Background Idiopathic normal pressure hydrocephalus (iNPH) is a reversible disorder characterized by cognitive, gait, and urinary dysfunction. While the cerebrospinal fluid (CSF) tap test can predict surgical response, screening-based cognitive assessment protocols remain undefined, limiting prognostic accuracy. Objectives To delineate temporal patterns of recovery for individual cognitive subdomains after the CSF tap test in patients with iNPH, and to establish high-sensitivity, time-stratified cognitive subdomains to improve preoperative prognostication and surgical decision-making. Design Single-centre retrospective observational study with rigorous inclusion/exclusion criteria. All patients underwent a full series of multidimensional cognitive assessments before and at 24, 48, and 72 hours after the CSF tap test. Cognitive functions were stratified into six standardized subdomains using validated weighted composite scores. All enrolled patients underwent ventriculoperitoneal (VP) shunt surgery and completed 3-month postoperative cognitive follow-up. Longitudinal changes were analysed using repeated-measures ANOVA, linear mixed models, and receiver operating characteristic curve analysis. Methods In this study, 53 patients with iNPH were included. Cognitive assessments were performed consistently across all time points using the Mini-Mental State Examination (MMSE), Animal Fluency Test (AFT), Trail Making Test (TMT and TMT-A), and Clock Drawing Test (CDT). Quantitative composite scores for each cognitive subdomain were computed and analysed longitudinally. Results Stratified analyses showed that language ability at 24 hours (P < 0.01), orientation ability at 48 hours (P < 0.01), and recall combined with attention and calculation at 72 hours (recall: P < 0.001; attention and calculation: P < 0.01) were the most sensitive and predictive for assessing the effects of the CSF tap test across time points. All enrolled patients underwent VP shunt surgery after multi-index assessment. These improvements correlated with 3-month postoperative cognitive benefits. Conclusions A time-stratified, subdomain-specific cognitive assessment protocol enhances tap test sensitivity, reduces misclassification, and supports personalized surgical decision-making for patients with iNPH.

INTRODUCTION:Idiopathic normal pressure hydrocephalus (iNPH), a condition that primarily affects the elderly, has an unclear prevalence rate in China. METHODS:A cross-sectional survey involving 1491 seniors aged 60 and above in Shanghai was conducted. Clinical symptoms and brain imaging data were collected for the diagnosis of suboptimal probable iNPH (s-probable iNPH). The crude prevalence was calculated and the estimated prevalence was inferred. RESULTS:The crude prevalence of s-probable iNPH was 3.09% and 2.62% respectively, using DESH score ≥6 and Radscale score ≥7 as the primary imaging diagnostic criteria. The estimated prevalence of Shanghai was 2.59% among people over 60 years old and it rose to 7.99% among people aged over 90, and it was estimated that 134,152 and 11,708, respectively, had s-probable iNPH among the corresponding age group. DISCUSSION:The prevalence of s-probable iNPH fluctuates based on the radiological scoring systems and the defined thresholds employed, and it tends to rise with advancing age. HIGHLIGHTS:**Significant Prevalence**: The study identified a substantial prevalence of iNPH in older adults, with rates increasing significantly with age, particularly among those aged 90-99 years and centenarians. **Diagnostic Approach**: The research utilized novel diagnostic methodologies by integrating the DESH score or Radscale score with stringent clinical symptoms, providing a closer approximation to the true prevalence of iNPH. **Gender Disparity**: A marked gender difference was observed, with the prevalence of iNPH being significantly higher in males compared to females across all age groups. **Clinical Implications**: The findings underscore the importance of considering iNPH in the differential diagnosis of dementia, particularly among older male patients presenting with cognitive impairment and gait disturbances. **Public Health Impact**: The estimated number of s-probable iNPH patients in Shanghai highlights the need for increased awareness and better management strategies for this underdiagnosed condition in the aging population.

BACKGROUND:The world has witnessed a steady rise in neurological diseases, which represent a heterogeneous group of disorders characterized by complex pathogenesis involving disruptions at multiple molecular levels, including genomic, transcriptomic, proteomic, and metabolomic levels. These disorders, often caused by genetic mutations, metabolic imbalances, immune dysregulation, and environmental factors, pose significant challenges to global public health due to their high prevalence, mortality, and disability burden. RESULTS:The advent of high-throughput technologies, such as next-generation sequencing and mass spectrometry, has provided valuable insights into the underlying mechanisms of disease, especially the development of multi- and high-spatial-resolution omics technologies, enabling the interaction of multiple levels of biology and analysis of the complex molecular networks and pathophysiological processes. CONCLUSIONS:This review provides a comprehensive analysis of the latest advancements in multi- and high-spatial-resolution omics, with a focus on their applications in precision diagnostics, biomarker discovery, and therapeutic target identification in brain diseases. The study also highlights the current challenges in the clinical implementation and discusses the future directions, with artificial intelligence being anticipated to enhance clinical translation and diagnostic accuracy significantly.

BACKGROUND:Ventriculoperitoneal (VP) shunt surgery is the primary treatment for patients with idiopathic normal pressure hydrocephalus (iNPH). This study compared the outcomes of VP shunt placement using electromagnetic (EM) navigation versus standard methods in patients with iNPH, focusing on catheter accuracy and postoperative complication rates. METHODS:This retrospective study included 31 patients with iNPH who underwent standard shunt placement using anatomical landmarks and 50 patients who underwent EM-guided shunt placement. Parameters assessed included shunt placement grade, catheter tip position, catheter angle, puncture attempts, operative duration, postoperative infection rates, intraparenchymal hemorrhage rates, and shunt malfunction rates. Patients had follow-ups at 3, 6, 12, and 24 months after surgery or until shunt failure. RESULTS:In the EM-guided group, a higher percentage of grade 1 shunt placements (92% vs. 71%, P = 0.03) and fewer grade 3 placements (2% vs. 13%, P = 0.068) were observed. The catheter tip position at the foramen of Monro was significantly more accurate (P < 0.001), with smaller lateral catheter deviation angles in both coronal (19.69° vs. 24.2°, P < 0.0001) and sagittal (21.75° vs. 39.3°, P < 0.01) sections. The EM-guided group had fewer puncture attempts, shorter operative durations, lower incidence of intraparenchymal hemorrhage (P < 0.01), and fewer shunt malfunctions over the 2-year follow-up period (2% vs. 26%, P = 0.0003). CONCLUSIONS:The use of EM navigation in VP shunt placement for patients with iNPH improves catheter placement accuracy, reduces postoperative complications and shunt malfunction rates, and provides precise and individualized surgical treatment.

Hydrocephalus is a prevalent neurological disorder, particularly impactful in older adults, characterized by high incidence and numerous complications that impose a significant burden on healthcare systems. This review aims to provide a comprehensive description of hydrocephalus pathogenesis, focusing on cellular and molecular insights derived from animal models. We also present the latest advances in hydrocephalus research and highlight potential therapeutic targets. Lastly, the review advocates the integration of findings from both animal and human studies to achieve better outcomes and examines the potential of emerging technologies. We wish to raise public attention about this disease in an aging society. Current animal models for hydrocephalus involve acquired hydrocephalus models and genetic/congenital hydrocephalus models. Studies from animals have shown that the main mechanisms of models can be broadly classified into nine types. A variety of drug-targeted therapy methods and non-surgical treatment methods have been used in clinical practice. But current treatment approaches primarily focus on symptomatic relief and intracranial pressure control rather than addressing the underlying pathological mechanisms. We call for the development of more accurate and representative animal models to achieve better outcomes and examine the potential of emerging technologies, such as artificial intelligence and neuroimaging. In summary, this review synthesizes recent findings in hydrocephalus research, identifies promising therapeutic targets and interventions, and critically evaluates the limitations of current research paradigms, aiming to align preclinical studies with clinical endpoints. Continued studies and multidisciplinary collaboration are essential to develop effective interventions and facilitate new treatments into bedside.

目的 总结很可能的特发性正常压力脑积水(probable idiopathic normal pressure hydrocephalus,Probable iNPH)患者淡漠、焦虑、抑郁症状的出现率、严重程度和特点,通过增强对这些神经精神症状的认识,提高iNPH诊疗效率.方法 收集自2017年3月至2021年3月就诊于航空总医院神经内科诊断为很可能的iNPH患者资料60例,进行改良淡漠评定量表(modified apathy evaluation scale,MAES)、宗氏焦虑自评量表(Zung self-rating anxiety scale,SAS)和抑郁自评量表(Zung self-rating depression scale,SDS)测定,分析淡漠、焦虑和抑郁症状的出现率、严重程度和特点.进一步根据有无淡漠、焦虑和抑郁症状,分别将患者分为有无淡漠组、有无焦虑组和有无抑郁组,分别对比分析有无上述症状患者的临床特点.结果 53例很可能的iNPH患者纳入研究,男37例、女16例.出现淡漠症状33例(62.3％),焦虑症状14例(26.4％),抑郁症状15例(28.3％),以出现轻度焦虑和抑郁症状比例最大.进一步按照有无淡漠、有无焦虑和有无抑郁分组分析显示,淡漠组患者北京版蒙特利尔认知测验(Montreal cognitive assessment,MoCA)量表得分低于无淡漠组[(15.1±5.8)分比(18.7±5.8)分,t=2.15,P=0.04];焦虑组患者SDS量表得分高于无焦虑组[(53.6±12.3)分比(37.0±11.6)分,t=-4.52,P＜0.001),病程短于无焦虑组[24.0(12.0,27.0)个月比 36.0(18.0,60.0)个月,Z=-2.20,P=0.03];抑郁组患者SAS和MAES量表得分均高于无抑郁组[分别(48.0±12.9)分比(32.6±10.9)分,t=-4.41,P＜0.001;(20.3±8.1)分比(15.0±5.1)分,t=2.90,P＜0.001].结论 淡漠、焦虑和抑郁症状在很可能的iNPH患者中出现率较高,以淡漠出现率最高(62.3％);抑郁和焦虑症状严重程度多为轻度损害;淡漠、焦虑和抑郁症状之间存在相互影响.通过常用量表有利于对这些特征进行识别,提高iNPH诊疗效率.

Abstract Background: Cerebrospinal fluid (CSF) shunt intervention is currently the standard and most effective treatment for idiopathic normal-pressure hydrocephalus (iNPH). However, many patients do not undergo surgery due to various reasons. The study aimed to assess the efficacy and safety of methazolamide (MTZ) in the treatment of iNPH. Methods: A 12-week randomized, double-blind, drug-placebo clinical studywas conducted at the Aviation General Hospital. Participants with a diagnosis of possible or probable iNPH according to Japanese second iNPH guidelines were consecutively recruited from September 2019 to May 2021. All patients were inoperable or had refused surgical treatment due to various reasons. The patients were assigned (2:1) to the MTZ or placebo group via a computer-generated randomization list. The gait and cognition function were assessed, and brain MRI scans were taken before and 12 weeks after drug administration. The primary endpoint was the difference change in the Boon gait sum score relative to baseline between the drug and placebo groups. Secondary endpoints were differences in MMSE and MOCA scores. In addition, the adverse reactions were also monitored. Results: Twenty participants were randomly included in the MTZ group and 12 in the placebo group. A total of 26 patients, 17 in the MTZ and 9 in the placebo group, were included in the final efficacy analysis. The difference in Boon sum score relative to baseline between the groups was -6.06 points (95% CI, -9.37 to -2.75; p =0.001) after 12 weeks of treatment. However, there was no significant difference in the MMSE and MoCA scores between the drug and placebo groups (MMSE 0.36, 95% CI, -2.36 to 3.09; p = 0.78; MoCA 0.001, 95% CI, -1.98 to 1.98; p = 1.00). No serious adverse reactions such as hypokalemia or acidosis occurred in any of the patients. Conclusions: MTZ significantly improved the gait of iNPH patients without any adverse effects. Large sample studies are needed for further confirmation of our results.

Objectives: To explore the relationship between the presence or parameters of right-to-left shunt (RLS) detected by c-TCD and attack clinical features in migraine patients with aura (MA+) or without aura (MA-). Methods: Migraine patients with aura and migraine patients without aura (MA-) were recruited consecutively. The RLS was assessed by a c-TCD examination. Results: A total of 528 migraine patients and 71 healthy were included. The prevalence of RLS especially of mild shunts was higher in patients with migraine. Patients of MA+ developed migraine earlier and experienced more severe pain, more frequent photophobia and phonophobia, although the yearly frequency, duration and degree of pain or type and size of shunt was similar. Moreover, patients with MA+ and RLS (MA+RLS+) also experienced more photophobia and phonophobia than that without RLS (MA+RLS-). The result was similar in MA-RLS+ group. Patients with moderate or massive of RLS experience longer duration of pain in both MA+RLS+ and MA-RLS+ groups. The sex distribution was only significantly different in MA+RLS+ group, in which women were more likely to suffer from RLS especially mild shunt. Conclusion: A higher prevalence and severity of RLS was found in the migraine patients, especially those with aura. MA+ patients develop earlier and experience more severe pain. The duration was consistent with the shunt size in both MA+RLS+ and MA-RLS+ groups.

Leigh综合征(Leigh syndrome,LS)是一种由于线粒体氧化磷酸化障碍所导致的严重退行性脑病.NADH/辅酶Q氧化还原酶复合体(线粒体复合物I)是线粒体呼吸链中最大的复合酶,至少包含45个亚基,其中38个核编码基因、7个线粒体编码基因[1].其结构域呈L型,中央部嵌入线粒体内膜,周围部游离在线粒体基质中[2,3].线粒体复合物I缺陷是导致线粒体疾病的最常见原因[4],约占呼吸链缺陷疾病的1/3[5],且临床表现形式不同.

目的 探讨特发性正常压力脑积水(idiopathic normal pressure hydrocephalus,iNPH)患者颅内体积参数与认知功能障碍的相关性.材料与方法 回顾性分析航空总医院神经内科诊断为iNPH的患者病例37例及与其年龄、性别和受教育程度匹配且认知功能正常的20名对照组.对两组进行认知功能评估,包括简易精神状态量表(Mini Mental Status Examination Scale,MMSE)(中文版),蒙特利尔认知评估量表(Montreal Cognitive Assessment Scale,MoCA)(中文版).并行头颅MRI扫描,测量受试者颅内总体积、脑脊液体积、脑灰质体积、脑白质体积,计算相对脑脊液体积比、脑灰质体积比、脑白质体积比,同时测量所有受试者的Evan's指数(Evan's index,EI),胼胝体夹角.分析iNPH患者脑脊液体积比、脑灰质体积比、脑白质体积比等与MMSE、MoCA相关性.结果 iNPH组与对照组相比,在EI、胼胝体夹角、灰质比率、白质比率、脑脊液比率之间差异有统计学意义(P<0.05),iNPH患者脑白质体积比与MMSE评分呈正相关(r=0.492,P=0.001),脑灰质体积比与MMSE评分呈负相关(r=-0.478,P=0.002),脑脊液体积比、EI、胼胝体夹角与MMSE无相关性.颅内体积参数与MoCA无相关性.结论 iNPH患者脑白质体积比、灰质体积比与认知功能障碍相关,脑白质体积比与认知功能障碍呈负相关,脑灰质体积比与认知功能障碍呈正相关,脑白质体积比大时,认知功能障碍相对较轻,脑灰质体积比大时,认知功能障碍相对较重.脑白质体积比,灰质体积比的测量可为iNPH认知功能障碍评估提供客观的影像学证据.

Objective:To study the efficacy and safety of Methazolamide(MTZ)for the treatment of normal pressure hydrocephalus(NPH)patients.Methods:A randomized, double-blind, placebo-controlled, prospective clinical study was conducted in Aviation General Hospital.A total of 35 NPH patients including 29 idiopathic normal pressure hydrocephalus(iNPH)and 6 secondary normal pressure hydrocephalus(sNPH)received drug treatment in our hospital from September 2019 to March 2021.All patients were unsuitable for or refused surgical treatment for some reasons.The patients were divided into drug group(n=18)and control group(n=10), taking oral MTZ or placebo 25 mg twice daily, increasing to 50 mg twice daily after 1 week if there was no discomfort.The 10 m gait score, cognitive function score, brain MRI check were completed before and 1 month after oral administration.The assessment of idiopathic normal pressure hydrocephalus scale(iNPHGS)score were performed 1 month and 3 months after oral administration.The primary efficacy endpoint was iNPHGS score for 3 months treatment and the secondary efficacy endpoint was the assessment of above scales for 1 month treatment.Results:As compared with baseline, the effect of 1 month treatment showed that MOCA scores[(16.2±8.8)and(14.8±8.7)scores, t=-2.68, P=0.02], 10 m gait scores[(22.3±11.2)and(25.6±12.9), t=2.76, P=0.02], iNPHGS scores[(7.3±3.2)and(8.1±3.5), t=4.08, P<0.01]were improved.The effect of 3 month treatment showed that the iNPHGS score(6.1±2.4)was improved compared with baseline( t=5.07, P<0.01)and 1 month( t=4.11, P<0.01). But the above scores of the control group were not significantly improved compared with the baseline(all P>0.05). After 1 month treatment, the 10 m gait score and iNPHGS score in the drug group were improved compared with those in the control group(all P<0.05). After 3 months treatment, the iNPHGS score was improved compared with the baseline level in the control group( t=-4.41, P<0.05). The above 35 patients had no serious adverse reactions such as hypokalemia and acidosis.There was no significant difference in adverse events between the two groups( χ2=0.01, P=1.00). Conclusions:The treatment of MTZ could effectively improve the clinical symptoms of NPH patients with good safety.

目的 探讨痉挛性斜颈(CD)和特发性震颤(ET)的头部震颤的临床和电生理特点.方法 对17例确诊特发性震颤(ET)和15例确诊痉挛性斜颈(CD)并且具有头部震颤的患者行肌电图震颤分析研究,并探讨两种疾病头部震颤的各自特点.结果 ET组平均年龄(59.58±2.78)岁,平均病程(100.94±31.46)个月,男性4例,女性13例,8例有ET家族史,头部抖动摇头型14例,点头型3例,混合型1例,17例ET患者均有手抖,2例下肢抖动,1例下颌抖动.静止震颤未引出,姿势震颤频率(7.45±0.34)Hz,负重震颤频率(7.52±0.39)Hz,头部震颤评分总分(3.39±0.22)分,平卧分数0分,站立分数(1.29±0.11)分,时间分数(2.41±0.19)分;CD组平均年龄(46.2±3.15)岁,平均病程83.2±21.79月,男性7例,女性8例,2例有ET家族史,头部抖动摇头型9例,点头型4例,混合型2例,4例CD患者有手抖,0例下肢抖动,0例下颌抖动.静止震颤频率(5.55±0.18)Hz,姿势震颤频率(5.58±0.19)Hz,负重震颤频率(5.88±0.23)Hz,头部震颤评分总分(5.67±0.33)分,平卧分数(1.6±0.16)分,站立分数(2.0±0.14)分,时间分数(2.07±0.15)分.CD的头部震颤存在感觉诡计和转颈后特定位置的震颤加重.统计学分析提示ET和CD在发病年龄、姿势性震颤和负重震颤频率、震颤评分总分及平卧分数、站立分数差异均有统计学意义.P值分别为0.033,0.000,0.001,0.000,0.000.0.000.结论 痉挛性斜颈比较特发性震颤就诊年龄更年轻,存在静止性震颤,姿势性和负重震颤频率更慢,头部震颤评分的总分和平卧分数及站立分数均较高.并且可以存在感觉诡计及转颈后加重.

Background: The value of cerebrospinal fluid (CSF) biomarkers for assessing idiopathic normal pressure hydrocephalus (iNPH) must be determined. This prospective study aimed to reveal the correlation between CSF biomarkers and clinical symptoms of iNPH and the predictive value of these biomarkers for tap test responsiveness. Methods: Thirty-nine patients with suspected iNPH were recruited, contributed qualified CSF, and underwent a tap test and unified pre- and post-test evaluations of the neurological function. Results: The analysis of biomarkers from the patients’ CSF showed decreased levels of tau and its phosphorylated form, especially in the tap test (+) group. The responsiveness of the tap test was also related to the number of combined symptoms ( p < 0.01), and a correlation was found between the end pressure or pressure difference in CSF and tap test responsiveness ( p < 0.05). The results of the binary logistic regression analysis showed that P (tap test responsiveness) = 1/1 + e ∧ − (−5.505 + 55.314 * ratio of p/ T -tau − 1.586 * numbers of combined symptoms). The combined indicators (−5.505 + 0.553 * percentage of p/ T -tau − 1.586 * numbers of combined symptoms) resulted in the highest sensitivity and specificity of 94.12% and 72.73%, respectively. Conclusions: CSF biomarkers may be assessed to judge tap test responsiveness, which is beneficial for the feasibility of a clinical application.

目的 观察正常压力脑积水(NPH)患者放液试验前后视觉诱发电位(VEP)的变化及其与脑脊液初压的相关性.方法 纳入航空总医院神经内科2019年01月至2020年01月收治的诊断临床可疑NPH患者28例,根据脑脊液放液试验结果将患者分为放液试验阳性组(n=21)和放液试验阴性组(n=7).另纳入来自作者医院体检中心的正常体检者16名为对照组.检测NPH患者放液前脑脊液压力.比较NPH患者放液前后VEP的P100潜伏期差异,并比较其与对照组VEP P100潜伏期的差异.采用Pearson相关性分析NPH患者脑脊液压力和VEP P100潜伏期的相关性.结果 放液试验阳性组及放液试验阴性组放液前其VEP P100潜伏期与放液后比较均无统计学差异〔(117.28±10.06)ms比(121.50±11.61)ms;t=-0.135,P=0.171;(116.64±9.14)ms比(116.42±6.72)ms;t=0.050,P=0.961〕;放液试验阳性组及阴性组放液前其P100潜伏期均较正常对照组〔(105.37±6.12)ms〕延长(校正P<0.01、P<0.05),而放液试验阳性者和阴性组间比较其P100潜伏期无统计学差异(P>0.05),且放液后两者间比较亦无统计学差异.放液试验阳性组和阴性组放液前脑脊液压力比较无统计学差异〔(144.85±27.76)mmH2O比(139.28±43.53)mmH2O;t=0.398,P=0.694〕.所有NPH患者、放液试验阳性者以及放液试验阴性者其P100潜伏期与脑脊液初压均无相关性(r=0.018,P=0.928;r=0.206,P=0.369;r=-0.429,P=0.337).结论 NPH患者存在视觉通路损害,但其视觉通路损害与脑脊液压力无明确相关性,推测NPH患者视觉通路的损害可能与NPH的其他病理生理改变有关.

目的 提高对以舌咽、迷走、位听神经损害为首发症状的Ramsay Hunt综合征的认识,在临床中早期诊断,早期治疗,避免误诊、误治.方法 回顾性分析2015年6月至2019年8月作者医院收治的6例以舌咽、迷走、位听神经损害为首发症状的Ramsay Hunt综合征患者,对其临床资料进行分析总结.结果 6例患者中男、女各3例,年龄34～70岁,平均(57.2±12.1)岁.4例患者首发症状为声音嘶哑和咽痛,2例为眩晕、恶心呕吐,均在首发症状3～14 d后发现周围性面瘫.6例患者病程中均有耳痛、咽痛,3例有听力下降,2例有疱疹.6例患者面神经神经传导提示病变侧面神经运动传导潜伏期较对侧延长,5例患者病变侧面神经运动波幅较对侧下降.3例患者电测听提示轻度感音神经性耳聋.4例患者电子喉镜提示病变侧喉黏膜出现散在点状白色伪膜,2例患者声带不同程度麻痹.6例患者均经过抗病毒联合糖皮质激素治疗,疗程结束时,所有病例耳痛、咽痛均减轻或缓解,2例耳后疱疹均消失,2例听力部分恢复.随访12个月后,痊愈4例,2例遗留部分面瘫和声嘶.结论 部分Ramsay Hunt综合征可以声音嘶哑、咽痛、眩晕为首发症状,耳痛可以提高诊断的敏感性,喉镜检查多有阳性发现,经抗病毒联合糖皮质激素治疗,多数患者远期预后良好.

Objectives: To evaluate gait characteristics and investigate changes pre- and post-cerebrospinal fluid tap test (CSF TT) in gait parameters in patients with probable idiopathic normal pressure hydrocephalus (iNPH). Methods: Sixty patients were sequential circuited and diagnosed with possible iNPH according to Japanese second iNPH guidelines at our hospital from December 2016 to March 2021. All patients underwent the CSF TT. Gait parameters, cognitive and urinary function were assessed pre-and post-CSF TT. Patients who were unable to ambulate to take the tests or could not walk independently or walked normally were excluded. Results: Twenty-six patients were diagnosed with probable iNPH using the CSF TT. After CSF TT, the Boon sum score improved from 20.0 +/- 7.7-16.6 +/- 8.0 (p < 0.001), the Boon walking score improved from 8.9 +/- 3.5-7.8 +/- 4.4 (p = 0.008), the Boon step score improved from 6.3 +/- 2.3-5.2 +/- 2.1 (p < 0.001), the Boon time score improved from 4.9 +/- 2.4-3.7 +/- 2.3 (p < 0.001), tandem walking disturbance improved from 1.7 +/- 0.7-1.4 +/- 0.9 (p = 0.043), tendency toward falling improved from 1.7 +/- 0.7-1.3 +/- 1(p = 0.022), 3-meter timed up and go test (3-mTUG) improved from 21.9 +/- 7.1-17.6 +/- 5.1( p < 0.001), 10-meter walking (10-MWT) step improved from 31.1 +/- 13.1-24.6 +/- 7.5 (p < 0.001), velocity improved from 0.7 +/- 0.2-0.8 +/- 0.3 (p < 0.001) and stride length improved from 0.4 +/- 0.1-0.46 +/- 0.1(p < 0.001), compared with before the CSF TT. Conclusion: These results suggest that many parameters in the Boon gait test were responsive to the CSF TT, and the Boon gait test may help objectify response to the CSF TT by combining the 10-MWT and 3-mTUG gait assessments.

目的 探讨枕神经痛的神经纤维受累的种类和纤维类型.方法 选择临床确诊枕神经痛患者31例,均单侧枕部和或耳后区域疼痛,其中左侧14例,右侧17例,VAS疼痛评分3～10分,患病时间1d～1年.对全部患者进行电流感觉阈值(CPT)测定,分别记录患侧及健侧在2000 Hz、250 Hz、5 Hz不同频率刺激枕大神经、枕小神经、耳大神经的电流感觉阈值,比较双侧阈值的差别.结果 患侧枕大神经2000 Hz、250 Hz、5 Hz刺激的阈值分别为216±60、60±41、50±22,健测分别为209±54、58±22、47±23.枕小神经患侧214±61、66±23、50±21,健侧198±37、47±15、37±3.耳大神经患侧136±45、35±16、24± 12,健侧135±48、36± 15、25± 11.在引起枕大神经、枕小神经、耳大神经粗有髓鞘纤维兴奋的2000Hz刺激下患侧和健测的电流感觉阈值差异无统计学意义(P＞0.05),引起枕大神经、耳大神经细有髓鞘纤维兴奋的250Hz和无髓鞘纤维兴奋的5Hz刺激下患侧和健测的电流感觉阈值差异无统计学意义(P＞0.05),而兴奋枕小神经细有髓鞘纤维的250 Hz和兴奋无髓鞘纤维的5 Hz患侧和健测的电流感觉阈值差异均有统计学意义(P＜0.05).结论 枕神经痛患者存在明确的枕神经损害,主要累及小纤维即细有髓鞘纤维及无髓鞘纤维.本组患者的枕神经以枕小神经受累为主.

阿尔茨海默病(AD)是引起老年期认知障碍最常见的变性疾病，载脂蛋白E(ApoE)是公认的散发型AD的风险基因，对两者之间关系的探究有助于AD的预防和诊疗。本文主要对两者关系近几年最新研究进展进行论述。