脑梗死后智能障碍影响因素分析

目的 探讨影响脑梗死后智能障碍的因素。方法 应用长谷川痴呆量表对249例经CT证实的脑梗死患者进行智能测评,评分0～21．5为智能障碍组,22～32．5为正常组,探讨智能障碍的发生与性别、年龄、文化程度、卒中主要危险因素(高血压和糖尿病)、梗死灶数量及体积,以及脑萎缩和脑白质疏松之间的相互关系．结果 249例脑梗死患者中有106例(42．6％)出现智能障碍．并发现年龄、性别、文化程度、高血压病、糖尿病与智能障碍的发生有关;梗死灶的数量越多、体积越大其智能障碍发生率越高;脑萎缩及脑白质疏松与智能障碍关系密切．结论 脑梗死后智能障碍是多因素相互作用的结果,与梗死灶数量、体积、脑萎缩及脑白质疏松等多种因素有关．     

Prevalence of potentially reversible dementias and actual reversibility in a memory clinic cohort

BACKGROUND: Although clinics for the evaluation of cognitive dysfunction have typically emphasized the detection and treatment of the reversible causes of dementia, it remains unclear whether the treatment of such causes results in reversal of the dementia. Therefore, the appropriate work-up for dementia is in dispute. METHODS: A chart review was performed with records from an urban tertiary care referral-based memory clinic. The records for 196 patients with dementia or suspected dementia, seen between October 1991 and December 1993, were examined to determine the prevalence of potentially reversible dementias and whether the cognitive dysfunction improved or resolved after treatment. Data abstracted from the medical charts included demographic information, medication use, presence of depression, and results of neuropsychological tests, blood work and neuroimaging. The clinical diagnosis, the response to treatment, if applicable, and the outcome (mean follow-up period 16 months) were analysed. The recommendations of the 1989 Canadian Consensus Conference on the Assessment of Dementia (CCCAD) on the use of CT were retrospectively applied in each case. RESULTS: Of the 196 patients, 45 (23.0%) had a potentially reversible condition identified by history, physical examination, blood testing or CT; in only 7 (3.6% of the total) did treatment result in improvement or resolution of the dementia. These 7 patients had higher results for the Mini-Mental State examination (mean result 26) and exhibited only mild cognitive deficits. Potentially reversible lesions were found in the CT scans of 6 (3.1%) patients: 4 had normal-pressure hydrocephalus and 2 had a brain tumour. If the CCCAD recommendations had been followed, CT would have been performed in 76 (38.8%) of the patients, and 1 of the 6 patients with a lesion would have been missed. INTERPRETATION: Both potential and actual reversibility of dementia was low in these memory clinic patients. The patients whose condition improved with intervention had early and milder cognitive deficits, which suggests that thorough evaluation of early memory loss is warranted.     

Computerized Tomographic Scanning in Cases of Dementia

In assessing the clinical value of computerized tomographic (CT) scanning in elderly patients with dementia, only one of 100 patients with dementia of insidious onset and no other abnormal neurologic signs was found to have a potentially treatable disorder. In a second group of 100 patients with dementia of abrupt onset or with additional abnormal neurologic signs, 12 were found to have a lesion that potentially required medical or surgical intervention. We conclude that a subgroup of patients with dementia, representing about a third of demented patients in our hospital, are unlikely to benefit from CT scanning.     

Bruikbaarheid en validiteit van de Nederlandse versie van de Montreal Cognitive Assessment (MoCA-D) bij het diagnosticeren van Mild Cognitive Impairment

Objective: The MoCA is a new screening test to detect Mild Cognitive Impairment (MCI). Purpose of this study is validating the Dutch version (MoCA-D). Method: We administered the MoCA-D to healthy control subjects and to elderly with MCI or dementia from a memory disorder outpatient clinic and a geriatric (outpatient) clinic (n=30, 32, 37 respectively, age≥60). Neuropsychological testing was part of the standard procedure for patients to diagnose MCI. Sensitivity, specificity and predictive values (positive: PPV and negative: NPV) of the MoCA-D were assessed. Results: A significant effect of group was found on MoCA-D total score (F(2,95)=67,9; p<0,01). With a cutoff score of d25, sensitivity and specificity to detect MCI in relation to healthy controls were 72% and 73%, respectively. PPV and NPV were 84% and 56%, respectively. With a cut-off score of d20, sensitivity to detect dementia in relation to MCI was 100% for severe dementia and 75% for mild dementia. Specificity for dementia was 81%, PPV 94% and NPV 55%. Conclusion: The MoCA-D distinguishes between healthy elderly, MCI patients and dementia patients. However, in this study, insufficient sensitivity and poor specificity were found. For the present, applying a broader and flexible screening procedure in order to detect MCI seems a more useful method than the interpretation of one test result in particular.     

Dementia of the Alzheimer Type: An Oral and Biochemical Study1

Alzheimer's disease, or pre-senile dementia, may occur as early as 40 years. Pathologically, there is, besides a loss of brain weight, a conical atrophy with ventricular dilatation and typical microscopic lesions in the cortex and the hippocampus. Previously, the authors [Sanchez & Gonzalez, 1986] have studied the modifications of the amino acids (AA) composition in the cerebrospinal fluid (CSF), Even if some were increased without specificity, three of them were decreased significantly in this type of dementia (Serine, Glutamate and Aspartate). Twenty subjects were studied (15 with Alzheimer's disease and 5 non-patients) having a mean age of 72 years. For each subject, two samples were tested (one blood and one saliva sample). In this study we tried to determine if our results would be similar to those previously obtained in the CSF, but in a different biological fluid, the saliva. Of the 13 AA of the saliva, tested by gas-liquid chromatology (Spectra Physics 7100), 3 were increased significantly, and curiously, these were similar to those found to be decreased in CSF. We attempted to find the possible biological and oral repercussions of this dementia, which is the most frequent type in elderly patients.     

Do general practitioners miss dementia in elderly patients?

General practitioners and community nurses were asked to rate the likelihood of dementia for each of their elderly patients. Cases of dementia were identified by research psychiatrists using the Cambridge mental disorders of the elderly examination (CAMDEX), a new structured diagnostic interview. General practitioners correctly identified dementia as at least a possibility in 121 of the 208 cases found. Nevertheless, they mistakenly rated as demented several patients suffering from functional psychiatric disorders, in particular depression. Community nurses correctly identified dementia as at least a possibility in 64 of the 74 demented patients known to them, but they incorrectly suspected dementia in a greater proportion of instances. Both general practitioners and families appeared to have low expectations of what general practice has to offer demented elderly people. General practitioners should take the initiative in diagnosing dementia in very elderly patients who show signs of the condition. In some cases it may be secondary to treatable disorders, and in others all that may be required are understanding, support, and advice to families.     

Possible relationship between periodontitis and dementia in a North Indian old age population: a pilot study

doi: 10.1111/j.1741‐2358.2010.00441.x Possible relationship between periodontitis and dementia in a North Indian old age population: a pilot study Background: Periodontitis and cognitive impairment or dementia is relatively common among older adults. Few cross‐sectional studies and some longitudinal studies have attempted to link oral health with dementia diagnosis or disease pathology but none has investigated the role of inflammation as a potential mediator. Objectives: This study was planned to establish a relation of inflammatory mediators between periodontitis and dementia. Materials and methods: Fifty‐five patients with severe periodontitis (range 60–69 years), 20 with dementia (10:10 M:F; range 59–69) and 32 healthy controls (range 58–69 years) were selected. The socio‐demographic characteristics, physical health, oral health, education status, and medical status were measured. Serum C‐reactive protein (CRP), matrix metalloproteinase (MMP)‐8, MMP‐9, total IGF‐I, free IGF‐I and TNF‐alpha and GCF MMP‐8 &MMP‐9 were calculated. Results: There was no significant difference between the three groups in the level of education, age, occupation, BMI, CAD, CHF and diabetes except dentate status. After adjusting for age, significant differences were found between patients and controls with respect to gingival inflammation, dental plaque, bleeding on probing and probing pocket depth. Total counts of WBCs, neutrophils, thrombocytic counts and serum CRP, MMP‐8, MMP‐9, TNF‐alpha levels were significantly higher in dementia and periodontitis patients in contrast to healthy controls, while, RBC counts, total IGF‐I and Hb levels were lowered in dementia and periodontitis patients in comparison to healthy controls, although higher in dementia as compared to periodontitis patients. Conclusions: This study data suggest a relationship of inflammatory mediators between periodontitis and dementia. Further exploration of this is warranted.     

Plasma carcinoembryonic antigen versus plasma calcitonin in the diagnosis of medullary carcinoma of the thyroid

Summary The value of carcinoembryonic antigen (CEA) assay for diagnosis and follow-up in patients suffering from medullary carcinoma of the thyroid (MCT) was investigated in a large sample (106 cases). High levels of CEA were found in 84% of patients suffering from either the sporadic or the familial form of the disease. Levels of CEA and calcitonin (CT) are significantly and positively correlated. Removal of tumoral tissue is followed by a decrease in both CEA and CT levels. High levels of CEA were also observed in the parents of patients suffering from the familial form of MCT. These patients were operated on and MCT was confirmed histologically. The limitations of the use of CEA assay in the diagnosis of MCT are discussed.     

Memorization and delayed expression of regulatory messages in plants

Plantlets of Bidens pilosus L., considered to be basically symmetrical, can be lateralized (A/B) by being administered a symmetry-breaking signal such as puncturing one of the plant cotyledons. The induced asymmetry remains latent as long as the plants have not been made permissive, i.e. as long as the plant apex is left functioning. When the apex has been removed (plant decapitation), the latent asymmetry is expressed by one of the cotyledonary buds (a/b) statistically beginning to elongate before the other. The interval of time between delivering the symmetry-breaking signal and making the plant permissive is the memorization-time, t. Memorization can be quantified by using a precedence index, q, the values of which range from 0 (no detectable asymmetry with regard to bud growth) to ±1 (bud growth perfectly asymmetric in favour of either bud b or a). Even for memorization times, t, up to 14 d, q-values up to 0.4 (or even larger) are observed. Various experimental characteristics (e.g. light, temperature, presence or absence of the root system) but not the plant age can affect the q-values, at the moment when the treatments are performed, at least in the range of 6 to 25 d. Combining several puncturing treatments either increases or decreases the q-values, depending on the nature of these treatments and the time-intervals, t, between them. Symmetrically removing both cotyledons in the minutes following the puncturing of one of them does not significantly alter the results, which means that the symmetry-breaking message is rapidly transported and memorized within the plant. Non-traumatic asymmetrical treatments (droplets of saline solutions, light-gradients) can also act as symmetry-breaking signals and be memorized. Plants other than Bidens are likely to possess similar memorization ability, although the q-values observed up to now have not been very large.     

Análisis de las defunciones de pacientes con demencia ingresados en una unidad de psicogeriatría

Aim

To determine the characteristics of patients with dementia who died in a psychogeriatric unit, and to describe the conditions that led to their death.

Material and methods

Observational study of patients who died in the Psychogeriatric unit of Hospital de la Santa Creu de Vic during a three and a half year period.

Results

Of the 554 patients admitted during the study period, we recorded a mortality of 14.6% (81 patients). The analysis of those who died showed that 67.9% were women, with a mean age of 85.8 years, with the most frequent cause being Alzheimer type dementia (37%) and being in an advanced stage (CDR3, GDS 6-7) in 72.8% of cases. On admission the following characteristics were recorded: Mini Mental State Examination (MMSE) 9.5, Barthel Index (BI) prior to entry 50.1, BI on admission 17.4, and Neuropsychiatric Inventory (NPI) 31.4. A therapeutic limitation treatment was determined for 84% of patients on admission. From the analysis of the conditions that lead to death it was noted that: In 74.1% of the patients the death was a direct result of a triggering event (the most frequent being respiratory infection), in 17.3% the death occurred by a gradual decline, with no clear precipitating factor, and in 8.6% of patients palliative sedation was required due to poorly controlled symptoms.

Conclusions

Intercurrent problems were the most common factors related to the death of the patients. Most patients died in the stages prior to the established criteria for terminal dementia. In some cases patients may experience disorder behavior as a refractory symptom.     

A possible emerging role of phytochemicals in improving age-related neurological dysfunctions: a multiplicity of effects

It is rare to see a day pass in which we are not told through some popular medium that the population is becoming older. Along with this information comes the "new" revelation that as we enter the next millennium there will be increases in age-associated diseases (e.g., cancer, cardiovascular disease) including the most devastating of these, which involve the nervous system (e.g., Alzheimer's disease [AD] and Parkinson's disease [PD]). It is estimated that within the next 50 years approximately 30% of the population will be aged 65 years or older. Of those between 75 and 84 years of age, 6 million will exhibit some form of AD symptoms, and of those older than 85 years, over 12 million will have some form of dementia associated with AD. What appears more ominous is that many cognitive changes occur even in the absence of specific age-related neurodegenerative diseases. Common components thought to contribute to the manifestation of these disorders and normal age-related declines in brain performance are increased susceptibility to long-term effects of oxidative stress (OS) and inflammatory insults. Unless some means is found to reduce these age-related decrements in neuronal function, health care costs will continue to rise exponentially. Thus, it is extremely important to explore methods to retard or reverse age-related neuronal deficits as well as their subsequent, behavioral manifestations. Fortunately, the growth of knowledge in the biochemistry of cell viability has opened new avenues of research focused at identifying new therapeutic agents that could potentially disrupt the perpetual cycle of events involved in the decrements associated with these detrimental processes. In this regard, a new role in which certain dietary components may play important roles in alleviating certain disorders are beginning to receive increased attention, in particular those involving phytochemicals found in fruits and vegetables.     

Neutrophilic Hypersegmentation Without Macrocytic Anemia

In five months of examining some 25,000 blood smears of hospital and clinic patients, 200 patients were found whose blood had hypersegmented neutrophiles without macrocytosis of the erythrocytes. Sixty-five of these patients subsequently received adequate laboratory work-up. Seven proved to have a bacterial inhibitor in their serum which interfered with the microbiological assay of folic acid. Of these patients, six had normal B-12 levels. Of the remaining 58, 45 had a deficiency of folate, of vitamin B-12 or of both. In 13, no such deficiency could be established. Of these, seven proved to be uremic. It is concluded that the additional effort required to search carefully for hypersegmentation, even in the absence of erythroid macrocytosis, is thoroughly justified, and that a large percentage of those patients in whose blood hypersegmented neutrophiles are found will prove to have important deficiencies of folate or B-12, or will prove to be uremic.     

Feeding frequency and survival of Anopheles gambiae in a rice-growing area in Ghana

Mortality rates, determined by dissection, of predominantly M form female Anopheles gambiae (Diptera: Culicidae) were estimated. Mosquitoes were collected in tent traps and light traps in an irrigation project village in Ghana in June and July 2010, when much of the area was flooded. Both M and S form larvae were collected from rice fields (74 of 80 specimens were M form). Adults were collected in equal proportions from the two traps (90 of 107 specimens from the light trap and 106 of 116 specimens from the tent trap were M form). During the study, collection numbers rose from 105 to 972 per night. A total of 1787 of the 15 431 An. gambiae collected were dissected. Of these, 953 (53%) were found to have taken their first bloodmeal, either as virgins or following mating. The age profiles of mosquitoes collected alive and dead, respectively, were similar. Eighteen of 2933 (0.61 ± 0.49%) specimens were found to be positive for sporozoites in an enzyme-linked immunosorbent assay (ELISA). Lagged cross correlations among the different age groups implied that the mosquitoes fed on days 2 and 4 following emergence prior to oviposition and every 2.65 ± 0.17 days thereafter. The best model to describe the observed population patterns implied a daily mortality of 84%. The results are discussed in relation to possible mosquito control measures for the village.     

Cystic fibrosis carrier population screening in the primary care setting.

To determine the receptivity of prenatal care providers and their patients to carrier testing for cystic fibrosis (CF), we offered free carrier screening, followed by genetic counseling of carriers, to all prenatal care providers in Rochester, NY, for all their female patients of reproductive age, pregnant or not. Of 124 prenatal care providers, only 37 elected to participate, but many of these offered screening only to pregnant women. The acceptance rate among pregnant women was approximately 57%. The most common reasons for accepting screening were to obtain reassurance (50.7%) and to avoid having a child with CF (27.8 %). The most common reasons for declining screening were not intending to terminate a pregnancy for CF (32.4%) and believing that the chance of having a CF child was very low (32.2%). Compared with decliners, acceptors were more likely to have no children, regarded having a child with CF as more serious, believed themselves more susceptible to having such a child, knew more about CF, would be more likely to terminate a pregnancy if the fetus were shown to have CF, and more strongly supported offering CF screening to women of reproductive age. Of 4,879 women on whom results were obtained, 124 were found to be carriers. Of these 124 carriers, the partners of 106 were tested. Of the five at-risk couples, four requested prenatal diagnosis and one requested neonatal diagnosis. No woman found to be a carrier whose partner tested negative requested prenatal diagnosis. Except for the imperfect knowledge of those testing negative, none of the adverse outcomes predicted for CF carrier testing in the general population were observed in this study.     

Cognitive Impairment in Chinese Patients with Sporadic Amyotrophic Lateral Sclerosis

Background

It has reached a consensus that patients with amyotrophic lateral sclerosis (ALS) could display cognitive impairment characterized by executive dysfunction or even dementia, but cognitive spectrum of Chinese patients with ALS still waits to be documented.

Methods

A total of 106 incident patients with sporadic ALS were enrolled and comprehensive neuropsychological tests covering memory, executive function, attention, language, and visuospatial function were administered to them. Neuropsychological performances of 76 age- and education- matched healthy controls were used for the purpose of classification and comparison.

Results

106 patients were categorized into 4 subtypes:84 (79.2%) ALS with normal cognition (ALS-NC), 12 (11.3%) ALS with executive cognitive impairment (ALS-ECI), 5 (4.7%) ALS with non-executive cognitive impairment (ALS-NECI), and 5 (4.7%) ALS with frontotemporal lobe degeneration (ALS-FTLD). Under the same criteria, 2 (2.6%) and 1 (1.3%) healthy controls were diagnosed as ECI and NECI, respectively. The proportion of ECI was significantly higher in non-demented ALS than that in healthy controls, but it was not for NECI. Patients with ALS-FTLD had significantly severer bulbar function and older age than those with ALS-NC.

Conclusion

Comorbid FTLD occurred in around 5% of Chinese sporadic ALS cases. Different genetic background and unique age distribution of Chinese ALS patients might be the reasons for the relatively low rate of comorbid FTLD. Cognitive dysfunction, predominant but not exclusive in executive area, was present in around 16% of non-demented ALS patients.     

宁波地区蝴蝶种类调查及区系分析

宁波地区蝶类164种,尿属于11科106属,其中,东洋种81个,占总数的49．39％,古北种15个,占总数的9．14％,东洋古北共有种65个,占39．63％,广布种3个,占1．82％,区系分析表明,本地区蝶类资源属于东洋区系范畴,并具有东洋区向古北区过渡的特性,蝶类分布型有24个,仅限于华中,华南,西南3区分布的种类有49个,占总数的近1／3,调查发现浙江省新纪录3种。     

兰州市婴幼儿艰难梭菌带菌状况

在兰州市随机采集的２１６名健康婴幼儿粪标本经分离并对其培养特性、菌落菌体形态特征、生化反应特性以及毒素原性等进行一系列检查,检出了３７人的粪便含有艰难梭菌（１０４─１０８／ｇ）,检出总阳性率为１７．１％,新生儿、婴儿及幼儿各年龄组的检出阳性率分别为１３．５％（１９／４１）、３３．３％（１３／３９）、１３．９％（５／３６）。３７株分离菌中毒素原性阳性者仅有８株（２１．６％）,均分布于婴儿与幼儿两组。新生儿１４１人中２７人的粪标本为胎粪,只有１人（３．７％）含艰难梭菌（２×１０６／ｇ）,但不产毒素。所有婴幼儿中有２２人因各种原因曾用过抗菌药物,但仅有２人的粪便含艰难梭菌,而且均为非产毒株,表明艰难梭菌检出率与药物服用之间似无显著的相关性。     

Indications for and results following exploration of the common bile duct for stones

Among 100 consecutive patients who had removal or drainage of the gallbladder and exploration of the common bile duct for stones, there were no serious, immediate or late complications and there were no operative deaths. Ninety-six of the 100 patients had stones in the gallbladder, in the common duct, or in both, and 52 of these patients had one or more stones in the common duct. Ten patients died subsequently of unrelated causes. Six patients were lost to followup. Of the 84 patients whose present condition is known, 75 or 89 per cent have had a completely satisfactory result. Six more patients have minor residual symptoms, and for them the result has been classified as good. In three patients, the results were unsatisfactory. Cholangiograms taken before the removal of the T-tube showed residual stones in two patients. In each instance, the stone or stones have been subsequently passed and both patients are in excellent condition.     

Value of Doppler ultrasound in diagnosis of clinically suspected deep vein thrombosis.

Doppler ultrasound was used to study 120 legs of 106 patients with suspected deep vein thrombosis (DVT) or pulmonary embolism. Venography was subsequently performed in all. DVT was confirmed by venography in 44 legs and was confined to the calf in 10 of these. Ultrasound detected three calf thromboses and 29 out of 34 more extensive thromboses. Of five undetected thrombi that were proximal to the calf one was associated with partial occlusion and four with extensive collateral circulation. Of the 76 limbs without venographic evidence of thrombosis 21 were thought to have DVT by ultrasound; 18 of these false-positive results could be attributed to external compression of veins, two to excessive tenderness precluding adequate examination; and in one no explanation was found. This test gives more accurate results than judging by clinical signs alone, but users must be aware of its limitations and, particularly, the causes of false-positive and false-negative results.