Contribution of perospirone and risperidone to reduce delirium in senile patients

Background: Serotonin–dopamine antagonists (SDAs) inhibit dopaminergic transmission in the mesolimbic system less than in the nigrostriatal dopaminergic pathway, which relates to the extrapyramidal side‐effects of these drugs. The SDAs seem to have an adequate receptor binding profile for the management of the behavioral and psychiatric symptoms of dementia. However, clinicians are discouraged from prescribing SDAs for elderly patients because of an advisory statement from the US Food and Drug Administration that warns about an increased mortality rate among elderly patients treated with atypical antipsychotics. Methods: We conducted a retrospective study involving 16 elderly patients (mean age 84.9 years; range 67–94 years) with delirium who were treated with one of two SDAs, namely perospirone (4–12 mg/day) or risperidone (1–2 mg/day). The time‐course of their psychiatric symptoms was assessed using subcategories of the Delirium Rating Scale (DRS) before treatment and on Days 10 and 24 of treatment. Results: Total DRS scores were significantly decreased from baseline in both treatment groups. Both agents led to significant improvements from baseline in psychomotor behavior and lability of mood. Of interest, perospirone decreased hallucinations and delusions and improved sleep–awake cycle disturbances compared with baseline. No serious side‐effects were seen with either drug. Conclusions: Both perospirone and risperidone are effective in the management of delirium in elderly patients. The improvement in the sleep–awake cycle with perospirone may be derived from its short pharmacological half‐life.     

Frontotemporal dementia with parkinsonism linked to chromosome 17 with the MAPT R406W mutation presenting with a broad distribution of abundant senile plaques

We report the autopsy results of a patient with familial dementia who was diagnosed as having frontotemporal dementia with parkinsonism linked to chromosome 17 (FTDP‐17) with an R406W mutation in the microtubule‐associated protein tau (MAPT) gene. This patient showed Alzheimer's disease (AD)‐like clinical manifestations from the age of 59, with reduced β‐amyloid1‐42 (Aβ₄₂) and elevated total and phosphorylated tau levels in the cerebrospinal fluid. He did not present with any apparent parkinsonism throughout the disease course. His autopsy at age 73 showed atrophy and neurodegeneration in many brain regions, particularly in the antero‐medial temporal cortex and hippocampus, followed by the frontal lobes, with abundant neurofibrillary tangles. In addition, a diffuse distribution of Aβ‐positive senile plaques, including many neuritic plaques, was observed and classified as stage C according to the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) criteria. These results suggest that analyzing of the MAPT gene is essential for diagnosing familial dementia, even if amyloid markers such as Aβ₄₂ in the cerebrospinal fluid and amyloid imaging are positive, or if neuropathological findings indicate a diagnosis of AD.     

易明胶囊治疗老年性白内障的临床研究

目的观察易明胶囊对老年性白内障的临床疗效。方法将早期老年性白内障患者278例(528只眼),按就诊先后次序分为对照组和治疗组,分别给予相应药物治疗,10d为1疗程,连续6个疗程,观察治疗前后自觉症状和视力的变化。结果两组药物均有治疗作用,易明胶囊治疗组极显著优于对照组(P<0.01)。结论易明胶囊对老年性白内障有一定的治疗作用.     

3种方案治疗老年性肺炎的成本-效果分析

目的：探讨不同药物的治疗方案对同一疾病所产生的经济效果。方法:采用回顾性研究方法,对经确诊 为老年性肺炎的住院患者115例,根据治疗方案不同分为3组,A组: 头孢呋辛+左氧氟沙星;B组: 头孢地嗪;C组:头孢派 酮舒巴坦。应用药物经济学成本-效果分析法进行比较。结果:A,B,C组成本依次为3 073.46元,4 248.96元,4 955.89元 ,有效率分别为84.6%,85.0%,86.1%,敏感性分析结果均与参数改变前的结果基本一致。结论:A组治疗方案优于B组、C 组。     

Alterations in the epidermal-dermal melanin axis and factor XIIIa melanophages in senile lentigo and ageing skin

Background Senile lentigo (SL) is a pigmentation disorder that occurs predominantly on the dorsa of the hands, the forearms and the face; its incidence increases with age. Histological hallmarks of SL lesions are hyperpigmentation of the epidermis and elongation of the epidermal rete ridges. Various factors such as α‐melanocyte‐stimulating hormone, endothelin‐1 or stem cell factor are involved in the onset and maintenance of the increased pigmentation. Alterations of the dermal compartment have not yet been analysed in detail in SL. Objectives To study the occurrence and distribution of melanin in the dermis from SL and aged skin, biopsies from 12 subjects were morphologically analysed by light and electron microscopy in comparison with unaffected skin. Methods Punch biopsies of SL and adjacent skin from 12 male or female volunteers aged 52–81 years were prepared for light and electron microscopy and samples were analysed by morphological, morphometric, histochemical and immunohistochemical methods. Results The epidermis from SL revealed morphological features such as hyperpigmentation of basal keratinocytes and the formation of elongated rete ridges. S100+ melanocytes in the stratum basale were not markedly increased, indicating that the hyperpigmentation is predominantly due to changes in melanin synthesis, distribution or turnover. Quantification of epidermal cells expressing the proliferation marker Ki67 did not show an increase of this parameter in SL, indicating that at least in the established lesion cell proliferation is not enhanced. We further focused on the dermal compartment and observed granulated cells which were more abundant in SL. Electron microscopic and histochemical analysis revealed that the granulation of these cells is based on melanosomes, mostly present in large melanosomal complexes. Immunohistochemistry using antibodies to CD68 and factor XIIIa (FXIIIa) showed these melanophages to be predominantly FXIIIa+ dermal dendrocytes, which were about six times more abundant than CD68+ macrophages. Conclusions In SL an increased number of melanophages was found compared with unaffected skin from the same subject. These melanophages were identified as FXIIIa+ dermal dendrocytes. Possible functional consequences of the massive melanin uptake by dermal dendrocytes are discussed.     

治疗老年性痴呆的中药研究进展

从提高胆碱能神经的功能、对单胺类神经递质及受体功能的影响、3抗自由基损伤、促进蛋白质和核酸合成、对钙离子拮抗作用、对抗毒性作用、调节过强的免疫炎症反应等方面对近年来治疗老年性痴呆的中药研究成果进行了综述。     

阿尔采末病发病机制及治疗药物研究进展

阿尔采末病是一种进行性记忆和认知功能损伤为特征的多病因机制介导的退行性神经系统疾病,其主要病理特征为脑内老年斑沉积、神经纤维缠结以及神经元缺失变性。研究发现氧化应激,炎症反应,雌激素缺失,胆固醇代谢异常,基因突变及单胺能、谷氨酸及神经肽能神经递质功能缺损等多个环节参与其发病,针对以上各环节开展的药物治疗研究取得了长足进展。     

老年人阻塞性黄疸的手术探讨

正常胆道是无菌的，但在胆道梗阻时胆汁细菌检出率可达80％，胆道梗阻伴有胆道感染常见于胆结石，胆管内压达到一定压力时细菌可通过毛细胆管进入肝血寳而致菌血症，老年阻塞性黄疸更易发生，而出现急性梗阻性化脓性胆管炎。我院从1993年1月～2003年7月共收治60岁以上的阻塞性黄疸180例，其中手术治疗96例，现分析如下。     

老年尿失禁病人生活质量评价量表的研究概况

重点介绍了尿失禁生活质量量表、King’s健康调查问卷、尿失禁影响问卷、急迫性尿失禁影响问卷、急迫性尿失禁影响量表5种测量老年尿失禁病人生活质量的量表，并叙述了量表的使用情况。     

Frequency of Alzheimer's Neurofibrillary Tangle in the Brains of Progressive Supranuclear Palsy, Postencephalitic Parkinsonism, Alzheimer's Disease, Senile Dementia and Non-Demented Elderly Person

Abstract: The frequency and the distribution of Alzheimer's neurofibrillary tangles were examined in those cases of progressive supranuclear palsy (one case), postencephalitic parkinsonism (one case), Alzheimer's disease (two cases), senile dementia (two cases) and non-demented elderly person (three cases). The light microscopic pattern of Alzheimer's neurofibrillary tangles seen in progressive supranuclear palsy was similar to those in postencephalitic parkinsonism, Alzheimer's disease, senile dementia and non-demented elderly person. Some differences in the frequency and the distribution of Alzheimer's neurofibrillary tangles were demonstrated.