100例成功老龄认知功能及相关因素的初步研究

目的通过对成功老龄认知功能及相关因素研究,完善理解老年人群的认知功能状况.方法对100例75岁以上符合成功老龄标准的军队离退休干部进行调查,分75～79岁、80～84岁、85岁及以上3个年龄组进行横断面分析.结果100例老人均保持较好的认知功能、躯体活动功能及良好的心态和身心健康,但认知功能随增龄有下降趋势.结论不同年龄段老人在视空间技能和运动速度上虽有显著差异,但认知功能水平保持还是较好的.     

成功老龄认知功能的研究进展

随年龄增长，与年龄相关的躯体与认知功能下降通常被认为是正常老化不可避免的结果，但是在老化过程中尚有躯体和认知等功能状况无改变或改变甚微的老年人群，即成功老龄（successful aging）。成功老龄化是人类共同期望的目标，它已成为世界老年医学研究领域中的新焦点。认知功能的改变是人体老化的一个显著表现，对于成功老龄认知功能的正确认识，将有助于全面理解老龄化群体的特征，促进老年人实现成功老龄化。故对近年来国内外有关成功老龄认知功能的研究作一综述。     

成功老龄认知功能及相关因素研究

目的通过对成功老龄认知功能及相关因素研究,以完善理解老龄人群的认知功能状况。方法采用横断面研究对293例>60岁符合成功老龄标准的军队离退休干部,分60～69岁(1组)、70～79岁(2组)、80～89岁(3组)、90～99岁(4组)4个年龄组,应用神经心理学检测试验进行认知功能分析,并对文化程度、婚姻、居住方式、饮食、饮酒、吸烟、锻炼、睡眠及疾病情况等相关因素进行分析。结果这293例老龄人均保持较好的认知功能、躯体活动功能及良好的心态和身心健康,但认知功能随年龄增长有下降趋势。结论不同年龄段在视空间技能、执行功能、认知加工速度,记忆力、注意力虽有显著差异,但保持认知功能水平还是较好的。     

血清睾酮在老龄大鼠运动中的水平变化及对认知功能的影响

目的探讨血清睾酮在老龄大鼠运动中的水平变化及对认知功能的影响。方法将24只雄性老龄SD大鼠随机平分为0 min组、30 min组和60 min组,每组8只。0 min组不运动,30 min组、60 min组分别每天进行30 min、60 min的跑台训练,为期16 w,训练结束后进行Morris水迷宫实验,测定老年大鼠的认知功能,并检测血清睾酮水平。结果三组逃离潜伏期差异有统计学意义(P<0.05);各组随着天数增加,逃离潜伏期均缩短(P<0.05)。平台持续时间三组之间差异无统计学意义(P=0.995)。平台象限时间百分比60 min组高于0 min组(P<0.05)。穿越平台次数、平台象限路程和血清睾酮水平30 min组、60 min组均高于0 min组(P<0.05)。结论运动可以改善老年大鼠的认知能力和增加血清睾酮水平。     

老龄大鼠肺炎双球菌肺炎肺脏免疫功能变化

目的：从肺脏免疫功能探讨老年肺炎的发病机制。方法：复制肺炎双球菌肺炎模型，分为青年对照组和模型组、老龄对照组和模糊型，观察肺脏组织病理改变和肺泡灌洗液免疫球蛋白，纤维接合蛋白（Fn)和中性粒细胞计数。结果：肺炎的肺组织损伤老龄大鼠较青年大鼠严重。青年模型组肺灌洗液sIgA和FN含量的降低和中性粒细胞、IgG增高均较青年对照组显著；与老龄对照组比较，老龄模型组sIgA和FN降低，IgA和中性粒细胞增高；老龄对照组IgG含量的增高及sIgA、FN含量降低较青年对照组显著；老龄模型组IgA含量增高和sIgA降低较青年模型组显著。结论：肺脏中性粒细胞和免疫球蛋白含量增多及sIgA、FN含量减少与肺炎的发生发展有着密切相关。随着增龄，肺免疫球蛋白含量增多及九FN含量减少，致使肺使老龄大鼠这种变化更为显著。     

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.     

忻州市忻府社区老年人群认知功能及疾病转归

目的 探讨认知功能障碍与年龄及预后的关系.方法 2005年选取忻州市忻府社区中年龄≥60岁的老年人群进行认知功能调查,并于2010年进行再次调查.结果 首次调查的254名老年人群中,随着年龄的增长,认知功能正常以及轻度认知障碍的比例逐渐递减(P＜0.05),而中重度认知障碍人群所占的比例则递增明显(P＜0.01).随访5年间共死亡26人,随着认知功能障碍的增加,不仅死亡人数增加明显,因慢性病导致死亡的比例亦增加显著,而且首次完成老年痴呆诊断程度人数所占的比例递减,随访5年后确诊老年痴呆人数增加明显(P＜0.05).结论 社区内老年人群大多存在认知功能障碍,而随着认知功能障碍程度的加重,其罹患老年痴呆的概率增加,认知功能障碍可作为老年痴呆的预测指标.     

高血压病患者认知能力功能与胰岛素抵抗的相关性

该文探讨高血压病患者认知功能损害与胰岛素抵抗的关系。方法：该院就诊的高血压病患者180例，根据国际通用的简易智力状况量表（mini mental state examination，MMSE）进行认知功能评定，将患者分为两组：认知功能障碍者41例作为病例组，认知功能正常者139例作为对照组。采集一般临床资料，测量血压、身高、体质量，     

抗癫痫药物与认知功能障碍

全世界有超过6000万的癫痫患者，认知功能障碍的发生率在癫痫患者中明显高于一般人群。导致癫痫患者容易出现认知功能障碍的原因是多方面的。一方面，癫痫的反复发作容易导致大脑皮层受损从而导致认知功能障碍；另外，某些特殊的癫痫类型本身即会导致认知功能障碍；抗癫痫药物也可以有相关认知功能障碍的不良反应。认知功能障碍在特定癫痫人群中造成的致残性可能远远超过了癫痫本身。     

老年脑白质疏松症和Binswanger病认知功能的对比研究

目的探讨在老年人脑白质疏松症（LA）和Binswanger病（BD）认知功能障碍程度、特征。方法采用简易精神状态量表（MMSE）对LA、BD患者及健康对照者进行评分，比较各组认知功能障碍者的比例。结果（1）BD组MMSE评分明显低于LA组（P〈0．05）。（2）LA组轻度认知功能障碍26例（72．2％）；BD组中度认知功能障碍8例（25．8％）。痴呆23例（74．2％）。结论LA多有轻度认知功能障碍，而BD多表现为中度认知功能障碍和痴呆。认知功能障碍的程度可作为临床诊断LA、BD的参考指标。     

Effect of exercise, aging and functional capacity on acute secretory immunoglobulin A response in elderly people over 75 years of age

Background:   Age-associated decline in immune function and regulation, referred to as immunosenescence, brings about an increased incidence of infectious diseases in the aged; however, there are few data on the effect of aging and exercise on mucosal immune function in elderly people. Moreover, there is no evidence on whether the change in functional capacity affects mucosal immunity in elderly people. Therefore, the aim of the present study was to examine the effects of exercise, aging and functional capacity on mucosal immune function in elderly people over 75 years of age.
Methods:   The subjects were 92 community-dwelling elderly women aged over 75 years who lived in a rural community in Miyagi Prefecture. The subjects periodically performed approximately 20 min of low intensity exercise. Saliva samples were collected before and after exercise, and saliva flow (SF), secretory immunoglobulin A (SIgA) concentration (SIgA-C) and SIgA secretion rate (SIgA-SR) were determined. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to measure functional capacity.
Results:   In comparison with before exercise, SF, SIgA-C and SIgA-SR were significantly increased after exercise in elderly subjects. In addition, when low and high value groups of resting SIgA levels were compared, acute SIgA responses were observed only in the low value group; however, there was no significant effect of aging and decline in functional capacity on exercise-induced SIgA response.
Conclusion:   These results suggest that resting SIgA levels influence the mucosal immune function response to exercise in elderly people over 75 years of age.     

Heart failure in the elderly - some aspects in pathophysiology, diagnosis and therapy that require special attention

Approximately 50% of all heart failure patients in the US are above 75 years of age, which is almost similar to most European countries and the Middle and the Far East. Even though aging is an independent molecular process with a multitude of genetic predetermination and biochemical mediations, aging itself does not automatically result in cardiac insufficiency. On the other hand, with increasing age, cardioprotective mechanisms in response to stress are lost, and progressive cardiomyocyte degeneration with replace- ment fibrosis is often seen in older hearts, even though the exact triggers are not completely understood. Older patients with heart failure have distinct features that require special attention in diagnosis as well as therapy. The elderly more frequently suffer from multiple co-morbidities and might have atypical clinical presentations. Several precautions are essential in the treatment of heart failure in the elderly due to co-existing morbidities and the pharmacokinetic and pharmacodynamic changes related to increased age. Also, treatment expectations, compliance, mental status and cognitive function might play a major role regarding optimized treatment and monitoring options in the elderly suffering from heart failure. This review summarizes current issues of heart failure management in the elderly.     

Long-term effect of hypertension on neurobehavioral and cardiac function in the apparently healthy community-dwelling elderly: a 5-year follow-up study

Recently, it has been reported that hypertension causes not only cerebro-cardiovascular diseases, but also a decline of cognitive function in the elderly. However, it is not clear whether or not aging and hypertension have a latent effect on the cognitive-neurobehavioral and cardiac functions in healthy elderly whose scores of basic activities of daily living (ADL) are fully maintained. We evaluated the effect of aging and hypertension on cognitive-neurobehavioral and cardiac functions in 25 healthy community-dwelling elderly subjects (mean age: 69 y.o.) whose scores of basic ADL were fully maintained. Subjects were followed over a 5-year period, and the following examinations were performed before and after a 5-year follow-up: echocardiography, 24-hr ambulatory blood pressure monitoring (ABPM), and cognitive-neurobehavioral function test. Left ventricular mass index was significantly increased in the hypertensive (HT) subjects relative to the normotensive (NT) subjects over the 5 years (% change: 3% for HT vs. -0.8% for NT, p = 0.03). The number of non-dippers significantly increased over the 5 years in the HT group (initially: 20% [2/10] vs. follow-up: 58% [7/12], p = 0.04). Visuospatial cognitive performance scale scores for evaluation of higher cognitive-neurobehavioral functions significantly deteriorated in the HT subjects (initially; 2,344 +/- 110 vs. 2,380 +/- 102, ns, and follow-up: 2,149 +/- 181 vs. 2,356 +/- 159, p = 0.04). Hypertension contributes to the impairment of the cognitive-neurobehavioral function in the elderly by latently affecting the functions of multiple organs. This occurs even if basic ADL is maintained for 5 years. Therefore, it is important to control BP not only to prevent cardiovascular events, but also to preserve the neurobehavioral function.     

北京老年人认知功能对生存率影响的八年随访观察

目的 通过对北京市社区居住的老年人进行队列追踪，观察不同认知功能水平的老年人的预后和生存概率。方法 对1992年抽取的55岁以上老年前期和老年人2047例进行前瞻性研究。结果 1992年认知功能正常组8年累积死亡率31．6％，显著低于认知功能异常组(60．4％)。正常组中正常高分者的累积死亡率27．7％，明显低于正常低限者(53．3％)。分年龄计算的3组生存曲线明显不同。控制了年龄、性别、城乡、一般健康状况等影响因素的多因素分析也证实，认知功能水平低者死亡的危险高于功能水平高者0．85至1．7倍。结论 认知功能是独立于年龄、性别、健康等状况外的影响老年人存活的重要因素。加强对认知功能水平低的老年人的监护可能对降低老年人死亡率有帮助。     

Longitudinal changes during aging using proton magnetic resonance spectroscopy

OBJECTIVE: We aimed to examine the longitudinal change in proton magnetic resonance spectroscopy ((1)H-MRS) visible metabolites (N-acetyl aspartate [NAA], creatine [Cr], choline [Cho], and myo-Inositol [mI]) in brains of elderly individuals over 3 years and relate them to cognitive function. METHODS: Neurologically and psychiatrically normal volunteers (n = 40) were examined at baseline and 3 years later with (1)H-MRS in two voxels (frontal white matter n = 29, and occipitoparietal gray matter n = 36) and with detailed neuropsychological assessments. Longitudinal analyses were performed with age, educational level, sex, and white matter hyperintensities (WMH) in voxels as covariates. RESULTS: Frontal mI was significantly increased over time in male participants, but all other metabolites were stable over time. Neuropsychological performance was not significantly changed over 3 years, and there was no relationship between change in metabolite levels and change in neuropsychological function. CONCLUSIONS: MRS-visible metabolites are stable in elderly persons over 3 years, with the exception of mI which shows an increase. Increasing mI may be a marker of aging or a preclinical neurodegenerative process. MRS changes do not correlate with change in neurocognitive function during aging.     

Rate of cognitive decline in relation to sex after 60 years‐of‐age: A systematic review

Some studies have shown differences in specific cognitive ability domains between the sexes at 60 years‐of‐age. However is important to analyze whether the rate of cognitive decline is also similar between the sexes after this age. The present study examined previously published literature to investigate whether cognitive decline is distinct between men and women after the age of 60 years. A systematic review was carried out with the PubMed, LILACS and PsycINFO databases (2001–2011) using the following search terms: aging, aged, cognitive function, mild cognitive impairment, mental health and cognition. We analyzed longitudinal research that used neuropsychological tests for evaluating cognitive function, showed results separated by sex and that excluded participants with dementia. Elderly women showed better performance in tests of episodic memory, whereas elderly men had a better visuospatial ability. Only one study detected distinct rates of cognitive decline in specific tests between the sexes. Despite differences observed in some domains, most of the studies showed that this rate is similar between the sexes until the age of 80 years. It is unclear whether sex influences the rate of cognitive decline after the age of 80 years. The present review observed that sex does not determine the rate of cognitive decline between 60 and 80 years‐of‐age. The contextual and cultural factors that involve men and women might determine a distinct decline between them, rather than sex alone. Geriatr Gerontol Int 2014; 14: 23–31.     

Periprocedural complications of cardiac implantable electronic device implantation in very elderly patients with cognitive impairment: A prospective study

Very elderly people (over 80 years) with cardiac implantable electronic devices (CIEDs) indications often have a higher prevalence of aging comorbidity, among which cognitive impairment is not uncommon. This study aimed to investigate periprocedural complications of CIED implantation among very elderly patients with and without cognitive impairment. One hundred eighty patients ≥80 years of age indicated for CIED implantation were included in our study. During hospitalization, the cognitive evaluation was performed according to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). According to the cognitive test results, patients were divided into 2 groups (90 patients with normal cognitive function and 90 patients with cognitive impairment). Meanwhile, their physical parameters and laboratory measurements were completed. The procedural data and periprocedural complications were collected from both groups. The association between cognitive impairment and periprocedural complications was analyzed using univariate and multiple logistic regression analyses. During a one-month follow-up, the most frequent periprocedural complications in very elderly patients were pocket hematoma and thrombosis events. Cognitively impaired patients had a higher incidence of complications than normal cognitive patients. Multivariate regression analysis showed that cognitive impairment was positively correlated with periprocedural complications in very elderly patients. Cognitive impairment is associated with increased periprocedural complications of CIED implantation in very elderly patients.