Cognitive dysfunction refers to the functional impairment in one or more cognitive domains, mostly occurs in older adults. Cognitive dysfunction can commonly be divided into subjective cognitive decline (SCD), mild cognitive impairment (MCI) and dementia, depending on the degree of cognitive impairment. People with SCD or MCI have a higher risk of dementia, which seriously affects their quality of life, and imposes a huge burden on families and society. Numerous studies have demonstrated that physical activity is one effective non-pharmacological intervention for cognitive dysfunction, but there are no uniform standards for physical activity programs for cognitive dysfunction worldwide, and China still has no physical activity guidelines based on the values and preferences of older adults with cognitive dysfunction, partially impeding the dissemination and application of relevant evidence. In view of this, we developed a guideline containing eight recommendations that is applicable in China, namely the Clinical Practice Guideline on Non-pharmacological Interventions for Older Adults with Cognitive Dysfunction: Physical Activity, by the use of existing evidence, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework combined with values and preferences of Chinese older adults with cognitive dysfunction. This guideline will contribute to the reduction of the incidence of cognitive dysfunction, and preventing or slowing the progression of cognitive dysfunction to dementia.

The number of dementia patients is increasing along with the aging of the population. Dementia greatly impairs health and quality of life of patients, so early prevention and identification are particularly important.

To compare the results of the brief Community Screening Interview for Dementia (CSI-D) and the Mini-Mental State Examination (MMSE) in dementia screening, and to assess the examination consistency of the two scales.

In November 2021, we collected data of a sample of 2 668 middle-aged and elderly people with complete data (including assessment results of CSI-D and MMSE, sex, age, place of residence, education level and marital status) of the CHARLS 2018. The brief CSI-D and MMSE were used to screen the risk of dementia. Pearson correlation analysis was used to analyze the correlation of the scores of the brief CSI-D with those of MMSE. The consistencies of the two scales in the screening of dementia in all cases and subgroups divided by personal characteristics were calculated, the overall consistency was assessed using Kappa statistic.

The average CSI-D score and average MMSE score for all participants were (5.84±2.26) and (24.93±3.24) , respectively. Pearson correlation analysis showed that the brief CSI-D score was positively correlated with the MMSE score (r=0.394, P<0.001) . The overall prevalence of dementia was 27.36% (730/2 668) screened by the brief CSI-D, and was 22.11% (590/2 668) by the MMSE, showing statistically significant difference (χ²=40.167, P<0.001) . The consistency of the two scales in screening dementia in all cases was 20.22%, and ranged from 12.50% to 30.43% in screening dementia in subgroups divided by personal characteristics. Kappa statistic showed that the kappa value between the two scales was 0.121 (P<0.001) , suggesting a weak level of consistency.

In general, there are differences and weak consistency in the screening results of dementia between CSI-D and MMSE in general household population. Therefore, the use of the scales should be analyzed according to the actual situation. The in-depth comparison and discussion on the screening accuracy of the two scales could be further performed in combination with the gold standard for diagnosing dementia.

Handwriting synthesis techniques have been extensively studied in the detection of cognitive impairment in dementia and Parkinson's disease. But handwriting characteristics in older adults with mild cognitive impairment (MCI) still need to be studied further.

To explore the differences between the handwriting characteristics of elderly patients with MCI and normal elderly people, and to assess the value of handwriting features in MCI screening.

By use of convenience sampling, 33 older adults with MCI were recruited from Huzhou communities from January to April 2022 (observation group), and were compared to age-, sex- and education level-matched 43 community-living older adults with normal cognitive function (control group). The General Information Questionnaire, the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment-Basic (MoCA-B), the Activity of Daily Living Scale (ADL), and the 15-item Geriatric Depression Scale (GDS-15) were used to survey subjects. Subjects were invited to complete six handwriting tasks (four are Chinese characters tasks and the other two are graphical drawing tasks) using a dot matrix digital pen to collect their kinematic parameters of handwriting. The classification accuracy, sensitivity and specificity of handwriting characteristics for the diagnosis of MCI were analyzed by discriminant analysis and receiver operating characteristic (ROC) curve, and predictive values of different schemes for MCI were analyzed.

Compared with the control group, the observation group had higher average pressure in writing (Z=-2.122, P=0.034), longer time in air (Z=-4.302, P<0.001), writing time (Z=-3.663, P<0.001) and total time (t'=-5.565, P<0.001), lower average writing velocity (Z=-2.458, P=0.014), horizontal (Z=-2.950, P=0.003) and vertical (Z=-2.094, P=0.040) average writing velocity and maximum horizontal writing velocity (Z=-2.206, P=0.027), lower average acceleration of writing in horizontal direction (Z=-2.667, P=0.008) and overall score for writing correctness (Z=-3.593, P<0.001) in completing graphical drawing tasks. The observation group had relatively longer time in air (Z=-3.464, P=0.001) and total time (Z=-2.940, P=0.003) in completing Chinese characters tasks. Compared with the total time for completing Chinese characters tasks, the total time for completing graphical drawing tasks had higher specificity (93.0% vs 55.8%) in differentiating between MCI and control groups, with an area under the curve (AUC) of 0.828. The summary of handwriting characteristics for graphical drawing tasks correctly classified 80.3% (61/76) of older adults with MCI, with 87.9% sensitivity and 79.1% specificity, and had higher diagnostic efficacy for those with MCI than the MMSE scale (Z=1.993, P=0.046) and the summary of handwriting characteristics for Chinese characters tasks (Z=2.408, P=0.016) .

Handwriting characteristics of graphical drawing tasks may have potential application in screening of older adults at risk for MCI, which can be used simultaneously or prior to sets of neuropsychological tests conducted for the diagnosis of MCI in community health care facilities.

The prevalence of age-related cognitive impairment, including dementia, has significantly increased with population aging. It has been shown that cognitive function is associated with gait status. Previously, researchers used statistical analysis methods instead of machine learning methods to study the gait of amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) .

To develop a model to identify aMCI and AD based on gait status using machine learning methods, explore gait markers differentiating between aMCI and AD, and to assess their possible values as aided tools in diagnosing aMCI and AD.

We recruited 102 cases from the Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation Technical Aids, the First People's Hospital of Foshan, and Affiliated Zhongshan Hospital of Dalian University from December 2018 to December 2020, and included 98 of them according to the screening criteria, including 55 patients with aMCI, 10 patients with AD, and 33 healthy controls (HC) . The gait parameters of the participants were collected during performing single-task (free walking) , dual-task (counting backwards in sevens) and another dual-task (counting backwards from 100) using a wearable device. Random forest (RF) algorithm and gradient boosting decision tree (GBDT) algorithm were separately used to establish a model to compare the effect of two algorithms in recognizing three groups, with 10 gait parameters as predictive variables and the physical status (healthy, aMCI, AD) as response variables. Then important features were chosen using a machine learning algorithm combined with recursive feature elimination (RFE) .

No statistically significant differences were found among the three groups in terms of sex ratio, average age, height, body weight or shoe size (P>0.05) , while the differences in terms of average MMSE score and MoCA score were statistically significant (P<0.05) . In the free walking test, aMCI group and AD group had shorter average stride length and smaller average heel-to-ground angle (HtA) than HC group (P<0.05) . AD group had slower average gait speed and smaller average toe-off angle (ToA) than both HC group and aMCI group (P<0.05) . In performing the dual-task of counting backwards in sevens, compared with HC group, aMCI group and AD group had slower average gait speed and smaller average ToA and HtA (P<0.05) . AD group had longer average stance phase than HC group (P<0.05) . AD group had average smaller ToA than aMCI group (P<0.05) .In performing the dual-task of counting backwards from 100, AD group had slower average gait speed and smaller average HtA and ToA than both HC group and aMCI group (P<0.05) . Moreover, AD group had shorter average stride length than HC group (P<0.05) . The average HtA in aMCI group was smaller than that in HC group (P<0.05) . Using the GBDT-RFE method, we found important gait features in distinguishing between aMCI and AD to be the stride length, ToA and HtA, and the model using the RF algorithm performed better in identifying aMCI and AD, with an accuracy as high as 87.69%.

Stride length, ToA and HtA are important gait markers to identify aMCI and AD. These findings could help clinicians diagnose aMCI and AD in the future.

Cognitive impairment (CI) is highly prevalent in patients with end-stage renal disease (ESRD) , which seriously affects the prognosis of patients. Early identification of its associated factors is of great significance, but there is no agreement as to existing relevant research conclusions, and no relevant systematic reviews conducted with Chinese patients with ESRD.

To systematically evaluate the factors associated with CI in Chinese patients with ESRD.

Databases of PubMed, Web of Science, EMBase, CNKI, WanFangData, CQVIP and CBM were searched from inception to October 2021 for studies (including cross-sectional studies, cohort studies and case-control studies) about associated factors of CI in Chinese ESRD patients (with stage CKD5 defined in the 2002 Kidney Disease Outcomes Quality Initiative, or treatment with peritoneal dialysis or hemodialysis) using subject words in combination with free words as search terms with adjustment by the database feature when necessary. Two researchers independently performed literature screening, data extraction, and methodological quality assessment. Stata 15.0 was employed for Meta-analysis.

In total, 44 studies were included, including 42 172 patients, among which, the cohort studies and case-control studies were rated as high-quality evidence, and the cross-sectional studies as moderate or high-quality evidence. Meta-analysis revealed that older age〔OR=1.17, 95%CI (1.13, 1.22) , P<0.001〕, long duration of dialysis〔OR=1.02, 95%CI (1.00, 1.03) , P=0.008〕, hypertension〔OR=2.02, 95%CI (1.06, 3.86) , P=0.032〕, stroke〔OR=1.93, 95%CI (1.33, 2.80) , P=0.001〕, diabetes〔OR=1.99, 95%CI (1.62, 2.44) , P<0.001〕, high Charlson Comorbidity Index (CCI) 〔OR=5.28, 95%CI (1.48, 18.82) , P=0.010〕, depression〔OR=2.46, 95%CI (1.61, 3.77) , P<0.001〕, high parathyroid hormone (PTH) 〔OR=1.02, 95%CI (1.00, 1.04) , P=0.034〕, high C-reactive protein (CRP) 〔OR=1.20, 95%CI (1.01, 1.42) , P=0.040〕and high Hcy 〔OR=3.34, 95%CI (2.06, 5.42) , P<0.001〕 were associated with increased risk of CI, while male〔OR=0.55, 95%CI (0.37, 0.82) , P=0.003〕, high education level〔OR=0.45, 95%CI (0.37, 0.55) , P<0.001〕, high Hb〔OR=0.91, 95%CI (0.86, 0.95) , P<0.001〕, high serum ALB〔OR=0.77, 95%CI (0.63, 0.94) , P=0.009〕 and high serum creatinine〔OR=0.997, 95%CI (0.995, 0.999) , P=0.003〕were associated with decreased risk of CI.

The current evidence proves that the risk of CI in Chinese patients with ESRD may be increased with older age, long duration of dialysis, hypertension, stroke, diabetes, high CCI, depression, high PTH, high CRP and high Hcy, and decreased with male, high education level, and high Hb, ALB and Cr. However, the conclusion needs to be verified by more high-quality studies due to limited number and quality of included studies.

Lifestyle factors are important modifiable risk factors for cognitive decline and dementia. The lifestyle intervention based on scientific assessment will be an important strategy and an orientation towards the implementation of primary prevention of dementia. So far, there is no special instrument to evaluate whether a lifestyle can help to reduce the risk of dementia in community-living residents.

To develop the Dementia Risk Reduction Lifestyle Scale (DRRLS) and test its reliability and validity, providing an instrument for scientifically evaluating whether a lifestyle is conducive to reducing the risk of dementia in community-living Chinese residents.

The item pool of the DRRLS was created based on the review of related theories of health promotion and literature analysis, then was used to form the initial version of the scale after the revision in accordance with the results of expert consultations and group discussion. After this, the initial version of the scale was pretested in a convenience sample of 30 middle-aged and elderly people in the community in January 2021, and was developed to be a revised version after revising items according to the pretest results. Then from January to October, 2021, the revised scale was tested in a large convenience sample of 506 community-dwelling middle-aged and elderly individuals. After screening items using item analysis of the test results of all 506 cases, exploratory factor analysis and confirmatory factor analysis were carried out with the test results of two randomly subdivided subsamples of the sample, subsample 1 (n=253) and subsample 2 (n=253) , respectively. Finally, the test results of the total sample were used for examining internal consistency and test-retest reliability, and the formal scale was formed eventually.

The formal Dementia Risk Reduction Lifestyle Scale consists of 32 items. Eight common factors were extracted by exploratory factor analysis (Health responsibility, Brain strengthening exercise, Brain healthy diet, mental activity, smoking control behavior, interpersonal relationship, stress management, spiritual growth) , explaining 60.189% variance of the total. Confirmatory factor analysis showed that the goodness-of-fit indices of the formal scale were acceptable: χ²/df=1.657, RMSEA=0.051, GFI=0.852, AGFI=0.819, NFI=0.743, TLI=0.858, IFI=0.880 and CFI=0.876. The content validity index, Cronbach's α, split-half reliability (odd-even) , and test-retest reliability of the formal scale were 0.943, 0.862, 0.909, and 0.864, respectively.

Our scale has been tested with good reliability and validity, which could be used as a suitable instrument for evaluating whether a lifestyle helps to reduce the risk of dementia in middle-aged and elderly people in the community.

Maintaining brain health is an advanced goal of healthy ageing. Eating a diet with appropriate nutrients has been identified as a promising approach to reducing the risk of dementia, but community-dwelling residents have inadequate or no health guidance from medical workers since there is no detailed and comprehensive clinical dietary nutrients management program for brain health promotion for community-dwelling people .

To search, evaluate and summarize the evidence on dietary nutrients management for brain health promotion in community-dwelling people, providing an evidence-based basis for clinical implementation of such management for this group of population.

In March 2022, we searched UpToDate, BMJ Best Practice, JBI Model of Evidence-based Healthcare, National Institute on Aging, Registered Nurses' Association of Ontario, the Cochrane Library, PubMed, CNKI, Medlive and other databases to collect literature (involving clinical decisions, recommended practices, guidelines, evidence summaries, expert consensuses and systematic reviews) regarding dietary nutrients management for brain health promotion in community-dwelling people. The retrieval period was from January 1, 2017 to March 29, 2022. Two researchers systematically trained in evidence-based medicine independently screened literature, extracted data, and evaluated the quality of the included literature. Then evidence was extracted from the included literature, and its quality was graded, then the best evidence was summarized.

A total of 28 studies with an overall high methodological quality were included, including three clinical guidelines, five expert consensuses, one clinical decision and 19 systematic reviews. Finally, 23 pieces of best evidence were summarized, involving seven aspects of intervention timing, dietary nutrients assessment and screening, dietary patterns and components, specific nutrients, coffee intake, body weight management, health education and guidance.

Eating a diet with appropriate nutrients can promote brain health of residents. Community medical workers should develop an individualized dietary nutrients management program for brain health for them in accordance with the practical clinical situation, residents' current dietary nutrients status and preferences, and insights from the best evidence.

Post-stroke mild cognitive impairment (PSMCI) is a common complication after stroke, which negatively affects patients' full recovery from stroke and imposes financial and emotional pressure on their families.

To observe the clinical efficacy of moxibustion on Governor vessel on the cognitive function and TCM syndromes in PSMCI due to deficiency of kidney essence.

Eligible patients with PSMCI (n=60) who were treated in Rehabilitation Center, the First Affiliated Hospital of Henan University of CM from July 2020 to July 2021 were selected, and evenly randomized to a control group (routine basic treatment plus routine cognitive rehabilitation training) and a moxibustion group 〔routine basic treatment plus routine cognitive rehabilitation training and moxibustion on the Governor vessel acupoints (once daily, five times per week) 〕, received four consecutive weeks of treatment. The Mini-Mental State Examination (MMSE) , and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function. Symptoms of kidney essence deficiency was assessed by the Scale for the Differentiation of Syndromes of Vascular Dementia (SDSVD) . And quality of life was measured by the Specifications for Stroke-Quality of Life (SS-QOL) . The overall clinical efficacy and safety of the two treatments were evaluated.

Pre- and post-treatment comparisons of scores of MMSE and MoCA, SDSVD, and SS-QOL revealed that moxibustion group patients group had greater improvements in cognitive function, symptoms of kidney essence deficiency, and quality of life than control group patients (P<0.05) . Moreover, moxibustion group patients had better clinical outcomes (P<0.05) . The safety of treatment showed no significant intergroup differences (P>0.05) .

Moxibustion of the Governor vessel helps to better improve the cognitive function and TCM symptoms of PSMCI patients due to deficiency of kidney essence with good clinical efficacy and safety.

Both frailty and potentially inappropriate medication (PIM) are relatively highly prevalent in adults with mild cognitive impairment (MCI) in the community, but the association of PIM with frailty in MCI population remains to be further explored.

To examine the association between PIM and frailty in older adults with MCI in the community.

This study was conducted between March to July 2021. By use of multistage sampling, older adults with MCI (n=230) were recruited from Baohe District, Hefei City. Sociodemographics, lifestyle indicators and physical functions of the subjects were collected by using the General Information Questionnaire developed by our research team. Frailty was assessed by the Comprehensive Frailty Assessment Instrument. PIM was assessed by the 2017 Criteria of Potentially Inappropriate Medications for Older Adults in China. Logistic regression analysis was applied to analyze the association of the number and types of PIM with frailty.

The prevalence of frailty and PIM in these older adults with MCI was 59.1% (136/230) and 59.1% (136/230) , respectively. The prevalence of PIM in the frailty group was much higher than that of non-frailty group〔80.9% (110/136) vs 27.7% (26/94) 〕 (P<0.05) . Multivariate Logistic regression analysis demonstrated that compared with MCI older adults without PIM, the risk of frailty was 4.591 times higher in those with only one PIM〔95%CI (1.903, 11.076) 〕, and 8.859 times higher in those with two or more PIMs〔95%CI (2.589, 30.321) 〕. Compared with MCI older adults with neurological disease but without PIM, the risk of frailty was 5.310 times higher in those with PIM〔95%CI (1.011, 27.877) 〕. The risk of frailty was 3.108 times higher in those with cardiovascular disease and PIM than that in those without PIM〔95%CI (1.173, 8.241) 〕.

The prevalence of frailty and PIM was higher in older adults with MCI in the community, and PIM was significantly associated with frailty. To decrease the prevalence of frailty and delay the progression of dementia in this population via reducing the prevalence of PIM, community-based health efforts should be made to strengthen the screening for frailty, enhance the identification of frailty related to medication use, and promote medication review and management.

Parkinson's disease (PD) is frequently accompanied with anxiety, depression, sleep disorders, autonomic dysfunction, cognitive impairment, and other non-motor symptoms, among which autonomic dysfunction and cognitive impairment severely impair the quality of life. The relationship between autonomic dysfunction and cognitive impairment in PD is still controversial.

To analyze the characteristic of autonomic dysfunction and its correlation with cognitive impairment in PD patients.

A total of 156 patients with idiopathic PD admitted to Henan Provincial People's Hospital between September 2018 and November 2020 were enrolled. General data of patients, including age, sex, duration of disease, age of onset and years of education, were collected. According to the prevalence and duration of autonomic dysfunction, they were divided into autonomic dysfunction group (AutD group, n=107) and non-autonomic dysfunction group (NAutD group, n=49) . The part Ⅲ of the Unified Parkinson's Disease Rating Scale (UPDRS-Ⅲ) was used to assess motor symptoms. The Hoehn-Yahr (H-Y) scale was used to assess the severity of PD. The non-motor symptoms were assessed by the Non-motor Symptoms Scale (NMSS) . The Hamilton Anxiety Scale (HAMA) and Hamilton Rating Scale for Depression 24-item (HAMD-24) were used to evaluate anxiety and depression symptoms, respectively. The 39-item Parkinson's Disease Questionnaire (PDQ-39) was used to evaluate PD-specific health related quality of life. Autonomic function was evaluated by Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) . Cognitive function was evaluated by Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) . Spearman correlation analysis was used to explore the correlation between autonomic function (assessed using the SCOPA-AUT score) and cognitive function (assessed using the MMSE score and MoCA score) .

Among the 156 patients, 83 were male and 73 were female, with a mean age of (63.9±0.7) years. AutD group had greater mean age (t=-4.391, P<0.001) and longer mean duration of PD (Z=-6.947, P<0.001) than NAutD group. AutD group also had higher mean UPDRS-Ⅲscore (t=-8.967) , higher prevalence of moderate-to-severe PD graded by the H-Y scale (χ²=44.350) , higher mean NMSS score (t=-13.707) , HAMA score (t=-3.665) , HAMD-24 score (t=-4.808) , and PDQ-39 score (t=-11.893) (P<0.001) . Digestive symptoms were the most prevalent symptoms (91.7%) , followed by urinary symptoms (91.0%) , dysregulation of body temperature (59.6%) and cardiovascular symptoms (50.0%) , while pupillary dysregulation (12.2%) and sexual dysfunction (5.1%) were less common. Compared to NAutD group, AutD group had lower mean total score of MMSE (Z=-3.826, P<0.001) , total score of MoCA (Z=-2.921, P=0.003) and the mean score of the naming item (Z=-2.868, P=0.004) , mean domain scores of attention (Z=-2.968, P=0.003) , language (Z=-3.546, P<0.001) , and delayed recall (Z=-2.804, P=0.005) . Spearman correlation analysis showed that, the score of SCOPA-AUT (r_s=-0.214, -0.181) , the score of urinary domain (r_s=-0.245, -0.191) and the score of thermoregulatory domain (r_s=-0.215, -0.225) were negatively correlated with the scores of MMSE and MoCA (P<0.05) .

PD patients with autonomic dysfunction have more severe non-motor symptoms such as anxiety, depression, and cognitive impairment, and lower quality of life. The incidence of autonomic dysfunction in PD is high, involving multiple systems. And the increase in the severity of autonomic dysfunction is associated with increased severity of cognitive impairment.

There is no effective cure for Alzheimer's disease. Early identification of mild cognitive impairment (MCI) and determination of its sensitive warning indicators are current research hotspots.

To explore the relationship between taste recognition decline and cognitive function, and to clarify the value of taste recognition decline in early recognition of MCI.

From July to August 2022, 30 older adults with MCI were recruited from a Nanjing community by convenience sampling method, and were compared to age-, sex-, and years of education-matched 32 healthy controls. The General Information Questionnaire, the Montreal Cognitive Assessment-Beijing Version (MoCA-Beijing), the Mini-Mental State Examination (MMSE), the Activities of Daily Living (ADL), and the Clinical Dementia Rating (CDR) were used to assess demographics, cognitive function, status of activities of daily living, and severity of dementia, respectively. The taste function was examined by the whole mouth test. Correlation analysis and the receiver operating characteristic (ROC) curve were used to determine the value of taste recognition decline in early warning of MCI.

Two groups had no significant differences in average age, gender ratio and average years of education (P>0.05), but significantly differed in the average MoCA-Beijing score and MMSE score (P<0.05). Compared with healthy controls, MCI patients had much lower average scores in overall taste recognition, sweet taste recognition, salty taste recognition and bitter taste recognition (P<0.05). In MCI patients, the overall taste recognition score was positively correlated with overall cognitive function, attention, orientation (r=0.433, 0.540, 0.392, P<0.05), salty taste recognition score was positively correlated with delayed recall ability (r=0.379, P<0.05), bitter taste recognition score was positively correlated with attention (r=0.471, P<0.05), umami taste recognition score was positively correlated with language ability (r=0.408, P<0.05). The AUC of the total score of taste recognition ability in predicting MCI was 0.781, with 0.844 sensitivity, 0.600 specificity, and an optimal cut-off value of 18.5.

Decreased abilities of sweet, salty and bitter recognition were found in MCI patients. The decreased ability of taste recognition was closely related to cognitive function. The decrease in the total score of taste recognition ability may partially predict MCI, and is a key early warning indicator of MCI.

Maintaining brain health is an advanced goal of healthy ageing. As an important intervention to promote brain health and reduce the risk of cognitive impairment, physical activity is highly recommended in the WHO Guidelines on Risk Reduction of Cognitive Decline and Dementia. However, due to the lack of specific guidance on the types of exercise, amount of exercise and intervention methods, it is difficult to carry out physical activity in the community.

To construct a community-based physical activity intervention program to promote brain health in community-dwelling Chinese residents.

A draft of Community-based Physical Activity Intervention Program Promoting Brain Health (CPAIPPBH) was developed in December 2021 based on the evidence extracted from studies searched systematically after being screened and assessed in terms of quality by two researchers independently, and review results of our research group. Then from February to March 2022, the draft was revised in accordance with the results of a two-round email-based Delphi survey with 13 experts, and response rate, authority coefficient, Kendall's W, weight of each indicator, and the logical consistency of indicators at all levels were calculated, and finally the formal version was developed.

Altogether, 26 out of the 8 943 searched studies were enrolled, from which 27 pieces of evidence were summarized, involving target group and principles of physical activity, type of physical activity, intensity and time of physical activity, effect and relevant evaluation of physical activity, and considerations for physical activity. The draft CPAIPPBH consisted of 6 primary indicators and 32 secondary indicators. The response rate, authority coefficient, and Kendall's W were 100.0%, 0.940, and 0.257 (χ²=123.386, P<0.001), respectively, for the first round of survey, and were 100.0%, 0.925, and 0.275 (χ²=139.548, P<0.001), respectively, for the second round of survey. The final program includes 7 primary indicators (including target group and principles of physical activity, pre-intervention assessment, form of intervention, type of physical activity, intensity and time of physical activity, effect and relevant evaluation of physical activity, and considerations for physical activity, with corresponding weights of 0.213, 0.213, 0.213, 0.066, 0.116, 0.116, 0.066, respectively) and 33 secondary indicators. The consistency ratios of primary and secondary indicators were all <0.100 0.

The CPAIPPBH developed by us has proven to be scientific and practical, which could be used to guide the management of community-based physical activity interventions for brain health by community medical workers.

Lifestyle factors are important modifiable influencing factors for cognitive decline and dementia. Understanding the status and influencing factors of community-dwelling middle-aged and elderly adults adhering to the lifestyles conducive to dementia risk reduction will be a basis for medical workers to formulate individualized interventions for primary prevention of dementia, yet there are still few related studies.

To understand the status and influencing factors of dementia risk reduction lifestyle in community-dwelling middle-aged and elderly adults.

Five hundred and six middle-aged and elderly adults (aged 45 years and older) who had received free health check-ups in a community health center were selected from five communities in Chongqing's Shapingba District by convenience sampling from January to October 2021. The self-designed general information questionnaire and the Dementia Risk Reduction Lifestyle Scale (DRRLS) were used to investigate. The level of DRRLS score in the participants was compare by sociodemographic characteristics. Ordinal and multinomial Logistic regression analysis was performed to identify the influencing factors of the levels of DRRLS scores.

The average score of DRRLS was (88.00±13.27). The median scores of items in mental activity and brain-benefiting exercise were at a low level (≤2.00). The level of DRRLS score in the participants varied significantly by gender, age, personal monthly income and experience of receiving dementia-related health education (P<0.05). Ordinal and multinomial Logistic regression revealed that gender, educational level, personal monthly income and experience of receiving dementia-related health education were important influencing factors of the level of DRRLS score (P<0.05) .

In general, the lifestyles for dementia risk reduction were assessed at a moderate level in the community-dwelling middle-aged and elderly adults. In the primary prevention of dementia, the effects of mental activity and brain-benefiting exercise should be emphasized. Moreover, priority in community health management should be given to men, those with a low educational level or no previous experience of receiving dementia-related health education, and relevant health education and preventive interventions should be strengthened for them. All these efforts will urge these adults to adopt a lifestyle for dementia risk reduction and brain health promotion.

China is seeing an increasing number of people suffering from dementia as aging advances and life expectancy prolongs. Early diagnosis is extremely important for dementia.

To understand the attitudes and views of community general practitioners (GPs) regarding dementia screening, providing suggestions for the development of dementia screening in the community.

In July 2021, by use of purposive sampling, GPs were recruited from community health centers (stations) in Lanzhou, Gansu, and invited to attend a semi-structured, in-depth, face-to-face individual interview for understanding their attitudes and views toward dementia screening. The interview results were analyzed using phenomenological analysis and thematic analysis.

Ten GPs from five community health centers and five community health stations were finally enrolled, including five males and five females, with an average age of (46.6±6.5) years〔range (35, 57) 〕, an average years of (14.90±8.46) working as a GP〔range (5, 26) 〕; seven with a bachelor degree; four with a title of attending physician. Three themes were extracted: insufficient basic conditions for carrying out community-based dementia screening, difficulties in carrying out community-based dementia screening, and improvement of community GPs' abilities to participate in dementia screening. Nine subthemes were also extracted.

Community GPs supported community-based dementia screening, but had insufficient capacities to carry out the screening. The following may be effective measures for promoting early screening and intervening dementia: improving the ability of community GPs to screen dementia, strengthening the publicity and popularization of dementia-related knowledge to reduce social discrimination against dementia, and deepening the development of contracted family doctor services.

Expert Consensus on the Management of Cognitive Impairment after Stroke 2021 has made it clear that, post-stroke cognitive impairment (PSCI) prevalence needs to be assessed by cognitive assessment 3-6 months after stroke, but the influencing factors found by existing studies are still controversial and need the support of EBM evidence.

To investigate the influencing factors of cognitive impairment 3 to 6 months after ischemic stroke, to provide an evidence-based reference for the prevention and intervention of PSCI.

We searched databases of the Cochrane Library, PubMed, EMBase, CINAHL, Web of Science, CNKI, SinoMed, VIP and Wanfang Data for cohort studies or case-control studies about influencing factors of cognitive impairment 3 to 6 months after ischemic stroke from inception to December 2020. RevMan5.3 software was used to conduct the Meta-analysis.

A total of 27 studies were finally included, involving 8 677 patients (4 322 with PSCI and the other 4 355 without) . Meta-analysis results demonstrated that, age〔OR=1.10, 95%CI (1.06, 1.14) , P<0.000 01〕, educational level〔OR=0.82, 95%CI (0.78, 0.85) , P<0.000 01〕, hypertension〔OR=2.69, 95%CI (1.90, 3.81) , P<0.000 01〕, diabetes〔OR=1.95, 95%CI (1.58, 2.39) , P<0.000 01〕, atrial fibrillation〔OR=2.92, 95%CI (1.92, 4.45) , P<0.000 01〕, history of stroke〔OR=2.68, 95%CI (1.95, 3.68) , P<0.000 01〕, Fazakas score〔OR=1.86, 95%CI (1.57, 2.21) , P<0.000 01〕, NIHSS score at admission〔OR=1.44, 95%CI (1.17, 1.77) , P=0.000 6〕, hyperhomocysteinemia〔OR=1.08, 95%CI (1.02, 1.14) , P=0.006〕and drinking〔OR=2.85, 95%CI (2.00, 4.04) , P<0.000 01〕 were associated with cognitive impairment 3 to 6 months after ischemic stroke.

Available evidence suggests that, age, educational level, hypertension, diabetes, atrial fibrillation, history of prior stroke, Fazakas score, NIHSS score at admission, hyperhomocysteinemia and drinking may be associated factors of cognitive impairment 3 to 6 months after ischemic stroke. To reduce the incidence of PSCI, individualized rehabilitation program is suggested to made according to the above-mentioned associated factors for PSCI in combination with the patient's details.

Pain is a common non-motor symptom in patients with Parkinson's disease (PD) , which has a serious impact on patients' quality of life. Current scholars have explored the factors influencing the occurrence of pain in patients with PD, but there is some variability in the findings.

To evaluate the influencing factors of pain in PD patients.

We searched the CNKI, Wanfang Data, VIP, SinoMed, Web of Science, PubMed, Medline, Embase and Cochrane Library databases for studies on factors influencing pain in patients with PD from database establishment to April 12, 2022. Two researchers independently conducted literature screening and relevant information extraction. We used the Agency for Healthcare Research and Quality (AHRQ) Scale and the Newcastle-Ottawa Scale (NOS) to evaluate the risk of bias in cross-sectional studies and case-control studies, respectively. We performed a descriptive analysis of all influencing factors of pain, and implemented a meta-analysis of these influencing factors using RevMan 5.3.

Sixteen studies were finally included, with a total sample size of 2 855 cases, and 24 influencing factors of pain identified. There were two protective factors and 22 risk factors in descriptive analysis. The meta-analysis showed that, female〔OR=3.73, 95%CI (1.75, 7.96) , P=0.000 7〕, long duration of PD〔OR=1.35, 95%CI (1.15, 1.60) , P=0.000 3〕, depressed mood 〔OR=1.14, 95%CI (1.07, 1.22) , P<0.000 01〕, high UPDRS Ⅲ score〔OR=1.07, 95%CI (1.03, 1.11) , P=0.000 2〕, advanced Hoehn-Yahr stages〔OR=2.28, 95%CI (1.28, 4.04) , P=0.005〕, and high NMSS score〔OR=1.68, 95%CI (1.46, 1.93) , P<0.000 01〕 were risk factors for pain in PD patients. The GRADE analysis showed that the quality of evidence for the effects of gender and NMSS score on pain was moderate, and that for the effects of duration of PD, depressed mood and UPDRSⅢ score on pain was low, and that for the effect of Hoehn-Yahr stage on pain was very low.

Female, long duration of PD, depressed mood, motor impairment, advanced Hoehn-Yahr stages and other severe non-motor symptoms (sleep disturbance, fatigue) are risk factors for pain in PD patients, which need to be further validated by high-quality, large-sample studies in the future.

The incidence of dementia is gradually increasing in China. Lifestyle is an important modifiable factor for dementia, and the health belief model can be widely used to explain and predict health-related behaviors.

To analyze the impact of dementia prevention beliefs on health promoting lifestyle in Chinese adults, providing a scientific basis for the development of targeted dementia prevention regimens based on the health belief model.

An online survey was used for collecting data including sociodemographics, dementia-related knowledge and prevention beliefs as well as health promoting lifestyle level of 1 202 Chinese adults using a self-developed electronic questionnaire〔consisting of general information questionnaire, dementia prevention knowledge questionnaire (DPKQ), Chinese version of the Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR) scale, and Chinese version of the revised Health Promoting Lifestyle ProfileⅡ (HPLP-Ⅱ R) 〕from February to March 2020. Multiple linear regression was used to analyze the effect of dementia prevention beliefs on health-promoting lifestyle.

A total of 1 201 cases returned responsive questionnaires, with a response rate of 99.92%. The average score of DPKQ of the respondents was (7.46±2.85), and the rate of correctly answering the questions in DPKQ was 67.82%. The average total score and average item score of the MCLHB-DRR in the respondents were (92.67±12.68), and (3.43±0.47), respectively. The average total score of HPLP-Ⅱ R was (100.00±15.81). The HPLP-Ⅱ R scores were affected by five domain scores of the Chinese version of MCLHB-DRR (perceived susceptibility, perceived benefits, perceived barriers, self-efficacy and general health motivation), the total score of DPKQ, living area (rural or urban), education level and the history of contacting with dementia patients.

The health promoting lifestyle of adults is partially affected by partial dimensions of dementia prevention beliefs and some sociodemographic characteristics. Therefore, health care workers can provide preventive interventions for adults to prevent dementia based on the relationship between the health belief model and health-related behaviors.