华山版听觉词语学习测验在主观认知下降和轻度认知障碍患者中的应用初探

摘要 目的：探索华山版听觉词语记忆测验（auditory verbal learning test-Huashan version,AVLT-H）在主观认知下降（subjective cognitive decline, SCD）和轻度认知障碍（mild cognitive impairment,MCI）患者记忆功能障碍中的应用价值。方法：筛查招募的老年人,根据入组标准分为三组,即正常组、SCD组和MCI组,并完成神经心理学测试简易智能精神状态检查（mini-mental status examination,MMSE）、北京版蒙特利尔认知评估量表（Montreal Cognitive Assessment-Beijing version,MoCA-BJ）及AVLT-H,从而获得MMSE、MOCA、AVLT-H的即刻回忆N1、N2、N3、延迟回忆N4、N5、线索回忆N6及再认N7得分;结果：①三组老年人的神经心理学测试发现MMSE、MoCA及AVLT各项评分均存在显著性差异（P<0.0167）。采用Bonferroni法校正显著性水平的事后两两比较发现,MMSE和MoCA评分在SCD与NC之间（P<0.001）、MCI与NC之间（P<0.001）均有显著性差异,在MCI与SCD之间无显著性差异;N1评分在MCI与NC之间（P=0.013）、MCI与SCD之间（P=0.001）均有显著性差异,在SCD与NC之间无显著性差异;N2、N3、N4、N5、N6及N7评分在MCI与NC之间（P<0.001）、MCI与SCD之间（P<0.001）均有显著性差异,在SCD与NC之间无显著性差异。②分别以NC组和SCD组为状态变量对MMSE、MoCA和AVLT-H得分进行曲线下面积检测,发现对于区分MCI和SCD,AVLT-H各项得分具有较大的曲线下面积,且敏感度和特异度较高,N1和N7的敏感度最高;对于区分MCI和NC,AVLT-H和MoCA得分具有较大的曲线下面积,且敏感度和特异度均较高,N4、N6和N7的敏感度最高。 结论：AVLT-H可完善MMSE、MoCA对于MCI和SCD的界定诊断,值得将AVLT-H作为MCI和SCD的常规评估方法,即联合使用AVLT-H、MMSE或MoCA可提高其诊断的准确性。     

非痴呆型血管性认知障碍的神经心理学研究

目的探讨测试非痴呆型血管性认知障碍者认知功能的新方法及其使用价值。方法应用YWG神经心理训练系统和修订版连线测验(TMT)对非痴呆型血管性认知障碍(VCIND)组(60例)、正常对照组(60例)进行测验。对比观察两组单侧脑功能、图形记忆、汉字记忆和数字连线测验结果,以及各指标与TMT得分的相关性。结果和对照组相比,VCIND组YWG各项目反应时延长27%~158%(P0.01),错误率增高27%~63%,连线测验两部分得分也明显降低(P0.01)。VCIND组内,男女患者之间、脑出血和脑梗死患者之间各项目得分无显著差异(P0.05)。实验组和对照组单侧脑功能反应时均与TMT得分有明显相关性(P0.01)。结论 YWG神经心理训练系统测试结果可反映VCIND执行功能损害,可作为VCIND患者的认知功能测试项目之一用于临床。     

海马体积对糖尿病认知功能障碍的诊断价值

目的探讨海马体积对糖尿病认知功能障碍诊断价值。方法选择糖尿病合并认知功能障碍（DM+MCI）组20例、病例对照组（DM组）20例、空白对照组（CON组）25例,采用蒙特利尔认知评估（MoCA）量表测评各组认知功能,行磁共振海马成像。结果DM+MCI组年龄、空腹血糖、糖化血红蛋白、甘油三酯、总胆固醇、MOCA评分高于DM组及CON组（P<0.05）。DM+MCI组双侧海马的体积明显变小,与MOCA评分具有相关性。左侧海马体积诊断糖尿病认知功能障碍的ROC曲线下面积为0.793（P<0.05）。在最优截断点时,左侧海马体积为2.845 cm³时诊断糖尿病认知功能障碍的灵敏度为95%,特异度为65%,阳性预测值为65%,阴性预测值为35%。右侧海马体积诊断糖尿病认知功能障碍的ROC曲线下面积为0.817（P<0.05）。在最优截断点时,左侧海马体积为2.875 cm³时诊断糖尿病认知功能障碍的灵敏度为90%,特异度为65%,阳性预测值为65%,阴性预测值为35%。结论糖尿病认知功能障碍患者海马体积明显变小,其对糖尿病认知功能障碍的诊断有一定临床价值。     

有氧舞蹈对轻度认知障碍患者认知和运动功能的影响

摘要 目的：探讨自主设计的有氧舞蹈对轻度认知障碍（MCI）患者认知和运动功能的干预作用。 方法：将MCI患者随机分为运动组和对照组,运动组接受35min/次、3次/周、为期3个月的有氧舞蹈,对照组仅接受健康宣教。所有受试者在干预前、干预3月后、入组6个月随访时接受认知功能和运动功能评估。 结果：干预前,两组的基线评估结果无显著性差异（P>0.05）。3个月有氧舞蹈干预后,运动组简易精神状态评分（mini-mental state examination, MMSE）、蒙特利尔认知评估(Montreal cognitive assessment,MoCA)评分、韦氏逻辑记忆测试评分、连线测试-A所需时间和连线测试-B所需时间与干预前比较均有显著性差异（P<0.05）;韦氏逻辑记忆量表评分,连线测试-B所需时间与对照组比较有显著性差异（P<0.01,P<0.05）。随访时运动组MoCA评分,韦氏逻辑记忆测试评分、连线测试-A与干预前比较有显著性差异（P<0.05）。3个月干预后,运动组Berg平衡量表评分与干预前和对照组比较差异均有显著性意义（P<0.05）。 结论：有氧舞蹈能够改善MCI患者的认知功能和运动功能。     

Comparative study between depression in Korean elderly with mild cognitive impairment and normal cognitive function

This cross‐sectional comparative study compares differences in depression in the elderly with mild cognitive impairment and those with normal cognitive function in a community. Study subjects were drawn from elderly people visiting one particular public health center in Seoul, South Korea and included 81 people with mild cognitive impairment and 81 with normal cognitive function who were matched based on age, sex, education, and daily living activities. Study variables, including cognitive function, activities of daily living, instrumental activities of daily living, and depression, were measured with standardized instruments. Collected data were statistically analyzed with Student's paired t‐test and χ² test. The results showed no significant differences between these groups in terms of depression. Therefore, in community practice settings, nurses should understand that depression is not a manifestation of cognitive impairment and should develop effective nursing strategies to assess depression while considering other factors including age, sex, education, and daily living activities.     

计算机化认知训练对轻度认知障碍老年人干预效果的Meta分析

目的 评价计算机化认知训练对轻度认知障碍老年人的干预效果。方法 检索中英文数据库中有关计算机化认知训练对轻度认知障碍老年人干预效果的随机对照试验,应用Revman5.2软件进行Meta分析。结果 共纳入12篇文献,涉及488例病人。结果显示,干预结束时试验组简易精神状态量表（MMSE）和蒙特利尔认知功能状态量表（MoCA）得分优于对照组［MD=1.78, 95%CI(0.41,3.15), P<0.05］,［MD=4.02, 95%CI(1.33,6.70), P<0.05］;试验组顺向数字测试（DSF）和逆向数字测试（DSB）得分优于对照组［MD=1.01, 95%CI(0.39,1.64), P<0.05］,［MD=0.67, 95%CI(0.16,1.17), P<0.05］;试验组延迟回忆得分优于对照组［MD=1.20, 95%CI(1.00,1.39), P<0.05］;但对言语流畅性测试（SF）、老年抑郁量表（GDS）和日常生活能力量表（ADL）得分的改善效果不明显。结论 计算机化认知训练能改善轻度认知障碍老年人的整体认知功能, 尤其是注意力和短时记忆力以及延迟记忆能力方面,但对言语功能、抑郁状态和ADL改善效果不明显。还需大样本、高质量的随机对照试验进行验证。     

蒙特利尔认知评估量表与简易精神状态量表用于筛查血管性认知障碍的比较

目的:比较蒙特利尔认知评估量表(MoCA)和简易精神状态检查(MMSE)在筛查脑血管病患者中血管性认知障碍(VCI)及其最主要的亚型血管性痴呆(VaD)的能力。方法:对广东省中医院神经科门诊及住院治疗的127例脑血管病患者进行广泛的神经心理学测验,包括记忆力、执行能力、注意力、视空间、语言等五个方面的内容,并进行MoCA量表和MMSE量表的评价。根据广泛的神经心理学评价结果,采用可操作性的方法诊断认知受损,由临床医生结合认知受损的结果及相应的诊断标准进一步诊断非痴呆型血管性认知障碍(VCIND)和VaD,以此诊断结果作为相对的临床金标准,绘制受试者工作曲线(ROC),比较Mo-CA量表和MMSE量表在筛查脑血管病患者中VC(I包括VCIND和VaD)及VaD的能力。结果:127例受试者中诊断为认知受损的共101例,进一步诊断为VaD患者55例,VCIND患者46例,诊断为认知正常的患者26例。结论:MoCA量表、MMSE量表在筛查脑血管患者中VCI患者时曲线下面积(AUC)比较,MoCA(0.956±0.0177)>MMSE(0.920±0.0233),Z=2.339,P=0.019;而在筛查脑血管病患者中VaD患者时AUC比较,MoCA(0.945±0.0194)与MMSE(0.931±0.0248)无显著性差异,Z=1.453,P=0.146。MOCA量表在筛查脑血管病患者中VCI患者时优于MMSE量表,而两量表在筛查脑血管病患者中VaD患者时能力相似。     

遗忘型轻度认知障碍近十年磁共振成像研究进展

随着我国社会老龄化的不断加速,老年痴呆的发病率不断增高,其也是中老年群体的重要死因之一。轻度认知障碍是介于正常脑老化与老年痴呆的一种认知功能障碍状态,遗忘型轻度认知障碍作为其主要分型,是老年痴呆的高危因素。在老年群体中,遗忘型轻度认知障碍发病率高达10%以上。与认知正常的老年人相比,轻度认知障碍患者患痴呆的风险高4~10倍,在此阶段对患者进行有效诊治,可极大延缓患者病情向痴呆转化的进程。目前,遗忘型轻度认知障碍诊断主要依靠临床神经电生理检查及神经影像学检查,近年来随着磁共振成像技术的不断发展,极大提高了遗忘型轻度认知障碍的早期诊断效能,本文对扩散张量成像、基于体素的形态学测量、动脉自旋标记成像、磁共振波谱、酰胺质子转移成像、静息态功能磁共振成像几种磁共振成像技术在遗忘型轻度认知障碍中的应用现状进行综述,以期为临床医生提供帮助。     

Disability and cognitive impairment in the elderly

Disability and cognitive impairment show similar patterns of increasing frequency with ageing. A review of the published literature shows that there is a cross-sectional relationship between cognitive impairment and disability, independent of demographic, medical, and lifestyle factors. Some instrumental activities of daily living (IADL) items appear more specifically related to cognitive impairment, but cognition and functional impairment are distinct concepts requiring separate assessments. Subjects with low cognitive performances are at higher risk of functional impairment in the following years. Cognitive impairment as well as disability increase the risk of death and institutionalization. Preventive strategies could be directed against the risk factors of cognitive impairment and disability, and would aim to delay the onset of dementia. Prevention of disability associated with cognitive impairment needs further assessment in elderly community-dwellers. Further research is needed to better identify the specific areas of cognition involved in the disablement process.     

简短智力状态检查在老年人轻度认知损伤检查中的应用

目的对1437例60岁以上男性非痴呆老年人简短智力状态检查(MMSE)参考值和轻度认知损伤(MCI)进行调查。方法每5岁作为一个年龄组,计算不同年龄-文化分层的MMSE及MCI患病水平和MMSE界值。结果MCI的患病率为14.61%。<70岁MMSE≤27即可考虑为MCI;≥70岁MMSE界值为≤26。地点定向、注意与计算、延迟回忆和语言4个子条目对预示痴呆患病有显著性意义(P<0.01)。结论MMSE仍可用于MCI的调查研究,对于其结果的解释,应结合年龄-文化参考值加权考虑。地点定向、注意与计算、延迟回忆和语言功能衰退的MCI患者患痴呆的危险性高。     

老年轻度认知功能障碍与血清总同型半胱氨酸、血脂水平相关性分析

目的观察老年轻度认知功能障碍（MCI）与血清总同型半胱氨酸（tHcy）、血脂水平之间的关系。方法测定50例老年MCI患者（MIC组）和50例年龄相匹配的健康者（对照组）血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDI。）及血清tHcy水平。结果MCI组患者血清Tc、TG、HDL、LDL的水平分别为（5．72±1．25）mmol／L、（1．90±O．31）mmol／L、（1．034-0．12）mmol／L、（3．97±1．02）mmol／L;对照组健康者相应指标分别为（4．27土1．04）mmol／L、（1．21±0．17）mmo／I。（1．34士0．25）mmol／I．、（3．03±1_00）mmol／I。。MCI组TC、LDI,、TG均明显高于对照组,差异有统计学意义（P〈0．05）。MCI组血清tHcy水平明显高于对照组（P〈0．05）。血清Hcy、血脂对预测MCI具有价值（P〈0．05）。Logistic多因素回归分析提示血浆Hcy、血脂是MCI的影响因素。结论MCI患者存在明显的脂质代谢紊乱及高同型半胱氨酸血症,Hey、TC、LDL、TG可能对MCI的发病有一定的影响,而HDI。与MCI发病可能无关联。,     

经颅微电流刺激对老年轻度认知功能障碍的效果

目的 探讨经颅微电流刺激(CES)对老年轻度认知功能障碍患者认知功能的疗效.方法 选择2018年至2019年在本院住院的老年轻度认知障碍患者40例,随机分为对照组(n=20)和治疗组(n=20).两组均接受常规药物治疗(无促认知药物);治疗组增加CES治疗,共8周.治疗前,治疗后4周、8周,由两人采用改良Barthel...     

Fall risk factors in older people with dementia or cognitive impairment: a systematic review

Title.  Fall risk factors in older people with dementia or cognitive impairment: a systematic review.
Aim.  This paper is a report of a review conducted to identify and summarize specific risk factors for falls in older people with dementia or cognitive impairments as documented by prospective or case–control studies.
Background.  People with dementia have a doubled to threefold risk for falls, but the reasons for this have not yet been fully explained. Several integrative literature reviews discuss possible specific fall risk factors. However, there is lack of a systematic evaluation of studies.
Data sources.  The CINAHL, PubMed, EMBASE and PsychInfo databases were searched for the period between 1980 and May 2007.
Review methods.  A systematic review was conducted. Cohort or case–control studies published in English or German were included if they investigated risk factors for falls or fall-related injuries in a sample consisting of participants with dementia or cognitive impairment. Two reviewers independently assessed study quality.
Results.  Six prospective studies were included in the review. These differed concerning samples, settings, follow-up periods and examined variables. Therefore, meta-analysis was not possible. Eight categories of risk factors emerged: disease-specific motor impairments, impaired vision, type and severity of dementia, behavioural disturbances, functional impairments, fall history, neuroleptics and low bone mineral density.
Conclusion.  There is lack of sound studies examining fall risk factors in cognitively impaired elders. Well-known risk factors such as motor impairment show particular characteristics in people with dementia. In addition, behavioural disturbances contribute to their high risk for falls. Further prospective studies are needed.     

Cognitive interventions for mild cognitive impairment and dementia: An overview of systematic reviews

PurposeConducting an overview of systematic reviews (SRs)/Meta analyses (MAs) to assess the effectiveness of cognitive interventions on participants with mild cognitive impairment (MCI) or dementia and evaluate the methodological quality of SRs/MAs.MethodsPubMed, EMBASE, Cochrane library, Web of science, China National Knowledge Infrastructure (CNKI) and Chinese Biomedical Databases (CBM) were systematically searched from inception to January 1, 2019 to identify SRs/MAs. Three reviewers independently screened the articles, extracted data and assessed the quality of the included studies according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the quality of evidence.ResultsA total of 22 reviews were included. New meta-analyses (36 RCTs) showed that cognitive interventions were more effective than routine therapies for the alleviation of MCI and dementia symptoms (SMD: 0.62; 95%CI: 0.47, 0.78; I² = 53.9%). The results of AMSTAR-2 showed that the methodological quality of most included studies was critically low, and two reviews were low quality. The lowest score was item 10, none of reviews reported on the sources of funding for the included studies. Followed by the “provide a list of excluded studies and justify the exclusions” item with only one (4.5%) reviews conforming to this item. Results of GRADE manifested that moderate quality evidence was provided in 11 reviews (39.3%), 12 (42.9%) were low quality and 5 (17.8%) were very low.ConclusionThe present SRs/MAs indicated that persons with MCI or dementia could benefit from cognitive interventions. Future trial designs should focus on measuring changes in individual specific cognitive functions. More high-quality evidence is needed to further determine the effectiveness of cognitive interventions.     

轻度认知障碍患者自我护理能力及其相关因素的研究

目的了解轻度认知障碍患者自我护理能力的现状及相关因素,为进行临床护理干预提供依据。方法对某综合医院神经内科记忆门诊就诊的患者进行调查,问卷选用Becker自我护理能力自评量表、日常活动能力量表及认知功能评定量表。结果轻度认知障碍患者自我护理能力总均分为（91．24±20．61）分,与痴呆组之间差异具有统计学意义（P〈0．01）,与正常组之间差异无统计学意义（P〉0．05）。单因素相关分析结果,文化程度、个人月收入、13常活动能力、认知能力与轻度认知障碍患者自我护理能力显著相关（P〈0．01）。结论轻度认知障碍患者自我护理能力较高,接近正常人水平,且受多因素影响,护理干预时应关注个体差异。     

轻度认知功能损害患者汉语双词素词的语音编码研究

目的探讨轻度认知功能损害 (MCI)患者汉语言语产生中双词素词语音激活的特点。方法对 10例MCI患者和 10例正常对照采用同音判断方法 ,选用以偏正结构的双词素词为名称的图片和与双词素词中首尾两个词素同音的两组探测字作为实验材料 ,探测字在图片呈现后 10 0ms出现 ,要求被试判断出现的探测字是否与图片名称中任何一个词素同音。对两组的反应时和错误率进行比较。结果正常老年人尾词素激活快于首词素激活 ,而MCI患者首尾词素激活时间无明显差异。首尾词素探测条件下正常老年人反应的错误率无明显差异 ,而MCI患者对尾词素探测条件的错误率低于首词素。结论正常老年人和MCI患者汉语言语产生中双词素词语音编码模式相同 ,均受词义和词素意义激活程度的影响 ;但激活的速度MCI患者慢于正常老年人。提示MCI患者语义记忆和语音提取的过程受损。     

轻度认知障碍的有关护理研究

介绍了轻度认知障碍的诊断标准、流行病学调查情况和护理干预。