象为社区中60岁以上的老人，共168名，其中，正常认知功能组93名，轻度认知功能损害组（MCI）75名。分别采用自编问卷（包括人口学资料）、躯体疾病清单、自我效能量表、个性指数问卷和MMSE进行测评。结果①两组间自我效能总分及保持健康、乘车、生活安排、生产力能力等项目均有显著性差异。②自我效能分别与躯体疾病指数及个性指数各不同分项显著相关。结论轻度认知功能损害者具有较低水平的自我效能，其可能受到躯体状态及个性特征的影响。     

遗忘型轻度认知障碍内隐记忆启动效应的研究

目的探讨遗忘型轻度认知障碍患者(aMCI)内隐记忆概念性启动和知觉性启动损害的特征。方法采用分类产生和图片辨别对35例aMCI患者和35名正常老年人的内隐记忆(概念性启动和知觉性启动)进行测试,同时进行外显记忆(即刻回忆、延时回忆、延时再认)和其他神经心理学背景测试,并进行组间比较和分析。结果与正常老年组相比,aMCI患者组即刻回忆、延时回忆、延时再认、概念性启动成绩均差于正常对照组(P0.01)。两组在知觉性启动成绩差异无统计学意义(P0.05)。患者组概念性启动成绩与词汇流畅性成绩呈正相关(r=0.74,P0.01)。结论aMCI患者外显记忆及内隐记忆的概念性启动存在损害,且其概念性启动损害可能与其额叶功能减退存在一定的相关性。     

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.     

Prospective memory on a novel clinical task in older adults with mild cognitive impairment and subjective cognitive decline

Despite the relevance of prospective memory to everyday functioning and the ability to live independently, prospective memory tasks are rarely incorporated into clinical evaluations of older adults. We investigated the validity and clinical utility of a recently developed measure, the Royal Prince Alfred Prospective Memory Test (RPA-ProMem), in a demographically diverse, non-demented, community-dwelling sample of 257 older adults (mean age = 80.78?years, 67.7% female) with amnestic mild cognitive impairment (aMCI, n = 18), nonamestic mild cognitive impairment (naMCI, n = 38), subjective cognitive decline (SCD, n = 83) despite intact performance on traditional episodic memory tests, and healthy controls (HC, n = 118). Those with aMCI and naMCI performed significantly worse than controls on the RPA-ProMem and its subtasks (time-based, event-based, short-term, long-term). Also, those with SCD scored significantly lower than controls on long-term, more naturalistic subtasks. Additional results supported the validity and inter-rater reliability of the RPA-ProMem and demonstrated a relation between test scores and informant reports of real-world functioning. The RPA-ProMem may help detect subtle cognitive changes manifested by individuals in the earliest stages of dementia, which may be difficult to capture with traditional episodic memory tests. Also, assessment of prospective memory can help guide the development of cognitive interventions for older adults at risk for dementia.     

Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors

BACKGROUND: Individuals who have Mild Cognitive Impairment (MCI) may be in a transitional stage between aging and Alzheimer's disease (AD). The high rate of conversion from MCI to AD makes early treatment an important clinical issue. Recent evidence suggests that cognitive training intervention may reduce the rate of progression to AD. OBJECTIVES: To evaluate the efficacy of a NeuroPsychological Training (TNP) in patients with MCI who are treated with cholinesterase inhibitors (ChEIs), compared with patients MCI treated only with ChEIs and patients not treated, in a longitudinal, one year follow-up study. METHODS: One year longitudinal and retrospective comparison study of neuropsychological performances in 59 subjects affected by Mild Cognitive Impairment (MCI) according to Petersen's criteria. Fifteen subjects were randomised to receive TNP plus cholinesterase inhibitors; 22 subjects cholinesterase inhibitors alone and 22 subjects no treatment. All the subjects referring memory complaints, corroborated by an informant, underwent a multidimensional assessment concerning neuropsychological, behavioural and functional characteristics, at baseline and after one year follow-up. RESULTS: Subjects without treatment maintained their cognitive, functional and behavioural status after one year; patients treated only with ChEIs improved in depressive symptoms whereas subjects treated with TNP and ChEIs showed significant improvements in different cognitive areas, such as memory, abstract reasoning and in behavioural disturbances, particularly depressive symptoms. CONCLUSIONS: A long-term TNP in ChEIs-treated MCI subjects induces additional cognitive and mood benefits.     

部分前循环脑梗死与遗忘型轻度认知功能损害患者认知功能的对比研究

目的 比较部分前循环脑梗死(partial anterior circulation infact,PACI)和遗忘型轻度认知损害(amnesic mild cognitive impairment,aMCI)患者的认知损害的特点.方法 选择29例符合牛津社区卒中项目(Oxford Community Stroke Droject,OCSP)分型的PACI患者,35例符合Petersen 诊断标准的aMCI患者,以及60例健康老年人为对照组,采用认知功能筛选测验-C2.1(Cognitive Ability Screening Instrument-C2.1,CASI)评定认知功能.结果 PACI组(86.28±12.04)和aMCI组(89.86±6.03)的CASI总分均比正常对照组(95.57±3.44)低,差异具有统计学意义[F(2)=8.547,P<0.05],而PACI组与aMCI组间无统计学差异.在CASI分领域方面,与对照组相比,PACI组在心算力(P=0.000)和定向力(P=0.021)两方面均较差;与aMCI组比较,PACI组的心算力(P=0.000)较aMCI组差,而短时记忆(P=0.016)和思维流畅性(P=0.005)方面则较好.aMCI组与对照组相比,在短时记忆(P=0.000)、抽象与判断能力(P=0.013)和思维流畅性(P=0.001)方面均较差.结论 PACI患者存在认知损害,尤其在心算力和定向力方面,与aMCI患者相比,可能更好地保留了执行功能,推测缺血性脑卒中与神经退行性变引起的认知损害可能涉及不同认知领域.     

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。     

Olfactory screening test in mild cognitive impairment

Abstract Mild cognitive impairment (MCI) is a transient status between physiologic ageing and dementia. Each year more than 12% of subjects with MCI develop Alzheimer’s disease. This study evaluated the presence of an olfactory deficit in amnesic MCI (aMCI) patients. Twenty–nine patients diagnosed with aMCI and a homogeneous control group of 29 subjects were enrolled in the study. Olfactory function was assessed by the Sniffin’ Sticks Screening Test (SSST) and the Mini Mental State Examination, the Clinical Dementia Rating, the Geriatric Depression Scale and the Mental Deterioration Battery were used to evaluate the neurocognitive status. aMCI patients showed a significant impairment of their olfactory identification compared to controls (SSST score: 8.3±2.1 vs. 10.8±0.9; p<0.001). These results suggest that olfactory tests should be part of the diagnostic armamentarium of pre–clinical dementia. A long–term follow up might confirm the olfactory identification function as an early and reliable marker in the diagnosis of pre–clinical dementia.     

2型糖尿病患者轻度认知功能障碍的临床分析

目的探讨2型糖尿病患者轻度认知功能障碍的特点。方法将122例2型糖尿病患者分为伴2型糖尿病轻度认知功能障碍组(45例)、不伴2型糖尿病轻度认知功能障碍组(41例)和对照组(36例),使用蒙特利尔认知评估量表(montreal cognitive assessme,MoCA)对患者的命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆进行评分评估。结果与对照组比较,伴2型糖尿病轻度认知功能障碍组在命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆等评分比较差异具有统计学意义(P0.01)。与不伴2型糖尿病MCI组比较,伴2型糖尿病MCI组在总分、视空间/执行功能、注意、持续注意、延迟回忆等评分2组间差异有统计学意义(P0.05)。结论伴2型糖尿病的MCI患者在命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆等方面有不同程度的损害;其总体认知功能损害较不伴2型糖尿病者严重,尤其在视空间/执行能力、注意、持续注意及记忆方面。     

Neuropsychological markers of mild cognitive impairment: A clinic based study from urban India

Background:

Mild cognitive impairment (MCI) is a transitional stage between normal aging and dementia. Persons with MCI are at higher risk to develop dementia. Identifying MCI from normal aging has become a priority area of research. Neuropsychological assessment could help to identify these high risk individuals.

Objective:

To examine clinical utility and diagnostic accuracy of neuropsychological measures in identifying MCI.

Materials and Methods:

This is a cross-sectional study of 42 participants (22 patients with MCI and 20 normal controls [NC]) between the age of 60 and 80 years. All participants were screened for dementia and later a detailed neuropsychological assessment was carried out.

Results:

Persons with MCI performed significantly poorer than NC on word list (immediate and delayed recall), story recall test, stick construction delayed recall, fluency and Go/No-Go test. Measures of episodic memory especially word list delayed recall had the highest discriminating power compared with measures of semantic memory and executive functioning.

Conclusion:

Word list learning with delayed recall component is a possible candidate for detecting MCI from normal aging.