老年人主观记忆抱怨研究进展

综述主观记忆抱怨概念,老年人主观记忆抱怨评估工具、影响因素及干预研究进展,以期为早期发现和预防我国老年人主观记忆抱怨的发生,提高存在主观记忆抱怨症状的老年人的生活质量和降低痴呆转化率提供参考。     

阿尔茨海默病患者的记忆策略训练

目的探讨记忆策略训练对阿尔茨海默病患者记忆康复的效果。方法运用无错误学习法和间隔提取法对1例阿尔茨海默病患者进行记忆策略训练。通过面孔姓名联想、图片故事阅读、记日记的方式训练患者的记忆功能。采用Rivermead行为记忆测验对患者干预前后的记忆功能进行评定。结果干预前患者Rivermead行为记忆测验仅识别面孔、识记图片、故事即时回忆和路线即时回忆各得1分,总分为4分,为重度记忆障碍;干预30d后,患者识别面孔、记忆姓名、识记图片、故事即时和延迟回忆项目各上升1分,总分为9分,仍为重度障碍,但记忆障碍程度有所好转。结论记忆策略训练可减轻阿尔茨海默病患者的记忆障碍。     

老年痴呆患者辨证施护联合记忆康复训练研究

目的探讨辨证施护联合记忆康复训练对老年痴呆患者自理能力、精神状态、记忆及生活质量等方面的影响。方法将106例老年痴呆患者随机分为观察组和对照组各53例。对照组实施常规护理干预,观察组实施中医辨证施护联合记忆康复训练干预,干预前及干预6个月采用日常生活自理能力量表(ADL)、简易智能精神状态量表(MMSE)、韦氏记忆量表(WMS)、匹兹堡睡眠质量指数(PSQI)、世界卫生组织生存质量测定量表(WHOQOL-100)、中国康复研究中心汉语标准失语症检查法(CRRCAE)评估患者。结果干预后观察组患者ADL、MMSE、WHOQOL-100、WMS、PSQI、CRRCAE评分显著优于对照组(P0.05,P0.01)。结论对老年痴呆患者实施辨证施护联合记忆康复训练,可提升患者生活自理能力及生活质量,改善改善睡眠质量及患者精神状态,增强患者记忆力,促进语言障碍恢复。     

冠心病患者参与心脏康复感知障碍的质性研究

目的了解冠心病患者参与心脏康复感知的障碍,为临床干预提供参考。方法采用质性研究中的现象学方法对12例冠心病患者进行深度访谈,分析资料并提炼主题。结果冠心病患者参与心脏康复的感知障碍可归纳为4个主题:患者缺乏参与的信息及动力,社会支持不足,后勤保障不充分,医疗卫生系统不完善。结论冠心病患者参与心脏康复存在多重障碍,医务人员应该加强对患者的健康宣教及心理疏导,帮助患者解决疑惑和实际困难,促进患者积极参与心脏康复。     

外科病人手术感知记忆调查

采用问卷调查的方法,对220例手术病人进行手术感知记忆调查.结果病人对医护人员的服务态度印象最深(60.0%,132/220),以下依次为技术(22.3%,49/220),术中疼痛(1.4%,3/220)、环境的不良刺激(0.9%,2/220)、术后疼痛(13.2%,29/220),其它(2.3%,5/220).提示病人术中需求医护人员优良的服务态度与技术,以增强安全感.     

orexin调控学习记忆的研究进展

背景 orexins是由位于下丘脑外侧部穹窿周围的神经元分泌的一类神经肽,它们在体内作用广泛,不仅能促进食欲,调节能量平衡,调节睡眠与觉醒,参与奖赏系统及情绪反应,调节内分泌及心血管系统,而且最新的研究表明,orexins对学习与记忆也有调控作用. 目的 对orexins调控学习记忆的各种认识和最近研究进展进行综述. 内容 简述orexins通过海马途径和非海马途径对学习记忆进行调控,以及与神经退行性变引起的学习记忆障碍之间的关系. 趋向 orexins在学习记忆过程中发挥的作用尚不完全清楚,进一步研究可能为解释和干预术后认知功能障碍及神经退行性变提供新的思路.     

术中失血量对手术患者记忆障碍的影响及护理对策

目的探讨术中失血量对手术患者记忆功能的影响。方法对282例外科手术患者采用称重法、计量法统计术中出血量,于术前24h、术后24h采用行为记忆测验第2版(RBMT-Ⅱ)进行记忆功能的测评。结果 282例患者中,发生术后记忆障碍194例(68.8%),其中轻度98例(50.5%),中度93例(47.9%),重度3例(1.6%);术中失血量>400mL的患者术后记忆障碍发生率高,且程度重(P<0.01)。结论术中失血量对术后患者的记忆功能有一定的影响,采取积极措施减少术中失血量可降低术后患者记忆障碍的发生率。     

主观记忆障碍高血压患者治疗依从性及其影响因素研究

目的分析主观记忆障碍高血压患者治疗依从性及其影响因素,为制定相关管理及护理干预措施提供参考。方法通过方便抽样的方法抽取326例主观记忆障碍的社区高血压患者,采用自制人口学问卷、高血压治疗依从性量表(TASHP)、简易精神状态量表(MMSE)、听觉词语记忆测验(AVLT)、连线测验(TMT)、数字广度测验(DST)、画钟测验(CDT)评估高血压治疗依从性和认知功能。结果高血压治疗依从性量表的总分为(100.69±11.61)分,量表的条目得分均值为(4.03±0.46)分,4个维度得分由高到低依次为不良服药管理、烟酒嗜好管理、遵医服药行为和日常生活管理维度。Logistic回归分析发现年龄(OR=2.132,P=0.000)、长延迟回忆(OR=1.203,P=0.001)是该人群治疗依从性的独立影响因素。结论主观记忆障碍高血压患者治疗依从性较好,但日常生活管理能力还有待提升;护理人员应针对具体人群实施针对性的干预措施,进一步提高患者非药物依从性。     

腔隙性脑梗死患者记忆障碍的相关因素

目的探讨腔隙性脑梗死患者发生记忆障碍的相关危险因素。方法选择98例住院诊断为腔隙性脑梗死患者作为研究对象。采用Wechsle成人记忆量表评定腔隙性脑梗死患者记忆障碍的临床特征及相关因素。结果腔隙性脑梗死患者记忆障碍的发生和教育程序、神经功能缺损重、伴发关系到状积分高、存在智能障碍及抑郁障碍有关。结论腔隙性脑梗死患者记忆障碍具有特定临床特点。     

丙泊酚麻醉对患者短期记忆的影响

目的 观察丙泊酚麻醉对患者短期记忆的影响.方法 选择无痛胃镜或肠镜检查的非住院患者67例,静注芬太尼和丙泊酚,待患者睫毛反射消失、OAA/S评分达0分开始进行胃镜或肠镜检查.检查结束后待患者OAA/S评分达5分后进行问卷调查.问卷调查内容包括给药前10min内患者的亲历事件、开始苏醒至OAA达5分之间的亲历事件以及患者检查前睡眠、精神状况等.结果 49.25%的患者发生了遗忘,其中发生顺行性遗忘、逆行性遗忘、顺行性十逆行性遗忘的患者分别有21.2%、69.7%和9.1%.发生记忆障碍与无记忆障碍患者的性别、年龄、职业类型、丙泊酚用约总量、术前情绪、检查时间、恢复时间、是否发生梦境的差异无统计学意义,无记忆障碍者的平均文化水平构成更低,用药量更大(P＜0.05).结论 丙泊酚镇静麻醉可导致一定程度的短期记忆障碍发生,其中逆行性遗忘较顺行性遗忘发生更多.     

Children's memory for trauma and positive experiences

Characteristics of children's memory for a trauma and for a positive event were compared and relationships of memory characteristics to trauma symptoms examined in 30 children who experienced a traumatic event. Results revealed that memories for trauma tended to have less sensory detail and coherence, yet have more meaning and impact than did memories for positive experiences. Sexual traumas, offender relationship, and perceived life threat were associated with memory characteristics. Few relationships between memory characteristics and trauma symptoms were found. Therapist ratings of child memory characteristics were correlated with some child trauma memory characteristic reports. These results are consistent with other studies. Possible explanations include divided attention during the traumatic event and cognitive avoidance occurring after the event.     

Autobiographical memory specificity,intrusive memory,and general memory skills in Dutch-Indonesian survivors of the World War II era

A lack of specific autobiographical memory may result from exposure to psychological trauma, intrusive memories of adverse events, and/or a general memory deficit. This study explored the role of these variables in 25 patients with various psychiatric diagnoses and 15 healthy controls. All participants had been exposed to war atrocities during their childhood in Indonesia. Patients produced significantly less specific memories than did controls. In addition, rather than performance on general neuropsychological memory tests, the frequent occurrence of intrusive memories and the avoidance of reminders of trauma predicted less autobiographical memory specificity. These results replicate and extend earlier findings on intrusive and nonspecific autobiographical memory in depressed samples to a group of people who experienced war atrocities in childhood.     

异丙酚对记忆功能的影响及相关脑机制

异丙酚作为一种短效、快速的静脉全麻药目前已在临床上广泛使用。同时，作为一种镇静-催眠药，它会影响人的注意力，对记忆造成短期或长期的干扰。探讨异丙酚对记忆的影响，不仅有助于更好地了解其在临床使用的安全性，确定其是否会对患者记忆功能造成不可逆的损伤，还将有助于进一步揭示全身麻醉的机制。     

Hypothalamic neuropeptides and memory

Summary Vasopressin and oxytocin exert pronounced effects on behavior by a direct action on the brain. A single injection of vasopressin results in a long-term inhibition of extinction of a conditioned avoidance response suggesting that vasopressin triggers a long-term effect on the maintenance of a learned response, probably by facilitation of memory processes. In addition vasopressin improves passive avoidance behavior, facilitates retention of sexually motivated T-maze choice behavior in male rats, delays extinction of an appetitive discrimination task, affects approach behavior to an imprinting stimulus in ducklings, delays the postcastration decline in copulatory behavior in male rats, prevents or reverses amnesia induced by electroconvulsive shock, CO₂ inhalation, pentylenetetrazol or puromycin. The majority of these effects may be explained by stimulatory influences of vasopressin on memory processes. Generally oxytocin exerts effects which are opposite to those of vasopressin and it has been suggested that oxytocin may be an amnesic neuropeptide.Evidence has been obtained that endogenous vasopressin and oxytocin play a physiological role in brain processes related to memory.Various limbic system structures seem to act as the anatomical substrate for the behavioral effects of vasopressin and different neurotransmitter systems seem to be involved. It is postulated that in case vasopressin affects retrieval processes the site of action is located in the amygdala and the dentate gyrus of the hippocampal complex with dopamine and serotonin as the respective neurotransmitter systems involved. In case the behavioral effect is due to changes in storage processes (memory consolidation) the main sites of action include the noradrenaline terminals in the dorsal septum, dorsal raphe and dentate gyrus of the dorsal hippocampus.Generally the clinical data obtained so far with vasopressin treatment are in agreement with the results from animal experiments and they support the notion on the involvement of vasopressin in memory function. The sometimes reported conflicting results on vasopressin effects in certain patients (Korsakoff or Alzheimer) may have to do with the wide-spread pathology in these diseases.     

Immediate peri-operative memory

BACKGROUND: Information about anterograde and retrograde amnesias in the immediate peri-operative period is scarce. During this period, assessment of memory for real-life events is also rare. We hypothesized that there would be both anterograde and retrograde amnesias and memory for peri-operative events would be better than for verbal memory. METHODS: We studied 40 patients who underwent general anesthesia and surgery and 19 control volunteers who were matched to the patients but did not have surgery. Patients completed the state anxiety part of the Spielberger State-Trait Anxiety Inventory in the pre-operative period. They were presented with three word lists in the holding area, the operating room before induction of anesthesia and the recovery room. Memory for the words was tested the next day by recall and recognition tests. Memory for events that happened on the day of surgery was tested by administering a questionnaire. The control subjects were tested similarly but did not complete the events questionnaire. Retrograde amnesia would be demonstrated by a decline in patients' memory from the holding area to the operating room which exceeded any corresponding changes in controls; anterograde amnesia would be demonstrated by memory impairment of the patients in the recovery room, relative to controls. RESULTS: Recall and recognition of words were significantly impaired in the recovery room with a decline from 12% in the holding area to zero% in the recovery room for recall and from 43% to 7% for recognition. The decline in memory from the holding area to the operating room was not significantly greater in patients than in controls, 80% vs. 56% for recall and 27% vs. 14% for recognition. There were no significant differences for recognition of events which happened in the three rooms. CONCLUSIONS: We were unable to detect retrograde amnesia. Patients' memory for neutral stimuli in the recovery room was severely impaired. The events questionnaire proved to be insensitive.     

形状记忆合金治疗四肢骨折

手术复位内固定是治疗四肢骨折的重要措施。内固定器材与骨折手术治疗的效果有密切的关系，内固定器材的改善可以明显地提高骨折治疗水平。形状记忆合金是一种新的TiNi合金，具有形状记忆效应、强度低、比重低、耐疲劳、耐腐蚀、耐磨损、低磁性、无毒性等特点，已作为一种新的内固定器材在骨科领域得到了初步应用，但是在应用中还存在着一些问题，临床经验少，应用技术还不成熟。     

瑞马唑仑全凭静脉麻醉下外显记忆和内隐记忆的评估

目的 评估瑞马唑仑全凭静脉麻醉（TIVA）下患者的外显记忆和内隐记忆，并观察皮质醇浓度。

方法 选择择期行全麻患者60例，男31例，女29例，年龄18～60岁，BMI 16 ～30 kg/m²，ASAⅠ—Ⅲ级。行BIS监测，维持BIS 40～60。根据听录音内容的不同，通过随机数字表法将患者分为三组：类别组（CT组）、单词组（WM组）和对照组（CG组），每组20例。CT组听五个中频动物词语，WM组听五个中频单词，CG组听大海声。术后1 h，在麻醉恢复室（PACU）对患者进行外显记忆和内隐记忆的评估。外显记忆评估，每组提问以下问题：（1）是否记得手术过程中的任何事情？（2）是否做梦？内隐记忆评估分组提问：（1）CT组行类别评估测试：请说出最先想到的5个动物名；（2）WM组行单词再认测试：请在10个中频词（其中5个在术中播放过）中选出近期听过的词。（3）CG组：提问前两组的所有问题，以获得基础值进行比较。于入室后、听录音20 min、术后1 h抽取静脉血，测定皮质醇。

结果 三组均报告不记得术中事件，CT组记得做梦2例，CG组记得做梦1例，三组差异无统计学意义。CT组和CG组类别评估测试差异无统计学意义。WM组和CG组单词再认测试差异无统计学意义。与入室后比较，听录音20 min CT组、WM组和CG组皮质醇明显降低（P<0.05），术后1 h CT组和WM组皮质醇明显升高（P<0.05）。与听录音20 min比较，术后1 h CT组、WM组和CG组皮质醇明显升高（P<0.05）。不同时点三组皮质醇差异无统计学意义。

结论 瑞马唑仑行全凭静脉麻醉时，BIS监测维持合适的麻醉深度下，未发现患者形成外显记忆或内隐记忆，术中皮质醇降低。     

Non-declarative memory in the rehabilitation of amnesia

The ability of amnesic patients to learn and retain non-declarative information has been consistently demonstrated in the literature. This knowledge provided by basic cognitive neuroscience studies has been widely neglected in neuropsychological rehabilitation of memory impaired patients. This study reports the case of a 43 year old man with severe amnesia following an anterior communicating artery (ACoA) aneurysm rupture. The patient integrated a comprehensive (holistic) day treatment programme for rehabilitation of brain injury. The programme explored the advantages of using preserved non-declarative memory capacities, in the context of commonly used rehabilitation approaches (i.e. compensation for lost function and domain-specific learning). The patient's ability to learn and retain new cognitive and perceptual-motor skills was found to be critical for the patient's improved independence and successful return to work.     

Positive evidence against human hippocampal involvement in working memory maintenance of familiar stimuli

Subjects (n = 40) performed a delayed item recognition task for visually presented letters with three set sizes (1, 3 or 6 letters). Accuracy was close to ceiling at all set sizes, so we took set size as a proxy for WM load (i.e. the amount of information being maintained in WM). Functional magnetic resonance imaging (fMRI) signal associated with the delay period increased in a nearly linear fashion with WM load in the left inferior frontal gyrus/anterior insula (possibly Broca's area, BA 44/45), right anterior insula, bilateral caudate, bilateral precentral gyrus (BA 6), bilateral middle frontal gyrus (BA 9/46), bilateral inferior parietal lobule (with foci in both BA 39 and 40), left superior parietal lobule (BA 7), medial frontal gyrus (BA 6), anterior cingulate gyrus (BA 32) and bilateral superior frontal gyrus (BA 8). These results lend support to the idea that at least some of the cortical mechanisms of WM maintenance, potentially rehearsal, exhibit a scaling with WM load. In contrast, the delay-related fMRI signal in hippocampus followed an inverted U-shape, being greatest during the intermediate level of WM load, with relatively lower values at the lowest and highest levels of WM load. This pattern of delay-related fMRI activity, orthogonal to WM load, is seemingly not consonant with a role for hippocampus in WM maintenance of phonologically codable stimuli. This finding could possibly be related more to the general familiarity of the letter stimuli than their phonological codability per se.     

西脉记忆合金接骨板治疗老年性骨折

老年性骨折由于常合并较严重的内科疾病及骨质疏松,其治疗一直是骨科临床上的一个难题.如何简化手术,减少创伤,缩短手术时间成了治疗老年性骨折的重要任务.西脉记忆合金接骨板的应用在一定程度上解决了这个问题.我院自2000年3月-2002年6月使用西脉记忆合金接骨板治疗老年性骨折29例,疗效满意,现报告如下.……