Clinical and neuroimage characteristics of reversible posterior leukoencephalopathy syndrome in elderly patients / 中华老年医学杂志

Objective To investigate the clinical and neuroimage characteristics of reversible posterior leukoencephalopathy syndrome (RPLS) in Chinese elderly patients. Methods The characteristic clinical presentation and neuroimaging of 5 elderly patients with RPLS were retrospectively analyzed. Results There were one male and four females in this study, with the average age of (63.0±2.4) years, all combined with hypertension. The most common clinical presentations were abnormality of visual perception (5 cases), headache (4 cases), epileptic seizure (4 cases), disturbance of consciousness (3 cases), pathological reflex (2 cases) and hemiplegia (2 cases). CT scan showed 4 cases with low density lesions. MR1 scan showed 5 cases with occipital lobe lesions, 2 with parietal lobe lesions and 1 with temporal lobe lesions. Re-examination of CT scans showed that 4 survived patients became normal at mean (48.8±29.2) days after discharging from hospital. Conclusions The etiologies of RPLS are diverse. The vasogenic theory is supported by neuroimage of RPLS. Neuroimage may be very important for the diagnosis of RPLS. Diffusion-weighted imaging and apparent diffusion coefficient map may be helpful for differential diagnosis between RPLS and cerebral infarct.

Characteristics of prospective memory impairment in patients with Parkinson's disease at early and middle stage / 中华神经科杂志

Objective To explore the characteristics of prospective memory impairments in patients with Parkinson's disease (PD) at the early and middle stage. Methods Fifteen PD patients at the early and middle stage and 15 normal controls matched with age, sex, education and occupation were asked to complete event-based prospective memory (EBPM) and time-based prospective memory (TBPM) tasks. Results In the EBPM task (points), there was a significant difference between PD patients (3.93±2.69) and normal controls (6.00±2.17, t =-2.318,P <0.05). In the TBPM task(points), there was no significant difference between PD patients (3.47±1.96) and normal controls (3.80±1.70, t= -0.498, P >0.05). Conclusion The EBPM is impaired and the TBPM is relatively spared in early and middle stage PD patients.

Approved effect of hydrochloric-acid arotinolol on trembling symptom of patients with essential tremor: 30 cases analysis / 中国组织工程研究

BACKGROUND: Essential tremor is a kind of dyskinesia disease with a tendency to heredity. β-adnephrin receptor blocker is mainly used for treatment, but the dosage was great, patients could not persist in treatment. Hydrochloric-acid arotinolol, which characterizes by little side effect, is a β-receptor blocking agent combined with blocking effect of α receptor, and is an ideal drug to treat essential tremor in Japan.OBJECTIVE: To observe the reliability and curative effect of hydrochloric-acid arotinolol on essential tremor among Chinese people.DESIGN: Case analysis.SETTING: Neurological Departments of Beijing Hospital of Ministry of Public Health and General Hospital of Beijing Military Area Command of Chinese PLA.PARTICIPANTS: Totally 30 patients with essential tremor, 19 males and 11 females, aged from 21 to 74 years, with course of 1-40 years, average of (15.8±12.6) years, were selected from Neurological Departments of Beijing Hospital of Ministry of Public Health and General Hospital of Beijing Military Area Command of Chinese PLA from April 1999 to December 2000.METHODS: Tremor degree of upper limb, caput and lower limb, degree of dysfunction of hand, tremor degree of hand during writing and circling, and chief complaint of pain caused by tremor were scored before medication and 2, 4 and 6 weeks after medication. Scores were determined as 1 point, 2 points and 3 points according to mild, moderate and severe degree respectively. Evaluated criteria: ① Obviously effective: Differences were more than 7 points before and after treatment. ② Effective: Differences were 6.5-3 points before and after treatment. ③ A little effective: Differences were 3-1.5 points before and after treatment. ④ No changes: Differences were from 1 to -1 points before and after treatment. ⑤ Worse: Differences were less than -1.5 points before and after treatment. Meanwhile, blood pressure and heart rate of patients and side effect of drug were observed.MAIN OUTCOME MEASURES: ① Results of effective evaluation; ②Blood pressure and heart rate before and after treatment; ③ Adverse events and side effect.RESULTS: Totally 30 patients entered the final analysis. ① Among 30 patients with essential tremor, 6 had obvious effect, 11 had effect, 5 had a little effect, 7 had no effect, and 1 was worse. ② Average of blood pressure before treatment was (138.5±14.6)/(84.2±6.4) mm Hg (1 mm Hg=0.133 kPa), and was (130±10)/(79.7±6.3) mm Hg after 1 course. Average heart rate was (77.5±6.4) times/minute before treatment and (75±6.4) times/minute after treatment. The difference was not significant. ③ Among 30 patients, 4 had side effect at various degrees which was accounted for 13.4%; 1 had distress after medication, 1 had agrypnia, 2 had fullness in head and dizziness, and 1 gave up the treatment because of deteriorated tremor.CONCLUSION: Hydrochloric-acid arotinolol can improve tremor symptom of patients obviously and is an effective drug to treat essential tremor with convenient and safe medication.

Clinical and pathological comparison of 42 elderly patients with dementia / 中国康复理论与实践

@#ObjectiveTo compare the clinical and the pathological diagnosis of elderly with dementia, assess the related factors affecting the diagnosis.MethodsThe 42 autopsied elderly patients with dementia were assessed with the National Institute for Neurological Disorders and Stroke (NINDS) criteria and the ischemic scales of Hachinski, Rosen, Loeb and Gandolfo for the clinical diagnosis of dementia. Specificity was calculated using the neuropathologic diagnosis as a gold standard.ResultsThe patients were differentiated with pathology verified Alzheimer's disease (AD), vascular dementia (VaD), and “mixed” (AD plus VaD) dementia, Parkinson's disease dementia (PDD). Comparing clinical criteria and neuropathology, the consistent rate was 80.0% for AD, 52.4% for VaD, 18.2% for AD+VaD and 0.0% for PDD. The consistent rate between 3 scores and the pathological diagnosis was about 40%～70%. There were no significant differences between the average age of onset and the survival time, and the ischemic scales of Hachinski, Rosen, Loeb and Gandolfo among the 4 types of dementia. There was no significant difference in the specificity of the NINDS criteria among the 4 types of dementia.ConclusionDementia associated with cerebrovascular disease and Parkinson's disease is the main factor affecting the diagnosis of elderly with dementia. There is no significant difference for the diagnosis of dementia among the ischemic scales of Hachinski, Rosen, Loeb and Gandolfo.

Open-label and non-randomized study of therapeutic effect of amantadine monotherapy and concomitant amantadine with salvia miltiorrhiza compound or selegiline on early Parkinson's disease / 中国康复理论与实践

@# Objective To assess the clinical efficacy and safety of amantadine monotherapy and concomitant amantadine with salvia miltiorrhiza compound or selegiline of the treatment of Parkinson's disease.Methods The clinical trial was performed in the multicenter, open label study. Amantadine group: 35 cases, amantadine plus salvia miltiorrhiza compound group: 34 cases and amantadine plus selegiline group: 29 cases. The clinical efficacy had been assessed with modified Webster scale (WR) and motor dysfunction rating scale for Parkinson's disease (MDRSPD) with interval of two months for one year. The safety data included blood glucose, hepatic and renal function tests, blood and urine routine tests.Results The clinical improved rates were 42.9% (WR) and 37.1% (MDRSPD) in amantadine group, respectively. The clinical score was improved in 34.2% (WR) and 26.5% (MDRSPD) in amantadine plus salvia miltiorrhiza compound group, respectively. The clinical improvement was 51.1% (WR)and 48.3% (MDRSPD) in amantadine plus selegiline group, respectively. There were no significant differences among these three groups (t-test,P>0.05). The clinical marked efficacy rates in assessment of MDRSPD were 2.8% in amantadine group, 11.8% in amantadine plus salvia miltiorrhiza compound group and 27.6% in amantadine plus selegiline group, respectively. There was significant difference between amantadine group and amantadine plus selegiline group, but no significant difference between amantadine group and amantadine plus salvia miltiorrhiza compound group. The adverse event rates were 27.8% in amantadine group, 8.8% in amantadine plus salvia miltiorrhiza compound group and 31.0% in amantadine plus selegiline group, respectively. All these events were mild, of short duration and resolved without treatment. Conclusion There was some efficacy rate in all three groups. Comparing with amantadine group, there was higher marked efficacy rate in amantadine plus selegiline group.

Evaluation of the role of plasma level of p-tau(~ (181)p) protein for clinical diagnosis of Alzheimer′s disease / 中华老年医学杂志

Objective To evaluate the roles of plasma p-tau(~ 181P)protein for clinical diagnosis of Alzheimer′s Disease (AD). Methods Subjects including 23 mild AD(19≤MMSE≤26) and 35 moderate and severe AD(MMSE0.05). Level of p-tau(~ 181P) protein was significantly higher in the moderate and severe AD group(18.3?20.3)ng/L than that in HC( P

Effects of anti-parkinsonian drugs on cytokines IL-6 and TNF-? in Parkinson's disease / 中华老年医学杂志

Objective To investigate the effects of anti-parkinsonian drugs on cytokines(IL-6 and TNF-?) produced by PBMC in PD patients. Methods 25 subjects were divided into 3 groups : normal controls(NC),pergolide and Madopar treated PD patients(P+M group),Madopar treated PD patients(M group). PBMC were cultured in the presence of pure RPMI-1640,RPMI-1640 with ConA and RPMI-1640 with pergolide,respectively. The amount of IL-6 and TNF-? in the culture media was measured by enzyme-linked immunosorbent assay (ELISA). Results IL-6 production amount by PBMC when stimulated with ConA was significantly lower in group P+M and M than in group NC( P 0.05). In group P+M,the concentration of TNF-? was significantly higher in the presence of ConA than in the presence of pure RPMI-1640 and in the presence of pergolide( P 0.05). Conclusions The ability of amount by PBMC of PD elderly patients to excrete IL-6 was significantly decreased in the presence of ConA. Pergolide might arise the excretion of IL-6 by PBMC during the treatment process of PD and at the same time does not arise the excretion of TNF-?,which might be neurotoxic.

An analysis of references cited from Chinese Journal of Geriatrics from 1992-2001 year / 中华老年医学杂志

Objective To analyze the references cited from Chinese Journal of Geriatrics from 1992 to 2001 year and to approach the regular patterns of references. Methods All references of scientificpapers printed in Chinese Journal of Geriatrics from 1992-2001 year were imputed into CP. All references of treatises, literature reviews and lectures were analyzed according to different languages, time distributions and cited half-life, etc. Results In recent 10 years the majority of references were in Chinese and English, accounting for 29.4% and 69.5%, respectively. The names of cited periodicals were much scattered, 335 periodicals in Chinese and 1 016 periodicals in English. The half-life of the value of information in Chinese and English periodicals was degraded by year. According to Bradford's law the nucleus of periodicals in Chinese was 5, which was similar to the nucleus of periodicals from 1982-1991 year. Chinese Journal of Geriatrics still took the first place in Chinese periodicals. The nucleus of periodicals in English was much changed as compared with nucleus of periodicals from 1992-2001 years. The journal "Circulation"occupied the first place. Conclusions It is easy to get all deliverable journal literature via the internet, so there was more broad collection of recent primaryjournal literature and secondarydatabase. Chinese Journal of Geriatrics took the first place in Chinese periodicals.

Clinical course and cause of death in elderly patients with idiopathic Parkinson's disease / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To improve the therapeutic and preventive measure for elderly patients (75 years and over) with idiopathic Parkinson's disease (OEIPD).</p><p><b>METHODS</b>Fifteen OEIPD patients were observed prospectively over a long period of time. Their diagnosis was confirmed by autopsy. Based on clinical and pathological data, the causes of death were analyzed.</p><p><b>RESULTS</b>The mean clinical course in OEIPD patients was 6.2 +/- 3.6 years. The majority of the 15 patients were the akinetic type and the akinetic type with tremor (80.0%). In the late stages of disease (4.8 +/- 3.5 year), choking occurred in 12 OEIPD patients who received nasal feeding for an average of 4 months after the occurrence of choking. The most common complication in 12 patients was repeated pulmonary infections with an average rate of 2.9 +/- 1.9. The causes of death were bronchial pneumonia and shock induced by pulmonary infection (11 cases, accounted for 73.3%), acute myocardial infarction (2 cases), one case with cardiac rupture and one case with rupture of aortic aneurysm.</p><p><b>CONCLUSIONS</b>The clinical course was shorter in OEIPD patients. Levodopa therapy should be started early in OEIPD patients. Bronchial pneumonia and infectious shock constitute the major cause of death and choking was one of the main causes of aspiration pneumonia. Nasal feeding should be started as early as possible after the appearance of choking. Silent aspiration can be reduced by teaching the patient to protect the airway by 'supraglottic swallowing'.</p>

A retrospective analysis on papers of geriatric neurological diseases published in Chinese core periodicals in 1992-2001 year / 中华老年医学杂志

Objective A retrospective analysis on papers of geriatric neurological diseases which were published in seven Chinese journals of core periodicals from 1992 year to 2001 year. Methods Ten years of Chinese Journal of Geriatrics, Chinese Journal of Neurology, Chinese Journal of Neurology and Psychiatry, Chinese Journal of Nervous and Mental Diseases, Journal of Clinical Neurology, Journal of Apoplexy and Nervous Diseases, Chinese Journal of Clinical Neurosciences were reviewed and all papers on nervous diseases in the elderly were statistically analyzed. Results In these 7 journals, 231 papers on topics of senile neurological diseases were published in the period of 10 years. Among them, 148(64.1%) papers were published in Chinese Journal of Geriatrics, 28 papers (12 1%) in Journal of Clinical Neurology and 25 papers(10 8%) in Chinese Journal of Nervous and Mental Diseases. In all papers of senile nervous diseases, the cerebrovascular diseases occupied the first place, totally 78 papers accounted for 33 8%; Alzheimer's disease took second place, with 51 papers, accounted for 22 1% and Parkinson's disease was third one, 29 papers, accounted for 12 5%. In the other items of senile neurological diseases, there were multiple system atrophy in the elderly, myasthenia graves in the elderly, epidemiological and clinical characteristics of senile depression, epilepsia in the elderly, facial nerve paralysis in the elderly, senile traumatic intracranial hematoma and severe head trauma, etc. Conclusions Chinese Journal of Geriatrics is main carrier for publishing the papers of senile neurological diseases. The main published articles were in following orders: cerebrovascular disease, Alzheimer's disease and Parkinson's disease. It indicates that these 3 diseases are the important risk illnesses for the health of the elderly.

Clinical analysis of 32 cases of cerebellar hemorrhage in the elderly / 中华老年医学杂志

Objective To study clinical characteristics and CT features of cerebellar hemorrhage in the elderly patients in order to make early diagnosis and treatment. Methods The clinical characteristics, CT scan, sites and causes of hemorrhage, as well as the treatment and the prognosis of 32 elderly patients with cerebellar hemorrhage were analysed. Results The main clinical symptoms were vomiting, vertigo and headache and were observed in 32(100.0%), 26(81.2%) and 18(56.2%) cases, respectively. High motality rate was observed in hemorrhage volume≥25 ml, patients aged over 70 years and accomanied with cerebral hernia and multi-organ failure. Conclusions The clinical manifestations of cerebellar hemorrhage were not typical in the elderly. Cerebral hernia and multiple organ failure were the main causes of death. Hypertension and artherosclerosis were the main etiologies of cerebellar hemorrhage. The early diagnosis is necessary for the treatment of cerebellar hemorrhage. The prognosis was related to the quantity and site of hemorrhage.

Working memory in patients with Parkinson disease / 中华神经科杂志

Objective To study the working memory changes in patients with Parkinson disease(PD).Methods The Smith working memory software was used and 66 cases of PD patients and 60 normal controls were enrolled.Results The results showed that the correct rate of visuo-spatial working memory was significantly decreased (P0.05) working memory impairment found in PD patients. The correct rate of visuo-spatial and visuo-object working memory in the middle stage of PD was significantly decreased than that in the early stage. The relative analysis showed that the Hoehn-Yahr stage, a negative relationship to the correct rate of visuo-spatial and visuo-object working memory.Conclusion Spatial working memory impairment without object shape and the color working memory impairment were found in the early stage of PD. As disease advanced both the visuo-spatial and object shape working memory deficits were found exacerbated.

Study on mirror writing in elderly patients with senile dementia and vascular dementia / 中华老年医学杂志

Objective To study the mirror writing in elderly patients with senile dementia and vascular dementia. Methods Thirty-three senile dementia patients and 30 vascular dementia patients were studied. Age- and education-matched 63 healthy elder people were included in control groups. Ten items for determination of handedness, Mini Mental Status Examination(MMSE), Global Deterioration Scale (GDS) and the written language of Chinese Aphasia Examination Scale(draft) were adopted to examine all patients. Hachinski Ischemic Scale was used for differentiation between senile dementia and vascular dementia. Results Seventeen (51.51%) of senile dementia patients and 23 (76.60%) of vascular dementia patients were mirror writiers. In the corresponding control groups, these numbers were found to be 2(6.06%) and 7 (23.30%) respectively. The occurrence rate of mirror writing in senile dementia group and vascular dementia group was markedly higher than in the normal controls(P

The fourth long-term follow-up study of 72 patients with transient ischemic attacks / 中华老年医学杂志

Objective　 In order to observe the long-term follow-up of 72 patients with transient ischemic attack（TIA），including the recurrence of TIA after the first attack, occurrence of complete stroke and myocardial infarction, fatality rate, causes of death, and the survival rate in each year and its 95% confidence interval, and to evaluate the clinical significance of neurovascular surgical indication.　Methods　 Seventy-two patients with TIA collected from 1959 to 1977 were followed up by means of face-to-face communication with the patients themselves or their families till 1998. And those aspects mentioned above were analyzed with the methods of cohort study, life table and other medical epidemiological statistics. 　Results　 The recurrent rate of TIA in 72 patients was 27.9%, and the occurrence rate of complete stroke 65.7%, and that of the myocardial infarction and the fatality 8.4% and 72.7%, respectively. There were 2(3.8%) patients died of myocardial infarction. It was showed from the study that the main cause of death was complete stroke, accounting for 59.6% of all dead patients, with the first cause in non-elderly patients was cerebral hemorrhage and that in the elderly patients was cerebral infarction. The 20-year survival rate was 39.9% and its 95% confidence interval was (28.4%，51.4%). Nineteen cases had the indication of neurovascular surgical operation, accounting for 26.6% of all 72 patients. 　Conclusions　 In the long-term follow-up study, the prognosis of patients with TIA was better than that of those with cerebral infarction. About one third of patients had the recurrence of TIA. The occurrence rate of the complete stroke was obviously higher than that of the myocardial infarction. It was considered that neurovascular surgical operation for preventing the happening of complete stroke in patients with TIA was limited.

Dispersible formulation of levodopa-benserazide in treatment of 204 parkinson disease: a multicenter study / 中国新药与临床杂志

AIM: To study the efficacy and safety of dispersible formulation of levodopa-benserazide on the parkinson disease.　METHODS: The multicenter, open-label, self-controlled trial was conducted at 23 hospitals in 15 cities. Two hundred and four patients with idiopathic parkinson who had received standard levodopa-benserazide previously participated in this study. Dispersible levodopa-benserazide instead of standard levodopa-benserazide for 8 wk as a course. The Webster rating scale and patient diary were applied to assess the efficacy and safety of dispersible levodopa-benserazide.　RESULTS： The medication with dispersible levodopa-benserazide increased “on” time by 47 min, decreased “off” time by 11 min, and speeded the onset of “on” time by 37 min. The Webster score was improved by 25 %. Statistical significant difference was calculated (P<0.01). Slight and few adverse reactions were found.　CONCLUSION: Dispersible formulation of levodopa-benserazide is a powerful anti-parkinsonian drug characterized by oral easy use and rapid reach to therapeutic action after ingestion. This drug is particularly used in the parkinsonian patients with morning akinesia, delayed onset of “on” time, afternoon “off” status and dysphagia.

A clinical study of Yangxueqingnaokeli in preventive treament of migraine / 中华神经科杂志

Objective To investigate the therapeutic efficacy and adverse-events of Yangxueqingnaokel i (main composition includes Chinese angelica, ligusticum wallichii, Paconia lac tiflora, Asarum sieboldii, etc) in patients with migraine. Methods One hundred and twelve patients with migraine with an average age of 38.1?9.8 years( ranging from 19～75) were investigated in a multicenter, doub le-blind, randomized, controlled and perspective study. Results (1) The total number an d total duration of migraine attacks were markedly decreased in therapeutic group of Yangxueqingnaokeli than those in placebo group, 3.1?2.5 and 4.2?2.7 ( Z=2.1 6, P=0.03); 31.0?48.0 and 51.2?73.8(Z=2.86, P=0.004), respe ctively. (2) The to tal decrease rate of migraine attacks (%) of therapeutic group and placebo group were 4.9?0.3 and 3.0?0.5(Z=5.76,P

A randomized,placebo-controlled,double-blind,parallel-group trial of entacapone in patients with fluctuating Parkinson's disease / 中华神经科杂志

Objective To study the efficacy and safety of entacapone as an adjunct to levodopa treatment in pakinsonian patients with wearing-off motor fluctuations. Methods A total 209 pakinsonian patients with end-of-dose deterioration participated in a multi-center,12-weeks randomized,placebo-controlled,double blind,parallel-group trial.The efficacy of entacapone was assessed using the patient’s diary card,the Unified Parkinson’s Disease Rating Scale (UODRS) score,the daily levodopa dosage,and the global assessment of changes.Results 96.2% of the entacapone and 92.4% of the placebo-treated patients completed the study.In 209 cases of the ITT population,in comparison to the placebo-treated patients,entacapone had increased the mean “on” time (h/d) from 7.4?1.8 in base-line to 9.1?2.5 in week 12,decreased the “fof” time (from 6.8?2.2 in base-line to 5.2?2.8 in week 12),improved the motor scores (from 36.7?11.3 in base-line to 30.0?14.4 in week 12),and reduced the levodopa dose (from 589.2?264.3 in base-line to 561.5?248.1 in week 4). The improvement was also evident on impression of successful treatment for 69.9% of neurologists through global change assessment.There was no significant difference in the frequency of dopaminergic adverse events and serious laboratory abnormalities between entacapone and placebo groups.Conclusion The results of this study demonstrate that entacapone,the COMT inhibitor is a safe and effective extender of levodopa treatment for Parkinson’s disease patients with motor flucturations.

The safety and the therapeutic efficacy of ?-dihydroergocriptin in the treatment of Parkinson's disease by multi-center clinical trial / 中华老年医学杂志

Objective To study the therapeutic efficacy of dopaminergic agonists,? dihydroergocriptin(Cripar) by multiple center opened trial Methods Sixty cases of Parkinson's disease were divided into two groups: monotherapy group(27 cases) and combined therapy group(33 cases) The improvement in both groups after therapy was observed Results Patients undergone monotherapy were treated with ? dihydroergocriptin and those undergone combined therapy were treated with combined use of ? dihydroergocriptin and L doparmine All patients after treatment showed improvement of clinical symptoms There were 7 patients (28 0%) in the monotherapy group and 13 patients (39 4%) in the combined therapy group markedly improved Evaluation of therapeutic improvement by modified UPDRS revealed that the average scores was 5 01 in monotherapy group and was 6 39( P

The influence of low-dose aspirin on the platelet aggregation in the elderly patients with ischemic cerebrovascular diseases / 中华老年医学杂志

Objective To observe the efficacy of low dose aspirin(ASA) on the platelet aggregation in aged patients with ischemic cerebrovascular diseases(ICVD). Methods Platelet aggregation by arachidonic acid(AA, 500 ?g/ml), adenosine diphosphate (ADP,5 ?mol/L), epinephrine(EPI, 5 ?mol/L), and collagen (COL,2 ?g/ml) using Born's method was induced in 70 elderly with ICVD treated with ASA (40 mg/d) and in 30 untreated patients as well as in 50 healthy controls. Results A high coefficient of variation of the maximum aggregation rate induced by AA, COL and EPI were observed in the ASA (40 mg/d) treated group. Twenty-five out of the 70 patients in the ASA treated group (40 mg/d) were found that their platelet aggregation induced by AA were not markedly inhibited. Ten patients were randomly selected from the above 25 patients to receive an increasing dose to 80 mg/d. At repeated tests, 8 of these 10 achieved marked inhibition, and 2 of the 10 who showed no inhibition continued receiving an increasing dose to 100 mg/d and then achieved marked inhibition. Conclusions There is a great individual variation in response to low dose aspirin in aged patients with ICVD, and the laboratory evaluation of aspirin efficacy and its individualization is necessary in clinical practice.