Treatment with Huperzine A Improves Cognition in Vascular Dementia Patients

In the present study, we tested the efficacy and safety of Huperzine A in treatment of mild to moderate vascular dementia (VaD). This was a randomized, double-blinded, placebo-controlled study with 78 patients with mild to moderate VaD. The participants were randomized to receive either vitamin C (100-mg bid) as placebo (n = 39) or Huperzine A (0.1-mg bid) (n = 39) for 12 consecutive weeks. The mini-mental state examination (MMSE), clinical dementia rating (CDR), and activities of daily living (ADL) scores were used for the assessment of cognition. The assessments were made prior to treatment, and 4, 8, and 12 weeks of the treatment. The adverse effects of the treatment were also recorded. After 12 weeks of treatment, the MMSE, CDR, and ADL scores significantly improved in the Huperzine A group (P < 0.01 for all comparisons), whereas the placebo group did not show any such improvement (P > 0.05 for all comparisons). No serious adverse events were recorded during the treatment. Conclusion: Huperzine A can significantly improve the cognitive function in patients with mild to moderate vascular dementia. Further, the medicament is safe.     

蒙特利尔认知评估量表在血管性认知功能障碍中的应用分析

目的:研究蒙特利尔认知评估量表(MoCA)诊断临界值在宁夏回族自治区患有血管性认知功能障碍(VCI)中的应用价值。方法:对宁夏回族自治区人民医院神经内科住院治疗的126例脑血管功能性认知缺陷患者分为非痴呆性血管认知功能障碍(VCIND)组53例、认知功能正常(NCI)组47例和血管性痴呆(VaD)组26例,分别予以简易精神状态量表(MMSE)和MoCA进行认知能力检测,分析比较三组患者的诊断效果。结果:将认知功能障碍MoCA临界值26分定义认知功能障碍时,VCIND组MoCA评分结果显示敏感度86.8%、准确度94.3%;VaD组敏感度100.0%、准确度88.5%与MMSE比较均有统计学意义(P0.05)。结论:采用MoCA在VCI筛查评估中的诊断效果极佳,具有良好的敏感性、特异度和信度,临床推荐应用。     

康复训练联合阿托伐他汀对SIVD患者认知功能及日常行为能力的影响

目的:研究康复训练联合阿托伐他汀对SIVD患者认知功能及日常行为能力的影响。方法:选取97例确诊为SIVD的患者,根据随机数表法将所有患者分为观察组(n=48)和对照组(n=49),对照组给予口服多奈哌齐,观察组给予口服阿托伐他汀和康复训练。结果:治疗1个月后,观察组和对照组的MMSE、Mo CA、BI评分与治疗前差异均无统计学意义(P0.05);治疗6个月后,观察组的MMSE、Mo CA、BI评分显著高于治疗前(P0.05);观察组的MMSE、Mo CA、BI评分显著高于对照组(P0.001);观察组治疗1个月与6个月后总有效分别为16.6%与87.5%,高于同期对照组的12.24%(x~2=0.363,P=0.547)与53.06%(x~2=27.523,P0.001),差异无统计学意义。结论:康复训练联合阿托伐他汀能有效治疗SIVD,值得在临床中推广。     

De relatie van psychiatrische functiestoornissen met cognitie, activiteiten dagelijks leven (ADL) en biografische gegevens

Psychiatric function disorders: association with cognitive function, activities of daily living and biographical data Background: The prevalence of non-cognitive, psychiatric function disorders (PFD) in psychogeriatric patients, staying in a nursing home is high; it varies from 70 to 80%. It has a negative impact on the quality of life and life-expectancy. It affects caregiver distress and is an important predictor of permanent admission to an institution. In addition the PFD has predictive potentialities for discharge from reactivation programmes and survival. Although there is a relationship between PFD (measured by NPI) and cognitive function disorders it has to be stated explicitly that from psychiatric point of view these two entities have to be distinguished. This distinction, already been studied by this research group, needed to be replicated in another population. Objective is to estimate 1) to which degree the prevalence of PFD in psychogeriatric patients, referred to a policlinics for cognitive function disorders (Index condition), differs from community dwelling psychogeriatric patients at referral to clinical and transmural nursing home programmes (Reference condition); 2) to which degree PFD is associated with both cognitive function disorders, activities of daily living for the two conditions; 3) to which degree PFD is associated with relevant general details of the patient, particularly gender, age and marital status, for the two conditions. Methods: In the Index condition particated patients aged ≥ 65 years suffering from cognitive function disorders (N=70) who were referred to a policlinic for cognitive function disorders who were suspected to suffer from psychiatric function disorders. For 35 patients of them complete data on NPI, MMSE en Barthel Index (BI) were available. In the Reference condition participated patients (age ≥ 65), who were referred to clinical and transmural nursing home programmes and who suffered from cognitive function disorders (MMSE ≥ 29) (N=487). For 385 patients of them all data on NPI, MMSE and BI were available. Results: Of all patients 92% suffered from at least one NPI symptom; 82% from two or more. Depression, Apathy, Anxiety and Irritability had high prevalences in the two samples. Application of logistic regression analysis for the prediction of total as well as individual NPI-symptoms showed that the prognostic potentialities of MMSE, BI and biographic data were very limited (R² = 0.11; max.). The non-metric princal component analysis and confirmatory factor analysis of NPI, MMSE and BI for the two samples, showed that MMSE and BI loaded highly on the dimension ‘Cognition’ and NPI on the dimension ‘Psychiatric function disorders’. The dimensional structure of the two samples did not show significant differences. Conclusion: The dimensional structure of the Index condition highly corresponded to the Reference condition; that is to say that the PFD appeared to be relatively independent of cognition and ADL. High prevalences of PFD (NPI), the broad variance of NPI-symptoms and the limited prognostic importance of MMSE, BI and general details for total NPI-score as well as individual NPI-symptoms were confirmed in both conditions. The dimension ‘Psychiatric function disorder’ was relative independent of the dimension ‘Cognition’. As a result it is of clinical interest - in case of referral to clinical and transmural programmes - to distinguish the psychiatric dimension from the cognitive dimension. Tijdschr Gerontol Geriatr 2007; 38: 77-87     

Vascular Cognitive Disorder. A Biological and Clinical Overview

Although vascular dementia (VaD) represents the second most common cause of dementia after Alzheimer’s disease (AD) in the elderly, and is referred as the “silent epidemic of the twenty-first century”, there is still a controversy on terminology, classification and diagnostic criteria of VaD. The diagnosis of VaD resides in clinical criteria determining a cognitive impairment, the presence of cerebrovascular disease and, only in the case of post-stroke dementia or multi-infarct dementia, a temporal relationship between these. The search for a reliable biochemical tests helping in the diagnosis of VaD is so far not available. Several vascular risk factors have a role in the development of VaD and their identification and treatment are among the major aspects of management of VaD. A new line of research in this field is the study of genetic factors underlying vascular cognitive impairment which are: (1) genes predisposing to cerebrovascular disease, and (2) genes that influence brain tissue responses to cerebrovascular lesions. Evidence in favour of a coexistence of vascular and degenerative components in the pathogenesis of dementia in an elderly population comes from neuropathological and epidemiological studies. There is now a great debate whether VaD and AD are more than common coexisting unrelated pathologies and, instead, represent different results of synergistic pathological mechanisms. Preventive approaches aiming at reducing incident VaD by targeting patients at risk of cerebrovascular disease (primary prevention), or acting on patients after a stroke (secondary prevention) to prevent stroke recurrence and the progression of brain changes associated with cognitive impairment are mandatory therapeutic strategies.     

Levels of Amyloid Beta-42, Interleukin-6 and Tumor Necrosis Factor-Alpha in Alzheimer’s Disease and Vascular Dementia

Amyloid β42 (Aβ42) and proinflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) have been suggested to contribute to the pathogenesis of Alzheimer's disease (AD) and vascular dementia (VaD). Our aim was to examine whether the changes in these parameters would be able to discriminate the patients with AD from those with VaD and from healthy individuals. We have analyzed the levels of Aβ42, IL-6 and TNF-α in the serum of newly diagnosed 28 AD patients, 16 VaD patients and 26 healthy non-demented controls. We also investigated whether there is an association between Aβ42, IL-6 and TNF-α levels and mini-mental state examination (MMSE) scores and body mass indexes (BMI) of patients. Our data showed a significant decrease in serum Aβ-42 levels in AD patients compared to VaD patients and controls. Levels of IL-6 and TNF-α were not different between AD patients, VaD patients and controls. We observed a correlation between Aβ-42 levels and MMSE scores and BMI levels in both AD and VaD patients. However, Aβ-42 levels were not correlated with IL-6 and TNF-α levels. Significantly lower levels of Aβ42 found in the serum of AD patients than that of VaD patients and controls suggests that it can be a specific biochemical marker for AD.     

Umbilical cord-derived mesenchymal stem cell transplantation for treating elderly vascular dementia

This study aimed to determine the efficacy and safety of human umbilical cord-derived mesenchymal stem cell (HUC-MSC) transplantation for treating elderly vascular dementia (VaD). Ten VaD patients (average age, 73.88 years old) were treated. HUC-MSCs were isolated, cultured, stem cell-marked, and qualified and administered as a 3-course intravenous infusion to these patients. The Mini-Mental State Exam (MMSE) and the Activities of Daily Living Index (Barthel Index scoring system) were used to assess the cognitive function and daily living activity improvements in these patients before transplantation (T0), 3 months after transplantation (T1), and 6 months after transplantation (T2). The MMSE and Barthel Index scores were 15.80 ± 5.49 and 42.00 ± 9.33 points at T0, respectively, and were significantly different when compared with those at T1 (19.20 ± 6.39 and 49.20 ± 10.86 points, respectively, P < 0.05), whereas there was no difference when compared with those at T2 (14.00 ± 6.55 and 40.70 ± 10.37 points, respectively, P > 0.05). HUC-MSC transplantation was safe and feasible for VaD and improved early cognitive functions and daily living activities in VaD patients to a certain extent, thus improving patients’ quality of life.     

Neuropsychiatric symptoms of dementia: psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI)

Behavioral and psychological symptoms are highly prevalent in dementia. The Neuropsychiatric Inventory was constructed to measure these symptoms. Data from three studies are presented concerning psychometric aspects of the NPI Dutch version. The NPI was compared to the Revised Memory and Behavioral Problems Checklist (RMBPC) and the Mini Mental State Examination (MMSE). In the three selected patient samples prevalence of behavioral or psychological symptoms was as high as 90%. Interrater agreement (n = 19) was very high (kappa > .90). Factor analysis (n = 199) supports NPI construct validity. The NPI items correlated reasonably high (R = .35 - .60) with the relevant RMBPC subscales (n = 24). Although some NPI items did, the NPI total score was not significantly related to the MMSE. The NPI Dutch version can be scored objectively and it is a valid rating scale for measuring a wide range of behavioral and psychological symptoms of dementia.     

肠道菌群与路易体痴呆的相关性研究

探讨路易体痴呆（DLB）患者的肠道菌群组成及相关性。

选取2021年1月—2023年8月在温州市中西医结合医院招募的17例DLB患者和招募的21名健康对照者（HC）,分别设为DLB组和HC组。DLB患者通过简易智能状态检查量表（MMSE）、日常生活活动能力（ADL）量表、统一帕金森病评定量表第三部分（UPDRSⅢ）评估病情。采用16S rRNA基因测序比较两组肠道菌群组成的异同。菌群特征和DLB病情严重程度的相关性分析采用Spearman相关性分析。

两组间性别、年龄、受教育时间差异均无统计学意义（P＞0.05）,DLB组MMSE评分、ADL评分、UPDRSⅢ评分与HC组相比,差异具有统计学意义（P＜0.001）。与HC组相比,DLB组肠道菌群菌种多样性降低（P＜0.05）,粪杆菌属相对丰度下降,埃希−志贺菌属、链球菌属、Ligilactobacillus相对丰度升高（P＜0.05）。粪杆菌属的相对丰度与MMSE评分呈正相关（r=0.405,P＜0.001）,与病程和UPDRSⅢ呈负相关（r= −0.238,P=0.019）;埃希−志贺菌属与病程和UPDRSⅢ呈正相关（r=0.263,P=0.008）,与MMSE评分和ADL评分呈负相关（r= −0.290,P=0.003）。

DLB患者肠道菌群结构发生改变,肠道菌群失调可能在DLB的发生发展中发挥重要作用。

     

Potential therapeutic targets of huperzine A for Alzheimer's disease and vascular dementia

Huperzine A (HupA), a novel Lycopodium alkaloid isolated from Chinese folk medicine Huperzia serrata (Qian Ceng Ta), is a potent, selective and well-tolerated inhibitor of acetylcholinesterase (AChE). It has been proven to significantly improve the learning and memory impairment in Alzheimer's disease (AD) and vascular dementia (VaD) patients in China. Interestingly, our recent data indicate that HupA also possesses other protective functions. This paper will give an overview on the protective effects of HupA, which includes regulating beta-amyloid precursor protein (APP) metabolism, protecting against Abeta-mediated oxidative stress, apoptosis and mitochondrial dysfunction, as well as anti-inflammation. The multiple neuroprotective effects of HupA might yield additional beneficial effects in AD and VaD therapy.     

Neuroprotective effect of yokukansan against cytotoxicity induced by corticosterone on mouse hippocampal neurons

Yokukansan, a traditional Japanese herbal medicine, has been used for the management of neurodegenerative disorders and for the treatment of neurosis, insomnia, and behavioral and psychological symptoms of dementia. Recently, several studies have shown that yokukansan has a neuroprotective effect. The aim of this study was to examine the neuroprotective effect of yokukansan on hippocampal neurons from embryonic mouse brain against the effects of corticosterone, which is considered to be a stress hormone and to be cytotoxic toward neurons. The cell survival rates were measured by the WST-8 assay and LDH assay. Twenty-four hours after treatment with corticosterone, cell numbers were significantly decreased compared with the control or treatment with vehicle in a dose-dependent manner. When cells were treated with 30 μM corticosterone, the decrease in the number of cells was significantly recovered by treatment with yokukansan (100–1000 μg/ml) in a dose-dependent manner. However, yokukansan did not suppress the decrease in cell numbers that was induced by treatment with 100 μM corticosterone. In the LDH assay, treatment with yokukansan at a high concentration (500–1000 μg/ml) suppressed the LDH concentration induced by treatment with both 30 μM and 100 μM corticosterone compared to treatment with corticosterone alone, respectively. These results suggest that yokukansan protects against the cytotoxic effect of a low concentration of corticosterone on hippocampal neurons.     

血清NGF、BDNF、GFAP水平与老年血管性痴呆严重程度的相关性分析

目的:探讨血清神经生长因子(Nerve Growth Factor,NGF)、脑源性神经营养因子(Brain Derived Neural Nutrition Factor, BDNF)、胶质纤维酸性蛋白(Glial Fibrillary Acidic Protein,GFAP)水平与老年血管性痴呆严重程度的相关性。方法:选择我院2016年1月至2018年12月收治的81例老年血管性痴呆患者,根据简易精神状态检查表(MMES)评分将其分为三组,以MMSE评分21～26分者为轻度组(26例),10～20分者为中度组(28例),0～9分者为重度组(27例),同时选择来院体检的50例健康者作为对照组,检测和比较各组的血清NGF、BDNF、GFAP水平,分析血清NGF、BDNF、GFAP水平与老年血管性痴呆患者MMSE分值的相关性。结果:老年血管性痴呆者的血清NGF、GFAP水平明显高于对照组(P0.05),血清BDNF水平明显低于对照组(P0.05)。轻度组、中度组、重度组的血清NGF、GFAP、BDNF水平对比差异均有统计学意义(P0.05):NGF水平:轻度组中度组重度组,BDNF水平:轻度组中度组重度组;GFAP水平:轻度组中度组重度组。血清NGF、BDNF水平与MMSE分值评分呈显著正相关(r_1=0.652,r_2=0.671,P0.05),血清GFAP水平与MMSE分值呈显著负相关(r3=-0.681,P0.05)。结论:血清NGF、BDNF、GFAP水平均与老年血管性痴呆的严重程度密切相关,可能用于评估老年血管性痴呆病情的严重程度。     

Relationship between behavioral and psychological symptoms of dementia and oral health status in the elderly with vascular dementia

doi: 10.1111/j.1741‐2358.2012.00664.x Relationship between behavioral and psychological symptoms of dementia and oral health status in the elderly with vascular dementia Objectives: The aim of this study was to clarify the relationship between behavioral and psychological symptoms of dementia (BPSD) and oral status in the elderly with vascular dementia. Background: There have been some reports of a relationship between disease symptoms and oral status in the elderly with Alzheimer’s disease, but few reports have been conducted in the elderly with vascular dementia. Until now, the relationship between BPSD and oral status has been unknown. Materials and methods: An investigation was conducted concerning BPSD and oral status among 57 subjects with vascular dementia (mean age, 85.7 ± 5.5 years). The wearing of dentures and oral activities of daily living (oral ADL) were examined. Results: Subjects with activity disturbances and those with aggressiveness had significantly lower rates of denture wearing than those without these two symptoms (p < 0.05). Significantly lower oral ADL scores were obtained from subjects with delusional ideas, hallucinations, activity disturbances and diurnal rhythm disturbances (p < 0.05), as well as those with affective disturbances (p < 0.01). Conclusion: This study indicated a relationship between BPSD and the wearing of dentures in the elderly with vascular dementia. The study also demonstrated relationships between BPSD and oral ADL.     

The blood-brain barrier permeability of 18β-glycyrrhetinic Acid, a major metabolite of glycyrrhizin in glycyrrhiza root, a constituent of the traditional Japanese medicine yokukansan

18β-Glycyrrhetinic acid (GA) is a major metabolite of glycyrrhizin (GL), which is one of the components of glycyrrhiza root, a constituent herb of the traditional Japanese medicine yokukansan. It is well known that most GL is metabolized to GA in the intestine by bacteria. A previous in vitro study using cultured rat cortical astrocytes suggested that GA activates glutamate transport, which is a putative mechanism of the psychotropic effect of yokukansan. To activate the glutamate transport in the brain, GA must be absorbed into the blood after oral administration of yokukansan and then cross the blood-brain barrier (BBB) to reach the brain. However, there is no data on the BBB permeability of GA derived from yokukansan. In the present study, the BBB permeability of GA was investigated in both in vivo and in vitro studies. In the in vivo study, GA was detected in the plasma, brain, and cerebrospinal fluid of rats orally administered yokukansan. In the in vitro study using a BBB model composed of co-culture of endothelial cells, pericytes, and astrocytes, the permeability rate and apparent permeability coefficient of GA were found to be 13.3?±?0.5?% and 16.5?±?0.7 × 10(-6) cm/s. These in vivo and in vitro results suggest that GL in orally administered yokukansan is absorbed into the blood as GA, and then reaches the brain through the BBB. This evidence further supports the possibility that GA is an active component in the psychotropic effect of yokukansan.     

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.     

比较MoCA和MMSE在卒中后认知功能筛查中的应用

目的：比较蒙特利尔认知评估量表（Montreal Cognitive Assessment,MoCA）和简易智能量表（mini-mental state examination,MMSE）在急性缺血性脑卒中后认知损害筛查中的应用。方法：对65例缺血性脑卒中患者在发病14天内应用简易精神状态检查量表（Mini-mental State Examination,MMSE）和MoCA进行神经心理评估。其中12例患者在发病3-6个月后应用MMSE、MoCA和神经心理成套测验进行神经心理评估。以MMSE〈23分、MoCA〈21为分界值,受教育年限小于12年加1分,文盲加2分。结果：MMSE的平均分值为25.2±4.3,MoCA的平均分值为18.6±5.7。37例患者MoCA评分显示有认知损害,但其中19例患者（29%）MMSE评分显示正常。28例MoCA评估显示认知正常的患者的MMSE评分均显示认知正常。视空间与执行功能、注意和语言重复测试受损最常见,定向和命名受损较少。在3-6个月的随访期内,12例患者中1例诊断为血管性痴呆患者的MoCA的分值上升1分,MMSE分值无变化;5例认知正常患者、3例轻度认知损害无痴呆的患者和3例中度认知损害无痴呆的患者MMSE和MoCA平均分值均有不同程度的上升,视空间与执行功能平均得分值在2次检测中无明显变化。结论：MoCA较MMSE检出血管性认知功能障碍患者敏感性更高,对认知变化更为敏感。     

Mutation screening of EXT genes in Chinese patients with multiple osteochondromas

Since vascular risk factors commonly act for susceptibility to Alzheimer's disease (AD) and vascular dementia (VaD) by declining cognitive abilities, we conducted a genetic association study to identify their common underlying genetic factors. We selected single nucleotide polymorphisms (SNPs) which had been previously discovered for association with AD, and case and control associations of VaD were examined with the individual SNPs using 207 patients with VaD and 207 sex- and age-matched control subjects. As a result, no significant associations of susceptibility to VaD with 13 selected SNPs were observed even without employing a multiple test (P>0.05). This study suggests that genetics of VaD might be quite different from that of AD, and cautions should be taken especially when inferences about genetic factors are made with patients with mixed dementia.     

The Effects of Anti-Dementia and Nootropic Treatments on the Mortality of Patients with Dementia: A Population-Based Cohort Study in Taiwan

Background

Few studies have examined the contribution of treatment on the mortality of dementia based on a population-based study.

Objective

To investigate the effects of anti-dementia and nootropic treatments on the mortality of dementia using a population-based cohort study.

Methods

12,193 incident dementia patients were found from 2000 to 2010. Their data were compared with 12,193 age- and sex-matched non-dementia controls that were randomly selected from the same database. Dementia was classified into vascular (VaD) and degenerative dementia. Mortality incidence and hazard ratios (HRs) were calculated.

Results

The median survival time was 3.39 years (95% confidence interval [CI]: 2.88–3.79) for VaD without medication, 6.62 years (95% CI: 6.24–7.21) for VaD with nootropics, 3.01 years (95% CI: 2.85–3.21) for degenerative dementia without medication, 8.11 years (95% CI: 6.30–8.55) for degenerative dementia with anti-dementia medication, 6.00 years (95% CI: 5.73–6.17) for degenerative dementia with nootropics, and 9.03 years (95% CI: 8.02–9.87) for degenerative dementia with both anti-dementia and nootropic medications. Compared to the non-dementia group, the HRs among individuals with degenerative dementia were 2.69 (95% CI: 2.55–2.83) without medication, 1.46 (95% CI: 1.39–1.54) with nootropics, 1.05 (95% CI: 0.82–1.34) with anti-dementia medication, and 0.92 (95% CI: 0.80–1.05) with both nootropic and anti-dementia medications. VaD with nootropics had a lower mortality (HR: 1.25, 95% CI: 1.15–1.37) than VaD without medication (HR: 2.46, 95% CI: 2.22–2.72).

Conclusion

Pharmacological treatments have beneficial effects for patients with dementia in prolonging their survival.     

中药通窍活血汤联合脑蛋白水解物对老年痴呆患者日常生活能力和血清Hcy、CRP、FA水平的影响

目的:探讨中药通窍活血汤联合脑蛋白水解物对老年痴呆日常生活能力和血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)、叶酸(FA)水平的影响。方法:选择2014年1月～2016年12月在我院脑病科神经内科进行诊治的79例老年痴呆患者,随机分为对照组40例和观察组39例。对照组静脉滴注脑蛋白水解物治疗,每次60 mg,每天2次;观察组联合口服中药通窍活血汤治疗,每天服用1剂,早晚分2次温服,每次200 mL。分别于治疗前后采用简易精神状态检查量表(MMSE)对患者的精神状态进行评估,比较两组的临床治疗有效率,治疗前后的日常生活能力情况以及血清Hcy、CRP、FA水平的变化,比较两组在治疗期间不良反应的发生情况。结果:观察组的有效率为92.31%(36/39),明显高于对照组的72.50%(29/40)(P0.05)。两组治疗后的日常生活能力BI、MMSE评分、血清FA水平均较治疗前明显升高(P0.05),且观察组明显高于对照组(P0.05)。两组治疗后的血清Hcy、CRP水平均较治疗前明显降低(P0.05),且观察组明显低于对照组(P0.05)。两组不良反应的发生情况间比较无显著差异(P0.05)。结论:中药通窍活血汤联合脑蛋白水解物对老年痴呆患者具有较为显著的临床效果,安全可靠,可提高其日常生活能力,改善精神状态以及血清Hcy、CRP、FA水平。     

血清尿酸、白介素6、P-tau181与阿尔茨海默病患者认知功能、日常生活能力和预后的关系分析

摘要 目的：探讨血清尿酸（UA）、白细胞介素-6（IL-6）、磷酸化Tau181（P-tau181）与阿尔茨海默病（AD）患者认知功能、日常生活能力和预后的关系。方法：选择2018年5月至2021年1月上海交通大学医学院附属第九人民医院与上海交通大学医学院附属第九人民医院黄浦分院收治的98例AD患者（AD组）和71例门诊体检的健康志愿者（对照组）,检测血清UA、IL-6、P-tau181水平,使用简易智力状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）评估患者认知功能,Barthel指数（BI）评估患者日常生活能力。所有患者出院后随访1年,统计随访期间不良预后发生情况。Pearson相关性分析UA、IL-6、P-tau181与MMSE、MoCA、BI的相关性,多因素Logistic回归分析AD患者预后不良的危险因素。结果：AD组血清UA水平和MMSE、MoCA评分、BI低于对照组（P＜0.05）,IL-6、P-tau181水平高于对照组（P＜0.05）。AD患者血清UA水平与MMSE、MoCA评分、BI呈正相关（P＜0.05）,IL-6、P-tau181水平与MMSE、MoCA评分、BI呈负相关（P＜0.05）。多因素Logistic回归分析结果显示：长期卧床、AD痴呆阶段、高水平IL-6、高水平P-tau181是AD患者预后不良的危险因素（P＜0.05）,高水平UA是保护因素（P＜0.05）。结论：AD患者血清UA水平降低,IL-6、P-tau181水平升高,且与认知功能障碍、日常生活能力降低以及预后不良有关,检测血清UA、IL-6、P-tau181可辅助评估AD病情和预后。