AD8:对病史陈述者进行简要询问以检出痴呆

Background: Brief measures that accurately discriminate normal cognitive aging from very mild dementia are lacking. Cognitive tests often are insensitive to very mild dementia. Informant-based measures may be more sensitive in detecting early dementia. Abstract:Objective: To identify informant-reported clinical variables that differentiate cognitively normal individuals from those with very mild dementia. Methods: A 55-item battery of informant queries regarding an individual’s cognitive status was derived from a semistructured interview and a consensus panel of dementia experts. The battery was evaluated with informants for 189 consecutive participants of a longitudinal study of memory and aging and compared with an independently obtained Clinical Dementia Rating (CDR) score for the participant. Multiple regression and receiver operator characteristic curves assessed subsets of the items to discriminate between CDR 0 (no dementia) and CDR 0.5 (very mild dementia). Results: The final version (AD8) querying memory, orientation, judgment, and function was administered to an additional sample of 112 CDR 0 and 68 CDR 0.5 participants. Using a cut-off of two items endorsed, the area under the curve was 0.834, suggesting good to excellent discrimination, sensitivity was 74%, and specificity was 86%(prevalence of 0.38 for very mild dementia). Inclusion of 56 additional individuals with mild to severe dementia (increasing dementia prevalence to 0.53) increased sensitivity to 85%. Conclusions: The AD8 is a brief, sensitive measure that reliably differentiates between nondemented and demented individuals. Use of the AD8 in conjunction with a brief assessment of the participant could improve diagnostic accuracy in general practice.

长期、高剂量应用抗胆碱能药物或增痴呆风险

美国学者研究表明,抗胆碱能药物高累积应用与痴呆风险升高具相关性。论文1月26日在线发表于《美国医学会杂志·内科学》（JAMA Intern Med）。研究纳入3434名年龄逸65岁基线时无痴呆的受试者,每2年随访一次。通过药房处方资料确定过去10年间累积抗胆碱能药物暴露。主要转归指标为痴呆和阿尔茨海默病（AD）发生率。

脑白质损害与痴呆的发病风险

Objective: To smtudy the association between white matter lesions (WML) in spe cific locations and the risk of dementia. Design: The Rotterdam Scan Study, a pr ospective population based cohort study. We scored periventricular and subcortic al WML on magnetic resonance imaging and observed participants until January 200 2 for incident dementia. Setting: General population. Participants: We included 1077 people aged 60 to 90 years who did not have dementia at baseline. Main Outc ome Measure: Incident dementia by Diagnostic and Statistical Manual of Mental Di sorders, Third Edition (DSM III R) criteria. Results: During a mean follow up of 5.2 years, 45 participants developed dementia. Higher severity of periventric ular WML increased the risk of dementia, whereas the association between subcort ical WML and dementia was less prominent. The adjusted hazard ratio of dementia for each standard deviation increase in periventricular WML severity was 1.67 (9 5%confidence interval, 1.25-2.24). This increased risk was independent of othe r risk factors for dementia and partly independent of other structural brain cha nges on magnetic resonance imaging. Conclusion: White matter lesions, especially in the periventricular region, increase the risk of dementia in elderly people.

帕金森病的预后:鹿特丹一项关于痴呆和死亡风险的研究

Background: Most prognostic studies on Parkinson disease have been hospital based or have applied register-based casefinding methods. Potential under-representation of mild cases may have given biased results. Abstract:Objective: To evaluate whether Parkinson disease is associated with an increased risk of dementia and death. Design: Population-based cohort study. Parkinson disease and dementia were assessed through in-per-son examination at baseline (1990-1993) and 2 follow-up visits (1993-1994 and 1997-1999). Computerized linkage to medical and municipality records provided additional information on disease outcomes and mortality. Setting: General population. Participants: A total of 6969 participants, including 99 prevalent and 67 incident cases of Parkinson disease. Main Outcome Measures: Incident dementia and death. Adjusted hazard ratios were calculated through Cox proportional hazards regression analysis. Results: Patients with Parkinson disease had an increased risk of dementia (hazard ratio, 2.8; 95%confidence interval, 1.8-4.4), which was especially pronounced in participants carrying at least 1 apolipoprotein E gene (APOE) 2 allele (13.5; 4.5-40.6). Parkinson disease was associated with an increased mortality risk (1.8; 1.5-2.3). The association consistently diminished when analyses were sequentially restricted to patients with shorter disease duration and after adjustment for the occurrence of dementia. Conclusions: Especially patients with Parkinson disease who carry an APOE 2 allele have an increased risk of developing dementia. Increased mortality risk in Parkinson disease is dependent on disease duration and is only modest in the absence of dementia.

出现在阿尔茨海默型痴呆前9年的认知功能下降:一项基于人群的前瞻性研究

Better knowledge of the preclinical phase of Alzheimer’s disease would be an important advance to allow earlier treatment of this ominous disease. This prodr omal period was investigated in the Paquid cohort by analysing change in cogniti ve performances at five time points over a 9 year period. Neuropsychological mea sures including global cognitive functioning (Mini-Mental State Examination), v isuo-spatial memory (Benton Visual Retention Test), verbal fluency (Isaacs Set Test) and abstract thinking (Wechsler Similarities Test) were assessed in 215 fu ture Alzheimer’s disease subjects and 1050 individuals without dementia. The resul ts showed that cognitive performances of the pre-morbid subjects at baseline we re already lower than those of individuals without dementia (1.4 points less on the Mini-Mental State Examination; 1.8 points less on the Benton Visual Retenti on Test; 4 points less on the Isaacs Set Test and 0.8 points less on the Wechsle r Similarities Test). For some neuropsychological tests, an acceleration of the decline occurred ～3 years before the diagnosis and, for each test, the course o f decline was modulated by education level. These findings show that abnormally low performances can be evidenced 9 years before the clinical diagnosis of Alzhe imer’s disease in several domains of cognition beyond memory and that cognitive change over time can be influenced by education.

神经囊虫病患者的痴呆是否可逆

Objective: To determine the correlates and outcome of dementia in patients with neurocysticercosis (NCC). Methods: Ninety consecutive patients with untreated NCC underwent a cognitive assessment (Mini-mental State Examination, Neurobehavioral Cognitive Status Examination, and IQCODE) and were classified as having or not having dementia according to DSM-IV criteria. Imaging and cerebrospinal fluid examination data were recorded. The cognitive measures were repeated six months after treatment with albendazole and steroids. Results: At the initial evaluation 15.5%(n=14) of the patients were classified as having dementia. Dementia was associated with older age, lower education level, increased number of parasitic lesions in the brain (mostly in the frontal, temporal, and parietal lobes). After six months, 21.5%of the patients from the dementia group continued to have a full dementia disorder and 78.5%no longer fulfilled the DSM-IV criteria for dementia, although some of these patients still showed mild cognitive decline. Conclusions: The results of this study suggest that dementia occurs frequently in patients with untreated NCC, and it is reversible in most cases.

大脑栓子是阿尔茨海默病和血管性痴呆的潜在病因:病例对照研究

目的:比较阿尔茨海默病或血管性痴呆患者与无痴呆对照者之间自发性大脑栓子和静脉-动脉循环分流的发生率。设计:横断面病例对照研究。机构:曼彻斯特的老年精神病二级护理服务中心。

他汀类药物应用和痴呆发病风险的心血管健康研究

Background: Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) reduce cardiovascular risk through mechanisms that might affect the development of dementia. Abstract:Objective: To evaluate whether statin use is associated with a lower risk of dementia compared with never use of lipid-lowering agents (LLAs). Design: Cohort study of community-dwelling adults 65 years and older. The analysis included 2798 participants free of dementia at baseline. Main Outcome Measures: Using Cox proportional hazards regression analysis, we estimated the risk of incident all-cause and type-specific dementia associated with time-dependent statin therapy compared with never use of LLAs. The primary analyses incorporated a 1-year lag between exposure and outcome. Secondary analyses included the final year of exposure and modeled statin use as current use vs nonuse to simulate a case-control approach. Results: Compared with never use of LLAs, ever use of statins was not associated with the risk of all-cause dementia (multivariable-adjusted hazard ratio [HR], 1.08; 95%confidence interval [CI], 0.77-1.52), Alzheimer disease alone (HR, 1.21; 95%CI, 0.76-1.91), mixed Alzheimer disease and vascular dementia (HR, 0.87; 95%CI, 0.44-1.72), or vascular dementia alone (HR, 1.36; 95%CI, 0.61-3.06). In contrast, in secondary analyses, current use of statins compared with nonuse of LLAs was associated with HRs of 0.69 (95%CI, 0.46-1.02) for all-cause dementia and 0.56 (95%CI, 0.35-0.92) for any Alzheimer disease. Conclusions: In this cohort study, statin therapy was not associated with a decreased risk of dementia. Methodological differences may explain why results of this cohort investigation differ from those of prior case-control studies. Additional investigation is needed to determine whether and for whom statin use may affect dementia risk.

鹿特丹地区膳食脂肪酸和帕金森病发病风险关系的研究

Background: Unsaturated fatty acids are important constituents of neuronal ce ll membranes and have neuroprotective, antioxidant, and anti- inflammatory prop erties. Objective: To determine if a high intake of unsaturated fatty acids migh t be associated with a lower risk of Parkinson disease (PD). Methods: In the Rot terdam Study, a prospective population- based cohort study of people ages ≥ 55 , the association between intake of unsaturated fatty acids and the risk of inci dent PD was evaluated among 5,289 subjects who were free of dementia and parkins onism and underwent complete dietary assessment at baseline. PD was assessed thr ough repeated in- person examination, and the cohort was continuously monitored by computer linkage to medical records. The data were analyzed using Cox propor tional hazards regression models. Results: After a mean follow- up of 6.0 years , 51 participants with incident PD were identified. Intakes of total fat, monoun saturated fatty acids (MUFAs), and polyunsatu rated fatty acids (PUFAs) were significantly associated with a lower risk of PD, with an adjusted hazard ratio per SD increase of energy- adjusted intake of 0.69 (95% CI 0.52 to 0.91) for total fat, of 0.68 (95% CI 0.50 to 0.94) for MUFAs, and 0.66 (95% CI 0.46 to 0.96) for PUFAs. No associations were found f or dietary saturated fat, cholesterol, or trans- fat. Conclusion: These finding s suggest that high intake of unsaturated fatty acids might protect against Park inson disease.

作家的灵魂

作家的灵魂宇文浩然凡人必有灵魂。可是偏偏有一个果戈里、却写了一部《死魂灵》。世界上有一种植物人，虽然有一口气，可是他的灵魂总不象健康人那么鲜活。有一种人虽然有灵魂，却是那么不干净、不高尚。还有一种人却在名利和美女面前，却将灵魂出卖了。对于作家，人们把...

领导干部个人爱好要有“度”

俗话说,人各有好。领导干部并非不食人间烟火,工作之余有自己的心爱之物或个人喜好,也在情理之中,不能因为当了官就连个人的爱好也都抛弃。明末散文家张岱说得好：＂人无癖不可与交,以其无深情也;人无痴不可与交,以其无真气也。＂就拿打高尔夫来说,其不过是一项体育运动,领导喜好之本无对错之分,但如果＂接受私营企业主安排＂,

血管危险因素聚集和阿尔茨海默病发生风险的研究

Background: The prevalence of Alzheimer disease (AD) is increasing in the elderly, and vascular risk factors may increase its risk. Abstract:Objective: To explore the association of the aggregation of vascular risk factors with AD. Methods: The authors followed 1,138 individuals without dementia at baseline (mean age 76.2) for a mean of 5.5 years. The presence of vascular risk factors was related to incident possible and probable AD. Results: Four risk factors (diabetes, hypertension, heart disease, and current smoking) were associated with a higher risk of AD (p < 0.10) when analyzed individually. The risk of AD increased with the number of risk factors (diabetes +hypertension +heart disease +current smoking). The adjusted hazards ratio of probable AD for the presence of three or more risk factors was 3.4 (95%CI: 1.8, 6.3; p for trend < 0.0001) compared with no risk factors. Diabetes and current smoking were the strongest risk factors in isolation or in clusters, but hypertension and heart disease were also related to a higher risk of AD when clustered with diabetes, smoking, or each other. Conclusions: The risk of Alzheimer disease (AD) increased with the number of vascular risk factors. Diabetes and current smoking were the strongest risk factors, but clusters including hypertension and heart disease also increased the risk of AD. These associations are unlikely to be explained by misclassification of the outcome, given strong associations when only probable AD is considered.

感悟太行新愚公的“坚、痴、舍”

近日,中共中央总书记、国家主席、中央军委主席习近平对河北农业大学教授、博士生导师李保国同志先进事迹作出重要批示,赞扬李保国同志堪称新时期共产党人的楷模,知识分子的优秀代表,太行山上的新愚公。听了李保国先进事迹的报告,令人心灵震撼,感慨良多。'了却百姓脱贫事。

测定血清S100蛋白用于诊断克-雅病:前瞻性病例对照研究

目的:分析克-雅病(Creutzfeldt-Jakob dis-ease,CJD)患者及对照组血清中脑特异性 S100蛋白浓度。设计:前瞻性病例对照研究。研究单位:国家 CJD 监测站。研究对象:224例疑为 CJD 的转诊患者及35例无痴呆的对照病例。主要结果测定:CJD 患者、其他疾病引起的痴呆患者及对照组血清 S100浓度。结果:224例疑为 CJD 的患者中,65例经病理证实确诊;6例有基因突变而肯定诊断;43例很可能患 CJD;36例可能患 CJD;74例患有其他疾病。108例为肯定或很可能 CJD 患者,其血清 S100浓度中位数为395 pg/ml(SD 387 pg/ml)。这明显高于患其他疾病的74例患者(S100浓度中位数为109pg/ml,SDl77pg/ml;P=0.0001)。以213pg/ml为界值,S100测定用于 CJD 诊断的敏感性为77.8%(95%的可信区间为66.8%～85.2%),特异性为81.1%(70.3%～89.3%)。在 Kaplan-Meier 曲线上,不同浓度 S100患者的存活时间差异有显著性(P=0.023)。结论:S100血清浓度测定是一种有价值的工具,在 CJD 的鉴别诊断中,较测定脑脊液更有价值。尚需更多的研究以确定连续测定是否有助于提高此病的诊断准确性。

佛言祖语

牟尼身口意清净,智慧光明照世间。此光最胜除冥暗,于释师子应归命。智慧大海胜威德,知法自在为法王。世间应供天中天,觉悟自在应归命。所有难调心已调,意净超出诸魔网。其所见闻不空过,解脱彼岸应归命。佛无体性无与等,所作无边常寂然。知净妙理除疑惑,一切深信应归命。施甘露药大医王,辩才雄猛摧邪道。法为眷属知胜义,导师演说无上法。

邮情深深缘何来?——读《郭润康的百年人生》

见证一个世纪的风云春秋,展陈几近百年的集邮成就,以人生也以邮情,铸就了令世人也让社会的＂恒敬＂。这已不单单是过耄耋之年达期颐之岁的贺寿,而是在提出一个很有启迪意义的生命话题了。

宜

热肠冷眼,观天观地观人生世相,然后笔墨淋漓,写这写那写东西南北,却很少直接写自己。随笔也好,应试文也罢,惊叹,赞美,惋惜,憎恶,我当然融入了自己,但终归有些旁观的味道,今天,且偷眼看自己,写自己。提笔却踌躇,好不容易动个写自己的念头,总不能＂十四进雅礼,十五转从文＂几句话草草了事,待要认真写时,发觉自己既不如五柳先生那般洒脱轻松,开头就是＂不知先生何许人也＂;又不具有丰子恺先生那闪烁智慧之光的幽默感,

下水“湿身”为哪般——写高考下水文的一点感受

明末散文家张岱有句名言：＂人无癖不可与交,以其无深情也;人无痴不可与交,以其无真气也。＂作为一名语文老师,我的一个癖好就是写高考下水作文,连续七年,不曾中断。同事曾戏称此为＂湿身＂,我亦＂湿＂志不渝。每年高考一结束,我就着手写下水文,每次＂湿身＂,感受颇多。今年高考,我又写了下水文。【真题回放】阅读下面的材料,根据要求写一篇不少于800字的文章。