Cognitive impairment in cerebral small vessel disease induced by hypertension

Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension and cerebral small vessel disease remains unclear.Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease.Chronic hypertension and lifestyle factors are associated with risks for stro ke and dementia,and cerebral small vessel disease can cause dementia and stroke.Hypertension is the main driver of cerebral small vessel disease,which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction,leukoaraiosis,white matter lesions,and intracerebral hemorrhage,ultimately res ulting in cognitive decline and demonstrating that the brain is the to rget organ of hypertension.This review updates our understanding of the pathogenesis of hypertensioninduced cerebral small vessel disease and the res ulting changes in brain structure and function and declines in cognitive ability.We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.

Meta-Analysis of Risk Factors of Vascular Cognitive Disorder in Acute Cerebral Infarction Patients

Objectives: To identify the main risk factors of vascular cognitive impairment in patients with acute cerebral infarction by Meta-analysis, and provide references for the effective prevention of the cognitive impairment in stroke patients. Methods: To retrieve the observational research literatures that refer to the risk factors of vascular cognitive impairment in patients with ischemic stroke, which are published on China National Knowledge Infrastructure (CNKI), Wanfang and Weipu Chinese databases. The screening and data extraction of these literatures are independently completed by two researchers, who also give the quality evaluation of the literatures according to the evaluation criterion of the Australian JBI Evidence-Based Health Care Center. Then, Meta-analysis is conducted by using Revman5.3 software. Results: There are twenty-eight articles selected from 1507 literatures, with a total of 10,711 cases and 50 risk factors included. Among them, there are combined effects of ten factors which have statistical significance, such as infarction area, alcohol consumption, smoking, hyper homocysteinemia, hypertension, diabetes mellitus, age, history of cerebral infarction, hyperlipoidemia and education level. The relational merging OR value and 95% CI between the type-variable factors and cognitive impairment are 3.25 (1.84, 5.76);2.98 (2.58, 3.45);2.79 (1.69, 4.59);2.35 (1.93, 2.85);2.25 (1.86, 2.71);2.14 (2.10, 2.18);1.82 (1.62, 2.03);1.54 (1.24, 1.92);1.45 (1.34, 1.56);0.83 (0.78, 0.89). Conclusion: Infarction area, alcohol consumption, smoking, hyper homocysteinemia, hypertension, diabetesmellitus, age, history of cerebral infarction, hyperlipoidemia and low education level are the main risk factors for vascular cognitive impairment in patients with acute cerebral infarction. Clinical nursing staff should include it into the routine assessment of patients with acute cerebral infarction and actively prevent and intervene.

Depressive Symptom Endorsement among Alzheimer’s Disease, Vascular Dementia and Mild Cognitive Impairment

Background: The Geriatric Depression Scale (GDS) is widely used to assess depressive symptoms in clinical and research settings. This study utilized a 4 factor solution for the 30-item GDS to explore differences in the presentation of depressive symptoms in various types of cognitive impairment. Method: Retrospective chart review was conducted on 254 consecutive cases of community dwelling elderly newly diagnosed with mild Alzheimer’s Dementia (AD) n = 122, mild Vascular Dementia (VaD) n = 71 or Amnestic Mild Cognitive Impairment (aMCI) n = 32 and Non-Amnestic MCI (nMCI) n = 29. Results: Analysis revealed no significant differences (p 05). No statistically significant differences were found between VaD and nMCI or between the MCI groups. Conclusions: Support is provided for the use of GDS subscales in a wide range of cognitively impaired elderly. This study suggests in mild dementia the number and type of depressive symptoms vary significantly between AD and VaD. There are indications that aMCI patients are similar in their symptom endorsement to AD and nMCI are similar to VaD which is consistent with some of the notions regarding likely trajectories of the respective MCI groups.

Advances in multimodal magnetic resonance imaging of vascular mild cognitive impairment

Vascular mild cognitive impairment(VaMCI)represents the early stage of symptoms of vascular cognitive impairment(VCI).There are many intervention factors in this period.If the active treatment can delay the further development of the disease and even reduce the risk of transforming into vascular dementia(VaD).As a widely used imaging method,multi-mode magnetic resonance imaging can evaluate the brain structure and function of patients with VaMCI noninvasively and explore the relationship between brain structure,function and cognitive function change.It is beneficial to provide an idea for early diagnosis of VaMCI and to further understand the neuropathologic mechanism of its occurrence,which has broad application prospects.In this paper,the research status and new methods of VaMCI are reviewed by using multi-mode magnetic resonance imaging in recent years.

Clinical Study of Endovascular Treatment of Severe Middle Cerebral Artery Stenosis or Occlusion and Vascular Cognitive Impairment

It is very important to study the factors affecting the incidence,progress and prognosis of patients with vascular dementia.50 cases of severe middle cerebral artery stenosis or occlusion underwent endovascular treatment(25 cases of mild cognitive dysfunction,25 cases of moderate cognitive dysfunction)were divided into two groups,where a medical drug treatment group and a control group established with 25 cases in each group.The cognitive function of each group of patients was evaluated before operation,7 days after operation,30 days after operation,and 180 days after operation.CTP was used to compare the hemodynamic changes in patients before and after operation.The severe stenosis or occlusion of the middle cerebral artery in patients can be improved,and the intracranial blood supply of patients with poorly compensated medial cranial circulation and hypoperfusion can be restored to a certain extent.Meanwhile,improvement of cognitive function was definitive in some patients with cognitive dysfunction.To guide the formulation of treatment plans for patients with severe middle cerebral artery stenosis or occlusion.

Microbleeds in fronto-subcortical circuits are predictive of dementia conversion in patients with vascular cognitive impairment but no dementia

Cerebral small vessel disease（CSVD） is a common etiology of vascular cognitive impairment with no dementia（V-CIND）. Studies have revealed that cerebral microbleeds（CMBs）, a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients（29.3%） had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits（odds ratio = 4.4; 95% confidence interval： 1.602-12.081, P = 0.004） and 5 or more CMBs overall（odds ratio = 17.6, 95% confidence interval： 3.23-95.84, P = 0.001） had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs.

β2-Microglobulin exacerbates neuroinflammation,brain damage,and cognitive impairment after stroke in rats

β2-Microglobulin(β2M),a component of the major histocompatibility complex class I molecule,is associated with aging-related cognitive impairment and Alzheimer’s disease.Although upregulation ofβ2M is considered to be highly related to ischemic stroke,the specific role and underlying mechanistic action ofβ2M are poorly understood.In this study,we established a rat model of focal cerebral ischemia by occlusion of the middle cerebral artery.We found thatβ2M levels in the cerebral spinal fluid,serum,and brain tissue were significantly increased in the acute period but gradually decreased during the recovery period.RNA interference was used to inhibitβ2M expression in the acute period of cerebral stroke.Tissue staining with 2,3,5-triphenyltetrazolium chloride and evaluation of cognitive function using the Morris water maze test demonstrated that decreasedβ2M expression in the ischemic penumbra reduced infarct volume and alleviated cognitive deficits,respectively.Notably,glial cell,caspase-1(p20),and Nod-like receptor pyrin domain containing 3(NLRP3)inflammasome activation as well as production of the inflammatory cytokines interleukin-1β,interleukin-6,and tumor necrosis factor-αwere also effectively inhibited byβ2M silencing.These findings suggest thatβ2M participates in brain injury and cognitive impairment in a rat model of ischemic stroke through activation of neuroinflammation associated with the NLRP3 inflammasome.

Diagnostic Value of Cerebrospinal Fluid Sequencing for Neurosyphilis with Cognitive Impairment

Neurosyphilis(NS)is an infectious disease caused by Treponema pallidum invading the central nervous system.It can manifest at any stage of syphilis,and is often misdiagnosed due to its atypical and progressive symptoms.The increasing incidence of NS underscores the necessity for early and accurate diagnosis.Here,we present a case where routine cerebrospinal fluid metagenomic next-generation sequencing(mNGS)was used to diagnose a patient with neurosyphilis.The patient exhibited cognitive impairment and was initially diagnosed with cerebral infarction due to syphilitic cerebral arteritis.Thus,the patient was treated with dual antiplatelet therapy(aspirin and clopidogrel)and statins to stabilize the plaques.Neurosyphilis was treated with penicillin sodium injections,resulting in significant improvement in the patient’s mental state.This case is a rare instance of neurosyphilis associated with cerebral infarction.These findings suggest that mNGS is a valuable tool in diagnosing neurosyphilis,potentially improving diagnostic accuracy and patient outcomes.

Efficacy of acupuncture in combination with medicine for mild cognitive impairment after cerebral infarction:a randomized controlled trial

Objective To observe the clinical effect of acupuncture in combination with medicine in the treatment of mild cognitive impairment after cerebral infarction as well as the impact on patients＇ daily living ability. Methods Seventy-two patients, in accordance with random number table, were divided into two groups, acupuncture combined with western medicine group （group A） and western medicine group （group B）, each group with 36 patients. In combination with nimodipine tablets, acupuncture which can regulate the mind and reinforce the intelligence [making Baihui （百会 GV 20）, Sishencong （四神聪EX-HN 1）, Sibai （四白 ST 2）, Fengchi （风池 GB 20）, Wanggu （完骨 GB 12）, Tianzhu （天柱 BL 10）, Shenmen （神门 HT 7）, Neiguan （内关 PC 6）, Shuigou （水沟 GV 26）, Sanyinjiao （三阴交 SP 6）, Taichong （太冲 LR 3）, Fenglong （丰隆 ST 40） as the main acupoints] was given in the treatment group （group A） while only nimodipine tablets were given in the control group （group B）. The efficacy of these two groups was evaluated by Montreal Cognitive Assessment （MoCA） Scale after the continuous treatment for three months. Results The remarkably effective rate was 69.4%.and the total effective rate was 91.7% in the treatment group, while the remarkably effective rate was 55.6% and the total effective rate was 80.6% in the control group; the differences between the two groups were statistically significant （P〈0.05）. When comparing the MoCA score before and after treatment, which was 20.23±4.67 before treatment and 26.84±3.87 after treatment in group A; 19.82±3.56 before treatment and 23.33±2.78 after treatment in group B, it was found that the score for both groups became higher after treatment than that before treatment. Furthermore, the increase of the score was higher in the treatment group （6.61±0.80） than that in the control group （3.51±0.78） and the differences were statistically significant （P〈0.05）. Conclusion Acupuncture, which can regulate the mind and reinforce the intelligence, combined with nimodipine tablets is an effective therapy for the treatment of mild cognitive impairment after cerebral infarction, which is superior to single treatment with nimodipine tablets.

Offspring of rats with cerebral hypoxia-ischemia manifest cognitive dysfunction in learning and memory abilities

Neonatal hypoxic-ischemic encephalopathy is a serious neurological disease,often resulting in long-term neurodevelopmental disorders among surviving children.However,whether these neurodevelopmental issues can be passed to offspring remains unclear.The right common carotid artery of 7-day-old parental-generation rats was subjected to permanent ligation using a vessel electrocoagulator.Neonatal hypoxic-ischemic rat models were established by subjecting the rats to 8%O2–92%N2 for 2 hours.The results showed that 24 hours after hypoxia and ischemia,pathological damage,cerebral atrophy,liquefaction,and impairment were found,and Zea-Longa scores were significantly increased.The parental-generation rats were propagated at 3 months old,and offspring were obtained.No changes in the overall brain structures of these offspring rats were identified by magnetic resonance imaging.However,the escape latency was longer and the number of platform crossings was reduced among these offspring compared with normal rats.These results indicated that the offspring of hypoxic-ischemic encephalopathy model rats displayed cognitive impairments in learning and memory.This study was approved by the Animal Care&Welfare Committee of Kunming Medical University,China in 2018(approval No.kmmu2019072).

Lacunar infarction with leukoaraiosis may aggravate cognitive dysfunction

This study semi-quantitatively analyzed the effects of leukoaraiosis.Patients with moderate or severe lacunar infarction were found to exhibit low scores on the Montreal Cognitive Assessment Scale （F=12.02,P=0.000）,and prolonged P300 Cz2.0 latency （F=16.04,P=0.000）.Correlation analysis revealed that the occurrence of leukoaraiosis was negatively correlated with Montreal Cognitive Assessment scores （r=-0.416,P=0.000）,and positively correlated with P300 Cz2.0 latency （r=0.538,P=0.000）.These findings indicate that leukoaraiosis aggravates cognitive impairment in patients with lacunar infarction,such that more severe leukoaraiosis is associated with more severe cognitive decline.

Identification and classification of traditional Chinese medicine syndrome types among senior patients with vascular mild cognitive impairment using latent tree analysis

OBJECTIVE： To treat patients with vascular mild cognitive impairment （VMCI） using traditional Chinese medicine （TCM）, it is necessary to classify the patients into TCM syndrome types and to apply different treatments to different types. In this paper, we investigate how to properly carry out the classification for patients with VMCI aged 50 or above using a novel data-driven method known as latent tree analysis （LTA）. METHOD： A cross-sectional survey on VMCI was carried out in several regions in Northern China between February 2008 and February 2012 which resulted in a data set that involves 803 patients and 93 symptoms. LTA was performed on the data to reveal symptom co-occurrence patterns, and the patients were partitioned into clusters in multiple ways based on the patterns. The patient clusters were matched up with syndrome types, and population statistics of the clusters are used to quantify the syndrome types and to establish classification rules. RESULTS： Eight syndrome types are identified： Qi deficiency, Qi stagnation, Blood deficiency, Blood stasis, Phlegm-dampness, Fire-heat, Yang deficiency, and Yin deficiency. The prevalence and symptom occurrence characteristics of each syndrome type are determined. Quantitative classification rules are established for determining whether a patient belongs to each of the syndrome types. CONCLUSION： A solution for the TCM syndrome classification problem for patients with VMCI and aged 50 or above is established based on the LTA of unlabeled symptom survey data. The results can be used as a reference in clinic practice to improve the quality of syndrome differentiation and to reduce diagnosis variances across physicians. They can also be used for patient selection in research projects aimed at finding biomarkers for the syndrome types and in randomized control trials aimed at determining the efficacy of TCM treatments of VMCI.

Selective Aberrant Functional–Structural Coupling of Multiscale Brain Networks in Subcortical Vascular Mild Cognitive Impairment

Subcortical vascular mild cognitive impairment(svMCI)is a common prodromal stage of vascular dementia.Although mounting evidence has suggested abnormalities in several single brain network metrics,few studies have explored the consistency between functional and structural connectivity networks in svMCI.Here,we constructed such networks using resting-state f MRI for functional connectivity and diffusion tensor imaging for structural connectivity in 30 patients with svMCI and 30 normal controls.The functional networks were then parcellated into topological modules,corresponding to several well-defined functional domains.The coupling between the functional and structural networks was finally estimated and compared at the multiscale network level(whole brain and modular level).We found no significant intergroup differences in the functional–structural coupling within the whole brain;however,there was significantly increased functional–structural coupling within the dorsal attention module and decreased functional–structural coupling within the ventral attention module in the svMCI group.In addition,the svMCI patients demonstrated decreased intramodular connectivity strength in the visual,somatomotor,and dorsal attention modules as well as decreased intermodular connectivity strength between several modules in the functional network,mainly linking the visual,somatomotor,dorsal attention,ventral attention,and frontoparietal control modules.There was no significant correlation between the altered module-level functional–structural coupling and cognitive performance in patients with svMCI.These findings demonstrate for the first time that svMCI is reflected in a selective aberrant topological organization in multiscale brain networks and may improve our understanding of the pathophysiological mechanisms underlying svMCI.

Effect of acupuncture on cerebral blood flow,serum S100β and ALP in the patients with post-stroke mild cognitive impairment in the convalescence stage

Objective:To explore the clinical therapeutic effect and the impacts of acupuncture on cerebral blood flow and serum S100β and alkaline phosphatase(ALP) in the patients with post-stroke mild cognitive impairment in convalescence stage.Methods:A total of 66 cases were randomized into a control group(33 cases) and an observation group(33 cases).The conventional treatment was applied in the control group.On the base of the treatment of the control group,acupuncture was added at Shéntíng(神庭GV24),Bǎihuì(百会GV20),Dàzhuī(大椎GV14),Mìngmén(命门GV4),Shènshū(肾俞BL23),Shénmén(神门HT7) and Xuánzhōng(悬钟GB39) in the observation group.Before and after treatment,separately,Montreal cognitive assessment(MoCA),mini-mental state examination(MMSE) and modified Barthel index(MBI) were assessed in the patients,peak systolic velocity(PSV) and resistance index(RI) and the levels of serum S100β and ALP were measured.At the end of treatment,the clinical therapeutic effect was evaluated in patients of the both groups.Results:After treatment,the scores of MoCA,MMSE and MBI in the observation group were all higher than those in the control group.PSV in the observation group was higher than the control group,while RI,S100β and ALP were lower than those in the control group,indicating the statistical differences(all P <0.05).The total effective rate was 93.75% in the observation group,higher than 67.74% in the control group,showing statistical difference(P <0.05).Conclusion:Acupuncture achieves the definite therapeutic effect on post-stroke mild cognitive impairment in convalescence stage.This therapy improves the cognitive function,the quality of life and cerebral blood flow in the patients and also down-regulates the levels of serum S100β and ALP.Hence,this acupuncture therapy is worthy of clinical promotion.

醒脑开窍针刺法联合中药治疗脑梗死后轻度认知障碍的疗效观察

目的 观察醒脑开窍针刺法联合补肾益髓汤治疗脑梗死后轻度认知障碍的临床疗效。方法 将80例脑梗死后轻度认知障碍的患者随机分为研究组(40例)和对照组(40例)。两组均予基础治疗,研究组在基础治疗外另予醒脑开窍针刺法联合补肾益髓汤治疗。比较两组临床疗效,观察两组治疗前后简易精神状态检查表(mini-mental state examination,MMSE)、蒙特利尔认知评估(Montreal cognitive assessment,MoCA)和Rivermead行为记忆测验(Rivermead behavioural memory test,RBMT)的评分变化,观察两组治疗前后连线测验-B(trail making test-B,TMT-B)结果、血清淀粉样蛋白A(serum amyloid A,SAA)和β-淀粉样蛋白(amyloid β-protein,Aβ)水平以及脑微循环指标(颈总动脉的平均血流量、最大血流速度、最小血流速度、临界压力、脉搏速度、特性阻抗、外周阻力和动态阻力)的变化。结果 研究组总有效率高于对照组(P<0.05)。治疗后,两组MMSE、MoCA和RBMT评分均高于同组治疗前(P<0.05),且研究组上述评分均高于对照组(P<0.05)。治疗后,两组TMT-B结果以及SAA和Aβ水平均优于同组治疗前(P<0.05),且研究组上述指标优于对照组(P<0.05)。治疗后,两组脑微循环指标均较治疗前改善(P<0.05),且研究组优于对照组(P<0.05)。结论 在基础治疗以上,采用醒脑开窍针刺法联合补肾益髓汤治疗脑梗死后轻度认知障碍可提高临床疗效,能进一步改善患者认知功能,并调节SAA和Aβ水平。

阿托伐他汀联合胞磷胆碱治疗脑小血管病轻度认知障碍疗效观察

目的 分析阿托伐他汀联合胞磷胆碱治疗脑小血管病(CSVD)轻度认知障碍(MCI)的疗效及对患者血-脑屏障功能和炎症因子的影响。方法 选取2021-03—2023-03自贡市第四人民医院收治的102例CSVD合并MCI患者为研究对象,分为观察组与对照组各51例。对照组口服胞磷胆碱钠片,观察组在对照组基础上加用阿托伐他汀钙片口服,2组均持续治疗3个月。治疗结束后比较2组患者临床疗效,以及治疗前、治疗3个月后蒙特利尔评定量表(MoCA)评分、血-脑屏障功能、炎症因子水平[血清C反应蛋白(CRP)、白细胞介素-6(IL-6)]和血脂水平[总胆固醇(TC)、甘油三酯(TG)和低密度脂蛋白(LDL-C)],记录治疗期间不良反应。结果 治疗后观察组总有效率优于对照组(94.12%比78.43%,P<0.05)。2组患者MoCA评分较治疗前均显著升高,观察组为(27.07±1.05)分,高于对照组的(25.89±1.54)分(P<0.05)。2组患者治疗后伊文思蓝水平、血清CRP、IL-6水平、血清TC、TG和LDL-C水平较治疗前均降低,观察组分别为(10.29±1.17)μg/g、(4.67±1.03)mg/L、(101.76±10.54)ng/L、(2.06±0.46)mmol/L、(1.65±0.32)mmol/L、(1.84±0.30)mmol/L,均低于对照组的(13.87±1.56)μg/g、(6.93±1.78)mg/L、(109.34±11.12)ng/L、(3.24±0.49)mmol/L、(2.24±0.48)mmol/L、(2.39±0.46)mmol/L(P<0.05)。2组患者治疗期间相关不良反应发生率无统计学差异(7.84%比5.88%,P>0.05)。结论 阿托伐他汀联合胞磷胆碱治疗CSVD合并MCI疗效确切,有利于改善患者认知功能、血-脑屏障功能,并降低炎症因子和脂质代谢水平。

脑梗死患者认知障碍与脑白质病变相关性分析

目的探讨脑梗死(CI)患者认知障碍与脑白质病变(WML)的相关性,基于多因素logistic回归分析认知障碍并发WML的危险因素。方法选取2020年8月至2022年10月医院收治的134例CI患者为研究对象,依据是否发生认知障碍分为发生组(56例)、未发生组(78例)。比较两组一般资料,分析认知障碍与年龄相关性脑白质改变评分(ARWMC)相关性。发生组患者依据是否发生WML病变分为非病变者36例、病变者20例,并分析WML病变者、非病变者血清学指标[视黄醇结合蛋白(RBP)、半乳糖凝集素-3(Galectin-3)、白细胞介素-33(IL-33)]水平。多因素logistic回归分析认知障碍并发WML的危险因素。评价危险因素联合预测认知障碍并发WML的预测价值。结果CI患者认知障碍与入院时ARWMC评分存在线性关系(P=0.005),且认知障碍与入院时ARWMC评分呈正相关(r=0.485,P<0.001)。病变者年龄、入院时NIHSS评分、重度颈动脉狭窄占比、多梗死灶占比高于非病变者,血清RBP、Galectin-3、IL-33水平高于非病变者(P<0.05)。高龄、入院时NIHSS评分增加、颈动脉狭窄程度加重、多梗死灶及血清RBP、Galectin-3、IL-33水平升高均为认知障碍并发WML的危险因素(P<0.05)。危险因素联合预测认知障碍并发WML的曲线下面积大于血清RBP、Galectin-3、IL-33单独预测(P<0.05)。结论CI患者认知障碍与WML呈正相关,年龄增长、入院时NIHSS评分增加、颈动脉狭窄程度增加、多梗死灶及血清RBP、Galectin-3、IL-33水平升高是影响认知障碍并发WML的危险因素,基于危险因素建立logistic回归预测模型,该模型对认知障碍并发WML具有一定预测价值。

中医导引功法组方治疗血管性轻度认知障碍的疗效研究

目的探讨中医导引功法组方治疗血管性轻度认知功能障碍(vascular mild cognitive impairment,VaMCI)的疗效。方法本研究为横断面研究。选取2017年1月至2019年1月在天津医科大学总医院康复医学科就诊的VaMCI患者50例作为研究对象,按随机数字表法将患者分为导引功法组25例[男12例、女13例,年龄(67.20±5.37)岁]和常规治疗组25例[男13例、女12例,年龄(67.36±5.38)岁]。另选取无疾病人群25例为正常组[男11例、女14例,年龄(67.04±4.36)岁]。常规治疗组给予基础治疗及常规运动功能康复训练,导引功法组在常规治疗组基础上经专业人员指导进行导引功法训练,疗程均为12周。对比3组治疗前后收缩压、舒张压及简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、洛文斯顿认知功能评定量表(LOTCA)及改良Barthel指数(MBI)评分。采用χ^(2)检验、t检验、方差分析。结果治疗12周后,导引功法组的MMSE评分、MoCA评分、MBI评分、注意力评分、视运动组织评分、思维操作评分及LOTCA总评分均高于常规治疗组[(23.64±2.90)分比(21.56±1.90)分、(23.72±2.42)分比(20.64±2.40)分、(75.80±7.31)分比(71.20±7.94)分、(3.12±0.73)分比(2.56±0.58)分、(21.96±1.90)分比(19.56±1.98)分、(26.16±1.89)分比(24.44±2.58)分、(96.20±4.25)比(90.44±6.58)分],导引功法组的收缩压、舒张压均低于常规治疗组[(137.00±10.70)mmHg(1 mmHg=0.133 kPa)比(147.60±8.91)mmHg、(73.80±10.23)mmHg比(85.40±10.60)mmHg],差异均有统计学意义(均P<0.05)。导引功法组治疗12周后的MMSE评分、收缩压、舒张压与正常组比较差异均无统计学意义[(23.64±2.90)分比(23.52±2.20)分、(137.00±10.70)mmHg比(138.80±7.94)mmHg、(73.80±10.23)mmHg比(73.40±10.08)mmHg](均P>0.05)。导引功法组治疗前后MMSE、MoCA、MBI、注意力、定向力、视运动组织、思维操作评分、LOTCA总分、收缩压的差值均大于常规治疗组和正常组(均P<0.05)。结论中医导引功法组方可以明显改善VaMCI患者的认知功能和日常生活活动能力,是VaMCI的有效治疗手段,值得在临床工作中进一步推广。

认知-运动双重任务训练对老年血管性轻度认知障碍病人认知状态及步行能力的影响

目的:探究认知-运动双重任务训练对老年血管性轻度认知障碍(VaMCI)病人认知状态及步行能力的影响。方法:选取我院2021年4月—2022年4月收治80例老年VaMCI病人作为研究对象,依据训练方式不同分为常规训练组和双重任务组,各40例。常规训练组给予常规认知功能训练,双重任务组给予认知-运动双重任务训练,干预3个月后比较两组病人认知状态、步行能力、跌倒风险控制。结果:干预后,双重任务组临床痴呆量表(CDR)评分低于常规训练组,简易精神状态量表(MMSE)评分高于常规训练组(P<0.05),改良Barthel指数(MBI)评分、步频、步速水平高于常规训练组(P<0.05),修订版跌倒功效量表(MFES)、Berg平衡量表(BBS)评分高于常规训练组(P<0.05)。结论:认知-运动双重任务训练可改善老年VaMCI病人的认知状态,调控跌倒风险控制水平,调节步行能力。

糖尿病前期对皮质下缺血性血管性认知障碍的影响

目的探讨糖尿病前期对皮质下缺血性血管性认知障碍(SIVCI)的影响。方法回顾性分析2017年4月至2022年7月于作者医院就诊的皮质下缺血性脑血管病(SIVD)患者242例。依据认知功能分为血管性痴呆组(VaD),轻度认知障碍组(vMCI)以及无认知障碍组(NoCI),记录并应用单因素分析比较各组一般临床资料以及空腹血糖、糖化血红蛋白等生化指标,以及颅内脑白质病变(WMLs)的Fazekas评分、腔隙性脑梗死评级等影像学指标的差异,并将组间差异有统计学意义(P<0.05)的指标纳入有序Logistic回归方程,分析SIVD发生SIVCI的危险因素。结果VaD组及vMCI组的受教育程度低于NoCI组,高血压、糖代谢异常的患者比例高于NoCI组,而VaD组糖尿病患者比例高于vMCI组(均P<0.05),VaD组与vMCI组的受教育程度、高血压、糖尿病前期患者比例差异无统计学意义(P>0.05);VaD组的MMSE评分低于vMCI组及NoCI组,重度WMLs患者比例高于vMCI组及NoCI组,vMCI组MMSE评分低于NoCI组(均P<0.05),vMCI组与NoCI组的重度WMLs比例差异无统计学意义(P>0.05)。有序Logistic回归分析提示糖尿病〔OR(95%CI)=2.921(1.636~5.215),P=0.001〕及糖尿病前期〔OR(95%CI)=2.743(1.461~5.150),P=0.002〕均是SIVD患者发生SIVCI的危险因素。受教育程度低〔OR(95%CI)=0.861(0.811~0.914),P=0.001〕、有高血压史〔OR(95%CI)=1.867(1.089~3.201),P=0.023〕、重度WMLs〔OR(95%CI)=2.227(1.344~3.690),P=0.002〕也是发生SIVCI的危险因素。结论除了受教育程度低、高血压史以及重度WMLs以外,糖尿病前期及糖尿病也是SIVD患者发生认知障碍的危险因素。对SIVD患者早期进行糖代谢筛查,在糖尿病前期进行血糖干预有助于预防SIVCI发生。