川芎嗪对妊娠高血压综合征的疗效探讨—球结膜微循环监测

本文采取自身对照及组间对照方法,对38例妊娠高血压综合征(简称妊高征)患者随机分川芎嗪(120～160mg/日)治疗组与硫酸镁(15～202/日)治疗组,按田牛氏球结膜微循环的观察方法进行连续观察。 治疗后发现川芎嗪组球结膜微循环改善较明显:渗出或水肿减轻,清晰度提高,微血管数目增多,缺血区减少,血流速度增快,红细胞聚集减轻,尤以中度妊高征明显。治疗后综合积分值下降幅度为9.44±7.49,治疗前后对照P<0.01有非常显著意义。说明治疗效果明显,而硫酸镁组中度妊高征综合积分值下降幅度为8.30±12.78治疗前后对照P>0.05,组间比较P>0.05.两组重度妊高征治疗前后及组间对照P>0.05,均无显著性差异。 本文还发现川芎嗪组改善自觉症状较硫酸镁组快,降低血压、消除尿蛋白及水肿较硫酸镁优。特别对中度妊高征更为理想,值得推广。     

哈伯因(石杉碱甲)治疗阿尔茨海默病的临床对比研究

老年性痴呆以阿尔茨海默 (AD)居高 ,约占 70 % ,且近年发病率逐年上升 ,改善 AD患者的生活质量是老年医学的首要任务 ,我们应用哈伯因治疗 AD患者 32例 ,能显著改善痴呆患者的记忆力 ,认知功能 ,日常生活能力 ,疗效明显优于脑复康 ,现报告如下 :1　临床资料选择门诊就诊的 AD患者 6 5例 ,随机分两组 ,治疗组 32例 ,男 2 0例 ,女 12例 ,平均年龄 77.3± 2 .4岁。赫金多斯基缺血量评分 :4.4± 3.5分 ,痴呆量表评分 :2 2 .4± 3.5分 ;对照组 33例 ,其中男 2 3例 ,女 10例 ,平均年龄 76 .8± 3.2岁 ,赫金斯基缺血量表评分 4.8± 3.2分 ,痴呆…     

精神科记忆门诊阿尔茨海默病患者的精神行为症状

目的:探讨精神科记忆门诊阿尔茨海默病(Alzheimer’s Disease,AD)患者精神行为症状特征及相关因素。方法:本研究样本来源于北京大学精神卫生研究所记忆中心2006年3月～2010年3月登记的数据库,共选取完成全套神经心理测查与精神行为评估的AD患者129例。采用神经精神科问卷(Neu-ropsychiatric Inventory,NPI)评定所有被试的精神行为症状。采用简易智力状态检查(Mini-Mental StateExamination,MMSE)和阿尔茨海默病评定量表-认知部分(Alzheimer Disease Assessment Scale-CognitivePortion,ADAS-Cog)评定认知功能,日常生活活动能力量表(Activities of Daily Living,ADL)评定生活功能状况。依据MMSE评分将被试分为轻度(MMSE≥20,46例)、中度(MMSE=11～19,59例)和重度(MMSE≤10,24例)3组。采用因子分析了解AD患者精神行为症状特征,采用方差分析比较3组间差异。结果:①对AD患者精神行为症状因子分析,得到3个症状群,分别为精神病性症状、额叶释放症状和情感症状。重度AD组NPI总分、精神病性症状因子分和额叶释放症状因子分显著高于轻、中度AD组(均P<0.05)。轻、中、重度AD组间情感症状因子分差异无统计学意义(P>0.05)。②AD患者精神行为症状相关因素:NPI精神病性症状因子、额叶释放症状因子评分与ADAS-Cog记忆、语言、操作能力和注意力等因子分及ADL评分与呈正相关(r=0.28～0.47,P<0.05),NPI情感症状因子分与ADAS-Cog语言和操作能力因子分呈正相关(r=0.19,0.24;P<0.05)。结论:阿尔茨海默病患者精神行为症状以精神病性、额叶损害和情感症状为主要特征,随疾病严重程度加重而加重。认知和日常生活功能差的阿尔茨海默病患者的精神行为症状更严重。     

阿尔茨海默病患者外周血Aβ抗体和细胞因子的变化

目的 探讨阿尔茨海默病（AD）患者外周免疫功能的变化。 方法 以2006-06～2007-04广州市老人院29例AD患者作为观察对象,其中轻中度AD患者19例,重度10例;对照组19例为同期健康老人。用夹心酶联免疫吸附法（ELISA）测定外周血Aβ抗体以及抗原特异性细胞因子的水平;流式细胞术(FACS)检测外周血淋巴细胞亚群变化;酶联免疫吸附斑点试验（ELISPOT）检测抗原特异性细胞因子的分泌细胞频数。 结果 轻中度和重度AD组患者外周血Aβ₄₂抗体水平较对照组有不同程度的下降(分别为P<0.05,P<0.01)。AD组CD8较对照组显著升高（P<0.05）; CD4较对照组显著降低（P<0.05）; 轻中度和重度AD组之间CD8、CD4及CD4/ CD8差异均无统计学意义(P>0.05)。AD组外周血单核细胞(PBMC)培养上清IFN-γ的含量较对照组降低（P<0.05）,以重度AD组更明显。ELISPOT检测结果,AD组每4×10⁵个PBMC中分泌IFNγ的细胞频数较对照组显著减少（P<0.01）,以重度AD患者更为明显。 结论 AD患者外周血Aβ抗体水平下降;淋巴细胞亚群失调,特异性细胞免疫功能受损。     

Boston命名测验在识别轻度认知损害和阿尔茨海默病中的作用

目的观察Boston命名测验(Boston Naming Test,BNT)30项版本在中国的适用状况和对于遗忘型轻度认知损害(aMCI)与阿尔茨海默病(AD)的识别作用。方法应用BNT(中文版)、简明精神状态量表(MMSE)和听觉词语记忆测验等神经心理测验评估100名社区正常老人、38名MCI、34名轻度AD和38名中度AD患者,4组被试的MMSE总分分别为28.4±1.5、26.1±2.6、20.7±1.7和15.6±3.3。结果正常老人的BNT的自发命名得分与年龄、性别和受教育程度显著相关。正常老人组、aMCI组、轻度AD组和中度AD组自发命名得分分别为24.9±3.0、20.9±3.6、18.7±4.0和15.7±4.2分。以BNT自发命名≤22分作为划界分,识别aMCI的敏感性为61%,识别轻度AD的敏感性为79%,识别中度AD的敏感性为95%,特异性均为81%。提示命名、选择命名能力在aMCI和轻中度AD患者中也呈现进行性损害,但比自发命名能力的下降轻得多。结论正常老人的命名能力受到其年龄、性别和教育程度的影响,aMCI和早期AD患者存在命名能力损害。     

阿尔茨海默病语言障碍的神经心理学研究

度 AD患者之间在除信息量、流利性、系列语言、视读、听字辨认等的所有亚项上差异均显著 (p<0 .0 5 ) ,但尚未出现经皮质感觉性失语 ;12例重度 AD患者 (CDR=3 )与中度 AD组之间在除流利性的所有亚项上差异均显著 (p<0 .0 5 ) ,有 6例类似于经皮质感觉性失语 ,5例类似于韦尼克失语 ,1例类似于命名性失语 ;痴呆严重程度与脑萎缩范围呈正相关 ,r=0 .5 5 3 p<0 .0 1。结论 :AD的语言障碍在各阶段表现为不同形式的流利型失语 ,其变化与不同程度的脑萎缩有关。     

两种画钟测验评估阿尔茨海默病的差异研究

目的:探讨自发画钟测验和模仿画钟测验(CDT)在评估不同严重度阿尔茨海默病(AD)中的价值.方法:30例正常中老年人、20例遗忘型轻度认知障碍(aMCI)患者、20例轻度AD患者、19例中度AD患者和14例重度AD患者完成自发画钟测验和模仿画钟测验等一系列神经心理测验.结果:自发CDT,MCI组与正常组比较,"锚定部分"(首先画出"12-3-6-9"4个关键点)有显著差异(P＜0.05),数字部分、指针部分无显著差异(P＞0.05),而轻度AD组与正常组比较,锚定部分、数字部分、指针部分均有显著差异(P＜0.05).根据CDT的成分分析,锚定部分在五组中下降早而且速度快:数字部分在五组中下降最缓慢,指针部分介于两者之间.就CDT模仿总分来说,轻度AD组与中度AD组比较、中度AD组与重度AD组比较有显著差异(P＜0.05),而正常组与MCI组比较、MCI组与轻度AD组比较无显著差异.结论:自发CDT有助于早期识别MCI和轻度AD,模仿CDT有助于区分AD的不同严重度.     

慢性萎缩性胃炎形态定量诊断的探讨

对正常胃体,胃窦大、小弯及浅表性炎症时粘膜固有腺体计数,经统计学处理求得标准单位面积内腺体密度。其结果:胃体37.4±5.4,胃窦大弯37.3±4.0,胃窦小弯33.4±4.3,中度浅表性炎症27.2±3.3,重度浅表性炎症21.6±2.6。以此为依据得到定量诊断萎缩性胃炎及分级的标准是:胃窦大、小弯,胃窦小弯中、重度浅表性炎症时,轻度萎缩的腺体密度分别为大于22、19、16、13,重度萎缩时分别为小于10、8、7、5,位于两者之间者为中度萎缩。     

小鼠胚胎发育过程中SCE值的观察分析

提要:本文运用液体石蜡-IUdR、UV-Giemsa术,对小鼠的早、中、晚期胚胎细胞和母鼠骨髓细胞的SCE值进行了测定,其数值分别为2.96±1.53、3.21±1.48、3.05±1.31和3.29±1.71,P>0.05。表明小鼠胚胎细胞的SCE值是比较恒定的,不受胚胎发育的影响,同时与母鼠间也无显著差异。     

胸腺形态与胸腺静脉的解剖学特点及其临床意义

目的:探讨胸腺形态与胸腺静脉的解剖学特点和临床意义。方法:回顾性分析1989￣2003年胸腺手术切除123例。将病例分为胸腺增生组和胸腺瘤组,观测胸腺形态、胸腺静脉的数目、走行、长度和直径。结果:术中见胸腺形态分5种形态:H型占65.9%,蝶型占14.6%,三角型占10.7%,条型占6.5%,多叶型占3.3%。胸腺静脉汇入部位变异较大,多汇入左无名静脉(占67.2%)。胸腺静脉长:胸腺增生组为(18.4±2.2)mm,外径(5.4±0.1)mm,胸腺瘤组为(18.8±2.4)mm,外径(5.5±0.1)mm,两组胸腺静脉长度与外径差异无统计学意义(P>0.05)。结论:了解胸腺形态、胸腺静脉的解剖学特点对胸腺手术具有临床意义。     

Detecting depression in Alzheimer's disease: evaluation of four different scales.

Depression is a frequent condition in Alzheimer's disease (AD). The prevalence of depressive symptoms depends on the severity of dementia and the instruments used. Our aim was to assess the prevalence of depression dependent on the severity of dementia by four different scales: The 15-point Geriatric Depression Scale (GDS), the Montgomery and Asperg Depression Scale (MADRS), the Cornell Scale for Depression in Dementia (CSDD) and the Nurses Observation Scale for Geriatric Patients (NOSGER). The study population consisted of 316 patients with Alzheimer's disease from a psychiatric out-patients memory-clinic, which was divided into two groups: mild AD (Mini-Mental Status Examination (MMSE) > or = 18) and moderate to severe AD (MMSE <18). Additionally, internal consistency and correlation of these scales were calculated. Prevalence of depression ranged between 27.5 and 53.4% in mild AD and between 36.3 and 68.4% in moderate to severe AD. Internal consistency was good in all scales (Cronbach's alpha .63-.85). For MADRS and CSDD it was independent of the stage of AD, while in GDS and NOSGER internal consistency decreased with severity of dementia. Correlation between the scales was better in mild AD than moderate to severe AD; the best results were obtained for the correlation between CSDD and MADRS in both groups. We conclude that in our study population CSDD and MADRS were the most consistent tools for detecting depression in AD independently of the severity of dementia.     

连线测验(中文修订版)在早期识别阿尔茨海默病中的作用

目的：中文修订版的连线测验（TMT）在识别轻度认知功能障碍（MCI）和轻度阿尔茨海默病（AD）中的作用。方法：对正常老人94名．遗忘型MCI组107例和轻度AD组54例进行MMSE、TMT在内的8种神经心理测验。结果：正常老人与MCI组TMT完成率均高于轻度AD组。年龄与教育程度对TMT—B的影响比TMT—A更大。TMT-A、B与MMSE、CFT模仿、CWCR、CFT回忆、AVLT延迟回忆均有显著相关性。完成TMT—A、B测验．NC组、MCI组与轻度AD组两两比较均有显著差异，TMT可以清楚的区分三组。结论：TMT对MCI病人有一定的辅助识别作用，对轻度AD病人有较强的辅助识别作用．     

ADAS-Cog中文版区分轻、中度阿尔茨海默病的能力

目的：探讨阿尔茨海默病评定量表认知部分(ADAS-Cog)中文版区分轻、中度AD的能力。方法：199例轻度和106例中度AD患者为研究被试(符合NINCDS-ADRDA很可能AD诊断标准),对所有被试进行ADAS-Cog中文版测试。结果：中度AD患者ADAS-Cog总分及各条目评分明显高于轻度AD被试,GLM分析提示ADAS-Cog评分不受被试年龄与受教育程度的影响,ADAS-Cog能有效反映轻、中度AD患者不同的认知损害模式而不依赖于被试的学历。Logistic回归分析定向力和结构性练习条目评分及ADAS-Cog总分能有效区分轻、中度AD,敏感度为78％-82％,特异度为70％-73％。结论：ADAS-Cog中文版对轻、中度AD具有较好的区分能力,推荐将该量表用于评估药物对中国AD患者认知功能的疗效。     

Detecting dementia with the Hopkins Verbal Learning Test and the Mini-Mental State Examination.

The Hopkins Verbal Learning Test (HVLT) and the Mini-Mental State Examination (MMSE) were administered to 323 non-demented elderly and 70 individuals who meet DSM-IV criteria for dementia in order to compare the validity of these two measures for detecting mild dementia and for the two most common dementia subtypes, Alzheimer's disease (AD) and vascular dementia (VaD). The study was conducted in an elderly, ethnically diverse community-dwelling population. Sensitivity, specificity, positive and negative predictive values were calculated over a range of clinically relevant cut scores for each test. We analyzed the influence of age, education, reading ability and sex on test performance using logistic regression models.When sensitivity is held constant at 0.69, the specificity for the HVLT total recall was 0.89 and the MMSE 0.82 for all dementias (P=.10). Age, sex and education did not significantly influence test performance for either test in this sample. Results were similar for AD and VaD. However, while adding a measure of reading ability to the regression models did not affect the overall dementia model, it resulted in improved specificities when combined with the MMSE for AD and combined with the HVLT for VaD. Additional tests such as reading ability can improve discrimination of dementia subtypes. The modest sensitivity of either the HVLT or the MMSE alone suggests that further neuropsychological evaluation is required to confirm dementia diagnosis.     

Daytime sleepiness in mild and moderate Alzheimer's disease and its relationship with cognitive impairment

The increased tendency to fall asleep during the daytime together with increased wakefulness during the night has been demonstrated in patients with advanced Alzheimer's disease (AD). The aim of this study was to assess daytime sleep propensity in a cohort of patients with mild/moderate AD and to correlate it with cognitive impairment. Twenty drug-free AD patients meeting the NINCDS-ADRDA criteria for probable AD were evaluated. According to their Clinical Dementia Rating scores, subjects were classified into mild (CDR1; n=11) and moderate (CDR2; n=9) dementia patients. A group of 12 healthy subjects was taken as controls. The subjects were evaluated by the multiple sleep latency test (MSLT) after their nocturnal sleep pattern had been assessed by a polysomnographic recording throughout the night before. Both groups of AD patients showed a higher level of daytime sleepiness, which was statistically significant for mean daytime sleep latency (MDSL) (controls versus CDR1 and versus CDR2, CDR1 versus CDR2) and for 10:00 and 12:00 hour naps (controls versus CDR1, controls versus CDR2). In the entire group of AD patients, MDSL was significantly related with MMSE, De Renzi's Token test, verbal fluency, verbal digit span, story recall, Raven's Progressive Matrices, Weigl test and Benton's three-dimensional test. These data indicate that an increased sleep propensity during daytime occurs also in patients with mild/moderate AD detected by objective neurophysiological techniques.     

Altered ionized magnesium levels in mild-to-moderate Alzheimer's disease

Magnesium deficiency is present in several chronic, age-related diseases, including cardiovascular, metabolic and neurodegenerative diseases. Alzheimer's disease (AD) is the most common cause of dementia. The aim of the present study was to study magnesium homeostasis in patients with mild to moderate AD. One hundred and one elderly (≥65 years) patients were consecutively recruited (mean age: 73.4±0.8 years; M/F: 42/59). In all patients, a comprehensive geriatric assessment was performed including cognitive and functional status. Admission criteria for the AD group (diagnosed according to the DSM-IV and the NINCDS-ADRDA criteria) included: mild to moderate cognitive impairment (MMSE score: 11-24/30, corrected for age and education). Blood samples were analyzed for serum total magnesium (Mg-tot) and serum ionized magnesium (Mg-ion). AD patients had significantly lower MMSE scores (20.5±0.7 vs 27.9±0.2; p<0.001), and for the physical function tests. Mg-ion was significantly lower in the AD group as compared to age-matched control adults without AD (0.50±0.01 mmol/L vs 0.53±0.01 mmol/L; p<0.01). No significant differences were found in Mg-tot between the two groups (1.91±0.03 mEq/L vs 1.95±0.03 mEq/L; p=NS). For all subjects, Mg-ion levels were significantly and directly related only to cognitive function (Mg-ion/MMSE r=0.24 p<0.05), while no significant correlations were found in this group of patients between magnesium and ADL or IADL. Our results show the presence of subclinical alterations in Mg-ion in patients with mild to moderate AD.     

Reduced frontal perfusion in depressed postmenopausal women: a SPECT study with WCST

OBJECTIVES: To investigate frontal cerebral blood flow (CBF) in depressed postmenopausal women and its relation to cognitive function and the severity of depressive symptoms. METHODS: Regional CBF of 20 unmedicated depressed postmenopausal women was measured using Tc-99m HMPAO SPECT, both at rest and during frontal activation using the Wisconsin card sorting test (WCST). Frontal CBF was semi-quantified by comparing the radioactivity in the prefrontal region to the cerebellum (F/C ratio). We measured the severity of the symptoms of depression using the hospital anxiety and depression scale (HADS) and cognitive function using the mini-mental status examination (MMSE). RESULTS: At rest, there was no difference in frontal CBF between patients with moderate or severe (HADS> or =11) and patients with mild depressive symptoms (HADS<11). During the WCST, however, the HADS> or =11 group did not score as well as the HADS<11 group (P=0.03). The changes in F/C ratios were inversely correlated with HADS scores (r=-0.43, P=0.05) and positively correlated with MMSE scores (r=0.58, P=0.004). After adjusting for age, F/C ratios were significantly correlated with MMSE (P=0.002), but not with HADS scores. CONCLUSIONS: Frontal CBF did not increase in postmenopausal women with moderate/severe symptoms of depression during the WCST activation task, and reduced frontal CBF was related to the impairment of cognitive function. The combination of the functional activation test and SPECT imaging powerfully revealed this functional disease, which remains undetectable using more common baseline measurements.     

言语流畅性测验在痴呆识别和鉴别诊断中的应用

目的:评价超市物品言语流畅性测验识别早期痴呆的效力。方法:正常对照242例,阿尔茨海默病276例,血管性痴呆41例,接受MMSE、言语流畅性(VFT)、临床痴呆量表检查。VFT指标有正确总数、串联长度及转换数。结果:不同教育划界分识别轻度AD的敏感度、特异度依次为:0-6年,11,56.5%,72.5%;7-12年,12,75.0%,72.9%;12年 ,13,83.1%,78.4%;对照组言语流畅性成绩与增龄呈负相关、与教育呈正相关;AD组与增龄无关,与教育关联程度明显减低;串联长度对VFT总分贡献高于转换次数;痴呆严重程度相同的VaD患者言语流畅性各项得分均显著低于AD组,类别转换的减少程度(P=0.003)较串联长度(p=0.011)更为明显。结论:超市物品言语流畅性测验识别轻度AD敏感性、特异性高。该测验反映多个认知领域,串联、转换等因子分对痴呆的鉴别诊断具有一定价值。     

Comparison of reading and spelling in patients with probable Alzheimer's disease.

Patients with probable Alzheimer's disease (AD) are reported to show mild, but reliable, difficulties reading aloud and spelling to dictation exception words, which have unusual or unpredictable correspondence between their spelling and pronunciation (e.g., touch). To understand the cognitive dysfunction responsible for these impairments, 21 patients and 27 age-and education-matched controls completed specially designed tests of single-word oral reading and spelling to dictation. AD patients performed slightly below controls on all tasks and showed mildly exaggerated regularity effects (i.e., the difference in response accuracy between words with regular spellings minus exception words) in reading and spelling. Qualitative analyses, however, did not demonstrate response patterns consistent with impairment in central lexical orthographic processing. The authors conclude that the mild alexia and agraphia in AD reflect semantic deficits and nonlinguistic impairments rather than a specific disturbance in lexical orthographic processing.     

不同认知功能障碍程度阿尔茨海默病患者海马、内嗅皮层体积变化及其与MMSE评分的关系

目的 探讨不同认知功能障碍程度的患者阿尔兹海默病（AD）海马、内嗅皮层体积的变化,及其与简易精神状态检查表（MMSE）评分的相关性。方法 横断面研究。纳入2017年9月—2021年9月联保部队第九六〇医院淄博院区86例AD患者临床和影像学资料,其中男54例、女32例,年龄55~87（73.9±8.1）岁。根据临床痴呆评定量表（CDR）评分将86例患者分为3组,其中36例CDR评分0.5分患者为轻度认知障碍（MCI）组,21例1分患者为轻度AD组,29例2~3分患者为中重度AD组。患者均应用MRI测量双侧海马体积、内嗅皮层体积,采用MMSE评分评估患者认知功能。观察指标：（1）比较3组患者性别、年龄、受教育年限等临床基线资料,以及MMSE评分;（2）比较3组患者海马体积和内嗅皮层体积;（3）分析AD患者MMSE评分与海马、内嗅皮层体积的相关性。结果 （1）3组患者性别、年龄、受教育年限等临床基线资料比较差异均无统计学意义（P值均>0.05）。MCI组、轻度AD组、中重度AD组患者MMSE评分依次降低,差异有统计学意义（F=113.29,P<0.001）。（2）MCI组、轻度AD组、中重度AD组左右侧海马体积MRI测量值分别为（3.24±0.32）cm³和（3.22±0.31）cm³、（2.72±0.53）cm³和（2.84±0.56）cm³、（2.31±0.55）cm³和（2.46±0.54）cm³,左右侧内嗅皮层体积分别为（1.42±0.26）cm³和（1.39±0.27）cm³、（1.28±0.24）cm³和（1.24±0.25）cm³、（1.04±0.31）cm³和（1.06±0.34）cm³。3组患者左右侧海马体积、内嗅皮层体积MRI测量值比较,均为MCI组>轻度AD组>中重度AD组,差异均有统计学意义（P值均<0.05）。（3）86例AD患者MMSE评分10~27（20.9±5.2）分,与左右两侧海马体积、内嗅皮层体积MRI测量值均呈正相关（r=0.82、0.81、0.73、0.72,P值均<0.001）。结论 随着认知功能障碍程度的加重,AD患者海马、内嗅皮层体积MRI测量值逐渐减小,且MMSE评分与海马、内嗅皮层体积存在相关性。