老年功能性消化不良患者的情感障碍及其治疗

目的 探讨老年功能性消化不良（FD）患者与情感障碍的关系以及抗抑郁治疗的重要性。方法 对87例老年FD患者进行情感障碍的调查,并随机选择80例内科其他系统老年病人作对照。以Sung抑郁自评量表（SDS）作为抑郁状态诊断标准。对其中FD伴有抑郁状态的36例患者,在对症治疗疗效不佳的基础上加用选择性5－羟色胺再摄取抑制剂（SSRIs)氟西汀进行治疗。比较治疗前后抑郁状态改善程度。结果 （1）老年FD患者伴有情感障碍的患病率为41．4％（36／87）明显高于老年内科其他系统病人的患病率23．8％（19／80）,P＜0．05。（2）本实验中,氟西汀治疗抑郁状态总有效率为88．9％,且消化道症状改善较情感障碍症状改善为早。结论 情感障碍在老年FD患者发病中有重要地位。及时诊断及治疗抑郁状态非常重要。对老年FD伴情感障碍氟西汀有着很高的治疗价值。     

阿尔茨海默病患者脑萎缩与认知功能障碍的相关性

目的探讨阿尔茨海默病(AD)和认知功能正常老年人脑萎缩的差异性及AD患者脑萎缩和认知功能障碍之间的相关性。方法随机选取北京老年医院年龄60岁以上临床诊断老年性痴呆患者30例,选取门诊及其他科室认知功能正常的60岁以上非AD老年人40例为正常对照组,测量近1个月脑CT成像,得出哈氏值、侧脑室体部指数、沟间距、左右外侧裂、第三脑室宽度,对两组病例上述脑萎缩指标做病例对照研究;对AD组患者行临床痴呆量表(CDR)评定,并将以上数值和CDR作相关性分析。结果 AD组和对照组脑萎缩指标方差分析显示有显著性差异(P0.05),CDR和哈氏值、沟间距、左右外侧裂、第三脑室宽度正相关,而和侧脑室体部指数负相关。结论 AD脑萎缩是老年性痴呆特异性标志,和认知功能障碍严重程度有密切相关性。     

阿尔茨海默病患者脑萎缩与认知功能障碍的相关性

目的探讨阿尔茨海默病(AD)患者脑萎缩和认知功能障碍之间的相关性。方法选择老年AD患者60例临床资料进行回顾性分析,另选取同期体检的认知功能正常的非AD老年人60例为对照组,测量两组脑CT参数作线性测量以确定脑萎缩的程度,并对AD组患者行临床痴呆量表(CDR)评定,并将以上数值和CDR作相关性分析。结果 AD组患者侧脑室颢角间径、侧裂池宽平均宽度、三脑室宽度、尾状核头间径、侧脑室前角宽度、侧脑室体部平均宽度、侧脑室枕部平均宽度、脑沟平均宽度等均明显高于对照组(P<0.05),说明脑颞叶、脑皮质及白质萎缩;AD组四叠体池宽度与对照组比较差异无统计学意义(P>0.05),说明脑干萎缩不明显。CDR和侧脑室颢角间径、侧裂池宽平均宽度、三脑室宽度、尾状核头间径、侧脑室前角宽度、侧脑室体部平均宽度、侧脑室枕部平均宽度、脑沟平均宽度等指标均呈正相关。结论老年性AD脑萎缩和认知功能障碍严重程度有密切相关性。     

快步走改善阿尔茨海默病患者睡眠障碍的疗效观察

目的探讨快步走对阿尔茨海默病(AD)患者睡眠障碍的治疗效果。方法入选2015年12月至2016年12月北京老年医院精神心理二科收治的72例轻、中度AD患者,随机分为对照组(常规治疗)和运动组(常规治疗+快步走),每组各36例,对照组维持原有的生活习惯,采用常规药物进行治疗;运动组在常规治疗的基础上,进行每日≥60 min、≥3次/周的快步走。采用匹兹堡睡眠质量指数量表(PSQI)对睡眠障碍严重程度进行评估,以PSQI减分率评定疗效。采用SPSS 13.0统计软件对数据进行分析,根据数据类型,组间比较采用配对样本t检验、独立样本t检验或χ2检验。结果治疗12周后,运动组PQSI总分及睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍得分较治疗前均明显下降,差异有统计学意义(P0.05),且与对照组相比亦显著下降,差异有统计学意义(P0.05);对照组仅PQSI总分较治疗前下降[(15.53±3.33)vs(14.94±3.53)分],差异有统计学意义(P0.05),余各因子得分变化不明显。运动组总有效率高于对照组[55.6%(20/36)vs 19.4%(7/36);P0.05]。结论快步走辅助常规治疗可有效改善AD患者的睡眠障碍。     

轻度阿尔茨海默病患者记忆障碍的临床研究

目的　探讨轻度阿尔茨海默病患者记忆障碍的临床特点及损害类型。　方法　轻度阿尔茨海默病患者 3 0例 ,轻度认知功能障碍患者 2 0例 ,健康老年人 2 0名 ;语言工作记忆和注意力测定应用韦氏数字广度测验进行 ;非陈述性记忆测定应用改良后SegwinGaddand型板测验 ;情节性记忆测定应用简历记忆访谈测验 ;词语性记忆测查应用临床记忆量表及ADAS cog量表。　结果　与健康老年人组比较 ,在记忆损害类型中 ,轻度阿尔茨海默病组及轻度认知功能障碍组语言工作记忆均受到损害 ,组间差异有显著性 (t =2 3 4 2 ,P <0 0 5) ;非陈述性记忆两组间差异无显著性 (t =1 653 ,P >0 0 5) ,且几乎不受损害。轻度阿尔茨海默病患者组与轻度认知功能障碍患者组之间 ,情节性记忆组间差异有显著性 (t =3 469,P <0 0 1) ,而词语性记忆中 (除即刻回忆、物品命名外 )组间差异有显著性 (t =2 618,P <0 0 5)。　结论　轻度阿尔茨海默病患者临床最早出现的并具特异性的记忆损害类型为情节性记忆和词语性记忆 ,且情节性记忆损害较词语性记忆损害更具特异性     

嗅觉障碍与阿尔茨海默病的关系

<正>阿尔茨海默病(AD)患者出现精神紊乱、记忆逐步遗失、认知能力下降和行为功能减退的症状。该病的病理现象有Tau蛋白过度磷酸化引起的神经纤维原缠结、β-淀粉样蛋白沉积形成的老年斑(SP)及神经元大量凋亡。目前尚未开发出可以终止或逆转AD进程的药物〔1〕。如何尽早发现并确诊病例以便减缓病情的发展并对症治疗,已成为备受关注的问题〔2~4〕。越来越多的研究结果表明,嗅觉系统与AD存在极大相关性。患     

阿尔茨海默病的嗅觉障碍分析

目的 分析阿尔茨海默病(AD)患者的嗅觉功能损伤,以利于早期诊断和观察病情进展.方法 收集解放军总医院第六医学中心神经内科门诊就诊的AD患者20例为AD组,轻度认知功能障碍(MCI)患者20例为MCI组和认知功能正常者20例为对照组.采用简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能.采...     

2型糖尿病家系一级亲属同胞代谢综合征患病状况的研究

研究2型糖尿病（T2DM）家系一级亲属同胞（n=142）和同胞配偶中的无糖尿病家族史的一级亲属同胞（n=138）代谢综合征（MS）的患病状况，结果显示T2DM家系一级亲属同胞MS的患病率显著高于无糖尿病家族史的一级亲属同胞（P〈0．01）。     

老年人群睡眠障碍与阿尔茨海默病相关性研究进展

睡眠模式随衰老而变化,老年人群易合并入睡困难、睡眠碎片化、白日嗜睡、早醒等睡眠障碍。阿尔茨海默病(AD)是衰老背景下的神经系统退行性疾病,也是老年人最常见的痴呆原因。目前,越来越多的研究发现,睡眠障碍与AD之间存在显著的相关性,尤其是睡眠觉醒障碍,可通过影响脑内淋巴循环代谢,导致β-淀粉样蛋白清除率降低,进而影响AD发生发展。尽管有一定的研究基础,但是睡眠障碍究竟是AD发生发展的因还是果仍未可知,睡眠障碍影响AD发生发展的潜在机制仍不明确,AD相关认知障碍患者的睡眠干预及调节策略仍缺乏统一的指导意见。因此,本文综述了衰老与睡眠生理变化、睡眠障碍与AD相关性及睡眠障碍干预与认知改善的最新研究证据,旨在提高人们对睡眠障碍及睡眠调节重要性的认识,以期达到疾病的早期预防。     

阿尔茨海默病共患癫痫的回顾性临床研究

目的分析阿尔茨海默病(AD)患者的癫痫患病率及相关临床特征。方法回顾性研究自2010年1月至2019年1月天津市环湖医院痴呆与变性病专病数据库中AD患者,统计AD合并癫痫的患病率,分析神经心理学评估特点、临床发作表现、脑电图特征等,并与不合并癫痫的AD患者进行对比。结果在376例AD患者中11.4%合并癫痫。其中4.0%患者出现非诱发性癫痫发作早于AD确诊时间,7.5%在AD确诊后出现。AD患者中首次出现癫痫年龄为(59.8±19.9)岁,确诊为AD年龄为(62.8±6.6)岁。癫痫类型多为局灶性发作(65.1%),脑电图表现多为局灶慢波(69.8%)及局灶癫痫样放电(23.3%)。合并癫痫AD患者较不合并癫痫AD患者确诊AD时间提前8年。结论癫痫在AD患者中具有更高的患病率,癫痫可能是认知损害进展为AD的危险因素,早期识别癫痫及认知损害可能对延缓痴呆进展有积极意义。     

Prevalence of autoimmune disorders in relatives of patients with celiac disease

Celiac disease (CD) is frequently associated with an autoimmune disorder (AD). The aim of the study was to establish if an AD is more frequent than expected in relatives of CD patients and, in particular, if it is related to the presence of silent unrecognised CD. We also evaluated the prevalence of ADs in CD patients and compared it with that in a control series. A structured questionnaire was used to evaluate the prevalence of ADs in 125 (51 males and 74 females with a mean age of 8.9 years) children with CD (group A), 125 (67 males and 58 females with a mean age of 8.1 years) matched healthy children (group B), all 1352 first- and second-degree relatives of the 125 children with CD (group C), all 1238 first- and second-degree relatives of the control group B of healthy children (group D), and all 205 first- and second-degree relatives of 20 children with AD (group E). We also used the antiendomysium antibody assay to screen 354 of the 373 first-degree relatives of group C. An AD was present in 9 of the 125 (7.2%) children with CD (group A), in 1 of the 125 (0.8%) healthy children (group B), in 67 of the 1352 (4.9%) relatives of CD patients (group C), in 14 of the 1238 (1.1%) relatives of healthy children (group D), and in 7 of the 205 (3.4%) of relatives of patients with AD (group E). Clinically silent CD was found in 20 of the 354 first-degree relatives of CD patients (5.6%), and the risk of silent CD was significantly higher, reaching 25% (4/16) in the subgroup of relatives also affected by another AD. Relatives of CD patients had an increased prevalence of AD compared to control groups, and relatives of CD patients with ADs, have a risk as high as 25% of being silent celiacs: they should thus be screened for CD.     

帕金森病痴呆与阿尔茨海默病认知障碍特点分析

目的 分析帕金森病痴呆(PDD)与阿尔茨海默病(AD)患者的认知障碍特点.方法 采用语义流畅性、语音流畅性、动作流畅性测验与物品和动作命名测验评定PDD组(30例)、AD组(30例)与对照组(60例)患者临床情况.结果 PDD组语义流畅性测验总分(9.33±2.78)分、语音流畅性测验总分(6.17±1.67)分、动作流畅性测验总分(7.03±2.34)分,AD组分别为(6.90±2.47)分、(7.87±2.01)分、(8.30±3.17)分;PDD组物件命名测验总分(36.33±3.39)分、动作命名测验总分(17.63±2.17)分,AD组分别为(33.23±3.56)分与(22.33±2.37)分.与对照组比较,PDD与AD患者三项言语流畅性与物品和动作命名均受损(P＜0.01).其中,PDD患者以语音流畅性、动作流畅性与动作命名损害为重,而AD患者以语义流畅性与物件损害为重(P＜0.01).结论 PDD与AD患者均存在执行功能障碍与命名损害,PDD是一种伴有皮质功能损害以额叶皮质下功能障碍为主要特点的认知损害性疾病,而AD亦存在皮质下功能障碍.

Abstract：

Objective To analyze the characterization of cognitive function in Parkinson's disease with dementia and Alzheimer's disease. Methods Cognitive function was examined in Parkinson's disease with dementia (PDD) patients ( n = 30) , Alzheimer's disease (AD) patients ( n = 30) and healthy elderly control subjects ( n = 60) . Neuropsychological evaluation contained semantic fluency test, phonemic fluency test, action fluency test, objective and action naming tests. Results In PDD group , the score of semantic fluency test is 9. 33 ±2. 78, 6. 17 ± 1.67 of phonemic fluency test and 7.03 ±2. 34 of action fluency test,it is 6.90 ±2.47, 7.87±2.01,8.30±3. 17 of AD group. The score of objective and action naming tests is 36.33 ±3.39, 17.63 ±2. 17 in PDD group,while AD patients is 33.23 ±3.56 and 22.33 ±2.37. The verbal fluency tests and naming tests were impaired in PDD and AD patients compared with the healthy elderly control group (P ＜ 0. 01 ), phonemic fluency, action fluency and action naming were more impaired in PDD patients compared with the AD group , while semantic fluency and objective naming were more impaired in AD patients (P ＜ 0. 01 ). Conclusions Executive function deficit and naming impairment are found in PDD and AD patients, it shows that PDD is characterized by the addition of cortical dysfunction upon a predominant and progressive fronto-subcortical impairment. There is subcortical dysfunction in AD patients.     

Increased risk of breast cancer in first-degree relatives of Crohn''s disease patients: An IG-IBD study

BACKGROUND: Increased rates of colorectal cancer have been reported in patients with ulcerative colitis as well as with Crohn's colitis. This risk could be the result of shared genetic susceptibility and could be co-inherited rather than being just secondary to a long-standing, extensive mucosal inflammation. AIM: To assess the prevalence of all malignancies in first-degree relatives of Crohn's disease patients in order to establish whether any association exists. PATIENTS AND METHODS: A total of 632 outpatients with a diagnosis of Crohn's disease and 632 control subjects were recruited. Information concerning the presence of malignancies was collected in 3,292 first-degree relatives of Crohn's disease patients and in 3,303 first-degree relatives of controls. RESULTS: Two hundred and fourteen (6.5%) subjects were found to be affected by malignancy in the first-degree relatives of Crohn's disease patients and 180 (5.5%) in the first-degree relatives of controls. Forty-seven (7.4%) of Crohn's disease patients had a first-degree relative with IBD, but none of them had cancer. The frequency of extra-intestinal malignancies was higher in first-degree relatives of Crohn's disease patients than in those of controls (p=0.011). Frequency of breast cancer in female relatives of Crohn's disease patients, mainly in mothers, was two-fold higher than that in controls (0.91% versus 0.42%; odds ratio=2.16; 95% confidence interval=1.14-4.08; p=0.015). The presence of breast cancer showed no association with any specific phenotype of disease in Crohn's patients. CONCLUSIONS: These results did not corroborate the hypothesis about a common genetic susceptibility between Crohn's disease and colorectal cancer. An unexpected finding was the more frequent occurrence of extra-digestive malignancies. The prevalence of breast cancer in first-degree relatives of Crohn's disease patients, in particular the mothers, was more than double than in those of controls. This association, if confirmed, would suggest that there may exist common genetic and/or environmental factors for Crohn's disease and breast cancer.     

Alzheimer 病的脑诱发电位初步探讨

目的探讨Ａｌｚｈｅｉｍｅｒ病（ＡＤ）脑诱发电位变异及临床应用价值。方法记录３９例ＡＤ患者和４０例健康老年人的脑干听觉反应（ＡＢＲ）、听觉诱发电位（ＡＥＰ）、视觉诱发电位（Ｆ－ＶＥＰ）以及事件相关电位Ｐ３００。结果与健康对照组相比,ＡＤ组的脑诱发电位变异为：（１）波幅下降（ＡＢＲ－Ⅴ,ＡＥＰ－Ｐ２,Ｆ－ＶＥＰ－Ｐ２,靶Ｐ３００－Ｐ２、Ｐ３,非靶Ｐ３００－Ｐ２）;（２）潜伏期延长（ＡＢＲ－Ⅲ,ＡＥＰ－Ｐ１、Ｎ１、Ｐ２）;（３）部分潜伏期提前（靶和非靶Ｐ３００－Ｎ１）。相关分析提示：除靶Ｐ３００－Ｎ１潜伏期外,以上指标均与ＡＤ的认知功能评定（ＣＡＳＩ分）有显著线性相关,部分指标同时又与被试者的教育年限显著相关。Ｋ－Ｍｅａｎｓ聚类分析表明：与ＣＡＳＩ和教育年限皆相关的脑诱发电位指标（ＢＥＰｓ）区分两类被试者的特异性高（１００．０％）而敏感性低（５１．７％）;仅与ＣＡＳＩ评分相关的ＢＥＰｓ指标则敏感性高（９３．６％）而特异性低（５５．６％）。结论ＡＤ患者的脑诱发电位指标变异程度基本上与其认知功能受损程度相平行;根据不同临床应用目的可选择相应的ＢＥＰｓ指标     

Anti-pancreatic antibody in Turkish patients with inflammatory bowel disease and first-degree relatives

AIM: To identify the role of anti-pancreatic antibody (PAB) in the diagnosis of inflammatory bowel diseases (IBD) among Turkish patients, and its frequency in firstdegree relatives.METHODS: PAB and anti-Saccharomyces cerevisiae (ASCA) were examined in serum samples of 214 subjects including patients with Crohn’s disease (CD, n = 64), ulcerative colitis (UC, n = 63), first-degree relatives of patients with CD (n = 25), first-degree relatives of patients with UC (n = 28),and a control group with gastrointestinal symptoms other than (IBD) (n = 34) by indirect immunofluorescence Positivity of PAB and ASCA was compared in terms of Vienna classification, disease activity and medications used.RESULTS: In terms of PAB positivity, no difference was found between patients with CD (14.1%) and UC (7.9%) however, significant difference was observed between patients with CD and subjects in the control group (P < 0.05). No difference was found between patients with CD and their relatives in terms of ASCA positivity, whereas a significant difference was found between other groups (P < 0.001). Compared to ASCA, the sensitivity of the PAB was 19% (7/37), its specificity was 93% (25/27), positive predictive value was 77% (7/9) and negative predictive value was 45% (25/55). ASCA was found with significantly higher prevalence in patients with CD activity index > 150 (P < 0.05).CONCLUSION: PAB is valuable in the diagnosis of IBD rather than CD, but cannot be used alone for diagnostic purposes. PAB is not superior to ASCA in CD diagnosis and in detecting CD among relatives of patients with CD.     

Cardiovascular risk factors in first-degree relatives of patients with premature coronary artery disease

OBJECTIVE: The objective of this study was to evaluate the prevalence of coronary risk factors among Iranian first-degree relatives of patients with premature coronary artery disease (PCAD) and compare them with the general population. METHODS AND RESULTS: The study comprised 144 siblings and offspring (aged 25-64 years) of patients with angiographically documented PCAD (< 55 years in men and < 65 years in women). Body mass index, blood pressure and smoking were investigated. Fasting venous blood was analysed for lipids and fasting plasma glucose. The means of measured values and prevalence of risk factors were compared with the results obtained from the Tehran University Population Laboratory Study. Two or more atherosclerosis risk factors were found in 76% of men and 50.3% of women. Prevalence of smoking, obesity, hypertension and diabetes was 24.3%, 30%, 29.9% and 6.9%, respectively. Total cholesterol and LDL-C levels were higher than desirable in 36.8% and 15.3% of our subjects, respectively, 14.6% had lower HDL-C values and 31.9% presented hypertriglyceridaemia. Overall, 60.4% of cases revealed at least one of the lipid abnormalities. Compared with the Tehran University Population Laboratory Study men showed a higher prevalence of high LDL and triglyceride (TG) levels and obesity. High LDL-C and smoking were found to be more prevalent among women with a family history of premature CAD. CONCLUSIONS: The prevalence of coronary risk factors among first-degree relatives of patients with premature CAD is high, especially in men. Risk factor identification and modification should be considered in individuals with a positive family history of premature CAD.     

轻度认知功能障碍向阿尔茨海默病转化的预测研究进展

轻度认知功能障碍（MCI）是介于正常衰老与痴呆之间的认知功能缺损状态,MCI进展为阿尔茨海默病（AD）的危险性较高,故MCI阶段可能是进行AD预防性治疗的最合适阶段,因而成为研究的焦点。本文就近年来MCI向AD的转化预测研究做一综述,主要包括五个方面：神经心理学测试、生物标志物检查、神经影像学检查、脑电生理学检查及其治疗进展。     

Treatment for breast cancer in patients with Alzheimer's disease

OBJECTIVES: To report use of breast cancer treatment (surgery, radiation, and chemotherapy) by patients with Alzheimer's disease (AD). DESIGN: Retrospective cohort study. SETTING: Surveillance, Epidemiology, and End Results (SEER) is a population-based cancer registry covering 14% of the U.S. population. PARTICIPANTS: Fifty thousand four hundred sixty breast cancer patients aged 65 and older, of whom 1,935 (3.8%) had a diagnosis of AD before or up to 6 months after cancer diagnosis. MEASUREMENTS: Diagnosis of AD was taken from International Classification of Diseases, Ninth Revision, diagnostic codes accompanying Medicare billing claims between 1992 and 1999. The SEER program reported surgery and radiation. Chemotherapy was taken from Medicare billing records. RESULTS: Subjects with AD were diagnosed with breast cancer at later stages, when tumors were larger and the likelihood of lymph node involvement had increased. Patients with AD had a lower likelihood of surgery (odds ratio (OR)=0.60, 95% confidence interval (CI)=0.46-0.81), radiation (OR=0.31, 95% CI=0.23-0.41), and chemotherapy (OR=0.44, 95% CI=0.34-0.58) than those without AD. CONCLUSION: Overall, AD patients receive less treatment for breast cancer than do comparable female Medicare beneficiaries. Chemotherapy and radiation are administered less frequently to women with AD than to other comparable patients. It is unclear whether suboptimal medical care has an effect on their survival. Further research on the effect of screening and treatment decision-making for these patients is warranted.