术后认知功能障碍和阿尔茨海默病相关的发病机制思考

术后认知功能障碍是手术麻醉后的并发症之一,阿尔茨海默病是一种常见的慢性进行性神经退行性疾病,在发病机制方面二者存在诸多的相似点,且目前在此方面对二者的研究都没有取得重大进展,有必要从发病机制角度对二者进行相关的辩证思考,以便更好地指导临床及基础研究.     

Neuropsychological Differences Between Frontotemporal Dementia and Alzheimer's Disease: A Review

This paper surveys the similarities and differences between frontotemporal dementia (FTD) and Alzheimer's disease (AD). The review covers findings primarily from neuropsychological studies on memory, language, attention/executive function, and visuospatial abilities. However, neuropsychiatric and neuroimaging data are also briefly discussed. Distinguishing features of both FTD and AD are described in order to present a comprehensive clinical picture of these dementing diseases, which is essential for the process of differential diagnosis. The cause of specific cognitive deficits is also considered. Our comprehensive review of the empirical literature reveals that AD is characterized by early memory loss and visuospatial problems, while among the main features of FTD are behavioral abnormalities and executive dysfunctions.     

Neuropsychological Functioning in Chronic Lyme Disease

Lyme disease is currently the most common vector-borne illness in the United States. The disease is multisystemic, and chronic disease, in particular, may be associated with neuropsychological deficits. However, to date, only a few empirical studies exist, which examine the neuropsychological sequelae associated with chronic Lyme disease. A review of the literature shows that the deficits observed in adults with chronic Lyme disease are generally consistent with the deficits that can be seen in processes with primarily frontal systems involvement. These observations are generally consistent with neuroradiologic findings. The clinical presentation in chronic Lyme disease and the nature of the neuropsychological deficits are discussed, as are several central issues in understanding neuropsychological functioning in chronic Lyme disease, such as the impact of chronic illness, response to treatment, and the relationship between neuropsychological performance and depression, fatigue, and neurological indicators of disease.     

Personality Trait Characteristics in Relation to Neuropsychological Dysfunction in Schizophrenia and Depression

Knowledge of the personality trait and psychopathology variables that differentiate neuropsychologically impaired and nonimpaired psychiatric patients has been limited relative to the study of higher cortical functions. This study reports findings from the Milton Clinical Multiaxial Inventory (MCMI) developed by Millon (1982) in a sample of hospitalized schizophrenics and depressives who also received the Luria-Nebraska Neuropsychological Battery. The principal findings indicate that neuropsychological dysfunction may be related to substance abuse, including its underlying personality dimensions, in schizophrenia, but only modest support is indicated for the construct of negative symptoms in schizophrenics with neuropsychological dysfunction. Further, the findings do not support the view that psychosis is a characteristic feature of depressives with impaired neuropsychological performance.     

Diffuse Lewy Body Disease: Clinical,Pathological, and Neuropsychological Review

The pathophysiological etiologies and clinical presentations of neurodegenerative dementias have been found to be complex and heterogeneous. Recently, Lewy body inclusions have been identified as an etiological factor in 20–34% of autopsied dementia cases. The term diffuse Lewy body disease (DLBD) is generally accepted as the diagnostic term representative of this currently under-reported and under-recognized disease. This article reviews the literature on the clinical, pathological, and neuropsychological features of this disorder. Differential diagnostic issues are discussed as well as current pharmacological treatment. Nine confirmed cases of DLBD are presented to demonstrate the various features of this disorder. The diagnostic implications of neuropsychological examination results are discussed in relation to other common dementing neurologic diseases.     

Source monitoring in Alzheimer's Disease

Source monitoring is the process of making judgments about the origin of memories. There are three categories of source monitoring: reality monitoring (discrimination between self- versus other-generated sources), external monitoring (discrimination between several external sources), and internal monitoring (discrimination between two types of self-generated sources). We investigated whether Alzheimer's Disease (AD) patients, when compared with young and older adults, are impaired at the same level on the three source monitoring categories. We designed three tasks, one for each source monitoring category. In the first task, aimed at reality monitoring, participants had to remember whether objects were previously placed in a bag by themselves or by the experimenter. In the second task, assessing external monitoring, participants had to remember whether the experimenter had previously placed objects in the bag with a black or white gloved hand. In the third task, measuring internal monitoring, participants had to remember whether they had previously placed or imagined themselves placing objects in the bag. Participants showed worse performances in the external and internal monitoring tasks, when compared with reality monitoring. The external monitoring deficit was even more pronounced in AD patients. Regression analyses showed that variation in the external monitoring performances was reliably predicted by inhibition. Our results emphasize the role of inhibitory processes in AD patients' source monitoring decline. The close relation between source and inhibitory decline in AD is interpreted in terms of a common neural base for both concepts.     

Neuropsychological Dysfunction in Children with Borderline Personality Disorder Features: A Preliminary Investigation

Borderline personality disorder (BPD) is often linked to neuropsychological deficits, yet few studies have examined BPD or its features and concomitant neuropsychological dysfunction in childhood. This study examined children with borderline features (n = 21) using the Coolidge Personality and Neuropsychological Inventory for Children and compared them to controls (n = 21) with features of at least one personality disorder, but not BPD. As hypothesized, the BPD group scored significantly higher than the control group on the Attention Deficit/Hyperactivity Disorder, Executive Functions Deficits, Mild Neurocognitive Disorder, Conduct Disorder, and Oppositional Defiant Disorder scales. It appears that behavioral disturbances associated with BPD are linked strongly with neuropsychological dysfunction. Because none of the children with BPD features in the present sample had a history of traumatic brain injury (TBI), it appears likely that TBI in the histories of adult BPD patients may not be the cause of BPD, but traits such as anger and impulsivity in BPD may cause TBI. Clinical implications and future research directions are discussed.     

Olfaction in Persons with Alzheimer's Disease

The need for low cost, noninvasive procedures for aiding in the diagnosis and understanding of Alzheimer's Disease (AD) has led to theories and procedures examining the role of olfactory disorders because of the finding that the brains of AD patients invariably exhibit neuropathology hi the hippocampus and entorhinal cortex. This loss correlates with the increase in the number of plaques and tangles and with the severity of dementia. Considered together, these findings suggest that brain structures closely related to the olfactory system demonstrate significant histopathology in AD. A comprehensive review of the literature pertaining to olfaction in persons with AD revealed that the olfactory identification ability of patients with memory disorders is impaired relative to controls. Consistency is lacking, however, when olfactory detection thresholds are investigated. Also, there is inconsistency in regards to severity of illness and olfactory function. In addition to differentiating AD patients from normals, the olfactory paradigm has shown some limited usefulness in differentiating AD patients from some other demented patients.     

Clinical Decision Making in Alzheimer's Disease

In the treatment of Alzheimer's Disease the occupational therapy goal is to enable persons to function as optimally as possible. Maximizing the patient's functioning in daily life necessitates a framework for clinical reasoning. Clinical reasoning currently emphasizes what persons can do but may fail to recognize the complex factors involved in what a person actually will do. A framework to guide clinical decision making for persons with Alzheimer's disease based on the model of human occupation was developed. The use of this framework is illustrated through a case application.     

Neuropsychological function and apolipoprotein E genotype in the preclinical detection of Alzheimer's disease.

Nondemented older adults genotyped for the Apolipoprotein E (ApoE) epsilon4 allele (n = 43) were neuropsychologically compared to participants without a copy of the epsilon4 allele (n = 90). At baseline, the groups did not differ on age, education, gender, or global cognitive status. ApoE-epsilon4 participants demonstrated significantly poorer mean performances on delayed recall, but no significant group differences emerged on attention, language, constructional skills, psychomotor speed, or executive function. Significantly more ApoE-epsilon4 participants developed probable or questionable Alzheimer's disease (AD) compared with non-epsilon4 participants, suggesting that the group differences resulted from a preponderance of preclinical AD cases within the epsilon4 group and not from a direct influence of ApoE genotype on cognition. Cox proportional hazards analysis, adjusting for age, years of education, and global cognitive status, revealed that ApoE-epsilon4 allele status and measures of recall performance were significant and independent predictors of conversion to AD. Results support the importance of specific episodic memory changes and possession of the ApoE-epsilon4 allele in the preclinical detection of AD.     

Emotional Experience and Facial Expression in Alzheimer's Disease

ABSTRACT

Emotional experiences and facial muscle activity of individuals with Alzheimer's Disease (AD) (n = 13) and healthy elderly control subjects (n = 21) were measured while viewing emotion-eliciting images. Alzheimer's disease and control groups rated their emotional experiences similarly and in the expected directions on dimensions of valence and arousal. Change in corrugator activity while viewing images, compared to baseline, was comparable across groups and was greatest while viewing negative images. Change in zygomatic activity, however, was significantly different between AD and control groups, with AD subjects demonstrating an inverted pattern of activity compared to controls. These findings are discussed as possible consequences of frontal cortical system involvement accompanying the disease process.     

Embodiment Effects and Language Comprehension in Alzheimer's Disease

It has been shown that when participants are asked to make sensibility judgments on sentences that describe a transfer of an object toward or away from their body, they are faster to respond when the response requires a movement in the same direction as the transfer described in the sentence. This phenomenon is known as the action compatibility effect (ACE). This study investigates whether the ACE exists for volunteers with Alzheimer's disease (AD), whether the ACE can facilitate language comprehension, and also whether the ACE can still be produced if the order of the two events is inverted, that is, whether overt movement can prime comprehension of transfer sentences. In Study 1, participants with AD, younger, and older adults were tested on an adaptation of the ACE Paradigm. In Study 2, the same paradigm was modified to include an arm movement that participants had to perform prior to sentence exposure on screen. In Study 1, young, older adults, and individuals with AD were faster to respond when the direction of the response movement matched the directionality implied by the sentence (ACE). In Study 2, no traditional ACE was found; participants were faster when the direction of the movement immediately preceding the sentence matched the directionality of the sentence. It was found that compatibility effects generated a relative advantage, that transfer schemata are easier to process, and that an ACE‐like effect can be the result of mutual priming between language and movement. Results suggested preservation in AD of the neural systems for action engaged during language comprehension, and conditions under which comprehension in AD can be facilitated in real life may be identified.     

Category and Attribute Knowledge Deterioration in Alzheimer's Disease

A prevalent theory regarding the deterioration of semantic memory in Alzheimer's disease is that it is a bottom-up process. If this is true, performance on tests of attribute knowledge should decline more rapidly than performance on tests of categorical knowledge as dementia severity increases. In the present study, a convincing pattern of findings to either support or reject the theory failed to emerge. This raised questions regarding the ability to separate attribute and categorical knowledge, and whether one can be tested without influence of the other. Questions also were raised regarding the additional cognitive processes needed to complete tasks of semantic memory.     

Verb Comprehension Deficits in Probable Alzheimer's Disease

Studies of lexical comprehension in probable Alzheimer's disease (pAD) have focused almost exclusively on nouns. In the following preliminary study, we examined whether lexical comprehension for verbs is also impaired in 25 pAD patients. The semantic meaning of motion verbs, cognition verbs, and perception verbs was assessed with a triadic comparison task. Structural meaning associated with these verbs was evaluated by asking the patients to judge the coherence of sentence frames that accept these verbs naturally or awkwardly. We found that pAD patients are significantly impaired at identifying semantic relations among verbs. pAD patients also encountered significantly more difficulty judging the coherence of sentences than control subjects. Correlation and regression analyses demonstrated that semantic characteristics of verbs are projected from the verbs' sentence frames in control subjects, but there was minimal evidence for such a structural–semantic relationship in pAD. We consider several possible explanations for our preliminary observations of an impairment that has consequences for processing both semantic and structural aspects of verb meaning.     

Alzheimer病人记忆损害特征的研究

目的了解AD病人记忆损害的特征。方法采用多维记忆评估量表中的12个分测验对30例临床诊断可能的Alzheimer病患者及与病人组相匹配的30例正常受试进行记忆功能的测定。结果AD组几乎在所有的分测验和指数分上均差于对照组。AD轻度组仅在自由组词、残图命名、空间广度、常识记忆等4个分测验及记忆广度、内隐记忆等2个指数分上与对照组之间无明显差异。中重度组则在所有分测验和指数分均差于对照组。经以教育年限为协变量校正后,轻度与中重度组在自由组词、残图命名、经历定向、常识记忆、自由回忆、内隐记忆、日常记忆等分测验和指数分上存在明显差异。12个分测验成绩的比较发现,负荷外显记忆的各个分测验的成绩均较差,负荷内隐记忆的两个分测验的成绩较好。结论轻度AD病人存在着广泛的外显记忆障碍,中重度AD病人除了存在外显记忆障碍外还表现出内隐记忆和日常生括记忆的障碍。这一结果提示人类大脑中存在着多个记忆系统,不同系统受损所导致的记忆障碍不同。     

Comparison between Oral and Written Spelling in Alzheimer's Disease

Written and oral spelling were compared in 33 patients with Alzheimer's disease (AD) and 25 control subjects. AD patients had poorer spelling results which were influenced by orthographic difficulty and word frequency, but not by grammatical word class. Lexical spelling was also more deteriorated than phonological spelling. Moreover, oral spelling was more impaired than written spelling in AD patients, whereas no difference was present between oral and written spelling of controls. Analysis of spelling errors showed that, for controls, errors were predominantly phonologically accurate in both spelling tasks. Significantly, AD patients produced more phonologically accurate than inaccurate errors in written spelling, whereas these errors did not differ in oral spelling. In contrast to controls who produced more constant than variable responses in oral and written spelling, AD patients made more variable responses (words correctly spelled in one task but incorrectly in the other) and they showed many instances of variable errors (different misspellings from one spelling task to the other). Two stepwise regression procedures showed that written misspellings were specifically correlated with language impairment, whereas oral spelling errors were correlated with attentional and language disorders. These results suggest that AD increases the attentional demands of oral spelling process as compared to written spelling. This dissociation argues, either for a unique Graphemic Buffer in which oral spelling requires more attentional resources than written spelling or for the hypothesis of separate buffers for oral and written spelling.     

Short- and Long-Term Implicit Memory in Aging and Alzheimer's Disease

ABSTRACT

Implicit memory processes were investigated via picture naming in healthy young and older adults and in persons with mild Alzheimer's disease (AD). Repetition priming in picture-naming was intact in all groups over the course of a short retention interval (seconds), and only the AD group revealed a deficit over a longer interval (72 hours). In addition, the AD group showed impaired procedural memory, with no benefit of practice on picture-naming. Impaired long-term priming was related to severity of AD. Both theoretical and methodological implications are discussed.