Mild cognitive impairment

轻度认知障碍
  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    手术可能与老年参与者的术后认知障碍有关,然而,其与轻度认知障碍(MCI)的关联程度仍未确定.
    确定手术与MCI之间的关系。
    分析了来自阿尔茨海默病神经影像学计划的参与者的数据,包括具有MCI或正常认知的个体。我们专注于45岁以后进行的手术,按手术数量分类,手术风险,以及手术发生的年龄。采用多变量逻辑回归来确定手术与MCI发展之间的关系。
    该研究由387名MCI个体和578名认知正常个体组成。总体手术暴露(校正OR=1.14,[95%CI0.83,1.56],p=0.43)和手术次数(调整后的OR=0.92[0.62,1.36],对于单次曝光,p=0.67,调整后的OR=1.12[0.71,1.78],对于两次曝光,p=0.63,调整后的OR=1.38[0.95,2.01],与没有暴露作为参考相比,三次或更多次暴露的p=0.09)与MCI的发展无关。然而,高风险手术(调整后的OR=1.79[1.00,3.21],p=0.049)或75岁以后进行的手术(调整后的OR=2.01[1.03,3.90],p=0.041)与发生MCI的风险更大相关。
    年龄较大的高风险手术有助于MCI的发展,表明对术后认知障碍发展的机制见解复杂。
    UNASSIGNED: Surgery may be associated with postoperative cognitive impairment in elder participants, yet the extent of its association with mild cognitive impairment (MCI) remains undetermined.
    UNASSIGNED: To determine the relationship between surgery and MCI.
    UNASSIGNED: The data of participants from the Alzheimer\'s Disease Neuroimaging Initiative were analyzed, including individuals with MCI or normal cognition. We focused on surgeries conducted after the age of 45, categorized by the number of surgeries, surgical risk, and the age at which surgeries occurred. Multivariable logistic regression was employed to determine the association between surgery and the development of MCI.
    UNASSIGNED: The study is comprised of 387 individuals with MCI and 578 cognitively normal individuals. The overall surgery exposure (adjusted OR = 1.14, [95% CI 0.83, 1.56], p = 0.43) and the number of surgeries (adjusted OR = 0.92  [0.62, 1.36], p = 0.67 for single exposure, adjusted OR = 1.12 [0.71, 1.78], p = 0.63 for two exposures, adjusted OR = 1.38 [0.95, 2.01], p = 0.09 for three or more exposures compared to no exposure as the reference) were not associated with the development of MCI. However, high-risk surgeries (adjusted OR = 1.79 [1.00, 3.21], p = 0.049) or surgeries occurring after the age of 75 (adjusted OR = 2.01 [1.03, 3.90], p = 0.041) were associated with a greater risk of developing MCI.
    UNASSIGNED: High risk surgeries occurring at an older age contribute to the development of MCI, indicating a complex of mechanistic insights for the development of postoperative cognitive impairment.
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  • 文章类型: Journal Article
    来自语言样本分析的结果可以提供老年人认知障碍的有效指标。
    本研究使用新的自动核心词典分析Cookie盗窃图片描述来评估三组典型使用的差异。
    参与者包括未诊断为认知障碍的成年人(对照),被诊断患有阿尔茨海默病(ProbableAD)的成年人,和诊断为轻度认知障碍(MCI)的成年人。Cookie盗窃图片描述使用CLAN进行了转录和分析。
    结果显示,与MCI和对照组相比,ProbableAD组总体上使用的核心词典单词明显减少。对于核心词典内容词(名词,动词),然而,MCI和ProbableAD组产生的单词明显少于对照组.这些小组在使用核心词典功能词方面没有差异。ProbableAD组比MCI和对照组产生大多数核心词典单词的速度也较慢。MCI组仅比对照组慢两个核心词典内容词。在描述的早期,所有小组都在图片的左上方象限中提到了一个核心词典单词。ProbableAD组在其他象限中提到核心词典单词的速度明显慢于其他组。
    这项标准且易于管理的任务揭示了整体核心词典得分的群体差异以及演讲者产生关键项目的时间。临床医生和研究人员可以使用这些工具进行早期评估和随时间变化的测量。
    UNASSIGNED: Findings from language sample analyses can provide efficient and effective indicators of cognitive impairment in older adults.
    UNASSIGNED: This study used newly automated core lexicon analyses of Cookie Theft picture descriptions to assess differences in typical use across three groups.
    UNASSIGNED: Participants included adults without diagnosed cognitive impairments (Control), adults diagnosed with Alzheimer\'s disease (ProbableAD), and adults diagnosed with mild cognitive impairment (MCI). Cookie Theft picture descriptions were transcribed and analyzed using CLAN.
    UNASSIGNED: Results showed that the ProbableAD group used significantly fewer core lexicon words overall than the MCI and Control groups. For core lexicon content words (nouns, verbs), however, both the MCI and ProbableAD groups produced significantly fewer words than the Control group. The groups did not differ in their use of core lexicon function words. The ProbableAD group was also slower to produce most of the core lexicon words than the MCI and Control groups. The MCI group was slower than the Control group for only two of the core lexicon content words. All groups mentioned a core lexicon word in the top left quadrant of the picture early in the description. The ProbableAD group was then significantly slower than the other groups to mention a core lexicon word in the other quadrants.
    UNASSIGNED: This standard and simple-to-administer task reveals group differences in overall core lexicon scores and the amount of time until the speaker produces the key items. Clinicians and researchers can use these tools for both early assessment and measurement of change over time.
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  • 文章类型: Journal Article
    背景:阿尔茨海默病(AD)是一种以Aβ斑块和神经原纤维缠结为特征的神经退行性疾病。慢性炎症和突触功能障碍导致疾病进展和认知下降。小细胞外囊泡(sEV)通过促进病理蛋白和炎性细胞因子的扩散而参与AD进展。这项研究调查了血浆来源的sEV(PsEV)中的突触功能障碍和神经炎症蛋白标志物,它们与淀粉样蛋白-β和tau病理有关,以及它们与AD进展的相关性。
    方法:共招募90名[AD=35,轻度认知障碍(MCI)=25,健康年龄匹配对照(AMC)=30]参与者。PsEV使用化学沉淀法分离,并通过透射电子显微镜对其形态进行了表征。使用纳米粒子跟踪分析,确定PsEV的大小和浓度。使用CD63、CD81、TSG101和L1CAM抗体对PsEV进行基于抗体的验证。用突触素评估突触功能障碍和神经炎症,TNF-α,IL-1β,和GFAP抗体。AD特异性标志物,淀粉样蛋白-β(1-42),使用蛋白质印迹和ELISA检查PsEV内的p-Tau。
    结果:我们的发现表明,与AMC相比,AD和MCI中的PsEV浓度更高(p<0.0001)。与AMC相比,在MCI和AD中PsEV内的淀粉样蛋白-β(1-42)表达显著升高。我们还可以区分AD和MCI中淀粉样蛋白-β(1-42)的表达。同样,与AMC相比,PsEV衍生的p-Tau在MCI中表达升高,在AD中进一步增加。与AMC相比,突触素在从MCI到AD的PsEV中表达下调(p=0.047),而IL-1β,TNF-α,与AMC相比,GFAP在MCI和AD中的表达增加。神经心理学测试与PsEVs衍生蛋白(包括突触完整性标记,神经炎症,和疾病病理学)也在我们的研究中进行。PsEV数量的增加与疾病病理标志物相关,突触功能障碍,和神经炎症。
    结论:PsEV升高,上调的淀粉样蛋白-β(1-42),和p-Tau表达在AD中显示出较高的诊断准确性。AD和MCI患者中突触素表达下调和神经炎症标志物上调提示潜在的突触变性和神经炎症。这些发现支持PsEV相关生物标志物用于AD诊断的潜力,并突出疾病进展中的突触功能障碍和神经炎症。
    BACKGROUND: Alzheimer\'s disease (AD) is a neurodegenerative disease characterized by Aβ plaques and neurofibrillary tangles. Chronic inflammation and synaptic dysfunction lead to disease progression and cognitive decline. Small extracellular vesicles (sEVs) are implicated in AD progression by facilitating the spread of pathological proteins and inflammatory cytokines. This study investigates synaptic dysfunction and neuroinflammation protein markers in plasma-derived sEVs (PsEVs), their association with Amyloid-β and tau pathologies, and their correlation with AD progression.
    METHODS: A total of 90 [AD = 35, mild cognitive impairment (MCI) = 25, and healthy age-matched controls (AMC) = 30] participants were recruited. PsEVs were isolated using a chemical precipitation method, and their morphology was characterized by transmission electron microscopy. Using nanoparticle tracking analysis, the size and concentration of PsEVs were determined. Antibody-based validation of PsEVs was done using CD63, CD81, TSG101, and L1CAM antibodies. Synaptic dysfunction and neuroinflammation were evaluated with synaptophysin, TNF-α, IL-1β, and GFAP antibodies. AD-specific markers, amyloid-β (1-42), and p-Tau were examined within PsEVs using Western blot and ELISA.
    RESULTS: Our findings reveal higher concentrations of PsEVs in AD and MCI compared to AMC (p < 0.0001). Amyloid-β (1-42) expression within PsEVs is significantly elevated in MCI and AD compared to AMC. We could also differentiate between the amyloid-β (1-42) expression in AD and MCI. Similarly, PsEVs-derived p-Tau exhibited elevated expression in MCI compared with AMC, which is further increased in AD. Synaptophysin exhibited downregulated expression in PsEVs from MCI to AD (p = 0.047) compared to AMC, whereas IL-1β, TNF-α, and GFAP showed increased expression in MCI and AD compared to AMC. The correlation between the neuropsychological tests and PsEVs-derived proteins (which included markers for synaptic integrity, neuroinflammation, and disease pathology) was also performed in our study. The increased number of PsEVs correlates with disease pathological markers, synaptic dysfunction, and neuroinflammation.
    CONCLUSIONS: Elevated PsEVs, upregulated amyloid-β (1-42), and p-Tau expression show high diagnostic accuracy in AD. The downregulated synaptophysin expression and upregulated neuroinflammatory markers in AD and MCI patients suggest potential synaptic degeneration and neuroinflammation. These findings support the potential of PsEV-associated biomarkers for AD diagnosis and highlight synaptic dysfunction and neuroinflammation in disease progression.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    背景:本病例报告显示1例患者出现进行性记忆丧失和舞蹈样运动。
    方法:神经心理学测试表明多领域遗忘型轻度认知障碍(aMCI),神经系统检查显示不对称的不自主运动过度。影像学研究显示,左侧额叶和颞顶叶皮层严重左侧萎缩和代谢低下。[18F]FlortaucipirPET在低代谢区域表现出适度增加的示踪剂摄取。诊断最初考虑阿尔茨海默病(AD),额颞叶变性(FTD),和皮质基底变性(CBD),脑萎缩综合征,但影像学和脑脊液分析排除了AD,并建议融合肉瘤相关FTD(FTLD-FUS),FTD行为变体的亚型。
    结论:我们的案例强调,尽管缺乏特异性的FUS生物标志物,但临床特征和神经影像学生物标志物的结合可以指导在复杂的神经系统病例中选择最有可能的鉴别诊断。成像特别允许准确测量神经变性的形貌和严重程度,并排除AD相关病理。
    BACKGROUND: This case report presents a patient with progressive memory loss and choreiform movements.
    METHODS: Neuropsychological tests indicated multi-domain amnestic mild cognitive impairment (aMCI), and neurological examination revealed asymmetrical involuntary hyperkinetic movements. Imaging studies showed severe left-sided atrophy and hypometabolism in the left frontal and temporoparietal cortex. [18F]Flortaucipir PET exhibited moderately increased tracer uptake in hypometabolic areas. The diagnosis initially considered Alzheimer\'s disease (AD), frontotemporal degeneration (FTD), and corticobasal degeneration (CBD), cerebral hemiatrophy syndrome, but imaging and cerebrospinal fluid analysis excluded AD and suggested fused-in-sarcoma-associated FTD (FTLD-FUS), a subtype of the behavioural variant of FTD.
    CONCLUSIONS: Our case highlights that despite the lack of specific FUS biomarkers the combination of clinical features and neuroimaging biomarkers can guide choosing the most likely differential diagnosis in a complex neurological case. Imaging in particular allowed an accurate measure of the topography and severity of neurodegeneration and the exclusion of AD-related pathology.
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  • 文章类型: Journal Article
    脑淀粉样血管病(CAA)经常在死后发现阿尔茨海默氏痴呆,但通常在生活中未被发现,特别是因为在疾病过程中,CAA的体内标志及其血管损伤变得相对较晚。已提出减少的神经血管与视觉刺激的耦合作为CAA疾病严重程度的早期MRI标记。本研究探讨了神经血管偶联在AD相关痴呆及其早期阶段的作用。我们纳入了25项主观认知障碍,33名轻度认知障碍和17名痴呆患者和44名对照。所有参与者都接受了脑部磁共振成像和神经心理学评估。单变量一般线性建模分析用于评估患者组和对照组之间的神经血管耦合。此外,线性回归分析用于评估神经血管偶联与认知之间的关联.我们的数据显示,与对照组(平均1.1±0.2)相比,痴呆(平均0.8±0.2,p=0.001)和MCI(平均0.9±0.3,p=0.004)患者的BOLD振幅较低。低BOLD振幅与多个认知领域的低得分相关。我们得出结论,脑血管功能障碍,很可能是由于CAA,是痴呆早期阶段的重要共病,对认知有独立影响。
    Cerebral amyloid angiopathy (CAA) is frequently found post mortem in Alzheimer\'s dementia, but often undetected during life especially since in vivo hallmarks of CAA and its vascular damage become overt relatively late in the disease process. Decreased neurovascular coupling to visual stimulation has been put forward as an early MRI marker for CAA disease severity. The current study investigates the role of neurovascular coupling in AD related dementia and its early stages. We included 25 subjective cognitive impairment, 33 mild cognitive impairment and 17 dementia patients and 44 controls. All participants underwent magnetic resonance imaging of the brain and neuropsychological assessment. Univariate general linear modeling analyses were used to assess neurovascular coupling between patient groups and controls. Moreover, linear regression analyses was used to assess the associations between neurovascular coupling and cognition. Our data show that BOLD amplitude is lower in dementia (mean 0.8 ± 0.2, p = 0.001) and MCI patients (mean 0.9 ± 0.3, p = 0.004) compared with controls (mean 1.1 ± 0.2). A low BOLD amplitude was associated with low scores in multiple cognitive domains. We conclude that cerebrovascular dysfunction, most likely due CAA, is an important comorbidity in early stages of dementia and has an independent effect on cognition.
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  • 文章类型: Case Reports
    路易体前驱痴呆(DLB)是指痴呆发作之前的状态,其具有可能指示DLB的未来发展的临床体征或症状。前驱症状不仅包括认知障碍,还包括包括睡眠障碍在内的临床特征。自主神经功能障碍,和神经精神障碍。虽然最近发表了前驱DLB亚型的诊断标准,它们主要用于研究环境。然而,这些标准对临床实践具有重要意义。识别前驱DLB阶段可以导致更快地识别缺陷,改善患者和家庭咨询,和提前护理计划。本病例系列介绍了3种前驱DLB亚型的例子-轻度认知障碍发作,谵妄发作,和精神病发作-帮助临床医生识别可能正在发展DLB的个体。
    Prodromal dementia with Lewy bodies (DLB) refers to a state prior to the onset of dementia with clinical signs or symptoms that may indicate the future development of DLB. Prodromal symptoms can include not only cognitive deficits but also a mix of clinical features including sleep disorders, autonomic dysfunction, and neuro-psychiatric disturbances. While diagnostic criteria for the subtypes of prodromal DLB were recently published, they are largely used in research settings. However, these criteria have important implications for clinical practice. Recognition of prodromal DLB stages can lead to identifying deficits sooner, improved patient and family counseling, and advance care planning. This case series presents examples of the 3 subtypes of prodromal DLB - mild cognitive impairment onset, delirium onset, and psychiatric onset - to help clinicians identify individuals who may be on a trajectory to develop DLB.
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  • 文章类型: Journal Article
    关于遗忘型轻度认知障碍(MCI-A)的神经心理学相关性的科学文献通常报告大型小组的发现,并采用多变量统计数据来描述与MCI-A向早期痴呆过渡相关的认知障碍领域。通常为阿尔茨海默氏症(AD)。个别患者可能会有所不同,然而,从MCI-A过渡到可能的AD时,他们的神经心理学测试表现的特定变化。在这个过渡时期,个人的主观经历也可能有所不同,但很少报告。跟踪患者的主观体验和他们在神经心理学措施上的表现可以更完整地了解患者的临床情况。这些组合的信息集帮助临床神经心理学家提供更个性化和个人相关的服务。我们对一名从MCI-A过渡到可能的早期AD的67岁女性进行了现象学和神经心理学案例分析,以试图说明这种组合分析如何有助于他们的心理护理。
    The scientific literature on neuropsychological correlates of Mild Cognitive Impairment of the Amnestic Type (MCI-A) often reports large group findings and employs multivariate statistics to describe domains of cognitive impairment associated with the transition of MCI-A to early dementia, typically of the Alzheimer\'s Type (AD). Individual patients may vary, however, in terms of specific changes in their neuropsychological test performance as they transition from MCI-A to probable AD. The subjective experiences of individuals during this time of transition can also vary but rarely are reported. Tracking both the patient\'s subjective experiences and their performance on neuropsychological measures provides a more complete picture of the patient\'s clinical situation. These combined sets of information help the clinical neuropsychologist provide a more individualized and personally relevant service. We present a phenomenological and neuropsychological case analysis of a 67-year-old woman who transitioned from MCI-A to probable early AD in an attempt to illustrate how such a combined analysis is helpful in their psychological care.
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  • 文章类型: Journal Article
    目的:医疗专业人员在各种环境中定期使用时钟绘制测试(CDT),以帮助评估所有年龄段的成年人的认知功能。随着我们的技术环境发生了重大变化,由于这项措施的开始,模拟时钟的使用和暴露已经减少。我们调查了年轻人,他们在一个主要是数字的世界中长大,可以在模拟时钟上绘制和分辨时间。
    方法:18-30岁的参与者(N=80,Mage=24.2,SD=3.93),自我认定具有正常认知能力的人,完成了CDT,以及在预先绘制的时钟上设置指针并识别模拟时钟时间。
    结果:约25%的参与者获得了低于预期范围的CDT评分。有一个温和的,仅在CDT上得分低于预期范围的组中,模拟时钟指针设置与时间识别之间呈正相关(rs(16)=0.472,p=0.048)。大多数参与者报告没有佩戴模拟手表。
    结论:基于这些发现,应谨慎使用CDT来筛查年轻人的认知功能(即,18-30岁)。建议针对该人群考虑筛查认知和修改嵌入CDT的认知评估的替代方法。这些发现值得进一步调查年轻成年人的CDT表现。
    OBJECTIVE: The clock drawing test (CDT) is being used regularly by medical professionals in a variety of settings to aid in assessing cognitive functioning in adults of all ages. As our technological environment has changed significantly, because of the inception of this measure, the use of and exposure to the analog clock have diminished. We investigated whether young adults, who have grown up in a mainly digital world, can draw and tell time on an analog clock.
    METHODS: Participants aged 18-30 years (N = 80, Mage = 24.2, SD = 3.93), who self-identified as having normal cognition, completed the CDT, as well as setting hands on a pre-drawn clock and identifying analog clock times.
    RESULTS: About 25% of participants received a CDT score below the expected range. There was a moderate, positive correlation between analog clock hand setting and time identification in the group who scored below the expected range on the CDT only (rs(16) = 0.472, p = .048). Most participants reported not wearing an analog watch.
    CONCLUSIONS: Based on these findings, the CDT should be used with caution to screen cognitive functioning in young adults (i.e., aged 18-30 years). Consideration of an alternative approach to screening cognition and modifying cognitive assessments in which the CDT is embedded is recommended for this population. These findings warrant further investigation into CDT performance in the young adult population.
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