轻度认知障碍的社区干预治疗

目的研究社区干预治疗轻度认知障碍(MCI)的方法.方法对我院社区721例60岁以上老人进行调查.有67例诊断为MCI.对其进行为期1年的社区干预治疗,干预方法主要有定期宣传教育、记忆力训练、生活习惯养成和心理治疗等.治疗前后用简易智能状态检查量表(MMSE)、日常生活活动能力量表(ADL)和临床痴呆评定量表(CDR)进行认知功能检查和状态评定,评价干预治疗效果.结果干预治疗后MCI患者认知功能有明显改善,与干预前比较,MMSE评分提高,ADL评分降低,差异有统计学意义(P＜0.01).结论 MCI患者应通过社区进行积极的干预治疗,能有效改善和提高患者的认知功能,避免老年痴呆的发生.     

依托家庭病房科学管理对轻度认知功能障碍老年患者疗效的观察

目的探讨依托家庭病房科学管理对轻度认知功能障碍(mild cognitive impairment,MCI)的高龄患者的疗效。方法选取驻津部队离休干部轻度认知功能障碍的患者68例,随机分为试验组及对照组各34例,依托家庭病房对试验组进行1年科学管理,对照组仅门诊指导,干预前后行简易智能状态检测量表(MMSE)、蒙特利尔认知评估(Moca)、日常生活活动量表(ADL)评分,两组间采用t检验,分析干预效果。结果科学管理后1年,试验组MMSE、Moca、ADL评分较对照组改善(P0.05)。结论依托家庭病房科学管理能有效改善MCI患者的认知功能和日常生活自理能力,延缓认知功能的减退,提高患者的生活质量,值得推广。     

多奈哌齐治疗老年人血管性痴呆的临床观察

目的观察多奈哌齐治疗老年人血管性痴呆(VD)的疗效和安全性。方法选择符合DSM-IV血管性痴呆诊断标准的30例轻至中度VD患者,分别于治疗前、治疗后8周和16周,用MMSE和ADL痴呆量表评定患者的认知功能及日常生活能力。结果多奈哌齐治疗8周后与治疗前比较,MMSE评分明显提高,提高率为26.67%,ADL评分明显降低,降低率为25.42%。继续治疗至16周后,病情改善明显,MMSE评分增分(增分率52.27%)及ADL评分的减分(减分率51.75%)较治疗前比较更明显。用药过程中1例出现关节疼,1例出现心动过缓,减量后副作用消失。结论多奈哌齐能有效地改善轻至中度老年性血管性痴呆患者的认知功能、社会活动能力及日常生活能力,与应用时间成正比,安全性能较高,值得临床推广。     

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。     

口服肠内营养液改善阿尔茨海默病病人的临床研究

目的:探讨营养干预对阿尔茨海默病(AD)病人营养状况、认知功能和日常生活活动能力(ADL)的影响。方法:将90例AD病人随机分为对照组和干预组,每组45例。对照组病人给予抗痴呆药物治疗;干预组病人在药物治疗的基础上给予增加肠内营养乳剂(TPF-T)口服营养补充治疗,6个月后分别评估两组病人治疗前后的营养状况、认知功能和ADL,同时观察病人的营养学指标等。结果:治疗6个月后,干预组病人的营养状况、简易精神状态量表(MMSE)、ADL评分、营养学指标明显改善,与对照组比差异有显著性统计学意义(P0.05)。结论:营养干预能有效改善AD病人的营养状况,并有利于认知功能和日常生活活动能力的提高。     

蒙特利尔认知评估量表对老年人轻度认知功能障碍筛查的应用研究

轻度认知功能障碍(MCI)的老年人是痴呆的高危人群,早期发现和干预有助于防止或延缓痴呆的进展.简易精神状态量表(MMSE)在我国已被广大临床医生广泛应用,但有研究发现,很多MCI患者MMSE得分超过了26分,而且MMSE对于文化背景不同者敏感性差别很大[1].     

老年轻度认知功能障碍患者认知评分变化3年前瞻性研究

目的 探讨社区老年轻度认知功能障碍(MCI)患者认知评分变化及其在阿尔茨海默病(AD)预测中的价值.方法 采用多级整群抽样方法选择对象,对贵阳市社区老年人开展3年前瞻性研究,将基线MCI患者前后简易智能状态检查(MMSE)总分及各领域得分变化进行对比分析,并对MCI患者不同转归结局MMSE前后得分进行比较,采用logistic回归分析方法对其在AD发病的危险性进行估计.结果 MCI患者基线和随访对认知功能总分及各领域得分差异有统计学意义(P＜0.05).结局为痴呆者基线MMSE得分低于保持MCI和转为正常者(P＜0.05).Logistic回归分析显示定向力下降的MCI患者转化为AD的危险性较高(OR=1.730,95％CI=1.283～2.332).结论 MCI患者各领域得分及MMSE总分较低者更容易转化为AD.在MCI转归为痴呆的过程中,定向力得分下降可能是其中一个重要的预测因子.     

护理干预对改善老年痴呆患者认知功能障碍的影响

目的探讨护理干预对改善老年痴呆患者认知功能障碍的影响。方法对31例老年痴呆症患者进行护理干预,采用简易智能精神状态检查量表(MMSE)和日常生活能力量表(ADL)进行分析评定。结果实施干预后,病人的认知功能有明显提高(P<0.05),日常生活能力有显著改善(P<0.01)。结论护理干预可显著提高老年痴呆患者的认知功能。     

北京市宣武区社区老年糖尿病患者认知功能障碍调查

目的 评价社区老年糖尿病与认知功能障碍之间的关系及影响因素.方法 在宣武区社区居民健康体检管理档案中,随机抽取符合2型糖尿病诊断标准的糖尿病患者308例,其中单纯糖尿病144例,糖尿病合并高血压164例,作为研究对象,并随机抽取了225例高血压病和186例相同年龄段及性别的社区健康老人作为对照组,进行MMSE测查,根据DSM-IV痴呆诊断标准及轻度认知功能障碍（MCI）诊断标准分为认知功能正常组、MCI组及痴呆组.结果 单纯糖尿病组MMSE评分低于正常对照组（25.87±3.33 vs 26.86±2.82,F=9.62,P〈0.01）,糖尿病合并高血压组MMSE评分（24.68±4.36）明显低于正常对照组（F=37.16,P〈0.01）.结论 老年糖尿病与认知功能障碍之间存在正相关,糖尿病是老年人痴呆的危险因素.糖尿病合并高血压时,可加重认知功能障碍.     

急性脑梗塞病人认知功能测定

目的：了解急性脑梗塞病人认知功能和痴呆的发生率及其影响因素。方法：采用简易智力状态检查表（MMSE）对74例急性脑梗塞病人的认知功能进行检查。对有认知受损进一步检查日常生活能力量表（ADL）和Hachinski缺血指数量表（HIS）以确诊血管性痴呆（VD），并对VD组和非痴呆组两组病人临床资料进行统计分析。结果：（1）21例确诊为VD，VD发生率为28．38％，其中≥65岁VD发生率为31．91％。（2）MMSE分值与年龄、化程度有明显相关。年龄大、化程度低MMSE分值低。（3）两组病人相比较，年龄有明显差异，VD组明显高于非痴呆组。结论：对急性脑梗塞病人尤其是老年病人需注意认知功能的减退，以便早期发现VD。     

Impact of Mixed Cognitive Intervention Training on Early Onset Dementia

ObjectivesThe aim of this study was to investigate the impact of mixed cognitive intervention training using spaced retrieval training, and errorless learning in participants with early onset dementia. This was based on reality orientation therapy for cognitive function, depression, and occupational performance of patients.MethodsTwo early onset vascular dementia patients (> 65 years) with mild or moderate impairment were enrolled in a pre-test - post-test single-subject research design study. Prior to the study, the caregivers were interviewed about meaningful times, people, places, and areas of interest for the participant. A list of individual training words were selected based upon this information, and the participant was instructed to recall them after a 45-second, 90-second, 6-minute, and 12-minute delay. Baseline (3 sessions), intervention (20 sessions), and a second baseline period (3 sessions) were conducted. Activities of daily living were measured, and cognition was measured using the Consortium to Establish a Registry of Alzheimer’s Disease Korean version, whilst depression was measured using the Korean Form Geriatric Depression Scale, and task performance and satisfaction measured by the Canadian Occupational Performance Measure.ResultsAfter intervention, both participants showed improvements in activities of daily living (ADL), word list memory/recognition, trail making A, occupational performance, and satisfaction improvement, which was clinically significant in 1 participant who also had a reduced score in the scale of depression classifying him as not depressed.ConclusionSpaced retrieval training and errorless learning based on reality orientation therapy is an effective intervention in patients with early onset dementia and mild or moderate impairment.     

轻度认知障碍老年人不同潜在类别的增长混合模型研究

目的 探讨增长混合模型在识别轻度认知障碍的老年人群中存在的潜在类别及识别不同类别的群体认知功能的发展轨迹的应用。方法 利用65岁以上轻度认知障碍老年人的随访数据构建增长混合模型（growth mixed model，GMM）。利用贝叶斯信息标准（Bayesian information criterion，BIC）进行潜在类别的确定并用后验概率进行模型评价。结果 轻度认知障碍的老年人呈现出了3种不同的认知轨迹:类别1的人群初始认知功能低且短时间内快速下降中间又有反弹，最后下降至一定程度后趋于平缓，称之为"痴呆高危人群"，占全部人群的4.46%。类别2的人群具有较低的认知功能且随着年龄增长认知能力急剧下降，这部分人群称之为"痴呆低危人群"，占全部人群的33.28%。类别3的人群具有较高的认知功能，随着年龄增长认知功能缓慢下降，称之为"正常老化人群"，占全部人群的62.26%。结论 研究揭示了轻度认知障碍的老年人群中认知发展轨迹的异质性，有助于健康促进人员针对高危人群及早制订干预措施从而减少老年痴呆的发生。     

The association between cognitive impairment and community service use patterns in older people living in Australia

Family plays a vital role in supporting individuals with dementia to reside in the community, thus delaying institutionalisation. Existing research indicates that the burden of care‐giving is particularly high for those caring for a person with dementia. Yet, little is known about the uptake of community services by people with a diagnosis of dementia. Therefore, this study aims to better understand the relationship between cognitive impairment and the receipt of community care services. In order to examine the relationship, secondary data collected across Queensland, Australia, from 59,352 home‐care clients aged 65 and over during 2007–2008 are analysed. This cross‐sectional study uses regression analyses to estimate the relationship between cognitive impairment and service mix, while controlling for socio‐demographic characteristics. The dependent variables include formal services, informal care and total home‐care service hours during a 12‐month period. The findings of this study demonstrate that cognitive impairment is associated with accessing more hours of respite and day centre care but fewer hours of other formal care services. Additionally, the likelihood of support from an informal caregiver increases when a client becomes cognitively impaired. Therefore, this study demonstrates that there is an increased need for respite programmes to support informal caregivers in the future, as the population of people living with dementia increases. These findings support the need for investigations of new and innovative respite models in the future.     

老年人认知功能障碍患病情况调查及影响因素分析

目的了解社区养老和机构养老老年人的认知功能障碍情况,探讨相关影响因素,为防治认知功能障碍提供科学依据。方法调查对象为545名广州市部分社区长者饭堂的用餐老年人和广州市、佛山市、中山市、清远市四地市养老院的入住老年人,对老年人的一般健康情况和认知功能(MoCA)进行问卷调查,对认知功能的影响因素进行Logistic回归分析。结果养老院老年人认知功能障碍的风险高于社区养老的老年人。养老院老年人(OR=3.099,95%CI:1.601,6.001)、年龄75岁以上(OR=2.050,95%CI:1.132,3.714)是老年人认知障碍的危险因素;学历与老年人的认知障碍呈负相关,高中或大学以上学历老年人认知功能障碍的风险低于文盲老年人(OR=0.292,95%CI:0.124,0.691)。结论应多关注社区养老和机构养老老年人的认知功能情况,及早发现认知功能障碍人群并进行干预,以减少认知功能障碍的进展性损害。     

P-Drive on-road: Internal scale validity and reliability of an assessment of on-road driving performance in people with neurological disorders

The aim of this study was to determine internal scale validity and reliability of P-Drive on-road by observing driving performance among people with neurological disorders. The study comprised a consecutive sample of 205 persons with stroke, dementia, or mild cognitive impairment who were remitted for and performed a standardized test in real traffic. Their driving abilities were evaluated with a new assessment tool, P-Drive on-road. Aspects of validity and reliability of the tool were analyzed using a Rasch rating scale model. The results indicated that the rating scale functioned as intended and a principal component analysis indicated that the items formed a unidimensional scale. Acceptable levels of person response validity were found and the scale was also able to distinguish between the abilities of the drivers with a person separation reliability of 0.90. The results indicate that P-Drive on-road is valid and reliable for producing a linear measure of driving ability in people with stroke, dementia and mild cognitive impairment, and has the potential to become a clinically useful assessment tool for on-road driving tests.     

绵阳市养老机构老人认知功能现状调查

目的 调查绵阳市养老机构老人的认知功能现状,为开展针对性的认知功能干预措施提供科学依据。方法 采取随机整群抽样法、运用全面衰退量表对主城区6家养老机构的老人进行调查。结果 共调查583名老人,认知功能障碍者210名,患病率为36%,轻度认知障碍者170人,占比为29.2%,认知功能障碍以轻度为主;不同年龄、文化程度、婚姻状况的老人认知功能分级比较,差异有统计学意义(P<0.05)。结论 养老机构老人认知功能减退检出率较高,养老机构应进行积极的早期干预,以提高老人的晚年生活质量。     

中国四省55岁及以上人群轻度认知功能障碍与高尿酸血症的关联性

目的探讨55岁及以上人群轻度认知功能障碍与高尿酸血症现状及其相关性。方法以"神经系统疾病专病社区队列研究"2018—2019年基线调查数据资料为基础,采用多阶段分层整群随机抽样的方法在河北、浙江、陕西及湖南省选取4272名55岁及以上人群作为研究对象,使用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)来评价人群轻度认知功能障碍情况并检测空腹血清尿酸水平,计算人群血清尿酸水平与MoCA得分的相关性,采用多变量Logistic回归模型分析血清尿酸水平对人群轻度认知障碍的影响。结果血清尿酸正常组和高尿酸血症组的55岁及以上人群认知功能障碍患病率分别为38.6%和38.4%;血清尿酸正常组中,非认知功能障碍人群的血清尿酸水平为291.4μmol/L,认知功能障碍人群的血清尿酸水平为283.7μmol/L,非认知功能障碍人群的血清尿酸水平显著高于认知功能障碍人群(F=16.12,P<0.05),且该组研究对象MoCA分值与其血清尿酸水平呈显著正相关(r=0.103,P<0.05);高尿酸血症组中,非认知功能障碍人群的血清尿酸水平为450.9μmol/L,认知功能障碍人群的血清尿酸水平为442.4μmol/L,非认知功能障碍人群与认知功能障碍人群血清尿酸水平差异无统计学意义(F=2.44,P>0.05),且该组研究对象MoCA分值与其血清尿酸水平亦无相关性(r=0.064,P>0.05)。Logistic回归模型分析结果显示,55岁及以上人群患有高尿酸血症不是其患认知功能障碍的危险因素(OR=1.04,95%CI 0.87~1.25,P=0.630)。结论血清尿酸在正常值范围内,适当提高血清尿酸水平可能会对轻度认知功能障碍具有保护作用;未发现高尿酸血症会增加55岁及以上人群患认知功能障碍的风险。     

Validation of the neurobehavioral cognitive status examination and the Rivermead Behavioural Memory Test in investigations of dementia

The aim of this retrospective study was to validate two commonly used instruments, Cognistat and the Rivermead Behavioural Memory Test, RBMT, for detection of MCI and mild dementia. Two different diagnosis groups, mild cognitive impairment (MCI) and Alzheimer's disease combined with mixed dementia representing mild dementia (MD), were compared with a group of patients who did not receive a diagnosis of dementia. All patients were assessed at a specialized outpatient memory clinic in a university hospital in Sweden using the Mini Mental State Examination (MMSE), Cognistat, and RBMT. Sensitivity, specificity, predictive value, and likelihood ratio were calculated for the tests. The Cognistat and RBMT have moderate validity in the detection of MCI and mild dementia. On their own, none of the tests used is sufficient for diagnosing MCI or mild dementia. A combination of the Cognistat and RBMT provides additional information in early stage dementia; in this regard the RBMT is better than the Cognistat, which also has other limitations. The RBMT can be helpful for distinguishing between MCI and mild dementia. There is a need for a more sensitive screening test to capture early cognitive impairment related to patients' occupational performance and problems in daily life.     

Mild cognitive impairment

A wide spectrum of cognitive ability is seen in older persons, ranging from intact cognitive function to clinically manifested dementia. The term mild cognitive impairment (MCI) is increasingly used to refer to individuals who have some cognitive impairment but do not meet the criteria for dementia. Despite a lack of consensus about precisely how to define MCI, researchers agree that the condition is relatively common in older people, and data suggest that MCI may be associated with an increased risk of Alzheimer's disease, parkinsonian signs and disability. Presently, the clinical assessment of MCI should include a detailed evaluation of cognitive functioning and the use of structural MRI can provide important diagnostic and prognostic information. Although therapeutic trials in MCI using the Choline acetylcholinesterase's have been disappointing with short term affects noted, pharmacologic prevention studies for MCI, are underway and may provide valuable data to prevent the development of this condition.     

Validation of the Neurobehavioral Cognitive Status Examination and the Rivermead Behavioural Memory Test in investigations of dementia

Abstract

The aim of this retrospective study was to validate two commonly used instruments, Cognistat and the Rivermead Behavioural Memory Test, RBMT, for detection of MCI and mild dementia. Two different diagnosis groups, mild cognitive impairment (MCI) and Alzheimer's disease combined with mixed dementia representing mild dementia (MD), were compared with a group of patients who did not receive a diagnosis of dementia. All patients were assessed at a specialized outpatient memory clinic in a university hospital in Sweden using the Mini Mental State Examination (MMSE), Cognistat, and RBMT. Sensitivity, specificity, predictive value, and likelihood ratio were calculated for the tests. The Cognistat and RBMT have moderate validity in the detection of MCI and mild dementia. On their own, none of the tests used is sufficient for diagnosing MCI or mild dementia. A combination of the Cognistat and RBMT provides additional information in early stage dementia; in this regard the RBMT is better than the Cognistat, which also has other limitations. The RBMT can be helpful for distinguishing between MCI and mild dementia. There is a need for a more sensitive screening test to capture early cognitive impairment related to patients' occupational performance and problems in daily life.