蒙特利尔认知评估量表在老年轻度认知功能障碍筛查中的应用

目的探讨蒙特利尔认知评估量表（MoCA）在老年轻度认知功能障碍（MCI）患者筛查中的应用。方法选择老年MCI患者56例为MCI组和认知功能正常者50例为对照组,分别给予MoCA、简易精神状态检查量表（MMSE）评估,并分析评估结果。结果 MCI组和对照组MoCA总分明显低于MMSE总分（P〈0.01）。MoCA筛查MCI的敏感性为96.4%、特异性为84%;MMSE筛查MCI的敏感性为35.7%、特异性为100%。MoCA中除定向力项外,总分及其余各亚项的评分在MCI组和对照组间差异均有统计学意义（P〈0.01）。结论 MoCA为高敏感性的MCI筛查工具,能全面评估MCI患者的认知功能,筛查MCI的敏感性优于MMSE。     

Visual Concerns that Interfere with Daily Activities in Patients on Rehabilitation Units: A Descriptive Study

The purpose of this study was to estimate the prevalence of patients with visual concerns that interfere with their activities of daily living (ADL) performance in physical rehabilitation units through occupational therapy assessment. Over the two-month study period, 215 adult inpatients from a physical rehabilitation hospital were evaluated using the Brief Vision Screen (BVS) through ADL. The BVS assessed four areas of visual concerns, namely left visual field, focusing, and near- and low-contrast acuity, while patients engaged in ADL. The occupational therapists identified 33% of patients who had at least one area of visual concern, with the largest proportion diagnosed with stroke (55%), followed by pulmonary disease (40%) and joint replacement (35%). When comparing the four areas of visual concerns in the BVS between the two major diagnostic groups (acquired brain injury, ABI and non-acquired brain injury, non-ABI), a significantly higher proportion of patients with ABI were identified as having left hemianopsia concerns compared to patients with non-ABI. No significant difference was observed in other areas of visual concern between the two groups. Findings indicated that visual concerns that interfere with ADL performance among older patients in rehabilitation units are common. The high proportion of patients with pulmonary disease identified as having visual concerns warranted further confirmation and investigation. Preliminary evidence to support the psychometric properties of the BVS for identifying visual concerns in patients on rehabilitation units was established.     

Prevalence and Correlates of Hearing and Visual Impairments in European Nursing Homes: Results From the SHELTER Study

Background

Visual and hearing impairments are known to be related to functional disability, cognitive impairment, and depression in community-dwelling older people. The aim of this study was to examine the prevalence of sensory impairment in nursing home residents, and whether sensory impairment is related to other common clinical problems in nursing homes, mediated by functional disability, cognitive impairment, and depressive symptoms.

Methods

Cross-sectional data of 4007 nursing home residents in 59 facilities in 8 countries from the SHELTER study were analyzed. Visual and hearing impairments were assessed by trained staff using the interRAI instrument for Long-Term Care Facilities. Generalized linear mixed models adjusted for functional disability, cognitive impairment, and depressive symptoms were used to analyze associations of sensory impairments with prevalence of clinical problems, including behavioral symptoms, incontinence, fatigue, falls, problems with balance, sleep, nutrition, and communication.

Results

Of the participants, 32% had vision or hearing impairment (single impairment) and another 32% had both vision and hearing impairments (dual impairment). Residents with single impairment had significantly higher rates of communication problems, fatigue, balance problems, and sleep problems, as compared with residents without any sensory impairment. Those with dual impairment had significantly higher rates of all clinical problems assessed in this study as compared with those without sensory impairment. For each clinical problem, the magnitude of the odds ratio for specific clinical problems was higher for dual impairment than for single impairment.

Conclusion

Visual and hearing impairments are associated with higher rates of common clinical problems among nursing home residents, independent of functional disability, cognitive impairment, and depressive symptoms.     

丹参酮ⅡA璜酸钠注射液治疗脑梗死的临床疗效观察

目的：观察并分析丹参酮ⅡA璜酸钠注射液治疗脑梗死的临床效果。方法：选取2011年1月-2014年1月本院诊治的62例脑梗死患者的临床资料,按照完全随机法1：1分成对照组和研究组各31例,对照组行常规西医对症治疗,研究组在对照组基础上加用丹参酮ⅡA璜酸钠注射液,观察比较两组患者的神经功能与生活能力改善,自由基与血液流变学指标水平变化情况。结果：与治疗前比较,两组治疗后的SOD活性均明显升高,MDA与LPO水平均明显降低（P〈0.05）。研究组治疗后的SOD活性（5.96±0.13）U/mL明显高于对照组的（4.85±0.11）U/mL,MDA水平（8.36±0.93）mmol/mL与LPO水平（10.57±2.16）mmol/mL均明显低于对照组（10.54±0.52）mmol/mL和（13.25±2.61）mmol/mL,差异均有统计学意义（P〈0.05）。治疗2周、4周时,两组NIHSS、NDS评分均明显降低,ADL、BI评分均明显升高,且同期组间比较差异显著,均有统计学意义（P〈0.05）;研究组治疗后的全血比粘度、血浆比粘度与红细胞聚集指数均明显低于治疗前与同期对照组,差异均有统计学意义（P〈0.05）。结论：丹参酮ⅡA璜酸钠注射液治疗脑梗死的临床效果显著,值得临床推广与应用。     

Understated Cognitive Impairment Assessed with the Clock-Drawing Test in Community-Dwelling Individuals Aged ≥50 Years

ObjectivesTo estimate the prevalence of understated cognitive impairment by administering the Clock-Drawing Test (CDT) to community-dwelling individuals aged ≥50 years and to investigate the associated clinical phenotype.DesignA cross-sectional analysis of baseline data on community-dwelling individuals assessed at an outpatient clinic in the Paris region of France.Setting and ParticipantsParticipants aged ≥50 years (n = 488, median age: 62.1 years) prospectively included in the SUCCessful agEing outpatiEnt's Department survey between 2010 and 2014.MethodsA multidimensional geriatric assessment, including cognition [7-point CDT, Mini-Mental State Examination (MMSE), the 5-word screening test (5-WT), and the Frontal Assessment Battery (FAB)], gait speed in dual tasks, mood [the Geriatric Depression Scale (GDS)], balance, physical functions (gait speed and handgrip strength), nutrition, bone density, and comorbidities; major cardiovascular risk factors, and Scheltens and Fazekas scores on brain magnetic resonance imaging. Baseline characteristics were analyzed as a function of the CDT score (<7 vs 7), using age-adjusted logistic models.ResultsThe prevalence of impairment in the CDT was 23.6%; higher than the values for the MMSE (12.7%), 5-WT (2.3%), and FAB (16.6%). In age-adjusted analyses, a lower educational level (odds ratio [95% confidence interval] = 0.72 [0.58‒0.89]), diabetes (2.57 [1.14‒5.79]), metabolic syndrome (1.93 [1.05‒3.56]), lower gait speed in the cognitive dual task (1.27 [1.05‒1.53]), a poorer Geriatric Depression Scale score (1.86 [1.04‒3.32]), a poorer MMSE score (2.56 [1.35‒4.88]), a poorer FAB score (1.79 [1.01‒3.16]), impaired episodic memory in the 5-WT (4.11 [1.12‒15.02]), and a higher Scheltens score (P = .001) were significantly associated with CDT impairment.Conclusions and ImplicationsUnderstated cognitive impairment is common among young seniors and is associated with factors known to be linked to a higher risk of cognitive decline and dementia. These findings suggest that the CDT may be of value for identifying high-risk individuals who may then benefit from targeted multidomain prevention actions (diet, exercise, cognitive training, and vascular risk factor management).     

Development and Validation of a Nomogram for Predicting the 6-Year Risk of Cognitive Impairment Among Chinese Older Adults

ObjectiveAlthough some people with mild cognitive impairment may not suffer from dementia lifelong, about 5% of them will progress to dementia within 1 year in community settings. However, a general tool for predicting the risk of cognitive impairment was not adequately studied among older adults.DesignProspective cohort study.SettingCommunity-living, older adults from 22 provinces in China.ParticipantsWe included 10,066 older adults aged 65 years and above (mean age, 83.2 ± 11.1 years), with normal cognition at baseline in the 2002–2008 cohort and 9354 older adults (mean age, 83.5 ± 10.8 years) in the 2008–2014 cohort of the Chinese Longitudinal Healthy Longevity Survey.MethodsWe measured cognitive function using the Chinese version of the Mini-Mental State Examination. Demographic, medical, and lifestyle information was used to develop the nomogram via a Lasso selection procedure using a Cox proportional hazards regression model. We validated the nomogram internally with 2000 bootstrap resamples and externally in a later cohort. The predictive accuracy and discriminative ability of the nomogram were measured by area-under-the-curves and calibration curves, respectively.ResultsEight factors were identified with which to construct the nomogram: age, baseline of the Mini-Mental State Examination, activities of daily living and instrumental activities of daily living score, chewing ability, visual function, history of stroke, watching TV or listening to the radio, and growing flowers or raising pets. The area-under-the-curves for internal and external validation were 0.891 and 0.867, respectively, for predicting incident cognitive impairment. The calibration curves showed good consistency between nomogram-based predictions and observations.Conclusions and ImplicationsThe nomogram-based prediction yielded consistent results in 2 separate large cohorts. This feasible prognostic nomogram constructed using readily ascertained information may assist public health practitioners or physicians to provide preventive interventions of cognitive impairment.     

特殊涉核环境人员黄斑区厚度研究

目的 探讨特殊涉核环境人员与普通环境非涉核人员黄斑区厚度的差异性。方法 在某基地年度体检时为特殊涉核环境人员（简称涉核人员）与普通环境非涉核人员（简称非涉核人员）增加眼科光学相干断层扫描（Optical coherence tomography,OCT）检查,测量黄斑区厚度值,每人测量3次,按照体检表末尾编号随机抽取204例编号为奇数的涉核人员和105例非涉核人员,取3次测量值的平均值进行比较。结果 涉核人员与非涉核人员两组年龄均值为（29.40 ±6.16）岁、（28.92 ±6.71）岁,P = 0.5325,无统计学差异。两组人员视力均值：涉核人员为（1.04 ±0.03）（右）,（1.05 ±0.03）（左）,非涉核人员为（1.00 ±0.05）（右）,（1.02 ±0.05）（左）,P = 0.5006（右）,P = 0.5962（左）,无统计学差异。涉核人员黄斑区厚度均值：（212.9 ±1.3） μm（右）,（205.5 ±1.1） μm（左）,P < 0.0001,两者比较差异有统计学意义;非涉核人员黄斑区厚度均值：（223.2 ±2.5） μm（右）,（211.7 ±2.4） μm（左）,P < 0.0001,两者比较有统计学差异。对涉核人员与非涉核人员右眼及左眼黄斑区厚度均值进行比较,P = 0.0003（右）,P = 0.0217（左）,均有统计学差异。结论 非涉核人员黄斑区厚度要厚于涉核人员。与涉核人员特殊工作环境中较多使用LED光源可能存在关联;其他因素包括涉核、气压、氧分压及人员的心理状态需要进一步的试验进行证明。     

公共卫生与预防医学类期刊热点和前沿研究

目的 通过Citespace软件分析国内公共卫生与预防医学类期刊的研究热点、前沿与知识基础研究,洞悉国内预防医学领域研究动向。方法 运用Citespace对从CNKI、万方、维普等数据库中收集的近五年（2013 - 2017年）中文核心期刊中预防医学、卫生学类核心期刊所载文献进行分析。按照中国学术期刊影响因子年报中公共卫生与预防医学领域期刊分类方式,将上述中文核心期刊分为两类,即医药卫生事业管理和预防医学与卫生学。结果 医药卫生事业管理类近五年的研究热点及前沿主要集中在基层医疗机构、医疗保险、医疗相关政策中,且研究更注重卫生服务效果和评价等方面。预防医学与卫生学类近五年的研究热点及前沿主要集中在医院感染、影响因素、艾滋病等各类传染病的流行病学特征及耐药性方面。结论 在公共卫生与预防医学领域中文核心期刊中,预防医学与卫生学类更注重艾滋病、医院感染等方面,医药卫生事业类主要集中在公立医院及满意度方面。