针刺与醒脑静并用对改善轻度非痴呆血管性认知障碍患者认知功能的效果分析

目的分析针药并用改善轻度非痴呆血管性认知障碍(VCIND)患者认知功能的效果。方法采用随机数字表法将95例确诊轻度VCIND患者进行分组,对照组47例给予醒脑静注射液20mL加入250mL氯化钠注射液静滴,1次/d;干预组48例在对照组基础上给予针刺治疗,每次留针45min,1次/d,连续针刺6d休息1d为一疗程。2组均连续治疗3周末,采用简易精神状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分评价改善认知功能的效果。结果 2组干预后MMSE评分、MoCA评分均提高,干预组提高幅度明显高于对照组,差异有统计学意义(P0.05)。结果针药并用改善轻度VCIND患者认知功能效果确切,在促进神经功能恢复和提高患者生存质量方面具有重要意义。     

针药合用对卒中后抑郁患者综合功能的影响

目的 探讨中药结合针刺干预对卒中后抑郁(PSD)患者综合功能的影响.方法 将88例患者分为中药组、针刺组、中药结合针刺组、氟西汀组(对照组)4组,每组各22例.4组均给予相应的康复治疗,在此基础上各组分别予疏肝健脾中药、针刺、疏肝健脾中药联合针刺及氟西汀治疗,各组疗程均为30 d.治疗前后评定用汉密尔顿抑郁量表(HAMD)和功能综合评定量表(FCA).观察不同治疗方案对PSD近期疗效及患者综合功能的影响.结果 与基线相比,各组患者在治疗后HAMD的评分均降低(P<0.01),FCA评分提高(P<0.01).组间比较,中药联合针刺组与其他3组间的差异有显著统计学意义(P<0.05,P<0.01),余3组间差异无显著统计学意义(P>0.05).结论 各治疗方案均能改善PSD患者的抑郁症状、提高患者的综合功能,中药联合针刺具有协同增效作用.     

针灸结合康复训练对颅脑损伤患者运动和认知功能的影响

目的 观察中、重型外伤性颅脑损伤(TBI)患者经针刺疗法结合康复训练后对患者运动功能、平衡功能、认知功能及ADL的影响.方法 将160例入选病例随机分为针康组和常规组,所有患者均接受常规药物治疗、胃肠营养、防治并发症,针康组在此基础上进行针刺结合康复训练,为期6周.采用Fugl-Meyer量表分别对2组患者下肢运动功能、平衡功能进行评定,用Barthel指数评定患者日常生活能力(ADL);认知功能评定采用简明精神状态检查(MMSE).结果 治疗后2组间患者下肢运动功能、平衡功能及ADL积分、MMSE总分等指标均有改善;与治疗前比较,差异均有统计学意义(P《0.05),而针康组疗效更优于常规组(P《0.05).结论 康复训练加针刺疗法可明显提高中、重型TBI患者下肢运动功能、平衡功能、认知功能及ADL积分值,对功能恢复有积极作用.     

认知康复训练结合头皮针治疗脑卒中后认知功能障碍的疗效观察

目的观察认知康复训练结合头皮针治疗脑卒中后认知功能障碍的疗效。方法将郑州人民医院康复医学科收治的120例脑卒中后认知功能障碍的患者随机分为头皮针治疗组、认知康复训练组、头皮针治疗联合认知康复训练组(联合治疗组)和对照组各30例,均给予神经内科常规药物治疗,头皮针治疗组、认知训练组、联合组分别给予头皮针治疗、认知康复训练、头皮针治疗结合认知康复训练,对照组除常规神经内科给药外不进行其他系统训练或药物治疗。治疗前及治疗后1个月、3个月、6个月分别用蒙特利尔认知估量表(MoCA)进行评定。结果治疗后3个月及6个月3组相对于对照组的MoCA评分均有升高,差异有统计学意义(P0.05);与治疗后3个月相比,治疗后6个月MoCA评分无显著提升(P0.05)。治疗后3个月及6个月,联合治疗组MoCA评分相对于单纯头皮针治疗组和单纯认知康复训练组明显升高,差异有统计学意义(P0.05)。相对于对照组,治疗后3个月3组韦氏评分均有显著提升(P0.05)。结论认知康复训练结合头皮针治疗可明显改善脑卒中后认知障碍患者的认知功能。     

养血清脑颗粒治疗血管性痴呆60例疗效观察

目的 观察养血清脑颗粒对血管性痴呆(VD)患者认知功能和行为能力的改善作用.方法 将VD患者120例随机分为治疗组与对照组各60例,治疗组采用养血清脑颗粒,对照组采用脑复康片.2组病人在治疗前后分别用简易智力状态检查量表(MMSE)及长谷川痴呆量表(HDS)进行认知功能评价,用日常生活能力(ADL)量表进行日常行为能力评价.结果 治疗组患者治疗后认知、行为能力均较治疗前明显改善(P<0.05).结论 养血清脑颗粒对VD患者认知、行为能力有明显改善作用.     

加兰他敏改善精神分裂症患者认知功能的研究

目的 探讨加兰他敏是否能改善精神分裂症患者的认知功能.方法 80例精神分裂症患者被随机分为利培酮单药治疗组(单药组,入组40例,完成30例)和利培酮合并加兰他敏治疗组(合并组,入组40例,完成34例),疗程8周.治疗前后采用阳性和阴性综合征量表(PANSS)评定精神症状,个人和社会功能量表(PSP)评定社会功能,视觉空间记忆测验(BVMT-R)、霍普金斯词语学习测验修订版(HVLT-R)、WAIS-Ⅲ数字符号以及连线测试评定患者的认知功能.结果 治疗后,两组患者的PANSS评分显著下降,PSP量表的总分显著上升,单药组阳性症状改善更明显(P＜0.05),两组患者社会功能改善无显著性差异(P＞0.05).治疗后,两组患者在BVMT-R测验中均有显著改善(P＜0.01),单药组在HVLT-R测验中有显著改善(P＜0.05),合并组在WAIS-Ⅲ数字符号测试中有显著改善(P＜0.01),两组患者间各项认知功能项目评定结果比较均无显著性差异(P＞0.05).结论 加兰他敏并不能有效改善精神分裂症患者的认知功能.     

天智颗粒治疗轻中度血管性痴呆疗效观察

目的 观察中成药天智颗粒对血管性痴呆(vascular dementia,VD)的疗效.方法 将60例VD患者采用天智颗粒治疗,对照组VD患者50例服用都可喜,疗程为60d.在治疗前后分别采用简易精神状态检查表(MMSE)和Blessed行为量表(BBS)对认知功能和行为能力进行评估,并在治疗前后观察2组的血液流变学变化.结果 中成药天智颗粒和都可喜均可以明显改善血管性痴呆患者的各项认知功能和行为能力的积分(P<0.05).对痴呆的总体疗效,两药物效果相近(P>0.05).两药对记忆认知和行为能力的改善方面的作用也近似(P>0.05).天智颗粒对血液流变学改善优于都可喜.结论 中药天智颗粒对轻中度痴呆有确切的疗效,可以提高患者的生存质量.     

针刺联合抗抑郁药对脑梗死后抑郁症患者日常生活能力及认知功能的影响

目的分析针刺联合抗抑郁药对脑梗死后抑郁症患者日常生活能力及认知功能的影响。方法将2014年9月~2016年7月在我院采用针刺联合抗抑郁药治疗的30例脑梗死后抑郁症患者纳入观察组,采用抗抑郁药治疗的30例患者列为对照组。分别于治疗前、治疗15天、治疗1月进行抑郁[汉密顿抑郁量表(HAMD)]、日常生活能力[Barthel指数(BI)]、认知功能[蒙特利尔认知评估量表(MoCA)]评分,以HAMD改善指数判定疗效,并统计并发症发生率。结果治疗前两组HAMD、BI、MoCA等评分对比无差异(P0.05);治疗后观察组各时间节点的HAMD评分低于对照组,BI指数及MoCA评分高于对照组;同时,观察组并发症发生率(10.00%)低于对照组(30.00%),对比差异皆有统计学意义(P0.05)。结论针刺联合抗抑郁药于改善脑梗死后抑郁症患者日常生活能力、认知功能及抗抑郁药物所致的并发症具重要意义。     

天智颗粒联合哈伯因治疗老年性痴呆临床观察

目的对中药天智颗粒治疗老年性痴呆(AD)的疗效进行观察。方法采用随机对照试验的研究方法 ,对100例AD患者随机分为治疗组50例(口服天智颗粒和哈伯因),对照组50例(口服哈伯因),疗程3个月。治疗前后分别采用简易精神状态检查(MMSE)和ADL行为量表对认知功能和行为能力进行评估。结果天智颗粒和哈伯因联合治疗组患者治疗后认知、行为能力较哈伯因组改善明显(P0.01)。结论天智颗粒和哈伯因联合治疗对老年性痴呆患者认知、行为能力有显著改善作用。     

认知功能训练联合尼莫地平对急性脑梗死认知功能障碍患者的影响

目的 探讨尼莫地平联合认知功能训练对急性脑脑梗死认知功能障碍患者的影响.方法 选择我院2007-11～2009-11急性脑梗死认知功能障碍患者81例,将以上患者随机分为2组,观察组和对照组.对照组患者给予常规神经内科治疗,同时给予物理治疗、作业治疗等.在对照组治疗基础上,观察组给予认知功能训练和尼莫地平治疗.2组患者均治疗3个月.患者治疗前和治疗3个月后,采用神经行为认知状态测试(NCSE)量表、画钟试验(CDT)、欧洲神经功能缺损评分(ESS)、Fugl-Meyer(FMA)量表、Barthel Index对患者进行评分.结果 观察组治疗3个月后NCSE总评分和画钟试验(CDT)评分分别与对照组治疗3个月后比较,差异有统计学意义(P<0.05);观察组治疗3个月后ESS评分、FAM评分和日常生活活动能力评分分别与对照组治疗3个月后比较,差异有统计学意义(P<0.05).结论 尼莫地平联合认知功能训练有助于改善急性脑脑梗死后认知功能障碍,有利于提高患者的肢体运动功能和日常生活活动能力,临床效果显著,值得借鉴.     

Active cognitive lifestyle associates with cognitive recovery and a reduced risk of cognitive decline

Education and lifestyle factors linked with complex mental activity are thought to affect the progression of cognitive decline. Collectively, these factors can be combined to create a cognitive reserve or cognitive lifestyle score. This study tested the association between cognitive lifestyle score and cognitive change in a population-based cohort of older persons from five sites across England and Wales. Data came from 13,004 participants of the Medical Research Council Cognitive Function and Ageing Study who were aged 65 years and over. Cognition was assessed at multiple waves over 16 years using the Mini-Mental State Examination. Subjects were grouped into four cognitive states (no impairment, slight impairment, moderate impairment, severe impairment) and cognitive lifestyle score was assessed as a composite measure of education, mid-life occupation, and current social engagement. A multi-state model was used to test the effect of cognitive lifestyle score on cognitive transitions. Hazard ratios for cognitive lifestyle score showed significant differences between those in the upper compared to the lower tertile with a more active cognitive lifestyle associating with: a decreased risk of moving from no to slight impairment (0.58, 95% CI (0.45, 0.74)); recovery from a slightly impaired state back to a non-impaired state (2.93 (1.35, 6.38)); but an increased mortality risk from a severely impaired state (1.28 (1.12, 1.45)). An active cognitive lifestyle is associated with a more favorable cognitive trajectory in older persons. Future studies would ideally incorporate neuroradiological and neuropathological data to determine if there is causal evidence for these associations.     

The cognitive laterality battery: tests of specialized cognitive function

The Cognitive Laterality Battery of neuropsychological tests is described and normative data and statistics are presented. Selection of tests was based on converging evidence from studies on patients with unilateral cerebral lesions, complete forebrain commissurotomy, and on normal subjects suggesting that visuospatial skills are primarily related to the right hemisphere while verbal and sequential skills are primarily related to the left. Factor analyses confirmed the dichotomy of the test choices. It is suggested that test results on individuals be interpreted as a cognitive profile defining the relative performance of specialized functions rather than the relative right or hemisphere locations. Previous studies with the CLB are described.     

Multiple cognitive deficits in amnestic mild cognitive impairment

OBJECTIVE: To determine if more widespread cognitive deficits are present in a narrowly defined group of patients with the amnestic form of mild cognitive impairment (MCI). METHODS: From a larger sample of patients clinically diagnosed as meeting the criteria of Petersen et al. for amnestic MCI, we selected 22 subjects who had Clinical Dementia Rating scores of zero on all domains besides memory and orientation. These MCI subjects with presumably isolated memory impairments were compared to 35 age-matched normal controls and 33 very mild Alzheimer's disease (AD) patients on a battery of neuropsychological tests. RESULT: In addition to the expected deficits in episodic memory, the amnestic MCI group performed less well than the controls but better than the AD group on design fluency, category fluency, a set shifting task and the Stroop interference condition. Over half the amnestic MCI group (vs. none of the normal controls) scored at least 1 standard deviation below control means on 4 or more of the nonmemory cognitive tasks. CONCLUSIONS: Isolated memory impairment may be fairly uncommon in clinically diagnosed amnestic MCI patients, even when the criteria for amnestic MCI are fairly narrow. Additional cognitive impairments are likely to include fluency and executive functioning. These more diffuse deficits argue for comprehensive cognitive assessments, even when the patient and family are reporting only memory decline, and are consistent with the increase in attention paid to the heterogeneity of MCI.     

Relationship of leukoaraiosis to cognitive decline and cognitive aging.

OBJECTIVE: Leukoaraiosis (LA) is a common finding on MRI scans of the elderly. However, its exact relationship to cognitive decline and dementia is in dispute. Because LA involves the paracallosal white matter, we sought to determine if LA, uncomplicated by ischemic lesions or complaints of cognitive impairment, is associated with cognitive loss or difficulties with interhemispheric integration of behavioral functions. METHODS: Two hundred fifty-seven MRI scans with deep white matter changes were screened. After a chart review, 38 patients had uncomplicated LA, and 31 gave informed consent to undergo cognitive and behavioral testing. RESULTS: LA severity was not related to any of the cognitive or behavioral assessments. However, some dependent measures showed medium effect sizes that were in keeping with published findings, indicating that LA has a marginal impact on cognition. In comparison, robust relationships with age were found for certain tasks, suggesting that our cohort size was sufficient to detect meaningful clinical relationships. CONCLUSION: Based on statistical interpretations using effect sizes, LA severity may be better viewed as a biomarker for physiological brain aging that is in advance of chronological age, leaving the elderly individual at greater risk for developing dementia.     

中文版MoCA和MMSE在诊断遗忘型轻度认知功能障碍中的应用

目的 研究中文版蒙特利尔认知评估量表(MoCA)在遗忘型轻度认知障碍(aMCI)诊断筛查中的作用. 方法 以2009-05-2010-03在卫生部北京医院神经内科门诊就诊的患者为检查对象,筛选出aMCI患者31例及健康对照者30名,分别进行简易精神状态量表(MMSE)、MoCA等量表检测,计算两量表诊断aMCI的敏感性和特异性并进行比较,分析MoCA在诊断aMCI中的作用和特点. 结果 以26分作为分界值时,MMSE和MoCA诊断aMCI的敏感性分别为9.68%和87.10%,特异性分别为93.33%和73.33%.MoCA的敏感性显著高于MMSE. 结论与MMSE 相比,MoCA以其较高的敏感性在筛查aMCI中具有较大作用,而且可对多个认知领域的功能进行检测,有望在多个认知损害类型的研究中起到重要作用.     

Application of a cognitive neuroscience perspective of cognitive control to late-life anxiety

Recent evidence supports a negative association between anxiety and cognitive control. Given age-related reductions in some cognitive abilities and the relation of late life anxiety to cognitive impairment, this negative association may be particularly relevant to older adults. This critical review conceptualizes anxiety and cognitive control from cognitive neuroscience and cognitive aging theoretical perspectives and evaluates the methodological approaches and measures used to assess cognitive control. Consistent with behavioral investigations of young adults, the studies reviewed implicate specific and potentially negative effects of anxiety on cognitive control processes in older adults. Hypotheses regarding the role of both aging and anxiety on cognitive control, the bi-directionality between anxiety and cognitive control, and the potential for specific symptoms of anxiety (particularly worry) to mediate this association, are specified and discussed.     

Predictors of future cognitive decline in persons with mild cognitive impairment

This study sought first to identify individual items of the Mini-Mental State Examination (MMSE) and demographic variables at baseline that predicted the trajectories of cognitive change among patients with mild cognitive impairment (MCI), and second to quantify the risk of cognitive decline in such patients based on their pattern of failure of MMSE items. 187 MCI patients were evaluated serially with the MMSE for up to 3.5 years. Patients who followed a declining cognitive trajectory differed from the stable reference group in their baseline profile of MMSE test performance. Patient age and performance on delayed recall, constructional praxis, attention, and orientation to time and floor predicted future cognitive decline with good accuracy (79.9%) and specificity (86.4%), and moderate sensitivity (67.2%). These results are presented in the form of a simple clinical tool for quantifying risk of future cognitive decline in MCI.