老年人甲状腺功能低下的认知损害特点研究

目的探讨老年甲状腺功能低下患者的认知损害特点。方法选择原发性甲状腺功能减退患者60例,根据年龄分为老年组15例和年轻组45例,并2组患者进行神经心理学检测。结果老年组在图形延迟回忆、连线A、词表学习3、数字倒背、符号数字试验中较非老年组成绩差,差异有统计学意义(P<0.05)。而简易智能状态检查量表评分、立体图形、画钟表试验、图像记忆、摆积木、复杂图形描摹、复杂图形回忆,连线B、词表学习1、词表学习2、词表延迟回忆、词语再认、数字顺背、词语流畅性等方面差异无统计学意义(P>0.05)。结论老年原发性甲状腺功能低下患者的认知损害在一些认知易老化区域表现较年轻患者有更严重的损害。     

南京军区离休老年人轻度认知功能损害的调查

目的 调查老年人轻度认知功能损害(MCI)的患病率,比较广义MCI和Petersen标准诊断遗忘型MCI(A-MCI)的异同.方法 选择南京军区年龄≥70岁的离休老干部586例,进行认知功能调查,将符合广义MCI的104例患者分为MCI组,将非MCI患者482例分为正常组.采用广义MCI和A-MCI进行神经心理检查,对2种诊断标准MCI患病率比较.结果 MCI组患者年龄较正常组高偏.与A-MCI 59例(10.07%)比较,广义MCI 104例(17.75%),惠病率升高;广义MCI中主观记忆障碍77例(74%),较A-MCI 59例(100%)低.结论 广义MCI较A-MCI诊断的患病率高,其包涵了更多类型的痴呆前期表现,有利于早期发现MCI及防治.     

老年人脑白质损害与认知功能的关系

目的探讨老年人脑白质损害(WML)与认知功能的关系。方法选择457例男性老年人行头颅CT及数字广度、言语流畅、积木测验、词语延迟回忆、连线测验A、符号数字检查,按头颅CT表现将研究对象分为无WML(132例)、轻度WML(147例)、中度WML(105例)及重度WML(73例)4组。多因素协方差分析比较不同组别各项神经心理测验结果;用logistic回归分析不同WML状态下认知功能损害的相对危险性。结果重度WML组各项认知检测分数较无WML组有显著性差异(P<0.01),重度WML是各项认知功能损害的危险因素(P<0.01)。中度WML组在部分认知项目上与无WML组有显著性差异(P<0.01),轻度WML组与无WML组的认知功能无显著性差异(P>0.05)。结论轻度WML对认知的影响不明显,WML严重到一定程度时将使老年人认知功能产生广泛损害。     

老年人认知功能损害程度60例分析

一、对象和方法　　 1.对象和方法 :采取入户调查的形式 ,于 2 0 0 0年 4月至 2 0 0 1年 6月 ,在河北省内随机抽取的 6个社区 (市区 4个 ,农村 2个 )中 ,对能够自愿配合、并有一定阅读能力、且视听功能良好的 6 0岁及以上的老年人口进行老年人成套神经心理测验常模逐个问卷调查。调查员系由经过系统培训的精神科高年资主治医师担任 ,每次至少 2人。共有 2 39名老年人配合做完了全部测验 ,其中有 6 0例 (2 5 .10 % )老年人的简易智能状态检查 (MMSE)测验得分达不到规定分值 ,被认为有程度不等的认知功能损害。并根据DSM Ⅳ分别确诊为阿尔…     

左室重量增加与老年人痴呆和认知功能减退有关

既往关于左室重量增加亦即左室重量指数（LVMI）增高与老年人痴呆和认知功能减退间相关关系远未清楚,本文特此进行了分析。     

老年人认知功能障碍研究进展

随着社会老龄化的迅速进展,认知功能障碍和痴呆患者日益增多,如何进行早期诊断及干预是老年医学研究在新世纪面临的重要课题。近些年,随着对老年人认知功能障碍及痴呆的定义和分类的规范,采用针对性和实践性强的神经心理学测查量表,使得大量回顾性及前瞻性流行病学研究具有了可比性,对包括轻度认知功能障碍在内的老年认知功能障碍及痴呆的危险因素进行了系统的分析,从而为临床药物及行为干预提供了靶点,同时为基础研究及药物开发提供了方向。     

蒙特利尔认知评估量表在帕金森病认知功能损害筛查中的应用

目的探讨蒙特利尔认知评估量表(MoCA)和简易智能状态检查量表(MMSE)在帕金森病(PD)患者认知功能损害筛查中的应用。方法选取1 29例年龄≥60岁的PD患者,根据认知功能将其分为正常组(60例)、轻度认知功能障碍(MCI,37例)组和PD痴呆(PDD,32例)组,采用MoCA和MMSE对患者进行评估和分析。结果 3组MoCA得分差异有统计学意义(P<0.01)。与正常组比较,MCI组和PDD组患者在画立方体、复述、1 mm动物数、抽象能力、延迟回忆得分较低(P<0.01);与PDD组比较,正常组和MCI组患者在命名、数字广度和定向力得分较高(P<0.05)。此外,受试者ROC曲线结果显示,MMSE诊断MCI的曲线下面积为0.803;MoCA诊断MCI的曲线下面积为0.947。MMSE诊断PDD的曲线下面积为0.952;MoCA诊断PDD的曲线下面积为0.990。结论 MoCA可作为有效的PD患者认知功能损害的筛查工具,且随着PD患者病情的进展,MoCA得分逐渐降低。MoCA筛查MCI的最佳界值为≤23分,且MoCA在筛查PD患者MCI方面的敏感性较MMSE高。     

老年轻度认知功能损害的脑诱发电位变化及其发展为痴呆的预测因素

目的检测老年轻度认知功能损害（MCI）患者的脑诱发电位变化，探索其发展为痴呆的脑诱发电位预测因素。方法前瞻性对照研究。对象为患轻度认知功能损害的老年人（MCI组）和认知功能正常的老年人（NC组）两组。结果23例MCI和29例NC完成了基线脑诱发电位检查。与NC组相比，MCI组的听觉脑干反应波V绝对波幅和P300的P3靶波幅降低有统计学意义（P〈0．01）。多元逐步判别分析显示听觉脑干反应波V绝对波幅和P300的P3靶波幅的判别具有统计学意义（P〈0．01），两组判别总正确率为75％，但Logislic回归分析未发现脑诱发电位指标对MCI是否发展为痴呆有显著性预测作用。结论脑诱发电位检测有助于了解MCI的脑电生理变化，听觉脑干反应波V绝对波幅和P300的P3靶波幅的降低对MCI具有诊断价值。本研究未证实4种检测的脑诱发电位指标对预测MCI发展为痴呆有统计学意义。     

血管性认知损害之我见

人们对血管病变影响认知功能的认识已逾一个世纪,并随研究的不断深化而先后萌生出动脉硬化性痴呆、多发梗死性痴呆和血管性痴呆(VaD)的概念.20世纪90年代血管性认知损害(VCI)概念的问世,为进一步研究创建了崭新的平台,但也衍生出不少新问题有待解决.     

唐山市城乡老年人认知功能的现状

目的 了解城乡老年人认知功能的现状及与老年人认知功能有关的影响因素,为社区健康教育和认知康复实施提供依据.方法 对唐山市城乡和男女老年人按照分层抽样的方法,应用简单智力状态检查法(MMSE)进行评测.结果 2 283名老年人认知障碍患病率25.9%,农村31.7%,城市19.8%,城乡差异显著(P＜0.01);与年龄、婚姻、性别、生活习惯、患病情况及心理社会因素有关(P＜0.01).城乡老年人在影响因素方面存在差异.结论 老年人认知障碍发生率较高,农村高于城市,应给予针对性预防和治疗,减少或延缓认知障碍的发生.     

Update on cognitive decline and dementia in elderly patients with diabetes

AimThis article is an update of the relationship between type 2 diabetes (T2D), cognitive dysfunction and dementia in older people.Methods and resultsThe number of older patients consulting for diabetes who also exhibit cognitive difficulties is consistently growing because of the increased longevity of the population as a whole and, according to a number of studies, the increased risk of cognitive impairment and dementia in older diabetic patients. Many studies have demonstrated a link between poor glucose control and deteriorated cognitive function in diabetic patients. A history of severe hypoglycaemic episodes has also been associated with a greater risk of late-in-life cognitive deficits and dementia in patients with T2D. Several processes are thought to promote cognitive decline and dementia in diabetics. Based on both clinical and non-clinical findings, the factors most likely to alter brain function and structure are cerebrovascular complications of diabetes, alterations in glucose and insulin, and recurrent hypoglycaemia. Together with other diabetes complications, cognitive deficits contribute to functional impairment, increased frequency of depression-related symptoms, greater incidence of recurrent hypoglycaemia, poorer adherence to treatment and, finally, poorer prognosis, as evidenced by recent longitudinal studies.ConclusionClinical guidelines have recently been devised for older diabetic patients, particularly those with cognitive deficits and a reduced capacity to self-manage. In the most vulnerable patients, specific treatment strategies have been proposed for glycaemic control to limit metabolic decompensation and avoid the risk of hypoglycaemia. Educational measures, provided mainly to maintain patient autonomy and avoid hospital admission, have also been adapted according to patients’ cognitive and functional status.     

Geriatric depression and its relation with cognitive impairment and dementia

Different subtypes of depressive syndromes exist in late life; many of them have cognitive impairment and sometimes it is difficult to differentiate them from dementia. This research aimed to investigate subtypes of geriatric depression associated with cognitive impairment, searched for differential variables and tried to propose a study model. A hundred and eighteen depressive patients and forty normal subjects matched by age and educational level were evaluated with an extensive neuropsychological battery, scales to evaluate neuropsychiatric symptoms and daily life activities (DLA). Depressive patients were classified in groups by SCAN 2.1: Major Depression Disorder (MDD) (n: 31), Dysthymia Disorder (DD) (n: 31), Subsyndromal Depression Disorder (SSD) (n: 29), Depression due to Dementia (n: 27) (DdD). Neuropsychological significant differences (p < 0.05) were observed between depressive groups, demonstrating distinctive cognitive profiles. Moreover, significant differences (p < 0.05) were found in DLA between DdD vs all groups and MDD vs controls and vs SSD. Age of onset varied in the different subtypes of depression. Beck Depression Inventory (BDI) and Mini Mental State Examination (MMSE) were significant variables that helped to differentiate depressive groups. Significant correlations between BDI and Neuropsychological tests were found in MDD and DD groups. Depressive symptoms and its relation with neuropsychological variables, MMSE, cognitive profiles, DLA and age of onset of depression should be taken into consideration for the study of subtypes of geriatric depression.     

Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study

Aims/hypothesis  The aim was to investigate the relationship between severe hypoglycaemia and cognitive impairment in older patients with diabetes. Methods  A sample of 302 diabetic patients aged ≥70 years was assessed for dementia or cognitive impairment without dementia in 2001–2002 and a subsample of non-demented patients (n = 205) was followed to assess cognitive decline. A history of severe hypoglycaemia was determined from self-reports, physician assessments and records of health service use for hypoglycaemia (HSH). Prospective HSH was determined up to 2006. Data analysis, including multiple logistic and Cox regression models, was used to determine whether: (1) there were cross-sectional associations between hypoglycaemia and cognitive status, (2) historical hypoglycaemia predicted cognitive decline, and (3) baseline cognitive status predicted subsequent HSH. Results  There were significant cross-sectional associations between both cognitive impairment and dementia and hypoglycaemia. Independent risk factors for future HSH included dementia (hazard ratio 3.00, 95% CI 1.06–8.48) and inability to self-manage medications (hazard ratio 4.17, 95% CI 1.43–12.13). However, there were no significant associations between historical hypoglycaemia, incident HSH and cognitive decline. Conclusions/interpretation  Dementia is an important risk factor for hypoglycaemia requiring health service utilisation. We found no evidence that hypoglycaemia contributes to cognitive impairment in older patients with diabetes.     

盐酸多奈哌齐治疗老年人认知功能障碍疗效及安全性观察

目的观察盐酸多奈哌齐（Donepezil）治疗老年人认知功能障碍的有效性及安全性。方法对517例老年认知功能障碍患者行盐酸多奈哌齐治疗,观察6m。应用简易精神状态检查（MMSE）评定临床疗效,并记录治疗过程中的副反应。结果盐酸多奈哌齐在治疗3m起MMSE评分显著升高,第6月有继续上升趋势（P〈0．05）,治疗总有效率为65％。盐酸多奈哌齐对中、重度认知功能障碍者作用显著,入选时MMSE评分与MMSE改善程度呈负相关。盐酸多奈哌齐治疗不良反应轻微,仅有2例患者存在轻度的恶心或胃纳减退,无严重不良反应。结论盐酸多奈哌齐能有效治疗老年认知功能障碍,病情较重的患者MMSE改善更明显;药物治疗不良反应少而轻微。     

老年脑梗死患者认知功能下降的特点及危险因素分析

目的 探讨老年脑梗死患者认知功能下降的特点及其影响因素。方法 采取横断面研究,在2014年11月13日至2014年12月21日对江苏省如皋市江安镇人群进行调查。样本来自“如皋衰老纵向研究”,纳入31个村的1 788名对象,年龄70~84岁,均为汉族,其中男830名,女958名。确认脑梗死病史根据二级以上医院神经科诊断或头部CT证实。认知功能的评价采用改良长谷川痴呆量表,对该人群的定向力、记忆力、近记忆力、计算力及常识5个维度进行评价,总分21.5为无认知功能障碍,≤21.5为有认知功能障碍。采用多因素Logistic回归分析老年脑梗死患者认知功能下降的危险因素。结果 (1)1 788名受检者中,合并脑梗死病史133例(7.4%),无脑梗死1 655名。合并脑梗死患者高血压的比例高于无脑梗死组[63.9%(85例)比41.7%(690例)],高密度脂蛋白胆固醇水平低于无脑梗死组[(1.40±0.29)mmol/L比(1.47±0.33)mmol/L],差异均有统计学意义(均P0.05)。(2)合并脑梗死患者在定向力和计算力方面存在部分受损,总体认知功能评分为(20±7)分,较无脑梗死患者的(21±6)明显下降,两组比较差异有统计学意义(P0.05)。(3)133例脑梗死患者中,存在认知功能障碍的76例,发生率为57.1%,其中女性59例。认知功能障碍患者血肌酐平均值为(59±15)μmol/L,较无认知障碍者(66±14)μmol/L明显降低,差异有统计学意义(P0.05)。(4)多因素Logistic回归分析显示,小学以下教育程度(OR=2.86,95%CI:2.19~3.72)、女性(OR=1.85,95%CI:1.50~2.28),是老年脑梗死患者认知功能下降的独立危险因素,较高血肌酐浓度(OR=0.96,95%CI:0.95~0.97)是保护因素。结论 脑梗死后的老年人总体认知功能下降,尤其是定向力和计算力方面受损明显。小学以下文化程度和女性是发生认知障碍的独立危险因素,较高水平血肌酐可能具有一定的保护作用。     

认知障碍对老年人健康预期寿命的影响

目的研究认知障碍对北京市城乡≥60岁人群的预期寿命（LE）、健康预期寿命（ALE）及ALE/LE比值的影响。方法纳入的样本来自＂北京老龄化多维纵向研究＂课题,对象为宣武区（城区）、大兴区（近郊平原）、怀柔区（远郊山区）≥60岁老年人群。于2009年采用简易精神状态量表对2111人行认知功能的评估。2011年对该样本进行随访。根据能否独立完成日常生活活动（ADL）,评定健康与否。应用多状态寿命表IMaCH软件计算各年龄段认知障碍组与非认知障碍组的LE、ALE和ALE/LE比值。结果基线调查的2111人中认知障碍者有312例。①北京市老年人总体LE和ALE趋势为女性高于男性,城市高于农村。认知障碍组的LE和ALE均明显低于认知正常组。②认知障碍组中,城市低龄组（〈70岁）男性LE和ALE均明显低于同龄段女性。男、女,城、乡均为高龄组（≥80岁）的LE和ALE最低,但与认知正常组比较,城、乡均为女性的LE和ALE下降程度大于男性。③ALE/LE比值总体趋势为男性高于女性,城市高于农村。ALE/LE比值在两组均随年龄的增长而下降,但是认知障碍组的比值下降速度更快,尤其以农村高龄（≥80岁）女性ALE/LE比值最低。结论认知障碍对北京市老年人的LE、ALE、ALE/LE比值均有显著影响,特别是对农村高龄女性影响更显著。     

脑脊液标志物在预测认知功能障碍转化及诊断中的应用

阿尔茨海默病(AD)是一种老年人常见的神经系统变性疾病,是痴呆的最常见病因.轻度认知功能障碍(MCI)是介于正常老化和痴呆间的一种临床状态MCI是痴呆的高风险人群,其每年转化成痴呆的风险约是健康老人的10倍,但也有一部分MCI患者的认知功能维持稳定或向正常逆转[1].因此,研究如何通过各种临床信息指标早期和准确的确定具有痴呆高转化风险的群体具有特别重要的意义.     

Effect of renal impairment on cognitive function during a 3‐year follow up in elderly patients with type 2 diabetes: Association with microinflammation

Aims/Introduction

We investigated the effect of renal impairment on cognitive function during a 3‐year follow up in elderly type 2 diabetic patients, and an association with microinflammation.

Materials and Methods

Four cognitive function tests – Mini‐Mental State Examination (MMSE), word recall, Digit Symbol Substitution (DSS) and Stroop Color Word – were carried out in 67 patients. Renal impairment was defined as the presence of albuminuria and a decline in estimated glomerular filtration (eGFR) <60 mL/min/1.73 m². Inflammatory markers, such as highly sensitive C‐reactive protein (hs‐CRP), tumor necrotizing factor‐α (TNF‐α), interleukin (IL)‐1β and IL‐6, were measured at baseline.

Results

At baseline, cognitive decline was found in patients with renal impairment. The DSS test was independently associated with eGFR decline, whereas MMSE tended to be associated with albuminuria after adjusting for confounding factors. Regarding changes in cognitive function and renal impairment, changes in urinary albumin to creatinine ratios were strongly and independently associated with changes in word recall scores. In patients with persistent eGFR decline, there was a tendency toward a greater decrease in MMSE and DSS scores, whereas in those with newly detected albuminuria, there was a tendency toward a greater decrease in word recall scores. Increased baseline levels of hs‐CRP, TNF‐α and IL‐6 were associated with renal impairment and cognitive function, especially DSS tests, respectively. However, the increased levels were not independent predictors for cognitive decline.

Conclusions

The present study showed a reciprocal relationship between cognitive decline and renal impairment, especially progression of albuminuria. Thus, monitoring treatment using renal biomarkers will be important for preserving both renal and cognitive function.     

心房颤动对认知障碍影响机制的研究进展

心房颤动（房颤）和认知障碍的发生有密切关系,流行病学研究显示房颤患者明显增加了1.5-2.5倍的认知障碍风险。临床研究提示房颤,特别是持续性房颤对脑组织造成病理生理影响,出现认知功能障碍的表现;房颤患者的抗凝、频率控制和复律等治疗能够减轻发生认知功能障碍的风险。本文对两者关系的最新研究进展进行综述。     

Association between diabetes mellitus and post-stroke cognitive impairment

Stroke survivors suffer from various physical, emotional, and cognitive impairments. These changes are dynamic and depend on multiple factors, including underlying diseases, baseline brain function and pathology, the site of the stroke and the post-stroke inflammation, neurogenesis as well as the subsequent remodeling of the neuro-network. First we review the structural and pathological changes of the brain in stroke survivors with diabetes mellitus, which may lead to post-stroke cognitive dysfunction. Second, we provide evidence of hyperglycemia, diabetes mellitus, hypoglycemia, and their relationship with post-stroke cognitive impairment (PSCI) and post-stroke dementia (PSD). In addition to conventional biomarkers, such as HbA1c, we also provide other novel tools to predict PSCI/PSD, such as glycemic variability, receptor for advanced glycation end products, and gut microbiota. Finally, we attempt to provide some modifying methods for glycemic control, focusing on the prevention of PSCI/PSD.