Is cognitive impairment a risk factor for poor compliance among Japanese elderly in the community?

OBJECTIVE: The association between cognitive impairment and compliance with prescribed medications was investigated among functionally independent Japanese elderly in the community. SUBJECTS: The subjects of this study were 220 elderly persons aged 60 years and over, who lived in the community. All participants were taking a regimen of one or more prescribed drugs. We included elderly with mild to moderate cognitive impairment. Medication use was observed by pharmacist-conducted interviews during home visits. Compliance was estimated by the pill count method. The Mini-Mental State Examination (MMSE) was used to estimate cognitive function. RESULTS: The mean age (SD) of the subjects was 75.7 (6.9) years. Of the subjects, 58 (26.4%) were cognitively impaired (MMSE < or = 23), and 76 (34.6%) exhibited poor compliance (rate of compliance< 80%). Poor compliance was associated with the subjects who had a lower education level, had lower MMSE scores, had concern about taking drugs, who intentionally self-selected (intentional noncompliance) prescribed drugs, had a poor relationship with a physician, who did not have one dose package, and those who did not use a medical calendar. In multiple logistic regression analyses, intentional noncompliance (OR 19.65, 95%, CI 9.22-41.92; OR, odds ratio; CI, confidence interval), cognitive impairment (MMSE < or = 23; OR 2.94, 95%, CI 1.32-6.58), and a poor relationship with a physician (OR 6.24. 95%, CI 1.55-25.20) were independent predictors of poor compliance for elderly in the community. CONCLUSION: We found that cognitive impairment was one of the predictors for poor compliance among the elderly who are functionally independent in the community. Intentional noncompliance was the strongest predictor for poor compliance, which was influenced by the relationship between patient and physician. Physicians should establish good communication with their elderly patients and provide some support to compensate for cognitive impairment.     

Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID Study

OBJECTIVES: To measure the association between the use of drugs with anticholinergic properties and cognitive performance in an elderly population, the PAQUID cohort. METHODS: The sample studied was composed of 1780 subjects aged 70 and older, living at home in South western France. Data on socio-demographic characteristics, medical history and drug use were collected using a standardized questionnaire. Cognitive performance was assessed using the following neuropsychological tests: the Mini-Mental State Examination (MMSE) which evaluates global cognitive functioning, the Benton Visual Retention Test (BVRT) which assesses immediate visual memory, and the Isaacs' Set Test (IST) which assesses verbal fluency. For each test, scores were dichotomized between low performance and normal to high performance using the score at the 10th percentile of the study sample as the cut-off point, according to age, gender and educational level. The association between the use of drugs with anticholinergic properties and cognitive performance was examined using logistic regression models, adjusting for several potential confounding factors. RESULTS: About 13.7% of the subjects used at least one drug with anticholinergic properties. In multivariate analyses, the use of these drugs was significantly associated with low performance in the BVRT [odds ratio (OR) = 1.6; 95% confidence interval (CI) 1.1, 2.3] and in the IST (OR = 1.9; 95% CI 1.3, 2.8). The association found with low performance in the MMSE (OR = 1.4; 95% CI 1.0, 2.1) was barely statistically significant. CONCLUSION: These findings suggest that the use of drugs with anticholinergic properties is associated with low cognitive performance among community-dwelling elderly people.     

Subclinical hypothyroidism and cognitive dysfunction in the elderly

While overt hypothyroidism is associated with reversible dementia in the elderly, the relationship of subclinical hypothyroidism with cognition remains a controversial issue. Our aim was to investigate the correlation between subclinical hypothyroidism and cognition in the elderly, with particular reference to long term memory and selective attention. We selected 337 outpatients (177 men and 160 women), mean age 74.3 years, excluding the subjects with thyroid dysfunction and those treated with drugs influencing thyroid function. The score of Mini Mental State Examination (MMSE) was significantly lower in the group of patients with subclinical hypothyroidism than in euthyroid subjects (p < 0.03). It was observed that patients with subclinical hypothyroidism had a probability about 2 times greater (RR = 2.028, p < 0.05) of developing cognitive impairment. Prose Memory Test (PMT) score resulted significantly lower in subjects with subclinical hypothyroidism (p < 0.04). Considering the Matrix Test (MT) score, the performance was slightly reduced in subclinical hypothyroidism (NS). Furthermore, TSH was negatively correlated with MMSE (p < 0.04), PMT (p < 0.05) and MT score (NS). No correlation was found between FT4 and FT3 and MMSE, PMT and MT score. In the elderly, subclinical hypothyroidism is associated with cognitive impairment, and its impact on specific aspects of cognition (long term memory and selective attention) is less evident.     

嗅觉障碍检测对轻度认知功能损害诊断价值的研究

目的探讨在中老年（50岁以上）人群中嗅觉障碍检测对轻度认知功能损害诊断的价值。方法运用简易智能状态检查（MMSE）对研究人群进行认知功能检查,根据MMSE结果将受试人群分为可能MCI组（n=19）和正常对照组（n=46）。采用气味感知阈试验、气味识别试验、气味再记忆试验等对受试者进行嗅觉功能检测。结果可能MCI组的气味感知阈值（P〈0.01）、气味识别（P〈0.01）和气味再记忆功能（P〈0.05）较正常对照组差;相关分析显示,MMSE总分与气味识别之间有显著的相关性（r=0.299,P〈0.05）。结论 MCI患者存在嗅觉功能损害,嗅觉障碍是MCI的简单反映;嗅觉的气味识别可以作为早期筛查认知功能损害的方法之一。     

Associations between use of benzodiazepines or related drugs and health, physical abilities and cognitive function: a non-randomised clinical study in the elderly

OBJECTIVE: To describe associations between the use of benzodiazepines or related drugs (BZDs/RDs) and health, functional abilities and cognitive function in the elderly. METHODS: A non-randomised clinical study of patients aged > or =65 years admitted to acute hospital wards during 1 month. 164 patients (mean age +/- standard deviation [SD] 81.6 +/- 6.8 years) were admitted. Of these, nearly half (n = 78) had used BZDs/RDs before admission, and the remainder (n = 86) were non-users. Cognitive ability was assessed by the Mini-Mental State Examination (MMSE). Patients scoring > or =20 MMSE sum points were interviewed (n = 79) and questioned regarding symptoms and functional abilities during the week prior to admission. Data on use of BZDs/RDs before admission, current medications and discharge diagnoses were collected from medical records. Health, physical abilities and cognitive function were compared between BZD/RD users and non-users, and adjustments were made for confounding variables. The residual serum concentrations of oxazepam, temazepam and zopiclone were analysed. RESULTS: The mean +/- SD duration of BZD/RD use was 7 +/- 7 years (range 1-31). Two or three BZDs/RDs were concomitantly taken by 26% of users (n = 20). Long-term use of these drugs was associated with female sex and use of a higher number of drugs with effects on the CNS, which tended to be related to diagnosed dementia. After adjustment for these variables as confounders, use of BZDs/RDs was not associated with cognitive function as measured by the MMSE. However, use of BZDs/RDs was associated with dizziness, inability to sleep after awaking at night and tiredness in the mornings during the week prior to admission and with stronger depressive symptoms measured at the beginning of the hospital stay. Use of BZDs/RDs tended to be associated with a reduced ability to walk and shorter night-time sleep during the week prior to admission. A higher residual serum concentration of temazepam correlated with a lower MMSE sum score after adjustment for confounding variables. CONCLUSIONS: Long-term use and concomitant use of more than one BZD/RD were common in elderly patients hospitalised because of acute illnesses. Long-term use was associated with daytime and night-time symptoms indicative of poorer health and potentially caused by the adverse effects of these drugs.     

Cognitive impairment as determinant for sub-optimal control of oral anticoagulation treatment in elderly patients with atrial fibrillation

BACKGROUND AND OBJECTIVE: Atrial fibrillation is an indication for oral anticoagulation treatment. Maintaining the International Normalized Ratio (INR) within the therapeutic range minimises thromboembolic and bleeding complications. We have investigated whether cognitive capacity affects control of anticoagulation in elderly patients with atrial fibrillation. PATIENTS AND METHODS: A retrospective study was conducted to investigate the association between cognitive impairment and control of anticoagulation. Patients > or =70 years of age with atrial fibrillation using acenocoumarol (nicoumalone) as anticoagulant were included. All patients were monitored by the Anticoagulation Clinic in the Midden-Brabant region in the Netherlands. The cognitive function of all patients was assessed using the Mini-Mental State Examination (MMSE) on the index date. INR values were obtained from the year preceding the index date. Patients with an MMSE score <23 were defined as cognitively impaired. The primary outcome of the study was the incidence of an INR value within the therapeutic range of 2.0-3.4 during < or =70% of treatment time in the year prior to the cognitive function assessment. The secondary endpoint was the number of patients with an INR <2.0 or > or =6.0 at least once during this year. Logistic regression analysis was used to evaluate the association between cognitive function and control of anticoagulation. RESULTS: A total of 152 patients were included in the study. An MMSE score <23 was associated with an inadequate INR control (odds ratio [OR] 2.77; 95% CI 1.13, 6.74). After correction for hospital admission and change of possibly interacting medication (both also associated with inadequate INR control), this association remained statistically significant. Significantly more patients with an MMSE score <23 had one or more INR values of six or higher (OR 3.06; 95% CI 1.14, 8.18). CONCLUSION: In elderly people with atrial fibrillation using oral anticoagulation, an MMSE score <23 is independently associated with an inadequate INR control, mainly because of an increased number of supratherapeutic INR values. This finding should be taken into account when making decisions about use of oral anticoagulants in the elderly.     

认知功能障碍与同型半胱氨酸水平的关系研究

目的探讨老年人认知功能障碍与血浆同型半胱氨酸(Hcy)水平的关系。方法收集102例认知功能障碍老年患者为病例组,收集40例认知功能正常老年人为对照组;采用简易精神状态量表(MMSE)评分,将病例组分为轻度认知功能障碍(MCI)组52例和痴呆组50例,痴呆组其中老年性痴呆(AD)13例和血管性痴呆(VD)37例;各组均检测血浆Hcy水平,进行组间比较,血浆Hcy浓度与MMSE评分进行相关性分析。结果病例组血浆Hcy水平显著高于对照组(P<0.01),痴呆组血浆Hcy水平显著高于MCI组(P<0.01);痴呆组血浆Hcy水平与MMSE评分呈明显负相关(P<0.01)。结论老年人认知功能障碍与高Hcy有关,而且认知障碍程度与血浆Hcy水平增高程度密切相关,高Hcy是老年人认知功能障碍的一个危险因素。     

Higher anticholinergic drug scale (ADS) scores are associated with peripheral but not cognitive markers of cholinergic blockade. Cross sectional data from 21 Norwegian nursing homes

AimThis study evaluated a presumed gradual decline in cognitive function in nursing home residents when the anticholinergic drug scale (ADS) score increased above 3.MethodThe study population was recruited from 21 nursing homes in Norway. Criteria for inclusion were ADS score ≥ 3 and no severe dementia, defined as Clinical Dementia Rating (CDR) score < 3. Primary cognitive end points were CERAD 10‐word lists for recall and Mini Mental State Examination (MMSE). Secondary end points were activity of daily living (ADL), mouth dryness and serum anticholinergic activity (SAA). The patients were stratified into subgroups according to ADS score, i.e. a reference group with score 3 and test groups with scores 4, 5 or ≥6. End points were compared by analyses of covariance (ancova).ResultsOverall, 230 of the 1101 screened nursing home residents (21%) had an ADS score ≥3. After exclusion 101 residents were recruited and among these, 87 managed to participate in the study. No significant differences were detected in cognitive function or ADL when ADS increased above 3 (P > 0.10), but in vivo (mouth dryness) and in vitro (SAA) measures of peripheral anticholinergic activity were significantly higher in patients with an ADS score ≥6 (P < 0.01).ConclusionThe present study does not support a progressive decline in cognitive function with ADS score above 3. This might indicate that the ADS score model has limited potential to predict the clinical risk of central anticholinergic side effects in frail elderly patients receiving multiple anticholinergic drugs.     

The use of the mini-mental state examination in recruitment for substance abuse research studies

BACKGROUND: Substance abuse is associated with cognitive impairment. Participation in clinical addiction research can be cognitively demanding. Screening tools can identify cognitively impaired subjects. We examined the use of the mini-mental state examination (MMSE) as an entry criterion in three randomized controlled substance abuse clinical trials. METHODS: In each of the three studies, we calculated the proportion of subjects excluded due to MMSE scores (<21) suggestive of cognitive impairment. We estimated the potential impact on enrollment based on the number of excluded subjects. Separately, for two of the studies, we assessed the impact of cognitive function on participation in follow-up using multivariable logistic regression. RESULTS: Of all persons screened for enrollment, 1.6% (171/10,791) were ineligible based solely on a MMSE score of <21. We estimate that 119 of these 171 ineligible persons would have consented and enrolled. These 119 persons would have represented 9.3% of all enrolled subjects across these studies. For subjects in a study in an inpatient detoxification unit, a higher MMSE score was associated with higher odds (adjusted odds ratio 1.15, 95% CI 1.03-1.30) of completing at least one follow-up assessment. A similar impact on subject follow-up was not observed in a study of medical inpatients with unhealthy alcohol use (adjusted odds ratio 1.01, 95% CI 0.86-1.20). CONCLUSION: Screening for cognitive impairment using the MMSE excludes a small, but substantial, number of persons from addiction research studies. Cognitive ability, as captured by the MMSE may impact follow-up. These data support cognitive screening of substance abuse research subjects.     

手指健智操治疗老年轻度认知功能障碍的效果

目的 探讨手指健智操对老年轻度认知功能障碍患者的临床疗效及其对脑血流的影响.方法 将120例老年轻度认知功能障碍患者按照随机数字表法分为对照组与观察组,各60例.对照组予银杏叶片治疗,观察组在对照组的基础上予手指健智操辅助治疗,进行1年随访观察.采用经颅内多普勒(TCD)检查脑血流异常情况;采用简易精神状态检查量表(MMSE)、日常生活能力评定量表(ADL)进行认知功能量化评价.结果 观察组总有效率为78.33％,而对照组为58.33％,提示观察组疗效明显优于单纯常规药物治疗对照组,两组比较差异有统计学意义(P＜0.05).同时,观察组患者MMSE与ADL均低于对照组,且其较治疗前改善差值亦明显优于对照组(P＜0.05).再者,观察组患者1年后TCD存在1项或以上异常的有31例(31/60,51.67％),明显优于对照组53例(53/60, 88.33％),差异有统计学意义(P＜0.05).结论 手指健智操能够有效地辅助治疗CMI患者.通过改善其脑代谢功能,减缓遗忘型损害的发生与发展,具有安神益智的功效,方法简便,值得推广.     

奥拉西坦和吡拉西坦治疗老年脑出血后认知功能障碍的疗效比较

目的 比较奥拉西坦和吡拉西坦治疗老年脑出血后认知功能障碍的临床疗效和安全性。方法 上海中冶职工医院2012年2月—2013年12月收治的老年脑出血患者104例,随机分为对照组和治疗组,每组各52例。对照组口服吡拉西坦片,4片/次,3次/d。治疗组口服奥拉西坦胶囊,2粒/次,3次/d。两组均持续治疗6个月。分别于治疗前后采用蒙特利尔认知评估（MoCA）量表、简易智能精神状态检查（MMSE）量表和日常生活活动（ADL）量表进行认知功能评定。结果 治疗后,两组MoCA、MMSE量表的项目评分均较治疗前显著提高,同组治疗前后差异有统计学意义（P<0.05）;治疗后,治疗组MoCA量表中执行功能、计算评分高于对照组;治疗组MMSE量表中即刻回忆力、注意计算力、语言能力、总分均高于对照组,两组比较差异有统计学意义（P<0.05）。两组不良反应发生率比较差异无统计学意义。结论 奥拉西坦较吡拉西坦可更好的改善老年脑出血后患者的认知功能障碍,且不良反应较少,具有良好的临床疗效和安全性。     

不同麻醉方式对老年创伤患者术后早期认知功能的影响

目的 探讨不同麻醉方式对老年创伤患者术后早期认知功能的影响.方法 选取2010年12月～2012年12月本院就诊的老年股骨手术患者59例,随机分为观察组（29例）和对照组（30例）,观察组行单侧腰-硬联合麻醉,对照组行全身麻醉.观察两组手术前后简易精神状况检查（MMSE）评分、术后认知功能障碍（POCD）发生率及血清神经元特异性烯醇化酶（NSE）、S100B、Aβ的变化.结果 两组患者手术前后MMSE评分比较,差异有统计学意义（P＜0.05）,术后观察组MMSE评分显著高于对照组（P＜0.05）.观察组术后POCD发生率与对照组比较,差异有统计学意义（P＜0.05）.观察组术后1、4d血清NSE、S100B、Aβ均低于对照组（P＜0.05）.结论 全身麻醉对于老年创伤患者具有较严重的早期认知功能损伤,应用腰-硬联合麻醉可以极大降低老年POCD的发生率.     

Impact of inappropriate drug use on physical performance among a frail elderly population living in the community

Objective The criteria for inappropriate drug use developed by Beers have been widely used in drug utilization reviews to assess the quality of prescribing, but there is still inconclusive evidence that these criteria can impact on patient outcomes. The aim of the present study was to evaluate the relationship between the use of inappropriate drugs and measures of physical performance, muscle strength and functional status in an elderly population (80+ years). Methods Data are from the baseline evaluation of 364 subjects enrolled in the ilSIRENTE study, a prospective cohort study performed in a mountain community living in the Sirente geographic area (L’Aquila, Abruzzo) in Central Italy. Physical performance was assessed using the physical performance battery score (SPPB), which is based on three timed tests: 4-m walking speed, balance and chair stand tests. Muscle strength was measured by hand grip strength. Inappropriate drug use was defined by the 2003 Beers criteria. Analyses of covariance were performed to evaluate the relationship of inappropriate drugs with physical function. Results In the unadjusted model, all of the physical performance, muscle strength and functional measures showed significant associations with inappropriate drug use. Following adjustment for potential confounders, which included age, gender, physical activity level, cognitive performance scale, comorbidity, lung diseases and diabetes, these associations were still statistically significant for the physical performance battery score [non-users inappropriate drugs: 7.0; standard error (SE): 0.1; users inappropriate drugs: 6.1; SE: 0.2; p = 0.007] The 4-m walking speed, physical performance battery score and Total Activities of Daily Living (ADL) scale score showed worsening results among subjects using two inappropriate medications compared with subjects using one inappropriate drug or none at all. Conclusions The use of inappropriate medication (as defined by Beers 2003 criteria) was found to be common among the elderly Italian study cohort living in the community. Our results suggest that among old–old subjects the use of inappropriate drugs is associated with impaired physical performance.     

Relation between comprehensive-geriatric assessment and the ability of self-administration in elderly diabetic patients

Intellectual ability of self-administration plays a crucial role in a diabetes regimen. However, in many cases, self-administration is considered difficult, because of the impairment of activities of the individual's daily living (ADL), instrumental ADL and cognitive function. To assess comprehensive-geriatric-assessment (CGA) in elderly diabetic sufferers, 62 elderly inpatients and outpatients aged over 70 years were investigated. CGA includes Barthel index (BI), Mini-mental-state-examination (MMSE) and the Tokyo Metropolitan Institute of Gerontology index of competence (TMIGIC). The relation of ability to self-administer and CGA was examined. In oral therapy, there was significant difference between self-administration and non-self-administration in MMSE (p=0.0065), BI (p=0.0219) and TMIGIC (p=0.0053). Among these indexes, TMIGIC was the most sensitive index in oral therapy. In insulin therapy, there was also significant difference between self-administration and non-self-administration: MMSE (p=0.00042), BI (p=0.000019) and TMIGIC (p=0.0019). Among these indexes, BI was the most sensitive index in insulin therapy. It was suggested that CGA was useful to assess the ability of self-administration in elderly diabetic patients.     

术中低血压与血压波动对老年患者术后认知功能的影响

目的 研究老年患者在非心脏手术过程中，血压变化对术后认知功能障碍（POCD）的影响。方法 选择2014年9月至2015年9月在安徽省立医院接受非心脏手术的74例老年患者，按照术中血压变化情况分为低血压组、血压波动组和正常血压组，分析3组患者麻醉时间、手术时间、术中血压情况等。术前、术后第1天、第3天采用简易精神状态量表（MMSE）对患者进行POCD评定。结果 3组患者麻醉时间、手术时间的差异无统计学意义（P>0.05）。血压波动组患者术后第1天MMSE评分显著低于术前，且显著低于正常血压组和低血压组术后第1天MMSE评分，差异有统计学意义（P<0.05），术后第3天MMSE评分结果基本恢复术前水平。结论 术中血压波动与POCD的发生存在一定联系，而术中低血压与POCD无关。     

丙泊酚对老年患者全麻手术后PODC的影响

目的：研究全麻对老年患者认知功能的影响。方法：15例患者麻醉诱导均采用静脉注射丙泊酚1.5～2.0mg/kg。记录术前、插管5min、切皮、拔管5min、术后1、4、24、48h患者收缩压变化,并于术前及术后1、4、24、48h,采用简易智力状态检查（mini-mental state examination,MMSE）评估患者的认知功能。记录患者的手术时间、出血量、输血量和输液量。结果：试验纳入患者15例,全部进入结果分析,中途无脱落。记录患者的手术时间,术中输血、输液量及出血量,各观察点收缩压以及患者自控镇痛效果,视觉模拟评分组间比较。术后1、4hMMSE评分均较术前明显下降。术后24h及48h两组MMSE评分与术前比较,差异无统计学意义。结论：接受全身麻醉的患者采用MMSE评估认知功能,患者术后短期内均出现认知功能的降低。     

尼麦角林联合加兰他敏治疗老年卒中后认知障碍的疗效及其对血清SOD、MDA、NSE水平的影响

目的 探讨尼麦角林联合加兰他敏治疗老年卒中后认知障碍（PSCI）的临床疗效及其对血清超氧化物歧化酶（SOD）、丙二醛（MDA）、神经元特异性烯醇化酶（NSE）水平的影响。方法 选取2016年6月-2019年12月保定市第一中心医院收治的130例老年PSCI患者作为研究对象,根据治疗方法将患者随机分成对照组（n=65）和观察组（n=65）。对照组口服氢溴酸加兰他敏片,起始剂量为4 mg/次,2次/d,于早、晚餐后服用;当受试者能良好耐受时,在连用4周后将剂量调整至8 mg/次,2次/d。观察组在对照组的基础上口服尼麦角林片,20 mg/次,3次/d,餐前温开水送服。连续治疗8周后评估两组疗效。比较两组治疗前后认知功能[蒙特利尔认知评估量表（MoCA）和简易精神状态检查表（MMSE）评分]、日常生活能力[日常生活能力量表（ADL）评分]、脑血流动力学参数[双侧大脑中动脉（MCA）及大脑前、后动脉（ACA和PCA）的平均血流速度（V_m）]及血清SOD、MDA和NSE水平的变化情况。结果 治疗后,观察组总有效率为92.3%,显著高于对照组的76.9%（P<0.05）。治疗后,两组MoCA、MMSE评分均显著增高,ADL评分则显著降低（P<0.05）;治疗后,观察组相关量表（MoCA、MMSE、ADL）评分的改善效果均显著优于对照组（P<0.05）。治疗后,观察组治疗后颅内各动脉（MCA、ACA和PCA）的V_m均显著增快（P<0.05）,且显著快于对照组（P<0.05）。治疗后,两组血清SOD水平均显著高于治疗前,血清MDA、NSE水平显著下降（P<0.05）;且治疗后,观察组血清SOD水平较对照组显著升高,而血清MDA、NSE水平均显著降低（P<0.05）。结论 尼麦角林联合加兰他敏治疗老年PSCI的整体疗效确切,可明显改善老年患者的认知功能障碍,提高其日常生活能力,其作用机制可能是通过显著改善老年患者局部脑血流灌注、纠正机体氧化应激状态的方式来实现的。     

妥泰与丙戊酸钠对癫痫患者认知功能影响的对比研究

目的:评价妥泰与丙戊酸钠对癫痫患者认知功能的影响。方法:将88例癫痫患者随机均分为妥泰组(治疗组)与丙戊酸钠组(对照组),利用简易精神状态检查量表(MMSE)、事件相关电位P300,分别于治疗前、用药4wk、用药8wk及用药6mo后对患者认知功能进行神经心理学和电生理学评估。结果:治疗组在用药4wk及8wk时与用药前比较,MMSE分值明显下降,P3潜伏期明显延长(P<0·01),而治疗前和用药6mo时各项指标比较无差异;对照组仅在用药8wk时MMSE分值明显下降,P3潜伏期明显延长(P<0·01)。结论:妥泰及丙戊酸钠均可引起癫痫患者认知功能障碍,认知功能障碍多发生于加量期,这种药物引起的认知功能障碍具有可逆性。     

脑卒中后遗症期伴牙周炎老年患者外周血炎症标志物水平变化及其与认知功能的相关性研究#br#

目的　探讨脑卒中后遗症期伴牙周炎老年患者外周血炎症标志物水平变化及其与认知功能的相关性。方法　选择脑卒中后遗症期伴牙周炎老年患者68例,均接受牙周炎规范治疗。根据治疗6个月后是否持续存在牙周炎分为持续组（33例）与治愈组（35例）,对比2组治疗前后血清C反应蛋白（CRP）、白细胞介素（IL）-10、肿瘤坏死因子（TNF）-α水平和简易智力状态检查（MMSE）评分、老年性痴呆评定量表-认知分量表（ADAS-cog）评分的变化。采用Spearman相关分析探讨所有患者治疗前后CRP、IL-10、TNF-α的变化值与MMSE评分、ADAS-cog评分变化值的相关性;采用多元线性回归分析探讨治疗前后MMSE评分、ADAS-cog评分变化值的影响因素。结果　治疗6个月后,持续组患者CRP、IL-10及TNF-α水平明显高于治愈组（P＜0.05）。与治疗前比较,治疗6个月后,持续组患者的CRP、IL-10及TNF-α水平明显升高,治愈组患者的CRP明显降低（P＜0.05）。治疗6个月后,持续组患者MMSE评分及ADAS-cog评分明显低于治愈组（P＜0.05）。与治疗前比较,持续组患者治疗6个月后MMSE评分及ADAS-cog评分明显降低（P＜0.01）。所有患者治疗前后CRP、IL-10、TNF-α的变化值与MMSE评分、ADAS-cog评分的变化值呈负相关。多元线性回归分析结果显示,牙周炎持续存在是MMSE评分、ADAS-cog评分治疗前后变化值的独立影响因素（P＜0.05）。结论　牙周炎与脑卒中后遗症期老年患者认知功能进一步下降有关,可能是通过对全身炎症的影响来介导的。     

颈动脉支架成形术、盐酸多奈哌齐对脑梗塞患者认知功能的影响

目的探讨颈动脉支架成形术、盐酸多奈哌齐（安理申）对脑梗塞患者认知功能的影响。方法选取有认知功能障碍的脑梗塞患者,在常规治疗的基础上,将有适应证的患者行颈动脉支架血管成形术,共有患者21例（下称支架组）,未行支架成形术的患者加用盐酸多奈哌齐（5mg,1次/d）治疗,共有25例（下称安理申组）。在治疗前、治疗三月后行简易精神状态量表（MMSE）、日常生活功能量表（ADL）评分,并行统计学分析。结果经治疗3月后支架组和安理申组的MMSE评分、ADL评分明显提高,与治疗前相比有统计学意义（P〈0.05）;支架组MMSE评分及ADL评分较安理申组相比亦有明显提高,两者相比有统计学意义（P〈0.05）。结论颈动脉支架血管成形术和盐酸多奈哌齐均可改善脑梗塞患者的认知功能,但支架术疗效更为显著。