老年期痴呆流行病学

老年期痴呆是老年期各种痴呆的总称 ,主要包括 Alzhei-mer病痴呆 (AD)和血管性痴呆 (VD)。近年来 ,老年期痴呆的流行病学研究已成为国内外研究热点之一。以患病率和发病率为主要目标的描述性流行病学 ,可以提供疾病的分布规律 ,为卫生决策提供依据。分析性流行病学 ,可提供疾病的危险因素及病因线索。实验性流行病学不仅可提供进一步的病因依据 ,还可验证预防和治疗手段的有效性。1　老年期痴呆的发病率与患病率1.1　患病率　关于老年期痴呆的患病率 ,80年代以前的文献报道差异悬殊 ;80年代以后 ,其诊断标准和研究方法逐渐趋向一致 ,其患…     

老年期痴呆的治疗

控制危险因素、治疗原发病是治疗老年期痴呆的根本措施。现将改善智能的药物治疗介绍如下。1　神经递质替代药物1.1　胆碱前体物质　从食物中补充卵磷脂和胆碱。1.2　胆碱酯酶抑制剂 (Ch EI)　 1塔克林 :主要抑制血浆和组织中的 Ach E。常见不良反应有转氨酶升高、尿频、流涎、多汗、眩晕和皮疹等。初始剂量为 10 mg/次 ,4次 / d,维持 6周 ;然后增到 80 mg/ d,间隔 6周后逐渐加量至 12 0～ 16 0 m g/ d。2多那哌齐 :5～ 10 mg/ d,晨服。可有恶心、心律减慢 ;溃疡病慎用。 3重酒石酸卡巴拉丁 :是选择性作用于中枢的长效药物 ,能明显改善认…     

老年期痴呆的诊断

引起老年期痴呆的疾病很多 ,诊断有一定困难。诊断痴呆标准较常用的有国际分类第 10版 (ICD- 10 )痴呆诊断标准、美国精神病学会的精神障碍诊断和统计手册 (DSM- IV)痴呆诊断标准等。因多数痴呆患者有智能减退、言语障碍和性格改变 ,故须依据其可靠的病史、精神和体格检查 ,以及必要的辅助检查进行综合分析 ,作出诊断。1　病史包括患者的起病时间、疾病发展过程、其认知功能和社会生活功能损害程度。可以记忆障碍为线索询问患者有无找词困难、人格及情感障碍和行为异常等 ,并注意询问患者生活自理能力丧失情况、既往有哪些疾病的危险因…     

老年期常见痴呆综合征

1　 Alzheim er病 (AD)和 Pick病痴呆AD常见原因占痴呆原因的 5 0 %～ 70 %。各年龄段都有相同的病理学过程 ,并且都有相同的 AD临床过程。 AD的临床表现为 :1脑机能障碍 :大多数患者开始仅有顶叶和颞叶机能障碍 ,记忆和空间定向力降低。随着病情的进展可出现额叶机能障碍 ,表现为社会性抑制丧失 ,伴有自控能力丧失和意志衰退 (自发性受损 ) ,失语症和失用症常见 ;有的患者额叶机能障碍明显早于颞叶和顶叶。许多 AD患者有各种运动障碍 ,包括运动不能、肌张力障碍和肌阵挛。在少见退行变所致的痴呆中 ,Pick病仅见额叶和颞叶萎缩。AD和 …     

北京城乡老年期痴呆患病率研究

目的 调查北京城乡老年人群痴呆的患病率及不同类型痴呆的患病率，分析老年期痴呆患病的危险因素。方法 流行病学调查分为2个阶段，第1阶段筛查，由经过培训的调查员，采用逐户访问方式，抽样调查了城乡60岁及以上老人2788例，完成调查问卷及筛查量表（MMSE）测验。第2阶段临床诊断，由神经科专科医师对MMSE低于界值分数的老人和部分MMSE正常的老人进行病史收集，临床体格检查和神经心理测验。根据DSM-Ⅲ-R，NINCDS-ADRDA诊断标准作出痴呆的临床诊断。结果 2788例60岁及以上老年人中患痴呆者208人，占7.5%，标化患病率为5.1%。痴呆分类AD占67.3%。VD占20.7%，混合型为10.1%，其他痴呆占1.9%，痴呆患病率在女性，农村地区及低文化水平的老年人群中增加，随年龄增长，患病率增高，结论 高龄，低教育水平，居住在农村的老年人是痴呆的高发人群。     

脑还丹胶囊治疗老年痴呆的临床研究

目的：探讨脑还丹胶囊治疗老年痴呆的临床疗效。方法：将符合美国精神病学会《精神障碍诊断与统计手册》（DSM－Ⅳ）诊断标准的老年痴呆患者58例,随机分为脑还丹组30例,脑复康对照组28例,分别采用脑还丹胶囊和脑复康片（吡拉西坦）治疗,疗程3月。采用简易精神状态检查表（MMSE）和日常生活自理能力量表（ADL）积分的变化进行疗效评估,检测患者血清雌二醇（E2）、睾酮（T）、E2／T比值,及血脂、血液流变学等水平变化。结果：脑还丹胶囊能提高E2和T水平,降低E2／T比值（P＜0．05）;能降低血脂,改变血液流变学,脑还丹组总有效率66．7％,对照组60．8％,2组比较差异无显著性（P＞0．05）;MMSE和ADL治疗前后差值比较,脑还丹组均优于对照组（P＜0．05和P＜0．01）。结论：脑还丹胶囊对老年痴呆有较好的防治作用,其机制与提高E2、T水平,降低E2／T比值及调节神经内分泌功能有关。     

脑还丹胶囊治疗老年痴呆的临床研究

目的探讨脑还丹胶囊治疗老年痴呆的临床疗效. 方法将符合美国精神病学会<精神障碍诊断与统计手册>(DSM-IV)诊断标准的老年痴呆患者58例,随机分为脑还丹组30例,脑复康对照组28例,分别采用脑还丹胶囊和脑复康片(吡拉西坦)治疗,疗程3月.采用简易精神状态检查表(MMSE)和日常生活自理能力量表(ADL)积分的变化进行疗效评估,检测患者血清雌二醇(E2)、睾酮(T)、E2/T比值,及血脂、血液流变学等水平变化. 结果脑还丹胶囊能提高E2和T水平,降低E2/T比值(P＜0.05);能降低血脂,改变血液流变学,脑还丹组总有效率66.7%,对照组60.8%,2组比较差异无显著性(P＞0.05);MMSE和ADL治疗前后差值比较,脑还丹组均优于对照组(P＜0.05和P＜0.01). 结论脑还丹胶囊对老年痴呆有较好的防治作用,其机制与提高E2、T水平,降低E2/T比值及调节神经内分泌功能有关.     

运动训练对老年痴呆小鼠的改善作用

目的 考察运动训练对老年痴呆小鼠学习记忆障碍的影响,并探讨其作用机制.方法　昆明种小鼠采用被动转笼法训练4 w后,采用Morris水迷宫法测试小鼠学习记忆能力;比色法检测脑组织中超氧化物歧化酶(SOD)活性及丙二醛(MDA)含量,HE染色观察海马组织形态学改变;BI-2000图像分析系统测定小鼠微循环;采用耐缺氧实验观察小鼠耐缺氧能力.结果 与空白对照组比较,模型组小鼠定向游泳实验潜伏期显著延长(P< 0.05),SOD活力显著降低,MDA含量显著升高(P<0.05),海马神经元变性、脱落,耐缺氧存活时间显著延长;与模型组比较,运动训练对上述指标均有显著改善作用.与空白对照组比较,运动训练显著改善微循环、提高耐缺氧能力.结论 运动训练能不同程度地改善小鼠学习记忆障碍,其作用机制可能与运动能提高小鼠清除自由基能力、改善微循环、提高耐缺氧能力有关.     

Self-recognition in senile dementia

Abstract

Eighteen women with senile dementia of the Alzheimer type were observed in two situations of mirror-image stimulation, which were repeated after a 3-week interval. Six out of six subjects scoring 5 on the Global Deterioration Scale of Reisberg et al. [11] reacted appropriately to an unfamiliar mark on their forehead when they observed it in the mirror, thus showing clear self-recognition. Fifty percent of the subjects at GDS 6 showed such evidence of self-recognition, and no subject at GDS 7 did so. In contrast, whereas 50% of GDS 5 subjects responded to a directly visible mark on the back of the hand, all GDS 6 subjects reacted to this mark. These results suggest that the capacity for self-recognition may start to be compromised by GDS stage 6, and that the eventual failure to show self-recognition in severe senile dementia cannot be dismissed in terms of a simple lack of motivation.     

A follow-up study on the outcome and relevant factors in senile dementia of Alzheimer type and vascular dementia]

We followed 126 patients with senile dementia of Alzheimer type (SDAT), and 129 over age 65 with vascular dementia (VD) who were diagnosed at the Center for Elderly Dementia in our institution between February 1990 and February 1993. At 5-year follow-up, 62 patients with SDAT and 71 patients with VD had died. These patients were assessed prospectively to investigate the neuropsychiatric and somatic factors related to the prognosis of SDAT and VD. There were no significant differences in the average age at onset and time of diagnosis of dementia between the SDAT and VD groups. Mean age at death, mean duration of dementia and 75% survival duration from dementia onset were shorter in patients with VD than in those with SDAT. Pneumonia was the most common cause of death in patients with either SDAT or VD, followed by geromarasmus in the SDAT group, and cerebrovascular and cardiovascular diseases in the VD group. In patients with SDAT, a poor prognosis was correlated with severe dementia, impaired intellectual function and degree of cortical atrophy. In patients with VD, physical complications, impaired motor function and hypoproteinemia enhanced the probability of death. This study confirmed that a progressive neurodegenerative course and physical conditions such as motor dysfunction or malnutrition are closely associated with the prognosis of patients with SDAT and VD, respectively.     

Idebenone in senile dementia of Alzheimer type: a multicentre study

Idebenone is a new cerebro-active drug, effective in dementia disorders, particularly indicated in primary degenerative dementias, i.e. Alzheimer's disease. This new molecule acts as an electron trapper and a free radical scavenger protecting mitochondrial membranes from lipid peroxidation. A multicentric, double-blind trial of idebenone (45 mg twice daily orally) vs. placebo was carried out on 102 elderly patients affected by Alzheimer-type dementia of mild or moderate severity. Idebenone was administered for 4 consecutive months, 45 mg twice daily. Clinical evaluations were performed at the time of enrollment (t0) and monthly thereafter (t30, t60, t90 and t120) and at follow-up (t150 ). Tolerability to idebenone treatment was good and was associated with a statistically significant improvement of memory, attention and behaviour. It is worthwhile noting that these cognitive and behavioral findings were observed after the first month of treatment with enhancement evident in the following period.     

老年糖尿病与老年性痴呆

糖尿病与老年性痴呆[又称阿尔茨海默病(AD)]是老年人的易患疾病。流行病学研究发现在老年人群中糖尿病和AD有很多相似之处。随着人口老龄化日益明显,严重影响着老年人的健康,深入了解糖尿病和AD之间的联系,对进一步理解AD的发病机制及寻求新的治疗方法有重要意义。本文对糖尿病和AD的关系作一综述,以期提高对两者关系的认识。