轻度认知障碍患者情感记忆编码和提取受损的研究

目的探讨轻度认知障碍(MCI)患者情感记忆编码和提取受损的特点,为极早发现MCI和干预治疗前移评估提供理论依据.方法人选MCI组34例,选取30例健康老年人作为对照组,所有受试者均进行情感记忆编码和提取测试.结果MCI组情感图片记住数(REM)(21.32±7.29)%明显低于对照组(26.00±9.57)%(P＜0.05),MCI组情感图片靶片提取率(85.44±4.94)%与对照组(96.76±2.18)%比较有极显著差异(P＜0.01).MCI组IPreti与(PP+UP)reti比较无显著性差异(t=1.41,P＞0.05),对照组IPreti与(PP+UP)reti比较有显著性差异(t=15.24,P＜0.05).两组间IPreti比较无显著性(t=1.28,P＞0.05),(PP+UP)reti比较有极显著性差异((t=25.49,P＜0.01).PPreti (Pleasant pictures retrieval index)、Upreti(unpleasant pictures retrieval index)IPreti(indifferent picturesretrieval index).结论MCI患者存在情感记忆编码受损,载有情感内容的图片不能增强MCI患者情感记忆提取,情感记忆编码和提取测试为极早发现MCI有效工具之一.     

轻度认知功能障碍患者情绪记忆损害特征

目的探讨轻度认知功能障碍(MCI)患者情绪记忆的改变。方法采用情绪记忆神经认知心理学检查评价22例MCI患者(MCI组)及22名健康成年人(正常对照组)的情绪记忆,并采用事件诱发电位(ERPs)检测P300的潜伏期和波幅。结果与正常对照组比较,MCI组MMSE、词汇流畅性试验、数字广度试验评分均显著降低(均P 0. 01)。MCI组与正常对照组正性、中性和负性情绪图片效价度差异无统计学意义(均P 0. 05)。与正常对照组比较,MCI组正性和负性图片再认正确率均显著降低(P 0. 05～0. 01),中性图片再认正确率差异无统计学意义(P 0. 05)。MCI组及正常对照组正性、负性与中性图片再认正确率差异有统计学意义(F=6. 27,F=39. 13;均P 0. 05)。与正常对照组比较,MCI组正性和负性图片再认反应时间差异有统计学意义(P 0. 05～0. 01),中性图片差异无统计学意义(P 0. 05)。MCI组及正常对照组正性、负性与中性图片再认反应时间差异有统计学意义(F=3. 74,F=16. 48;均P 0. 05)。MCI组与正常对照组学习阶段ERPs-P300的潜伏期、波幅差异无统计学意义(均P 0. 05)。与正常对照组比较,MCI组再认阶段正性和负性图片ERPs-P300潜伏期显著增加,波幅显著降低(P 0. 05～0. 01);中性图片潜伏期及波幅差异无统计学意义(均P 0. 05)。MCI组学习阶段(F=55. 20,P 0. 05; F=43. 12,P 0. 05)及再认阶段(F=29. 36,P 0. 05; F=19. 39,P 0. 05)正性、负性与中性情绪图片ERPs-P300潜伏期及波幅差异均有统计学意义;正性与负性ERPs-P300潜伏期及波幅比较差异无统计学意义(均P 0. 05)。正常对照组的学习阶段(F=55. 66,P 0. 05; F=39. 33,P 0. 05)及再认阶段(F=114. 48,P 0. 05; F=51. 77,P 0. 05)正性、负性与中性情绪图片ERPs-P300潜伏期及波幅差异均有统计学意义。结论 MCI患者存在情绪记忆的受损及反应时间延长,且情绪效价"正向"选择性偏向受损。     

载脂蛋白E、总补体与阿尔采默病的关系

目的　探讨载脂蛋白E(apoE)及总补体 (CH50 )与阿尔采默病 (AD)的关系。方法　应用自动化生化仪对 4 4例AD患者的apoE和总补体 (CH50 )进行测定 ,并与 2 9例血管性痴呆 (VD)患者进行对比。结果　AD组apoE为 (4.84± 3.10 )mg/dL ,高于VD组的 (4.2 1± 1.17)mg/dL ,差异有显著性 (t =1.6 7,P =0 .0 3) ;AD组CH50 为 (40 .5 2± 10 .1)ku/L ,低于VD组的 (45 .6 6± 9.9)ku/L ,差异有显著性 (t=1.6 7,P <0 .0 5 )。结论　载脂蛋白E异常是阿尔采默病发病的危险因素之一 ;载脂蛋白E的测定对鉴别阿尔采默病与血管性痴呆有一定价值 ;免疫反应在阿尔采默病中的作用不明     

老年性痴呆患者白细胞褪黑素受体昼夜节律的研究

目的　探讨老年性痴呆 (AD)患者褪黑素受体 (MR)结合容量的变化及 MR昼夜节律的改变。方法　选择正常老年人 1 0名 [年龄 (69.3± 6.77)岁 ]作为对照组 ,AD患者 9例 [年龄 (73 .4± 9.2 6)岁 ],采用放射配体法测定 1 2∶ 0 0 (光中期 )和 2 4∶ 0 0 (暗中期 )外周血白细胞 MR的结合容量 ,比较两组 MR结合容量及昼夜节律变化。结果　 Scatchard分析和一点法分析均显示 ,AD组光中期 MR结合容量明显低于对照组 [分别为 (0 .1 3 3±0 .0 1 8)、(0 .2 3 4± 0 .0 2 3 )及 (0 .1 0 7± 0 .0 3 )、(0 .1 99± 0 .0 1 9) fmol/1 0 6细胞 ],两组差异均有非常显著性 (t=5 .3 1 6,P<0 .0 0 5和 t=8.1 4,P<0 .0 0 1 )。但两组 MR结合的亲和力无明显改变 (P>0 .0 5 )。对照组光中期的 MR结合容量明显高于暗中期 (t=3 .496,P<0 .0 5和 t=1 4.44,P<0 .0 0 1 ) ,而 AD组光中期与暗中期比较差异无显著性 (P>0 .0 5 )。结论　 AD患者 MR表达降低 ,MR昼夜节律发生紊乱。正常老年人 MR存在昼夜节律。     

首发精神分裂症患者的糖代谢研究

目的　探讨首发精神分裂症患者的糖代谢情况。方法　对 86例首发精神分裂症患者及 45名健康人进行糖耐量试验(OGTT) ,并检测其空腹血浆胰岛素、C肽的浓度。结果　两组间空腹血糖、餐后 3h血糖、空腹胰岛素、C肽的差异无显著性 ,病例组餐后 1h血糖值 [( 7 89± 1 77)mmol/L]、2h的血糖值 [( 6 2 4± 1 14 )mmol/L]、OGTT血糖曲线下面积 (AUC) [( 18 2 4± 2 76)mmol/(L·h) ]比对照组 [分别为 ( 6 5 4± 1 84)mmol/L ,( 5 88± 2 78)mmol/L ,( 15 86± 1 93 )mmol/L/h ,P分别小于 0 .0 1、0 .0 5、0 0 1]要大 ;组间糖耐量减退 (IGT)的发生率无显著性差异 ( χ2 =0 5 84,P >0 0 5 ) ;偏执型患者组与青春型患者组间的空腹血糖、2h血糖值无显著性差异 (t=1 476,P均大于 0 0 5 ) ;发生IGT的病例组与未发生IGT病例组组间阳性和阴性症状量表 (PANSS)总分及 4个分量表分值的差异无显著性差异 (P均大于 0 0 5 )。结论　首发精神分裂症患者存在餐后高血糖现象。     

强迫症、抑郁症及焦虑症患者血小板5-羟色胺浓度的对照研究

目的　研究 5 羟色胺 ( 5 HT)在强迫症发病中的作用及强迫思维与强迫动作亚组、抑郁症及焦虑症患者间血小板 5 HT含量的差异。方法　采用高效液相色谱法 ,分别测定 2 9例强迫症患者 [(强迫症组 ,根据Y BOCS强迫量表因子得分将其分为强迫思维 ( 16例 )、强迫动作 ( 7例 )和混合性( 6例 ) 3组 ]、2 0例抑郁障碍患者 (抑郁症组 )、17例焦虑障碍患者 (焦虑症组 )和 2 8名正常人 (正常人组 )的血小板 5 HT含量。结果　强迫症组血小板 5 HT水平 [( 139± 172 ) μg/L]低于正常人组 [( 2 4 8±2 15 ) μg/L]及焦虑症组 [( 397± 4 0 1) μg/L],差异具有显著性 (P =0 0 39;P =0 0 2 0 ) ;与抑郁症组 [( 2 0 2± 16 2 ) μg/L]的差异无显著性 ( P >0 0 5 ) ;强迫思维 [( 85± 6 6 ) μg/L]与强迫动作组 [( 16 9± 10 0 ) μg/L]间血小板 5 HT含量的差异有显著性 (P =0 0 2 5 )。结论　强迫症患者 5 HT浓度变化与抑郁障碍患者趋同 ,与焦虑障碍患者的差异有显著性 ;单纯强迫思维者的 5 HT浓度与单纯强迫动作患者的差异有显著性     

精神分裂症迟发性运动障碍患者血清肌酸激酶水平的研究

目的　探讨血清肌酸激酶(CPK)水平变化与抗精神病药物所致迟发性运动障碍(TD)的关系。方法　测定3 0例TD、3 0例非TD精神分裂症患者及3 0名正常人血清CPK水平,并分析TD组CPK水平与不自主运动评定量表(AIMS)评分的相关性。结果　TD组患者血清CPK水平(4 4 2 . 2 8±165. 42 )U/L、非TD组(2 3 9 .5 4±97. 94)U/L与正常组(98. 0 6±3 0. 3 6)U/L比较,有显著性差异,TD组与非TD组比较,有显著性差异(P =0 . 0 0 0 )。3 0例TD患者血清CPK水平与AIMS总分的相关系数为0 .44 9,P =0 . 0 13。结论　迟发性运动障碍患者血清CPK水平升高,与TD的严重程度相关。     

成功老龄化机制的系列研究:基线部分

目的探索成功老龄(SA)化的可能机制。方法通过心理社会问卷、神经心理学测验、分子遗传学及功能磁共振成像等方法,比较230名SA与137名常态老龄(UA)及58例轻度认知功能损害(MCI)患者的差异。结果(1)SA组老年人的自我效能水平高于UA组及MCI组,评分分别为[(18·99±1·84)分,(19·46±1·72)分,(20·11±2·14)分],差异均有统计学意义(P=0·01);神经质和宿命感倾向的评分从高至低依次为MCI组(均为0·19)、UA组(均为0·04分)和SA组(均为-0·14分),差异均有统计学意义(P分别=0·02和0·00)。(2)除UA组在信息处理及加工速度、即刻及延迟回忆的评分低于SA组外,多数认知测验评分与SA组的差异无统计学意义。MCI组与SA组、UA组在绝大多数认知测验分项目上的差异均有统计学意义,其中以SA组与UA组71~75岁老年人在神经心理学测验中有差异的项目最多。(3)分子遗传学指标:SA组血管紧张素转换酶I/I基因型频率(23·67%)分布高于UA组(11·21%)及MCI组(1·72%),外周血单核粒细胞端粒酶活性亦高于UA组及MCI组,差异均具有统计学意义(P均=0·00)。(4)功能磁共振成像:在听觉词汇流畅性任务刺激下,SA组前额叶尤其是背外侧皮质激活比UA组及MCI组明显,偏侧化指数为0·46,差异均有统计学意义。结论SA在多个维度具有一定特点,UA的认知功能有可塑性,71~75岁是认知老化的敏感阶段。     

抑郁症患者细胞色素P4502C19基因型对阿米替林血药浓度及其去甲基代谢的影响

目的　探讨中国人的CYP2C19基因型对阿米替林血药浓度及其去甲基代谢的影响。方法　采用多聚酶链式反应和限制性片段长度多态性分析测定 5 9例汉族抑郁症患者CYP2C19的基因型。高效液相色谱紫外检测法测定阿米替林及去甲替林的稳态血浆浓度。结果　 5 9例患者检测出 4种CYP2C19基因型 :wt/wt型 (n =4 ) ,wt/m1型 (n =4 9) ,m1/m1型 (n =4 ) ,m1/m2型 (n =2 )。基因m1频率为 0 5 ,基因m2频率为 0 0 17。单位剂量阿米替林及去甲替林的稳态血药浓度有明显个体差异 ,分别相差 31倍和 2 6倍。CYP2C19不同基因型的单位剂量阿米替林浓度差异无显著性意义 (P >0 0 5 ) ;单位剂量去甲替林血浓度wt/m1型与m1/m1型相比 [(0 6 4± 0 4 4 ) μg·L-1·mg-1比 (0 18± 0 0 8) μg·L-1·mg-1) ]有显著性差异 (P <0 0 5 ) ,其他分型之间比较无显著性差异 (P >0 0 5 )。阿米替林 /去甲替林浓度比值大小依次为 :wt/wt型 1 0 5± 0 2 8,wt/m1型 1 4 5± 0 81,m1/m1型 4 5 9± 1 4 4 ;wt/wt型和wt/m1型与m1/m1型相比均有极显著性差异 (P <0 0 1) ,wt/wt型与wt/m1型相比无显著性差异 (P >0 0 5 )。结论　在中国汉族抑郁症患者中 ,CYP2C19介导的阿米替林去甲基代谢表现出基因剂量效应倾向 ,其中m1/m1型阿米替林     

慢性应激对大鼠海马CA3区长时程增强的影响

目的　探讨慢性应激对大鼠海马CA3区长时程增强 (LTP)的影响及机制。方法　将 34只Wistar大鼠随机分成应激组 (8只 )、应激 +盐水组 (8只 )、应激 +MK 80 1组 (8只 )及空白对照组 (1 0只 ) ,应激刺激为饮水冲突模型 ,分别于实验初和LTP检测前 1天评定大鼠情绪性行为 ,在应激 1 5天后检测大鼠强直性LTP ,测量强直后 1 ,5 ,1 0 ,30 ,60 ,90 ,1 2 0minLTP群体峰电位幅度及峰潜期。结果(1 )应激前各组情绪性行为评分的差异均无显著性 ;应激后 ,应激 +盐水组 [(4 33± 0 50 )分 ]、应激 +MK 80 1组 [(3 60± 0 55)分 ]及应激组 [(2 90± 0 74)分 ]的评分均高于对照组 [(2 0 2± 1 1 6)分 ] ,差异有显著性 (P =0 0 0 0 ) ;(2 )应激组测试刺激阈值较对照组高 (45V∶30V) ;(3)在强直后第 1 ,90min时的LTP群体峰电位变化率应激组 [分别为 (2 1 1± 58) %和 (2 4 3± 69) % ]、应激 +盐水组 [分别为 (1 69±92 ) %和 (1 82± 1 61 ) % ]低于对照组 [分别为 (30 2± 2 1 0 ) %和 (30 3± 1 4 1 ) % ]和应激 +MK 80 1组 [分别为(375± 99) %和 (489± 2 36) % ] ,差异有显著性 (P <0 0 5) ,应激 +MK 80 1组与对照组的差异无显著性 ;(4)各应激组于各时点LTP峰潜期均较对照组长 ,但差异未呈显著性。结论　慢性     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.