Objective:To analyze the characteristics of the apolipoprotein E(Apo E)genotype and cognitive impairment in patients with cerebral microbleeds(CMBs)and positive β-amyloid(Aβ)by using [18F]-AV45 positron emission tomography(PET).Methods:From September 2015 to May 2018, 152 patients with cognitive impairment and CMBs on the susceptibility-weighted imaging(SWI)sequence of head MRI at the neurology department of our hospital, assessed by mini-mental status examination(MMSE)score ≤26 and Montreal cognitive assessment(MoCA)≤25, were consecutively recruited in this retrospective study.After assessment with the inclusion and exclusion criteria, 69 patients aged 68.8±9.3 years were considered eligible for further analysis.Patients were divided into the Aβ-positive group(Aβ + Group, n=37)and the Aβ-negative group(Aβ -Group, n=32)after cognitive assessment, ApoE genotyping and [18F]-AV45 PET examination.Twenty-one healthy elderly controls(HC Group)who took health examination during the same period were enrolled.The results of cognitive assessment and Apo E genotyping were compared between the three groups. Results:The positive rate of the ApoE ε4 allele was 35.6%(32/90), 56.8%(21/37), 18.8%(6/32), and 23.9%(5/21)in the Aβ + , Aβ -and HC groups, respectively, with statistical significant differences between the groups( χ2=12.467, P<0.01). There were significant differences in the positive rate of the ApoE ε4 allele between the Aβ + and HC groups and between the Aβ + and Aβ -groups( χ2=5.880 and 10.407, P<0.05 and P<0.01). The percentage of patients with deep cerebral microbleeds was higher(56.3% or 18/32 vs.8.1% or 3/37, χ2=18.784, P<0.01)and of patients with lobar hemorrhage was lower(12.5% or 4/32 vs.45.9% or 17/37, χ2=9.066, P<0.01)in the Aβ -group than in the Aβ + group, while there was no significant difference in the percentage of patients with mixed cerebral microbleeds between the Aβ -and Aβ + groups( χ2=1.556, P>0.05). There were significant differences in cognitive function between the Aβ + and HC groups, in memory, executive function, visuospatial ability and language between the Aβ + and Aβ -groups, and in executive function, visuospatial ability and attention between the Aβ -and HC groups. Conclusions:Cognitive impairment is more extensive and severe in CMBs patients with Aβ deposition and is associated with positive ApoE ε4.

目的:本研究应用神经心理学测验与静息态功能磁共振(resting-state functional magnetic resonance imaging,rs-fMRI)分析2型糖尿病(type 2 diabetes mellitus,T2DM)患者执行功能损伤及相关脑功能网络改变.方法:对39例T2DM患者和32例健康对照完善神经心理学测验,分别应用Stroop色词试验、连线试验、语音流畅性及数字广度测试评价执行功能中抑制、定势转换、任务启动和工作记忆四个成分.应用rs-fMRI提取两组被试的默认网络、凸显网络、背侧注意网络及执行控制网络,进行统计学比较并分析静息态功能连接(resting-state functional connectivity,rs-FC)与执行功能的相关性.结果:T2DM组与对照组的总体认知功能无显著差异(MMSE:T2DM组:28.30±0.27,对照组:28.84±0.26,P=0.156;MoCA:T2DM组:25.08±0.32,对照组:26.13±0.43,P=0.050).T2DM患者抑制和定势转换功能较对照组显著降低(抑制:T2DM组:-45.79±3.24,对照组:-32.40±2.85,P=0.004;定势转换:T2DM组:-52.23±5.02,对照组:-30.63±4.00,P=0.002),但任务启动和工作记忆功能无显著差异(任务启动:T2DM组:6.03±0.33,对照组:6.94±0.42,P=0.089;工作记忆:T2DM组:6.10±0.34,对照组:6.5±0.43,P=0.421).与对照组相比,T2DM组的默认网络和执行控制网络的网络内rs-FC减低,而凸显网络rs-FC增强.T2DM患者抑制功能与默认网络及执行控制网络的rs-FC呈显著正相关,定势转换功能则与默认网络的rs-FC相关.结论:本研究表明T2DM患者可以在总体认知功能正常阶段即出现执行功能损伤,并且执行功能与脑网络rs-FC改变相关.

目的:比较阿尔茨海默病(AD)与健康对照(NC)的精神和行为症状(BPSD),了解AD患者BPSD的特点.方法:回顾分析2010年1月～2014年12月在中日医院记忆门诊就诊的患者,AD患者181例,轻度、中度、重度AD分别为104、52、25例,NC组105例,采用神经精神科问卷(NPI)评估BPSD.结果:AD组各项症状发生率均显著高于NC组,且均具有统计学差异.AD组BPSD发生率为92.8％,其中发生率最高的症状为易激惹,其次为淡漠、睡眠/夜间行为.在AD组,除抑郁和焦虑外,其余10项症状的发生率均随着病情的加重而增加.NPI总分随着简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分的下降及日常生活能力量表(ADL)、临床痴呆评定量表(CDR)评分的增加而增加.结论:AD患者BPSD发生率高,且BPSD的严重程度随认知功能及日常生活能力的下降而加重.

目的:总结语义性痴呆(SD)患者的临床、神经心理及影像学特点.方法:以2011年9月～2014年11月于我院神经内科记忆门诊就诊患者为检查对象,通过收集患者的临床资料、进行神经心理评估及影像学检查,根据2014年我国《额颞叶变性专家共识》中SD诊断标准,诊断SD患者7例.神经心理学评估包括:简易精神状态检查(MMSE)、蒙特利尔认识评估量表(MoCA)、Boston命名(30项版)、词语流畅性检查、神经精神行为量表以及日常生活能力量表.影像学检查包括头颅MRI及单光子发射计算机化断层显像(SPECT).结果:患者男3例、女4例,发病年龄为63～80岁,其中2例为70岁后发病.患者以命名及词语理解障碍为最早最突出的症状.5例患者有记忆力减退主诉.7例患者均伴有精神行为异常.MMSE评分6～22分,MoCA评分4～17分.患者物体命名、词语流畅性等项目受损严重.5例患者出现不同程度日常生活能力下降.头颅MRI提示5例患者以左侧颞叶前部萎缩为主,2例以右侧颞叶为重;SPECT检查提示萎缩相应区域灌注下降.结论:SD平均发病年龄轻于阿尔茨海默病,但仍可于70岁以后发病.患者命名障碍和词汇理解障碍最为突出,常伴随精神行为异常.影像学表现为非对称性的颞叶前部萎缩或灌注下降.

Objective] To identify the brain regional perfusion patterns associated with performance on Trail Making Test (TM T ) in patients with mild Alzheimer's disease(AD) .[Methods]22 patients with high TM T scores (TM T‐B ∶ A ≥ 3) and 21 patients with low TM T scores(TM T‐B ∶ A < 3) were selected .All 43 subjects underwent brain single photon emission computed tomography (SPECT ) ,and the SPECT images were analyzed by statistical parametric mapping (SPM ) .[Results]No significant differences between high‐ and low‐scoring groups were found with respect to years of education ,MMSE scores ,HDS scores ,ADAS‐cog scores , and scores on TM T‐B .There are significant differences between high‐ and low‐scoring groups in scores on TM T‐A( P < 0 .05)and scores of TM T‐B ∶ A ( P < 0 .01) .Compared to patients with high scores on TM T , patients with low scores showed significant hypoperfusion in the bilateral anterior cingulate ,medial prefrontal lobe and posterior parietal lobe .[Conclusion]Our results suggest that functional activity of the bilateral anteri ‐or cingulate and medial prefrontal lobe is closely related to performance on ratio of TM T ‐B ∶ A .The perform‐ance ratio of TM T‐B ∶ A might be a promising index of dysfunction of the bilateral anterior cingulate and medi‐al prefrontal lobe among patients with mild AD .

<正>患者女性,69岁,右利手。因“发作性左下肢抖动及短暂无力2d”于2006年6月2日入院。患者入院2d前站立时突发左下肢不自主抖动、无力,当时尚可在扶持下站立,1min后自行缓解。发作时意识清,无头晕、黑朦、耳鸣、肢体麻木等症状。外院测量血压为180/80mmHg,予降压治疗(具体不详)。

<正>干燥综合征(sjogren syndrome,SS)是累及外分泌腺为主的慢性炎性自身免疫病,当病变隐袭、多系统受累,而口、眼干症状不显著时极易漏诊[1~3]。患者女性,63岁。因"双腿痛3年,腰背痛1年"入院。患者入院前3年无明显诱因出现右足背胀痛,渐出现双

阿尔茨海默病(Alzheimer's disease,AD)发病率随年龄增高,65岁以上患病率5%,80岁以上患病率约20%.患者的各种认知功能的减退,包括记忆力、注意力、理解力、语言能力、空间结构能力、执行能力以及精神和行为异常,构成了AD的临床特点.近年来轻度认知功能障碍(mild cognitive dysfunction,MCI)作为AD前驱阶段已经为该领域广泛接受,每年有10%～15%的MCI者发展成为AD患者,其危险性是正常人群的10倍.染色体中携带载脂蛋白Eε4(apolipoprotein Eε4,APOEε4)等位基因也是AD的危险因素[1].