阿尔茨海默病缘何成为当今医学领域多学科的焦点

在医学史上,某种疾病成为研究的热点、众多学科之论坛的例子不胜枚举,这种独特的现象有着深刻的哲学根源。从汇集当今医学领域多学科的阿尔茨海默病(Ａｌｚｈｅｉｍｅｒ’ｓＤｉｓｅａｓｅ,ＡＤ),可窥其一斑。1　人口老龄化和发病率上升是ＡＤ成为热点的前提虽然在20世纪初已经发现了ＡＤ,但当时该病的发病率并不高,这显然与人口的年龄结构以及该病主要发病于老年人有关。近一个世纪以来,随着人口老龄化的发展,老年性疾患已经成为一个明显影响人类健康的突出问题。据国外报道,老年痴呆的患病率占老年人口的4.6%,其中半数为ＡＤ[1]。我国的人…     

Alzheimer型痴呆病因学的研究现状,困惑与出路

Ａｌｚｈｅｉｍｅｒ型痴呆病因学的研究现状、困惑与出路解放军总医院老年医学研究所博士生（北京１００８５３）黄福南导师李文彬Ａｌｚｈｅｉｍｅｒ型痴呆（又称早老性痴呆）被认定是独立的疾病将近一百年了。早期它被认为是一个少见病，不被重视。［１］随着时间的推移...     

早期阿尔兹海默氏病患者记忆损伤的研究

０引言健忘症病人（ａｍｎｅｓｉｃｐａｔｉｅｎｔｓ）是人类记忆研究对象的重要组成部分。对其进行研究,一方面可以验证有关正常记忆理论的正确性和适用性,同时其特异性现象还可以促使新理论的产生;另一方面,对其进行研究还可以为临床诊断和治疗提供心理依据。阿尔兹海默氏病患者是健忘症病人中的主要类型,目前对阿尔兹海默氏病患者的研究呈增长趋势。阿尔兹海默氏病（Ａｌｚｈｅｉｍｅｒ’ｓｄｉｓｅａｓｅ）,或更准确地称为阿尔兹海默氏型痴呆,是４０岁以上人群易患的疾病,由德国神经病理学家ＡｌｏｉｓＡｌｚｈｅｉｍｅｒ于１９…     

大学生皮肤电反应、MMPI及其关系的初步研究

应用日产Ｓａｎ－ｅｉｌＡ９７Ａ型脑电图机及ＭＭＰＩ（中国版本）对２６名大学生进行了皮肤电反应记录及人格特征的测查。结果表明：（１）普通大学生中皮电基础水平个体差异十分明显。（２）皮电平均每分钟自发波动次数与ＭＭＰＩ中的Ｄ、Ｓｉ、Ｍａｓ、Ｃｎ呈显著正相关,与Ｌ、Ｋ呈显著负相关。皮电平均每分钟自发波动幅度与Ｆ、Ｄ、Ｍａｓ呈显著正相关;与Ｌ呈显著负相关。（３）皮电基础水平高组与低组在Ｌ、Ｓｉ、Ｍａｓ之Ｔ分上的差异达显著水平。（４）习惯化倾向差组与优组在Ｋ、Ｓｔ、ＭａｓＴ分的差异有显著意义,差组与中组在Ｓｉ、ＣｎＴ分上有显著性差异。（５）习惯化倾向差组皮电基础水平较高;优组皮电基础水平较低,两组差异达显著水平。     

知难而进的斗士──桑德斯

作为ＡＭＤ（超微）公司的创始者、美国半导体协会的主席，桑德斯（Ｗ．Ｊ．Ｓａｎｄｅｒｓ）是美国信息产业界极富个性的一个领袖。ＡＭＤ正是在桑德斯的领导之下，与英特尔（Ｉｎｔｅｌ）及国家半导体公司 （Ｎａｔｉｌｎａ Ｓｅｍｉｃｏｎ－ｄｕｃｔｏｒ）在激烈的市场竞争中相抗衡，并拥有一席之地的。ＡＭＤ公司经营风格中渗透着桑德斯的个性，说其是ＡＭＤ的旗帜，也并不为过。 和英特尔公司的诺伊斯（Ｒｏｂｅｒ’ｔ Ｎｏｙｃｅ）、格鲁夫（Ａｎｄｎ Ｇｒｏｖｅ）、摩尔（Ｇｏｄｏｎ Ｍｏｏｒｓ）一样，桑德斯也曾经为硅谷中具有传奇…     

DM病因研究的综合方法

ＤＭ病因研究的综合方法天津医科大学研究生（３０００７０）杨新军导师王建华，王正伦指导张金钟糖尿病（ＤｉａｂｅｔｅｓＭｅｌｌｉｔｌｌｓ，ＤＭ）是一种古老的疾病，也是目前遍及世界各地的常见病。ＤＭ病因学研究近年来取得了一定的进展，获得许多新知识。特别是分...     

腺苷与阿尔采默氏型老年痴呆症──一种可能的分子机制的新思路

本文通过研究阿尔采默氏型老年痴呆症（ＳＤＡＴ）的病理变化,认为ＳＤＡＴ可能是中枢神经系统多种递质联合受损性疾病,但是应用递质替代疗法,却往往不能收到满意的效果,提示可能存在更深层次的分子机理．近年来的研究表明：腺苷作为一种神经调质对各类递质有着广泛的调制作用,因此认为,中枢神经系统内腺苷的随龄变化很可能是ＳＤＡＴ产生的另一个分子机制,为研究ＳＤＡＴ治疗对策提供一个新思路．     

糖尿病病因研究过程的哲学思考

糖尿病病因研究过程的哲学思考福建医科大学附属协和医院（福州３５０００１）张芳林叶传忠指导老师林绍春朱红梅１７世纪ＷｉｌｉａｍＣｕｌｅｎ（１６０７－１６７０）提出了糖尿病（ＤｉａｂｅｔｅｓＭｅｌｉｔｕｓ）这个名词。之后,１７８８年Ｌａｗｌｅｙ在解剖ＤＭ...     

当代心理学对口语报告的研究评述

０引言本世纪八十年代至九十年代初口语报告法已经被广泛用来研究认知过程,主要领域涉及心理学、教育学和认知科学．在特定任务中,同时发生的和追述的口语报告现在正越来越被认可为研究被试认知过程的主要资料来源（Ｊ．ＲＡｎｄｅｒｓｏｎ,１９８７）．许多文章已在探讨用口语报告来研究特定任务,包括做出决策（Ｍｏｎｔｇｏｍｅｒｙ＆Ｓｖｅｎｓｏｎ,１９８９）、第二种语言的学习（Ｆａｅｒｃｈ＆Ｋａｓｐｅｒ,１９８７）、课文领会（Ｌａｓｚｌｏ,Ｍｅｕｔｓｃｈ,＆Ｖｉｅｈｏｆｆ,１９８８）,和人力因素研究（Ｄｅｆｆｎｅｒ…     

马丁，大卫

马丁，大卫（ＤａｖｉｄＭａｒｔｉｎ，１９２９－）伦敦高级济济学与政治学学院社会教授。积极从事宗教社会学问题研究。１９６７年发表的《英国宗教社会学》（ＡＳｏｃｉｏｌｏｇｙｏｆＥｎｇｌｉｓｈＲｅｌｉｇｉｏｎ）一书提供了有关大不列颠宗教动态的社会学综合资料...     

系统生物学引导阿尔茨海默病治疗新策略

阿尔茨海默病（AD）是一种发生于中老年期的退行性脑神经变性疾病,临床上以进行性智能衰退,伴有人格改变为主要特征.其发病过程涉及许多途径和靶点.现代医学认为脑内胆碱能递质功能紊乱、β-淀粉样蛋白沉积、tau-蛋白过磷酸化、炎症反应以及基因突变等在其发病过程中起着重要作用.治疗方法从胆碱酯酶抑制剂、神经递质受体阻滞剂到补气活血、益精填髓、化痰开窍等中医药疗法不等.但抑制剂、阻滞剂等药物阻滞疗法,从单一环节阻断发病途径,忽略了AD发病的整体复杂性.中医辨证论治从整体观念出发,在宏观上治疗AD,对AD的发病缺乏微观深入研究.AD治疗需要借助于“系统生物学”理论的指导.中西医结合为AD的治疗提供了较为科学、有效的途径和发展空间.     

Melatonin rhythm abnormalities and sleep disorders in the elderly

Biological aging is often associated with sleep problems and daytime napping. Complaints of difficulty in initiating and maintaining sleep, as well as daytime drowsiness, are more common in the elderly than in any other age group. This report reviews evidence that impaired melatonin secretion is associated with sleep disorders in old age. Circulating melatonin levels have been found to be significantly lower and onset and peak times have been delayed in elderly insomniacs as compared to age-matched control subjects. In view of these findings, we investigated the effects of melatonin treatment on melatonin-deficient insomnia in the elderly. From the results of our study, it seems likely that melatonin replacement therapy may be beneficial in the initiation and maintenance of sleep in this population.     

主观记忆减退老年人情节记忆的行为表现及其脑机制

情节记忆是个体对特定时间,特定地点所经历的特定事件的记忆.主观报告情节记忆下降是主观记忆减退老年人最典型的表现.与健康对照组老年人相比, 主观记忆减退老年人情节记忆下降的速率更快, 罹患老年性痴呆的风险更高, 但其情节记忆加工的脑机制尚不明确.前人研究提示, 主观记忆减退老年人在外在记忆行为尚未出现损伤的情况下, 其大脑情节记忆相关脑区的神经活动已经出现异常.探究主观记忆减退的记忆神经环路关键节点和路径的异常, 揭示神经环路在老年痴呆发生发展中的变化规律, 对深入理解老年痴呆的发病机制有重要的科学意义.同时, 主观记忆减退老年人作为特殊的记忆损伤群体, 对其神经环路的深入探究, 也必将为揭示人类记忆的神经机制做出独特的贡献.     

Melatonin and jet lag syndrome: experimental model and clinical implications

What is the effect of melatonin on jet lag syndrome? Jet lag desynchronizes the internal sleep-wakefulness cycle with the environmental light/dark cycle. Advance (but not delay) of light onset is known to abolish pineal N-acetyltransferase activity and urine excretion of 6-sulphatoxymelatonin. Measurements of pineal serotonin, the substrate of melatonin biosynthesis; N-acetylserotonin (NAS), the immediate melatonin precursor; and melatonin (high-performance liquid chromatography-fluorimetric method) in the animal (rat) model of jet lag revealed that prolonged delay of dark-phase onset disrupted the rhytms in comparable ways as the advance of light-phase onset. Advance of dark phase onset resulted in less severe disturbances of rhythms as compared with the advance of light phase onset. Melatonin, but not NAS, injections at the beginning of a new dark period accelerated recovery of NAS and melatonin, but not serotonin, rhythms. Spontaneously hypertensive rats were more sensitive to advance of light onset and less responsive to melatonin injections than normotensive rats. NAS and methylene blue, an inhibitor of monoamine oxidase A, attenuated light-induced disruption of NAS but not melatonin rhythms. We draw the following conclusions from our data: the beginning of the dark period may be preferable to the beginning of light period as the arrival time on eastward flights; the efficacy of melatonin in alleviating jet lag may be enhanced by administering it before, during and after rapid transition through time zones; and hypertension may exaggerate jet lag syndrome.     

The free and cued selective reminding test for predicting progression to Alzheimer's disease in patients with mild cognitive impairment: A prospective longitudinal study

Amnestic mild cognitive impairment (aMCI) patients carry a greater risk of conversion to Alzheimer's disease (AD). Therefore, the International Working Group (IWG) on AD aims to consider some cases of aMCI as symptomatic prodromal AD. The core diagnostic marker of AD is a significant and progressive memory deficit, and the Free and Cued Selective Reminding Test (FCSRT) was recommended by the IWG to test memory in cases of possible prodromal AD. This study aims to investigate whether the performance on the FCSRT would enhance the ability to predict conversion to AD in an aMCI group. A longitudinal study was conducted on 88 aMCI patients, and neuropsychological tests were analysed on the relative risk of conversion to AD. During follow‐up (23.82 months), 33% of the aMCI population converted to AD. An impaired FCSRT TR was significantly associated with the risk of conversion to dementia, with a mean time to conversion of 25 months. The FCSRT demonstrates utility for detecting AD at its prodromal stage, thus supporting its use as a valid clinical marker.     

Response Inhibition in Children With DSM-IV Subtypes of AD/HD and Related Disruptive Disorders: The Role of Reward

The current study had four aims: (a) to replicate previous findings of slow response inhibition in Attention Deficit/Hyperactivity Disorder (AD/HD), (b) to explore whether poor response inhibition in children with AD/HD is a core problem or rather a result of an underlying problem related to reward, (c) to investigate the specificity of poor response inhibition and the role of reward in relation to AD/HD, and (d) to study whether findings would be different for three subtypes of AD/HD. In order to address these issues, a stop paradigm was administered under a reward condition and under a nonreward condition to an AD/HD group (n = 24), an Oppositional Defiant Disorder (ODD)/Conduct Disorder (CD) group (n = 21), a comorbid AD/HD+ODD/ CD group (n = 27), and a normal control (NC) group (n = 41). Firstly, contrary to prediction, none of the Disruptive Behavior Disorder (DBD) groups differed from the NC group with respect to the speed of the inhibition process. Secondly, it was shown that children with AD/HD and children with comorbid AD/HD+ODD/CD, but not children with ODD/CD alone, slowed down more dramatically in the reward condition than normal controls. This finding was interpreted as a strategy to increase the chance of being rewarded in children with AD/HD and children with comorbid AD/HD+ODD/CD, but not in children with pure ODD/CD. Finally, analysis of AD/HD subtypes did not change the main findings of this study.     

Melatonin and sleep qualities in healthy adults: pharmacological and expectancy effects

The impact of expectancy on melatonin's effects on sleep qualities was investigated. Both the pharmacological dose of 6 mg of melatonin and the expectation of receiving melatonin were predicted to improve subjective ratings of sleep qualities. The balanced placebo design varied 2 factors within-subjects: actual treatment and expected treatment. Adults (N = 53; 21 men and 32 women) between the ages of 26 and 71 years were administered either 6 mg of melatonin or a placebo for 8 nights. An instructional manipulation directed participants' expectations. Participants rated their nightly sleep experiences. Results revealed that feelings upon awakening differed between genders and that expecting melatonin increased ratings of sleep continuity. Most important, high ratings of "grogginess/tiredness" were associated with receiving melatonin, regardless of expectancy, as well as with receiving placebo when melatonin was expected. Overall, the findings underscore the need to consider expectancy and gender differences in research on melatonin and sleep experiences.     

Response inhibition in children with DSM-IV subtypes of AD/HD and related disruptive disorders: the role of reward.

The current study had four aims: (a) to replicate previous findings of slow response inhibition in Attention Deficit/Hyperactivity Disorder (AD/HD), (b) to explore whether poor response inhibition in children with AD/HD is a core problem or rather a result of an underlying problem related to reward, (c) to investigate the specificity of poor response inhibition and the role of reward in relation to AD/HD, and (d) to study whether findings would be different for three subtypes of AD/HD. In order to address these issues, a stop paradigm was administered under a reward condition and under a nonreward condition to an AD/HD group (n=24), an Oppositional Defiant Disorder (ODD)/Conduct Disorder (CD) group (n=21), a comorbid AD/HD+ODD/CD group (n=27), and a normal control (NC) group (n=41). Firstly, contrary to prediction, none of the Disruptive Behavior Disorder (DBD) groups differed from the NC group with respect to the speed of the inhibition process. Secondly, it was shown that children with AD/HD and children with comorbid AD/HD+ODD/CD, but not children with ODD/CD alone, slowed down more dramatically in the reward condition than normal controls. This finding was interpreted as a strategy to increase the chance of being rewarded in children with AD/HD and children with comorbid AD/HD+ODD/CD, but not in children with pure ODD/CD. Finally, analysis of AD/HD subtypes did not change the main findings of this study.     

Effects of two-year treatment with the cholinesterase inhibitor rivastigmine on behavioural symptoms in Alzheimer's disease

Alzheimer's disease (AD) is accompanied by prominent behavioural disturbances. They cause significant distress for both caregivers and patients and can play a major role in the decision to institutionalise AD patients. Recent evidence suggests that cholinergic deficiencies not only contribute to the memory and cognitive abnormalities of AD but are also responsible for some behavioural abnormalities seen over the course of the disease. In this study we assessed the ability of rivastigmine, a pseudo-irreversible cholinesterase inhibitor, to improve behavioural and psychopathologic symptoms in AD. The analysis included 34 patients present in the Germanarm of the international study B303 who received and completed long-term treatment with rivastigmine in the open-label study B305. Assessments of behaviour and psychopathological symptoms were performed using the behavioural component of the Clinicians Interview Based Impression of Change Plus (CIBIC-Plus). Results show that long-term treatment with rivastigmine can slow the progression of behavioural and psychopathological symptoms of AD. Behavioural symptoms showing stabilisation included aggressiveness, activity disturbances, hallucinations and paranoid features. Results also suggest that patients treated earlier with rivastigmine may attain a greater benefit compared with patients whose treatment is delayed 6 months. Further studies examining the effects of rivastigmine on behavioural disturbances in AD are therefore warranted.     

Échelle de stigmatisation familiale dans la maladie d’Alzheimer (ESF-MA) : une adaptation et validation française

According to scientific research, individuals diagnosed with neurodegenerative dementia of the Alzheimer type and their surroundings (family, family caregiver), experience a phenomenon of family stigmatization of which there are many consequences. Not only can they experience emotional reactions such as fear, anxiety, more depressive symptoms, but they can also face discrimination with a sense of care giving burden and be the result of social relationships avoidance. These effects lead to reduce family life quality. At the same time, scientific studies reveal that stigma acts on a personal, associative (family), public and on a structural level. Their joint perception seems necessary to apprehend their synergy and to adapt interventions. However, in the AD context, no tool exists in the French language to measure perceived family stigma on different levels. To fill this gap, we analyzed the construct validity (intra-concept validity), an aspect of the divergent validity, concurrent validity as well as the reliability of the AD family stigma scale (ESF-MA) in the French context. The results of the principal component analysis (n = 263 family caregivers) reveal 10 factors divided into 3 dimensions (intra-personal, public and structural) that explain 57 % of the total variance. The validity of the construct like the reliability represents satisfying results. The measurement of the family stigma by the ESF-MA presents an opportunity to complete clinical observations among family caregivers of people diagnosed with AD.