血清睾酮对老年男性轻度认知损伤和轻度痴呆患者认知功能的影响

目的　探讨认知损伤的老年男性患者中血清睾酮水平与认知功能的关系。方法　对 15例轻度认知损伤(MCI组 )、17例轻度阿尔茨海默病 (AD组 )、7例轻度血管性痴呆 (VaD组 )患者进行详细的认知功能检查。应用放射免疫法检测血清睾酮浓度。应用多元线性回归分析各项认知功能成绩与血清睾酮的关系 ,对年龄和文化水平进行调整。结果　MCI组睾酮与结构性检查的成绩呈正相关。轻度AD组睾酮与词表学习 3、复杂图形回忆和延迟回忆、领悟力、词语流畅性均呈正相关。轻度VaD组睾酮与词表学习 1的成绩呈负相关。当轻度AD和轻度VaD合并后 ,睾酮与词表学习 3、复杂图形复制和回忆及延迟回忆、领悟力、词语流畅性、简易智力状态检查表、地点定向、符号数字呈正相关关系 (P <0 .0 5 )。结论　血清睾酮水平与MCI和轻度痴呆患者的视空间技能有选择性关系 ,并可能与词语和图形记忆以及执行功能有关 ,这对于雄激素替代治疗痴呆的研究有重要意义。     

阿尔茨海默病与胰岛素抵抗及动脉粥样硬化的相关性研究

目的探讨阿尔茨海默病(AD)与胰岛素抵抗及动脉粥样硬化的相关性。方法选取2009年1月—2012年11月在济宁市第一人民医院神经内科和门诊确诊的AD患者187例和轻度认知功能障碍(MCI)患者116例,将MCI患者作为MCI组,AD患者分为轻度痴呆组81例、中度痴呆组72例和重度痴呆组34例,另选取同期我院体检健康者76例作为对照组。测定各组受试者空腹血糖(FPG)、空腹胰岛素(FINS)及稳态模型胰岛素抵抗指数(HOMA-IR);记录各组血脂水平(包括TC、TG、LDL)及收缩压;记录患者斑块检出率和颈动脉内膜中层厚度(IMT)。结果对照组HOMA-IRMCI组轻度痴呆组中度痴呆组重度痴呆组(P0.05)。MCI组斑块检出率高于对照组(P0.05)。MCI组IMT高于对照组(P0.05)。等级相关分析结果显示,痴呆严重程度与胰岛素抵抗程度呈正相关(r=0.80,P0.01);直线相关分析结果显示,胰岛素抵抗程度与IMT、斑块检出率呈正相关(r值分别为0.68、0.70,P0.01)。结论 AD患者痴呆严重程度随着胰岛素抵抗程度加重而加重,改善胰岛素抵抗,防治动脉粥样硬化,保护神经元,有利于改善AD患者病情及预后。     

认知障碍简明评价量表对老年人认知功能衰退的预测价值初探

目的探讨认知障碍简明评价量表(Cog-12)对老年人认知功能下降的预测能力。方法选择56例患者,其中基线水平认知正常29例和轻度认知功能障碍(MCI)27例,将基线与随访2年认知均正常18例作为NC组,认知正常转为MCI 11例作为CM组,基线及随访2年保持MCI状态作为10例MM组,MCI转化为阿尔茨海默型痴呆11例作为AD组。在初入组及随访2年后,分别通过知情者或照料者对患者进行Cog-12、蒙特利尔认知评估量表(MoCA)、简易智能状态检查量表(MMSE)评分,对患者的认知能力进行评价。结果认知正常者中,NC组的MoCA、MMSE评分较CM组明显升高,Cog-12-Ⅰ评分明显降低(P<0.05)。MCI患者中,MM组MoCA评分较AD组明显升高,Cog-12-Ⅰ和Cog-12总分明显降低(P<0.05)。认知正常者中,仅Cog-12为MCI预测因素(P=0.029),在MCI患者中,Cog-12不是MCI预测因素(P=0.082)。ROC工作曲线显示,当Cog-12界值为4.5分时,预测MCI的敏感性为81.4%。结论 Cog-12是有效而全面的认知功能筛查工具,在评估患者整体智能、精神、行为的表现基础上,可有效地发现认知功能的下降,一定程度上预测将发生认知下降的可能。     

阿尔茨海默病和轻度认知功能障碍的神经心理学研究

目的探讨阿尔茨海默病(AD)与轻度认知功能障碍(MCI)的神经心理学特点。方法52例AD、26例MCI患者及24例正常认知者分别接受临床评估和多项神经心理学检查,包括简易精神状态检查法(MMSE)、临床痴呆评定量表(CDR)、日常生活能力量表(ADL)、临床记忆量表(CMS)。结果AD组、MCI组、正常认知组总成绩MMSE分别为(18．9±5．1)分、(26．9±2．1)分、(29．0±1．1)分;ADL分别为(48．3±17．7)分、(26．7±9．3)分、(22．1±4．1)分;MQ分别为(52．5±26．7)分、(811．3±10．8)分、(101．8±11．6)分;CMS分别为(52．5±26．7)分、(81．3±10．8)分、(101．8±11．6)分。与正常认知组比较,MCI除ADL成绩外,其余各量表值均显著降低;与AD组比较,MCI组MMSE、ADL、记忆商(MQ)和CMS中各项成绩均优于AD(P<0．05)。CMS测验中的图像自由回忆分随痴呆程度加重而明显下降,各组比较,差异均有统计学意义(P<0．05)。结论以本研究设立的诊断标准所确立的MCI,其认知功能介于痴呆和正常认知老年人之间,并与早期AD具有相似的认知功能改变。神经心理学检查对于MCI、痴呆的早期诊断和客观反映痴呆严重程度具有重要价值,图像自由回忆是筛选MCI、早期诊断痴呆、评定痴呆程度的敏感指标。     

快速认知筛查测验识别老年轻度认知功能障碍的效果

目的评价老年人快速认知筛查测验识别轻度认知功能障碍(MCI)和早期痴呆(AD)的效能。方法 60岁及以上的轻度AD患者84例、MCI患者112例、正常老人(NC)196例,采用老年人快速认知筛查测验(QCST-E)、简易精神状态检查量表(MMSE)、日常生活能力(ADL)量表、临床痴呆评定量表(CDR)、华文认知能力量表(CCAS)进行认知功能评估。QCST-E分别测量12个认知领域:即刻记忆、实物命名、视觉空间、言语流畅性、数字广度、抽象能力、听觉模仿、视觉模仿、动作指令、延迟记忆、简单计算、时空定向,最高总分83分,得分越低,认知功能损害越严重。结果轻度AD组、MCI组、NC组QCST-E总分分别为(51.47±3.91)分、(61.47±2.96)分、(72.60±3.01)分,差异显著(P<0.01)。QCST-E各领域和总分与年龄、受教育年限及MMSE、ADL、CCAS得分显著相关(均P<0.01)。根据不同文化程度制定QCST-E的划界分,其中QCST-E总分识别MCI与正常老人的总体敏感度为89.6%、特异度为94.5%,曲线下面积(AUC)为0.903(95%CI:0.857~0.963);识别MCI与轻度AD的总体敏感度为81.7%、特异度为88.6%,AUC值为0.898(95%CI:0.845~0.940)。结论老年人快速认知筛查测验内容全面、简便易行,识别MCI的敏感度和特异度良好。     

阿尔茨海默病和轻度认知障碍患者血清皮质醇水平变化及意义

目的探讨阿尔茨海默病(AD)和轻度认知障碍(MCI)患者血清皮质醇水平的变化及意义。方法采集46例AD、42例MCI及44例正常对照者的外周静脉血进行血清皮质醇水平检测,所有受试者均进行简易精神状态量表(MMSE)、Hachinski缺血指数(HIS)及汉密顿抑郁量表(HAMD)评定,AD患者用临床痴呆评定量表(CDR)进行痴呆严重程度分级。结果 AD组血清皮质醇水平为(596.47±58.29)nmol/L,MCI组为(558.64±71.05)nmol/L,正常对照组为(408.65±79.86)nmol/L,AD组和MCI组均显著高于对照组(P0.01);AD组与MCI组比较无显著差异(P0.05)。AD组血清皮质醇水平与MMSE评分存在负相关(P0.05)。结论 AD和MCI患者存在血清皮质醇升高,且与AD严重程度显著相关,皮质醇可能参与了AD和MCI的病理过程。     

规律性体育运动干预老年人轻度认知功能障碍的疗效

认知功能障碍(CI)是一组后天获得的在记忆力、定向力及计算力等多个认知领域发生障碍的综合片,包括轻度认知功能障碍(MCI)和痴呆(AD)。随着我国老龄人口社会的到来,老年AD患者日益增多、文献报道表明,我国≥65岁老年人群AD的发病率为5%〔1〕。老年人MCI是介于正常衰老及AD之间的一种认知损伤状态,也是一种过渡状态。研究表明,每年约10%～15%的MCI患者可发展为AD〔2〕,而且MCI还严重影响了患者的生活质量,给患者家庭及社会均带来严重负担。MCI根据病因可分为退行性MCI(NMCI)、血管性MCI(VMCI)。目     

轻度认知障碍情景记忆损伤的神经心理学研究进展

<正>轻度认知障碍(MCI)指介于正常老化与痴呆之间的一种认知缺损状态,表现为与年龄和教育程度不相称的认知功能减退,但不影响日常生活能力,并尚未达到痴呆的临床诊断标准〔1〕。许多研究表明每年大约有10%~15%的MCI患者转变为痴呆,其中绝大部分转化为阿尔茨海默病(AD)〔2〕。作为MCI的分型,遗忘型轻度认知障碍(a MCI)最易转变为AD。情景记忆是指以时间和空间为坐标对个人亲身经历的、发     

轻度认知功能障碍人群中APOE基因与核磁共振影像改变在阿尔茨海默病早期诊断中的应用

阿尔茨海默病(Alzheimer's disease,AD)作为一种隐匿进展的神经退行性疾病,是痴呆最主要的类型,临床主要表现为进行性的认知功能下降和行为损害。轻度认知功能障碍(mild cognitive impairment,MCI),是指已有认知功能障碍,但尚未达到痴呆诊断标准的一种介于痴呆和正常衰老之间的中间状态。MCI作为AD的临床前阶段,是对AD进行早期干预的最佳时期,一方面MCI患者转化为AD的风险远高于普通人,每年有10%~15%的MCI患者发展为临床可诊断的AD,而健康人中这一比率仅为1%~2%[1]。     

轻度认知障碍动物模型进展

轻度认知障碍(MCI)是介于正常衰老和痴呆,尤其是阿尔茨海默病(AD)之间的一种认知缺损状态.研究发现每年约10%～15%的MCI患者发展为痴呆,而相同年龄的健康老年人每年发生AD的概率为1.0%～2.0%[1].     

Endogenous sex hormones as risk factors for dementia in elderly men and women

BACKGROUND: The associations of endogenous sex hormones with risk of dementia in the elderly population are not well known. METHODS: The relationship of baseline serum total estradiol (E2) and free testosterone (FT) to 4-year risk of all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD) was examined in a dementia-free, population-based cohort of 433 women (mean age 74 years) and 376 men (mean age 73 years). Multivariable proportional hazards regression was used to adjust for sociodemographic and lifestyle variables, body mass index, apolipoprotein E genotype, cardiovascular conditions, and homocysteinemia. RESULTS: Dementia developed in 71 women (46 AD, 21 VaD) and 39 men (23 AD, 12 VaD). In women with high E2 (serum E2 >or= 10 pg/mL), the multivariable-adjusted hazard ratio (HR) for dementia was 1.75 (95% confidence interval [CI], 1.06-2.89). The corresponding multivariable-adjusted HR for AD was 1.94 (95% CI, 1.04-3.61), whereas no association was found for VaD. No association with dementia was found for serum FT in women and for either serum E2 or FT in men. CONCLUSION: High serum E2 is an independent predictor for dementia and AD in elderly women.     

Small dense low-density lipoprotein and carotid atherosclerosis in relation to vascular dementia

Vascular dementia (VaD) and Alzheimer's disease (AD) are the most common causes of dementia in the elderly. The aim of this study was to investigate carotid atherosclerosis, serum lipid profiles, and atherogenic hormone levels in nondiabetic Japanese men with VaD or AD. Carotid artery intima-media thickness (IMT) and plaque, serum lipid and lipoprotein profiles, including low-density lipoprotein (LDL) particle size, as well as insulin-like growth factor-I (IGF-I, somatomedin C) and testosterone levels, were determined in 34 patients with AD, 37 patients with VaD, and 63 healthy male controls. Age, body mass index, systolic and diastolic blood pressure, and fasting plasma glucose, hemoglobin A(1c) (HbA(1c)), triglyceride, high-density lipoprotein (HDL)-cholesterol, and apolipoproteins (apo) A-I, B, and E levels did not differ significantly among the 3 groups. However, the mean value of carotid IMT, the frequency of atherosclerotic plaque deposition, the serum levels of LDL-cholesterol, lipoprotein(a), and lipid peroxides, and the incidence of small dense LDL (particle diameter 相似文献   

Cerebrovascular disease in the elderly: lipoprotein metabolism and cognitive decline

Data concerning the treatment of lipoprotein disturbances in patients with cerebrovascular disease (CVD) are less robust than those for coronary heart disease (CHD), raising clinical questions as to which is the appropriate therapeutic approach to stroke patients. Although observational cohort studies have failed to demonstrate an association between lipoprotein disorders and stroke incidence, recently completed trials of subjects at risk for CHD have shown that statins reduce not only the risk of myocardial infarction and death, but also that of brain infarction and transient ischemic attacks. At present, it seems reasonable to conclude that stroke patients with undesirable lipid profiles who have a history of CHD should receive specific treatment for the lipid disorder. Recommendations are more problematic for stroke patients with lipid disorder but no history of CHD. Furthermore, many of the risk factors for CVD and vascular dementia (VaD), including serum total cholesterol (TC), lipoprotein(a), diabetes, atrial fibrillation, hypertension, apolipoprotein E levels, and atherosclerosis, have also been shown to increase the risk of Alzheimer's disease (AD). In a recent study, we estimated the prevalence, incidence and rate of progression of Mild Cognitive Impairment (MCI) to dementia, and correlated vascular risk factors with incident MCI and its progression to dementia. We evaluated 2963 individuals from the population-based sample of 5632 subjects 65-84 years old of the Italian Longitudinal Study on Aging, with a 3.5-year follow-up. We found a progression rate to dementia (all causes) of 3.8/100 person-years. Furthermore, age was a risk factor for incident MCI, while education was protective, and serum TC evidenced a non-significant borderline trend for a protective effect. There was a non-significant trend for stroke as a risk factor of progression of MCI to dementia. In conclusion, in our population, among MCI patients who progressed to dementia, 60% progressed to AD and 33% to VaD. Vascular risk factors and CVD may influence the development of MCI and the rate of progression to dementia.     

Prevalence and severity of gait disorders in Alzheimer's and non-Alzheimer's dementias

OBJECTIVES: To compare the prevalence, severity, and type of gait and balance disorders in Alzheimer's disease (AD), vascular dementia (VaD), Parkinson's disease with dementia (PDD), dementia with Lewy bodies (DLB), Parkinson's disease without dementia (PD), and age-matched controls. DESIGN: Cross-sectional. SETTING: Secondary care clinics in geriatric psychiatry, neurology, and geriatrics. PARTICIPANTS: Two hundred forty-five participants aged 65 and older (AD, n=40; VaD, n=39; PDD, n=46; DLB, n=32; PD, n=46; and controls, n=42). MEASUREMENTS: Prevalence and severity of gait and balance disorders were assessed using the Tinetti gait and balance scale. The types of gait disorders in each diagnostic group were classified using the Nutt et al. classification. RESULTS: Gait and balance disorders were more common with PDD (93%), VaD (79%), and DLB (75%) than with PD (43%) and AD (25%) and in controls (7%). The risk of gait and balance disorder was higher in the non-Alzheimer's dementia groups (VaD, PDD, and DLB) than in the AD group (odds ratio=15 (95% confidence interval=6-37). If a gait disorder was present in mild dementia (Cambridge Examination for Mental Disorders of the Elderly cognitive subsection score >65), this was diagnostic of non-Alzheimer's dementia, with sensitivity of 78% and specificity of 100%. Non-Alzheimer's dementia groups had worse Tinetti gait and balance scores than the AD group (all P<.001). The types of gait disorders discriminated between non-Alzheimer's dementias. CONCLUSION: The findings support the idea that gait and balance assessment may augment the diagnostic evaluation of dementia.     

High prevalence of Chlamydia pneumoniae antibodies and increased high-sensitive C-reactive protein in patients with vascular dementia

OBJECTIVES: To determine the relationships between Chlamydia pneumoniae infection, carotid atherosclerosis, and dyslipidemia in patients with vascular dementia (VaD) and Alzheimer's disease (AD). DESIGN: Case control study. SETTING: Showa University Karasuyama Hospital, Tokyo, Japan. PARTICIPANTS: One hundred twenty-four elderly subjects: 31 with VaD, 61 with AD, and 32 age-matched controls without dementia. MEASUREMENTS: Presence of antibodies to C. pneumoniae (immunoglobulin G (IgG) and IgA), the serum concentrations of high-sensitive C-reactive protein (hs-CRP) and atherogenic lipoproteins, and the carotid artery intima-media thickness (IMT) and plaques were determined. RESULTS: Age; body mass index; systolic and diastolic blood pressures; and fasting plasma glucose, hemoglobin A(1c), high-density lipoprotein cholesterol, and apolipoprotein A-I, B, and E concentrations did not differ significantly between the three groups, but the mean IMT and frequency of atherosclerotic plaques in the carotid arteries, as well as the serum concentrations of low-density lipoprotein cholesterol (LDL-C), lipoprotein(a), and lipid peroxides were significantly greater in VaD patients than in AD patients or nondemented controls. Hs-CRP concentrations and prevalence of C. pneumoniae IgG and IgA antibodies also were significantly higher in VaD patients than in AD patients and nondemented controls. Multiple logistic regression analysis revealed that carotid IMT and plaques, LDL-C, lipid peroxides, hs-CRP, and IgG and IgA C. pneumoniae seropositivity were independent risk factors for VaD. CONCLUSION: These results suggest that carotid atherosclerosis, atherogenic lipoproteins, and C. pneumoniae infection (as documented by the IgG and IgA seropositivity together with increased hs-CRP) may be VaD risk factors.     

阿尔茨海默病和血管性痴呆患者血管紧张素转换酶和载脂蛋白E基因多态性分析

目的　探讨阿尔茨海默病 (AD)及血管性痴呆 (VaD)与血管紧张素转换酶 (ACE)和载脂蛋白E(apoE)基因多态性的关系。方法　应用聚合酶链反应和限制性片段长度多态性方法 ,检测了 2 6例晚发AD患者、5 4例VaD患者和6 8例正常老年人的ACE和apoE基因多态性。结果　AD组中apoE等位基因频率分别为ε2 0 .0 77、ε30 .6 15及ε40 .30 8,VaD组apoE等位基因频率分别为ε2 0 .0 5 6、ε30 .6 85及ε4 0 .2 5 9,AD组和VaD组apoEε4等位基因频率显著高于对照组。ACE基因AD组和VaD组DD型频率高于对照组 ,D等位基因亦高于对照组。结论　ACEDD型、apoEε4可能是AD及VaD发病的危险因素     

Awareness of memory deficits in patients with dementias: a study with the Everyday Memory Checklist

AIM: We examined the level of awareness of memory deficits in 63 patients with Alzheimer's disease (AD), 17 patients with dementia with Lewy bodies (DLB), 14 patients with vascular dementia (VaD), and 56 patients with amnestic mild cognitive impairment (MCI). METHODS: The unawareness of memory impairment was evaluated with a standardized memory questionnaire system based on the Everyday Memory Checklist (EMC). The EMC scores for the patient's own rating, the caregivers' rating and the unawareness score, defined as the discrepancy between these (caregiver rating-patient rating), were analyzed. RESULTS: Although the EMC self-rating scores were comparable among the four groups, the EMC scores in caregivers were significantly higher in the AD group than in the DLB, VaD, and MCI groups. Therefore, the unawareness scores were significantly higher in the AD groups than in other groups. When an unawareness score of 9 or more was defined as significant, impaired awareness was found in 41 (65%) patients with AD, 1 (6%) patient with DLB, 5 (36%) patients with VaD, and in 19 (34%) patients with MCI. CONCLUSION: We found that impaired awareness was found in two-thirds of patients with mild AD and even in one-third of patients with MCI. However, other dementias, in particular DLB, had less severe and less frequent unawareness of memory deficits than AD, suggesting the difference in the pathophysiology between them.     

Mild cognitive impairment: epidemiology and dementia risk in an elderly Italian population

OBJECTIVES: To investigate prevalence and incidence of mild cognitive impairment (MCI) and its risk of progression to dementia in an elderly Italian population.
DESIGN: Longitudinal.
SETTING: Population-based cohort aged 65 and older resident in an Italian municipality.
PARTICIPANTS: A total of 1,016 subjects underwent baseline evaluation in 1999/2000. In 2003/04, information about cognitive outcome was collected for 745 participants who were free of dementia at baseline.
MEASUREMENTS: MCI (classified as with or without impairment of the memory domain), dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) diagnosed according to current international criteria.
RESULTS: Overall prevalence of MCI was 7.7% (95% confidence interval (CI)=6.1–9.7 %) and was greater with older age and poor education. During 4 years of follow-up, 155 incident MCI cases were diagnosed, with an incidence rate of 76.8 (95% CI=66.8–88.4) per 1,000 person-years. Approximately half of prevalent and incident MCI cases had memory impairment. Compared with normal cognition, multivariable-adjusted risk for progression from MCI with memory impairment to dementia was 4.78 (95% CI=2.78–8.07) for any dementia, 5.92 (95% CI=3.20–10.91) for AD, and 1.61 (95% CI=0.37–7.00) for VaD. No association with dementia risk was found for MCI without memory impairment. Approximately one-third of MCI cases with memory impairment did not progress to dementia.
CONCLUSION: MCI occurs often in this elderly Italian cohort and is associated with greater risk of AD, but only when the impairment involves the memory domain. However, a substantial proportion of MCI cases with memory impairment do not progress to dementia.     

Toll样受体4在阿尔茨海默病及血管性痴呆患者外周血单核细胞表达的初步研究

目的:检测Toll样受体4(TLR4)在阿尔茨海默病(AD)及血管性痴呆(VaD)患者外周血单核细胞的表达情况,探讨TLR4在老年期痴呆发病机制中的可能作用。方法:选择临床确诊的AD患者(n=26)、VaD患者(n=31)和正常对照组(n=29)共86例,采用流式细胞术检测3组外周血单核细胞膜上TLR4蛋白阳性表达率及平均荧光强度(MFI)并进行比较分析。结果:外周血单核细胞膜表达TLR4的阳性表达率和MFI AD组和VaD组较对照组明显增高(P0.05)。结论:TLR4作为免疫炎性机制信号通路的关键蛋白,在AD、VaD的发病中均表现为增高,提示炎性机制在AD和VaD的发病中均发挥了作用,TLR4可能不能作为鉴别诊断的潜在生物标志物。