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Decreased Time on the Nondominant One-Leg Standing Test Associated with Repeated Falls in Older Residents with Healthy Aging, Mild Cognitive Impairment, and Dementia: The Wakuya Project. 在健康老龄化、轻度认知障碍和痴呆的老年居民中,非优势单腿站立测试时间减少与重复跌倒相关:Wakuya项目。
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2021-05-21 eCollection Date: 2021-05-01 DOI: 10.1159/000516360
Keiichi Kumai, Mika Kumai, Junko Takada, Jiro Oonuma, Kei Nakamura, Kenichi Meguro

Introduction: The aim of this study is to clarify the association between repeated falls and the dominant/nondominant side in the open-eyed one-leg standing (OLS) test among people who are healthy or have mild cognitive impairment (MCI) or dementia in a community setting. We recruited 180 participants from 39 areas in the town of Wakuya.

Methods: This is a cross-sectional study. Participants were classified into 3 Clinical Dementia Rating (CDR) groups, i.e., CDR 0 (healthy, n = 71), CDR 0.5 (MCI, n = 85), and CDR 1+ (n = 23), and they were investigated for motor function (grip strength, 6-m normal gait speed, timed up and go test, and OLS test) and falls during the past year.

Results: Subjects with a CDR of 0.5 had higher rates of single and repeated falls (13.0 and 23.4%, respectively) than the CDR 0 group (12.1 and 4.5%, respectively), as did those in CDR 1+ group (15.0 and 30.0%). For the CDR 0.5 group, the frequency of falls was negatively (biologically meaningful direction) correlated with the left OLS time. No significant correlations with falls were found for other motor function tests. Another analysis separating the CDR 0.5 group into 2 subgroups (repeated falls vs. no or a single fall) also showed that the left OLS time was lower in subjects with repeated falls.

Conclusion: People with MCI who had fallen repeatedly in the year before the assessment had a significantly lower left OLS time compared to those who had not fallen or had had 1 fall with MCI. None of the other physical measures were associated with past repeat falls including OLS on the dominant right side. No such findings were noted in the CDR 0 and CDR 0+ groups.

简介:本研究的目的是澄清在社区环境中健康或轻度认知障碍(MCI)或痴呆的人群中,反复跌倒与睁眼单腿站立(OLS)测试中优势/非优势侧之间的关系。我们从Wakuya镇的39个地区招募了180名参与者。方法:这是一个横断面研究。参与者被分为3个临床痴呆评分(CDR)组,即CDR 0(健康,n = 71), CDR 0.5 (MCI, n = 85)和CDR 1+ (n = 23),并调查了他们在过去一年中的运动功能(握力,6米正常步态速度,计时起来和走测试,OLS测试)和跌倒。结果:CDR为0.5的受试者的单次和重复跌倒率(分别为13.0%和23.4%)高于CDR 0组(分别为12.1%和4.5%),CDR 1+组(分别为15.0%和30.0%)也是如此。对于CDR 0.5组,跌倒频率与左OLS时间呈负相关(具有生物学意义的方向)。其他运动功能测试未发现与跌倒有显著相关性。另一项分析将CDR 0.5组分为2个亚组(重复跌倒与不跌倒或单次跌倒),也表明重复跌倒的受试者的左OLS时间更短。结论:在评估前一年多次跌倒的MCI患者的左OLS时间明显低于没有跌倒或有1次跌倒的MCI患者。没有其他物理测量与过去的重复跌倒有关,包括主要右侧的OLS。在CDR 0和CDR 0+组中未见此类发现。
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引用次数: 2
Maintenance of the Amygdala-Hippocampal Circuit Function with Safe and Feasible Shaking Exercise Therapy in SAMP-10 Mice. 安全可行的震动运动疗法对SAMP-10小鼠杏仁核-海马回路功能的维持
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2021-05-19 eCollection Date: 2021-05-01 DOI: 10.1159/000515957
Runhong Yao, Kazuhiro Nishii, Naoki Aizu, Takumi Kito, Kazuyoshi Sakai, Kouji Yamada

Introduction: Patients with dementia show reduced adaptive, behavioral, and physiological responses to environmental threats. Physical exercise is expected to delay brain aging, maintain cognitive function and, consequently, help dementia patients face threats and protect themselves skillfully.

Methods: To confirm this, we aimed to investigate the effects of the shaking exercise on the avoidance function in the senescence-accelerated mouse-prone strain-10 (SAMP-10) model at the behavioral and tissue levels. SAMP-10 mice were randomized into 2 groups: a control group and a shaking group. The avoidance response (latency) of the mice was evaluated using a passive avoidance task. The degree of amygdala and hippocampal aging was evaluated based on the brain morphology. Subsequently, the association between avoidance response and the degree of amygdala-hippocampal aging was evaluated.

Results: Regarding the passive avoidance task, the shaking group showed a longer latency period than the control group (p < 0.05), even and low intensity staining of ubiquitinated protein, and had a higher number of and larger neurons than those of the control group. The difference between the groups was more significant in the BA region of the amygdala and the CA1 region of the hippocampus (staining degree: p < 0.05, neuron size: p < 0.01, neuron counts: p < 0.01) than in other regions.

Conclusions: The shaking exercise prevents nonfunctional protein (NFP) accumulation, neuron atrophy, and neuron loss; delays the aging of the amygdala and hippocampus; and maintains the function of the amygdala-hippocampal circuit. It thus enhances emotional processing and cognition functions, the memory of threats, the skillful confrontation of threats, and proper self-protection from danger.

引言:痴呆症患者对环境威胁的适应、行为和生理反应减弱。体育锻炼有望延缓大脑衰老,保持认知功能,从而帮助痴呆症患者面对威胁并巧妙地保护自己。方法:为了证实这一点,我们旨在从行为和组织水平上研究摇晃运动对衰老加速小鼠倾向性菌株10(SAMP-10)模型回避功能的影响。SAMP-10小鼠随机分为2组:对照组和摇动组。使用被动回避任务评估小鼠的回避反应(潜伏期)。根据大脑形态学评估杏仁核和海马的衰老程度。随后,评估了回避反应与杏仁核-海马衰老程度之间的关系。结果:在被动回避任务方面,摇晃组表现出比对照组更长的潜伏期(p<0.05),泛素化蛋白染色均匀且低强度,神经元数量和体积比对照组更多。两组之间的差异在杏仁核BA区和海马CA1区(染色程度:p<0.05,神经元大小:p<0.01,神经元计数:p<0.01)比其他区域更显著。结论:摇动运动可防止非功能蛋白(NFP)积累、神经元萎缩和神经元丢失;延缓杏仁核和海马体的衰老;并维持杏仁核-海马回路的功能。从而增强情绪处理和认知功能,增强对威胁的记忆,熟练对抗威胁,以及适当的自我保护。
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引用次数: 4
Assessing the Possible Influence of Residues of Ractopamine, a Livestock Feed Additive, in Meat on Alzheimer Disease. 评估家畜饲料添加剂莱克多巴胺在肉类中的残留对阿尔茨海默病的可能影响。
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2021-05-07 eCollection Date: 2021-05-01 DOI: 10.1159/000515677
Frank S Fan

The feed additive ractopamine, a β-adrenergic agonist, has been approved for use in livestock for nearly 2 decades. Studies of its possible adverse effects in humans have concentrated exclusively on cardiovascular disease and cardiovascular functional disorders in the past. In this article, whether and how ractopamine may affect neurodegeneration, either to promote or to reduce the incidence of Alz-heimer disease, will be discussed based on the recent controversial findings that β-adrenoreceptor activation not only can stimulate Alzheimer-pathogenic amyloid-β accumulation but also are able to enhance hippocampal neurogenesis and ameliorate mouse memory deficits in independent laboratory studies. Furthermore, environmental enrichment has been found to prevent impairment of memory-related hippocampal long-term potentiation and microglia-mediated neuroinflammation induced by amyloid-β. These beneficial effects are achieved mainly through enhanced β-adrenergic signaling and can be imitated by β agonist isoprotenerol. Finally, it has been demonstrated that the β-adrenergic agonist salbutamol could bind directly to tau protein and interfere with the tau filament formation seen in the prodromal phase of Alzheimer disease. These complex but interesting issues lead to contradictory speculations of possible effects of ractopamine residue in meat on Alzheimer disease. Hypotheses derived from this review surely deserve carefully designed laboratory investigations and clinical studies in the future.

饲料添加剂莱克多巴胺是一种β-肾上腺素能激动剂,已被批准在牲畜中使用近20年。过去对其可能对人类产生的不良影响的研究仅集中在心血管疾病和心血管功能障碍方面。在本文中,莱克多巴胺是否以及如何影响神经变性,促进或减少阿尔茨海默病的发病率,将根据最近有争议的发现,β-肾上腺素受体激活不仅可以刺激阿尔茨海默病致病性淀粉样蛋白-β积累,而且能够增强海马神经发生和改善小鼠记忆缺陷,在独立的实验室研究中讨论。此外,环境富集已被发现可以防止记忆相关的海马长期增强和由淀粉样蛋白-β诱导的小胶质细胞介导的神经炎症的损害。这些有益作用主要通过增强β-肾上腺素能信号传导实现,并可由β激动剂异丙烯醇模拟。最后,研究表明β-肾上腺素能激动剂沙丁胺醇可以直接与tau蛋白结合并干扰阿尔茨海默病前驱期tau丝的形成。这些复杂而有趣的问题导致了关于肉中莱克多巴胺残留对阿尔茨海默病可能影响的相互矛盾的猜测。从这篇综述中得出的假设肯定值得在未来仔细设计实验室调查和临床研究。
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引用次数: 5
Characteristics of Regional Cerebral Blood Flow in Alzheimer Disease and Amnestic Mild Cognitive Impairment by Single-Photon Emission Computerized Tomography: A Cross-Sectional Study. 单光子发射计算机断层扫描对阿尔茨海默病和遗忘性轻度认知障碍患者局部脑血流特征的横断面研究
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2021-05-06 eCollection Date: 2021-05-01 DOI: 10.1159/000515864
Yota Kunieda, Chiaki Arakawa, Takumi Yamada, Mizue Suzuki, Shingo Koyama, Yosuke Kimura, Takeo Ichikawa, Shuhei Shino, Minoru Yamada, Ryuto Hirokawa, Tadamitsu Matsuda, Tomokazu Takakura, Tomohide Adachi, Haruhiko Hoshino

Introduction: The regional cerebral blood flow (rCBF) distribution can affect brain functioning, leading to amnestic mild cognitive impairment (aMCI) and mild Alzheimer disease (AD). This study aimed to clarify the detailed characteristics of rCBF distribution in patients with mild AD and aMCI.

Methods: This cross-sectional study from April 2015 to March 2018 included 103 older adults (mean age 78.9 years; 60% females), out of a total of 302 adults, and categorized them into 3 groups according to cognitive symptoms. The normal control (NC), aMCI, and mild AD groups included 20, 50, and 33 participants, respectively. The primary outcome was rCBF, which was compared among the 3 groups using a 2-sample t test without correction for multiple comparisons.

Results: In the aMCI group, the rCBF decreased in the bilateral parietal and left frontal association cortex and the bilateral premotor cortex (p < 0.01) but increased in the bilateral cerebellum (p < 0.01). In the mild AD group, the rCBF decreased in the bilateral parietal and occipital association cortex, the bilateral premotor cortex, the left temporal and frontal association cortex, and the left limbic lobe (p < 0.01). Conversely, the rCBF increased in some parts of the cerebellum, the bilateral frontal and temporal association cortex, the left occipital association cortex, and the right premotor cortex (p < 0.01).

Conclusion: Based on the analysis of the values obtained, it was inferred that the rCBF undergoes reduction and elevation in aMCI and AD patients.

区域脑血流量(rCBF)分布可影响脑功能,导致遗忘性轻度认知障碍(aMCI)和轻度阿尔茨海默病(AD)。本研究旨在阐明轻度AD和aMCI患者rCBF分布的详细特征。方法:该横断面研究于2015年4月至2018年3月期间纳入103名老年人(平均年龄78.9岁;(60%为女性),并根据认知症状将其分为3组。正常对照组(NC)、aMCI组和轻度AD组分别包括20、50和33名参与者。主要终点为rCBF,使用两样本t检验比较三组间的rCBF,未对多重比较进行校正。结果:aMCI组双侧顶叶、左额叶联合皮层和双侧运动前皮层rCBF减少(p < 0.01),双侧小脑rCBF增加(p < 0.01)。轻度AD组双侧顶叶和枕叶联合皮层、双侧运动前皮层、左侧颞叶和额叶联合皮层、左侧边缘叶rCBF减少(p < 0.01)。相反,小脑、双侧额颞联合皮层、左侧枕联合皮层和右侧运动前皮层部分区域rCBF增加(p < 0.01)。结论:通过对所得值的分析,推断aMCI和AD患者rCBF均有降低和升高的趋势。
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引用次数: 3
A Systematic Review of the Association between Amyloid-β and τ Pathology with Functional Connectivity Alterations in the Alzheimer Dementia Spectrum Utilizing PET Scan and rsfMRI. 利用PET扫描和rsfMRI对阿尔茨海默病谱系中淀粉样蛋白-β和τ病理与功能连通性改变之间关系的系统回顾。
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2021-05-06 eCollection Date: 2021-05-01 DOI: 10.1159/000516164
Seyede Anis Hasani, Mahsa Mayeli, Mohammad Amin Salehi, Rezvan Barzegar Parizi

The association between functional connectivity (FC) alterations with amyloid-β (Aβ) and τ protein depositions in Alzheimer dementia is a subject of debate in the current literature. Although many studies have suggested a declining FC accompanying increased Aβ and τ concentrations, some investigations have contradicted this hypothesis. Therefore, this systematic review was conducted to sum up the current literature in this regard. The PROSPERO guideline for systematic reviews was applied for development of a research protocol, and this study was initiated after getting the protocol approval. Studies were screened, and those investigating FC measured by resting-state functional MRI and Aβ and τ protein depositions using amyloid and τ positron emission tomography were included. We categorized the included studies into 3 groups methodologically, addressing the question using global connectivity analysis (examining all regions of interest across the brain based on a functional atlas), seed-based connectivity analysis, or within-networks connectivity analysis. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Among 31 included studies, 14 found both positive and negative correlations depending on the brain region and stage of the investigated disease, while 7 showed an overall negative correlation, 8 indicated an overall positive correlation, and 2 found a nonsignificant association between protein deposition and FC. The investigated regions were illustrated using tables. The posterior default mode network, one of the first regions of amyloid accumulation, and the temporal lobe, the early τ deposition region, are the 2 most investigated regions where inconsistencies exist. In conclusion, our study indicates that transneuronal spreading of τ and the amyloid hypothesis can justify higher FC related to higher protein depositions when global connectivity analysis is applied. However, the discrepancies observed when investigating the brain locally could be due to the varying manifestations of the amyloid and τ overload compensatory mechanisms in the brain at different stages of the disease with hyper- and hypoconnectivity cycles that can occur repeatedly. Nevertheless, further studies investigating both amyloid and τ deposition simultaneously while considering the stage of Alzheimer dementia are required to assess the accuracy of this hypothesis.

阿尔茨海默氏症中功能连接(FC)改变与淀粉样蛋白-β (a β)和τ蛋白沉积之间的关系是当前文献中争论的主题。尽管许多研究表明,随着a β和τ浓度的增加,FC下降,但一些研究反驳了这一假设。因此,本文对这方面的现有文献进行了系统的综述。应用PROSPERO系统评价指南制定研究方案,并在获得方案批准后启动本研究。筛选研究,包括通过静息状态功能MRI测量的FC和使用淀粉样蛋白和τ正电子发射断层扫描测量的Aβ和τ蛋白沉积的研究。我们将纳入的研究在方法上分为三组,使用全局连通性分析(基于功能图谱检查大脑中所有感兴趣的区域)、基于种子的连通性分析或网络内连通性分析来解决问题。研究的质量采用纽卡斯尔-渥太华量表进行评估。在纳入的31项研究中,14项研究发现与所研究疾病的脑区和阶段呈正相关和负相关,7项研究发现总体负相关,8项研究发现总体正相关,2项研究发现蛋白质沉积与FC之间无显著相关性。调查区域用表格表示。后默认模式网络是淀粉样蛋白最早积累的区域之一,而颞叶是早期τ沉积区域,这是两个研究最多的存在不一致性的区域。总之,我们的研究表明,当应用全局连通性分析时,τ的跨神经元扩散和淀粉样蛋白假说可以证明更高的FC与更高的蛋白质沉积相关。然而,在局部研究大脑时观察到的差异可能是由于在疾病的不同阶段大脑中淀粉样蛋白和τ过载代偿机制的不同表现,具有可重复发生的超连接和低连接周期。然而,需要进一步的研究同时调查淀粉样蛋白和τ沉积,同时考虑阿尔茨海默病的阶段,以评估这一假设的准确性。
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引用次数: 8
Factors Associated with Home Care Outcomes among Community-Dwelling Older Adult Patients with Dementia. 社区居住老年痴呆患者家庭护理结果的相关因素
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2021-05-06 eCollection Date: 2021-05-01 DOI: 10.1159/000516086
Amal Al Ghassani, Mohammad Rababa

Background: With the increase in the proportion of people with dementia (PWD), it is necessary to address dementia-related issues among older adults who live at home; however, there is no integrative review on this issue.

Objectives: To describe and analyze quantitative and qualitative studies from primary sources in order to identify the factors which impact home care outcomes among PWD.

Methods: A computer search of PsycINFO, MEDLINE (PubMed), and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed. This study was guided by Whittemore and Knafl's integrative review method.

Results: This review of the literature identified 3 main factors related to home care outcomes among PWD. These factors are environmental factors, caregiver-related factors, and social network factors.

Conclusions: Further research is required to investigate the impacts of multiple social and environmental factors on home care outcomes among PWD; which can eventually be used by nurses and family caregivers when providing care for older adult PWD.

背景:随着痴呆症患者(PWD)比例的增加,有必要解决居家老年人的痴呆症相关问题;然而,目前尚无关于这一问题的综合综述。目的:描述和分析来自主要来源的定量和定性研究,以确定影响残疾人士家庭护理结果的因素。方法:计算机检索PsycINFO、MEDLINE (PubMed)和护理与相关健康文献累积索引(CINAHL)。本研究以Whittemore和Knafl的综合评价方法为指导。结果:本文献综述确定了与残疾患者家庭护理结果相关的3个主要因素。这些因素包括环境因素、照顾者相关因素和社会网络因素。结论:多种社会环境因素对残疾患者家庭护理结果的影响有待进一步研究;护士和家庭护理人员在为老年残疾患者提供护理时最终可以使用。
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引用次数: 4
Symptoms and Well-Being in Older Hospitalized Patients with Cognitive Impairment, As Self-Reported and Reported in Patient Records: A Quantitative Exploratory Subgroup Analysis. 自我报告和病历报告的老年住院认知障碍患者的症状和幸福感:定量探索性亚组分析
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2021-05-05 eCollection Date: 2021-05-01 DOI: 10.1159/000515822
Yvonne A Johansson, Catharina Gillsjö, Elisabeth Kenne Sarenmalm

Introduction: Given the aging population and the high prevalence of cognitive impairment in older hospitalized patients, it is essential to provide good fundamental care to these vulnerable patients, who easily might be affected by poor outcomes as delirium. Risk factors for delirium are, for example, cognitive impairment, old age, pain, and sleep deprivation. Different symptoms are often unidentified in hospitals, and associated with poor well-being, but this is rarely studied in older patients with cognitive impairment. The study aim was to examine symptoms and sense of well-being in older hospitalized patients with cognitive impairment, as self-reported and reported in patient records.

Methods: Exploratory quantitative subgroup (n = 25) analysis of a point-prevalence study (n = 210). Inclusion criteria were age ≥65, and cognitive impairment. Data were collected through structured interviews, validated instruments, and patient records. Associations between well-being and symptoms, and concordance between the occurrence of self-reported symptoms and symptoms reported in patient records were analyzed.

Results: The patients reported severe and distressing symptoms that were sparsely reported (14%) in their records. As well were cognitive impairment, and the patients' own descriptions of their well-being. Some symptoms and the total symptom burden were associated with poor well-being.

Discussion/conclusion: To our knowledge, this hypothesis-generating study is one of few studies that describe both symptoms and well-being as self-reported and reported in patient records, in vulnerable patients due to old age, cognitive impairment, and hospitalization. Despite the limited sample size, the results indicate that symptoms were more insufficient alleviated in these patients compared to patients with normal cognitive function in other studies. To our knowledge, this has not been shown previously. Additionally, patients' own experiences were sparsely reported in their records. A larger sample size and longitudinal design has the potential to determine if symptom alleviation differs between patients with and without cognitive impairment, and if a total symptom burden increases the risk of poor outcomes as delirium in vulnerable patients.

鉴于人口老龄化和老年住院患者认知功能障碍的高发,为这些易受影响的患者提供良好的基础护理是至关重要的,他们很容易受到谵妄等不良预后的影响。谵妄的危险因素有认知障碍、年老、疼痛和睡眠不足等。在医院里,不同的症状往往是不确定的,并且与健康状况不佳有关,但很少对老年认知障碍患者进行研究。研究的目的是检查老年住院认知障碍患者的症状和幸福感,包括自我报告和患者记录。方法:对一项点流行研究(n = 210)进行探索性定量亚组(n = 25)分析。纳入标准为年龄≥65岁和认知障碍。通过结构化访谈、验证仪器和患者记录收集数据。分析了幸福感与症状之间的关系,以及自我报告的症状与患者记录中报告的症状之间的一致性。结果:患者报告了严重和痛苦的症状,这些症状在他们的记录中很少报告(14%)。认知障碍和患者自己对健康状况的描述也是如此。一些症状和总症状负担与不良的幸福感有关。讨论/结论:据我们所知,这项产生假设的研究是为数不多的将症状和幸福感描述为自我报告和在患者记录中报告的研究之一,这些研究是在老年人、认知障碍和住院治疗的弱势患者中进行的。尽管样本量有限,但结果表明,与其他研究中认知功能正常的患者相比,这些患者的症状缓解更为不足。据我们所知,这一点以前从未出现过。此外,患者自己的经历在他们的记录中很少被报道。更大的样本量和纵向设计有可能确定认知障碍患者和非认知障碍患者的症状缓解是否不同,以及总症状负担是否会增加易感患者谵妄等不良结局的风险。
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引用次数: 0
Ten Years of Dementia and Geriatric Cognitive Disorders EXTRA 痴呆症和老年认知障碍十年
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2021-04-15 DOI: 10.1159/000516197
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引用次数: 2
Etiology of Dementia in Thai Patients. 泰国痴呆患者的病因学。
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2021-04-15 eCollection Date: 2021-01-01 DOI: 10.1159/000515676
Pornpatr A Dharmasaroja, Jintana Assanasen, Sunsanee Pongpakdee, Kankamol Jaisin, Praween Lolekha, Muthita Phanasathit, Laksanun Cheewakriengkrai, Chanisa Chotipanich, Pirada Witoonpanich, Sutisa Pitiyarn, Pongtawat Lertwilaiwittaya, Charungthai Dejthevaporn, Chanin Limwongse, Kammant Phanthumchinda

Introduction: Molecular imaging has been developed and validated in Thai patients, comprising a portion of patients in the dementia registry. This should provide a more accurate diagnosis of the etiology of dementia, which was the focus of this study.

Methods: This was a multicenter dementia study. The baseline characteristics, main presenting symptoms, and results of investigations and cognitive tests of the patients were electronically collected in the registry. Functional imaging and/or molecular imaging were performed in patients with an equivocal diagnosis of the causes of dementia, especially in atypical dementia or young onset dementia (YOD).

Results: There were 454 patients in the study. The mean age of the patients was 78 years, with 60% female. Functional imaging and/or molecular imaging were performed in 57 patients (57/454 patients, 13%). The most common cause of dementia was Alzheimer's disease (AD; 50%), followed by vascular dementia (VAD; 24%), dementia with Lewy bodies (6%), Parkinson's disease dementia (6%), frontotemporal dementia (FTD; 2.6%), progressive supranuclear palsy (2%), multiple system atrophy (0.8%), and corticobasal syndrome (0.4%). YOD accounted for 17% (77/454 patients), with a mean age of 58 years. The causes of YOD were early onset amnestic AD (44%), VAD (16%), behavioral variant FTD (8%), posterior cortical atrophy (6.5%), and logopenic variant primary progressive aphasia (5.2%).

Conclusion: AD was the most common cause of dementia in Thai patients and the distribution of other types of dementia and main presenting symptoms were similar to previous reports in Western patients; however, the proportion of YOD was higher.

分子成像已经在泰国患者中得到开发和验证,包括痴呆登记的一部分患者。这将为痴呆症的病因提供更准确的诊断,这是本研究的重点。方法:这是一项多中心痴呆研究。以电子方式收集患者的基线特征、主要表现症状以及调查和认知测试结果。对痴呆病因诊断不明确的患者,特别是非典型痴呆或年轻发病痴呆(YOD)患者进行功能影像学和/或分子影像学检查。结果:共纳入454例患者。患者平均年龄78岁,女性占60%。57例患者(57/454例,13%)进行了功能成像和/或分子成像。痴呆症最常见的原因是阿尔茨海默病(AD;50%),其次是血管性痴呆(VAD;24%),路易体痴呆(6%),帕金森病痴呆(6%),额颞叶痴呆(FTD);2.6%),进行性核上性麻痹(2%),多系统萎缩(0.8%)和皮质基底综合征(0.4%)。YOD占17%(77/454例),平均年龄58岁。YOD的病因为早发性遗忘性AD(44%)、VAD(16%)、行为变异型FTD(8%)、后皮层萎缩(6.5%)和语言缺失变异型原发性进行性失语(5.2%)。结论:阿尔茨海默氏症是泰国患者最常见的痴呆原因,其他类型痴呆的分布和主要表现症状与西方患者相似;然而,YOD的比例更高。
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引用次数: 4
Risk Factors for Falls in Patients with Alzheimer Disease: A Retrospective Study of Balance, Cognition, and Visuospatial Ability. 阿尔茨海默病患者跌倒的危险因素:平衡、认知和视觉空间能力的回顾性研究
IF 2.3 Q4 CLINICAL NEUROLOGY Pub Date : 2021-03-22 eCollection Date: 2021-01-01 DOI: 10.1159/000514285
Mayuka Oki, Miyuki Matsumoto, Yukiko Yoshikawa, Mitsuko Fukushima, Akira Nagasawa, Tomokazu Takakura, Yukiko Suzuki

Aim: This study aimed to determine the main risk factors for falls in patients with Alzheimer disease (AD) by comparing balance, cognition, and visuospatial ability between those who have experienced a fall and those who have not.

Methods: Forty-seven AD patients were admitted to a ward for patients with dementia (22 men and 25 women). The balance of patients was evaluated using the Functional Reach Test (FRT), the one-leg standing duration, and the Timed Up and Go (TUG) test. The Mini-Mental State Examination-Japanese (MMSE-J) was used to evaluate cognition. For visuospatial ability assessment, the Clock-Drawing Test (CDT) as well as overlapping figure identification and shape discrimination in the Visual Perception Test for Agnosia (VPTA) were used. The patients were allocated to either the fall group or the nonfall group based on their history of falls in the past year. The relationships between patients' characteristics and evaluation outcomes were compared and examined. Logistic regression analysis was performed using a fall as the objective variable. The area under the curve (AUC) and the cutoff value were calculated.

Results: Of the 47 participants, 22 had experienced falls within the past year (46.8%). The results of the FRT, one-leg standing duration, the TUG, the CDT, and the VPTA were significantly lower in the fall group. No significant difference between the MMSE-J scores of the fall group and those of the nonfall group was observed. The results of the logistic regression analysis indicated that falls in AD patients were significantly associated with the FRT. It was found that a shorter FRT distance (cm) had a significant impact on falls. For the FRT, the fall-related AUC was 0.755. At a cutoff value of 24.5 cm, the level of sensitivity was 68.0%, and the level of specificity was 77.3%.

Conclusions: The findings of this study indicate that balance and visuospatial abilities are risks factors for falls in AD patients. In contrast, cognitive impairment was not a risk factor for falls. It was demonstrated that the FRT could be an appropriate risk predictor for falls in AD patients. In particular, falls in AD patients were strongly affected by a reduced dynamic balance.

目的:本研究旨在通过比较有跌倒经历者和没有跌倒经历者的平衡、认知和视觉空间能力,来确定阿尔茨海默病(AD)患者跌倒的主要危险因素。方法:47例AD患者(男性22例,女性25例)入住痴呆病房。使用功能到达测试(FRT)、单腿站立时间和计时起身(TUG)测试评估患者的平衡能力。采用日本简易心理状态测验(MMSE-J)评估认知能力。在视觉空间能力评估方面,采用时钟绘制测试(CDT)和视觉失认测验(VPTA)中的重叠图形识别和形状辨别。根据患者过去一年的跌倒史,将他们分为跌倒组和非跌倒组。比较检查患者特征与评价结果之间的关系。以跌倒为目标变量进行Logistic回归分析。计算曲线下面积(AUC)和截止值。结果:在47名参与者中,有22人在过去一年内经历过跌倒(46.8%)。跌倒组的FRT、单腿站立时间、TUG、CDT和VPTA的结果显著低于跌倒组。跌倒组与非跌倒组MMSE-J评分无显著差异。logistic回归分析结果显示,AD患者跌倒与FRT显著相关,FRT距离(cm)越短对跌倒有显著影响。对于FRT,与下跌相关的AUC为0.755。截止值为24.5 cm时,敏感性水平为68.0%,特异性水平为77.3%。结论:本研究结果表明,平衡和视觉空间能力是AD患者跌倒的危险因素。相比之下,认知障碍并不是跌倒的危险因素。研究表明,FRT可能是AD患者跌倒的适当风险预测因子。特别是,AD患者的跌倒受到动态平衡减少的强烈影响。
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引用次数: 5
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Dementia and Geriatric Cognitive Disorders Extra
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