老年前列腺癌患者雄激素去势治疗后的长期心力衰竭风险的回顾性研究

目的 回顾性分析美国国立癌症数据库(SEER)老年前列腺癌患者雄激素去势治疗(ADT)后的长期心力衰竭(HF)风险,并分析ADT和HF风险的相关性。方法 回顾性观察性研究。纳入1996—2003年在SEER数据库中老年(≥65岁)前列腺癌患者,根据是否给予ADT治疗分为ADT组(82 514例)和对照组(121 856例)。比较两组的基线临床资料,Kaplan-Meier生存分析和Log-rank检验比较两组的长期随访的HF发生率。Cox风险比例回归分析评估ADT治疗和HF的相关性。结果 共纳入204 370例患者,平均年龄为(77. 2±11. 8)岁。与对照组比较,ADT组的年龄更大,合并糖尿病、高血压的比例更高,前列腺特异抗原水平更高,肿瘤分化不良比例更高,社会经济状况更差(均为P0. 05)。平均随访(13. 1±2. 7)年,共诊断48 496例HF,其中ADT组23 893例,对照组26 603例。Kaplan-Meier生存分析和Log-rank检验结果显示,ADT组和对照组随访5年HF发生率分别为6. 4%和2. 8%,随访10年HF发生率分别为15. 7%和8. 1%,随访15年的HF发生率分别为21. 7%和14. 9%,ADT组的HF发生率显著高于非ADT组(24. 9%比16. 2%,HR=1. 582,95%CI:1. 217～2. 074,P=0. 001)。采用多因素Cox比例风险回归模型,结果显示ADT治疗是HF的独立危险因素(HR=2. 261,95%CI:1. 519～3. 365,P=0. 002)。另外,高血压(HR=2. 802,95%CI:1. 674～4. 690,P=0. 001)、糖尿病(HR=3. 158,95%CI:2. 127～4. 519,P=0. 001)、高龄(≥75岁)(HR=5. 662,95%CI:2. 583～12. 411,P=0. 001)和社会经济状况低(HR=4. 293,95%CI:1. 834～8. 830,P=0. 003)均为HF的危险因素。结论 老年前列腺癌患者ADT治疗后出现HF的风险明显增高,ADT是增加发生HF风险的独立危险因素之一。     

75岁及以上老年早期局限性前列腺癌患者手术去势治疗后长期脑血管事件风险分析

目的观察75岁及以上老年早期局限性前列腺癌手术去势治疗后的长期脑血管事件的发生风险,并分析手术去势和脑血管事件的相关性。方法回顾性队列研究。纳入2004—2016年在美国国立癌症数据库(SEER)中75岁及以上老年早期局限性前列腺癌患者,根据是否行手术去势治疗分为手术去势组(3 648例)和对照组(17 899例)。比较两组的基线临床资料,Kaplan-Meier生存分析比较两组的脑血管事件(脑血管性死亡、卒中、短暂性脑缺血发作)发生率。结果 21 547例患者中,平均年龄为(83.2±7.1)岁。与对照组比较,手术去势组的合并症更多(P0.05)。平均随访(13.2±2.1)年,共诊断3 281例脑血管事件,Kaplan-Meier生存分析结果显示,手术去势组的总体脑血管事件发生率明显高于对照组(19.2%比15.6%,χ~2=4.905,P=0.035)。Cox回归分析结果显示,手术去势显著增加脑血管事件的发生风险(HR=2.17,95%CI:1.35～3.52,P=0.02)。结论 75岁及以上老年局限性前列腺癌患者手术去势治疗后脑血管事件发生风险增加。     

真实世界老年小细胞肺癌患者一线免疫联合化疗疗效与不良反应观察

目的探讨真实世界中老年小细胞肺癌(SCLC)患者一线免疫联合化疗疗效和不良反应。方法回顾性分析2013年1月至2023年6月就诊于北京医院经穿刺/气管镜活检或手术病理明确诊断SCLC并接受一线内科治疗的广泛期老年患者(≥65岁)148例, 其中化疗组103例、免疫联合化疗组(联合组)45例。按年龄分为≥75岁组和<75岁组, 比较不同年龄组、一线不同治疗方式的疗效和免疫相关不良反应情况。评价程序性死亡配体1(PD-L1)表达和肿瘤突变负荷(TMB)表达情况及与生存的关系。采用实体瘤疗效评价标准(RECIST1.1)评价近期疗效, 常见不良反应分级评价标准(CTCAE 4.03)评价免疫相关不良反应。Kaplan-Meier法进行生存曲线分析, 并进行Log-rank检验。Cox风险比例回归模型分析影响预后的因素。结果老年SCLC患者一线联合组总有效率(ORR)79.1%(34/43), 高于化疗组63.2%(60/95), 但差异未达到统计学意义(χ2=3.451, P=0.063)。≥75岁组患者联合组ORR显著高于化疗组, 分别为87.5%(7/8)比48.6%(17/35)...     

主动脉球囊反搏在老年急性冠状动脉综合征中的应用及对预后的影响

目的探讨主动脉球囊反搏(IABP)在老年急性冠状动脉综合征(ACS)患者治疗中的应用及预后以及影响预后的因素。方法回顾性分析2005年1月～2011年1月住院置入IABP的ACS患者76例,根据年龄分为<75岁组40例,≥75岁组36例,分析其住院期间及1年的预后。结果 76例患者中,院内死亡22例,占28.9%,1年死亡29例,占38.2%,2组院内病死率比较差异无统计学意义(P>0.05),≥75岁组较<75岁组1年病死率明显升高(P<0.05)。Kaplan-Meier生存曲线显示,与<75岁组比较,≥75岁组患者1年生存率明显降低(P=0.009)。Cox比例风险回归模型分析显示,年龄偏大、LVEF降低、PCI术后TIMI血流0～1级降低是1年死亡的独立危险因素。结论联合IABP治疗的ACS患者预后良好。高龄、LVEF低、PCI术后TIMI血流降低,是应用IABP的ACS患者1年死亡的独立危险因素。     

同型半胱氨酸水平对老年男性高血压患者血栓前状态及血栓事件的影响

目的分析同型半胱氨酸(Hcy)水平对老年男性高血压患者血栓前状态特点及发生血栓事件的影响。方法 108例老年男性高血压患者,按照Hcy水平分为高Hcy水平组(H组,44例)和低Hcy水平组(L组,64例)。检测两组患者血栓前状态的实验室指标,多元线性逐步回归分析Hcy水平与血栓前状态实验室指标的相关性。对所有患者进行长期随访,采用Cox比例风险模型对可能影响血栓事件的指标进行多因素回归分析,采用Kaplan-Meier生存曲线计算无血栓事件生存率,生存分析采用Log-rank检验。结果 H组患者抗凝血酶Ⅲ(AT-Ⅲ)水平明显低于L组(P0.01),而血栓调节蛋白(TM)、血小板α颗粒膜蛋白(GMP)-140和凝血酶原片段(F)1+2则均明显高于L组(P0.01,P0.05)。两组间D-二聚体(D-Dimer)、纤维蛋白原(FIB)、血浆黏度无统计学差异(P0.05)。简单相关分析和偏相关分析显示血浆Hcy水平与AT-Ⅲ呈负相关(r=-0.201,P=0.040),与TM呈正相关(r=0.236,P=0.032)。多因素Cox比例风险分析结果显示高龄(OR=1.050,P=0.002)、高Hcy(OR=1.048,P0.007)是高血压患者发生血栓事件的独立危险因素。Log-rank检验H组和L组间无血栓事件生存率有统计学差异。结论高龄及高Hcy是老年男性高血压患者发生血栓事件的独立危险因素。     

年龄大于75岁的老年左主干病变患者介入治疗的远期预后分析

目的分析年龄≥75岁的老年左主干病变患者PCI的远期预后。方法选择行PCI年龄≥65岁的老年患者213例,均经冠状动脉造影证实左主干病变。患者根据年龄分为年龄≥75岁组81例和年龄75岁组132例。患者随访(358.6±37.7)d,比较2组PCI成功率、并发症、远期主要不良心脏事件(MACE)和不良临床事件发生率。绘制Kaplan-Meier生存曲线分析1年生存率。结果年龄≥75岁组置入支架直径明显小于年龄75岁组[(3.2±0.5)mmvs(3.3±0.5)mm,P=0.035]。年龄≥75岁组与年龄75岁组的远期MACE发生率(23.9%vs20.6%,P=0.593)、不良临床事件发生率(43.7%vs 30.8%,P=0.081)、心源性死亡(2.8%vs 0.9%,P=0.718)、全因死亡(5.6%vs 2.8%,P=0.577)无差异,年龄≥75岁组与年龄75岁组的1年生存率无统计学差异(94.4%vs97.2%,P=0.337)。结论年龄≥75岁老年左主干病变患者行PCI是安全有效的。     

体位性低血压对老年心力衰竭患者长期预后的影响

目的 探讨体位性低血压(OH)对老年心力衰竭(HF)患者长期不良心脑血管事件(MACCE)的影响,并分析影响MACCE的危险因素。方法 回顾性队列研究,连续纳入2015年1月至2018年1月在我院诊治的老年HF患者。依据是否合并OH,选择100例合并OH的HF患者为OH组,并按照1∶2比例选择年龄和左室射血分数匹配的、未合并OH的200例HF患者为对照组。随访截止到2019年12月,记录MACCE发生情况,包括全因死亡、因HF再入院、急性心肌梗死、卒中和恶性心律失常。应用Kaplan-Meier生存分析和Log-rank检验分析两组的MACCE发生情况。应用单因素和多因素Cox比例风险回归模型分析影响MACCE的危险因素。结果 300例老年HF患者中,男性160例(53. 3%),平均年龄(72. 3±12. 1)岁。与对照组相比,OH组患者较多合并高血压(57. 8%比40. 5%)和糖尿病(38. 0%比25. 5%),空腹血糖、立位收缩压和舒张压、卧位收缩压和舒张压水平均较高,但应用利尿剂比例较低(83. 0%比93. 5%)(均为P0. 05)。平均随访(28. 3±15. 4)个月,失访29例(9. 7%)。随访期间,共有107例(35. 7%)患者发生MACE,包括12例(4. 0%)死亡、50例(16. 7%)因HF再入院、18例(6. 0%)急性心肌梗死和10例(3. 3%)卒中。Kaplan-Meier生存分析和Log-rank检验结果提示,OH组患者的因HF再入院(27. 0%比11. 5%,P=0. 001)、卒中(6. 0%比2. 0%,P=0. 037)和MACCE发生率(53. 0%比27. 0%,P0. 001)均显著高于对照组。多因素Cox比例风险回归模型结果显示,OH是老年HF患者发生MACCE的独立危险因素(HR=1. 779,95%CI:1. 165～2. 717,P=0. 008)。结论 OH可显著增加老年HF患者的再入院率和卒中发生风险,且为MACCE的独立危险因素。     

老年射血分数降低心力衰竭合并贫血患者的短期认知功能障碍发生风险分析

目的评估合并贫血的老年射血分数降低心力衰竭(HFrEF)患者随访短期发生认知功能障碍的风险,并分析其相关危险因素。方法回顾性病例对照研究。选取2016年1月至2018年12月在我院诊治的442例HFrEF老年患者。根据是否合并贫血分为贫血组(94例)和对照组(348例),随访1年比较两组患者认知障碍发生风险,并行多因素logistic回归分析评估认知障碍的危险因素。结果 442例HFrEF老年患者中,男性218例,平均年龄(77.7±10.2)岁。94例贫血患者中,轻度、中度和重度贫血分别有37例、31例和26例。两组患者的年龄、合并房颤、合并睡眠呼吸暂停、肾损伤、左室射血分数和血脂水平等均有显著性差异(均为P0.05)。平均随访(10.3±2.3)个月,失访37例(8.4%),共有55例认知障碍患者。贫血组的认知障碍发生率显著高于对照组(χ~2=5.976,P=0.014),且随着贫血程度加重,认知障碍发生率逐渐升高(χ~2=8.740,P=0.013)。多因素logistic回归分析显示:高龄(OR=1.791,95%CI:1.230～2.608)、吸烟(OR=2.207,95%CI:1.339～3.638)、心房颤动(OR=3.115,95%CI:1.114～8.710)、左室射血分数(OR=1.937,95%CI:1.332～2.817)、睡眠呼吸暂停(OR=2.135,95%CI:1.462～3.118)和中重度贫血(OR=2.769,95%CI:1.108～6.921)是认知功能障碍的独立危险因素(均为P0.05)。结论合并贫血的HFrEF老年患者发生认知障碍的风险高,且随着贫血程度加重,认知障碍发生率逐渐升高。     

老年患者经皮冠状动脉介入治疗围手术期出血与术后1年预后的关系

目的 探讨老年冠心病患者经皮冠状动脉介入治疗(PCI)围手术期出血与术后1年主要不良心血管事件的关系.方法 2006年6月至2011年8月,前瞻性纳入在阜外心血管病医院行PCI的老年(≥75岁)冠心病患者1 105例.将患者分为出血组(围手术期发生出血,共153例)和无出血组(围手术期无出血,共952例).利用Cox比例风险回归模型分析出血与术后1年死亡和心肌梗死复合终点的关系.结果 出血学术研究联合会(BARC)2级出血比例为9.5％(105/1 105),≥2级出血比例为11.8％ (130/1 105);穿刺点相关出血占所有出血的62.7％(96/153).出血组术后1年死亡和心肌梗死复合终点事件率高于无出血组[9.2％(14/153)比4.2％(40/952),P=0.008],心原性死亡比例也高于无出血组[3.9％ (6/153)比0.8％(8/952),P=0.007],而非心原性死亡比例两组间差异无统计学意义(P=0.360).Cox比例风险模型分析显示,以无出血为对照,BARC≥2级出血术后1年死亡和心肌梗死复合终点的HR值为2.368(95％ CI:1.201-4.669,P=0.013).结论 PCI围手术期出血是≥75岁冠心病患者术后1年死亡和心肌梗死复合事件的独立危险因素.     

内镜下缩瘤术治疗老年晚期胃癌的临床疗效

目的回顾性分析106例老年晚期胃癌病例,评价内镜下缩瘤术对老年晚期胃癌预后的影响.方法将收集的老年晚期胃癌病例分为采用内镜下缩瘤术治疗的治疗组和仅接受最佳支持治疗的同期对照组,主要观察指标为有效率和生存期.完成4疗程以上缩瘤术治疗后评估短期疗效及不良反应.采用Cox多因素分析方法 ,在基线均衡的条件下比较两组胃癌病例的生存期,Kaplan-Meier法估算中位生存时间.结果收集中国人民解放军第455医院消化肿瘤科2010-01-01/2015-06-30诊治的老年晚期胃癌患106例,治疗组为51例,对照组为55例,治疗组和对照组的近期有效率分别为76.5%和27.3%(P0.05).C o x多因素回归分析示:内镜下缩瘤治疗(P=0.000)、肿瘤大小(P=0.000)是影响老年晚期胃癌病例生存期的独立的预后因素,在组间基线均衡的条件下,治疗组(51例)的中位生存期较对照组(55例)延长(12.496 mo vs 8.384 mo,P=0.000),采用内镜下缩瘤治疗的相对危险度:0.430(95%CI:0.274-0.675).治疗组1、2年生存率较对照组明显延长(52.8%vs 29.1%、22.9%vs 2.8%).结论内镜下缩瘤术对晚期胃癌具有较好临床疗效,可延长老年晚期胃癌患者的生存期,使其生存获益.     

The association between vascular risk factor-mediating medications and cognition and dementia diagnosis in a community-based sample of African-Americans

OBJECTIVE: To determine the association between medications that ameliorate vascular risk factors and the prevalence of cognitive impairment and dementia in an older African-American population. DESIGN: A community-based survey to identify subjects with and without evidence of cognitive impairment and subsequent diagnostic evaluation of a stratified sample of these subjects using formal diagnostic criteria for dementia and Alzheimer's disease (AD). SETTING: Urban neighborhoods in Indianapolis, Indiana. SUBJECTS: A random sample of 2,212 African-American adults aged 65 years and older residing in 29 contiguous census tracts. MEASUREMENTS: Subjects' scores on the Community Screening Instrument for Dementia (CSID), formal diagnostic and clinical assessments for dementia, current medication use and history of medical illnesses, both self-report and, where possible, from an informant. Four outcome measures were defined by the following criteria: (1) cognitive impairment as defined by the subject's performance on the CSID cognitive scale; (2) cognitive/ functional impairment as defined by the total CSID score that included a relative's assessment of the subject's functional abilities; (3) dementia as defined by explicit diagnostic criteria; and (4) possible or probable Alzheimer's Disease as defined by explicit criteria. RESULTS: The vascular risk factor mediating medications, when analyzed together, were associated with a significantly decreased risk of diagnosis of cognitive impairment after controlling for age, education, and stroke (OR 0.73, P = .01) and also a significantly decreased risk of cognitive/functional impairment (OR 0.66, P = .02). Antihypertensive agents, excluding centrally acting sympatholytic drugs were associated with a significantly reduced risk of diagnosis of cognitive impairment (OR 0.56, P < .01) and cognitive/functional impairment (OR 0.64, P = .01). Centrally acting sympatholytic agents were associated with an increased risk of diagnosis of cognitive impairment (OR 2.24, P < .01). There was a trend toward protection from a diagnosis of AD and dementia for the vascular risk factor mediating medications and for the antihypertensive medication, but this did not reach significant levels. CONCLUSIONS: These data suggest that the use of medications to ameliorate vascular risk factors, particularly antihypertensive medication, may also be useful in reducing the risk of cognitive impairment in older subjects. However, they also suggest that physicians should be cautious in prescribing antihypertensive drugs with centrally acting sympatholytic properties to older subjects.     

Mild cognitive impairment

Mild cognitive impairment is a syndrome defined as cognitive decline greater than expected for an individual's age and education level but that does not interfere notably with activities of daily life. Prevalence in population-based epidemiological studies ranges from 3% to 19% in adults older than 65 years. Some people with mild cognitive impairment seem to remain stable or return to normal over time, but more than half progress to dementia within 5 years. Mild cognitive impairment can thus be regarded as a risk state for dementia, and its identification could lead to secondary prevention by controlling risk factors such as systolic hypertension. The amnestic subtype of mild cognitive impairment has a high risk of progression to Alzheimer's disease, and it could constitute a prodromal stage of this disorder. Other definitions and subtypes of mild cognitive impairment need to be studied as potential prodromes of Alzheimer's disease and other types of dementia.     

Mild cognitive impairment in older people

CONTEXT: As public awareness of Alzheimer's disease increases, more people are asking for help and advice about memory problems. Memory complaints may be secondary to psychiatric, psychological, and physical conditions and is an almost universal early symptom of dementia. The concept of amnestic mild cognitive impairment attempts to describe those people in whom memory loss is not of such severity to merit a diagnosis of dementia. The importance of this group of people is not just the need to develop interventions which ameliorate individual suffering but that they represent a population at high risk of developing dementia, especially Alzheimer's disease, and are an appropriate target for dementia prevention strategies. STARTING POINT: K Kantarci and colleagues (Dement Geriatr Cogn Disord 2002; 14: 198-207) looked at the diagnostic accuracy of magnetic-resonance hippocampal volumetry and spectroscopy in patients with mild cognitive impairment, in normal older people, and in patients with Alzheimer's disease. Hippocampal volumes and N-acetyl aspartate/creatine spectroscopy were the most sensitive assessments discriminating people with mild cognitive impairment from Alzheimer's disease. Combination assessments were better at discriminating these two groups from normal controls. The histological underpinning of cognitive symptoms in older people has been demonstrated by the Cognitive Function and Ageing study (Lancet 2001; 357: 169-75), which showed that a third of people with no clinical evidence of dementia had histopathological hallmarks of Alzheimer's disease. WHERE NEXT? 25 million people across the world have dementia. Mild cognitive impairment, if a validated concept, represents an opportunity for preventing dementia. As more information becomes available about the cause of Alzheimer's disease and prospects emerge for prevention, identification of predementia states offers considerable scope to reduce the individual and societal cost of the illness. Continued validation of the criteria for mild cognitive impairment and studies of intervention should be a priority. As more evidence becomes available highlighting the relatively arbitrary nature of dementia diagnosis (based largely on interference with activities) and interventions become available for the prevention of dementia, mild cognitive impairment and related conditions will become more important.     

Distinction between preclinical Alzheimer's disease and depression

OBJECTIVE: To assess the prevalence of depression in subjects with preclinical Alzheimer's disease (AD) and to investigate the possibility of differentiating subjects with preclinical AD and depression from subjects with depression-related cognitive impairment. DESIGN: A prospective, observational cohort study. SETTING: An outpatient memory clinic of a university-affiliated hospital. PARTICIPANTS: Nondemented subjects with cognitive impairment older than 55 years (n = 111) without neurological or somatic causes for the cognitive impairment. MEASUREMENTS: At baseline, data were collected on patient characteristics, the severity of depression, and cognitive functioning. The course of the cognitive impairment and the presence of dementia were assessed after 2 and 5 years. RESULTS: Twenty-five subjects had preclinical dementia with Alzheimer's type dementia at follow-up. Sixty percent of these subjects (n = 15) were depressed at baseline. Subjects with depression and preclinical AD had at baseline a poorer performance on the cognitive tasks and were older than the subjects with depression-related cognitive impairment. Logistic regression with backward step selection selected age and memory performance as the best predictors for Alzheimer's type dementia in the depressed subjects. The specificity of these predictors for the diagnosis of future Alzheimer's type dementia in depressed subjects was 94%, sensitivity was 90%, positive predictive value was 90%, and negative predictive value was 94%. CONCLUSIONS: Depression is common in preclinical AD. Depressed subjects with preclinical AD can be accurately differentiated from subjects with depression-related cognitive impairment by age and the severity of the memory impairment. Research that aims to investigate preclinical AD should not exclude a priori subjects with depression inasmuch as preclinical AD is often accompanied by depression.     

Functional status and cognitive impairment in Alzheimer's patients with and without depression

Cognitive impairment and depression each compromise functional status in the elderly, but it is not known whether their coexistence is associated with additive functional impairment. The effect of the presence or absence of a diagnosis of major depression on functional status was examined in a group of 50 community-residing patients with dementia of the Alzheimer's type (DAT). Patients were diagnosed as depressed (N = 20) or not (N = 30) according to DSM-III criteria. Cognitive status was assessed with the Mini-Mental State Exam (MMSE), and functional status was assessed by family report of Instrumental Activities of Daily Living (IADLs). Consistent with previous reports, patients with a depression diagnosis were less cognitively impaired than their nondepressed counterparts. When cognitive status was controlled for, depression diagnosis was found to have a main effect on functional impairment. Although the direction of effects between depression and functional limitations was not determined here, these results suggest that alleviating depression may decrease functional limitations in DAT patients.     

Dementia undiagnosed in poor older adults with functional impairment

OBJECTIVES: To identify variables associated with diagnosing dementia in poor older adults by comparing older people with dementia who were diagnosed by their primary care physicians (PCPs) with those not diagnosed by their PCP.
DESIGN: Observational study.
SETTING: Community-based, in-home cognitive assessment program.
PARTICIPANTS: Four hundred eleven adults aged 55 and older with cognitive impairment.
MEASUREMENTS: Instrumental activities of daily living (IADLs), activities of daily living (ADLs), Mini-Mental State Examination, Short Blessed Memory Orientation and Concentration Test, and Clinical Dementia Rating.
RESULTS: Alzheimer's disease was the most common diagnosis in this group of primarily African-American (73%) older people. Of the 411 participants, 232 (56%) were not diagnosed by their PCP. Participants without a previous diagnosis were older (mean age 81.7 vs 78.7, P =.01), more independent in IADLs ( P <.001), and more likely to live alone ( P =.001) than persons diagnosed by their PCP. Of the 201 who lived alone, 66% were not diagnosed with dementia by their PCP. Variables associated with PCP diagnosis were more severe cognitive impairment ( P <.001), spouse caregiver ( P =.009), younger age ( P =.02) and care from a university-based PCP ( P =.04).
CONCLUSION: Persons with dementia who were older and lived alone were less likely to be diagnosed by their PCP. Although persons not diagnosed by their PCP had less cognitive impairment, they had substantial impairment in activities, including handling finances, cooking, and managing medications.     

Clinical backgrounds and morbidity of cognitive impairment in elderly diabetic patients

Despite numerous reports that have linked diabetes with cognitive impairment (CI), there are few studies that have attempted to clarify the morbidity of CI among elderly diabetic patients. The Mini-Mental State Examination (MMSE) was performed on 240 diabetic patients aged 65 years or older who had no diagnosis of dementia. The MMSE scores were 28-30 (normal range) in 151 patients (63%), 24-27 (suspected CI) in 77 (32%), and ≤ 23 (definite CI) in 12 (5%). Eight of the 12 patients with MMSE scores ≤ 23 underwent further detailed examination: the final diagnosis was Alzheimer's disease (AD) (N = 5), vascular dementia (N = 2), and mixed dementia (N = 1). Among 24 of the 77 patients with MMSE scores of 24-27 who were referred for further detailed examination, the final diagnosis was early AD (N = 5), cerebrovascular disease (CVD) (N = 10), and mild CI (N = 7). Only 2 of the patients were judged as being normal. The percentage of patients with a history of CVD, the rate of diuretic use, and the serum levels of non-high-density lipoprotein cholesterol were higher, and the percentage of patients with a history of habitual alcohol consumption was lower in the low MMSE score group than in the normal MMSE score group. Among elderly diabetic patients aged 65 years or older, 5% had evident CI and 32% had suspected CI. Medical staff involved in the care of diabetic patients should be highly aware of possible CI in this patient population.     

Physical exercise at midlife and risk of dementia three decades later: a population-based study of Swedish twins

BACKGROUND: With the number of people with dementia increasing, identifying potential protective factors has become more important. We explored the association between physical exercise at midlife and subsequent risk of dementia among members of the HARMONY study. METHODS: Measures of exercise were obtained by the Swedish Twin Registry an average of 31 years prior to dementia assessment. Dementia was diagnosed using a two-stage procedure--screening for cognitive impairment followed by full clinical evaluation. We used two study designs: case-control analyses included 264 cases with dementia (176 had Alzheimer's disease) and 2870 controls; co-twin control analyses included 90 twin pairs discordant for dementia. RESULTS: In case-control analyses, controlling for age, sex, education, diet (eating fruits and vegetables), smoking, drinking alcohol, body mass index, and angina, light exercise such as gardening or walking and regular exercise involving sports were associated with reduced odds of dementia compared to hardly any exercise (odds ratio [OR] = 0.63, 95% confidence interval [CI], 0.43-0.91 for light exercise; OR = 0.34, 95% CI, 0.16-0.72 for regular exercise). Findings were similar for Alzheimer's disease alone. In co-twin control analyses, controlling for education, the association between higher levels of exercise and lower odds of dementia approached significance (OR = 0.50, 95% CI, 0.23-1.06; p =.072). CONCLUSIONS: Exercise at midlife may reduce the odds of dementia in older adulthood, suggesting that exercise interventions should be explored as a potential strategy for delaying disease onset.     

Vascular dementia versus dementia of Alzheimer's type: do they have differential effects on caregivers' burden?

OBJECTIVES: We investigated homecare patients with dementia of Alzheimer's type (DAT; n = 36) or vascular dementia (VD; n = 36) and their care-providing relatives regarding clinical and psychosocial variables to determine whether DAT and VD impose different burdens on caregivers. METHOD: All patients were diagnosed according to ICD-10 criteria. The diagnoses were confirmed by internal medical, clinical-neurological, and psychiatric parameters. The severity of the dementias was graded according to the Global Deterioration Scale (GDS). Caregiving relatives responded to the Behavioral Pathology in Alzheimer's Disease Rating Scale (BAD), the Blessed Dementia Scale (BDS), and the Screen for Caregiver Burden (SCB). RESULTS: Analyses revealed that caregivers' burden (SCB), disease symptoms and personality changes of patients (BAD), and the patients' inability to cope with everyday tasks (BDS) were sharply higher for DAT than for VD patients in the group with severe dementia. Concerning patients with mild or moderately severe disease, scores in the DAT group were similar or lower than those in the VD group. CONCLUSION: In early stages, VD patients impose a greater burden on relatives than do patients with DAT. In severe stages this relationship undergoes a reversal, with relatives of DAT patients experiencing the burden more adversely than those of VD patients. The differences in the onset and course characteristics, as well as the specific differences between these two types of dementia with respect to caregiver burden factors, call for their diagnostic separation and the development of specific homecare support systems for family caregivers.     

帕金森病痴呆与阿尔茨海默病认知障碍特点分析

目的 分析帕金森病痴呆(PDD)与阿尔茨海默病(AD)患者的认知障碍特点.方法 采用语义流畅性、语音流畅性、动作流畅性测验与物品和动作命名测验评定PDD组(30例)、AD组(30例)与对照组(60例)患者临床情况.结果 PDD组语义流畅性测验总分(9.33±2.78)分、语音流畅性测验总分(6.17±1.67)分、动作流畅性测验总分(7.03±2.34)分,AD组分别为(6.90±2.47)分、(7.87±2.01)分、(8.30±3.17)分;PDD组物件命名测验总分(36.33±3.39)分、动作命名测验总分(17.63±2.17)分,AD组分别为(33.23±3.56)分与(22.33±2.37)分.与对照组比较,PDD与AD患者三项言语流畅性与物品和动作命名均受损(P＜0.01).其中,PDD患者以语音流畅性、动作流畅性与动作命名损害为重,而AD患者以语义流畅性与物件损害为重(P＜0.01).结论 PDD与AD患者均存在执行功能障碍与命名损害,PDD是一种伴有皮质功能损害以额叶皮质下功能障碍为主要特点的认知损害性疾病,而AD亦存在皮质下功能障碍.

Abstract：

Objective To analyze the characterization of cognitive function in Parkinson's disease with dementia and Alzheimer's disease. Methods Cognitive function was examined in Parkinson's disease with dementia (PDD) patients ( n = 30) , Alzheimer's disease (AD) patients ( n = 30) and healthy elderly control subjects ( n = 60) . Neuropsychological evaluation contained semantic fluency test, phonemic fluency test, action fluency test, objective and action naming tests. Results In PDD group , the score of semantic fluency test is 9. 33 ±2. 78, 6. 17 ± 1.67 of phonemic fluency test and 7.03 ±2. 34 of action fluency test,it is 6.90 ±2.47, 7.87±2.01,8.30±3. 17 of AD group. The score of objective and action naming tests is 36.33 ±3.39, 17.63 ±2. 17 in PDD group,while AD patients is 33.23 ±3.56 and 22.33 ±2.37. The verbal fluency tests and naming tests were impaired in PDD and AD patients compared with the healthy elderly control group (P ＜ 0. 01 ), phonemic fluency, action fluency and action naming were more impaired in PDD patients compared with the AD group , while semantic fluency and objective naming were more impaired in AD patients (P ＜ 0. 01 ). Conclusions Executive function deficit and naming impairment are found in PDD and AD patients, it shows that PDD is characterized by the addition of cortical dysfunction upon a predominant and progressive fronto-subcortical impairment. There is subcortical dysfunction in AD patients.