功能性认知障碍的临床诊治研究进展

功能性认知障碍(FCD)是指患者主诉存在持续的认知下降,认知下降具备“内部不一致性”特征,并且不能用其他疾病解释的一组临床综合征。FCD在临床很常见,但存在普遍认识不足、诊断率低的现状。在老龄化社会认知障碍高发和新冠肺炎疫情大流行后的公共卫生问题背景下,FCD的识别和规范诊治显得尤为重要。本文对FCD的概念演变、临床表现与诊断进行阐述,分析其与相似疾病概念的关系,探讨其临床诊断的重要性,并对其病理生理学机制和治疗现状进行综述。元认知受损被认为是FCD的关键机制,非药物治疗可能对FCD尤其重要,药物治疗尚有待研究。客观、标准化的诊断工具是FCD亟待解决的临床问题。

QCC应用对改善脑卒中患者上肢功能性电刺激治疗认知度及治疗效果的研究

目的:研究与观察QCC应用对改善脑卒中患者上肢功能性电刺激治疗认知度及治疗效果的价值。方法:将2014年11月-2016年5月本院收治的72例脑卒中后上肢功能障碍患者按照随机数字表法分为观察组和对照组,每组36例。对照组以常规脑卒中后康复护理模式进行干预,观察组则以QCC模式进行护理指导。统计与比较两组干预前后疾病认知度、功能性电刺激治疗认知度及上肢功能状态。结果:干预前两组疾病认知度、功能性电刺激治疗认知度及上肢功能状态比较,差异均无统计学意义(P>0.05);而干预后不同时间观察组疾病认知度、功能性电刺激治疗认知度及上肢功能状态均显著好于对照组(P<0.05)。结论:QCC应用可显著改善脑卒中患者上肢功能性电刺激治疗认知度及治疗效果,因此认为本模式适用于脑卒中后肢体功能障碍患者。

中国传统乐学观念下的曲牌研究——以【行道章】为例

回溯历史,从传统乐学视角整体认知曲牌音乐,对音乐本体文本分析的同时,对其创作、表演、制度、功能加以梳理研究,系统地把握曲牌音乐之内涵。应特别注重从国家用乐的逻辑起点,辨析曲牌音乐的礼、俗定位,将其表演、功能性等方面的资料完整地保存、传承,以彰显音乐“活态”的整体内涵,进一步补充音乐史研究中的有声资料,对曲牌音乐的传播与传承有重要的意义。

老年慢性非特异性腰痛综合康复治疗效果分析

目的观察以神经松动术和认知功能性训练为主的综合康复治疗对老年慢性非特异性腰痛患者的疗效。方法将125例老年慢性非特异性腰痛患者分成治疗组(67例)和对照组(58例),治疗组采用以神经松动术为主的综合康复治疗,对照组主要采用卧床休息、口服非甾体抗炎药、红外直线偏振光和干扰电等物理治疗及针灸治疗。治疗前后分别进行VAS评分、Oswestry评分及JOA疗效评定。结果治疗后,VAS评分及Oswestry评分均较治疗前有所下降,治疗组VAS评分及Oswestry评分值较对照组低,差异有统计学意义(P<0.05);治疗后,治疗组优良率为71.64%,治疗组疗效优于对照组(P<0.05)。结论部分老年慢性非特异性腰痛与硬脊膜粘连有关。以神经松动术和认知功能性训练为主的综合康复治疗能够有效改善老年慢性非特异性腰痛患者腰痛症状,此方法安全有效,值得临床推广。

Is there an acute exercise-induced physiological/biochemical threshold which triggers increased speed of cognitive functioning? A meta-analytic investigation

Purpose： The purpose of this study was to examine, using meta-analytic measures, the evidence regarding the optimal exercise intensity at which improvements in speed of cognitive function are triggered. Specifically, it was hypothesized that the catecholamine, lactate, and ventilatory thresholds is the point at which significant improvements in speed of cognitive function are observed. Methods： We compared mean effect sizes for threshold studies and for those studies where exercise intensity was classed as moderate （40%-- 79% VO2 or equivalent） but in which the thresholds were not measured. Results： Random effects meta-analysis showed significant, moderate, mean effect sizes for studies at the threshold （g = 0.58, Z = 2.98, p 〈 0.003） and for those during moderate intensity exercise but in which the threshold was not measured （ g = 0.54, Z = 5.0l, p 〈 0.001）. There was no significant difference between mean effect sizes, which suggests that the thresholds are unlikely to represent a trigger point. Conclusion： Moderate intensity exercise, even below the thresholds, can induce improved speed of cognition, possibly due to a combination of increased peripheral catecholamine concentrations inducing vagal/nucleus tractus solitarii pathway activation and central increases due to perceptions of stress.

Double-edged blinde, hemorrhagic or cardioembolic cognitive impairment

To the Editor I have read the article entitled ＂Cognitive function and adherence to antieoagulation treatment in patients with atrial fibrillation＂ by Jankowska-Polafiska, et al., with great interest. The investigators reported that cognitive impairment is an independent determinant of compliance with pharmacological therapy in elderly patients with atrial fibrillation （AF）.

Exercise training and antioxidant supplementation independently improve cognitive function in adult male and female GFAP-APOE mice

Purpose： The purpose of this study was to determine if antioxidant supplementation, moderate exercise, and the combination of both treatments could ameliorate cognitive performance in adult mice and whether the apolipoprotein E （APOE） genotype as well as sex could influence the functional outcomes of the treatments. Methods： For a period of 16 weeks, separate groups of male and female mice expressing either the human APOE3 or APOE4 isoforms were fed either a control diet （NIH-31） or the control diet supplemented with vitamins E and C （1.12 IU/g diet a-tocopheryl acetate and 1.65 mg/g ascorbic acid）. The mice were further separated into a sedentary group or a group that followed a daily exercise regimen. After 8 weeks on the treatments, the mice were administered a battery of functional tests including tests to measure cognitive and affective function. Results： There was no effect of genotype or treatment on the learning performance in the Morris water maze. In the discriminated avoidance task, APOE4 mice performed better in learning the discrimination component of the task. Overall, exercise improved performance of APOE4 and APOE3 mice on various aspects of the active avoidance task. Antioxidant supplementation improved performance only in the APOE4 mice. On the test for anxiety, APOE4 mice spent more time in the open arms and supplementation with antioxidant reversed that effect. Conclusion： Exercise was the most effective treatment at improving cognitive function in both genotypes and sex, while antioxidants seemed to be effective only in the APOE4. In young adult mice only non-spatial learning and memory were improved. The combination of the two treatments did not yield further improvement in cognition, and there was no antagonistic action of the antioxidant supplementation on the beneficial effects of exercise.

Contrast study on cognitive function with MRI and positron emission tomography imaging in transient global amnesia

OBJECTIVE: To study cognitive function and cerebral metabolic changes in patients with transient global amnesia (TGA). METHODS: Three patients with TGA were given mini-mental state examination (MMSE), revised Wechsler memory scale (WMS-R) examination and magnetic resonance imaging (MRI) scans after they had been diagnosed as TGA. Using (18)F labelled deoxyglucose as tracer, patients were given a positron emission tomography (PET) examination at different periods during recovery. RESULTS: No obvious abnormality was found in MMSE and MRI scans in the three patients. However, WMS-R examination and cerebral PET imaging displayed cognitive dysfunction of varying degrees and low metabolism in local areas related to memory in 2 of 3 patients. CONCLUSIONS: In TGA patients, cognitive function and cerebral metabolic levels are closely correlated with duration of symptoms. It is necessary to stop the TGA attack as quickly as possible early time.

Minocycline reduces astrocytic reactivation and neuroinflammation in the hippocampus of a vascular cognitive impairment rat model

Objective To study the neuroprotective mechanism of minocycline against vascular cognitive impairment after cerebral ischemia. Methods The rat model with vascular cognitive impairment was established by permanent bilateral common carotid artery occlusion （BCCAO）. The observing time-points were determined at 4, 8 and 16 weeks after BCCAO. Animals were randomly divided into sham-operated group （n = 6）, model group （subdivided into 3 groups： 4 weeks after BCCAO, n = 6; 8 weeks after BCCAO, n = 6; and 16 weeks after BCCAO, n = 6）, and minocycline group （subdivided into 3 groups： 4 weeks after BCCAO, n = 6; 8 weeks after BCCAO, n = 6; and 16 weeks after BCCAO, n = 6）. Minocycline was administered by douche via stomach after BCCAO until sacrifice. Glial fibrillary acidic protein （GFAP） was examined by Western blotting and immunohistochemistry. Levels of cyclooxygenase-2 （COX-2） and nuclear factor-kappaB （NF-κB） were measured by immunohistochemistry. IL-1β and TNF-α levels were tested with ELISA method. Results Levels of GFAP, COX- 2, NF-κB, IL-1β and TNF-α were all up-regulated after permanent BCCAO, which could be significantly inhibited by minocycline. Conclusion Minocycline could ameliorate the inflammation and oxidative stress in the hippocampus of the vascular cognitive impairment rat model.

Influence of acupuncture on cognitive function and markers of oxidative DNA damage in patients with vascular dementia

OBJECTIVE:To test the influence of acupuncture on cognitive function and a marker of oxidative DNA damage in patients with vascular dementia(VD).METHODS:Sixteen VD patients were evaluated before and after acupuncture,using the Folstein Mini-Mental State Examination-Revised(MMSE-R) to assess cognitive function,and the ADL-R scale to assess independence in activities of daily living(ADL).Life quality was evaluated using the DEMQOL(Dementia quality of life questionnaire) questionnaire,and syndromes and expression of vascular dementia were evaluated with the Scale for the Differentiation of Syndromes of Vascular Dementia(SDSVD).In addition,the urine concentration of 8-hydroxy-2'-deoxyguanosine(8-OHdG)-a marker of oxidative damage-was quantified with enzyme-linked immunosorbent assay.RESULTS:The MMSE-R and DEMQOL scores were higher after acupuncture than before(P<0.05),while there were no obvious differences in the ADL-R or SDSVD scores(P>0.05).The 8-OHdG content in urine significantly decreased after acupuncture(P<0.05).CONCLUSION:Acupuncture reduces the levels of 8-OHdG and improves cognitive function and quality of life in VD patients,suggesting that acupuncture is beneficial at least in part by preventing oxidative damage.