1 临床资料 患者男性,81岁,主因"间断咳嗽3个月余"于2021年3月16日入住中国人民解放军总医院,患者3个月来间断咳嗽,伴少量白痰,自觉游泳时气短,余无特殊. 内科系统查体未见明显异常. 既往史 巨细胞动脉炎. 2018 年 4 月查血沉 64 mm/h, C反应蛋白(C-reactive protein, CRP)4. 49 mg/dl. 正电子发射计算机断层显像(positron emission tomography/computed tomography,PET-CT) -核磁共振成像(2018-04-10)示双侧锁骨下动脉、胸主动脉及腹主动脉管壁弥漫性代谢轻度增高,不除外炎性改变.

Numerous studies have shown abnormal brain functional connectivity in individuals with Alzheimer's disease (AD) or amnestic mild cognitive impairment (aMCI). However, most studies examined traditional resting state functional connections, ignoring the instantaneous connection mode of the whole brain. In this case-control study, we used a new method called dynamic functional connectivity (DFC) to look for abnormalities in patients with AD and aMCI. We calculated dynamic functional connectivity strength from functional magnetic resonance imaging data for each participant, and then used a support vector machine to classify AD patients and normal controls. Finally, we highlighted brain regions and brain networks that made the largest contributions to the classification. We found differences in dynamic function connectivity strength in the left precuneus, default mode network, and dorsal attention network among normal controls, aMCI patients, and AD patients. These abnormalities are potential imaging markers for the early diagnosis of AD.

Background : Hippocampal atrophy is a characteristic of Alzheimer’s disease (AD). However, alterations in structural connectivity (number of connecting fibers) between the hippocampus and whole brain regions due to hippocampal atrophy remain largely unknown in AD and its prodromal stage, amnestic mild cognitive impairment (aMCI). Methods : We collected high-resolution structural MRI (sMRI) and diffusion tensor imaging (DTI) data from 36 AD patients, 30 aMCI patients, and 41 normal control (NC) subjects. First, the volume and structural connectivity of the bilateral hippocampi were compared among the three groups. Second, correlations between volume and structural connectivity in the ipsilateral hippocampus were further analyzed. Finally, classification ability by hippocampal volume, its structural connectivity, and their combination were evaluated. Results : Although the volume and structural connectivity of the bilateral hippocampi were decreased in patients with AD and aMCI, only hippocampal volume correlated with neuropsychological test scores. However, positive correlations between hippocampal volume and ipsilateral structural connectivity were displayed in patients with AD and aMCI. Furthermore, classification accuracy (ACC) was higher in AD vs. aMCI and aMCI vs. NC by the combination of hippocampal volume and structural connectivity than by a single parameter. The highest values of the area under the receiver operating characteristic (ROC) curve (AUC) in every two groups were all obtained by combining hippocampal volume and structural connectivity. Conclusions : Our results showed that the combination of hippocampal volume and structural connectivity (number of connecting fibers) is a new perspective for the discrimination of AD and aMCI.

Background: Alzheimer's disease (AD) is the most common cause of dementia in older individuals, and amnestic mild cognitive impairment (aMCI) is currently considered the prodromal stage of AD. The hippocampus and fornix interact functionally and structurally, with the fornix being the major efferent white matter tract from the hippocampus. Objective: The main aim of this study was to examine the impairments present in subjects with AD or aMCI and the relationship of these impairments with the microstructure of the fornix and the functional connectivity (FC) and gray matter volume of the hippocampus. Methods: Forty-four AD, 34 aMCI, and 41 age- and gender-matched normal controls (NCs) underwent neuropsychological assessments and multimode MRI. We chose the bilateral hippocampi as the region of interest in which gray matter alterations and FC with the whole brain were assessed and the fornix body as the region of interest in which the microstructural integrity of the white matter was observed. We also evaluated the relationship among gray matter alterations, the abnormal FC of the hippocampus and the integrity of the fornix in AD/aMCI. Results: Compared to the NC group, the AD and aMCI groups demonstrated decreased gray matter volume, reduced FC between the bilateral hippocampi and several brain regions in the default mode network and control network, and damaged integrity of the fornix body (decreased fractional anisotropy and increased diffusivity). We also found that left hippocampal FC with some regions, the integrity of the fornix body, and cognition ability were significantly correlated. Therefore, our findings suggest that damage to white matter integrity may partially explain the reduced resting-state FC of the hippocampus in AD and aMCI. Conclusion: AD and aMCI are diseases of disconnectivity including not only functional but also structural disconnectivity. Damage to white matter integrity may partially explain the reduced resting-state FC in AD and aMCI. These findings have significant implications for diagnostics and modeling and provide insights for understanding the disconnection syndrome in AD.

Alzheimer's disease (AD) is a worldwide progressive neurodegenerative disorder in the elderly. Previous research has indicated that Alzheimer's disease impairs white matter (WM) tracts. Anatomical and neuroimaging studies have indicated that WM tracts are associated with cognitive function. Whether the abnormal WM integrity in AD is associated with cognitive impairments and the clinical symptoms is still not clear. To this end, we investigated the relationship between the impairments in WM tracts and the decline of cognitive ability in AD. Diffusion tensor imaging (DTI) data were collected from 38 AD patients and 30 normal, cognitively healthy volunteers. The tract-based spatial statistics (TBSS) approach was used to compare the fractional anisotropy (FA) and mean diffusivity (MD) values between the two groups. WM tracts (cingulum, superior longitudinal fasciculus (SLF), uncinate fasciculus (UF), and inferior longitudinal fasciculus (ILF)) associated with cognition function were extracted for region of interest (ROI)-based analysis. Significantly decreased FA values and increased MD values of the cognition-related WM tracts were observed in the AD group compared with the normal cognition (NC) group. In addition, we further demonstrated that the decreased FA values and increased MD values of the cognition-related WM tracts were significantly correlated with MMSE scores. These results indicated that abnormal changes in WM integrity are observed following AD. Finally, we used support vector machine (SVM) with a repeated, stratified 10-fold cross-validated classifier to evaluate the ability of FA and MD values to discriminate disease. The accuracy of the SVM using cognition-related WM as classified features was higher than that using non-cognition-related tracts. Most importantly, our results showed the relationship between abnormal WM tracts and cognitive ability in AD. These findings further suggested that AD-related impairments in cognition-related WM tracts may influence the cognitive ability of AD patients.

Alzheimer's disease (AD) and mild cognitive impairment (MCI) have been associated with impaired communication among large-scale brain networks. Given nature that interconnected subnetworks are responsible for daily behavior than a single pair of functional connectivity, it is valid to use a network-based statistic (NBS) method to exploit the clustering structure of connectivity alterations in AD/MCI. We explored abnormal network components using NBS based on resting-state functional magnetic resonance imaging (fMRI)connectivity in a sample of patients with AD (N = 35), MCI (N = 27) and age-matched healthy subjects (N = 27). The results demonstrated that patients had reduced functional connectivity strength in several components, including the default mode network, sensorimotor network, visual-sensory network, and visual-attention network. In patients with AD, the functional connectivity of these components of interest (COIs) exhibited greater attenuation than that in MCI subjects compared with normal cognition. A greater degree of cognitive impairment was correlated with a greater decrease in functional connectivity in the identified COIs. These results indicate that the neurodegenerative disruption of fMRI connectivity is widely distributed in several networks in AD/MCI. These profiles deepen our understanding of the neural basis of AD/MCI dysfunction and indicate the potential of resting-state fMRI measures as biomarkers or predictors of AD.

Rapid eye movement (REM) sleep behavior disorder (RBD) is commonly associated with neurodegenerative disorders characterized by α-synuclein deposition, including Parkinson’s disease, multiple system atrophy, and Lewy body dementia. However, this tendency in tauopathy-mediated diseases is rare and only sporadically reported. We systematically illustrate the occurrence of RBD and sleep features among a cohort of patients with Alzheimer’s disease (AD), a non-synucleinopathy.

Objective To study the alteration of thalamus function connectivity pattern in patients with mild cognitive impairment( MCI) during a one year follow-up. Methods In the present study,neuropsychological tests and functional connectivity analysis based on resting state functionalmagneticresonanceimaging(fMRI)wereevaluatedin13MCIsubjects(age74.5±8.7years,gender8M/5F)bothatthebaselineand one year later. Then a correlation analysis was performed between the strength of functional connectivity of the identified regions and various clinical variables for evaluating the relationships between the strength of functional connectivity and the cognitive abilities of the MCI patients. Results Compared to the baseline,MCI patients showed decreased functional connectivity between the left thalamus and several regions of brain including left inferior parietal cortex,left putamen and right cerebellar posterior lobe( VIIB). Decreased functional connectivity was also detected between the right thalamus and left putamen. There were no correlations between alteration on the functional connectivity and changes of cognitive function. Conclusion Functional connectivity between the thalamus and several brain regions which were involved with high level cognition is impaired over time in the MCI patients. Our results provided useful information for research on the pathophysiological mechanism of the conversion from MCI to AD.

The marginal division (MrD) is a neostriatum subregion that links the limbic system and basal nucleus of Meynert; it is an important subcortical center that is involved in learning and memory. Alzheimer's disease (AD) is a neurodegenerative disorder and the most common cause of dementia in the elderly. AD clinically manifests as gradually progressive cognitive decline with behavioral disorders. Prior to full dementia, AD patients typically experience a transient state, i.e., mild cognitive impairment (MCI). Amnestic MCI individuals, but not all MCI individuals, frequently convert to AD dementia. To specify whether and how the functional relationships between the MrD and other brain regions change during AD, functional connectivity was assessed using resting-state functional MRI data and associated neuropsychological tests in AD and MCI patients (amnestic-type). Compared with normal controls, a different decreased functional connectivity pattern was observed between the MrD and caudate, the amygdala/parahippocampal region, the inferior frontal gyrus, the superior temporal gyrus, and the cerebellum for AD/MCI patients. Moreover, the functional connectivity between the MrD and the identified regions was significantly correlated with the neuropsychological scores among the MCI and AD subjects. Our results suggest that the MrD functional network is disrupted during AD.

Objective To explore the characters of cognitive dysfunction in the aged population with diabetes. Methods Aged patients were approached through inpatient and outpatient neurology practices between January 2009 and December 2012,which were divided into diabetes group and control group. Medical history acquisition,neurological examination and neuropsychological scales assessment were conducted. The neu_ropsychological examinations included MMSE,AVLT,ADL,comparability and perception test. Results The results were analyzed by SPSS soft_ware. A total of 273 aged patients were enrolled in this study,among which 65 had diabetes. There were no significant difference in age,sex and education level between two groups. The total score of MMSE was 21. 35 ± 5. 039 in diabetes group and 23. 32 ± 5. 020 in control group,which was significant difference between two group. The sub-item analysis showed the orientation to time test in diabetes group,which was significantly lower than that of control group( P =0. 002). Persons with diabetes had lower AVLT immediate recall and delayed recall scores than persons without diabetes( P ﹤0. 05). ADL score in diabetes group was significantly less than that of in control group( P =0. 018). Conclusion The aged population with diabetes had a selective cognitive dysfunction. Preventing and treating diabetes is very important.

Objective To explore the correlation between diabetes and cognitive dysfunction and to elucidate the effect of diabetes on cognitive dysfunction in the aged population. Methods The study was a cross-sectional study. People with subjective complaints(80 years old) were approached through inpatient and outpatient neurology practices between January2009 and December 2012. Medical History acquisition, neurological examination and neuropsychological scales assessment was conducted. The prevalence of diabetes in different cognitive function populations and the effect of diabetes on cognitive dysfunction were analyzed. Results A total of 286 aged patients were enrolled in this study, among which 60 had normal cognitive function, 85 had mild cognitive impairment and 141 had dementia. The prevalence of diabetes was 8.33%(95% CI18.5%~30.3%) in normal cognitive group vs 23.53%(95CI14.4%~36.3%) in patients with MCI and 29.79%(95%CI 21.5%~40.3%)in patients with dementia. The prevalence of diabetes in the dementia group was significantly higher than that of in normal cognitive group(P0.05). Diabetes decreased with the MMSE and CDT score by using Spearman Rank Order Correlation.Multivariable logistic regression analysis showed diabetes was significantly associated with essential hypertension.Conclusion The prevalence of diabetes in elderly patients with dementia was significantly higher and diabetes was significantly correlated with cognitive dysfunction. Tightly control of diabetes is very important for prevention and treatment of dementia in the aged population.

Mild cognitive impairment (MCI) is considered to be the prodromal stage of Alzheimer's disease. The amygdala, which is considered to be a hub, has been shown to have widespread brain connections with many cortical regions. Longitudinal alterations in the functional connectivity of the amygdala remain unclear in MCI. We hypothesized that the impairment in the amygdala-cortical loop would be more severe in a follow-up MCI group than in a baseline MCI group and that these alterations would be related to the disease processes. To test this hypothesis, we used resting-state functional magnetic resonance imaging to investigate alterations in amygdalar connectivity patterns based on longitudinal data from 13 MCI subjects (8 males and 5 females). Compared to the baseline, decreases in functional connectivity were mainly found located between the amygdala and regions at the conjunction of the temporal-occipital system and the regions included in the default mode network in the follow-up MCI individuals. The alterations in the functional connectivity of the identified regions were validated in an independent dataset. Specifically, reduced amygdalar connectivity was significantly correlated with cognitive abilities. These findings indicate that impairments in the functional connectivity of the amygdala may be potential biomarkers of the progression of MCI.

Objective To study the distribution of cerebral microbleeds (CMBs) in elderly patients and its related risk factors. Methods Medical records and laboratory test data of 217 elderly patients aged 60-96 years admitted to our department from February 2010 to February 2012 were collected. The patients underwent MRI and routine laboratory tests. The number of CMBs in their brain was recorded. Results The detection rate of CMBs was 39.2%, which increased with the age of patients. The CMBs were mainly located in frontotemporal lobe, white matter and thalamus. Single factor analysis showed that age, hypertension, cerebral hemorrhage and infarction history were the risk factors for CMBs. Logistic analysis showed that age (OR=1.677, 95%CI:1.061-2.652, P=0.027), hypertension (OR=5.415, 95%CI:1.723-17.016, P=0.004) and cerebral hemorrhage history (OR=4.065, 95%CI:1.129-14.629, P=0.032) were closely related with CMBs. However, cerebral infarction history (OR=3.376, 95%CI:1.661-6.863, P=0.001) was an independent risk factor for CMBs. Conclusion The risk factors are different for CMBs at different locations.

Objective: To investigate the etiology,pathogenesis,clinical manifestations and treatment of neuroleptic malignant syndrome(NMS).Methods: All clinical data of one NMS were studied retrospectively.Results: The patient presented with altered levels of consciousness,increased muscular rigidity,tachycardia and hypertension,tremor,and elevation of serum creatine kinase(CK).Antipsychotic drugs was discontinued,and he received oral bromocriptine mesilate and amantadine,the patient was recovered quickly.Conclusion: NMS is a severe complication during treatment with antipsychotic drug.The manifestation can be atypical and various.The patient may came to other department beside neurology and psychiatry,so all the internal medicine doctors should be familiar with the disease.Then the NMS patient can be diagnosed and treated quickly and correctly.The prognosis will be better.

OBJECTIVE:To investigate the prevalence of cognitive and motor disorders as well as emotional and sleep abnormality in the veterans from military communities in Beijing.METHODS:The participants underwent a comprehensive in-person evaluation including detailed neuropsychological testing, Hospital Anxiety and Depression Scale and special questionnaires for movement and sleep disorders.RESULTS:The overall prevalence of cognitive impairment, extrapyramidal diseases was 32.7%, 8.8%. The prevalence of mild cognitive impairment, dementia, Parkinson disease, essential tremor, anxiety and depression was 26.2%, 6.5%, 2.0%, 6.1%, 1.4% and 4.1% respectively. Prevalence of all kinds of sleep disorders ranged from 10.3% to 53.9%. The prevalence of cognitive impairment had no significant difference of sex, but were correlated to age and education, the correlation coefficient was 0.326 and -0.221 (P<0.01).CONCLUSION:Veterans from military communities had higher prevalence of cognitive impairment, extrapyramidal diseases and sleep disorders and lower that of anxiety and depression relatively.

Objective:To analyze clinical characteristics of migraine in childhood and adolescence. Method:Clinical manifestations of 269 patients which include 45 children and 224 adults were analyzed retrospectively. Patients were collected in department of neurology in PLA General Hospital from 2005 to 2006 and information collected included demographic data, attack frequency, duration, severity, location, quality and associated symptoms of headache. Results:The male/female ratio is 1:1.05 for adults and 1:3.48 for children (χ2=13.493, P0.001); The ratio of migraine with aura is 53.3% for children and 21.9% for adults (χ2=18.754, P0.001);The attack frequency, duration, severity of headache are 1(1～2))/month vs. 2 (1～3) /month (P=0.032), 6 (2.5～24)h vs. 24(7.25～36)h (P=0.001) and 7.5 (6～8) vs. 8 (7～9)(P=0.002) respectively; there was no significant difference in proportion of unilateral headache (children 57.8% vs. adults 65.2%, P=0.345) and pulsatile headache (children 55.6% vs. adults 67.9%, P= 0.112). No significant difference was observed in associated symptoms (nausea and vomiting: 88.9% vs. 92.0%, P=0.501; photophobia and phonophobia: 60.0% vs. 70.5%, P=0.164; aggravation after activity: 86.7% vs. 74.1%, P=0.071). Conclusion:Migraine with aura may be more common in children and adolescent than that in mature; Migraine in childhood and adolescence seemed to be characterized as shorter duration, milder severity and minor attack frequency. Two kinds of above-mentioned migraineurs may share similar location, quality and associated symptoms of headache.