中文修订版智能筛查检测在阿尔茨海默病和轻度认知损害评估中的作用

目的:探讨智能筛查测验(CASI)在不同严重度的阿尔茨海默病(AD)患者中的表现及与MMSE总分的关系。方法:使用2.0版本的CASI、MMSE及临床痴呆量表等对30名正常中老年人、20例轻度认知损害(MCI)和53例不同严重度的AD患者(20例轻度、19例中度、14例重度)进行评估。结果:根据CASI因子分分析发现,MCI组新记忆和概念判断受损、完成测验的耗时数延长,AD组在从轻至重度组中依次出现定向障碍、心算障碍,直到所有因子分均显著减退。除"概判"因子外,其余因子分都随着病情严重度而逐渐降低。除了重度AD组以外,MCI组、轻度AD组和中度AD组均较前一组下降约10分。CASI总分以≤85分为界:识别MCI的敏感度为70.6%;识别轻度AD的敏感度为82.7%;特异度均为73.9%。对于大学及以上文化者,CASI难度过低,容易出现假阴性。结论:CASI可有效判断AD认知损害的严重度,并能从组成项目中获得MMSE总分。     

ADAS评估阿尔茨海默病的认知功能研究

目的：分析不同严重度的阿尔茨海默病(AD)患者的认知缺损特征。方法：符合DSM-Ⅳ与NINCDS-ADRDA制定的可能AD诊断标准的AD患者68例，其中轻、中、重度AD分别为27、25和16例。选择正常老人69例作为对照组。采用简明精神状态量表(MMSE)和ADAS-cog评定认知功能。结果：轻度AD组的ADAS-cog总分平均19分，中度AD组34分，重度AD组为46分。ADAS-cog总分变化比MMSE总分能更精确地反映AD患者认知功能的变化。根据项目分变化分析，轻-中度AD以记忆损害为主，重度以语言损害为主。记忆损害在中-重度期间有一个平台期，衰退减速。结论：ADAS-cog可以有效地反映AD的认知缺损，这使它可以作为抗痴呆药物疗效的判定工具，但它的缺点(如被试必须有一定的阅读能力)限制了它在国内的推广应用。     

认知功能筛查量表在MCI和轻度AD患者中的应用

目的:探讨认知功能筛查量表在轻度认知功能损害(Mild Cognitive Impairment,MCI)和轻度阿尔茨海默病(Alzhei mer disease,AD)患者中的应用。方法:对61例MCI患者和47例轻度AD患者进行系列神经心理学测验,同时选择41例正常老年人做对照。结果:MCI组和正常老年人比较,MGR、MMSE的短时记忆亚项、FOM、LM、DR、CDT均有统计学差异。轻度AD组和MCI组比较,MMSE的即刻记忆亚项、RVR、DS、ADL、IADL、POD均有统计学差异。CES-D在三组间无统计学差异。结论:MGR量表可用来鉴别正常人和认知功能损害人群,但不宜用来鉴别MCI和轻度AD患者。RVR和DS量表可以用于鉴别MCI和轻度AD患者。ADL量表在轻度AD患者显示损害,提示AD患者存在日常生活行为能力的损害。     

MCI患者血清中Tau蛋白 Aβ1-42P-tau的检测价值分析

目的 探讨血清磷酸化Tau（P-tau）、β淀粉样蛋白1-42（Aβ1-42）以及Tau蛋白在轻度认知障碍（MCI）患者中的临床应用价值.方法 采用酶联免疫法测定主诉健忘组（SMC）30例,MCI患者30例,阿尔茨海默病组（AD）68例（轻度AD 24例,中度AD 22例,重度AD 22例）以及健康对照组35例血清中P-tau、Aβ1-42、Tau蛋白水平,并分析三种标记物与疾病的相关性.结果 与对照组及MCI组相比,MCI组、AD组MMSE评分显著上升,差异有统计学意义（P〈0.05）,重度AD组MMSE评分显著高于轻度、中度AD组,两两比较差异有统计学意义（P〈0.05）.与对照组相比,MCI组、AD组P-tau、Tau蛋白水平显著上升,且AD组高于MCI组,而Aβ1-42水平显著下降,且AD组下降幅度大于MCI组,差异有统计学意义（P〈0.05）.其中重度AD组P-tau、Tau蛋白水平高于轻度、中度AD组,而Aβ1-42水平低于轻、中度组,差异有统计学意义（P〈0.05）.SMC 组与对照组相比,各标记物水平差异无统计学意义（P〉0.05）.与单纯Tau蛋白、Aβ1-42、P-tau诊断相比,Tau蛋白、Aβ1-42、P-tau联合诊断的灵敏性、特异性、准确性显著增加,差异有统计学意义（P〈0.05）.结论 MCI病情发生及发展过程可能与血清P-tau、Aβ1-42、Tau蛋白水平异常有关,通过测定这三种标记物可有效预测MCI患者病情进展情况.     

轻度认知障碍和阿尔茨海默病患者认知功能和MRI对照研究

目的探讨轻度认知障碍（MCI）和阿尔茨海默病（AD）的认知功能及影像学特点。方法回顾性分析经临床确诊的21例MCI和24例AD患者的临床资料。所有实验对象均用简易智力量表（MMSE）和蒙特利尔认知评估（MoCA）测定。结果MCI与AD的认知功能损害相比较：除了MMSE的记忆力组间无统计学意义（P＝0．28）,其余均有统计学差异（P〈0．05）。MoCA比MMSE具有更好的敏感性。AD的MRI表现：脑萎缩,特别是海马存在不同程度的萎缩;老年性脑改变;MCI的MRI主要表现为脑白质脱髓鞘病变,少数提示轻度脑萎缩或未见明显异常。结论MCI和AD患者早期均表现为记忆力下降,对记忆力减退人群进行MMSE、MoCA量表筛查有助于AD的早期诊断。AD患者到中晚期治疗较困难,因此早期诊断及干预对延缓病程起积极作用。     

阿尔茨海默病患者认知功能损害的调查研究

目的 探讨阿尔茨海默病（AD）患者的认知功能损害特征.方法 采用精神状态简易速查表（MMSE）对32例AD患者及32例正常老年人（对照组）进行了测评,并将测评结果加以比较.结果 AD组患者的MMSE总分及各项分测验（除物体命名外）评分均极明显低于正常对照组（P＜0.01）.轻度痴呆组在时间定向、地点定向、语言即刻记忆、注意和计算、短程记忆、阅读理解、言语表达及图形描述等项评分均极明显高于中度痴呆（P＜0.01）.结论 AD患者普遍存在着认知功能损害,且与痴呆的程度有关.     

蒙特利尔认知评价量表(中文版)在轻度认知损害诊断及进展过程中的作用

目的研究蒙特利尔认知评价量表(MoCA)中文版在轻度认知损害(MCI)诊断筛查中的作用,评价认知功能在疾病进展过程中的临床意义。方法对年龄、性别、文化程度构成无统计学差异的两组受试者(正常对照组29例、MCI组28例)进行MoCA和简易智能状态检查量表(MMSE)测试,以其总成绩及各单项成绩作为基线成绩,观察MoCA和MMSE在筛查MCI中的作用,并比较两种量表对筛查轻度认知损害的敏感性、特异性的差异。于初次筛查后12个月对两组受试者进行再次测试,并与基线成绩进行配对t检验,比较前后测试成绩间的差异及各单项成绩对预测疾病进展的作用。结果 MoCA和MMSE对鉴别正常老龄化和轻度认知损害均具有初步筛查作用,MoCA量表中的视空间执行功能(t=2.151,P=0.036)、抽象(t=2.787,P=0.009)、定向(t=3.162,P=0.003)、记忆(t=4.704,P=0.000)等单项测试成绩,两组间差异具有统计学意义;以26分为分界值,MoCA和MMSE诊断MCI的敏感度分别为89.29%和10.71%,特异度为82.76%和100%,MoCA诊断敏感性显著高于MMSE。MCI组患者在12个月后的随访测试中各项成绩均略有下降,其中MoCA总成绩(t=6.454,P=0.000)、视空间执行功能(t=5.610,P=0.000)、语言(t=4.954,P=0.000)测试成绩,复查前后差异有统计学意义。结论 MoCA对轻度认知损害的诊断敏感性高于MMSE,其中视空间执行功能、抽象、定向、记忆各单项测试成绩具有诊断价值;MoCA总评分、视空间执行功能、语言等项成绩复查后降低,对轻度认知损害向阿尔茨海默病转化具有提示作用。     

Rey-Osterriche复杂图形测验在轻度阿尔茨海默病和轻度认知损害患者中的应用研究

目的:研究Rey-Osterrich复杂图形测验(CFT)对轻度阿尔茨海默病(AD)和遗忘型轻度认知损害(MCI)的诊断价值。方法:应用CFT、简明精神状态量表(MMSE)对45例轻度AD患者、73例遗忘型MCI和66名正常老年人进行检测,MMSE总得分分别为(20.2±2.5)分、(26.9±1.8)和(28.2±1.6)分。结果:对照组,CFT结构模仿和延迟回忆得分与教育程度有显著正相关性,与年龄、性别无相关性。MCI组的结构模仿得分为(32.4±6.2)分,轻度AD组为(26.1±10.9)分,对照组为(33.6±3.1)分。AD组与对照组及MCI组比差异有显著意义,延迟记忆对于识别MCI有一定作用,协助AD诊断有较好的敏感性(P<0.01);MCI组的延迟回忆得分与对照组比差异有显著统计学意义(P<0.01),轻度AD组下降更为明显,与MCI组比差异有显著统计学意义(P<0.01)。结论:CFT延迟记忆对于识别MCI有一定作用,协助AD诊断有较好的敏感性。CFT结构模仿不能识别MCI,对轻度AD,其敏感性亦不理想。     

晚发型抑郁障碍与轻度认知功能损害患者的认知功能差异研究

目的 探讨晚发型抑郁障碍患者与轻度认知功能损害患者的认知功能损害的差异.方法 研究对象为2012年7月～2013年8月上海市精神卫生中心老年科住院与门诊就诊符合DSM—Ⅳ诊断标准且起病年龄≥60岁的抑郁障碍患者,共26例为晚发型抑郁障碍组（LOD组）,另选择26例轻度认知功能损害的患者（MCI组）与26例正常老年人（NC组）.认知功能评估采用简明精神状态量表（MMSE）、蒙特利尔量表（MoCA）.结果 MMSE总分、MMSE分测验中计算力与注意力及MoCA总分、MoCA分测验中连线、注意、持续注意、计算、复述、延迟回忆在LOD组与MCI组差比较异无统计学意义（P＞0.05）,两组与NC组比较差异有统计学意义（P＜0.05）.三组在MMSE分测验的时间定向、延迟回忆、三步指令、书写书面指令及MoCA分测验的复制图、画钟、命名比较,MCI组均值最低,与NC组比较差异有统计学意义（P＜0.05）,与LOD组比较差异无统计学意义（P＞0.05）.结论 LOD组认知功能在注意力、延迟回忆、连线测验方面与MCI组损害程度相当.MCI组认知功能受损范围较LOD组广泛.     

蒙特利尔认知评估量表在轻度认知功能障碍中的应用

目的探讨蒙特利尔认知评估量表在轻度认知功能障碍患者中的应用。方法测试年龄及教育程度相匹配的42例MCI患者及39例正常对照组进行MoCA测查。结果与对照组（27.36±1.38）相比,MCI组的MoCA总分（23.93±3.69）更差,差异有统计学意义（P〈0.01）;MCI组在命名、语言及定向方面与对照组无明显差异（P〉0.05）。MCI组在视空间与执行功能（HC 4.46±0.78,MCI 3.57±1.23）、注意（HC 5.95±0.22,MCI 5.61±0.73）、抽象思维（HC 1.61±0.54,MCI1.21±0.68）及延迟回忆（HC 3.54±0.88,MCI 1.97±1.20）方面,均较对照组更差,差异有统计学意义（P〈0.01）。结论MCI患者不仅在记忆上较正常人差,可能在视空间与执行功能、注意、抽象思维方面存在损害。MoCA量表对MCI患者各认知方面可起到初筛作用。     

Early stages in the formation of the cerebellum in the frog

The formation of the cerebellum was studied during the first 6 months of the tadpole stage of the bullfrog by using standard histological methods and reconstructions from serial horizontal sections. Three major developmental phases were noted in the formation of the cerebellum. (1) During the first 5 weeks of development, the neuroepithelium proliferated and the dorsal mesencephalic plates increased in size. (2) Starting in the sixth week, a patch of neuroepithelium began to differentiate and gave rise to a small population of Purkinje cells. In subsequent weeks, the area of differentiation continued to spread and a Purkinje cell layer became established along the dorsal margin of the cerebellar plate. (3) In the 12th week, the ventrolateral part of the cerebellar plate began to increase in size and generate two populations of small cells. The lateralmost part of the neuroepithelium in this area generated a group of cells that formed an external granular layer that was one cell deep. Cells of this external granular layer migrated inward into the primitive molecular layer, and by the 26th week only a remnant of an external granular layer remained in the cerebellum. The more medially situated part of the neuroepithelium gave rise to another population of small cells that formed a column, which appeared to be continuous with the Purkinje cells, but differed from them in size. It should be noted that full maturation of the cerebellum occurs during metamorphosis, which in this species remains some 2 years away.     

Inhomogeneities in the propagation of the slow wave in the stomach

The propagation of the slow wave in the stomach and its role in inducing sweeping peristaltic contractions toward the pylorus, essential for a proper digestion and emptying, have been studied for many years. Irregularities in the timing or in the pattern of propagation of the slow wave have been known to induce various gastric malfunctions and, recently, several types of gastric dysrhythmias have been described which could lead to gastric contraction abnormalities. In this study, Du et al. have analyzed the disturbances caused by a simple transmural incision in a human stomach, performed to obtain a biopsy of the muscle, on the propagation pattern of the slow wave. In addition, they show that such an incision may by itself also induce new types of gastric dysrhythmias. These results are important in demonstrating that the function of the stomach can easily be disturbed by such procedures. This mini‐review describes several ways in which inhomogeneities in propagation may affect the conduction pattern of the slow wave, including the genesis of several dysrhythmias, and what is currently known about their impact on gastric contraction and digestion.     

Asymmetry in the structural organization of the ganglion layer of the retina in the frog

Silver-impregnated retinal preparations were used to study the distribution density and topographic features of small and large ganglionic cells (GC) of Rana ridibunda and Rana temporaria. For both species the increased density of GC (a streak) stretched higher than the naso-temporal axis passing through the optic disk. Beyond the streak the density of small GC was maximal in the central zone of the retina and decreased towards its periphery. For the upper quadrants of the retina the density of small GC was higher than that for the lower ones by 26% on the average. On the contrary, the density of large GC was higher in the lower part of the retina as compared to the upper one, the difference being more pronounced for R. temporaria. The density of large GC was also asymmetric with respect to the dorso-ventral axis being higher in nasal quadrants than in temporal ones by 40-55%. The highest density of large GC was found in the middle zone of the retina. The found structural asymmetry in the retinal output raster may bear an adaptively ecological meaning and may condition the particularities of the formation of the visually guided prey-catching and avoidance reactions.     

Local nonuniformities in the syncytium of the horizontal cells of the retina in the turtle

Electrical coupling between horizontal cells of the turtle retina was investigated by means of two microelectrodes (current and recording ones) penetrating neighbouring cells at a fixed distance from each other. The morphological coupling was revealed by means of fluorescent dye Lucifer Yellow. The electrical coupling was confirmed between elements of similar type (L1--axonal terminals, or L2--cell bodies, or R/G type cells) and no coupling was found between elements of different types, though L1 and L2 are directly connected through thin axons. In the L1 syncytium the electrical coupling at small (less than or equal to 50 microns) but fixed distances between microelectrodes could differ several times depending on the minimal displacement of microelectrodes. This local nonuniformity of coupling can be explained on the basis of structural nonuniformities in the L1 (axon terminal) network. It is unlikely however that the structural nonuniformities can influence the functional properties of horizontal cell network when the retina is stimulated adequately (by light).     

Challenges in the Management of the HIV Patient in the Third Decade of AIDS

The epidemic of AIDS has been increasingly recognized as a major health and socioeconomic problem, not only in the United States or Africa, but also the rest of the world. The face of the epidemic has changed. The role that mental health providers play has also significantly grown as the epidemic continues on. Prior to the introduction of Highly Active Anti-Retroviral Therapy (HAART) and other advances in HIV care, the patients faced issues that related to death and dying. These advances brought with them renewed hope and resurrected lives. The patients fought with issues related to living new lives with HIV no longer an imminent death threat. In the third decade of AIDS, the struggles of the post-HAART era continue but bring with it more challenges. Mental health providers need to familiarize themselves with these issues so that they can better help HIV patients cope with this devastating disease.     

Role of the subthalamo-nigral input in the control of amygdala-kindled seizures in the rat

The substantia nigra pars reticulata (SNpr) is a critical site for the control of epileptic seizures. Potentiation of the inhibitory GABAergic input from the striatum to the SNpr suppresses primary or secondary generalized seizures in the rat. The purpose of this study was to examine the possible involvement of the excitatory glutamatergic input from the subthalamic nucleus to the SNpr in the control of both the electroencephalographic and the motor components of amygdala-kindled seizures in the rat. Microinjections of either an N-methyl- -aspartate (NMDA) antagonist in the substantia nigra or a GABA_A agonist in the subthalamic nucleus, significantly reduced motor seizures but did not modified the afterdischarges. These results provide evidence for the involvement of the subthalamo-nigral projection in the modulation and the propagation of the motor components of amygdala-kindled seizures.     

Patterning in the regeneration of electroreceptors in the fin of Kryptopterus

The influence of the target tissue on afferent nerve regeneration was studied in the adult glass catfish, Kryptopterus. In this fish, electroreceptors in the anal fin are distributed in a characteristic pattern in the proximal part of the fin and are absent in the distal portion of the fin. We tested whether axons were more likely to induce electroreceptors in certain regions of fin epidermis than in others. We rotated fin transplants so that the location of the degenerating electroreceptors was altered with respect to the regenerating axons in the host tissue dorsal to the fin. The effects of these rotations were observed in the living animal with differential interference contrast optics over a period of 10 weeks. When transplants were reversed rostrocaudally, new electroreceptors formed in the caudal half of the interradial zone, where degenerating electroreceptors were at the time of transplantation. When transplants were rotated so that the dorsoventral and rostrocaudal axes were reversed, some new receptors formed in the old target site regions that were located in the caudal interradial zones (in the distal half of the graft with respect to the host). Regenerating axons reached these regions of the transplant by taking unusual routes around the electroreceptor-free regions of fin. Very few electroreceptors formed in the distal/caudal or proximal/caudal interradial quadrants of grafts where the original orientation of the tissue was maintained. We suggest that old target sites have a neurotropic influence on the regenerating afferent axons and discuss the possibility that the distal fin epidermis is not as permissive to electroreceptor formation as proximal fin epidermis.     

Organization in the descending tracts of the dorsolateral funiculus in the cat

Organization of the fibers in the descending tracts of the dorsolateral funiculus of the cervical spinal cord was investigated in cats. The spinal cord was penetrated with microelectrodes at 400 mum intervals in the medio-lateral direction at the c5/c6 and c6/c7 segmental borders. Silicon substrate microelectrodes with a linear arrangement of activated iridium contacts were used. The stimulus consisted of a 20 ms train of charge balanced biphasic current pulses at 330 Hz. The evoked activities from selected forelimb muscles were acquired into computer. Only the data points with an activation threshold of less than 35 muA were considered in the analysis. Muscle contractions were mostly in the form of short twitches. In both spinal segments, an area of high threshold was found in the middle of the dorsolateral funiculus. Majority of the muscles studied had a dorsal or ventral concentration of activation points. The distal muscles were mostly activated in the ventro-lateral aspect of the funiculus, while the elbow muscle maps spread to both dorsal and ventral sides. These results show a functional organization in both cervical segments studied, with overlapping regions between the areas dedicated for each forelimb muscle.     

Pursuit of the origin of the large myelinated fibers of the anterolateral funiculus in the spinal cord in humans in relation to the pathomechanism in amyotrophic lateral sclerosis

To determine the origin of the large myelinated fibers in the anterolateral funiculus (ALF) in the spinal cord of humans, myelinated fibers in the ALF of the mid-cervical spinal cord were examined quantitatively. Five groups of subjects were examined, consisting of control subjects, patients with cerebral lesions and showing complete degeneration of the unilateral/bilateral pyramis of the medulla oblongata, those with lesions of the pontine tegmentum, those with lesions of the lower cervical spinal cord, and those with thoracic/lumbar lesions. The results indicate that the large myelinated fibers in the ALF of the mid-cervical spinal cord of humans originate from the tegmentum of the brain stem and the lower cervical spinal cord, and not from the cerebrum, or the thoracic or lumbar spinal cord. Thus, they are descending fibers from the brain stem tegmentum and ascending fibers from the lower cervical cord, and not corticospinal tracts or long-ascending fibers from the thoracic or lumbar spinal cord. The origin of the large myelinated fibers in the ALF of the spinal cord in humans, the number of which was severely decreased in patients with amyotrophic lateral sclerosis, is considered to be the long-descending neurons in the brain stem tegmentum and the propriospinal neurons in the spinal cord. Received: 23 December 1998 / Revised, accepted: 29 March 1999     

Selectivity between faces in the responses of a population of neurons in the cortex in the superior temporal sulcus of the monkey

There is a population of neurons in the cortex in the middle and anterior part of the superior temporal sulcus (STS) of the monkey with responses which are selective for faces. If, consistent with the effects of damage to the temporal lobe, these neurons are involved in face recognition or in making appropriate social responses to different individuals, then it might be expected that at least some of these neurons might respond differently to different faces. To investigate whether at least some of these neurons do respond differently to different faces, their responses were measured to a standard set of faces, presented in random sequence using a video framestore. It was found that a considerable proportion of the neurons with face selective responses tested (34/44 or 77%) responded differently to different faces, as shown by analyses of variance. An index of the discriminability of the most and least effective face stimulus (d') ranged between 0.2 and 5.0 for the different neurons. Although these neurons often responded differently to different faces, they did not usually respond to only one of the faces in the set, so that information that a particular face had been shown was present across an ensemble of neurons, rather than in the responses of an individual neuron. These findings indicate that the responses of these neurons would be useful in providing information on which different behavioral responses made to different faces could be based. These neurons could thus be filters, the output of which could be used for recognition of different individuals and in emotional responses made to different individuals.