老人认知功能变化及其意义：1.BSSD总分变化

应用自编的简易痴呆筛查量表（ＢＳＳＤ），相隔４年对５２３名７５岁以上生活在社区的老年人，进行两次检测。结果发现，随年龄增长，认知功能进一步减退，全组ＢＳＳＤ总分平均下降３．３６分，随访诊断为痴呆者有５８例，其认知功能的衰退，远甚于正常者；而且他们原先的认知功能便不如正常组。另外，还就影响认知功能动态变化的其它因素及痴呆早期诊断可能性等问题，简作讨论。     

神经心理测验和轻性痴呆

应用简易痴呆筛查量表（ＢＳＳＤ）、简易智力检查表（ＭＭＳＥ）、常识记忆注意测验（ＩＭＣＴ）、长谷川痴呆量表（ＨＤＳ）、Ｆｕｌｄ物体记忆测验（ＦＯＭ）、言语流畅性测验（ＲＶＲ）、积木测验（ＢＤ）、数字广度测验（ＤＳ）、日常生活功能量表（ＡＤＬ）检测３０７５例社区老人，结果发现对轻性痴呆诊断敏感的指标有（１）由ＢＳＳＤ、ＭＭＳＥ、ＨＤＳ筛选出的４个因子：时间定向、计算／注意、常识／图片理解、名词即刻记忆；（２）ＦＯＭ、ＲＶＲ、ＢＤ、ＤＳ中２项或２项以上阳性     

老人日常生活活动能力的变化及与痴呆的关系

目的：了解正常老人日常生活活动能力的自然衰退情况及其影响因素，探索ＡＤＬ评定对预测痴呆的作用。方法：用１４项日常生活活动能力量表对３０１９例正常社区老人进行间隔５年的两次随访并按ＤＳＭ－Ⅲ－Ｒ标准诊断是否痴呆。结果：正常老人ＡＤＬ平均得分１４．９５，５年后增加１．４３。增幅随年龄增长而加大。痴呆组ＡＤＬ总分显著高于正常组，且离散度大，５年间平均增加１４．４９分。Ｌｏｇｉｓｔｉｃ回归分析显示，年龄大，ＰＳＭＳ得分高以及教育程度低者，发生痴呆的相对危险性大。结论：社区智力正常老人ＡＤＬ保持良好，自然衰退幅度不大，与年龄有关。如无特殊躯体原因，ＡＤＬ总分年内上升５分以上，应考虑痴呆可能。     

社区老人神经心理功能的5年随访观察

目的：调查分析社区老人同一组神经心理测验５年随访结果。方法：应用Ｆｕｌｄ物品记忆测验（ＦＯＭ）、言语流畅性测验（ＲＶＲ）、积木测验（ＢＤ）和数字广度测验（ＤＳ）评定１２１名社区老人５年前后的认知功能变化。结果：ＮＰＴ变化幅度是：正常老人组：ＢＤ＞ＲＶＲ＞ＤＳ＝ＲＥＣ１３。痴呆老人组：ＢＤ＞ＲＶＲ＝ＲＥＣ１３＞ＤＳ。正常衰老与病理衰老在物品短时记忆与语义长时记忆的减退速率上有显著的差异。结论：正常衰老与病理衰老具有不同的神经心理学变化特点，这些特点有助于痴呆的诊断与预测。     

事件相关电位对帕金森痴呆的早期诊断意义

目的：探讨事件相关电位（ＥＲＰ）在帕金森病（ＰＤ）痴呆中的诊断价值。方法：对２１例ＰＤ患者进行ＥＲＰ检测及长谷川智能量表（ＨＤＳ）检查。结果：ＰＤ组Ｎ２、Ｐ３潜伏期比对照组显著延长，ＰＤ患者ＥＲＰ阳性率为６２％，ＨＤＳ为３８％。结论：ＥＲＰ检测结果敏感，对帕金森痴呆的诊断、尤其是早期诊断有重要意义     

精神分裂症患者血中SOD,GSH—PX,GSH及LPO的变化及临床意义的研究

应用超氧化物歧化酶超微量快速测定法、血中谷胱甘肽过氧化物酶活力测定法（ＤＴＮＢ）、二硫双硝基苯甲酸定量测定法和血清中丙二醛与硫代巴比土酸定量测定法（ＴＢＡ）测定４０例精神分裂症病人血中超氧化物岐化酶（ＳＯＤ）、谷胱甘肽过氧化物酶（ＧＳＨ－ＰＸ）活力，还原型谷胱甘肽（ＧＳＨ）、脂质过氧化物（ＬＰＯ）含量，并与简明精神病量表（ＢＰＲＳ）总分、因子分、病人性别进行相关分析。结果表明：精神分裂症病人中血ＳＯＤ活力明显升高，与ＢＰＲＳ总分及五个因子分呈直线正相关，而ＧＳＨ－ＰＸ活力正常。ＧＳＨ含量明显下降，且与ＢＰＲＳ总分及因子３、４、５的分数呈直线负相关。血中ＬＰＯ含量正常。     

嗜碱性粒细胞脱颗粒试验与点酶联免疫吸附试验在过敏性哮喘…

本文以粉尘螨为抗原和刺激剂，采用点酶联免疫吸附试验（Ｄｏｔ－ＥＬＩＳＡ）和嗜碱性粒细胞脱颗粒试验（ＨＢＤＴ），结合皮内试验比较检测过敏性哮喘患者８２例，对照健康人４４例（儿童１７例、成人２７例）。结果患者阳性率分别为６３．４％、５４．９％、６７．１％。健康人４．６％、２．３％、４．６％。Ｄｏｔ－ＥＬＩＳＡ和ＨＢＤＴ符合率（患者８４．１％，健康人９７．７％），上法可作为过敏性哮喘特异性诊断指标。     

载脂蛋白E基因多态性与血管性痴呆关系的研究

为探讨载脂蛋白Ｅ（ＡｐｏＥ）基因多态性与血管性痴呆（ｖａｓｃｕｌａｒｄｅｍｅｎｔｉａ，ＶＤ）的关系，采用单链构象多态性分析（ＰＣＲ－ＳＳＣＰ）检测了３７例ＶＤ患者的ＡｐｏＥ基因型，并与４０例同龄对照组及４０例非痴呆脑梗塞组比较，同时检测血脂、脂蛋白及部分载脂蛋白。结果表明，ＶＤ组ε４基因频率明显高于对照组（Ｐ＜０．０１）和非痴呆脑梗塞组（Ｐ＜０．０５），ＶＤ患者中携ε４等位基因者血ＴＣ及ＬＤＬ－Ｃ水平显著高于携ε２、ε３者。提示：ε４基因可能是ＶＤ的危险因子，其机理可能与大脑血管性和变性性损害有关。     

16例难治性精神分裂症前瞻性研究

目的 进一步验证ＩＬＩＴ对难治性精神分裂症的确切疗效。方法 ３１例精神分裂症患者随机分为治疗组和对照组，采用简明精神病评定量表于治疗前后每周评定一次，３周后进行疗效评定。结果 激光组与对照组的显效率分别为４４％和２０％，ＢＰＲＳ总分比较χ＾２＝４．１０，Ｐ〉０．２５，无差异。Ｉ项因子分在第２周〈０．０１，第３周Ｐ〈０．００１，疗效明显，Ⅱ、Ⅲ、Ⅳ、Ⅴ项因子分变化针差异。加项Ｘ２，Ｐ〈０．０１，有显     

抗D型葡萄球菌肠毒素单克隆抗体的研制及其初步应用

应用小鼠杂交瘤技术获得５株分泌抗Ｄ型葡萄球菌肠毒素（ＳＥＤ）ＭｃＡｂ的杂交瘤细胞（ＤＣ３、ＤＣ４、ＤＢ１１、４Ｄ３和４Ｄ５）。其中４Ｄ３为ＩｇＭ（λ），其余为ＩｇＧ１（ｋ）。这组ＭｃＡｂ除ＤＣ３外，其它４株ＭｃＡｂ识别的抗原构象表位相同，其相对亲和力依次为４Ｄ５＞ＤＣ３＞ＤＣ４＞４Ｄ３＞ＤＢｌｌ。利用抗ＳＥＤ多克隆抗体与ＨＲＰ标记的ＤＣ３和４Ｄ３（针对不同表位）混合ＭｃＡｂ建立了夹心ＥＬＩＳＡ法，并以该法检测了自临床标本中分离的８０林金葡萄菌所产生的ＳＥＤ，其产毒率为４１．３％。     

Subclassifications for mild cognitive impairment: prevalence and predictive validity

BACKGROUND: Mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. Recently published results of the Current Concepts in MCI Conference suggested subclassifications for MCI (MCI-amnestic, MCI-multiple domains slightly impaired, MCI-single nonmemory domain) based on the recognized heterogeneity in the use of the term. These subclassifications have not been empirically validated to date. METHOD: A community sample of 1045 dementia-free individuals aged 75 years and over was examined by neuropsychological testing in a three-wave longitudinal study. The prevalences and the predictive validities for the subclassifications of MCI and their modifications (original criteria except for the report of subjective decline in cognitive function) were determined. RESULTS: The prevalence was 1 to 15% depending on the subset employed. Subjects with a diagnosis of MCI progressed to dementia at a rate of 10 to 55% over 2.6 years, depending on the subset employed. MCI-amnestic achieved the highest positive predictive power (PPP). ROC curves of the subclassifications for MCI indicate that all but one subset for MCI failed to predict dementia (MCI-multiple domains slightly impaired-modified: AUC=0.585, P<0.01, 95% CI, 0.517-0.653). The use of modified criteria for MCI (original criteria except for the report of subjective decline in cognitive function) is associated with a higher diagnostic sensitivity but also with a reduction in diagnostic specificity and PPP. CONCLUSIONS: Modified criteria should be applied if a concept for MCI with a high sensitivity is required and the original criteria (including subjective cognitive complaint) if a concept with high specificity and high PPP is required.     

Memory performance in healthy elderly without Alzheimer's disease: effects of time and apolipoprotein-E.

Transgenic mice expressing human APOE-epsilon4 develop an age-dependent decline in memory without pathological features of Alzheimer's disease (AD). This implicates APOE in the maintenance of memory during normal senescence, but parallel human studies are limited because longitudinal investigations of memory usually do not exclude patients with AD or "questionable" AD (QD). The current study examined the effect of APOE on cognitive function over time in elderly without dementia. We hypothesized that, compared to other APOE alleles memory decline even in healthy elderly would be greater among those with an APOE-epsilon4. The results of neuropsychological tests, grouped into domains of memory, language and visuospatial/cognitive function by factor analysis, were examined at three intervals over a seven-year period in 563 healthy elderly without AD or QD using generalized estimating equations. Memory performance declined over time, while scores on the visuospatial/cognitive and language factors did not change. Increased age was associated with lower scores, and higher education with higher scores on all factors at each interval. No APOE allele was associated with performance on a specific cognitive factor at any interval, but the presence of an APOE-epsilon4 allele was associated with a more rapid decline in the memory factor over the follow-up period. The effect was most pronounced among individuals with less than 10 years of formal education. There was no similar time-dependent relationship between APOE-epsilon4 and the language or visuospatial/cognitive factors. Transgenic mice and elderly humans without AD or QD expressing APOE-epsilon4 show a decline in memory performance over time. These observations provide evidence for an APOE-specific effect on memory during senescence.     

Association of sleep‐disordered breathing with decreased cognitive function among patients with dementia

Sleep is known to be essential for proper cognitive functioning. Sleep disturbance, especially respiratory disturbance during sleep, is a risk factor for the development of dementia. However, it is not known whether hypopnoea during sleep is related to severity of cognitive function in patients already diagnosed with dementia. Considering the high prevalence of sleep problems in aged people, it is important to determine if hypopnoea during sleep contributes to dementia. In addition, it would be desirable to develop a feasible method for objectively evaluating sleep in patients with dementia. For this purpose, a simple sleep recorder that employs single or dual bioparameter recording, which is defined as a type‐4 portable monitor, is suitable. In this study, a type‐4 sleep recorder was used to evaluate respiratory function during sleep in 111 patients with dementia, and data suggesting a possible relationship with cognitive function levels were examined. Multivariate logistic regression was used to investigate the association of severity of dementia with sleep‐disordered breathing, age, diabetes, dyslipidaemia and hypertension. It was found that the respiratory disturbance index was associated with severity of cognitive dysfunction in our subjects. Furthermore, patients younger than 80 years were more susceptible to lower cognitive function associated with sleep‐disordered breathing than patients 80 years old or over, because an increase in the respiratory disturbance index was associated with deteriorated cognitive function only in the former age group. These results suggest that proper treatment of sleep apnea is important for the preservation of cognitive function, especially in patients with early‐stage dementia.     

Brain tissue volumes in relation to cognitive function and risk of dementia

We investigated in a population-based cohort study the association of global and lobar brain tissue volumes with specific cognitive domains and risk of dementia. Participants (n=490; 60-90 years) were non-demented at baseline (1995-1996). From baseline brain MRI-scans we obtained global and lobar volumes of CSF, GM, normal WM, white matter lesions and hippocampus. We performed neuropsychological testing at baseline to assess information processing speed, executive function, memory function and global cognitive function. Participants were followed for incident dementia until January 1, 2005. Larger volumes of CSF and WML were associated with worse performance on all neuropsychological tests, and an increased risk of dementia. Smaller WM volume was related to poorer information processing speed and executive function. In contrast, smaller GM volume was associated with worse memory function and increased risk of dementia. When investigating lobar GM volumes, we found that hippocampal volume and temporal GM volume were most strongly associated with risk of dementia, even in persons without objective and subjective cognitive deficits at baseline, followed by frontal and parietal GM volumes.     

Polymorphisms in LMNA and near a SERPINA13 gene are not associated with cognitive performance in Chinese elderly males without dementia

Aging is associated with cognitive deterioration. A recent study showed two polymorphisms (rs505058 in LMNA and rs11622883 near a SERPINA13 gene), identified in a genome-wide association study of late-onset Alzheimer's disease, to be associated with cognitive function (Mini Mental State Examination) in a UK elderly population. This study replicated these findings in Chinese elderly males without dementia. A total of 358 elderly subjects were assessed by the Cognitive Abilities Screening Instruments (CASI) and the Wechsler Digit Span Task tests. Analysis of covariance was used to compare cognitive scores among genotypic groups, with age and total education years as covariates. The two polymorphisms were not associated with the global cognitive function or specific cognitive domains in the elderly without dementia. Our data argue against that these two polymorphisms may affect cognitive function in the elderly.     

Steroid and nonsteroidal anti-inflammatory drugs, cognitive decline, and dementia

The aim of this study was to evaluate the effects of anti-inflammatory intake on cognitive function in 7234 community-dwelling elderly persons. Cognitive performance, clinical diagnosis of dementia, and anti-inflammatory use were evaluated at baseline, and 2, 4, and 7 years later. Multivariate logistic regression analyses were adjusted for sociodemographic, behavioral, physical, mental health variables, and genetic vulnerability (apolipoprotein E ε4). Elderly women taking inhaled corticosteroids were at increased risk for cognitive decline over 7 years in executive functioning (odds ratio, 1.76; 95% confidence interval, 1.14-2.71; p = 0.04); the effect being increased after continuous use (odds ratio, 3.15; 95% confidence interval, 1.29-7.68; p = 0.01) and not found after discontinuation of treatment. In men, no significant associations were observed. Corticosteroid use was not significantly associated with an increase risk of incident dementia over 7 years. Nonsteroidal anti-inflammatory drug use was not significantly associated with either dementia incidence or cognitive decline in both sexes. The association may be related to hypothalamic-pituitary-adrenal corticotropic axis dysfunctioning rather than a direct anti-inflammatory mechanism. Long-term use of inhaled corticosteroids may constitute a form of reversible cognitive disorder in elderly women. Physicians should check this possibility before assuming neurodegenerative changes.     

Synaptic proteins, neuropathology and cognitive status in the oldest-old

An increasing number of individuals in our population are surviving to over 90 years and a subset is at risk for developing dementia. However, senile plaque and neurofibrillary tangle pathology do not consistently differentiate individuals with and without dementia. Synaptic protein loss is a feature of aging and dementia and may dissociate 90+ individuals with and without dementia. Synaptophysin (SYN), postsynaptic density 95 (PSD-95) and growth-associated protein 43 (GAP-43) were studied in the frontal cortex of an autopsy series of 32 prospectively followed individuals (92-105 years) with a range of cognitive function. SYN protein levels were decreased in individuals with dementia and increased in those with clinical signs of cognitive impairment insufficient for a diagnosis of dementia. SYN but neither PSD-95 nor GAP-43 protein levels were significantly correlated with mini-mental status examination (MMSE) scores. Frontal cortex SYN protein levels may protect neuronal function in oldest-old individuals and reflect compensatory responses that may be involved with maintaining cognition.     

Cardiorespiratory fitness is associated with atrophy in Alzheimer's and aging over 2 years

We sought to describe change in cardiorespiratory (CR) fitness over 2 years in those with early-stage Alzheimer's disease (AD) and nondemented aging and assess the relationship of CR fitness with cognitive decline, brain atrophy, and dementia progression. Individuals with early-stage AD (n = 37) and without dementia (n = 53) attended clinical evaluations, cognitive and exercise tests, and magnetic resonance imaging (MRI) at baseline and 2 years later. CR fitness was lower in those with AD over the study period. Lower baseline CR fitness was associated with progression of dementia severity in AD. Declining CR fitness over 2 years was associated with brain atrophy in AD, especially in the parahippocampus. In nondemented participants, there was a trend for lower baseline fitness to be related to cognitive decline. Both lower baseline CR fitness and declining CR fitness over 2 years were associated with regional brain atrophy. We conclude that CR fitness is chronically reduced in those with AD. Further, in those with AD, CR fitness is associated with progression of dementia severity and brain atrophy in AD, suggesting a link between progression of dementia severity and cardiorespiratory health.     

Regional Multiple Pathology Scores Are Associated with Cognitive Decline in Lewy Body Dementias

Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) are characterized by the presence of α‐synuclein‐containing Lewy bodies and Lewy neurites. However, both dementias also show variable degrees of Alzheimer's disease (AD) pathology (senile plaques and neurofibrillary tangles), particularly in areas of the cortex associated with higher cognitive functions. This study investigates the contribution of the individual and combined pathologies in determining the rate of cognitive decline. Cortical α‐synuclein, phosphorylated tau (phosphotau) and Aβ plaque pathology in 34 PDD and 55 DLB patients was assessed semi‐quantitatively in four regions of the neocortex. The decline in cognition, assessed by Mini Mental State Examination, correlated positively with the cortical α‐synuclein load. Patients also had varying degrees of senile Aβ plaque and phosphotau pathology. Regression analyses pointed to a combined pathology (Aβ plaque plus phosphotau plus α‐synuclein‐positive features), particularly in the prefrontal cortex (BA9) and temporal lobe neocortex with the superior and middle temporal gyrus (BA21, 22), being a major determining factor in the development of dementia. Thus, cognitive decline in Lewy body dementias is not a consequence of α‐synuclein‐induced neurodegeneration alone but senile plaque and phosphorylated tau pathology also contribute to the overall deficits.     

腺样体肥大患者的认知功能改变

目的探讨腺样体肥大患者的认知功能改变,进一步指导临床。方法对70名10～19岁腺样体肥大患者采用《基本认知能力测验》（2.0版）进行认知功能检查。结果除无意义图形再认以外,基本认知能力总分及各分项分均为两个高年龄组低于10～12岁组。总分13～15岁组与10～12岁组差异有显著性（P=0.039）;汉字比较13～15、16～19岁组分别与10～12岁组的差异均有显著性（P值分别为0.007、0.001）;双字词再认16～19岁组与10～12岁组的差异有显著性（P=0.029）。两个高年龄组基本认知能力的印象评定均显著差于10～12岁组。除无意义图形再认外,总分及各分项分均为男性差于女性,其中总分及汉字比较、双字词再认男女差异均具有显著性（P分别为0.028、0.000、0.028）。结论腺样体肥大是认知功能损害的重要因素,认知速度、记忆能力的损害尤为显著;12岁是一重要的分界年龄;同等基线条件下男性的认知功能损害重于女性。建议早期手术治疗,对于男性相对放松手术指征,以减少对患者认知功能的损害。