Special Issue:Dementia
Prevalence and Distribution Trends of Mild Cognitive Impairment among Chinese Older Adults：a Meta-analysis
Mild cognitive impairment (MCI) has become a major disorder affecting the quality of life of Chinese older adults, a rapidly increasing population. Understanding MCI prevalence in this population is important for promoting healthy ageing, but there is a lack of comprehensive reports on MCI prevalence in a large national sample of older adults in the past decade.
To examine the trends of MCI prevalence and geographical distribution in Chinese older adults in the past 10 years, providing data support for further research on public service policies for the elderly.
In January 2021, we searched for studies about MCI prevalence in Chinese older adults published from January 2010 to December 2020 from databases of SinoMed, CQVIP, Wanfang Data, CNKI, PubMed, Ovid, SpringerLink, and EmBase, and extracted data regarding MCI prevalence from the eligible ones, then chose effects models with indicators based on the within-study heterogeneity.
A total of 47 studies were included, involving 137 599 samples. The overall prevalence of MCI in Chinese older adults in the last decade was 19%〔95%CI (17%, 21%) 〕. Demographic analysis showed the following results: the MCI prevalence was 17%〔95%CI (15%, 19%) 〕 and 19%〔95%CI (17%, 21%) 〕 for men and women, respectively, 16%〔95%CI (11%, 22%) 〕 and 23%〔95%CI (16%, 30%) 〕 for urban and rural areas, respectively, 16%〔95%CI (14%, 19%) 〕 and 24%〔95%CI (20%, 28%) 〕for those living with a spouse and without, respectively, and 13%〔95%CI (9%, 17%) 〕, 12%〔95%CI (9%, 15%) 〕, 17%〔95%CI (13%, 20%) 〕, 26%〔95%CI (20%, 31%) 〕, 33%〔95%CI (24%, 42%) 〕and 42%〔95%CI (22%, 62%) 〕 for those at 60-64 years, 65-69 years, 70-74 years, 75-79 years, 80-84 years, 85 and above, respectively. Besides this, MCI prevalence showed a trend of decrease with the increase of education level: 30%〔95%CI (25%, 35%) 〕 in those with little education (<1 year of education) , while 10%〔95%CI (7%, 13%) 〕 in those with university education (>12 years of education) . Spatial distribution trend: prevalence varied significantly between provinces (autonomous regions/municipalities) (15%-37%) and between northern, northwestern, eastern, south-central, southwestern parts of China (17%-22%) . Temporal distribution trend: the prevalence showed an increasing trend in the last decade (11%-28%) .
The prevalence of MCI in Chinese elderly population showed an increasing trend from January 2010 to December 2020, with differences across provinces (autonomous regions/ municipalities) and 5 geographical regions. In addition, the prevalence was higher in the female, less educated, older, rural, and spouseless groups.
Quality Assessment of Guidelines forVascular Cognitive Impairment Using the AGREEⅡ
As the second primary type of cognitive impairment worldwide, vascular cognitive impairment (VCI) is closely associated with cerebrovascular risks, which imposes a heavy burden on the society and families. Early diagnosis and treatment are important for intervening and reversing VCI. And formulating high-quality clinical guidelines is an effective way to improve diagnosis and treatment levels of VCI.
To assess the quality of guidelines for VCI, aiming at offering support for making clinical decisions for VCI.
From August to November 2021, we searched literature databases and websites in China and abroad to identify guidelines for VCI, and assessed them using the Appraisal of Guidelines for Research & Evaluation (AGREE) Ⅱ.
A total of 18 guidelines were enrolled, 12 of which are Chinese guidelines and 6 are foreign guidelines; 9 of which are evidence-based guidelines, and the other 9 are not. The intraclass correlation coefficient was 0.935, indicating a high degree of agreement between raters. The overall quality of these guidelines was relatively low, since in the six domains, only the average score of Clarity of Presentation was greater than 60% (64.04%) , and the average scores of Scope and Purpose (52.31%) and Editorial Independence (42.01%) were between 30% and 60%, and those for other three domains, Stakeholder Involvement (27.24%) , Rigor of Development (20.05%) and Applicability (13.83%) , were all less than 30%. The grade of recommendation for 6 guidelines was B, and that for other 12 guidelines was C.
The overall quality of the included guidelines was rated relatively low, especially their average score for each of the three domains, Stakeholder Involvement, Rigor of Development, and Applicability, was below the average level. It is suggested to enhance the quality of VCI guidelines via improving the details of guidelines strictly under the evidence-based principle.
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.
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.
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.
Effect of Cognitive Behavioral Therapy with Virtual Reality in the Treatment of Insomnia in Adolescents
The number of adolescents with insomnia is increasing in recent years. Cognitive behavioral therapy (CBT) is traditional treatment for this disease, but has some limitations. Virtual reality technology (VRT) is a novel treatment, but there is a lack of research on its effect on this disease.
To explore the effect of CBT with VRT on adolescents with insomnia.
Adolescents with insomnia were selected from Hangzhou Seventh People's Hospital from April 2020 to June 2021, and randomized into a control group (treated with CBT) and a test group (treated with CBT and VRT) . Sleep quality was measured in both groups at admission and four weeks after admission using the Pittsburgh Sleep Quality Index (PSQI) .
77 patients with adolescent insomnia were initially included, 15 cases of shedding were removed (12 in the control group and 3 in the test group) , and finally 62 cases were included, including 32 in the control group and 30 in the test group. After treatment, the test group had mean lower scores of four domains (overall sleep quality, sleep latency, duration of sleep, sleep efficiency) and mean total PSQI score than that of the control group (P<0.05) . But the mean scores of other three domains, sleep disturbance, need meds to sleep and day dysfunction due to sleepiness, were similar in the two groups (P>0.05) . The overall response rate of the test group was higher than that of the control group (P<0.05) . The patient treatment satisfaction rate of the test group was also higher than that of the control group (P<0.05) .The failure rate of the test group was lower than that of the control group (P<0.05) .
Adolescents with insomnia showed good response to and high satisfaction with CBT in combination with VRT. The therapy could notably improve the sleep quality of such patients, so its clinical application will be promising.
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.
Latest Research on the Neuroprotective Mechanism of Short-chain Fatty Acids in Stroke and Its Relation with Post-stroke Cognitive Impairment
Post-stroke cognitive impairment is one of the common complications of stroke, seriously affecting patients' ability to perform activities of daily living. Recent studies about microbiota-gut-brain axis have found that gut microbiota and their metabolites play an important role in the development of neurological diseases. Short-chain fatty acids, the main metabolites of gut microbiota, are key transmitters of gut-brain communication, which have a neuroprotective effect in stroke, yet the mechanism of action is not fully clear. This paper presents a review of the neuroprotective mechanism of short-chain fatty acids in stroke, and its relation with post-stroke cognitive impairment, providing evidence for studying the pathogenesis and treatment of stroke.
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.
With the deepening and acceleration of the aging process, an increasing prevalence of mild cognitive impairment (MCI) is found in China's elderly population. To reduce MCI prevalence in this group, early screening and diagnosis are approaches having great social significance. To provide support for the choice of appropriate tools for early screening and identifying MCI in community-dwelling Chinese older adults, we comprehensively reviewed the commonly used scales in clinical MCI screening and assessment〔Informant Questionnaire on Cognitive Decline in the Elderly Individuals (IQCODE) , Cambridge Neuropsychological Test Automated Battery, Montreal Cognitive Assessment, Clock Drawing Test, Clock Reading Test, Clock Setting Test, Consortium to Establish a Registry for Alzheimer's Disease, Ascertain Dementia 8 (AD8) , Addenbrooke's Cognitive Examination-Revised (ACE) , and General Practitioner Assessment of Cognition〕, and put forward a strategy after analyzing the advantages and disadvantages of each of the above-mentioned scales, namely, combined use of the quick and highly effective AD8, IQCODE, and the sensitive and comprehensive ACE, for these three scales may make up for each other's shortcomings when they are used together.
Research Progress on the Relationship between Osteoporosis and Cognitive Impairment
In recent years, studies have shown that among elderly comorbidities, the incidence of comorbidity between osteoporosis and cognitive impairment is increasing year by year, which is manifested as a high incidence of falls and an increased risk of fractures, which leads to disability, increased mortality, and serious harm to health and quality of life of patients with comorbidities also bring a heavy economic burden to the family and society, which has become a more difficult problem in the management of chronic diseases in the community. This article reviews the progress of the relationship between osteoporosis and cognitive impairment. The focus is on the co-morbidity mechanism, clinical risk factors and clinical features of co-morbidity between osteoporosis and cognitive impairment. It is found that osteoporosis is closely related to cognitive impairment and seriously endangers the health of the elderly. It is hoped that this article can provide ideas for exploring new risk factors for comorbidity of osteoporosis and cognitive impairment, and provide help for the effective prevention and management of patients with comorbidity of osteoporosis and cognitive impairment.
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 (rs=0.574, P=0.040) and hallucinations factor (rs=0.595, P=0.032) and diurnal rhythm disturbances factor (rs=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 (rs=0.588, P=0.034) and hallucinations factor (rs=0.572, P=0.041) and diurnal rhythm disturbances factor (rs=0.650, P=0.016) , whereas content of amide protons in the left hippocampus was negatively correlated with the score of spatial orientation (rs=-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 (rs=0.625, P=0.022) and hallucinations factor (rs=0.606, P=0.028) and diurnal rhythm disturbances factor (rs=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 (rs=0.615, P=0.025) , whereas content of amide proton in the left hippocampus was negatively correlated with scores of temporal orientation (rs=-0.570, P=0.042) , attention (rs=-0.570, P=0.042) , and remote memory (rs=-0.732, P=0.004) . The amide proton content in the total hippocampus under 4 ut was positively correlated with score of emotion factor (rs=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.
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.
Developments in the Role of Iron Imbalance in the Pathogenesis of Alzheimer's Disease
Iron load is closely associated with the initiation and progression of Alzheimer's disease (AD) . Although age-dependent deposition of β-amyloid (A β) in senile plaques (SPs) , and neurofibrillary tangles (NFTs) formed by accumulation of hyperphosphorylated tau proteins are two major pathological features of AD, there are still many different views on the inducing factors of SPs and NFTs. We reviewed the new developments in the relationship between imbalance of brain iron homeostasis and the pathogenesis of AD, with a summary presented as follows: (1) Age-related iron deposits in different brain regions may damage normal cognitive function and behavior. (2) Iron imbalance and oxidative stress may together or independently promote Aβ overproduction by activating β- or γ-secretases and inhibiting α-secretase, and also cause tau hyperphosphorylation by activating protein kinases, such as glycogen synthase kinase-3β, cyclin-dependent protein kinase-5, and inhibiting protein phosphatase 2A. Iron imbalance-induced changes will in turn aggravate brain iron deposition and distribution. The vicious circle between iron imbalance and Aβ/tau anomalies may eventually lead to AD. (3) Iron overload may also directly or indirectly injure organelles, causing endoplasmic reticulum stress, mitochondrial and autophagy dysfunction, and damaging synaptic function via inducing or aggravating the aggregation or accumulation of A βand tau. At the same time, hydroxyl radicals produced via the Fenton reaction associated with abnormal iron metabolism, may trigger oxidative stress, destroy the structure and function of cell lipids, protein and DNA, eventually leading to cell death. (4) Given the limitations and side effects of long-term application of traditional iron chelators, alpha-lipoic acid and lactoferrin as self-synthesized naturally small molecules, are expected to be applied to clinical practice, for they have shown very intriguing biological activities in blocking Aβ-aggregation, tau hyperphosphorylation and neuronal damage. We believe that iron-targeted therapies are a promising direction for the treatment of AD.
Chronic cerebral hypoperfusion-induced cognitive impairment (CCHCI) is a cognitive deficit caused by cerebral cortex or subcortical infarction, white matter degeneration, blood-cerebrospinal fluid barrier, and hippocampal injury due to long-term hypoperfusion of the brain. Clinical evidence shows that there is still no effective pharmacological treatment for CCHCI. But numerous animal studies have demonstrated that enriched environment can alleviate brain tissue damage caused by chronic hypoperfusion and promote nerve growth and functional recovery in ischemic brain areas. We reviewed the latest advances in the use of enriched environment as a non-drug intervention for CCHCI in animal models via regulating autophagy and epigenetic mechanisms to inhibit oxidative stress, protect the blood-cerebrospinal fluid barrier, promote neurovascular reconstruction and stimulate synaptic plasticity. We hope the review could provide new ideas for the treatment and clinical research of CCHCI to reverse CCHCI-induced neurological impairment and improve cognitive impairment.
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 (rs=-0.214, -0.181) , the score of urinary domain (rs=-0.245, -0.191) and the score of thermoregulatory domain (rs=-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.
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.
Physicians' Perspective on Shared Decision-making：a Qualitative Study
Shared decision-making has promoted the transformation of the role of patients from passive recipients of health care to active participants and supervisors, deeply reflecting the idea of patient-centered care. Research on shared decision-making in China is still in its infancy. Physicians are major participants in decision-making, but their perspectives on shared decision-making have been rarely studied.
To explore physicians' perspective on shared decision-making, offering evidence for the implementation of shared decision-making.
From May to July 2020, we conducted semi-structured interviews with 15 physicians selected by convenience sampling method from a grade A tertiary hospital in Shanghai for investigating their actual decision-making process, their views and attitudes about shared decision-making, and the obstacles to clinical implementation of shared decision-making. The interview results were analyzed by Colaizzi's method of data analysis.
Among the 15 physicians, 10 were male and 5 were female; aged 28-53 years old, with an average age of (38.4±7.0) years old; 4 residents, 5 attending physicians, 4 associate chief physicians, and 2 chief physicians; 5 physicians, 7 surgeons and 3 oncologists. Four themes including 15 subthemes were identified: differences in physicians thederstanding of policies related to shared decision-making; unclear understanding of physicians and patients' roles in shared decision-making; acknowledging the importance of shared decision-making; obstacles to clinical implementation of shared decision-making.
Our study suggests that improving physicians' understanding level of shared decision-making, and creating conditions facilitating clinical implementation of shared decision-making may promote the sound development of shared decision-making.
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.
Progression and Reversion of Mild Cognitive Impairment：a Study Using Data from the Uniform Data Set
Mild cognitive impairment (MCI) has highly variable cognitive trajectories. Approximately 10% to 15% of MCI patients progress to dementia, and nearly 24% revert to normal cognition each year. There are few studies on the progression and reversion of MCI, especially there version of MCI to normal cognition.
To construct a multi-class classification model of MCI outcomes (reversion, stabilization and progression) and to explore the possible associated factors of these outcomes.
Data were collected from the National Alzheimer's Disease Coordinating Center Unified Data Set, involving 397 patients who were initially diagnosed with MCI during 2005—2019 with at least two follow-ups and complete clinical and follow-up data. Patients' demographic information, physical examination, disease history, and measurement results by assessment scales in MCI were selected for analysis. Boruta was used for feature selection. Random forest was used for supporting the classification of MCI outcomes. A stepwise multinomial logistic regression was used to explore the associated factors of different MCI outcomes.
Of the 397 cases, 124 (31.23%) reverted to normal cognition, 77 (44.58%) were in stable condition, and 96 (24.18%) progressed to dementia. In the multi-classification task, the accuracy of direct three-class classification was 67.58%. In multiple binary classifications, the accuracies of reversion and stabilization, and reversion and progression were above 90%. Among the hierarchical three-class classification, the accuracy based on stabilization→ reversion → progression was 84.38%. Stepwise multinomial Logistic regression analysis showed that age ≥80 years 〔OR=0.260, 95%CI (0.117, 0.574) 〕, self-reported cognitive impairment 〔OR=0.295, 95%CI (0.139, 0.623) 〕, and decreased Clinical Dementia Rating (CDR) scores〔OR=0.220, 95%CI (0.092, 0.525) 〕 were associated with decreased risk of MCI progressing to dementia, while history of stroke 〔OR=2.896, 95%CI (1.370, 6.122) 〕, fecal incontinence 〔OR=6.556, 95%CI (1.787, 24.047) 〕, and higher Functional Activities Questionnaire score〔OR=1.048, 95%CI (1.003, 1.095) 〕were associated with increased risk of MCI progressing to dementia. Decreased probability of reversion from MCI to normal cognition was related to age ≥80 years 〔OR=0.289, 95%CI (0.091, 0.914) 〕, obesity 〔OR=0.236, 95%CI (0.075, 0.740) 〕, self-reported cognitive impairment 〔OR=0.289, 95%CI (0.111, 0.757) 〕, and higher CDR scores 〔OR=0.015, 95%CI (0.003, 0.089) 〕, while increased probability of reversion from MCI to normal cognition was related to higher MMSE score 〔OR=1.708, 95%CI (1.428, 2.043) 〕 and higher numbers of correct naming of animals 〔OR=1.139, 95%CI (1.046, 1.240) 〕.
The outcome of MCI patients is affected by multiple factors. Advanced age, obesity, history of stroke, fecal incontinence, self-reported cognitive impairment and reduced functional activity were important factors influencing MCI progression and reversion.
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.
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.
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 (rs=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.
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.
Special Issue:Dementia
