盐酸美金刚与盐酸多奈哌齐治疗阿尔茨海默病疗效对比

目的比较盐酸美金刚与盐酸多奈哌齐治疗阿尔茨海默病(AD)的有效性和安全性。方法将72例AD患者随机分为2组:美金刚组36例给予盐酸美金刚片20mg/d,多奈哌齐组36例给予盐酸多奈哌齐10mg/d,2组疗程均为6个月。2组患者治疗前和治疗3个月、6个月后均采用简易智能精神状态检查量表(MMSE)和AD评定量表的认知次级量表(ADAS-cog)评价患者认知功能、精神行为及痴呆严重程度。结果经治疗3个月、6个月后,2组患者MMSE、ADAS-cog评分均较治疗前明显好转(P<0.05或P<0.01);治疗3个月、6个月后,2组患者MMSE、ADAS-cog评分比较差异无统计学意义(均P>0.05);美金刚组的不良反应发生率低于多奈哌齐组(χ2=4.5714,P>0.05)。结论盐酸美金刚与盐酸多奈哌齐均能显著改善AD患者的认知功能、日常生活能力和人格情感障碍,两药疗效无明显差异,且盐酸美金刚具有良好的安全性。     

Evidence-based pharmacological treatment of dementia.

The current literature on the pharmacological treatment of dementia was reviewed and the strength of evidence for the efficacy of each drug was categorized using an evidence-based approach. Acetylcholinesterase-inhibitors represent the only category of drugs with consistently demonstrable efficacy in well-designed studies of Alzheimer's disease, although the effect is not large. There is a lack of prospective, controlled, randomized studies for most of the nootropics. Epidemiological evidence suggests prophylactic effects of oestrogens and anti-inflammatory agents, and a single large-scale trial suggests that long-term administration of vitamin E or selegiline may be associated with improved outcome in patients with Alzheimer's disease. A number of drugs were reported to be effective in the treatment of non-cognitive symptoms of dementia including classical and atypical neuroleptics, antidepressants and anticonvulsants. The evidence for efficacy, however, is not strong for the majority of these compounds.     

Phenomenologic subtypes in dementia and previous psychiatric hospitalization

Psychiatric features in dementia may reflect the coexistence of a previous ?functional”? mental disorder and dementia. To test this hypothesis we used the national Psychiatric Case Register (PCR) as a data source and (a) compared PCR data between phenomenologic subtypes of dementia patients with and without history of psychiatric hospitalization; (b) investigated in what way past psychiatric diagnoses relate to present dementia phenomenology. A small but significant portion of senile (31%) and arteriosclerotic (23%) dementia sufferers did have a documented history of psychiatric hospitalization. No significant or consistent differences concerning PCR demographic, clinical and clinical-administrative variables studied were found when dementia patients of each subtype, with and without previous psychiatric hospitalizations, were compared. However, phenomenologic subtypes with delusions and depression in senile and arteriosclerotic patients were significantly associated with previous psychiatric ?functional”? diagnoses of a similar phenomenology. We suggest that, at least in a subgroup of senile and arteriosclerotic dementia patients, the psychiatric subtypes of delusions and depression might reflect the coexistence of two separate mental illnesses.     

Natural course and predictors of severe disability and death in Thai patients with dementia

More than half of patients with dementia lived in countries with low and middle incomes. However, there have been few studies on the natural course of disease in these countries. The purpose of this study was to study the natural course and the predictive factors of advanced stage and death in Thai patients with dementia. Patients with dementia who were treated in neurologic and psychiatric clinic from September 2004 to February 2016, were included. Data about natural course of diseases, behavioral and psychological symptoms in dementia (BPSD) and complications were studied. 207 patients were included. Mean age was 77 years old. Mean Thai Mental State Examination (TMSE) was 17.5. Alzheimer’s disease was the most common cause of dementia (55%). With the mean follow-up of 39 months (range from 2 to 126 months), 64% of the patients had BPSD. Sixty-two patients (30%) had complications required admission. Seven patients died. Fifty-four patients (29%) ended in the advanced stage of dementia. Mean duration from diagnosis to the advanced stage was 49 months. Complications that required admission usually occurred in moderate to severe dementia and were strongly associated with the advanced stage or death (OR 6.1, 95%CI 2.57–14.49, p-value < 0.0001). Alzheimer’s disease was the most common cause of dementia in the study. Most demented patients presented in moderate severity of dementia. Mean duration from diagnosis to the advanced stage of dementia was approximate 4–5 years. Complications required admissions related to the progression to advanced stage or death.     

Error-monitoring in an everyday task in people with Alzheimer-type dementia: Observations over five years of performance decline

Research suggests that, although everyday action errors increase significantly with dementia progression, accomplishment of the task remains high, even in severe dementia. We used archive observational data charting progressive decline in everyday task performance to explore error-monitoring over a 5-year period in four people with dementia. None of the participants showed effective error-monitoring during their execution of their established tea-making routine: Over 5 years and into more severe stages of dementia, errors increased, but there was no reactive increase from our participants in error-monitoring. Training to error-monitor routine tasks may be an appropriate target for further study.     

美金刚联合多奈哌齐对阿尔茨海默病患者认知功能及神经递质的影响

目的 探讨美金刚联合多奈哌齐对阿尔茨海默病(AD)患者认知功能及神经递质的影响.方法 选取北京航天总医院收治的AD患者100例,随机分为试验组(n=50)、对照组(n=50),对照组予以多奈哌齐治疗,试验组在此基础上予以盐酸美金刚治疗,比较2组临床疗效、AD评定量表的认知分量表(ADAS-Cog)评分、神经精神科问卷(...     

2013年痴呆临床研究进展

本文重点对2013年阿尔茨海默病及痴呆相关疾病的临床研究热点进行介绍,包括流行病学、危险因素、生物学标志、治疗等内容。     

中国痴呆的现状和未来

目前,痴呆在我国的患病率和发病率居高不下,给社会和家庭都带来了沉重的经济负担。与此同时,痴呆的诊疗水平在不同的医院之间存在较大差异。近年来虽已有了长足进步,但依然不能完全满足临床需要。而在治疗方面,目前多为对症治疗,未来需要采取多靶点干预。本文作者针对目前我国痴呆诊疗方面存在的问题与不足,对于未来的研究策略提出了自己的看法和建议。     

心房颤动与痴呆

研究发现,心房颤动(简称房颤)是痴呆相关的高危独立因素。心房颤动易引起心房产生血栓,栓子脱落后,并发体循环栓塞的风险极大。当栓子堵住脑部小血管时,损害足够容量的脑组织,就会引起血管性痴呆。因此,如果可以研究清楚二者之间的发病机制和危险因素,通过治疗阻断这一机制,并减少二者发生的危险因素,就会减少由心房颤动引发的痴呆。然而,抗凝不足或过度抗凝都会导致痴呆。     

小剂量多奈哌齐联合美金刚治疗老年性痴呆的疗效及安全性

目的观察多奈哌齐联合美金刚治疗老年性痴呆患者认知功能和行为能力的改善作用及安全性。方法将30例老年性痴呆患者随机分为多奈哌齐对照组和多奈哌齐联合美金刚试验组。疗程16周,每4周随访1次,评估简易精神状态量表(MMSE);治疗16周后进行有效性评估:采用阿尔茨海默病评定量表的认知分量表(ADAS-Cog)评定患者认知功能;采用临床医生访谈时对病情变化的印象补充量表(CIBIC-Plus)评价患者总体功能变化情况;采用神经精神科问卷(NPI)了解患者精神行为症状的变化;采用日常生活能力量表(ADL)了解患者日常功能情况。结果 29例患者完成最后随访,对照组MMSE,ADAS-Cog,CIBIC-Plus,NPI,ADL评分治疗前后比较有统计学意义(P<0.05);试验组MMSE,ADAS-Cog,CIBIC-Plus,NPI,ADL评分治疗前后比较有统计学意义(P<0.05);治疗前两组各量表评分比较无统计学意义;治疗16周后,两组比较,试验组较对照组患者NPI评分明显下降(P<0.05),表现在脱抑制和激越等情绪方面;CIBIC-Plus总体功能变化实验组较对照组好转明显(P<0.05),余各项评分两组间无显著性差异(P>0.05)。结论多奈哌齐及多奈哌齐联合美金刚治疗老年性痴呆均有效,后者更优于前者,尤其对情绪方面的阳性症状控制较好,且具有良好的安全性和耐受性。     

Reducing post-lumbar puncture headaches with small bore atraumatic needles

Lumbar puncture for testing of Alzheimer’s disease pathophysiology for diagnostic confirmation is likely to become more common in the coming years. Minimizing adverse effects from this testing will be essential for clinical practice. Small bore, atraumatic needles reduce the occurrence of post-lumbar puncture headache (PLPH). Our goal was to extend this recommendation specifically to a well-characterized aging population. We assessed PLPH in the Alzheimer’s Disease Neuroimaging Initiative cohort and found that PLPH occurrence was reduced only when using a 24 gauge atraumatic needle. We recommend that lumbar punctures for clinical and research purposes in Alzheimer’s disease be conducted with 24 gauge atraumatic needles.     

Diagnostic accuracy of the Phototest for cognitive impairment and dementia in Argentina

Phototest is a simple, easy and very brief test with theoretical advantages over available dementia screening tests in Spain. The objective of this study was to estimate the diagnostic accuracy of the Phototest for cognitive impairment and dementia and to compare it with that of the MMSE and the Clock Drawing Test (CDT) in an Argentine population. A phase II cross-sectional study of diagnostic tests evaluation was performed in a sample of 30 controls, 61 with amnestic mild cognitive impairment (a-MCI), and 56 with mild Alzheimer type dementia (DAT). The diagnostic accuracy (DA) was assessed in relation to the clinical diagnosis by calculating the area under the ROC curve (UAC), Sensitivity (Sn), and Specificity (Sp).The DA of the Phototest for a-MCI and DAT (0.93 and 0.97 [UAC]) was higher than that of the MMSE and the CDT. The cut-off points of 27/28 for DAT (Sn = 89.29 [78.1–96.0], Sp = 96.67 [82.8–99.9]) and 30/31 for a-MCI (Sn = 85.25 [73.8–93.0], Sp = 90.00 [73.5–97.9]) maximized the sum of Sn and Sp. Phototest correlates significantly with MMSE and CDT. The Phototest is an efficient instrument for the detection of mild dementia or MCI, with good accuracy and good correlation with tests measuring overall cognitive impairment.     

Assessment of patients with memory problems using a nurse-administered instrument to detect early dementia and dementia subtypes

Background. With the development of pharmacological treatments for Alzheimer's disease there will be an increase in the numbers of patients requiring assessment from specialist services. Could the role of the specialist clinician be supported by other health professionals screening those who might benefit from treatment? Method. Sixty-four consecutive referrals to the Leicester University Memory Clinic were assessed at home by a community psychiatric nurse using a semi-structured interview. The nurse then reported her findings to a psychiatrist and a diagnosis was agreed. This diagnosis was then compared to the Memory Clinic diagnosis and a standardized (ICD-10) diagnosis recorded by another psychiatrist examining the clinic records. Results. The nurse assessment procedure performed well in detecting dementia, with a kappa statistic (κ) of 0·75 when compared to the standardized and Memory Clinic diagnoses. There was, however, only moderate concordance between the ICD-10 diagnosis and nurse (κ=0·46) and the Memory Clinic and nurse (κ=0·60) for Alzheimer's disease. The relatively low κ value for Alzheimer's disease was principally a result of difficult in differentiating vascular dementia. Conclusions. A single supervised community psychiatric nurse, using a structured assessment instrument, can adequately detect early dementia in a sample of patients referred with memory problems. Subtypes of dementia are not, however, accurately differentiated. © 1998 John Wiley & Sons, Ltd.     

认知干预在痴呆防治中的研究进展

痴呆是指伴随有进行性日常生活能力下降的认知减退或行为损害的综合征.鉴于目前缺乏有效的逆转病程的治疗手段以及药物治疗效果局限,治疗策略正拟向病前干预模式转移,旨在实现功能的最大化以及减缓认知减退,由此作为主要非药物治疗之一的认知干预,近年发展迅速,现将对不同人群中防治痴呆的认知干预综述如下.     

广州市城乡65岁及其以上人群痴呆患病率调查

目的调查广州市城乡≥65岁人群痴呆的患病率。方法采用分层随机整群抽样方法对广州市城乡人群进行抽样，用筛查和确诊两阶段法进行调查，实查14个居委会、2个村委会中≥65岁人群共3780人。按美国精神障碍诊断与统计手册第4版的标准诊断痴呆，阿尔茨海默病（AD）诊断采用美国神经病学、语言障碍和卒中研究所及阿尔茨海默病与相关障碍协会的标准。结果（1）查出痴呆患者182例，粗患病率为4．81％；其中AD128例（3．39％），血管性痴呆（VD）44例（1．16％）；经2000年广州市人口年龄构成进行标化，痴呆、AD和VD患病率分别为4．54％、3．17％和1．11％。（2）女性痴呆患者134例，粗患病率（5．98％）高于男性（48例，3．12％；P〈0．001），经年龄标化患病率分别为6．03％和2．74％。（3）痴呆患病率随年龄增长急剧上升。结论广州地区年龄≥65岁老人的痴呆患病率为4．81％，AD患病率高于VD。老年期痴呆患病率随年龄的增长而急剧升高。     

The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials

Physically-active video games (‘exergames’) have recently gained popularity for leisure and entertainment purposes. Using exergames to combine physical activity and cognitively-demanding tasks may offer a novel strategy to improve cognitive functioning. Therefore, this systematic review and meta-analysis was performed to establish effects of exergames on overall cognition and specific cognitive domains in clinical and non-clinical populations. We identified 17 eligible RCTs with cognitive outcome data for 926 participants. Random-effects meta-analyses found exergames significantly improved global cognition (g = 0.436, 95% CI = 0.18–0.69, p = 0.001). Significant effects still existed when excluding waitlist-only controlled studies, and when comparing to physical activity interventions. Furthermore, benefits of exergames where observed for both healthy older adults and clinical populations with conditions associated with neurocognitive impairments (all p < 0.05). Domain-specific analyses found exergames improved executive functions, attentional processing and visuospatial skills. The findings present the first meta-analytic evidence for effects of exergames on cognition. Future research must establish which patient/treatment factors influence efficacy of exergames, and explore neurobiological mechanisms of action.     

成都地区1997年和2000年两次老年期痴呆患病率调查结果的比较

目的了解老年期痴呆和阿尔茨海默病（AD）患病率在不同时间的变化。方法分别于1997年6月至1998年4月（第1次）和2000年11月至2001年3月（第2次），在成都地区用多层分级整群抽样方法，对调查时年龄≥55岁的社区人口进行痴呆患病率调查，两次调查的程序和使用工具相同。采用美国精神障碍诊断与统计手册第3版修订本的标准诊断痴呆。结果第1次调查实查5353人，失访202人，漏查率3．64％；诊断痴呆患者143例。第2次调查实查3908人，失访407人，漏查率9．43％；诊断痴呆患者107例。第1次与第2次调查现场诊断不一致的患者6例，均为轻度痴呆。第1次调查的痴呆、AD和血管性痴呆（VD）患病率分别为2．67％、2．04％和0．39％，第2次调查为2．74％、2．00％和0．46％，差异均无统计学意义（P〉0．05）。结论≥55岁的人口中，痴呆、AD和VD患病率在一定时期内保持稳定。对界于轻微认知功能损害与轻度痴呆之间的患者诊断较为困难，随访对明确诊断是必要的。