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.

Post-stroke cognitive impairment, characterized by cognitive dysfunction, is a common complication of stroke and has a direct impact on the quality of life of ischemic stroke patients. Previous studies have found that astrocytes play an important role in the pathogenesis of PSCI. In addition, extracellular vesicles (EVs) have been recognized as an important medium for intercellular communication and are involved in various pathophysiological processes by carrying and transporting various cargoes. Astrocyte-derived extracellular vesicles (ADEVs) may communicate with other brain cells to improve PSCI by enhancing synaptic plasticity, modulating neuroinflammation, regulating angiogenesis and autophagy. This review clarifies the multiple effects of ADEVs on the development of PSCI, offers new strategies for studying the underlying mechanisms of PSCI, and further explores the potential uses of ADEVs as novel drugs and biomarkers in the diagnosis and treatment of PSCI.

Alzheimer's disease (AD) is a common and irreversible neurodegenerative brain disease that severely affects the quality of life and survival of patients, while there is still a lack of effective treatments to delay or stop disease progression. Traditional Chinese medicine (TCM) and its active ingredients have important potential in the prevention and treatment of AD.

To investigate the effects of poric acid (PA) on cognitive impairment and nuclear factor E2-related factor 2 (Nrf2) /solute carrier family 7A11 (SLC7A11) /glutathione peroxidase 4 (GPX4) signaling pathway in AD rats.

Seventy-five male SPF grade SD rats aged 6 to 8 weeks were divided into the control group (Control group), AD Model group (Model group), PA treatment group (PA group) and PA+Nrf2 inhibitor group (PA+ML385 group) by random number table method to prepare AD rat model from January to September, 2022. After successful modeling 50 mg/kg PA was intraperitoneally injected into the PA group, 50 mg/kg PA and 30 mg/kg ML385 was intraperitoneally injected into the PA+ML385 group, and 0.9% sodium chloride solution was intraperitoneally injected into the Control group and Model group. The Morris water maze experiment was performed 24 h after the last dose, and the positioning navigation experiment was carried out on days 2, 4 and 6 to record the time when the rats arrived at the platform (escape latency). The platform was removed on day 7, and the duration of the rats staying on the platform and the number of times they crossed the platform within 120 s were recorded. The pathological changes of hippocampal neurons in each group were observed after Nissl staining. Iron deposition was detected by Prussian blue staining, GPX4 expression and GSH, MDA and Fe²⁺ contents were detected by immunofluorescence staining. The protein expression levels of Nrf2, SLC7A11 and GPX4 in rat hippocampus were detected by Western blotting.

The escape latency of the Model group was higher than that of the Control group and PA group, and escape latency of the PA+ML385 group was higher than that of the PA group at 2, 4 and 6 days after the last administration. The platform residence time and platform crossing times in the Model group were lower than those in the Control group and PA group, and those in the PA+ML385 group were lower than those in PA group, and the difference was statistically significant (P<0.05). The results of Nissl staining showed severe neuronal necrosis, nucleus shrinkage and decreased number of Nissl bodies in the Model group, decreased neuronal necrosis with tight arrangement and increased number of Nissl bodies in the PA group, significantly increased neuronal damage and decreased the number of Nissl bodies in the PA+ML385 group. The Prussian blue staining results showed that iron deposition in the Model group was higher than that in the Control group, iron deposition in the PA group was lower than that in the Model group, and iron deposition in the PA+ML385 was higher than that in the PA group. The results of immunofluorescence staining showed that green fluorescence was weakened and GPX4 positive cells were reduced in the Model group, green fluorescence was enhanced and GPX4 positive cells were increased in the PA group compared with the Model group, and GPX4 positive cells were decreased in the PA+ML385 group compared with the PA group. GSH in the Model group was lower than that in the Control group and PA group, GSH in the PA+ML385 group was lower than that in the PA group. MDA and Fe²⁺ in the Model group were higher than those in the Control group and PA group, and those in the PA+ML385 group were higher that the PA group, and the differences were statistically significant (P<0.05). The relative expression levels of Nrf2, SLC7A11 and GPX4 in the Model group were lower than those in the Control group and PA group, and those in the PA+ML385 group were lower than those in the PA group, and the differences were statistically significant (P<0.05) .

PA can improve the cognitive impairment of AD rats, and its mechanism may be related to the inhibition of iron death by activating Nrf2/SLC7A11/GPX4 signal pathway.

Recent studies have identified a trend toward cognitive decline and even progression to dementia in patients with metabolic syndrome (MetS), and Alzheimer's disease (AD) is the most important subtype of dementia. In reviewing the correlation between cognitive impairment due to MetS and development of AD in previous studies, this paper highlights the growing body of data that supports MetS as a whole as well as its components of hypertension and hyperglycemia as risk factors for AD, whereas insulin resistance, neurologic chronic inflammation, and adipokine disorders play important roles in the pathogenesis. Since there are now no viable treatment alternatives available to stop or reverse the degenerative progression of AD, it is expected to provide scientific evidence for a comprehensive strategy for early prevention and treatment of AD by targeting relatively curable MetS for intervention.

Cognitive impairment can lead to a decline in cognitive function, depression, and loneliness, as well as decreased self-efficacy and quality of life in older adults.

To investigate the effects of non-pharmacological integrated interventions on cognitive function, depression, loneliness, self-efficacy, and quality of life in older adults with mild cognitive impairment.

Based on risk factors for cognitive impairment, a non-pharmacological integrated intervention program was developed in five dimensions of cognitive training, physical exercise, emotional management, social connection, and healthy lifestyle habits. Using a single-subject A-B-A experimental design, a 3-month intervention, which was conducted once a week for 60 minutes, was performed in three elderly individuals with mild cognitive impairment from June to December 2021. The Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale-15 (GDS-15), 12-item Short Form Health Survey (SF-12), General Self-Efficacy Scale (GSES), and De Jong Gierveld Loneliness Scale (DJGLS) were administered to the 3 older adults at baseline, 3 months of the intervention, and 3 months after the intervention, to assess the scores of each scale from the 5 dimensions of cognitive function, self-efficacy, quality of life, depression, and loneliness, the changes in the scores were analyzed. A semi-structured interview was conducted 3 months after the intervention to evaluate the intervention effects in terms of cognitive function, quality of life, depression, self-efficacy, and loneliness dimensions.

The 3 older adults included in the study were 74, 70, 73 years old, all married, living with their spouses and grandchildren. The three older adults had MoCA scores of 21, 22, and 24 at baseline, 28, 26, and 27 at 3 months of intervention, and 25, 19, and 23 at 3 months after intervention; GSES scores were 25, 30, and 27 at baseline, 29, 29, and 30 at 3 months of intervention, and 28, 31, and 28 at 3 months after intervention. SF-12 scores were 69, 32, and 51 at baseline, 81, 81, and 83 at 3 months of intervention, and 78, 38, and 59 at 3 months after intervention. The GDS-15 scale scores were 4, 8, and 2 at baseline, 2, 6, and 1 at 3 months of intervention, and 1, 8, and 4 at 3 months after intervention. The DJGLS scores were 8, 7, and 8 at baseline, 5, 5, and 4 at 3 months of intervention, and 5, 5, and 7 at 3 months after intervention. Semi-structured interview data indicated improvement in all five dimensions of cognitive function, quality of life, depression, loneliness, and self-efficacy of the subjects.

For older adults with mild cognitive impairment, it is of great significance to perform a non-pharmacological integrated intervention in terms of cognitive training, physical exercise, emotional management, social connection, and healthy lifestyle habits. The MoCA, SF-12, GDS-15, and DJGLS scores of older adults with mild cognitive impairment improved at 3 months of intervention, while the GSES scores improved at 3 months after intervention. GSES scores were not as effective after the intervention. All dimension scores showed a decreasing trend at 3 months after the intervention.

China has entered a comprehensive aging society, and stroke is the primary cause of death and disability among adults in China, post-stroke cognitive impairment has become an important cause for long-term disability and quality of life decline in stroke patients.

To analyse and clarify the prevalence and influencing factors of cognitive impairment in elderly stroke patients in China by Meta-analysis.

CNKI, Wanfang Data, VIP, China Biology Medicine disc (CBM), PubMed, Embase, Cochrane Library, and Web of Science were searched by computer to collect cohort, case-control, and cross-sectional studies on influencing factors of cognitive impairment in elderly stroke patients from inception to 2023-02-12. After independent screening of the literature and data extraction by two investigators, the quality of the literature was assessed and a Meta-analysis of the prevalence and influencing factors of cognitive impairment in elderly stroke patients in China was performed using Stata 14.0 software.

A total of 46 papers were included, with 3 281 cases of cognitive impairment and 27 influencing factors involved. The Meta-analysis results showed that the prevalence of cognitive impairment in elderly stroke patients in China was 42.4%〔95%CI (36.6%, 48.3%) 〕; female〔OR=4.167, 95%CI (1.937, 8.967), P<0.001〕, hypertension〔OR=2.824, 95%CI (2.292, 3.481), P<0.001〕, systolic blood pressure〔OR=1.572, 95%CI (1.444, 1.711), P<0.001〕, diabetes mellitus〔OR=3.344, 95%CI (2.611, 4.284), P<0.001〕, hyperlipidemia 〔OR=2.228, 95%CI (1.091, 4.547), P=0.028〕, carotid plaque 〔OR=2.544, 95%CI (1.076, 6.014), P=0.033〕, infarction location of frontal lobe〔OR=1.615, 95%CI (1.167, 2.235), P=0.004〕, infarction location of temporal lobe〔OR=1.739, 95%CI (1.246, 2.427), P=0.001〕, multiple cerebral infarction〔OR=2.583, 95%CI (2.009, 3.321), P<0.001〕, encephalanalosis 〔OR=2.943, 95%CI (1.938, 4.469), P<0.001〕, homocysteine (Hcy) 〔OR=2.209, 95%CI (1.656, 2.948), P<0.001〕, hyperhomocysteinemia〔OR=3.043, 95%CI (2.092, 4.426), P<0.001〕, high-sensitivity C-reactive protein (hs-CRP) 〔OR=4.331, 95%CI (1.756, 10.685), P=0.001〕, and National Institutes of Health Stroke Scale (NIHSS) score >10〔OR=1.977, 95%CI (1.320, 2.961), P=0.001〕 were influencing factors for cognitive impairment in elderly stroke patients in China.

The prevalence of cognitive impairment in elderly stroke patients in China was high (42.4%), and female, hypertension, systolic blood pressure, diabetes mellitus, hyperlipidemia, carotid plaque, infarction location of frontal lobe and temporal lobe, multiple cerebral infarction, encephalanalosis, Hcy, hyperhomocysteinemia, hs-CRP, and NIHSS score >10 were influencing factors for cognitive impairment in elderly stroke patients in China.

Mild cognitive impairment (MCI) is an important stage to intervene and delay the progression of dementia, and it has been shown closely associated with genetic factors, among which apolipoprotein E (APOE) ε4 is recognized as an important risk allele of MCI in the medical field. Due to the lack of Genome-Wide Association Study (GWAS) summary data of MCI, it is common to use the GWAS summary data of Alzheimer's disease (AD) as the base dataset to calculate the polygenic risk score (PRS) of MCI, resulting in suboptimal PRS genetic risk prediction for MCI.

To explore the and optimize the statistical modeling strategy of genetic risk in MCI from the perspective of generalized linear model and machine learning, using meta-polygenic risk score (metaPRS) and APOEε4 as important predictors.

PRS for the 12 MCI-related traits were calculated and integrated into metaPRS for MCI by elastic-net Logistic regression model. SCORE_APOE was calculated by weighting the APOEε4 effect size with age correction. XGBoost, GBM, Logistic regression and Lasso regression were used as statistical modeling methods to verify the inclusion strategies of different predictors based on metaPRS, SCORE_APOE and basic demographic information (age, gender, education level) . AUC and F-measure were used to evaluate the predictive effect of statistical modeling of genetic risk of MCI.

metaPRS and SCORE_APOE have high predictive value for the genetic risk of MCI. After including metaPRS, SCORE_APOE and basic demographic information (age, gender, education level) , the predictive effect of each statistical modeling method is XGBoost (AUC=0.69, F-measure=0.88) , GBM (AUC=0.76, F-measure=0.87) , Logistic regression (AUC=0.77, F-measure=0.89) , and Lasso regression (AUC=0.76, F-measure=0.92) .

When the sample size is 325 (less than 500) , the Lasso regression model constructed by including metaPRS, SCORE_APOE and basic demographic information (age, gender, education level) as predictors has the best effect on MCI genetic risk prediction, providing a new idea and perspective for statistical modeling of genetic risk of complex diseases such as MCI.

Stroke often leads to persistent post-stroke cognitive impairment (PSCI), which mainly manifests as impairment in learning and memory. The pathogenesis remains unclear as present, but it is closely related to mitochondrial dysfunction, and healthy mitochondria are essential for neuronal survival. Recent studies have shown that intercellular mitochondrial transfer can be linked to stroke through increasing neuronal viability, enhancing mitochondrial metabolism, and modulating neuroinflammation, thereby improving cognitive impairment. This review overviews the mechanisms of mitochondrial transfer and the key role of intercellular mitochondrial transfer in PSCI, and discusses that mitochondrial transplantation may serve as a novel therapeutic intervention for PSCI, providing references for its clinical management.

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.

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.

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.

A common complication of stroke patients is post-stroke cognitive impairment (PSCI) , which significantly reduces their quality of life. There are no effective targeted treatment measures currently available for PSCI in clinical practice. A large number of studies have already indicated that the activation of NLRP3 inflammasome plays a crucial role in PSCI, and many inhibitory treatments have been shown to improve cognitive impairment. The purpose of this study was to summarized the activation and modulating factors of NLRP3 inflammatory bodies and the relationship with PSCI. Some studies have been demonstrated that inhibiting NLRP3 or its associated inflammatory body components reduces the inflammatory response, promoting cognitive function recovery in cell and animal models of PSCI. Consequently, targeting NLRP3 inflammatory bodies may be a new trends of dealing with PSCI treatment. Despite the fact that numerous drugs and therapeutic measures have been proved to suppress the activation of NLRP3 inflammatory bodies, their clinical efficacy and safety have not yet been confirmed.

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 prevalence is increasing as aging population grows in China, which greatly affects the quality of life of the sufferers. Currently, the screening forcognitive-linguistic impairment still relies on traditional neuropsychological scales, which are technically demanding, time-consuming, and poorly tolerant.

To explore the feasibility of the Computer-aided Language Assessment System (CLAS) in the measurement of cognitive-linguistic impairment.

Random sampling method was used to recruit 73 participants, among them 55 (75.3%) were stroke/brain injury patients〔with a baseline score of 10-20 on the Mini-Mental State Examination (MMSE) 〕hospitalized in Department of Rehabilitation Medicine, the First Hospital of Jinan University from March 2018 to March 2020, and the other 18 (24.7%) were healthy volunteers (consisting of undergraduate medicalinterns from Jinan University, family members and accompanying caregivers of the patients) . The CLAS, Montreal Cognitive Assessment Scale (MoCA) , MMSE and Aphasia Battery of Chinese (ABC) were used to evaluate the linguistic and cognition functions of the participants. The Spearman correlation was used to assess the correlation of the score of CLAS with that of MoCA and MMSE. A receiver operating characteristic curve (ROC) of CLAS was plotted to estimate its diagnostic value for cognitive-linguistic impairment, with sensitivity, specificity and accuracy being calculated as well. A satisfaction survey was conducted in 18 healthy volunteers to understand their satisfaction with the use of the CLAS.

The total CLAS score was positively correlated with that of MMSE, and MoCA (r_s=0.910, 0.884, P<0.05) .Compared with MoCA (total MoCA score <26) in combination with ABC in diagnosing cognitive impairment, the CLAS had an AUC of 0.733〔95%CI (0.632, 0.834) , P<0.001〕in identifying cognitive-linguistic impairment when the optimal cut-off value was set as 85 points, and the maximum Youden index was obtained, with 1.000 sensitivity, 0.703 specificity, and 0.931 (68/73) accuracy. The average satisfaction score of 18 healthy volunteers was (4.07±0.48) , indicating an overall satisfaction level of "satisfactory".

High participant satisfaction with the CLAS was obtained in this study. And as the CLAS has proven to have good validity and diagnostic accuracy, as well as good performance in identifying cognitive-linguistic impairment, it could be applied to the screening and identification of cognitive-linguistic impairment.

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.

Alzheimer's disease (AD) prevalence is increasing as aging advances worldwide, but its diagnosis is difficult due to atypical early clinical symptoms. Therefore, exploring new and reliable imaging techniques to improve early diagnosis rate of AD has become an important challenge in medical research.

To assess the correlation of amide proton content in brain with clinical symptoms of AD.

41 AD patients over 55 years old in Affiliated Psychological Hospital of Anhui Medical University were enrolled from November 2019 to August 2021, and 37 healthy volunteers were recruited at the same time. The Mini-Mental State Examination (MMSE) and the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) were used to evaluate the cognitive function, and behavioral symptoms, respectively. APTw MRI was used to take cephalograms. Spearman rank correlation analysis was used to explore the relationship between content of brain amide protons and psychiatric symptom factors in AD patients.

(1) The results showed that the MMSE and BEHAVE-AD scores were significantly different between AD patients and healthy controls (P<0.05) . AD patients had significantly increased contents of amide protons in the right, left, and total hippocampus under 2 ut, and in the right, left and total hippocampus under 4 ut, than did healthy controls (P<0.05) . But the contents of amide protons in the left and total hippocampus under 3 ut in AD patients were lower than those in healthy controls (P<0.05) . (2) Spearman rank correlation analysis showed that the content of amide protons in the right hippocampus under 2 ut was positively correlated with the scores of delusional ideation factor (r_s=0.574, P=0.040) and hallucinations factor (r_s=0.595, P=0.032) and diurnal rhythm disturbances factor (r_s=0.591, P=0.033) . Under 3 ut, the content of amide protons in the right hippocampus was positively correlated with the scores of delusional ideation factor (r_s=0.588, P=0.034) and hallucinations factor (r_s=0.572, P=0.041) and diurnal rhythm disturbances factor (r_s=0.650, P=0.016) , whereas content of amide protons in the left hippocampus was negatively correlated with the score of spatial orientation (r_s=-0.590, P=0.034) . The amide proton content in the total hippocampus under 3 ut was positively correlated with scores of delusional ideation factor (r_s=0.625, P=0.022) and hallucinations factor (r_s=0.606, P=0.028) and diurnal rhythm disturbances factor (r_s=0.611, P=0.026) . Under 4 ut, the content of amide protons in the right hippocampus was positively correlated with the score of emotion factor (r_s=0.615, P=0.025) , whereas content of amide proton in the left hippocampus was negatively correlated with scores of temporal orientation (r_s=-0.570, P=0.042) , attention (r_s=-0.570, P=0.042) , and remote memory (r_s=-0.732, P=0.004) . The amide proton content in the total hippocampus under 4 ut was positively correlated with score of emotion factor (r_s=0.580, P=0.038) .

We found that there were abnormal changes in the content of amide protons in the hippocampus of AD patients, which may be related to the patients' cognitive fuction and psychotic symptoms. This study may provide a new idea for clinical diagnosis of AD.

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.

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.

In China, a country owning a large number of hypertensive patients, offline management is still a major approach for hypertension prevention and control, but the efficiency and effectiveness of this approach are unsatisfactory. Therefore, it is necessary to develop a closed-loop hypertension management path using online management approaches actively explored based on cognitive-behavioral models.

To assess the effect of cognitive-behavioral change model-based online health education in the management of hypertension.

A total of 122 essential hypertension outpatients and inpatients were recruited from General Practice Department, General Hospital of Medical University of Ningxia Medical University from November 2018 to October 2019, and randomly divided into online management group (n=61) and off-line management group (n=61) . Off-line management group received routine management. Online management group received online health education (including systematic courses and personalized self-management information in line with the five stages of behavior transformation of hypertension patients provided via the WeChat platform for gradually changing their health-related behaviors) based on the cognition-behavioral change model (a model built upon improved knowledge-attitudes-behavior model, health belief model, and transtheoretical model) . Systolic blood pressure (SBP) and health-related behaviors at baseline and 12 weeks after intervention were compared between the groups.

The average SBP levels at baseline demonstrated no significant difference between the groups (P<0.05) . After intervention, the average SBP level decreased significantly in both groups (P<0.05) , and it decreased more significantly in the online management group (P<0.05) . Two groups showed no significant differences in the prevalence of self-monitoring blood pressure, taking medications, eating a diet and exercising as well as taking actions to improve psychological state according to the doctor's advice at baseline (P<0.05) . After intervention, the prevalence of self-monitoring blood pressure according to the doctor's advice was significantly increased in the online management group (P<0.05) although the prevalence of other four of the above-mentioned health-related behaviors was still similar in both groups (P<0.05) .

This hypertension management approach developed based on mobile health technologies and the cognition-behavioral change model could help general practitioners to effectively manage hypertension patients, which will contribute to the improvement of work efficiency of general practitioners, and the achievement of long-term preservation and real-time analysis of patient management data. So this management is worthy of application and 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.

The Severe Mental Illness Reporting System (SMIRS) has been operated for many years as an important part of mental health monitoring, but its effectiveness needs to be further explored.

To analyze the perceptions of mental health workersfrom municipal-, district- and community-level hospitals in Beijing regarding the importance, main role, effects and problems during the implementation, and improvement measures concerning the SMIRS, providing suggestions facilitating the improvement of the system.

From March to June 2019, a survey was conducted among a convenient sample of 234 mental health workers from municipal-level psychiatric hospitals, and two stratified samples of 397 mental health workers (one sample of 183 cases from district-level psychiatric hospitals, and the other sample of 214 cases from community-level hospitals) , using a questionnaire named Status of the Rule of Mental Health Laws in Beijing for understanding these workers' general information and their perceptions of the SMIRS.

The SMIRS was assessed as "very important" by 56.3% (103/183) of the mental health workers from district-level hospitals and 54.7% (117/214) of those from community-level hospitals, and as "relatively important" by 66.7% (156/234) of those from municipal-level hospitals.The major role of the SMIRS was assessed as "risk warnings for mental illnesses" by 76.9% (180/234) of the mental health workers from municipal-level hospitals and 82.7% (177/214) of those from community-level hospitals, and as facilitating community-based management of mental illnesses by 80.9% (148/183) of those from district-level hospitals. The implementation effectiveness of the SMIRS was evaluated as "relatively good" by 44.4% (104/234) of mental health workers from municipal-level hospitals, 50.3% (92/183) of those from district-level hospitals, and 50.9% (109/214) of those from community-level hospitals. And the number of workers choosing "relatively good" accounted for the highest percentage of the total workers from each kind of hospitals. The major problem during the implementation of the SMIRS was assessed as "involving patient privacy" by 77.8% (182/234) of the mental health workers from municipal-level hospitals, 78.1% (143/183) of those from district-level hospitals, and 83.2% (178/214) of those from community-level hospitals. And the number of workers choosing "involving patient privacy" accounted for the highest percentage of the total workers from each kind of hospitals. "Standardizing the system of information entry, registration, correction, and summary" was chosen as a measure for improving the implementation of the SMIRS by 73.5% (172/234) of the mental health workers from municipal-level hospitals, and 76.6% (164/214) of those from community-level hospitals, while "standardizing the system of information sharing and protection of patients' privacy" was chosen by 68.9% (126/183) of those from district-level hospitals.

The role and implementation effectiveness of the SMIRS have won the approval of mental health workers from municipal-, district- and community-level hospitals. To further improve the implementation of SMIRS with a dual emphasis on risk containment and privacy protection and consideration for patient management services, we put forward the following recommendations: detailing relevant legal provisions; insisting on ensuring patients access to relevant services (including management) , improving the mental health service system, and implementing the essential and major public health service programs; increasing policy publicity to improve the recognition of the system by patients and their families.

Cognitive impairment (CI) is a common complication of chronic heart failure (CHF) , which may significantly increase the risk of poor prognosis, so early identification of associated factors of CI in CHF is of great significance. Although there have been many relevant studies recently, their conclusions are inconsistent.

To perform a systematic review of the influencing factors of CI in CHF.

In August 2021, studies relevant to influencing factors of CI among patients with CHF were searched in databases including PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, PsychINFO, CNKI, Wanfang Data, CQVIP, and SinoMed from inception to August 2021. Two researchers independently screened studies based on the inclusion and exclusion criteria, extracted data, and performed risk of bias assessment using the Newcastle-Ottawa Scale and The Agency for Healthcare Research and Quality methodology checklist, then conducted a descriptive analysis of the factors associated with CI in CHF. RevMan 5.3 was adopted for meta-analysis.

Fourteen studies were included, involving 6 324 cases of CHF, and 1 753 of them also with CI. Descriptive analysis indicated that five factors decreased the risk of CI in CHF, and 22 factors increased the risk, but the influence of sex and systolic blood pressure on CI is still far from inclusive. Meta-analysis demonstrated that education level〔OR=0.45, 95%CI (0.30, 0.70) 〕, age〔OR=1.17, 95%CI (1.10, 1.24) 〕, diabetes〔OR=2.17, 95%CI (1.17, 4.01) 〕, anemia〔OR=3.03, 95%CI (1.80, 5.10) 〕and left ventricular ejection fraction〔OR=0.91, 95%CI (0.88, 0.94) 〕were associated with CI in CHF.

High education level lowered the risk of CI in CHF, while older age, diabetes, anemia and decreased left ventricular ejection fraction increased the risk. Due to limited number and quality of included studies, the above-mentioned conclusion still needs to be verified by more high-quality studies.