Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline

The aim of this international guideline on dementia was to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists, and other specialist physicians responsible for the care of patients with dementia. It covers major aspects of diagnostic evaluation and treatment, with particular emphasis on the type of patient often referred to the specialist physician. The main focus is Alzheimer's disease, but many of the recommendations apply to dementia disorders in general. The task force working group considered and classified evidence from original research reports, meta-analysis, and systematic reviews, published before January 2006. The evidence was classified and consensus recommendations graded according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided. The recommendations for clinical diagnosis, blood tests, neuroimaging, electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, genetic testing, tissue biopsy, disclosure of diagnosis, treatment of Alzheimer's disease, and counselling and support for caregivers were all revised when compared with the previous EFNS guideline. New recommendations were added for the treatment of vascular dementia, Parkinson's disease dementia, and dementia with Lewy bodies, for monitoring treatment, for treatment of behavioural and psychological symptoms in dementia, and for legal issues. The specialist physician plays an important role together with primary care physicians in the multidisciplinary dementia teams, which have been established throughout Europe. This guideline may contribute to the definition of the role of the specialist physician in providing dementia health care.     

The aging man and woman: are the differences important?

This article celebrates the continuing differences between men and women that are present in our twilight years. Although men die earlier than women, they spend fewer years with major disability. There is increasing interest in the use of testosterone to improve the quality of life in both older men and women. Sarcopenia, osteopenia, hip fractures, and frailty are all more common in women than in men. Sexuality remains important to both men and women throughout life. Finally, it is known that cytokines play a major role in the pathophysiology of aging, a process now recognized as the cytokine-related aging process.     

Dose-response differences in the ability of ramipril to improve retention in diabetic mice

Ramipril blocks the conversion of angiotensin I to II. The literature indicates that diabetes is often associated with mild impairment of learning and memory. The study reports the effects of ramipril on memory retention in diabetic and non-diabetic mice. Mice were made diabetic by an injection of streptozocin. After overt signs of diabetes were present, diabetic or vehicle-treated mice were partially trained on a footshock active avoidance task. Immediately after training, ramipril (0.5–1.5 mg/kg s.c.) was administered and retention was tested by continuing training one week later until mice avoided footshock on five out of six trails. The results indicate that ramipril enhanced retention of both diabetic and control mice but it required about 5 times as much ramipril in diabetic as control mice to achieve the same effect on retention. Increased sensitivity to angiotensin II may play a role in cognitive impairment in diabetes.     

老年人主观认知下降与慢性病共病的相关性分析

背景 主观认知下降（SCD）是阿尔茨海默病（AD）早期预防的目标阶段,AD与慢性病共病关系密切,但二者间相关性尚不十分明确。目的 探究老年人SCD与慢性病共病的相关性,为AD早期预防和干预提供理论依据。方法 于2021年1月至2022年6月,在广州市城市生活小区和养老机构以便利抽样法抽取≥60岁的老年人612例。采用基础版蒙特利尔认知评估量表（MoCA-B）、临床痴呆量表（CDR）、Hachinski缺血指数量表（HIS）评定客观认知功能水平,通过SCD标准诊断框架和SCD问卷（SCD-Q9）进行分组,将整体客观认知水平无异常、符合SCD标准诊断框架和SCD-Q9≥5分的老年人分入SCD组,将整体客观认知功能无异常和SCD-Q9<5分的老年人为认知无异常（CN）组。采用一般资料问卷收集老年人的社会人口学（性别、年龄、居住地、受教育年限、婚姻状况、退休前职业类型、月收入）和健康相关资料[体质指数、腰围、吸烟习惯、饮酒习惯、饮茶习惯、锻炼频率、午觉习惯及平均时长、睡眠质量、抑郁及焦虑症状、日常生活活动能力（ADL）],其中睡眠质量、抑郁症状、焦虑症状及ADL分别采用匹兹堡睡眠指数量表...     

亚临床甲状腺功能减退症患者TSH与肾上腺皮质功能的关系

目的分析亚临床甲状腺功能减退症患者促甲状腺激素(TSH)与肾上腺皮质功能的关系。 方法选取150例亚临床甲状腺功能减退症患者为研究组,甲状腺功能正常的健康人群150例为对照组。比较两组TSH、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、皮质醇(CORT)和促肾上腺皮质激素(ACTH)水平。采用Pearson法分析亚临床甲状腺功能减退症患者TSH水平与ACTH、CORT水平的相关性。 结果与对照组比较,研究组患者TSH、ACTH水平升高,CORT水平降低(P＜0.05)。Pearson分析结果显示,亚临床甲状腺功能减退症患者TSH水平与ACTH水平呈正相关(P＜0.05),与CORT水平呈负相关(P＜0.05)。 结论亚临床甲状腺功能减退症患者血清TSH水平与肾上腺皮质功能指标ACTH、CORT水平存在相关性。     

Electroconvulsive Therapy in the Medically Ill Elderly

Treatment with electroconvulsive therapy (ECT) of medically ill geriatric patients with affective disorders is described. Of 135 patients to whom ECT was administered in 6 years, 55% were over 60 years of age. One-third (45) exhibited cardiovascular (62%), central nervous system (15%), or other medical conditions (22%) increasing the risks of the treatment. Treatment strategies are described.     

Cell surface and intracellular marker analysis as a laboratory test for the diagnosis of hematological disorders

Immunophenotyping of hematopoietic malignancies is representative application of cell (surface) marker analysis by flow cytometry and monoclonal antibodies in the clinical laboratory. The multitude of available monoclonal antibodies demands a standardization of the selection and combination of antibodies. Therefore, some international committee or working group proposed the panels or guidelines for the selection of antibodies. Intracellular antigens are of major importance for immunophenotyping of hematological malignancies, and flow cytometric detection of intracellular antigens was improved by the development of new permeabilization/fixation solutions. Recently new gating method was recommended for better isolating the target cells in the flow cytometric analysis. Finally CD55 and CD59 assay for the diagnosis of PNH was mentioned.