阿尔茨海默病与血管性痴呆的非认知功能损害

目的　观察阿尔茨海默病与血管性痴呆的患者除认知功能异常外 ,是否存在非认知功能的异常。方法　根据DSM -Ⅳ阿尔茨海默病及血管性痴呆的诊断标准以及CDR的临床痴呆分级标准 ,对神经内科老年记忆障碍专科病房的 2 1例轻中度阿尔茨海默病及 2 5例血管性痴呆患者的非认知功能损害的临床表现进行了观察 ,包括情感反应、行为异常、人格变化及知觉异常。结果　阿尔茨海默病患者的非认知功能损害在情感障碍 (16例 ,76 % )、人格异常 (10例 ,48% )及知觉异常 (6例 ,2 9% )方面 ,明显多于血管性痴呆组 (分别为 10例 ,40 % ;1例 ,4% ;1例 ,4% )。结论　痴呆患者不仅有认知功能的损害 ,还有非认知功能的损害。阿尔茨海默病的非认知功能损害重于血管性痴呆 ,可能与两种痴呆的发病机制不同有关。     

老年认知功能障碍的筛查与诊断

正老年认知功能障碍对患者、家庭及其照料者的生活都会产生重大影响。从早期诊断,到生命终止,它对健康专业人士也提出了一系列挑战。痴呆不是正常老化的一部分,其显著影响老年人的健康生活。据2015年全球痴呆报告,年龄60岁老年人痴呆患者约4850万,平均每3s即新诊断一例痴呆。从认知功能障碍的严重程度划分,常见的认知功能障碍主要有轻度认知功能障碍(mild cognition impair-     

阿尔茨海默病认知障碍表现与量表检测

认知功能障碍是阿尔茨海默病(AD)的重要临床表现。记忆、语言、执行功能和视空间功能的评定是痴呆认知功能评定的重要组成部分。详尽的神经心理检查有助区分正常衰老和AD,并评估痴呆的严重程度。而根据患者认知功能的损伤模式,则有助于AD和其他痴呆类型的鉴别诊断。     

阿尔茨海默病患者就诊状况及多奈哌齐治疗效果的调查

目的 调查医院背景下阿尔茨海默病(AD)患者的就诊状况及多奈哌齐治疗的有效性.方法 由中华医学会老年医学分会立项,并与卫材(中国)药业有限公司共同组织全国40个城市60家大型医院,针对符合世界卫生组织国际疾病分类(ICD-10)及精神障碍诊断和统计工作手册第4版(DSM-Ⅳ)等痴呆诊断标准的患者进行首发症状、就诊时间和科室、诊断时间及多奈哌齐治疗至少3个月前后的认知、生活功能及精神行为变化进行调查.结果 调查痴呆患者808例,其中记忆力下降703例(87%)、精神行为症状250例(31%)、生活能力下降388例(48%),首次就诊时的病程9～16个月,平均(13.0±0.2)个月.首次作出痴呆诊断的科室神经内科占74%、精神科6%、老年科19%、其他科室1%.出现症状至首次确诊时间3～21个月,平均(14.4±0.3)个月.多奈哌齐治疗后痴呆患者的认知功能、日常生活自理能力及精神状况均有改善(P＜0.05).结论 我国痴呆患者就诊率低,就诊及诊断时多为中重度患者,影响患者疾病的预后及生活能力的维持.多奈哌齐能有效改善患者的认知功能、日常生活自理能力及精神行为,在治疗过程中未出现严重不良反应.     

尿酸对认知功能的影响

阿尔茨海默病和帕金森病是老年人常见的神经退行性疾病。认知功能障碍是阿尔茨海默病的主要临床表现,帕金森病在发展过程中,尤其到疾病晚期,可合并有痴呆表现,称帕金森病痴呆。不同的调查研究显示,帕金森病患者中有17％～57％会伴发认知功能障碍。研究影响认知功能的相关因素对于防治阿尔茨海默病,提高帕金森病患者的生活质量具有重要的意义。近年来发现,血尿酸水平与认知功能密切相关。     

认知障碍简明评价量表在行为异常型额颞叶痴呆及阿尔茨海默病病人照料者负担评估中的应用

目的探讨认知障碍简明评价量表(Cog-12)在评估行为异常型额颞叶痴呆(bv FTD)及阿尔茨海默病(AD)病人照料者负担中的应用价值。方法研究对象取自2007年1月至2015年11月来自中国阿尔茨海默病与相关疾病研究协作组(CARDS)研究课题登记的基线调查部分的对象,共计入组了临床痴呆量表(CDR)评分为1~2分的206例痴呆病人(AD组120例,bv FTD组86例)。所有病人均完成Cog-12量表、Addenbrooke改良认知评估量表(ACE-R)、额叶行为量表(FBI)的测评,所有照料者均完成照料者负担问卷(caregiver burden inventory,CBI)、神经精神问卷(NPI)、焦虑自评量表(SAS)、抑郁自评量表(SDS)的测评。结果 (1)bv FTD组病人ACER,FBI,Cog-12,NPI评分均高于AD组。bv FTD组照料者CBI,SAS,SDS评分均高于AD组,其中,bv FTD组时间依赖负担及情感负担较AD组重,2组发展受限评分、身体负担评分及社交负担评分差异无统计学意义;(2)bv FTD组CBI与Cog-12,NPI,FBI均呈显著正相关,AD组CBI与Cog-12,NPI呈显著正相关;2组SAS、SDS与CBI呈显著正相关;(3)bv FTD组照料者负担主要来源于病人的神经精神及行为症状,而AD组照料者负担主要来源于神经精神症状。结论 bv FTD照料者负担较AD照料者负担更重,出现抑郁、焦虑风险更高。bv FTD照料者负担重与病人神经精神症状及行为紊乱密切相关,AD照料者负担主要与神经精神症状相关,Cog-12可推广作为间接评估痴呆病人照料者负担的工具。专业照料指导、心理支持等减轻照料者负担措施迫在眉睫。     

路易体痴呆诊治进展

路易体痴呆(dementia with Lewy bodies,DLB) 是仅次于阿尔茨海默病(AD) 的常见老年痴呆类型,但其病因、 发病机制目前尚不清楚。DLB 患者的临床表现各异,容易因认知功能障碍、幻觉及帕金森样症状等被误诊误治。且 多数患者存在对神经安定药的高敏感性,因此临床医生应了解DLB 的临床表现及诊治进展,提高对DLB 的认识并 引起重视,及早为DLB 患者制定个体化的诊疗方案。     

认知功能障碍与腔隙性脑梗死和脑微梗死

<正>认知功能障碍的主要病因为阿尔茨海默病和血管性痴呆。新近研究提示,诊断血管性痴呆患者时,病理诊断与临床诊断存在极大差异。其中,阿尔茨海默病患者占40%,小血管病性混合型痴呆同样占40%,单纯血管性痴呆患者仅占10%,然而大血管病伴随血管性痴呆只占8%,其余2%为其他原因所致痴呆。临床诊断与病理学诊断存在60%的不匹配,提示神经内科专业医师对痴呆的认识仍有距离,应有更多的生物标记物在起病早期发现并予以干     

老年轻度认知功能障碍的神经心理学研究及康复训练的疗效观察

轻度认知功能障碍(MCI)是介于正常衰老和痴呆之间的一种认知损害状态,据统计每年约有10%～15%的遗忘型MCI患者发展为阿尔茨海默病(AD),而正常人每年转化率仅为1%[1],因此认识MCI的神经心理学特点、早期诊断并进行干预治疗对预防AD和其他类型痴呆的发生具有重要意义.目前国内外对MCI的认知损害特点没有统一的认识,而且没有统一的概念和诊断标准,本研究采用神经心理学方法对MCI患者和正常老年人的认知功能进行全面的评价分析,探讨MCI认知功能损害特点并对认知康复训练的疗效进行观察.     

胆碱酯酶抑制剂治疗阿尔茨海默病患者伴发痴呆的行为和精神症状的研究进展

阿尔茨海默病是一种中枢神经系统原发性退行性疾病,其临床特征以痴呆综合症和精神病性症状为主,其中痴呆的行为和精神症状对患者及照料者有重要影响。针对痴呆的行为和精神症状抗精神病药物已成为阿尔茨海默病研究的一大热点,本文对胆碱酯酶抑制剂治疗痴呆的行为和精神症状研究进展进行综述。     

Dementia and its associations in type 2 diabetes mellitus: the Fremantle Diabetes Study

BACKGROUND: recent studies indicate that diabetes is an important risk factor for dementia in older patients, but the cause remains unknown. OBJECTIVES: to determine whether vascular or diabetes-related risk factors predict the development of dementia in older subjects with diabetes. PATIENTS: 63 patients with type 2 diabetes of mean age 75.3 years. METHODS: Subjects were screened for cognitive impairment using the Mini-Mental State Examination (MMSE) and informants who knew the subjects answered the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Probable dementia was diagnosed using highly specific criteria based on the combination of both tests. Potential risk factors for dementia obtained at the time of the cognitive test and annually from a median of 3.2 years previously were examined using univariate methods and simple general linear modelling. RESULTS: since there was a significant association between MMSE and English speaking ability, ten non-Anglo-Celt patients were excluded from the analysis. Probable dementia was diagnosed in six of the remaining 53 subjects (11%). Dementia was significantly and independently associated with higher diastolic and mean arterial blood pressure measurements over the 3 years before assessment. Blood pressure declined over this time in the patients with probable dementia and was similar to that in non-demented subjects at the time of cognitive assessment. CONCLUSIONS: these preliminary data suggest that the high rate of dementia found in older people with diabetes may be explained by the high rate of hypertension in this population.     

Cognitive dysfunction among the elderly evaluated by the cognitive abilities screening instrument (CASI)

The Cognitive Abilities Screening Instrument (CASI) was developed by Japanese and American researchers, including the authors, to examine cognitive functions, based on previous neuropsychological tests, such as Hasegawa's Dementia Scale and the MMSE. From the Adult Health Study (AHS) population of the Radiation Effects Research Foundation, 2052 men and women aged 60 or over and living in Hiroshima were evaluated for their cognitive functions using the CASI. Dementia was diagnosed in 93 and 1,959 were considered not to suffer from dementia based on the DSM-III-R criteria using neurological examination and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) completed by caregivers. Multivariate regression analysis not only indicated that total score was higher with lower age and higher education but that the slope of its decrease is steeper with higher age and fewer years of education. The slope of score decrease with increase of age was steeper for women than for men. Furthermore, CASI items were categorized by domains of cognitive function. Multivariate regression analysis for each cognitive domain showed clear effects of age and level of education. The effect of age for the nondementia subjects was large in cognitive domains dealing with temporal orientation, short-term memory, and list-generating fluency. The most useful cognitive domains for diagnosing dementia were temporal orientation, short-term memory, and list-generating fluency, as was indicated by high sensitivity and specificity.     

Correlates of delayed referral for the diagnosis of dementia in an outpatient population

BACKGROUND: Early diagnosis of dementia is critical, but there is usually a time lag between onset of symptoms and referral for neuropsychological testing and dementia diagnosis. We aimed to identify factors correlated with this delayed referral. METHODS: We studied 140 patients with cognitive deterioration referred to the Memory Clinic of the Catholic University (Rome) between 1995 and 1996. Alzheimer's disease or multi-infarct dementia was diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria and Hachinski ischemic score. Global cognitive and neuropsychological functions were assessed with the Mini-Mental State Exam (MMSE) and the Mental Deterioration Battery. The performance on the Activities of Daily Living was used to measure physical function. The time between onset of signs of cognitive deterioration and referral for diagnosis (time to diagnosis: TTD) was estimated through a semistructured interview of the caregiver. Independent correlates of TTD were identified after adjustment for potential confounders and stratifying patients based on level of physical function. RESULTS: Of 127 eligible patients, 63% had Alzheimer's disease, 26% multi-infarct dementia, and 11% had dementia of other types. Mean age was 73.9 +/- 8.2 years, and 59% of patients were females. The mean TTD was 13.8 +/- 10.8 months and did not differ by gender, household composition, or type of dementia. For patients with normal physical function, increased age (beta = .50), female sex (beta = .51), and low MMSE score (beta = .36) were associated with longer TTD. Among patients with physical impairment, only MMSE score showed an association with TTD, but it was of opposite direction (beta = -.31). These associations were consistent by type of dementia. CONCLUSIONS: Age, gender, and degree of cognitive impairment are important correlates of the time between onset of signs/symptoms and referral for dementia diagnosis. These factors are independent of the type of dementia but are influenced by the level of physical function.     

老年人认知功能减退知情者问卷检测老年人认知功能损害

目的评价老年人认知功能减退知情者问卷在中国老年人群中应用的信效度,以及在认知功能损害筛查中的有效性。方法认知功能损害患者93例,应用简短版本的老年人认知功能减退知情者问卷(IQCODE)对其知情者进行问卷调查。对128名60岁以上来自于社区的健康老年人的知情者进行调查,作问卷的信效度检验。结果 IQCODE 内部一致性系数达0.83。重测信度Pearson 相关系数为0.86。与简短精神状态量表(MMSE)、日常生活活动能力量表(ADL)的效度系数分别为-0.78和0.71。IQCODE 得分在轻度认知障碍和轻、中、重度痴呆患者中分别为(3.5±0.4)分和、(4.2±0.4)分、(4.7±0.2)分和(4.9±0.2)分,差异有统计学意义,但在阿尔茨海默病(AD)和血管性痴呆(VaD)等不同痴呆病因组间差异无统计学意义。结论 IQCODE 信效度良好。得分与病情严重程度密切相关,此问卷能将痴呆和轻度认知功能损害患者与健康人群很好地区分开来,可用于认知功能损害的检测。但对 AD、VaD 等痴呆类型的鉴别作用有限。     

Mini-mental state examination and mental deterioration battery: analysis of the relationship and clinical implications

OBJECTIVES: To explore the associative structure between a screening test for dementia, the Mini-Mental State Examination (MMSE), and a neuropsychological battery for the detection of dementia, the Mental Deterioration Battery (MDB). DESIGN: A retrospective analysis. SETTING: Psychology unit of a general hospital in Rome, Italy. PARTICIPANTS: Three hundred consecutive outpatients and inpatients referred to our hospital on the basis of suspected cognitive impairment and evaluated between January 1999 and March 2000. MEASUREMENTS: MMSE and MDB. RESULTS: Of the 300 subjects evaluated by the MMSE score, 142 (47.3%) were considered to be cognitively healthy, and 116 (38.7%) were mildly and 42 (14.0%) moderately impaired. Factor analysis of MDB extracted three factors able to account for 75% of the total variance: a visuospatial factor, verbal memory ability, and a language skill. Using MMSE as an independent variable, a linear regression model could account for the visuospatial and language factors and a cubic regression model for the verbal memory factor. Within the normal MMSE boundaries (24-30), a dramatic decrease of verbal memory could be documented, whereas the slope is less steep in the mild impairment group (16-23). CONCLUSIONS: Our findings indicate the presence of a warning range within the normal MMSE interval. Thus, the traditional MMSE cutoff values may not be appropriate in detecting early phases of dementia. When patients score about 27 on MMSE, it should be of interest to check whether they fail only on long-term memory tests, because this could be a first signal of a preclinical condition heralding clear dementia (e.g., mild cognitive impairment).     

脑梗死存活率影响因素的前瞻性研究

目的研究脑梗死后痴呆对存活率的影响。方法对619例急性脑梗死患者进行人文因素、血管因素、卒中特征资料收集和神经心理检查。在入院及卒中后3个月按美国精神病学会DSM-Ⅳ标准对卒中患者进行痴呆诊断,随访2年,分析痴呆患者的存活率及死亡相关预测因素。结果 卒中后3个月共有146例(23.6％)患者被诊断为痴呆,其中39例为卒中前痴呆,107例为卒中相关痴呆。随访(19.4±8.3)个月,卒中后痴呆患者存活率为49.3％,随访(21.3±9.1)个月,卒中相关性痴呆存活率为53.7％,非痴呆患者存活率为92.0％。多因素分析显示,卒中后痴呆与死亡明显相关,脑梗死后痴呆病死率的独立危险因素是年龄、心房颤动、卒中史、日常生活能力评分、卒中后痴呆和卒中相关痴呆。结论痴呆降低卒中患者存活率,并可作为卒中后存活的一个预测因素。     

Assessment of behavioral and psychological symptoms of dementia by family caregivers

This study was designed to test the performance and related factors of a self-administered instrument in assessing behavioral and psychological symptoms of dementia (BPSD) by family caregivers. We recruited 173 patients with dementia and major caregivers from two neurological clinics. Information about clinical diagnosis, the Mini Mental State Examination (MMSE), the Clinical Dementia Rating (CDR), the Dementia Behavior Disturbance Inventory (DBDI), and global caregivers’ strain were collected from interview and chart review. We found that DBDI has acceptable construct validity and good internal consistency reliability. BPSD was more frequently found in patients with advanced dementia, poor cognitive function and highly correlated to caregivers’ strain. Multivariate analysis revealed that female patients and caregivers, advanced CDR stages, patient-caregiver relationship, types of dementia and MMSE score were related to the increase of frequency and disturbance index of DBDI. We concluded that BPSD could be evaluated by family caregivers using a self-administered instrument. Further study is indicated to clarify how caregiver characteristics affect the report of behavioral symptoms, and its clinical importance.     

Neuropsychological characterization of the AIDS dementia complex: a preliminary report

The AIDS dementia complex (ADC) is a frequent complication of advanced HIV infection. In order to better define the neuropsychological character and progression of the ADC, four groups of subjects were studied with a battery of neuropsychological tests: an HIV-seronegative comparison group (n = 20), asymptomatic HIV-seropositive patients (n = 16), newly diagnosed AIDS patients (n = 44) and AIDS patients who were referred for neurological consultation (n = 40). Results showed significant reductions in performance in the two AIDS groups, with impairment being most prominent in tests that assessed motor speed and fine control, concentration, problem solving and visuospatial performance. This pattern of neuropsychological dysfunction is consistent with the characterization of the ADC as a subcortical dementia.     

Nutritional status and Alzheimer's disease: preliminary results of the REAL.FR study

Weight loss is common in elderly people with dementia, particularly those with Alzheimer' disease (AD), and feeding difficulties are major issues in their care in the later stages of the disease. In this study (REAL FR for Réseau sur la maladie d'Alzheimer Fran?ais) we prospectively used the Mini Nutritional Assessment (MNA) to examine the nutritional status of 479 subjects. Three groups of patients were studied: group 1 = 22 patients with undernutrition (MNA = 17), group 2 = 166 patients with risk of undernutrition (17 < MNA < 24), and group 3 = 291 patients without undernutrition (MNA = 24). Correlations with behavioral and psychological signs and symptoms of dementia (Neuropsychiatric Inventory NPI), with caregiver distress (Zarit), and with the Mini Mental State Examination (MMSE) were studied. Undernutrition is more frequently associated with low MMSE (p < 0.001), high behavioural disturbances (p < 0.001) and high distress of caregivers (p < 0.001). Risk of undernutrition is also associated with NPI (p < 0.001) and Zarit (p < 0.001). These first results in a French cohort of patients with AD underline the importance of the evaluation of nutritional status and finally the follow-up of eating behavior, cognitive status and the quality of life of the caregivers.     

Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients

BackgroundDelirium is a risk factor for dementia in cognitively intact patients. Whether an episode of delirium accelerates cognitive decline in patients with known dementia, is less explored.MethodsThis is a prospective follow-up study of 287 hip fracture patients with pre-fracture cognitive impairment. During the hospitalization, the patients were screened daily for delirium using the Confusion Assessment Method. Pre-fracture cognitive impairment was defined as a score of 3.44 or higher on the pre-fracture Informant Questionnaire on Cognitive Decline in the Elderly Short Form (IQCODE-SF). At follow-up after 4–6 months, the caregivers rated cognitive changes emerging after the fracture using the IQCODE-SF, and the patients were tested with the Mini Mental State Examination (MMSE). A sub-group of the patients had a pre-fracture MMSE score which was used to calculate the yearly decline on the MMSE in patients with and without delirium.Results201 of the 287 patients developed delirium in the acute phase. In linear regression analysis, delirium was a significant and independent predictor of a more prominent cognitive decline at follow-up measured by the IQCODE-SF questionnaire (p = 0.002). Among patients having a pre-fracture MMSE score, the patients developing delirium had a median (IQR) yearly decline of 2.4 points (1.1–3.9), compared to 1.0 points (0–1.9) in the group without delirium (p = 0.001, Mann–Whitney test).ConclusionsHip fracture patients with pre-fracture dementia run a higher risk of developing delirium. Delirium superimposed on dementia is a significant predictor of an accelerated further cognitive decline.