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 th...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.展开更多
BACKGROUND Cognitive decline is common among older patients with cardiovascular disease(CVD) and can decrease their self-management abilities. However, the instruments for identifying mild cognitive impairment(MCI) ar...BACKGROUND Cognitive decline is common among older patients with cardiovascular disease(CVD) and can decrease their self-management abilities. However, the instruments for identifying mild cognitive impairment(MCI) are not always feasible in clinical practice. Therefore, this study evaluated whether MCI could be detected using the Japanese version of the Rapid Dementia Screening Test(RDST-J), which is a simple screening tool for identifying cognitive decline.METHODS This retrospective single-center study included patients who were ≥ 65 years old and hospitalized because of CVD.Patients with a pre-hospitalization diagnosis of dementia were excluded. Each patient's cognitive function had been measured at discharge using the RDST-J and the Japanese version of the Montreal Cognitive Assessment(Mo CA-J), which is a standard tool for MCI screening. The correlation between the two scores was evaluated using Spearman's rank correlation coefficient. Receiver operating characteristic(ROC) analysis was also to evaluate whether the RDST-J could identify MCI, which was defined as a Mo CA-J score of ≤ 25 points.RESULTS The study included 78 patients(mean age: 77.2 ± 8.9 years). The RDST-J and Mo CA-J scores were strongly correlated(r = 0.835, P < 0.001). The ROC analysis revealed that an RDST-J score of ≤ 9 points provided 75.4% sensitivity and 95.2% specificity for identifying MCI, with an area under the curve of 0.899(95% CI: 0.835-0.964). The same cut-off value was identified when excluding patients with a high probability of dementia(RDST-J score of ≤ 4 points).CONCLUSIONS The RDST-J may be a simple and effective tool for identifying MCI in older patients with CVD.展开更多
Forty patients with multi-infarct dementia (MID) were randomly assigned to the treatment group (25 cases) treated with Jian Nao Ning (健脑宁JNN) and the duxil control group (15 cases). Memory function were assessed at...Forty patients with multi-infarct dementia (MID) were randomly assigned to the treatment group (25 cases) treated with Jian Nao Ning (健脑宁JNN) and the duxil control group (15 cases). Memory function were assessed at baseline and endpoint using memory subscales of a battery of New Psychometric Tests (Chinese version) including mini-mental state examination (MMSE), verbal memory, and non-verbal memory, etc. After treatment, the mean scores of verbal memory in the Hopkins Verbal Learning Test (P<0.05) and total memory scores of memory items (P<0.001) in JNN group increased significantly; and improvement in episodic memory function including story recall (immediate and delayed), delayed word recall, verbal learning and verbal recognition and visual recognition in the JNN group was better than that in the duxil control group, suggesting that JNN can obviously improve memory function for the patients with mild or moderate multi-infarct dementia.展开更多
Objective:To explore the clinical effects of acupuncture and repeated transcranial magnetic stimulation in patients with mild vascular dementia.Method:From May 2020 to May 2021,40 patients with mild vascular dementia ...Objective:To explore the clinical effects of acupuncture and repeated transcranial magnetic stimulation in patients with mild vascular dementia.Method:From May 2020 to May 2021,40 patients with mild vascular dementia in Harbin Fourth Hospital(our hospital)were divided into the experimental group(20 cases,using conventional drugs+acupuncture+repeated transcranial magnetic stimulation)and the control group(20 cases,for example,the application of conventional medication).The improvement of cognitive function score,sleep quality score,quality of life score,and cerebral hemodynamics before and after treatment were compared between the two groups.Result:Before treatment,the difference in cognitive function score,sleep quality score,quality of life score,and cerebral hemodynamic index between the two groups of patients did not form,that is,p>0.05;after treatment,the experimental group5s cognitive function score was(19.45±2.47)points,Sleep quality score(12.18±2.09),quality of life score(33.29±4.08),left cerebral blood flow velocity(65.76±3.32)cm/s,right cerebral blood flow velocity(64.32±3.25)cm/s,more For the control group,P<0.05・Conclusion:In the clinical treatment of patients with mild vascular dementia,based on conventional drugs,combined with acupuncture and repetitive transcranial magnetic stimulation,the patients?cognitive function can be improved,and the quality of sleep and quality of life can be improved.Comprehensive clinical promotion.展开更多
OBJECTIVE: To investigate the efficacy and safety of Chinese herbal medicines in the treatment of patients with vascular dementia. DATA RETRIEVAL: We retrieved publications from Cochrane Library (2004 to July 2011...OBJECTIVE: To investigate the efficacy and safety of Chinese herbal medicines in the treatment of patients with vascular dementia. DATA RETRIEVAL: We retrieved publications from Cochrane Library (2004 to July 2011), PubMed (1966 to July 2011), the Chinese Science and Technique Journals Database (1977 to July 2011), the China National Knowledge Infrastructure (1979 to July 2011), Google Scholar (July 2011), and the Chinese Biomedical Database (1977 to July 2011) using the key words "Chinese medicine OR Chinese herbal medicine" and "vascular dementia OR mild cognition impair OR multi-infarct dementia OR small-vessel dementia OR strategic infarct dementia OR hypoperfusion dementia OR hemorrhagic dementia OR hereditary vascular dementia". SELECTION CRITERIA: Randomized controlled trials comparing Chinese herbal medicines with placebo/western medicine in the treatment of patients with vascular dementia were included. Diagnostic standards included Diagnostic and Statistical Manual of Mental Disorders-IV, and National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherche et I'Enseignement en Neurosciences. Two participants independently conducted literature screening, quality evaluation and data extraction. The quality of each trial was assessed according to the Cochrane Reviewers' Handbook 5.0. MAIN OUTCOME MEASURES: Effective rate, Mini-Mental State Examination scores, Hasegawa Dementia Scale scores, and incidence of adverse reactions. RESULTS: We identified 1 143 articles discussing the effects of Chinese medicine on vascular dementia. Thirty-one of these were included in the analysis. These studies involved a total of 2 868 participants (1 605 patients took Chinese medicine decoctions (treatment group); 1 263 patients took western medicine or placebo). The results of our meta-analysis revealed that Chinese herbal remedies in the treatment group were more efficacious than the control intervention (relative risk (RR) = 1.27; 95% confidence interval (C/): 1.18-1.38, P 〈 0.01). Mini-Mental State Examination scores were higher in patients taking Chinese herbal medicines than in those in the control group (weighted mean difference (WMD) = 2.83; 95%CI: 2.55-3.12, P 〈 0.01). Patients in the treatment group showed better disease amelioration than those in the control group (Hasegawa Dementia Scale scores; WMD = 2.41, 95%CI: 1.48-3.34, P 〈 0.01). There were also considerably fewer adverse reactions among those in the treatment group compared with those in the control group (RR = 0.20, 95%CI: 0.08-0.47, P 〈 0.01). CONCLUSION: Chinese herbal medicine appears to be safer and more effective than control measures in the treatment of vascular dementia. However, the included trials were generally low in quality. More well-designed, high-quality trials are needed to provide better evidence for the assessment of the efficacy and safety of Chinese medicines for vascular dementia.展开更多
Objectives: Although people with amnestic mild cognitive impairment (aMCI) benefit from cerebrolysin treatment, some still develop dementia. The aim of the current study was to identify most informative clinical asses...Objectives: Although people with amnestic mild cognitive impairment (aMCI) benefit from cerebrolysin treatment, some still develop dementia. The aim of the current study was to identify most informative clinical assessment tests to predict the therapy efficacy in aMCI subjects treated with cerebrolysin. Methods: We studied patients with amnestic mild cognitive impairment (aMCI;n = 53) who had regular neurocognitive and clinical psychiatric assessments and were treated with cerebrolysin i.v. infusions 20 × 30 ml twice a year over three years period. Data were analyzed using non-parametric statistics, cluster and linear discriminant analyses. Results: Combined mathematical modeling enabled to predict cognitive decline from aMCI to dementia in the cerebrolysin-treated patients based on their initial neurocognitive assessment scores. We identified a “dementia risk group” with fast cognitive decline (i.e. low efficacy of the treatment). Lower baseline scores in the Mattis Dementia Rating Scale Memory subtest, Mini-Mental State Examination (MMSE), 10 word list immediate recall, and Frontal Assessment Battery tests when accompanied by higher depression score (Hamilton Depression Rating Scale) suggest poor prognosis for aMCI patients treated with cerebrolysin. Changes in scores on the MMSE, Boston naming test, Digit span forward, and Wechsler scale subtest “Categorical associations” during the treatment course are more characteristic for patients who convert to dementia than their initial scores. Conclusions: aMCI subjects treated with cerebrolysin with lower baseline cognitive functioning and subclinical depression have poor prognosis in terms of converting to dementia. Changes in the MMSE, Boston naming test, Digit span forward, and Wechsler scale subtest “Categorical associations” scores during the treatment course are more informative to identify patients who will develop dementia than their initial scores.展开更多
Background: Amnestic mild cognitive impairment (aMCI) and mild-to-moderate Alzheimer’s disease (AD) are clinically distinct but impact cognitive and functional ability similarly. Comprehensive assessment of cognitive...Background: Amnestic mild cognitive impairment (aMCI) and mild-to-moderate Alzheimer’s disease (AD) are clinically distinct but impact cognitive and functional ability similarly. Comprehensive assessment of cognitive and functional deficits may prove useful in informing differential diagnosis in early stages of dementia and in informing endpoint selection in therapeutic AD trials. Objective: The objective of this study was to characterize patterns of cognitive and functional impairment in aMCI and mild-to-moderate AD subjects compared to cognitively intact healthy elderly (HE). Methods: Thirty-one healthy elderly, 20 aMCI and 19 AD participants were administered a cognitive test battery that included the ADAS-Cog and functional assessments. Z-scores were calculated for all endpoints based on the HE reference group. Results: Cognitive deficits were observed in AD and aMCI participants relative to the referent group. On average, aMCI participants performed 1 - 2 standard deviations below HE on cognitive tests, and AD participants performed 2 - 3 standard deviations below HE. Domain-specific functional deficits among AD participants (z- score -0.4 to -6.4) were consistently greater than those of aMCI participants (z-score 0 to -1.7). Conclusion: This study provides further support for comprehensive assessment and monitoring of cognitive and functional domain scores in the diagnosis and treatment of aMCI and mild AD. Domain-specific cognitive scores may be more useful than composite scores in characterizing impairment and decline. Measuring domains such as attention, processing speed and executive function may increase the sensitivity of detecting disease progression and therapeutic effects, particularly in mild-moderate AD where memory decline may be too slow to detect drug effects during a typical clinical trial.展开更多
Background: Mild cognitive impairment (MCI) is a heterogeneous condition with a variety of clinical outcomes, the presence of which correlates with risk of Alzheimer’s disease as well as pre-clinical stages of other ...Background: Mild cognitive impairment (MCI) is a heterogeneous condition with a variety of clinical outcomes, the presence of which correlates with risk of Alzheimer’s disease as well as pre-clinical stages of other dementia subtypes. The aims of this study were to assess the specific patterns of cognitive profiles and to identify changes from baseline to 24 weeks in patients with MCI using detailed neuropsychological testing. Methods: We consecutively recruited 120 MCI patients at baseline according to the Petersen’s clinical diagnostic criteria, who were admitted to the Dementia and Memory Clinics. We analyzed patients who fulfilled both inclusion and exclusion criteria for MCI and classified them into four subtypes according to deficits in major cognitive domains;amnestic MCI single domain (aMCI-s), amnestic multiple domain MCI (aMCI-m), non-amnestic single domain MCI (naMCI-s) and non-amnestic multiple domain MCI (naMCI-m). Four groups of MCI were evaluated by a detailed neuropsychological battery test. Results: 83 patients with MCI at the 24-week follow-up were classified into four subtypes. The most frequent subtype was amnestic multi-domain MCI, with the frequency of MCI subtypes as follows: aMCI-s (n = 21, 25.3%), aMCI-m (n = 53, 63.9%), naMCI-s (n = 5, 6.0%) and naMCI-m (n = 4, 4.8%). In the major cognitive items of the SNSB-D, there were significant changes between the initial and follow-up tests in the domains of language, memory and the fron-tal/executive function (p < 0.05), except for attention, in all MCI patient subtypes. At 24-weeks follow-up, the conversion rate to Alzheimer’s disease was 2.4% (n = 2) from a subtype of amnestic multi-domain MCI. Conclusions: Our study revealed the most frequent subtype of MCI to be multiple domain amnestic MCI, with this subtype having a higher tendency of conversion to Alzheimer’s disease.展开更多
目的分析轻中度老年痴呆患者采用针刺飞腾八法穴位联合多奈哌齐治疗的效果。方法选取2022年12月—2023年12月广州中医药大学第一附属医院收治的100例轻中度老年痴呆患者,按治疗方法不同分为多奈哌齐组(50例,多奈哌齐治疗)和针刺飞腾组(5...目的分析轻中度老年痴呆患者采用针刺飞腾八法穴位联合多奈哌齐治疗的效果。方法选取2022年12月—2023年12月广州中医药大学第一附属医院收治的100例轻中度老年痴呆患者,按治疗方法不同分为多奈哌齐组(50例,多奈哌齐治疗)和针刺飞腾组(50例,多奈哌齐联合针刺飞腾八法穴位治疗)。比较两组中医证候积分、简易智能精神状态检查量表(Mini-mental State Examination,MMES)评分、巴塞尔指数、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、同型半胱氨酸(homocysteine,Hcy)。结果治疗后,针刺飞腾组中医证候积分、MMES评分、巴塞尔指数均高于多奈哌齐组,差异有统计学意义(P均<0.05)。治疗后,针刺飞腾组血清BDNF及Hcy水平[(15.55±0.24)pg/mL,(15.48±0.16)μmol/L]显著优于多奈哌齐组[(13.92±0.16)pg/mL、(19.74±0.33)μmol/L],差异有统计学意义(t=18.534、82.136,P均<0.05)。结论与单纯多奈哌齐治疗比较,对轻中度老年痴呆患者施行针刺飞腾八法穴位联合多奈哌齐治疗效果明显,能够改善患者的中医证候积分、MMES评分、巴塞尔指数、血清BDNF及Hcy。展开更多
文摘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.
文摘BACKGROUND Cognitive decline is common among older patients with cardiovascular disease(CVD) and can decrease their self-management abilities. However, the instruments for identifying mild cognitive impairment(MCI) are not always feasible in clinical practice. Therefore, this study evaluated whether MCI could be detected using the Japanese version of the Rapid Dementia Screening Test(RDST-J), which is a simple screening tool for identifying cognitive decline.METHODS This retrospective single-center study included patients who were ≥ 65 years old and hospitalized because of CVD.Patients with a pre-hospitalization diagnosis of dementia were excluded. Each patient's cognitive function had been measured at discharge using the RDST-J and the Japanese version of the Montreal Cognitive Assessment(Mo CA-J), which is a standard tool for MCI screening. The correlation between the two scores was evaluated using Spearman's rank correlation coefficient. Receiver operating characteristic(ROC) analysis was also to evaluate whether the RDST-J could identify MCI, which was defined as a Mo CA-J score of ≤ 25 points.RESULTS The study included 78 patients(mean age: 77.2 ± 8.9 years). The RDST-J and Mo CA-J scores were strongly correlated(r = 0.835, P < 0.001). The ROC analysis revealed that an RDST-J score of ≤ 9 points provided 75.4% sensitivity and 95.2% specificity for identifying MCI, with an area under the curve of 0.899(95% CI: 0.835-0.964). The same cut-off value was identified when excluding patients with a high probability of dementia(RDST-J score of ≤ 4 points).CONCLUSIONS The RDST-J may be a simple and effective tool for identifying MCI in older patients with CVD.
文摘Forty patients with multi-infarct dementia (MID) were randomly assigned to the treatment group (25 cases) treated with Jian Nao Ning (健脑宁JNN) and the duxil control group (15 cases). Memory function were assessed at baseline and endpoint using memory subscales of a battery of New Psychometric Tests (Chinese version) including mini-mental state examination (MMSE), verbal memory, and non-verbal memory, etc. After treatment, the mean scores of verbal memory in the Hopkins Verbal Learning Test (P<0.05) and total memory scores of memory items (P<0.001) in JNN group increased significantly; and improvement in episodic memory function including story recall (immediate and delayed), delayed word recall, verbal learning and verbal recognition and visual recognition in the JNN group was better than that in the duxil control group, suggesting that JNN can obviously improve memory function for the patients with mild or moderate multi-infarct dementia.
文摘Objective:To explore the clinical effects of acupuncture and repeated transcranial magnetic stimulation in patients with mild vascular dementia.Method:From May 2020 to May 2021,40 patients with mild vascular dementia in Harbin Fourth Hospital(our hospital)were divided into the experimental group(20 cases,using conventional drugs+acupuncture+repeated transcranial magnetic stimulation)and the control group(20 cases,for example,the application of conventional medication).The improvement of cognitive function score,sleep quality score,quality of life score,and cerebral hemodynamics before and after treatment were compared between the two groups.Result:Before treatment,the difference in cognitive function score,sleep quality score,quality of life score,and cerebral hemodynamic index between the two groups of patients did not form,that is,p>0.05;after treatment,the experimental group5s cognitive function score was(19.45±2.47)points,Sleep quality score(12.18±2.09),quality of life score(33.29±4.08),left cerebral blood flow velocity(65.76±3.32)cm/s,right cerebral blood flow velocity(64.32±3.25)cm/s,more For the control group,P<0.05・Conclusion:In the clinical treatment of patients with mild vascular dementia,based on conventional drugs,combined with acupuncture and repetitive transcranial magnetic stimulation,the patients?cognitive function can be improved,and the quality of sleep and quality of life can be improved.Comprehensive clinical promotion.
基金supported by a Special Funding Project for the Chinese National Outstanding Ph.D.Thesis Author,No.201082the First Grade of China Postdoctoral Science Foundation,No.20110490080the National Natural Science Foundation of China,No.81202653
文摘OBJECTIVE: To investigate the efficacy and safety of Chinese herbal medicines in the treatment of patients with vascular dementia. DATA RETRIEVAL: We retrieved publications from Cochrane Library (2004 to July 2011), PubMed (1966 to July 2011), the Chinese Science and Technique Journals Database (1977 to July 2011), the China National Knowledge Infrastructure (1979 to July 2011), Google Scholar (July 2011), and the Chinese Biomedical Database (1977 to July 2011) using the key words "Chinese medicine OR Chinese herbal medicine" and "vascular dementia OR mild cognition impair OR multi-infarct dementia OR small-vessel dementia OR strategic infarct dementia OR hypoperfusion dementia OR hemorrhagic dementia OR hereditary vascular dementia". SELECTION CRITERIA: Randomized controlled trials comparing Chinese herbal medicines with placebo/western medicine in the treatment of patients with vascular dementia were included. Diagnostic standards included Diagnostic and Statistical Manual of Mental Disorders-IV, and National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherche et I'Enseignement en Neurosciences. Two participants independently conducted literature screening, quality evaluation and data extraction. The quality of each trial was assessed according to the Cochrane Reviewers' Handbook 5.0. MAIN OUTCOME MEASURES: Effective rate, Mini-Mental State Examination scores, Hasegawa Dementia Scale scores, and incidence of adverse reactions. RESULTS: We identified 1 143 articles discussing the effects of Chinese medicine on vascular dementia. Thirty-one of these were included in the analysis. These studies involved a total of 2 868 participants (1 605 patients took Chinese medicine decoctions (treatment group); 1 263 patients took western medicine or placebo). The results of our meta-analysis revealed that Chinese herbal remedies in the treatment group were more efficacious than the control intervention (relative risk (RR) = 1.27; 95% confidence interval (C/): 1.18-1.38, P 〈 0.01). Mini-Mental State Examination scores were higher in patients taking Chinese herbal medicines than in those in the control group (weighted mean difference (WMD) = 2.83; 95%CI: 2.55-3.12, P 〈 0.01). Patients in the treatment group showed better disease amelioration than those in the control group (Hasegawa Dementia Scale scores; WMD = 2.41, 95%CI: 1.48-3.34, P 〈 0.01). There were also considerably fewer adverse reactions among those in the treatment group compared with those in the control group (RR = 0.20, 95%CI: 0.08-0.47, P 〈 0.01). CONCLUSION: Chinese herbal medicine appears to be safer and more effective than control measures in the treatment of vascular dementia. However, the included trials were generally low in quality. More well-designed, high-quality trials are needed to provide better evidence for the assessment of the efficacy and safety of Chinese medicines for vascular dementia.
文摘Objectives: Although people with amnestic mild cognitive impairment (aMCI) benefit from cerebrolysin treatment, some still develop dementia. The aim of the current study was to identify most informative clinical assessment tests to predict the therapy efficacy in aMCI subjects treated with cerebrolysin. Methods: We studied patients with amnestic mild cognitive impairment (aMCI;n = 53) who had regular neurocognitive and clinical psychiatric assessments and were treated with cerebrolysin i.v. infusions 20 × 30 ml twice a year over three years period. Data were analyzed using non-parametric statistics, cluster and linear discriminant analyses. Results: Combined mathematical modeling enabled to predict cognitive decline from aMCI to dementia in the cerebrolysin-treated patients based on their initial neurocognitive assessment scores. We identified a “dementia risk group” with fast cognitive decline (i.e. low efficacy of the treatment). Lower baseline scores in the Mattis Dementia Rating Scale Memory subtest, Mini-Mental State Examination (MMSE), 10 word list immediate recall, and Frontal Assessment Battery tests when accompanied by higher depression score (Hamilton Depression Rating Scale) suggest poor prognosis for aMCI patients treated with cerebrolysin. Changes in scores on the MMSE, Boston naming test, Digit span forward, and Wechsler scale subtest “Categorical associations” during the treatment course are more characteristic for patients who convert to dementia than their initial scores. Conclusions: aMCI subjects treated with cerebrolysin with lower baseline cognitive functioning and subclinical depression have poor prognosis in terms of converting to dementia. Changes in the MMSE, Boston naming test, Digit span forward, and Wechsler scale subtest “Categorical associations” scores during the treatment course are more informative to identify patients who will develop dementia than their initial scores.
文摘Background: Amnestic mild cognitive impairment (aMCI) and mild-to-moderate Alzheimer’s disease (AD) are clinically distinct but impact cognitive and functional ability similarly. Comprehensive assessment of cognitive and functional deficits may prove useful in informing differential diagnosis in early stages of dementia and in informing endpoint selection in therapeutic AD trials. Objective: The objective of this study was to characterize patterns of cognitive and functional impairment in aMCI and mild-to-moderate AD subjects compared to cognitively intact healthy elderly (HE). Methods: Thirty-one healthy elderly, 20 aMCI and 19 AD participants were administered a cognitive test battery that included the ADAS-Cog and functional assessments. Z-scores were calculated for all endpoints based on the HE reference group. Results: Cognitive deficits were observed in AD and aMCI participants relative to the referent group. On average, aMCI participants performed 1 - 2 standard deviations below HE on cognitive tests, and AD participants performed 2 - 3 standard deviations below HE. Domain-specific functional deficits among AD participants (z- score -0.4 to -6.4) were consistently greater than those of aMCI participants (z-score 0 to -1.7). Conclusion: This study provides further support for comprehensive assessment and monitoring of cognitive and functional domain scores in the diagnosis and treatment of aMCI and mild AD. Domain-specific cognitive scores may be more useful than composite scores in characterizing impairment and decline. Measuring domains such as attention, processing speed and executive function may increase the sensitivity of detecting disease progression and therapeutic effects, particularly in mild-moderate AD where memory decline may be too slow to detect drug effects during a typical clinical trial.
文摘Background: Mild cognitive impairment (MCI) is a heterogeneous condition with a variety of clinical outcomes, the presence of which correlates with risk of Alzheimer’s disease as well as pre-clinical stages of other dementia subtypes. The aims of this study were to assess the specific patterns of cognitive profiles and to identify changes from baseline to 24 weeks in patients with MCI using detailed neuropsychological testing. Methods: We consecutively recruited 120 MCI patients at baseline according to the Petersen’s clinical diagnostic criteria, who were admitted to the Dementia and Memory Clinics. We analyzed patients who fulfilled both inclusion and exclusion criteria for MCI and classified them into four subtypes according to deficits in major cognitive domains;amnestic MCI single domain (aMCI-s), amnestic multiple domain MCI (aMCI-m), non-amnestic single domain MCI (naMCI-s) and non-amnestic multiple domain MCI (naMCI-m). Four groups of MCI were evaluated by a detailed neuropsychological battery test. Results: 83 patients with MCI at the 24-week follow-up were classified into four subtypes. The most frequent subtype was amnestic multi-domain MCI, with the frequency of MCI subtypes as follows: aMCI-s (n = 21, 25.3%), aMCI-m (n = 53, 63.9%), naMCI-s (n = 5, 6.0%) and naMCI-m (n = 4, 4.8%). In the major cognitive items of the SNSB-D, there were significant changes between the initial and follow-up tests in the domains of language, memory and the fron-tal/executive function (p < 0.05), except for attention, in all MCI patient subtypes. At 24-weeks follow-up, the conversion rate to Alzheimer’s disease was 2.4% (n = 2) from a subtype of amnestic multi-domain MCI. Conclusions: Our study revealed the most frequent subtype of MCI to be multiple domain amnestic MCI, with this subtype having a higher tendency of conversion to Alzheimer’s disease.
文摘目的分析轻中度老年痴呆患者采用针刺飞腾八法穴位联合多奈哌齐治疗的效果。方法选取2022年12月—2023年12月广州中医药大学第一附属医院收治的100例轻中度老年痴呆患者,按治疗方法不同分为多奈哌齐组(50例,多奈哌齐治疗)和针刺飞腾组(50例,多奈哌齐联合针刺飞腾八法穴位治疗)。比较两组中医证候积分、简易智能精神状态检查量表(Mini-mental State Examination,MMES)评分、巴塞尔指数、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、同型半胱氨酸(homocysteine,Hcy)。结果治疗后,针刺飞腾组中医证候积分、MMES评分、巴塞尔指数均高于多奈哌齐组,差异有统计学意义(P均<0.05)。治疗后,针刺飞腾组血清BDNF及Hcy水平[(15.55±0.24)pg/mL,(15.48±0.16)μmol/L]显著优于多奈哌齐组[(13.92±0.16)pg/mL、(19.74±0.33)μmol/L],差异有统计学意义(t=18.534、82.136,P均<0.05)。结论与单纯多奈哌齐治疗比较,对轻中度老年痴呆患者施行针刺飞腾八法穴位联合多奈哌齐治疗效果明显,能够改善患者的中医证候积分、MMES评分、巴塞尔指数、血清BDNF及Hcy。
文摘目的研究听觉词汇学习测验(auditory vocabulary learning test,AVLT)对轻度认知障碍(mild cognitive impairment,MCI)进展为痴呆的预测能力。方法对257例MCI患者进行纵向随访,然后根据临床结果将其分为痴呆进展组和非痴呆进展组。比较这些组的基线人口统计学信息和AVLT评分。构建受试者工作特征(receiver operating characteristic,ROC)曲线以评估AVLT评分对MCI转归的区分值。结果在6年后的随访中,有45例受试者进展为痴呆,归为痴呆进展组(MCI progression,MCIp),3例受试者恢复正常认知,209例受试者维持MCI,一同归为非痴呆进展组(MCI non-progression,MCInp)。在基线时,MCIp组的AVLT评分明显低于MCInp,差异有统计学意义(P<0.05)。ROC曲线分析显示,AVLT延迟回忆(delayed recall,AVLT-DR)在区分MCI患者进展为痴呆方面有最大的曲线下面积(largest area under the curve,AUC),是重要预测指标。结论AVLT,尤其是AVLT-DR评分较低能较好预测MCI进展为痴呆,但由于其特异度偏低,需要联合其他特异度高的量表综合使用来运用于临床工作。