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Objective:To study the correlation between hearing loss and cognitive decline in community-dwelling older adults and to analyze the influencing factors.Methods:Using Pure-tone audiometry, the Hearing Handicap Inventory for the Elderly (HHIE), Mini-Mental State Examination (MMSE), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder, a survey was conducted with 492 community-dwelling older adults aged 60 years and above in Beijing. Age, gender, education level, hearing loss, levels of anxiety and depression, and other factors were used as independent variables, and the MMSE scores were used as dependent variables. Analysis of variance and multiple linear regression were performed.Results:Among the 492 subjects, based on the better ears, 418 (85.0%) had hearing loss and 160 (32.5%) had disabled hearing loss. Factors such as age (β=-0.33, P<0.01), gender (β=0.09, P=0.04), education level (β=0.31, P<0.01), hearing loss (β=-0.11, P=0.02) and marital status (β=0.56, P=0.02) were significantly related to cognitive decline. Gender (β=-0.17, P<0.01) and hearing loss (β=0.08, P=0.02) correlated with anxiety indicators; gender (β=-0.84, P=0.02) and hearing loss (β=0.04, P=0.01) also correlated with depression indicators. Conclusion:Results indicated a correlation between hearing loss and cognitive decline, and between hearing loss and anxiety and depression among community-dwelling older adults in Beijing.
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Objective To investigate the value of transcranial Doppler ultrasonography(TCD)for assessing the cerebrovascular reactivity (CVR)in obstructive sleep apneahypopnea syndrome (OSAHS)patients.Methods Sixty OSAHS outpatients and inpatients admitted to our neurology department from August 2015to December 2016served as an OSAHS group,then further divided into mild group(n=15),moderate group(n=27)and severe group(n=18)according to apneahypopnea index(AHI).Meanwhile,20healthy individuals served as a control group.They underwent TCD on admission to detect their CVR,including the average velocity of cerebral artery blood flow(Vm)during calm breathing and after breath holding.The breath holding index(BHI) was calculed.The relationship between BHI and CVR was analized by pearson linear correlation analysis. Results There was no statistically significant difference in Vm during calm breathing between the OSAHS and control groups(73.64±9.87cm/s vs 72.79±8.68cm/s,P＞0.05).Both of Vm after breath holding and BHI of the OSAHS group were lower than those of the control group(88.63±6.65cm/s vs 93.26±7.12cm/s,0.71±0.16 vs 0.93±0.37,P＜0.01).Both of Vm after breath holding and BHI of the mild group were the highest,while the severe group had the lowest values and the moderate group was in between(P＜0.05).No significant correlation was found between AHI and Vm during calm breathing(r=0.197,P=0.052),while AHI was negatively correlated with Vm after breath holding and BHI(r=-0.557,P =0.011;r=-0.605,P=0.000).Conclusion TCD can detect CVR changes in OSAHS patients,whose Vm after breath holding and BHI decrease significantly.The more severe the OSAHS is,the lower the CVR is.
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Objective To study the risk factors for PSD and post-stroke cognitive impairment (PSCI) after first AIS.Methods One hundred and three AIS patients were divided into non PSD group (n=77) and PSD group (n=26) according to their HAMD score and into non-PSCI group (n=30) and PSCI group (n=73) according to their MoCA score.Their depression and congnitive impairment were assessed,their demographic and clinical data were recorded.Risk factors for PSD and PSCI were analyzed by multivariate logistic regression analysis.Results The incidence of CHD,serum homocysteine level,rate of foci in front of head,HAMA score and rate of MoCA score＜21 were significantly higher in PSD group than in non PSD group (38.5％ vs 19.5％,P=0.04;20.12±12.96 μmol/L vs 14.73±6.41 μmol/L,P=0.01;84.6％ vs 61.0％,P=0.02;12.04±9.95 vs 3.35±2.79,P=0.00;65.4％ vs 42.9％,P=0.04).The age was significantly older,the rate of solitudianrians was significantly higher,the number of males was significantly greater,the middle school education level was significantly higher,the history of smoking and alcohol comsumption was significantly longer,the serum hemoglobulin level was significantly higher in PSCI group than in non PSCI group (P＜0.05).Multivariate logistic regression analysis showed that anxiety and hyperhomocysteinemia were the independent risk factors for PSD and age was the independent risk factor for PSCI (P＜0.05).Conclusion The relationship between first acute PSD and PSCI is uncertain.PSD and PSCI are characterized by their own independent risk factors.
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Objective To investigate the pathogenesis of cerebral watershed infarction (CWI) through analyzing the appearance examined by Color duplex Imaging(CDI) and transcranial doppler (TCD).Methods One hundred and forty-two patients with CWI diagnosed by magnetic resonance imaging(MRI) were enrolled in the study group and 150 patients with acute cerebral infarction were enrolled in the control group.The results of CDI and TCD were retrospectively analyzed of the two groups.The vascular stenosis,plaque detection rate,plaque characteration,plaque scores,the cause of low blood volume,intracranial collateral circulation were compared between the two groups to investigate the pathogenesis of CWI.Results Among the 142 cases in the study group,there were 72 cases of severe stenosis and occlusion,21 cases of moderate stenosis,31 cases of mild stenosis and 18 cases without stenosis and there were 19 cases of severe stenosis and occlusion,41 cases of moderate stenosis,23 cases of mild stenosis and 67 cases without stenosis among the 150 cases in the control group.There were significant differences in the two groups (x2 =66.583,P =0.000).There were significant differences on the plaque detection rate between the two groups (80.99％ (115/142) vs 49.33％ (74/150),x2 =32.010,P =0.000).There were significant differences on the scores of plaque between the study group and the control group ((11.47 ± 3.78) points vs (6.57 ± 3.53) points,t =4.019,P =0.001).There were significant differences on the defined cause of low blood volume between the study group and the control group (54.93％ (78/142) vs 11.33％ (17/150),x2 =63.164,P =0.000).There were 50 patients had collateral circulation in the study group and 38 cases in the control group,there were no significant differences between the two groups (35.31％ (50/142) vs 25.33％ (38/150),x2 =3.381,P =0.066).Conclusion Angiostegnosis,microemboli from the unstable atherosclerosis plaque,lower perfusion on the basis of hypovolemia are all the pathogenesis of CWI.CDI combine with TCD can provide more information in vascular evaluation and treatment.
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Objective To explore the relationship between collateral circulation and clinical manifestation after se-vere stenosis or occlusion of internal carotid artery. Methods According to the clinical manifestation, 78 cases of ICA ste-nosis or occlusion confirmed by digital subtraction angiography (DSA) were divided into two groups:asymptomatic group (n=31) and symptomatic group (n=47). Collateral circulation pathway in circle of Willis and the mean flow velocity of the middle cerebral arteries (MVMCA) were measured by Transcranial Doppler Ultrasonography (TCD). The correlation of the types of intracranial collateral circulation and clinical manifestation was analyzed. Results ① The collateral circulation opening rate of severe stenosis or occlusion of internal carotid artery in 78 cases of patients was 70.5%(55/78). The collat-eral patency rate (27/31, 87.1% of patients) was higher in asymptomatic group than in the symptomatic group (28/47, 59.6%of patients)(P<0.01).②Collateral patency of anterior communicating artery (ACoA)in asymptomatic group (24/31, 77.4%of patients) was higher than that in symptomatic group (20/47, 42.6%of patients) (P<0.01). Collateral patency of ophthalmic artery (OA) in symptomatic group (21/47, 44.7%of patients) was higher than that in asymptomatic group(6/31, 19.4%of patients)(P<0.05). The opening rate of ACoA was significantly higher than that of either the posterior commu-nicating artery (PCoA) or OA collateral circulation in asymptomatic group (P<0.05).③The mean flow velocity of the af- fected side middle cerebral arteries (MVMCA) in asymptomatic group (51.58±12.36cm/s) was significantly higher than that in symptomatic group (32.23±10.31cm/s) (P<0.01). Conclusion The clinical manifestation is closely related to arterial circle of Willis collateral circulation opening after severe stenosis or occlusion of internal carotid artery and collateral patency of anterior communicating artery is the major collateral supply vessel.
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OBJECTIVE To explore cognitive dysfunction of sleep apnea syndrome (SAS) and compare the sensitivity of different measuring methods. METHODS Odd ball auditory P300 (2t- P300), three- tone paradigm auditory P300 (3t-P300) and mini- mental status estimate (MMSE) were performed on 24 patients with SAS and 22 healthy subjects. Results of two groups were compared. RESULTS 2t- P300 of study group:(341?14.5)ms, (342?13.8)ms; 2t- P300 of normal group:(317?14.7)ms, (318?12.8)ms; r-dT1 of study group:(327?13.0)ms,(326?14.9)ms;r-dT1 of normal group: (309?11.1)ms,(309?12.0)ms; r-dT2 of study group:(325?14.9)ms,(326?11.1)ms; r-dT2 of normal group:(306?9.7)ms, (305?11.7)ms.Latency of P300 evoked by odd-ball and 3-tone paradigm were both statistically prolonged in SAS patients than those of normal controls. SAS patients had statistically lower MMSE scores than that of normal group but all of them were above 27. On the other hand, statistical difference of abnormal rate between 3-tone P300 and odd-ball P300 was not found in SAS patients group. CONCLUSION Cognitive function impairment was found in SAS patients both by P300 and MMSE. While P300 might be more sensitive than MMSE in detecting it, different paradigm of auditory P300 did not show difference in sensitivity.