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This article aims to comprehensively review the concept, etiology, classification, classical cortical mapping, assessment, a proposed flowchart for the diagnosis and differential diagnosis, treatment, rehabilitation, mechanisms of development and recovery, prognosis, and influencing factors for post-stroke aphasia(PSA)types in the Chinese language.We emphasize the necessity and significance of neuroimaging assessment of the brain and blood vessels and neuropsychological assessment in the diagnosis and differential diagnosis of PSA in Chinese.We also recommend and encourage the use of the dichotomies of internal vs.external and anterior vs.posterior as a starting point, based on the association of anatomical locations of the brain and blood vessels with brain language areas and language disorders.A classification system of PSA in Chinese developed from this approach in the form of a flowchart is well-suited for guiding the clinical treatment of cerebral stroke.Incorporating the "four elements" , the flowchart enables convenient diagnosis, classification and differential diagnosis of PSA in Chinese and facilitates targeted and personalized rehabilitation planning to benefit the patient.This article introduces the use of memantine, piracetam, donepezil and other drugs for PSA treatment, evaluates clinical trials on memantine conducted in China and abroad and its mechanisms of action for the treatment of PSA, and discusses how rehabilitation therapy achieves therapeutic effects.For the treatment of PSA, clinical research and practice using drugs such as memantine, piracetam and donepezil in combination with non-pharmacotherapy and rehabilitation training should be promoted.
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Criteria for diagnosis of Alzheimer's disease (AD) is not available in China.The international criteria is not a proper choice due to issues such as translation and lead to low diagnostic rate and high rate of missed diagnosis.The research group of Alzheimer's Disease Chinese (ADC) reviewed knowledge and techniques in neuropsychology,neuroimaging,molecular biology,and clinical neurology,and systematically studied the detection techniques such as memory,language,visuospatial,executive function,and medial temporal lobe visual scores on MRI,and their optimal threshold and diagnostic value for the diagnosis of AD.Through a systematic review and consensus meeting,a diagnostic framework for screeningAD in the Chinese population was established.Among these methods,an operational standard for clinical pathology models increased the diagnostic sensitivity by 15％.The sensitivity and specificity of screening memory impairment increased by 18.1％ and 11.6％,respectively.The sensitivity of screening medialtemporal lobe atrophy increased by 24.5％ and missed diagnosis was decreased by 34.5％.An operational standard for clinical biology models,incorporating the latest molecular imaging and molecular biology techniques,has enabled the early diagnosis of AD in China.The framework combines a principled diagnostic guideline with an operational screening protocol,which is applicable to all clinical settings and of great significance for the early detection,early diagnosis and early treatment of AD.
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For lack of cognitive screening standard system and controversy over the value of imaging for cerebrovascular diseases in China, the research group of Alzheimer′s Disease Chinese (ADC) studied the knowledge of neuropsychology, neuroimaging and clinical neurology, systematically reviewed the diagnostic techniques such as memory, language, visuospatial, executive, function, and magnetic resonance imaging (MRI) of cerebrovascular diseases, and their optimal threshold and diagnostic value for vascular dementia. Via a consensus meeting, the diagnostic guidelines and practical screening process are combined to construct a framework in Chinese population, which is based on the objective evidence of medical history and clinical evaluation. The diagnosis of vascular dementia is supported by imaging evidence of cerebrovascular diseases and differentiates from other causes of dementia or comorbidities. This consensus is applicable to medical units in China, and is of great significance for early detection, early diagnosis and early treatment of vascular dementia.
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There are no standard diagnostic criteria for Alzheimer′s disease (AD) in China. The copied international criteria has led to a high rate of missed diagnosis due to issues such as translation and cultural discrepancy. Under the principles of semantic equivalence, content equivalence and performance equivalence, the research group of Alzheimer′s Disease Chinese (ADC) adopted several effective methods, such as two-way translation, content conversion, performance evaluation, etc. to systematically study the cognitive, behavioral, functional, and general assessment techniques in dementia screening and diagnosis, as well as their screening thresholds and diagnostic values. We also established a dementia screening and assessment framework in clinical practice through systematic reviews and group consensus. It has improved the early diagnosis rate of dementia in China, been accepted by home and abroad academic institutions, which is of great significance for early diagnosis and treatment of dementia.
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Objective To study the protective effect of pure carbachol or combined with dietary fiber on intestinal mucosal barrier of rats after diffuse brain injury (DBI).Methods An adult male Wistar rat model of DBI was reproduced by gravitational shock method. The rats injured and survived after resuscitation were divided into three groups: model group (n = 40), carbachol group (n = 40) and carbachol combined with dietary fiber group (combined group,n = 32). In addition, a control group was established by simply an incision performed on the scalp, and the rats could drink freely (n = 5). In the experimental groups, 2 hours after resuscitation the rats began to receive gavage, 6 hours once, the liquid amount 15 mL/kg should be assured in every 6 hours, and if insufficient, normal saline was supplemented. In model group, normal saline 90 mL/kg was given, in carbachol group, carbachol 300μg/kg was administered and in combined group, carbachol 300μg/kg combined with dietary fiber 60 mL/kg was supplied. At 3 (combined group being excluded), 6, 12, 24 and 48 hours after resuscitation, the rats were anesthetized to collect samples and detect the plasma levels of D-lactate and activity of diamine oxidase (DAO) respectively, and the changes of villus height of small intestine were examined by a light microscope.Results The plasma D-lactate levels and the activities of DAO at any time point in the experimental groups were significant higher than those in control group (allP < 0.01). Along with the prolongation of time, the levels of plasma D-lactate and DAO activities in carbachol and carbachol plus diatary fiber groups were gradually lower than those of the model group, and at 48 hours after injury they reached their valley values [D-lactate (ng/L): 6.32±0.79, 7.46±1.67 vs. 17.65±1.53, DAO activity (kU/L): 0.76±0.01, 0.86±0.01 vs. 2.23±0.15]. Under light microscopy, compared with control group, the villus height of small intestinal mucosa at any time point in any experimental group was gradually lowered, and reached the valley values at 12 hours, then gradually increased , and peaked at 48 hours, the villus height in carbachol group and combined group was higher than that in model group (μm: 265.36±10.20, 261.54±10.38 vs. 247.51±9.39, bothP < 0.05).Conclusion When only carbachol is administered into the rat intestine early after diffuse brain injury in rats, beginning from 6 hours after injury, the protective effect of intestinal mucosal barrier is shown, representing decrease of plasma D-lactate level and DAO activity, amelioration of intestinal mucosal damage and protection of intestinal mucosal barrier; under the same above situation, the carbachol combined with dietary fiber was applied, showing the similar above carbachol protective effects.
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Objective To observe the protection of carbachol on intestinal barrier function in patients with trauma. Methods A prospective randomized controlled trial was conducted. Seventy patients after trauma with a definite diagnosis of multiple organ dysfunction syndrome(MODS)from Department of Critical Care Medicine in Hebei United University Affiliated Hospital were included. According to random number table,the patients were divided into a carbachol treatment group(37 cases)and a mosapride citrate treatment group(33 cases),and all the patients in the two groups were treated by antibacterial drugs,supportive agents for organ function,surgery, etc symptomatic treatment. Based on the conventional treatment,in the carbachol treatment group,carbachol was administered through a stomach tube at the dose of 0.2 mg/kg,twice a day,and the dose was doubled if no exhaust or defecation persisted for 3 days after treatment,while in the mosapride group,mosapride citrate was given at the dose of 5 mg once and thrice a day,the therapeutic course of both groups being 7 days. On the 1st,3rd,5th, 7th day after admission,peripheral venous fasting blood in early morning was collected,the activity of diamine oxidase(DAO),expression rates of CD11b+and CD18+in polymorphonuclear neutrophil(PMN),contents of tumour necrosis factor-α(TNF-α)and interleukin-10(IL-10) were detected,and the clinical curative effects were observed. Results Compared to the mosapride citrate treatment group,the total effective rate was significantly higher in the carbachol treatment group on the 7th day after treatment〔70.3%(26/37)vs. 45.5%(15/33),P<0.05〕. The activity of DAO,expression rates of CD11b+and CD18+in PMN,contents of TNF-αand IL-10 in the carbachol treatment group were decreased with the extension of time,and reached valley values on the 7th day,the differences were statistically significant in the comparisons with those in mosapride citrate treatment group at the same time point〔DAO(mg/L):3.21±0.52 vs. 3.93±0.51,CD11b+:(14.89±2.16)% vs.(28.92±1.59)%,CD18+:(53.67±2.44)% vs. (72.46±4.08)%, TNF-α(ng/L):111.44±16.42 vs. 129.73±18.74, IL-10(ng/L):67.71±38.83 vs. 121.45±40.23,all P<0.05〕. At the various time points,the above indexes had no obvious changes in mosapride citrate treatment group. Conclusion Carbachol can ameliorate the ischemic/reperfusion(I/R)injury in patients with intestinal barrier dysfunction after trauma,decrease the release of inflammatory cytokines in vivo,and promote peristalsis of intestinal tract,therefore carbachol has clinical value of protecting intestinal barrier function.
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@#Objective To assess the level of plasma thromboxane B2(TXB2),6-keto-prostaglandin F1α(6-keto-PGF1α) of patients with acute cerebral infarction,so as to know the changes of platelet function on acute cerebral vascular diseases.MethodsThe level of plasma TXB2,6-keto-PGF1α and TXB2/6-keto-PGF1α(T/6-K) of 205 patients with acute cerebral infarction were measured within 24 hours and on the 7th day and 14th day,and were compared with the normal controls(n=40).ResultsThe levels of plasma TXB2,6-keto-PGF1α of patients within 24 hours,on the 7th day and 14th day were significantly higher than those in the normal controls(P<0.01).The level of plasma TXB2 was the highest on the 7th day and decreased on 14th day.The level of plasma 6-keto-PGF1α was the highest on the 14th day.T/6-K was higher than those in the normal controls within 24 hours and on the 7th day;it was highest on the 7th day and decreased on 14th day to level of the normal controls(P>0.05).ConclusionThe determine on levels of plasma TXB2,6-keto-PGF1α has important significance for knowing the changes of platelet function on acute cerebral infarction.The balance between TXB2 and 6-keto-PGF1α is important in keeping the blood smoothly.
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@#Objective To reveal the cerebral activation areas related to semantic processing of language functions in patients with temporal lobe epilepsy(TLE).Methods 6 patients with left-TLE,6 patients with right-TLE,and 6 controls,all right-handed,were studied using functional magnetic resonance imaging(fMRI)during a reversible words decision task.Their responses were recorded by key-press.The image data was analyzed by statistical parametric mapping 2(SPM2)including the individual statistical analysis and group analysis.Results There was no difference between the right-TLE patients and controls in cerebral activation,which included left inferior frontal gyrus,left middle frontal gyrus,left superior temporal gyrus,left middle temporal gyrus and bilateral cingulate gyrus,bilateral fusiform gyrus,bilateral basal ganglia,bilateral cerebellum(especially right).The activation in patients with left-TLE was atypically distributed relative to the controls,there were more activation in right inferior frontal gyrus,right precentral gyrus and left cuneus,left precuneus.Conclusion There is atypical distribution of the cerebral activation area related to semantic processing of language functions in patients with left-TLE,and enantiomorphous transformation is found in the contrelateral side of cerebrum.
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@#The standard of speech disability used in Chinese Second Disability Sampling Survey is introduced in the paper,including classification,screening,survey instrument,diagnose,cause analysis and rehabilitation advice.
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@#ObjectiveTo investigate the characteristics of event-related potential (ERP) N270 and the value of ERP N270 to detect the cognitive function in patients with epilepsy.MethodsThirty-five epileptics were divided into carbamazepine (CBZ) group (n=10), valproate (VPA) group (n=10) and no treatment group (n=15) according to drugs they took, and other 10 healthy subjects were selected as the control group. All subjects were evaluated by Mini-Mental State Examination (MMSE), and ERP was recorded at same time.ResultsAll patients in three groups showed a delayed and smaller N270 than the control group ( P<0.01). VPA group had the lowest N270 amplitude. The amplitude of P300 elicited in the match condition decreased in the VPA group compared with other three groups ( P<0.05), but latency of the VPA group was not different from other three groups.ConclusionCognitive impairment is present in epilepsy patients, and the effect of anti-epileptic drug VPA on ability of patients to process conflict is more evidence than CBZ. The sensitivity of N270 to detect early cognitive impairment in epileptics is higher than P300.
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BACKGROUND: Patients with Alzheimer disease (AD) usually have visuospatial dysfunction at an early stage and most patients with AD were evolved from mild cognitive impairment (MCI).OBJECTIVE: To detect whether a patient with MCI has a visuospatial dysfunction similar to AD. To compare the cerebral activation with ferromagnetic resonance between the healthy people and the patients with mild cognitive disorder.DESIGN: A case controlled observationSETTING: The Department of Neurology of the First Hospital of Peking University.PARTICIPANTS: Nine inpatients with mild cognitive disorder hospitalized at the Department of Neurology of the First Hospital of Peking University from April 2000 to March 2003 were involved and other 9 healthy people matching in age, gender and the educational level were also involved.METHODS: The subjects had the task of discriminating the different finger positions on the clockface. They could see the mission clearly showed on the cloth through refractor, and they were supposed to give the corresponding reaction to different cognitive tasks with left and right hands pressing the keys according to visual sign generated by the computer.Block design was adopted in the cognitive task. Stimulus block and baseline block appeared in turn. Baseline block displayed "+" mapped in the center of the image and was kept for 21s. Stimulus block displayed 10 pictures successively. The finger position of the two clockfaces among three clockfaces was the same in one picture. The absolute value of the rotated angles of the different clockfaces in each image on the same stimulus block was the same. The angles formed by six stimulus block fingers arranged randomly were 300, 450, 1800. The two clockfaces had the same finger positions, and the subjects were requested to discriminate the finger position of these two clockfaces. It was carried out on a 1.5 T GEMRTWIN magnetic resonance scanning apparatus. Then t test was performed to work out the right reaction time and proper rate with Excel software between the patients with mild Alzheimer's disease and the healthy persons. Pretreatment and statistical analyses were performed with analysis of functional neuroimages software used internationally.MAIN OUTCOME MEASURES: Comparison of the reaction time and proper rate between the two groups.parison of the reaction time between the two groups: The reaction time for distinguishing the change of 300, 450, 1800 was longer than that in the control group, and there was significant difference in distinguishing the change of 300, 450, 1800 for the patients [(1 776.7±570.2), (1 646.3±432.7)ms;of the proper rate between the two groups: The proper rate for distinguishing the change of 300, 450, 1800 was significantly lower than that in the control group (62.8±21.4)%, (82.8±15.8)% ;(76.7±17.0)%, (95.0±8.7)%; (69.4vation: the activation density at the bilateral parietal lobe, bilateral temporooccipital borderline and bilateral lateral striate cortex in patients was weaker than that in the control group (P ＜ 0.05).CONCLUSION: Neural network activation related with visual space in patients with MCI was weaker than that in the healthy people indicating that visuospatial impairment exists in the patients with mild cognitive impairment.
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BACKGROUND: Memory impairment is the main manifestation of Alzheimer disease (AD) and mild cognitive impairment (MCI) conspicuous in the early stage. However, such patients very often develop attentional dysfunction, which may affect their normal work and daily life.OBJECTIVE: To investigate the attentional function, including continuous attention, selective attention and divided attention, of patients with mild AD and of those with MCI.DESIGN: A case-control study.SETTING: Department of neurology of a university hospital and department of psychology in a university.PARTICIPANTS: The research was completed in the Laboratory of Neuropsychology, the First Hospital of Peking University from November 2003 to January 2004. Totally 18 patients with mild AD and 19 with MCI were enrolled in this study, with 20 normal elderly subjects also included to serve as the normal control group.INTERVENTIONS: Several tests were designed to assess the attentional functions of all the subjects, including continuous performance task (CPT) test for assessing continuous attention, simplified Stroop test for selective attention, and dual task test for divided attention.MAIN OUTCOME MEASURES: The reaction time (RT) and the percentage of false response were recorded in CPT test and Stroop test, and performance decrement in dual task test was observed.RESULTS: In CPT test, the RT of mild AD patients was much longer, and the rates of missing and false responses were higher than those of normal control group [(539.29±103.86) vs (458.47±40.87) ms, 4.08% (3. 13, 13.64) vs0.91% (0.60, 1.90), and 1.51% (0.64, 2.54) vs 0.43% (0.37, 0. 84), respectively, P ＜ 0. 05]. The difference between MCI group and normal control group failed to reach statistical significance. The rate of missing response of all the three groups grow higher with the prolongation of time, with the highest occurring in the third 5 minutes of the test.More AD patients showed sustained attention deficiency after 10 minutes of test (33.33% within 10 minutes and 77.8% within 20 minutes). In Stroop test, all the three groups tended to make more false responses under incongruous condition[11.25% (7.50, 22.50), 2.50% ( -2.50, 5.00), 2.50% (0.00, 4. 38) ], exhibiting significant interference effect, which was the most obvious in mild AD group ( P ＜ 0.05). Patients with mild AD responded more slowly than MCI patients and normal control subjects [ (579. 19 ± 89.93) ms,(524.28 ± 68. 96) ms, (486. 75 ± 51.58) ms, respectively, P ＜ 0.05 ]. MCI group made more false responses than normal control group during the whole course of the test as well as under coincident and neutral conditions[5.83% (4. 17, 8.33) vs2.92% (1.67,3.96); 5.00% (2.50, 7.50) vs0.00% (0.00, 2.50); 5.00% (2.50, 10. 00) vs 2.50% (0.00, 5.00), P ＜ 0. 05]. In dual-task test, a significant decrement in mild AD patients was noted without statistical difference between MCI and normal control group[ 1.03 (0.49,3.75),0.46 (0.08, 1.02),0. 10 ( -0.25, 0. 64), P ＜0.05]. Within mild AD group, more patients showed deficiency in Stroop test and CPT test than in dual-task test (81.25%, 77.8%, and 29.41%, respectively).CONCLUSION: Patients with mild AD suffer impairment in continuous,selective and divided attentions, especially obvious in the former two attentional functions. MCI also impairs selective attention as compared with normal aged subjects, with the continuous and divided attention remaining normal. Mild AD patients, MCI patients and normal elderly subjects all show decreased continuous attention, and longer time (than 10 ninutes) of CPT may more sensitively identify continuous attention deficit.
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@#ObjectiveTo determine the frequency of cerebral microembolism in patients with asymptomatic or symptomatic extracranial and intracranial arterial stenosis and to assess its relationship to the onset and course of ischemic stroke.MethodsTCD was used to monitor patients with extracranial and intracranial cerebral arterial stenosis. Double channel four-gated and power M-Mode were used to detect microembolic signals (MES). The recording time was 60 min and the number of MES was counted. Patients were divided into 2 groups as extracranial internal carotid artery (ICA) stenosis and middle cerebral artery (MCA) stenosis. Each group was divided into 3 subgroups as asymptomatic, acute ischemic stroke (<30 d) and old ischemic stroke (≥30 d).ResultsThe total number of monitored artery was 74 in 63 patients. In ICA stenosis with asymptom, old ischemic stroke and acute ischemic stroke, the frequency of MES was 0(0/10), 0(0/7), 33%(6/18) and the number of MES in acute ischemic stroke was 3, 9, 8, 10, 1, 40 (mean=11.8). In MCA stenosis with asymptom, old ischemic stroke and acute ischemic stroke, the frequency of MES was 14%(2/14), 14%(1/7), 39%(7/18) and the number of MES was 4 and 1 in asymptom, 1 in old ischemic stroke, 4, 1, 4, 15, 16, 1 and 29(mean=10) in acute ischemic stroke. In ICA stenosis, the difference between acute ischemic stroke and asymptom (P=0.013), between acute and old ischemic stroke (P=0.031) reached statistic significance.In MCA stenosis, there was no significant difference between acute ischemic stroke and asymptom (P=0.115), so as between acute and old ischemic stroke (P=0.214).ConclusionEmbolism was important in the mechanism of ischemic stroke due to extracranial and intracranial arterial stenosis. The closer to ischemic stroke onset, the higher the frequency and the number of MES. TCD monitor was helpful to study the pathogenesis of ischemic stroke due to extracranial and intracranial arterial stenosis and determine the treatment.
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@#ObjectiveTo investigate the survival and migration of the neural stem cells(NSC) in the cerebrospinal fluid (CSF) circle of mice after ventricle transplantation. MethodsNSC labeled with green fluorescence protein (GFP) were implanted into the lateral cerebral ventricle of the mice. The mice were killed at time point of 24 h, 48 h, 2 weeks and 10 weeks after transplantation. The brain sections were observed and the behaviors of the mice were evaluated. ResultsGFP-positive cells were found in the lateral cerebral ventricle.Some of them migrated into the parenchyma and located in fibria-fornix, hippocampus,corpus callusum, septum,subventricle zone and beside the blood vessels at the time point of 2 weeks and 10 weeks. There were no obvious complications occured during operations which affected the outcome of growth and development. ConclusionNSC not only can survive, but also can migrate into the local parenchyma of the brain after ventricle transplantation. There were no obvious complications occured after the transplantation of NSC.
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@#ObjectiveTo explore the pattern and the time course changes of semantic and phonological processing during Chinese language cognition study in patients with mild Alzheimer's disease(AD) and mild cognitive impairment (MCI).MethodsPatients with mild AD and MCI and normal controls matched with age, gender, level of education were enrolled in the single-character words naming task, which applied short and long stimulus onset asynchrony (SOA). Semantic, homophonic, semihomophonic and unrelated primes preceded the words as well as nonwords targets. Subjects were asked to read the targets aloud. Semantic and phonological priming effects were analyzed by comparing reaction time of semantic, homophonic or semihomophonic related targets to unrelated targets. The reaction time and accuracy for each response were recorded.ResultsThe mean reaction time of mild AD and MCI patients were prolonged for all types of priming in contrast with normal controls. Responses of the normal controls were faster during the long SOA comparing to short SOA, whereas the mild AD group's reaction time was longer for long SOA than for short SOA. Normal controls exhibited homophonic priming, whereas mild AD and MCI groups exhibited tonal inhibition effects.ConclusionThe speed of Chinese language cognitive processing decreased in mild AD and MCI patients. The phonological encoding and accessing ability may be impaired in mild AD and MCI.
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@#ObjectiveTo explore the differences of patients with mild cognitive impairment (MCI) and normal elderly individuals in neuropsychology and ApoE genotype polymorphism.Methods23 patients with MCI and 28 normal controls were examined with the neuropsychological test and ApoE phenotypes. The neuropsychological test included mini-mental state examination (MMSE), activities of daily living scale (ADL), Preffer outpatient disability questionnair (POD), Fuld object memory evaluation (FOM), rapid verbal retrieve (RVR), digit span (DS), logical memory (LM), Geometry figures, clock drawing test (CDT), delayed recall, clinical dementia rating scale (CDR), global deterioration scale (GDS), Hachinski ischaemic scale (HIS) and center for epidemiological studies-depression scale (CES-D).ResultsMCI cases achieved significantly lower scores than healthy elderly in all cognitive function measures (P<0.05～0.001)except ADL,POD performance and naming, especially in logical memory and semantic memory, similar with the earlier period of AD. The ApoE genotype polymorphism examination showed that the rate of ApoE epsilon 4 allele carry in MCI patients was around 10 times to that in normal controls.ConclusionIndividuals with MCI appear to be at an increased risk of developing AD. Susceptible neuropsychological marker binding other biomarker, e.g. ApoE, can raise the sensibility and specificity in early diagnosis of AD.
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Objective To delineate the changes in pattern and time course of semantic and phonological processing during Chinese language cognition study in patients with mild Alzheimer’s disease (AD) and mild cognitive impairment (MCI). Methods Patients with mild AD(n=32)and MCI (n=39) as well as normal controls (NC, n=40) matched with age, gender, level of education were enrolled in the study. Subjects completed Chinese compound word decision task applying both short and long stimulus onset asynchrony (SOA). Semantic, homophonic, semihomophonic and unrelated primes preceded the real words as well as nonwords targets. Subjects were asked to judge whether the targets were real words or nonwords. The reaction time and accuracy were recorded for each response. Semantic and phonological priming effects were analyzed by comparing the related primes versus unrelated primes. Analyses of variance (ANOVA) and t-test were conducted for reaction time and accuracy respectively. Results The mean reaction times of mild AD and MCI groups were prolonged (411 ms and 234 ms) for all types of priming in contrast with NC(P