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目的：比较双模态PET/MRI显像技术与其他分子影像技术的优势和劣势。方法：随着分子医学及影像医学的飞速发展,将二者结合的分子影像技术促进了医学科学的发展。单模态及多模态分子影像技术主要包括了PET/MRI、光学成像、PET/CT、SPECT/CT、SPECT/MRI及超声分子成像。本文比较了以上各种分子影像技术在临床前及临床医学中的应用。结果：双模态PET/MRI优势主要集中在肿瘤学、心脏病学、神经科学中的研究,为研究者及临床医生提供更多的分子信息。结论：多模态分子医学影像设备的发展势必推动整个医学科学的发展,PET/MRI将解开更多的未解之谜。 相似文献
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目的：研究AD（Alzheimer’s disease,AD）的静息态功能磁共振影像学表现,揭示其影像学早期变化。方法采用3.0T磁共振扫描仪对17例AD病人及17例对照组（normal cognition, NC）进行静息态功能磁共振检查。对原始数据进行预处理,获取局域一致性（Regional Homogeneity,ReHo）图,将两组结果图进行组内单样本t检验和组间独立样本t检验,得到两组间差异脑区。结果 AD组与对照组相比,右侧小脑后叶、右侧颞下回、左侧楔状叶、右侧丘脑、右侧中央后回、右侧额下回、右侧顶叶、左侧尾状核及左侧额中回ReHo值升高,右侧额中回、右侧内侧颞叶、左侧壳核、右侧额上回、右侧后扣带回、右侧顶下小叶、左侧颞中回、左侧额下回及左侧前扣带回ReHo值减低。结论阿尔茨海默病患者与正常老龄化组相比,在静息状态下存在着局部脑区功能上的异常,揭示其改变对该病的早期诊断有重要意义。 相似文献
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目的探讨磁共振（MR）全身类正电子发射断层成像（PositronEmissionTomography,PET）技术对“健康人群”肿瘤普查的应用价值。方法选择1056例无明确肿瘤病史,做磁共振常规部位检查的病人,在常规部位检查同时加扫全身弥散加权成像（DiffusionWeightedImaging,DWI）。结果发现35例42个病灶,DWI图像上均呈高信号,ADC图为低信号,每个病灶ADC值均与正常区域比较明显降低,降低幅度〉50％。上述病灶均经临床证实为恶性病变或转移瘤。结论磁共振全身类PET技术可以发现肿瘤原发灶及转移灶,具有无辐射、无需注射造影剂、检查简便快捷的优势,适合于“健康人群”肿瘤筛选。 相似文献
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目的：探讨阿尔茨海默病（AD）患者静息状态下不同频段低频振幅（ALFF）脑功能活动特点。方法使用3.0T磁共振对20例AD患者及20名正常对照者进行脑静息态功能磁共振检查。采用静息态功能磁共振数据处理助手（DPARSF）和静息态功能磁共振数据分析工具包（REST）进行处理及检验统计分析,主要观察Slow-4和Slow-5频率段AD组的脑功能活动特点,用REST软件呈现结果,确定有统计学意义的脑区解剖位置。结果与正常对照组相比,AD患者组ALFF值减低的脑区包括：后扣带回、楔前叶、双侧额叶及双侧顶下小叶（P〈0.05）;双侧海马旁回和梭状回、右侧额顶叶、右侧小脑后叶和双侧基底节区的ALFF值则明显升高（P〈0.05）;双侧基底节区的自发神经活动对Slow-5频率段更敏感,而较高频率的Slow-4频率段更适合检测出双侧海马旁回及梭状回等脑区自发神经活动的异常。结论 AD患者多个脑区自发神经元活动存在异常,且部分脑区的自发神经元活动存在频率依赖性。 相似文献
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正电子发射型计算机断层显像（positron emission tomography,PET/CT）融合了PET功能显像与CT解剖显像的优点。PET功能显像可反应组织器官及病灶的生理代谢情况,但图像质量较差,分辨率不能满足临床的需要。CT解剖显像可起到定位病灶的作用,解决了单独PET显像的缺点,二者融合可以在分子水平上实现疾病的临床诊断、分期判断及疗效检测。目前,随着PET/CT的广泛应用,其在肿瘤疾病、心血管系统疾病及神经系统疾病中的应用价值得到了越来越多的关注,有望将分子影像学的发展推向一个新的高度。 相似文献
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正阿尔茨海默病(Alzheimer’s disease,AD)是老年期痴呆中最常见的一种类型。该病早期常表现为情景记忆损害,随病程进展逐渐出现更广泛的认知功能损害(如记忆、执行功能、语言、视空间等)及日常生活能力障碍,并可伴有精神行为异常。其特征性的病理改变包括淀粉样老年斑、神经元纤维缠结及广泛的神经元缺失。AD是严重威胁老年人生命健康的疾病,然而一旦发病,目前尚缺乏有效的可逆转病程的药物。因此,AD的早期诊断与预警的基础研究,已成为当前 相似文献
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血管性认知障碍是由脑血管疾病导致的一种从轻度认知功能障碍至痴呆的综合征,由于缺乏敏感性和特异性生物标志物,早期不易鉴别和诊断。血管性认知障碍患者脑网络连接异常的脑区多位于默认网络,其异常变化的功能连接与患者的认知障碍程度相关。静息态功能磁共振成像技术是一种常用的检测静息态大脑内在活动的方法,应用静息态磁共振不同分析技术探索血管性认知障碍患者默认网络异常变化有助于深入研究血管性认知障碍的发病机制,并提供客观的影像依据。该文主要综述静息态功能磁共振成像技术在血管性认知障碍患者默认网络研究中的应用成果,为血管性认知障碍的精准诊断和评估提供新思路。 相似文献
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Janine van Kooten Martin Smalbrugge Johannes C. van der Wouden Max L. Stek Cees M.P.M. Hertogh 《Journal of the American Medical Directors Association》2017,18(6):522-527
Objectives
To study pain prevalence, pain type, and its pharmacological treatment in Dutch nursing home residents in relation to dementia subtype and dementia severity.Design
Data were collected as part of the PAINdemiA study, an observational cross-sectional study conducted between May 2014 and December 2015.Setting
Ten nursing homes in the Netherlands.Participants
A total of 199 nursing home residents in various stages of dementia.Measurements
We collected data on pain (by observation: MOBID-2 Pain Scale and by self-report scales), pain type, pain medication, dementia subtype, dementia severity (GDS), and demographic features.Results
In the whole sample, the prevalence of pain was 43% (95% confidence interval 36%–50%) using the MOBID-2 Pain Scale. Regardless of regularly scheduled analgesics, approximately one-third of the residents with pain suffered from moderate to severe pain. Pain assessment with the MOBID-2 Pain Scale showed no difference in pain between dementia subtypes, but residents with more severe dementia experienced pain more often than those with less severe dementia (27% vs 15%). The prevalence of self-reported pain was significantly higher in residents with vascular dementia (VaD) (54%) compared with those with Alzheimer disease (18%) and other dementia subtypes (14%). Nociceptive pain was the predominant type of pain (72%) followed by mixed pain (25%). Acetaminophen was the most prescribed analgesic (80%).Conclusion
Most of the participating nursing home residents had no pain; however, pain was observed more often in residents with severe dementia, whereas residents in the early stages of VaD self-reported pain more often that those with other dementia subtypes.As one-third of the residents with clinically relevant pain had moderate to severe pain regardless of using pain medication, more focus should be on how pain management could use more tailored approaches and be regularly adjusted to individual needs. 相似文献12.
Alessandro Morandi Daniel Davis Giuseppe Bellelli Rakesh C. Arora Gideon A. Caplan Barbara Kamholz Ann Kolanowski Donna Marie Fick Stefan Kreisel Alasdair MacLullich David Meagher Karen Neufeld Pratik P. Pandharipande Sarah Richardson Arjen J.C. Slooter John P. Taylor Christine Thomas Zoë Tieges James L. Rudolph 《Journal of the American Medical Directors Association》2017,18(1):12-18
Delirium occurring in patients with dementia is referred to as delirium superimposed on dementia (DSD). People who are older with dementia and who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision are considered the standard reference for the diagnosis of delirium and include criteria of impairments in cognitive processes such as attention, additional cognitive disturbances, or altered level of arousal. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision does not provide guidance regarding specific tests for assessment of the cognitive process impaired in delirium. Importantly, the assessment or inclusion of preexisting cognitive impairment is also not addressed by these standards. The challenge of DSD gets more complex as types of dementia, particularly dementia with Lewy bodies, which has features of both delirium and dementia, are considered. The objective of this article is to critically review key elements for the diagnosis of DSD, including the challenge of neuropsychological assessment in patients with dementia and the influence of particular tests used to diagnose DSD. To address the challenges of DSD diagnosis, we present a framework for guiding the focus of future research efforts to develop a reliable reference standard to diagnose DSD. A key feature of a reliable reference standard will improve the ability to clinically diagnose DSD in facility-based patients and research studies. 相似文献
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Vincenzo Solfrizzi Emanuele Scafato Davide Seripa Madia Lozupone Bruno P. Imbimbo Angela D&#x;Amato Rosanna Tortelli Andrea Schilardi Lucia Galluzzo Claudia Gandin Marzia Baldereschi Antonio Di Carlo Domenico Inzitari Antonio Daniele Carlo Sabbà Giancarlo Logroscino Francesco Panza 《Journal of the American Medical Directors Association》2017,18(1):89.e1-89.e8
Objectives
Cognitive frailty, a condition describing the simultaneous presence of physical frailty and mild cognitive impairment, has been recently defined by an international consensus group. We estimated the predictive role of a “reversible” cognitive frailty model on incident dementia, its subtypes, and all-cause mortality in nondemented older individuals. We verified if vascular risk factors or depressive symptoms could modify this predictive role.Design
Longitudinal population-based study with 3.5- and 7-year of median follow-up.Setting
Eight Italian municipalities included in the Italian Longitudinal Study on Aging.Participants
In 2150 older individuals from the Italian Longitudinal Study on Aging, we operationalized reversible cognitive frailty with the presence of physical frailty and pre-mild cognitive impairment subjective cognitive decline, diagnosed with a self-report measure based on item 14 of the Geriatric Depression Scale.Measurements
Incidence of dementia, its subtypes, and all-cause mortality.Results
Over a 3.5-year follow-up, participants with reversible cognitive frailty showed an increased risk of overall dementia [hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.02–5.18], particularly vascular dementia (VaD), and all-cause mortality (HR 1.74, 95% CI 1.07–2.83). Over a 7-year follow-up, participants with reversible cognitive frailty showed an increased risk of overall dementia (HR 2.12, 95% CI 1.12–4.03), particularly VaD, and all-cause mortality (HR 1.39, 95% CI 1.03–2.00). Vascular risk factors and depressive symptoms did not have any effect modifier on the relationship between reversible cognitive frailty and incident dementia and all-cause mortality.Conclusions
A model of reversible cognitive frailty was a short- and long-term predictor of all-cause mortality and overall dementia, particularly VaD. The absence of vascular risk factors and depressive symptoms did not modify the predictive role of reversible cognitive frailty on these outcomes. 相似文献14.
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PET/MRI研制进展及展望 总被引：2，自引：0，他引：2
PET/MRI的出现必将对分子影像学的发展产生深远影响,本文就目前PET/MRI研制存在的问题和进展情况做一综述,并展望其潜在的临床和科研价值。 相似文献
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一体式PET/MRI较其他多模态成像,如PETCT等具有明显的优点：同步采集、无射线危害、高软组织对比度,可实现各种功能成像等。一体式PET/MRI技术具有许多难点,如磁兼容性问题、PET和MRI的互相干扰问题,磁共振孔径有限等。一体式PET/MRI采用的技术包括基于光纤式、基于APD传感器式等,其中,APD传感器对设计全身临床型一体式PET/MRI更有前途。目前,一体式动物PET/MRI已应用较多,但临床型一体式PET/MRI尚处于初期发展阶段,不过初步的临床应用揭示PET/MRI对临床医学成像具有重要意义。 相似文献
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《Journal of the American Medical Directors Association》2021,22(7):1449-1455.e4
ObjectiveBoth cognitive reserve and subjective cognitive decline are closely related to the risk of dementia. We investigated whether cognitive reserve can modify the risk of dementia developing from subjective cognitive decline.DesignLongitudinal population-based study.Setting and ParticipantsThe prospective study analyzed data from 2099 participants aged 65 or over from the Cognitive Function and Ageing Study–Wales (CFAS-Wales).MethodsDementia was ascertained through the comprehensive judgment symptoms of geriatric mental state automated geriatric examination for computer assisted taxonomy (GMS-AGECAT). Subjective cognitive decline was evaluated by 2 questions in the baseline interview. Cognitive reserve indicators were derived from 3 previously identified factors: early life education, mid-life occupational complexity, and late-life cognitive activities. We used logistic regression models to estimate dementia risk in relation to subjective cognitive decline and indicators of cognitive reserve. The interaction between subjective cognitive decline and cognitive reserve were evaluated by additive and multiplicative scales.ResultsBaseline subjective cognitive decline and low cognitive reserve significantly increased the risk of dementia, after 2 years of follow-up. There was an additive interaction between subjective cognitive decline and cognitive reserve [the relative excess risk due to interaction = −0.63, 95% confidence interval (CI) = −0.89 to −0.36, P for additive interaction <0.001]. There was no multiplicative interaction between subjective cognitive decline and cognitive reserve indicator (P = .138). Statistically significant association between subjective cognitive decline and dementia was found only in the low-level and medium-level cognitive reserve group (OR = 3.78, 95% CI = 1.50–9.55 and OR = 3.64, 95% CI = 1.09–12.2, respectively), but not in the high-level groups.Conclusion and ImplicationsCognitive reserve attenuated subjective cognitive decline associated risk of developing dementia. This finding suggests the need for greater emphasis on detecting prodromal dementia when older patients having lower cognitive reserve present with subjective cognitive decline. 相似文献
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PET/CT作为一种多模式显像技术,已在科研与临床工作中取得了令人瞩目的成就。MRI在多方面优于CT,因此,PET/MRI分子影像设备的研究成了近些年的热点。PET/MRI融合显像可提供分子、形态与功能信息,具有较大的潜力,但其研制过程中仍存在一系列问题,若能合理解决必将给分子影像学带来深远影响。 相似文献