There are growing concerns regarding psychological complications associated with diabetes. Studies suggested that glucagon-like peptide 1 functional agonists (GLP-1 FAs), including glucagon-like peptide 1 receptor agonist (GLP-1 RA) and dipeptidyl peptidase 4 inhibitor (DPP-4i), might hold promise in alleviating emotional disorders. Our objective was to assess the anxiolytic effects of GLP-1 FA in patients with diabetes. A systematic review and meta-analysis were undertaken. Searches were conducted in PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov for relevant articles up to March 1st, 2024. We included studies that compared the effects of GLP-1 FAs with control groups on anxiety levels. We analyzed the mean differences in anxiety rating scale scores from baseline to endpoint. Our review comprised 10 studies, with data from 7 RCTs being suitable for meta-analysis. Compared to the control group, GLP-1 RA significantly improved scores (SMD = 1.17; 95

China is facing a rapidly aging population,significantly impacting public health and healthcare systems.According to the"National Report on the Development of Undertakings for the Aged(2022),"there are 280 million people aged 60 years and above in China,accounting for 19.8％of the total population(Fig.1A)[1].This percentage has steadily increased from 14.3％in 2012.Projections indicate that by 2050,the elderly population in China will peak at approximately 487 million,representing 34.9％of the total population[2].In this perspective article,we analyze the current challenges facing China's dementia prevention and control system,with the aim of presenting policy recommendations to effectively address these issues.

目的 评估帕金森病(PD)患者对PD知识的了解情况以及对PD疾病的认识.方法 选取北京医院神经内科门诊就诊的PD患者62例,记录被调查者的性别、年龄、认知功能等一般资料,采用《帕金森病知识及认识问卷》(KPPDQ)调查其对PD基本知识的掌握及对PD疾病的理解.以KPPDQ问卷的知识部分单项回答正确率≥80％为对本项PD基本知识认识良好,<60％为对本项PD基本知识认识不足;认识部分主要根据符合率评估患者对疾病及其对患者影响的认知度.结果 62例患者的KPPDQ问卷结果显示,PD基础知识部分,6个问题认识良好;3个问题认识不足,分别为"帕金森病可以通过头颅磁共振确诊""帕金森病经常会影响一个家庭里的多个成员""所有帕金森病患者都有震颤".对PD的认识部分:(1)对PD疾病影响的认识部分,70％以上的PD患者认为疾病增加个体和家人负担,导致苦恼并影响家人,50％以上患者对PD存在误解,仅不足20％的患者认为能够较容易获得社会支持.(2)PD患者对于治疗及终末期的认识,80％ 以上PD患者对目前的治疗效果感到满意,在替代治疗中,脑深部电刺激(DBS)手术及中医疗法选择率较高.结论 PD患者对PD疾病知识的了解存在不足.PD患者认为PD加重患者及其家人负担,而能够获得的社会支持不足.

Parkinson's disease (PD) was reported to be connected with thyroid diseases clinically, which might be a critical clew to immune pathogenesis of PD. However, there was no further research to study the pathogenesis correlation between PD and thyroid diseases. In this study, except for investigating the difference in thyroid hormone between PD and the control group, we explored genetic correlation between thyroid and PD. We tried to find their shared molecular pathway by analyzing the effect of PD risk genes on thyroid function. Interestingly, most of those 12 meaningful SNPs we found could affect PD and thyroid function through immune mechanism, which is consistent with our original conjecture and provides significant evidence for the immune pathogenesis of PD.

阿尔茨海默病(AD)是一种生物复合体和异质性疾病,不同的发病年龄、性别和各异的临床表型,都会导致AD临床诊断发生漏诊和误诊.近年来,研究者基于AD病理改变特点,结合磁共振成像分型并整合各种阳性生物标志物形成了新理念诊疗框架.即AD生物亚型.临床研究显示,通过AD生物亚型可以进一步理解AD病理生理作用机制;解释AD临床表型的异质性,对早期诊断很有帮助;可以帮助判断疾病进展和疗效评估;有助于未来AD药物试验方案设计和促进AD疾病修饰治疗研究.本文针对AD生物亚型的临床应用价值进行探讨.

Background : Repressor element 1-silencing transcription/neuron-restrictive silencer factor (REST) was considered as a new therapeutic target for neurodegenerative disorders like Alzheimer’s disease (AD). However, the relationships between AD and REST remain unclear. This study aimed to 1) examine plasma REST levels and REST gene AD patients, and 2) further explore the pathological relationships between REST protein levels and cognition decline in clinic, including medial temporal-lobe atrophy. Methods : Subjects (n=252, mean age 68.95±8.78 years old) were recruited in Beijing, China, and then divided into normal cognition (NC) group (n=89), amnestic mild cognitive impairment (aMCI) group (n=79) and AD group (n=84) according to diagnostic criteria. All subjects received neuropsychological assessments, laboratory tests and neuroimaging scans (MRI) at baseline. Plasma REST protein levels and distribution of the single-nucleotide polymorphisms (SNPs) of REST were compared across the three groups. Correlation between cognitive function, neuro-image and REST level was calculated using multi-linear-regression analysis. medial temporal-lobe atrophy (need to add this method). Results : The plasma REST levels in both NC group (430.30±303.43) and aMCI group (414.27±263.39) were significantly higher than AD group ( NC vs AD, p=0.034; aMCI vs AD, p=0.033). There was no significant difference between NC and aMCI group (p=0.948). There was no significant difference among three groups on the distribution of the genotype distribution of Rs2227902 and Rs3976529 of REST gene. The REST level was correlated to left medial temporal-lobe atrophy index (r=0.306, p=0.023). After 6-month follow up, the REST level in NC group was positively related to the change scores of mini-mental state examination scale (MMSE) (r=0.289, p=0.02). Conclusion : Plasma REST protein declines in AD patients, which also associated with memory impairment and left temporal-lobe atrophy, which may have potential value for clinical diagnosis of AD.

传统帕金森病(PD)依据病理改变和临床特点进行聚类分型和诊治，这只能达到缓解症状的目的。基因检查和生物标志物的检测未来有可能成为PD分型的依据。本文通过葡糖脑苷脂基因(GBA1)突变所致PD的发病机理、临床表现及治疗方法进行系统论述，以便更深刻理解未来PD可能践行的诊治新理念。

目的 应用超声探查帕金森病(Parkinson's disease,PD)患者和健康人群颈部迷走神经横截面积,探讨PD患者颈部迷走神经横截面积与临床特征的相关性.方法 30例PD患者为观察组,同期31例体检健康者为对照组.观察组采用统一PD评分量表Ⅲ(unified Parkinson's disease rating scale-Ⅲ,UPDRS-Ⅲ)评估运动症状.比较2组自主神经症状量表(the scales for outcomes in Parkinson's disease-autonomic,SCOPA-AUT)评分;2组均行颈部迷走神经超声探查,计算左、右侧迷走神经横截面积;Pearson相关法分析PD患者左、右侧颈部迷走神经横截面积与病程、UPDRS-Ⅲ、SCOPA-AUT评分的相关性.结果 观察组左、右侧颈部迷走神经横截面积[(0.72±0.25)、(0.82±0.31)11m12]均小于对照组[(0.99±0.13)、(1.18±0.21)mm2](P<0.05);观察组左、右侧颈部迷走神经横截面积比较差异无统计学意义(P>0.05),对照组左侧颈部迷走神经横截面积小于右侧(P<0.05).PD患者左、右侧颈部迷走神经横截面积与病程(r=-0.033,P = 0.863;r=0.097,P = 0.611)、UPDRS-Ⅲ(r=-0.145,P = 0.445;r=-0.359,P = 0.052)、SCOPA-AUT评分(r=-0.361,P=0.050;r=-0.296,P=0.113)均无相关性.结论 PD患者颈部迷走神经横截面积缩小,颈部迷走神经横截面积与病程、UPDRS-Ⅲ、SCOPA-AUT评分无相关性.

[目的]研究帕金森病疲劳症状中医证候要素特征.[方法]将83例帕金森病患者按照帕金森疲劳量表(PFS-16)分数标准分为疲劳组(PFS-16≥3.3,32例),非疲劳组(PFS-16<3.3,51例),采用帕金森病证候要素量表(PD-PES-13)进行证候要素辨别,比较两组中医证候要素积分和所占比例的差异以及复合证候要素分布情况,采用Logistic回归法分析中医证候要素对帕金森病疲劳发病的危险性.[结果]疲劳组脾虚证、血虚证的比例显著高于非疲劳组(P<0.05或P<0.01),脾虚证、血虚证、气虚证积分显著高于非疲劳组(P<0.05或P<0.01).疲劳组脾虚+髓减、脾虚+血虚、肾虚+阴虚复合证候要素比例显著高于非疲劳组(P<0.05或P<0.01).脾虚、血虚证候要素对帕金森病疲劳发病具有危险性(OR=3.500,P=0.008;OR=2.678,P=0.038);脾虚+血虚、脾虚+髓减、肾虚+阴虚复合证候要素对帕金森病疲劳发病具有危险性(OR=6.000,P<0.001;OR=2.923,P=0.022;OR=2.679,P=0.034).[结论]脾虚、血虚和复合证候要素脾虚+血虚、脾虚+髓减、肾虚+阴虚在伴有疲劳的帕金森病患者中出现频率更高,且可能是其发病的危险因素.

患者,男性,60岁,2020年6月10日因受凉后突发高热,体温高达40.3℃,偶有咳嗽,伴少量白色黏痰.自行服用对乙酰氨基酚缓释片(泰诺林,0.65 g,bid)和酚麻美敏片(泰诺,1粒,bid)退烧,间断交替服用,因症状无好转6月11日于当地发热门诊就医.经对症处理后患者仍间断发热(体温高达39.8℃)且精神萎靡、情绪烦躁,自觉帕金森症状(强直、运动迟缓、震颤)较前明显加重,并伴乏力,肢体酸痛.门诊血生化阳性结果:肌酸激酶(creatine kinase, CK) 7375 U/L,乳酸脱氢酶(lactate dehydrogenase, LDH) 688 U/L,谷丙转氨酶(alanine aminotransferase, ALT) 64 U/L,谷草转氨酶(aspartate aminotransferase, AST) 208 U/L,肌酐100μmol/L.尿常规检查:潜血3+,酮体1+,蛋白2+.血常规显示:白细胞13.5×109/L,中性粒细胞百分比86.7％.肺部CT显示左肺下叶少量磨玻璃密度影,少许炎症.

目的 研究T细胞相关炎症因子与帕金森病发病的关系.方法 纳入41例确诊的早期PD患者(病程＜5年、Hoehn-Yahr分期≤Ⅱ期),选择39例年龄、性别匹配的非神经变性病患者作为对照,测定两组外周血中T细胞相关炎症因子如白细胞介素17A(IL 17A)、白细胞介素10(IL-10)、白细胞介素6(IL-6)、干扰素γ(IFN-γ)、白细胞介素-12p70(IL-12p70)、白细胞介素-23(IL-23)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、干扰素-α(IFN-α)等水平,并进行比较.结果 PD组外周血中IL-6、IFN-α、IL-12p70水平高于对照组,IL-17A水平明显低于对照组(均P＜0.05).结论 T细胞相关炎症因子与帕金森病关系密切,可能参与帕金森病发病机制.

采用国际通用的循证医学研究方法，从6 922项阿尔茨海默病(AD)痴呆诊疗的原始研究中筛选符合纳入标准的367项进行系统评价和荟萃分析，并参考全国德尔菲共识调查结果，形成了17条主要推荐意见和42条次要推荐意见，供临床医生使用。(1)对于拟行AD痴呆诊断的患者，应在适当的场景中使用经过验证的本土化工具进行临床评估(2B，共识率为98.16%，下同)。(2)认知功能评估是AD痴呆诊断的首选方法，应正式评估综合认知和至少4个认知领域(2B，96.93%)。(3)在做出AD痴呆诊断前，应评估与认知障碍相关的精神行为和生活功能，通过对患者和知情者面诊，进行观察和量表评估(2B，97.55%)。(4)在AD痴呆诊断常规检查流程中，应推荐脑CT和MRI检查，在可行的情况下首选MRI头颅冠状位内侧颞叶扫描或海马体成像(2B，98.77%)。(5)当病史和常规检查不能明确AD痴呆诊断时或早发型痴呆、前驱期或非典型AD患者，应与患者或家属讨论使用PET或脑脊液或血液AD生物标志物检测，在可行的情况下将患者转诊至相关研究中心或专科中心(2B，97.55%)。(6)对于有痴呆家族史或快速进展型/非典型痴呆患者，应与患者或家属讨论使用基因检测，在可行的情况下将患者转诊至相关研究中心或专科中心(1A，98.77%)。(7)在AD鉴别诊断的常规检查流程中，应推荐血液常规、生化和血清学检查，对潜在可治疗的认知障碍危险因素进行评估(2B，97.55%)。(8)有经验的临床医生，应采用以病史和检查证实的症状学特征为依据的AD痴呆诊断"核心标准"进行AD痴呆的常规临床诊断(1A，89.57%)。(9)首次就诊者或先前的纵向临床评估信息不可用或需要做出治疗选择时，应进行AD痴呆的临床分期或严重程度判断(3C，93.25%)。(10)在做出AD痴呆临床诊断时，应除外其他已知的痴呆病因(2B，98.77%)。(11)AD痴呆的治疗应遵循药物和非药物干预结合的原则，以获得对认知、行为及功能的协同效益(3C，98.16%)。(12)对于轻中度AD痴呆，在与患者或家属充分讨论可能的获益和风险后，应首先提供胆碱酯酶抑制剂治疗(1A，96.93%)。(13)对于中重度AD痴呆，在与患者的家属充分讨论可能的获益和风险后，应选择美金刚治疗或胆碱酯酶抑制剂治疗(1A，96.93%)。(14)当中重度AD痴呆患者对胆碱酯酶抑制剂达到足够且稳定剂量而缺乏满意疗效时，在与患者的家属充分讨论可能的获益和风险后，应加用美金刚治疗(1A，98.16%)。(15)对于AD痴呆的精神行为症状，当常规抗痴呆药物和非药物干预缺乏满意的疗效且足以给他人或患者造成严重困扰或危险时，在与患者的家属充分讨论可能的获益和风险后，应加用非典型抗精神病药物治疗(2B，98.77%)。(16)对于AD引起的情绪症状，可选择对认知无负面影响的5-羟色胺类药物(3C，95.71%)。(17)对于早期AD痴呆或接受常规治疗而缺乏满意疗效的AD痴呆患者，可选择或加用中医药治疗(3C，90.8%)。

Objectives: The purpose of this study was to evaluate the feasibility and whether synthetic MRI can benefit diagnosis of Alzheimer’s disease (AD). Materials and Methods: Eighteen patients and eighteen age-matched normal controls (NCs) underwent MR examination. The mini-mental state examination (MMSE) scores were obtained from all patients. The whole brain volumetric characteristics, T1, T2, and proton density (PD) values of different cortical and subcortical regions were obtained. The volumetric characteristics and brain regional relaxation values between AD patients and NCs were compared using independent-samples t -test. The correlations between these quantitative parameters and MMSE score were assessed by the Pearson correlation in AD patients. Results: Although the larger volume of cerebrospinal fluid (CSF), lower brain parenchymal volume (BPV), and the ratio of brain parenchymal volume to intracranial volume (BPV/ICV) were found in AD patients compared with NCs, there were no significant differences ( p > 0.05). T1 values of right insula cortex and T2 values of left hippocampus and right insula cortex were significantly higher in AD patients than in NCs, but T1 values of left caudate showed a reverse trend ( p < 0.05). As the MMSE score decreased in AD patients, the BPV and BPV/ICV decreased, while the volume of CSF and T1 values of bilateral insula cortex and bilateral hippocampus as well as T2 values of bilateral hippocampus increased ( p < 0.05). Conclusion: Synthetic MRI not only provides more information to differentiate AD patients from normal controls, but also reflects the disease severity of AD.

Parkinson's disease combined with thyroid dysfunction is not uncommon in clinical practice.Due to similarities and overlaps between their symptoms and an unclear cause-and-effect relationship, the diagnosis and treatment may be missed and delayed.Here we summarize the clinical manifestations of the two diseases and analyze the potential pathogenic mechanisms shared between them, in order to provide a reference for the understanding of their pathogenesis and for the treatment of Parkinson's disease.

目的 探讨原发性帕金森病的关键中医证候.方法 招募的108例原发性帕金森病患者中85例完成经颅黑质超声检查,测量黑质强回声区面积(SN).应用帕金森病证候量表进行中医证候评分,将85例病例进行中医证候诊断,辨证为髓减证、阴虚证、肝风证、气虚证、内热证、肾虚证、脾虚证、阳亢证、痰浊证、血虚证、阳虚证、血瘀证、气滞证,并分为证候阳性组和证候阴性组.比较两组间黑质强回声区异常扩大(SN+)病例比例的差异,应用偏相关及Spearman相关分析中医证候与黑质强回声区面积的相关性. 结果 髓减证患者SN+占79.7％,高于非髓减证患者的36.4％ (P =0.002);肾虚证患者SN+占84.6％,高于非肾虚证患者的65.2％ (P =0.042).髓减证(r=0.276,P=0.011)、肾虚证(r=0.279,P=0.011)、痰浊证(r=0.277,P=0.011)证候积分与最大侧黑质强回声区面积(SNL)呈正相关;髓减证(r=0.297,P=0.006)、肾虚证(r=0.242,P=0.026)证候分布与SNL呈正相关. 结论 髓减证、肾虚证、痰浊证是PD的关键证候,一定程度上反映了原发性帕金森病颅内黑质区的神经病理改变.

目的 研究帕金森病睡眠障碍患者的中医证候特征. 方法 将156例帕金森病患者采用帕金森病睡眠障碍量表分为睡眠障碍组(105例)和非睡眠障碍组(51例),并采用课题组制定的帕金森病证候要素量表进行证候要素辨别,包括肾虚、脾虚、气虚、血虚、阴虚、阳虚、髓减、血瘀、阳亢、内热、痰浊、气滞和肝风13个中医证候要素.比较两组患者各证候要素积分和所占比例的差异及复合证候要素分布情况,用Logistic回归法分析各证候要素对帕金森病睡眠障碍发病的危险度.结果 睡眠障碍组阴虚占85.7％,髓减占87.6％,非睡眠障碍组分别为70.6％、66.7％,差异有统计学意义(P =0.031,P=0.004);睡眠障碍组肾虚证候要素积分为(10.62±3.46)分,非睡眠障碍组为(9.04±3.43)分,差异有统计学意义(P=0.012).睡眠障碍组阴虚+阳亢、肾虚+髓减、阴虚+髓减比例分别为63.8％、81.9％、77.1％,显著高于非睡眠障碍组的45.1％、58.8％、47.1％,差异具有统计学意义(P =0.038、P=0.003、P＜0.001).阴虚(P =0.027、OR=2.500)、髓减(P=0.003、OR=3.538)证候要素对帕金森病睡眠障碍发病具有危险性;阴虚+阳亢(P=0.028、OR =2.146)、肾虚+髓减(P =0.002、OR =3.168)、阴虚+髓减(P＜0.001、OR=3.797)对帕金森病睡眠障碍发病具有危险性.结论 帕金森病睡眠障碍的主要证候要素为阴虚、髓减,常以阴虚阳亢、肾虚髓减的复合证候形式出现,其对帕金森病睡眠障碍的发病具有危险性.

As a noninvasive technique, transcranial sonography (TCS) of substantia nigra (SN) has gradually showed its effectiveness not only in diagnosis but also in understanding clinical features of Parkinson's Disease (PD). This study aimed to further evaluate TCS for clinical diagnosis of PD, and to explore the association between sonographic manifestations and visual hallucinations (VH). A total of 226 subjects including 141 PD patients and 85 controls were recruited. All participants received TCS. A series of rating scales to evaluate motor and non-motor symptoms were performed in PD patients. Results showed that 172 subjects were successfully assessed by TCS. The area of SN was greater in PD patients than that in controls (P < 0.001). As receiver-operating characteristic (ROC) curve analysis showed, the best cutoff value for the larger SN echogenicity size was 23.5 mm2 (sensitivity 70.3%, specificity 77.0%). Patients with VH had larger SN area (P = 0.019), as well as higher Non-Motor Symptoms Scale (NMSS) scores (P = 0.018). Moreover, binary logistic regression analysis indicated that SN hyperechogenicity (odds ratio = 4.227, P = 0.012) and NMSS scores (odds ratio = 0.027, P = 0.042) could be the independent predictors for VH. In conclusion, TCS can be used as an auxiliary diagnostic tool for Parkinson's disease. Increased SN echogenicity is correlated with VH in Parkinson's disease, possibly because the brain stem is involved in the mechanism in the onset of VH. Further studies are needed to confirm these findings.

Tremor is a common movement disorder,but its etiological identification and clinical diagnosis pose a certain difficulty due to its complex clinical manifestations,various types,requirement of multidisciplinary knowledge,and similar symptoms shared by many other causes and diseases.In recent years,many advances in the clinical classification,diagnosis and treatment of tremor have been published and will help us better understand tremor and improve the diagnosis and treatment of tremor.

目的 探讨帕金森病合并功能性便秘的中医证候特征.方法 296例帕金森病患者依据功能性便秘诊断标准分为便秘组123例和非便秘组173例.应用帕金森病证候量表(PD-PES-13)对两组受试者进行中医证候评分.比较两组中医证候积分和各证候分布频率,并用Logistic回归法分析中医证候对帕金森病合并功能性便秘发病的危险度.结果 便秘组肾虚、气虚、阴虚、髓减、阳亢、内热、肝风的积分显著高于非便秘组(P＜0.05),肾虚、阴虚、阳亢、内热、肝风的分布频率显著高于非便秘组(P＜0.05).中医证候对帕金森病便秘危险度的分析显示,帕金森病合并功能性便秘的发生与阴虚(r=1.006,P=0.001)、阳亢(r=0.748,P=0.003)、内热(r=0.747,P=0.003)、肝风(r=0.733,P=0.008)、肾虚(r=0.516,P=0.031)具有正相关性. 结论 帕金森病合并功能性便秘患者的中医证候以阴虚、阳亢、内热、肾虚、肝风、气虚、髓减为主.