【摘要】 目的 通过比较遗忘型轻度认知障碍（amnestic mild cognitive impairment，aMCI）和血管性认知障碍非痴呆型（vascular cognitive impairment-no dementia，VCI-ND）患者及正常老年人群在简易智能精神状态检查量表（mini mental state examination，MMSE）、听觉词语学习测验（auditory verbal learning test，AVLT）、画钟试验（clock drawing test，CDT）及临床痴呆评定量表（clinical dementia rating scales，CDR）中的表现，进一步分析aMCI和VCI-ND在认知损害方面的不同特点。 方法 选取首都医科大学宣武医院神经内科门诊收治aMCI患者23例及VCI-ND患者27例（CDR＝0.5分），同时选取40名正常老年人（CDR=0分）作为对照组。每位受试者均进行MMSE、AVLT、CDT及CDR等神经心理学量表测查，分析以上3组被试各项神经心理学测查得分之间的差异。 结果 各组受试者的年龄、性别及受教育程度差异无统计学意义（Pgt;0.05），具有可比性。aMCI和VCI-ND组在MMSE、CDT、即刻记忆、延迟记忆及延迟再认检测中的平均值均低于对照组，且差异均具有统计学意义（Plt;0.05）。aMCI和VCI-ND两组除延迟再认检测外，其余各项测查的平均分均无统计学意义（Pgt;0.05）。在延迟再认检测中，aMCI组（6.65±4.00）较VCI-ND组（8.67±2.76）再认词语数量少，两组延迟再认的得分均低于对照组（12.83±1.77），差异有统计学意义（Plt;0.05）。 结论 aMCI和VCI-ND在记忆力、执行能力和信息处理能力方面较正常老年人均有所损害。由于aMCI和VCI-ND不同的病理改变，导致患者存在不同类型的记忆储存和提取机制。【Abstract】 Objective To investigate the different patterns of cognitive impairment in patients with amnestic mild cognitive impairment (amci), vascular cognitive impairment-no dementia (VCI-ND) and normal elder people. Methods A total of 23 patients with aMCI and 27 patients with VCI-ND (CDR＝0.5) and another 40 healthy elder people (CDR=0) were selected. Each individual underwent the neuropsychological tests, including mini mental state examination (MMSE), auditory verbal learning test (AVLT), clock drawing test (CDT), clinical dementia rating scales (CDR) and hamilton rating scale for depression (HAMD). The differences between the three groups were analyzed. Results The differences in age, sexes, and the education background among the three groups were not significant (Pgt;0.05) which meant comparability. The mean scores of MMSE, CDT, instant memory and delayed awareness in aMCI and VIC-ND group were much lower than that in the control group (Plt;0.05). The differences in all the test items except for delayed awareness between aMCI group and VCI-ND groups were not significant (Pgt;0.05). However, in the recall recognition test, these three groups had significant differences: the score in patients with aMCI (6.65±4.00) was much lower than that in patients with VCI-ND (8.67±2.76; Plt;0.05), and the scores of the two groups were both lower than that in the normal aging group (12.83±1.77; Plt;0.05). Conclusion Compared with normal elder people, the cognition of aMCI and VCI-ND patients is impaired severely. The memory tests suggeste that compared with aMCI patients, VCI-ND patients may have different neuropathological changes leading to different mechanism of memory encoding and retrieval.
目的:探讨被误诊为功能性精神障碍的麻痹性痴呆患者的临床特点和诊治要点。方法:回顾性分析10例被误诊为功能性精神障碍的麻痹性痴呆患者的临床资料。结果:被误诊为功能性精神障碍的麻痹性痴呆均以精神症状为首发，多表现为精神病性症状、类躁狂、抑郁、类神经症、人格的改变及进行性痴呆等不典型症状群，本研究显示误诊率高达71.4%，误诊例次率以精神分裂症最高（47.3%），其次为躁狂症或躁狂状态（37.5%）。抗精神病药物能有效改善精神症状，青霉素驱梅能阻止病情进展使病情得到缓解，两者缺一不可。结论:被误诊为功能性精神障碍的麻痹性痴呆均以精神症状为首发且症状不典型而易被误诊，早期鉴别诊断十分重要，抗精神病药物和青霉素治疗可以有效控制症状。
Objective To evaluate the effectiveness and safety of donepezil in the treatment of senile vascular dementia. Methods The databases such as the Chinese Journal Full-text Database, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, Chinese Biomedicine Database, PubMed and The Cochrane Library were searched by computer, and the related journals and conference proceedings were also manually searched to include randomized controlled trials (RCTs) on donepezil in the treatment of senile vascular dementia. Studies were screened according to the inclusion and exclusion criteria, data were extracted, the methodological quality of the included studies was assessed according to Jadad score criterion, and meta-analyses were performed by using RevMan 5.0 software. Results Among 25 studies (3586 patients) included, eight described the randomization methods, and three described the double blind methods. The results of meta-analyses showed, compared with the placebo group, donepezil was superior in improving vascular dementia patients’ cognition level (three studies, MD= –1.25, 95%CI –1.61 to –0.88, Plt;0.000 01), intellectual spirit level (two studies, MD=0.66, 95%CI 0.35 to 0.97, Plt;0.000 1), dementia level (three studies, MD= –0.74, 95%CI –1.16 to –0.31, P=0.004), and viability level (two studies, MD= –0.74, 95%CI –1.16 to –0.31, P=0.000 6). In improving the intellectual spirit level, donepezil was superior to piracetam (seven studies, MD=3.25, 95%CI 2.15 to 4.35, Plt;0.000 01), Xuesaitong (two studies, MD=6.12, 95%CI 4.02 to 8.22), Huperzine A (three studies, MD=2.45, 95%CI 1.14 to 3.76, P=0.000 2), and vitamin (two studies, MD=4.00, 95%CI 2.73 to 5.27, Plt;0.000 01). For improving the viability level, donepezil was superior to piracetam (five studies, MD= –3.86, 95%CI –4.83 to –2.89, Plt;0.000 01), Xuesaitong (two studies, MD= –5.49, 95%CI –7.18 to –3.80, Plt;0.000 01), Huperzine A (two studies, MD= –0.78, 95%CI –4.23 to –2.66, P=0.66), vitamin (three studies, MD= –5.88, 95%CI –8.29 to –3.48, Plt;0.000 01), and nimodipine (one study, MD= –7.09, 95%CI –10.81 to –3.37, P=0.000 2). In improving the dementia level (HDS Scale), donepezil was superior to piracetam (one study, MD=5.80, 95%CI 2.78 to 8.82, P=0.000 2), Xuesaitong (one study, MD=3.95, 95%CI 2.32 to 5.58, Plt;0.000 01), vitamin (one study, MD=3.91, 95%CI 0.94 to 6.88, P=0.010), and almitrine (one study, MD=3.37, 95%CI 1.10 to 5.64, P=0.004). Conclusion Current evidence shows that donepezil is likely to be more effective in the treatment of vascular dementia than placebo, piracetam, Xuesaitong, Huperzine A and vitamin. However, for the limited evidence and lower methodological quality of the included studies, this conclusion still needs to be verified with more high-quality RCTs.
Objective To assess the efficacy and safety of Zhiling decoction for vascular dementia. Methods The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group was searched in Feb. 2004 using the term Zhiling. In addition, we handsearched 83 traditional Chinese medicine journals （1993 to 2004 ）. We included all randomized controlled trials（RCTs）of Zhiling decoction treating people with vascular dementia. We also evaluated the internal validity of the RCTs . If all included RCTs were of high quality and homogeneity, then the meta-analysis was conducted. Results Only one RCT was identified. The outcomes were listed as the followings ： ① The Hasegawa＇ s dementia scale scoring （ HDS ） scores of the patients in Zhiling decoction group were improved significantly from baseline after 8 weeks course of treatment and there was no significant difference in the control group. The HDS scores improvement was greater than control group（P 〈0.01 ）o ② The latency of P3 was shorter in both groups after treatment, and there was a significant treatment effect in Zhiling group （t = -52. 09, 95% CI -69.79 to -34.39, P 〈0. 000 01 ）. The amplitude of 173 increased in both groups after treatment, and there was a non-sigmficant treatment effect in Zhiling group for change from baseline （t =1.40, 95% CI -0.02 to 2.82, P =0.05）. ③ Brain electrical activity monitoring （BEAM） showed that benefits in those treated by Zhiling decoction were higher than those treated by Naofukang with OR9.90 （ 95% CI 3.34 to 29.38）. ④In the Zhiling group serum cholesterol （P 〈0.01 ） , serum triglyceride （P 〈0.01 ） and LPO（P 〉0. 01 ） decreased after treatment. There was an increase in the level of high density lipoprotein （HDL） and superoxide dismutase （SOD） in red blood cells compared with baseline for Zhiling groups （P 〈0.01 ）. ⑤ The cerebral blood flow decreased in both groups after treatment, and there was a significant treatment effect in favour of Zhiling （treatment effect t = -1.03, 95% CI -1.26 to -0.80, P 〈0. 00001 ）.⑥ No side effects on heart, liver or renal function were reported in Zhiling decoction group. Conclusions The currendy available evidence is insufficient to assess the potential efficacy for Zhiling decoction in the treatment of vascular dementia. Just one RCT concerning the management of Zhifing decoction versus Naofukang suggests that Zhiling decoction may be effective in treating vascular dementia. Further randomised, double-blind, placebo-controlled trials are urgendy needed .
【摘要】 目的 探讨3分法画钟测验（clock drawing test，CDT）对阿尔茨海默病患者（Alzheimer disease，AD）与血管性痴呆患者（vascular dementia，VD）的鉴别作用。 方法 收集四川大学华西医院神经内科门诊及住院部2009年9月-2010年6月就诊的认知功能障碍患者150例，进行病史采集及神经心理测试量表，筛选出AD患者57例及VD患者43例，共计纳入100例。在两者间进行CDT，分析两者间CDT有无差别、CDT与中文版简易智能量表（Chinese version of the mini-mental state examination，MMSE）及临床痴呆评定量表（clinical dementia rating scale，CDR）的相关性。 结果 AD患者及VD患者间CDT差异无统计学意义（Pgt;0.05）；CDT与MMSE及CDR有相关性，Spearman相关系数分别为0.573和-0.542（Plt;0.001）。 结论 3分法画钟测验无法准确区分AD和VD，但对粗略判断AD及VD程度可能有一定效果。【Abstract】 Objective To investigate the differential function of the three-point scoring system for the clock drawing test (CDT) between Alzheimer’s disease (AD) and vascular dementia (VD). Methods We analyzed the clinical data of 150 patients with cognitive impairment treated in the neurology and inpatient departments of our hospital from September 2009 to July 2010. Medical history of the subjects were collected. Through the assessment by neurological and psychological rating scale, we picked out 57 patients with AD and 43 with VD and tested them with CDT. The difference of CDT results between the two groups, and the correlation of CDT with Chinese version of the mini-mental state examination (MMSE) and clinical dementia rating scale (CDR) were analyzed. Results There was no statistical difference of CDT results between AD and VD patients (Pgt;0.005). CDT had a correlations with MMSE and CDR, the Spearman correlation coefficient being 0.573 and -0.542 respectively (Plt;0.001). Conclusion The three-point scoring system for the clock drawing test cannot differentiate exactly between Alzheimer Disease and Vascular Dementia, but it can make a gross judgment of the degree of AD and VD.
【摘要】 目的 了解老年门诊患者痴呆症的发生率及其相关危险因素。方法 对2007年7月—2009年5月,年龄≥60岁644例门诊患者进行简易智能表(MMSE简易评分)评价,并收集患者文化程度、吸烟、基础疾病、用药史进行危险因素相关分析。结果 样本人群老年痴呆症的发病率为16.0%。与老年性痴呆密切相龄、高血压、脑卒中史、听力受损和视力受损。结论 高龄、高血压、脑卒中是老年性痴呆主要的危险因素,当前的医疗卫生机构应该积极有效地采取措施,控制可变因素,减少老年性痴呆的发生。
目的：总结我们对表现为麻痹性痴呆的晚期神经梅毒的诊治经验。方法：报道4例麻痹性痴呆病例，并复习相关文献。结果和结论：麻痹性痴呆的临床表现复杂多变，早期误诊率高；诊断主要根据临床特点、血清学及脑脊液检查综合考虑；治疗上仍首选水剂青霉素G。
摘要:目的:探索丹红注射液联合长春西汀对老年血管性痴呆患者智能状况的改善效果。方法:将116例符合血管性痴呆标准的患者分为对照组和治疗组。对照组用血塞通0.4 g,治疗组用丹红注射液20 mL和长春西汀10 mg,10 d为1个疗程,6个月共6个疗程,其后分别采用中文版简易智能状态检查(MMSE)量表进行积分,用中国修订韦氏成人量表(WAISRC)进行智力测验比较。结果:根据WAISRC测验结果,两组1年后知识、领悟、算术、相似、数字广度、词汇、数字符号、填图、图片排列等项目比较,治疗组积分明显高于对照组t=1.98～5.25,Plt;0.05或001),治疗组治疗前后上述项目自身对照积分亦有显著提高(t=1.68～4.25,Plt;0.05或0.01)。结论:丹红注射液联合长春西汀能有效抑制神经细胞的凋亡,改善脑部供血,减少脑功能的受累.治疗血管性痴呆,对老年群体的康复有积极的治疗作用。Abstract: Objective:To investigate the curative effect of DanHong injection and Vinpocetine injection in improving intelligence of vascular dementia (VD) patients. Methods: One hundred and sixteen patients with VD were randomly assigned to treat with Danhong at a daily dose of 20 mL and Vinpocetine at a daily dose of 10 mg (treatment group) and Xuesaitong at a daily dose of 0.4 g alone (control group) for 10 day as a course. The duration was six months for 6 courses. To score using the Mini. Mental state examination (MMSE) of Chinese version and WAISRC were conducted after 1 year. Results: At the end of one year, according to WAISRC examination. The scores of knowledge, comprehension, arithmetic, acquaintance, digit span,vocabulary figure,fill the diagram and toy bricks were significantly higher than those of the control group (t=1.985.25 Plt;0.05).Before and after treatment, there was a significant difference in the treatment group (t=1.684.25 Plt;0.05 or 0.01).Conclusion: DanHong injection and Vinpocetine injection are effective to inhibit the apoptosis of nerve cells. and decrease the tiredness of brain function. It has a certain effect in treatment of vascular dementia and plays a good role in the rehabilitation of oldage community
ObjectiveTo systematically review the relationship between Cadmium (Cd) level and Alzheimer's disease (AD). MethodWe searched PubMed, EMbase, CNKI, WanFang Data and CBM databases from inception to December 2014 to collect case-control studies about the relationship between Cd level and AD. Two reviewers screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 11 studies were included, among them 8 studies were included into final meta-analysis. Three studies including 154 patients and 141 controls reported the relationship of serum Cd concentrations and AD, and the result of meta-analysis showed that the higher serum Cd level was found in the AD group than the control group (SMD=0.36, 95%CI 0.12 to 0.59, P=0.003). Six studies including 358 patients and 423 controls reported the relationship of blood Cd concentrations and AD, and the result of meta-analysis showed that there was no significant difference of blood Cd levels between both groups (SMD=0.35, 95%CI -0.14 to 0.84, P=0.16). ConclusionSerum Cd concentrations may be associated with AD, but blood Cd concentrations not. Due to the limitation of quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.