RESUMO
Objective:To observe the sleep characteristics of mild cognitive impairment (MCI) patients and Alzheimer disease (AD) patients, and to evaluate their values in distinguishing MCI and AD.Methods:50 patients with MCI and 50 patients with AD diagnosed in Hangzhou Seventh People′s Hospital from June 2020 to March 2022 were recruited in this study. All-night polysomnography (PSG) was performed for each patient. The total sleep time (TST) , proportion of sleep structure (N1%, N2%, N3%, REM%) , sleep efficiency (SE), sleep latency (SL), rapid eye movement sleep latency (REML), wake time after sleep onset (WASO), sleep spindle density (ρ spindle) and sleep k-complex density (ρ KC) were compared between the two groups. The indexes of sleep characteristics with statistical significance between the two groups were included to perform logistic stepwise regression. The single-factorial and multi-factorial prediction models were established. Receiver operating characteristic (ROC) curve was used to compare the value of single-factorial model and multi-factorial model in distinguishing MCI and AD patients. Results:There were statistically significant difference in TST, N3, SE, ρ spindle between MCI and AD groups ( t=3.315, 2.798, 3.682, 6.488, all P<0.05). Logistic stepwise regression analysis showed that N3, SE, ρ spindle was included in the modeling portfolio, and the joint prediction model was Logit (pre)=-19.972-0.269N3-0.141SE-3.303 ρ spindle. The sensitivity of N3, SE, ρ spindle and multi-factorial model for distinguishing MCI and AD was 64%, 32%, 96%, 90%, and the specificity was 58%, 98%, 50%, 76%, respectively. The area under the ROC curve (AUC) of the multi-factorial model and multi-factorial model were 0.639, 0.684, 0.810 and 0.901, respectively. The AUC of multi-factorial model was significantly better than that of single-factorial models ( P<0.05). Conclusions:In AD suspected population, the multi-factorial prediction model based on N3, SE and ρ spindle has a certain predictive value in distinguishing MCI and AD. Comprehensive judgment combined with the prediction model is helpful to improve the scientificity and accuracy of diagnosis.
RESUMO
One hundred Alzheimer′s disease (AD) patients with behavioral and psychological symptoms of dementia (BPSD) treated with donepezil+risperidone group ( n=50, group 1) or hydrochloride memantine+risperidone group ( n=50, group 2) in geriatric departments of Hangzhou Seventh People′s Hospital were enrolled in the study. Montreal cognitive assessment scale (MoCA), positive and negative syndrome scale (PANSS), treatment emergent symptom scale (TESS) were applied for evaluation; and blood routine examination, blood biochemistry, eletrocardiogram were performed in two groups before and after treatment. After treatment, MoCA score in group 2 (16.10±3.90) was significantly higher than that in group 1 (18.14±3.71)( t=-3.99, P<0.01), and PANSS score in group 2 (86.66±6.62) was significantly lower than that in group 1 (109.50±11.51; t=12.67, P<0.01). The incidence rates of dry mouth (16%,8/50), extrapyramidal side effects (10%,5/50) and the total score of TESS (3.92±2.02) in group 2 were markedly lower than those of group 1 [44%(22/50), 36%(18/50), (12.49±1.45);χ 2=9.33,9.54, t=17.90,all P<0.01]. Meanwhile, group 2 had significantly lower influences on the levels of blood lipids and fasting blood glucose (all P<0.01). The risperidone dose used in group 2 was significantly lower than that in group 1 [(2.06±0.50) vs. (3.85±0.89)mg, t=14.40, P=0.04].The results suggest that hydrochloridememantine combined with risperidone is more effective with less side effects compared to donepezil combined with risperidone for AD patients with BPSD.
RESUMO
Objective To investigate the changes of serum soluble factor-related apoptosis (sFas) and soluble Fas ligand (sFasL) and their relations with cognition disorders in the patients with vascular dementia (VaD). Methods Serum concentrations of sFas and sFasl were detected by enzyme-linked immunosorbent assay (ELISA) and compared between 70 patients with VaD aged (72.5± 7.5)years and 50 healthy elderly people aged(72.5 ± 7.5)years.The VaD patient's cognitive functions were evaluated by activity of daily living scale (ADL),mini mental state examination (MMSE) and hachinski ischemia score (Hachinski). Results The serum levels of sFas and sFasL in VaD patients were (228.0±60.7)μg/L and (146.8±30.1)μg/L,and in the healthy elderly were (62.4±22.6)μg/L and (82.3 ± 18.7)μg/L,respectively.The serum levels of apoptosis factors in VaD patients were significantly higher than in the healthy controls (t=20.883,14.453,P＜0.01).sFas level was negatively correlated with age,the scores of ADL and Hachiuski while positively with the scores of MMSE (r=-0.956,-0.943,-0.950 and 0.904,all P＜0.01). sFasL level was negatively correlated with the scores of MMSE while positively with age,the scores of ADL and Hachinski (r=-0.899,0.963,0.948 and 0.939,a11 P＜0.01). Conclusions Apoptosis may be involved in the pathological change during VaD and the serum levels of sFas and sFasL might be related with cognition disorders.