Integrating repetitive transcranial magnetic stimulation and Mediterranean diet for cognitive and anxiety improvement in early Alzheimer's disease: A case report and literature review

Background Severe Alzheimer's disease (AD) is characterized by significant neuropsychiatric symptoms and sleep disorders, with limited effectiveness of conservative drug treatments. Deep brain stimulation (DBS) offers a potential alternative. Objective To evaluate the efficacy, safety, and long-term outcomes of DBS versus conservative treatment in patients with severe AD. Methods We retrospectively analyzed 40 patients with severe AD diagnosed at the People's Liberation Army General Hospital from 2015 to 2022. Twenty patients received DBS, and twenty received conservative treatment. Treatment effects were assessed using standardized scales at three- and twelve-months post-treatment. Primary outcomes included changes in cognitive function [Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Alzheimer's Disease Rating Scale-Cognitive subscale, Clinical Dementia Rating). Secondary outcomes included quality of life, sleep quality, neuropsychiatric symptoms, and caregiver burden (Barthel Index, Functional Activity Questionnaire, Functional Independence Measure (FIM), Neuropsychiatric Inventory (NPI), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Pittsburgh Sleep Quality Index (PDQI), Zarit Burden Interview (ZBI)]. Results DBS patients showed significantly greater improvements in MMSE, MoCA, FIM, and ZBI scores than controls, suggesting improved cognitive function and quality of life, and reduced caregiver burden (p < 0.05). Notably, DBS significantly reduced HAM-A, HAM-D, and PSQI scores, and improved NPI scores more than controls, indicating significant amelioration of neuropsychiatric symptoms and sleep disorders (p < 0.05). Conclusions DBS is a safe and reversible treatment that potentially enhances cognitive function and quality of life in severe AD patients and alleviates caregiver burden. For the first time, we report that DBS also improves neuropsychiatric symptoms and sleep disorders, highlighting its clinical potential in AD.

Background and objectives: Alzheimer’s disease is a progressive brain degeneration and is associated with a high prevalence of sleep disorders. Amyloid β peptide-42/40 (Aβ42/40) and Tau-pT181 are the core biomarkers in cerebrospinal fluid and blood. Accumulated data from studies in mouse models and humans demonstrated an aberrant elevation of these biomarkers due to sleep disturbance, especially sleep-disordered breathing (SDB). However, it is not clear if sleep quality improvement reduces the blood levels of Ab42/40 ratio and Tau-pT181 in Alzheimer’s disease patients. Materials and Methods: In this prospective study, a longitudinal analysis was conducted on 64 patients with mild–moderate cognition impairment (MCI) due to Alzheimer’s disease accompanied by SDB. Another 33 MCI cases without sleep-disordered breathing were included as the control group. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) score system. Neuropsychological assessments were conducted using the Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), Clinical Dementia Rating (CDR), 24-h Hamilton Rating Scale for Depression (HRSD-24), and Hamilton Anxiety Rating Scale (HAMA) scoring systems. Aβ42, Aβ40, and Tau-pT181 protein levels in blood specimens were measured using ELISA assays. All patients received donepezil treatment for Alzheimer’s disease. SDB was managed with continuous pressure ventilation. Results: A significant correlation was found among PSQI, HRSD-24, HAMA, Aβ42/40 ratio, and Tau-pT181 level in all cases. In addition, a very strong and negative correlation was discovered between education level and dementia onset age. Compared to patients without SDB (33 non-SD cases), patients with SDB (64 SD cases) showed a significantly lower HRSD-24 score and a higher Aβ42/40 ratio Tau-pT181 level. Sleep treatment for patients with SDB significantly improved all neuropsychological scores, Aβ42/40 ratio, and Tau-pT181 levels. However, 11 patients did not completely recover from a sleep disorder (PSQI > 5 post-treatment). In this subgroup of patients, although HAMA score and Tau-pT181 levels were significantly reduced, MoCA and HRSD-24 scores, as well as Aβ42/40 ratio, were not significantly improved. ROC analysis found that the blood Aβ42/40 ratio held the highest significance in predicting sleep disorder occurrence. Conclusions: This is the first clinical study on sleep quality improvement in Alzheimer’s disease patients. Sleep quality score was associated with patient depression and anxiety scores, as well as Aβ42/40 ratio and Tau-pT181 levels. A complete recovery is critical for fully improving all neuropsychological assessments, Aβ42/40 ratio, and Tau-pT181 levels. Blood Aβ42/40 ratio is a feasible prognostic factor for predicting sleep quality.

Objective To investigate the regional homogeneity (ReHo) changes of primary insomnia (PI) with cognitive impairment using resting-state fMRI. Methods Twenty-one patients with primary insomnia and cognitive impairment and 25 healthy volunteers matched with age, gender and education level were collected from Southwest Hospital of China from November 2014 to June 2015. Pittsburgh sleep quality index (PSQI), Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE), Activity of Daily Living Scale (ADL), Hamilton depression scale (HAMD), and Hamilton Anxiety Scale (HAMA) were conducted to evaluate the sleep and cognitive conditions of all subjects. Independent sample t-test was performed to evaluate the significant difference of neuropsychology scores of two groups. ReHo of rs-fMRI were evaluated and compared between two groups using independent sample T-test, meanwhile, the partial correlation analysis was conducted in ReHo values of different brain regions and neuropsychology scores (age, gender and education level were regarded as covariates). Results Compared with normal controls, patients with primary insomnia and cognitive impairment showed significant higher PSQI score and lower MoCA and MMSE scores(P<0.05). The patient group also showed significant increased ReHo in the left medial temporal gyrus(54 voxels, t=3.14), left inferior temporal gyrus(76 voxels, t=4.80), right inferior temporal gyrus(84 voxels, t=4.30) and left parahippocampal gyrus(301 voxels, t=4.44) (P<0.05) and decreased ReHo in the left superior temporal lobe(79 voxels, t=-3.38), right fusiform gyrus(50 voxels, t=-3.17), right superior temporal gyrus(283 voxels, t=-5.34), right inferior frontal gyrus(56 voxels, t=-3.98), right anterior cingulate(233 voxels, t=-3.91), left parietal lobe angular gyrus(67 voxels, t=-3.27) and superior parietal lobule(65 voxels, t=-3.45) (P<0.05). The partial correlation analysis showed positive correlations between the ReHo values and PSQI scores of the left parahippocampal gyrus (R=0.771, P<0.01), negative correlations between the ReHo values and PSQI scores of the right anterior cingulate gyrus (R=-0.649, P<0.01) and positive correlations between the ReHo values and MoCA scores of the right anterior cingulate gyrus(R=0.555, P<0.05). Conclusions Patients with primary insomnia and cognitive impairment have ReHo alterations in various brain regions. The decreasing ReHo in the right anterior cingulate gyrus can reflect the level of sleep disorder and cognitive impairment, and increasing ReHo in the left parahippocampal gyrus can reflect the compensation of sleep disorders of PI. Key words: Sleep initiation and maintenance disorders; Magnetic resonance imaging; Cognition disorders

Background Alzheimer's disease (AD) is increasingly prevalent, leading to severe cognitive decline and a diminished quality of life for patients. Nucleus basalis of Meynert deep brain stimulation (NBM-DBS) is a potential treatment approach. Objective This study aims to assess the efficacy and safety of NBM-DBS for AD patients. Methods We conducted a clinical study involving 6 patients with severe AD who received NBM-DBS. The treatment's safety and efficacy were evaluated using cognitive function tests (Mini-Mental State Examination, Montreal Cognitive Assessment, Alzheimer's Disease Rating Scale- cognitive subscale, Clinical Dementia Rating) and assessments of neuropsychiatric symptoms and sleep disorders (Functional Activity Questionnaire, Functional Independence Measure, Zarit Burden Interview, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Neuropsychiatric Inventory, Pittsburgh Sleep Quality Index). Results NBM-DBS was safe, with no severe adverse events. It improved cognitive functions and self-care abilities without altering the disease's progression. Notably, NBM-DBS significantly alleviated neuropsychiatric symptoms and sleep disturbances. Conclusions NBM-DBS could be a promising therapeutic approach for severe AD, particularly for managing neuropsychiatric symptoms and sleep disorders. Further research is warranted to confirm these preliminary findings.

To compare the clinical effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on cognitive function, depression and anxiety in patients with post-stroke cognitive impairment. A total of 660 patients with post-stroke cognitive impairment who were admitted to 3 hospitals in Shenzhen City between May 2017 and May 2020 were recruited and randomly assigned to the IDSA (218 cases), SCT (222 cases) and TSA groups (220 cases) according to a random number table. All the patients received conventional drug therapy for cerebral stroke and exercise rehabilitation training. Scalp acupuncture and computer-based cognitive training (CBCT) were performed simultaneously in the IDSA group, but separately in the morning and in the afternoon in the SCT group. The patients in the TSA group underwent scalp acupuncture only. The course of treatment was 8 weeks. Before treatment (M0), 1 (M1) and 2 months (M2) after treatment, as well as follow-up at 1 (M3) and 2 months (M4), the cognitive function of patients was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) Scales; depression, anxiety, sleep quality, and self-care ability of patients were assessed using Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Pittsburgh Sleep Quality Index (PSQI), and Modified Barthel Index (MBI), respectively. During this trial, all adverse events (AEs) were accurately recorded. There were no significant differences in the MMSE, MoCA, HAMD, HAMA, PSQI, and MBI scores among the 3 groups at M0 (all P>0.05). In the IDSA group, the MMSE, MoCA and MBI scores from M2 to M4 were significantly higher than those in the SCT and TSA groups, while the HAMD, HAMA and PSQI scores were significantly reduced (all P<0.01). The changes of all above scores (M2-M0, M4-M0) were significantly superior to those in the SCT and TSA groups (all P<0.01, except M4-M0 of HAMD). At M2, the severity of MMSE, HAMD, HAMA, PSQI and MBI in the IDSA group was significantly lower than that in the SCT and TSA groups (all P<0.01). There was no serious AE during this trial. IDSA can not only significantly improve cognitive function, but also reduce depression, anxiety, which finally improves the patient's self-care ability. The effect of IDSA was significantly better than SCT and TSA. (Trial registration No. ChiCTR1900027206).

ObjectiveAlzheimer’s disease (AD) is characterized by complex pathological mechanisms involving neuroinflammation, oxidative stress, and vascular dysfunction. Remote Ischemic Conditioning (RIC) has shown potential in addressing these pathways by improving cerebral blood flow, reducing oxidative stress, and modulating inflammatory responses. This protocol focuses on evaluating the safety, feasibility, and preliminary efficacy of RIC as a multi-target intervention for delaying cognitive decline in patients with mild Alzheimer’s dementia, aiming to improve cognitive outcomes and overall quality of life.Methods and expected resultsThis study is a randomized, controlled, single-center, prospective clinical trial designed to evaluate the safety, feasibility, and preliminary efficacy of RIC in patients with mild Alzheimer’s dementia. Eligible participants will be recruited and randomly assigned to either the RIC group or a control group receiving sham RIC, with 20 patients in each group. Participants will receive either RIC or sham RIC once daily over a 3-month period. Outcome measures will assess cognitive function, psychological well-being, and inflammatory and neurodegenerative biomarkers. Psychiatric adverse events will be monitored throughout the treatment using the Hamilton Anxiety Rating Scale (HAMA) and the Hamilton Depression Rating Scale (HAMD-17). Cognitive function and daily living abilities will be evaluated at baseline, 3 months, 6 months, and 12 months post-treatment using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and the Activities of Daily Living (ADL) scales. In addition, blood samples will be collected at each time point to measure plasma biomarkers of β-amyloid species and serum inflammatory cytokines to assess potential changes in cognitive decline, disease progression, and inflammation. The primary endpoint is safety, with the expectation that RIC will not increase psychiatric adverse events as reflected in HAMA and HAMD-17 scores. Primary efficacy endpoints include improvements in MMSE, MoCA, CDR, and ADL scores, indicating potential cognitive benefits and enhanced daily functioning. Secondary endpoints will analyze biomarkers to evaluate disease progression and inflammation levels before and after treatment.ConclusionThis trial aims to determine the safety, feasibility, and potential effectiveness of RIC as a multi-target intervention for mild Alzheimer’s dementia by integrating cognitive and neuropsychological assessments with biological markers, providing a foundation for future studies.

Spinocerebellar ataxia type 3 (SCA3) poses challenges for patients due to motor dysfunctions and non-motor symptoms (NMS), such as sleep disorders, cognitive deficits, and mood disturbances. These issues significantly impact the quality of life, with limited benefits from conventional pharmacotherapies. This study explores the potential of repetitive transcranial magnetic stimulation (rTMS) as a treatment for SCA3-related NMS. This is a secondary analysis of a randomized, double-blind, sham-controlled trial (The Chinese Clinical Trial Registry identifier is ChiCTR1800020133). Thirty-seven SCA3 patients included underwent either real (n = 21) or sham (n = 16) rTMS over 15 days, targeting the cerebellum. Study outcomes included the Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS), assessed baseline and post-intervention. The results disclosed significant time effects for all the outcomes with post hoc comparisons showing differences of baseline and post-treatment evaluation, with decreases for PSQI, AIS, HARS, and HDRS as well as increase for MMSE and MoCA. Correlation analyses revealed no significant predictors of rTMS response based on age at onset, disease duration, number of expanded CAG repeat lengths, or baseline motor symptom severity scores. Repetitive transcranial magnetic stimulation is a feasible treatment of non-motor related symptoms in patients with SCA3, including sleep, cognition, and mood disorders. The treatment is well-tolerated, and its feasibility appears independent of demographic or disease severity indicators. These findings encourage further exploration of rTMS as a safe alternative for managing SCA3 NMS.

Background To explore the relationship between sleep time, sleep quality, and emotional and cognitive function in the elderly. Methods A total of 150 elderly patients over 65 years old who were admitted to our hospital from February 2019 to April 2021 were divided into a normal cognitive function group (Mini-Mental State Examination (MMSE) score: illiteracy, >17; primary school, >20; and middle school and above, >24; N = 86) and cognitive impairment group (MMSE score: illiteracy, ≤17; primary school, ≤20; and middle school or above, ≤24; N = 64). The sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), and anxiety and depression were evaluated by Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD), respectively. The cognitive function between the two groups was compared via the Montreal Cognitive Assessment (MoCA) score, visual spatial execution, and attention. Pearson correlation analysis was used to analyze the correlation between sleep quality, sleep time, and emotional and cognitive function. Results In the comparison of sleep quality between the two groups, the total score of PSQI, sleep quality, falling asleep time, sleep time, and sleep efficiency of patients with cognitive impairment were higher than those of patients with normal cognitive function (P < 0.05). There was no significant difference in the scores of hypnotic use and daytime dysfunction between the two groups, but the scores of nocturnal sleep disorders and ESS in the cognitive impairment group were significantly higher than those in the normal group (P > 0.05). Compared between the two groups, the MoCA score, visual spatial execution, and attention in the cognitive impairment group were significantly lower than those in the normal group, and the difference was statistically significant (P < 0.05). The delayed recall in the cognitive impairment group was significantly higher than that in the control group (P < 0.05). There was no significant difference in orientation, naming, language, and abstract ability between the two groups (P > 0.05). The scores of HAMA and HAMD in the cognitive impairment group were significantly higher than those in the normal group. Pearson correlation analysis was used to analyze the correlation between sleep therapy, sleep time, and the score of cognitive scale. The results showed that PSQI was negatively correlated with MoCA and MMSE, and ESS was negatively correlated with MoCA and MMSE. Pearson correlation analysis results indicated that PSQI was positively correlated with HAMA and HAMD, while ESS was negatively correlated with HAMA and HAMD. Conclusion The sleep quality and sleep time of elderly patients are positively correlated with their cognitive function. The worse the sleep quality is, the worse their cognitive function is and the more serious their anxiety and depression are. In the course of clinical therapeutics, more attention should be paid to the sleep quality of elderly.

BackgroundParkinson’s disease (PD) affects both sexes, but there are notable differences in its clinical manifestations and management in women.ObjectiveThis study aimed to compare variations in sex and thyroid hormone levels and menstrual factors between postmenopausal women with and without motor complications (PWP-MC and PWP-nMC, respectively) and analyze their correlations with motor complications.MethodsNinety-five Postmenopausal Women with Parkinson’s Disease (PWP) provided data on age at menarche, age at menopause, menstrual cycle duration (interval between cycle starts (days)), total years of menstruation (menopausal age - age at menarche), thyroid disease history, and gynecological surgical history. Six sex hormones and seven thyroid function indicators were measured, followed by an analysis of the relationships among sex hormone levels, thyroid function, menstrual factors, clinical characteristics, and disease severity in PWP. The effects of sex hormones and menstrual factors on motor complications in PWP were also investigated.ResultsThe results revealed several key findings: (1) PWP-MC exhibited lower serum prolactin levels than PWP-nMC (p < 0.05). (2) In PWP, serum estradiol levels were negatively correlated with Hamilton Anxiety Rating Scale (HAMA) scores (r = −0.208, p = 0.043). (3) There were no statistically significant differences in age at menarche, age at menopause, menstrual cycle duration, menstruation duration (Days of active bleeding per cycle), or total years of menstruation between PWP-MC and PWP-nMC (p > 0.05). (4) In PWP, age at menarche was negatively correlated with Mini-Mental State Examination (MMSE) scale scores (r = −0.264, p = 0.01) and Montreal Cognitive Assessment (MoCA) scale scores (r = −0.297, p = 0.004); total years of menstruation were positively correlated with MoCA scale scores (r = 0.278, p = 0.006); menstrual cycle duration was negatively correlated with Unified Parkinson’s Disease Rating Scale, Part III (UPDRS-III) scores (r = −0.246, p = 0.016) and Hoehn–Yahr (H-Y) stages (r = −0.236, p = 0.021); and menstruation duration was positively correlated with HAMA (r = 0.215, p = 0.036) and Non-Motor Symptoms Scale (NMSS) scores (r = 0.214, p = 0.037). (5) In PWP-MC, age at menopause and total years of menstruation were positively correlated with Hamilton Depression Rating Scale (HAMD) scores (r = 0.335, p = 0.043; r = 0.352, p = 0.033, respectively); menstruation duration was negatively correlated with UPDRS-III scores (r = −0.362, p = 0.028) and positively correlated with HAMD (r = 0.329, p = 0.047) and HAMA (r = 0.451, p = 0.005) scores; and menstruation duration was positively correlated with NMSS (r = 0.325, p = 0.050) scores. (6) In PWP-nMC, age at menarche was negatively correlated with MMSE (r = −0.332, p = 0.011) and MoCA (r = −0.296, p = 0.024) scores; total years of menstruation were negatively correlated with UPDRS-III (r = −0.287, p = 0.029) scores and positively correlated with MMSE (r = 0.316, p = 0.016) and MoCA (r = 0.337, p = 0.010) scores. (7) Compared with PWP-nMC, PWP-MC had lower serum triiodothyronine levels (p < 0.05) and higher serum thyroid-stimulating hormone levels (p < 0.05). (8) In PWP-MC, triiodothyronine levels were negatively correlated with UPDRS-III scores (r = −0.344, p = 0.037) and H-Y stages (r = −0.445, p = 0.005); free triiodothyronine (FT3) levels were negatively correlated with H-Y stages (r = −0.476, p = 0.003); and free thyroxine (FT4) levels were negatively correlated with UPDRS-III scores (r = −0.422, p = 0.009) and H-Y stages (r = −0.365, p = 0.026).ConclusionThese findings suggest that the occurrence of motor complications in PWP may be correlated with prolactin, T3, and FT3 levels. Additionally, attention should be given to thyroid function and serum T3, T4, FT3, and FT4 levels in PWP, as lower levels may be associated with more severe motor symptoms, higher H-Y stages, and poorer cognitive function. Furthermore, older age at onset was inversely associated with motor complications in PWP, whereas a longer disease duration and higher NMSS score are risk factors.

Objective:Considered the second biggest tragedy with fatal victims caused by fire, the Kiss nightclub fire tragedy that occurred in the interior of southern Brazil brought several problems to survivors. It is reported that 30–40% of victims of disasters can develop post-traumatic stress disorder. Application of repetitive transcranial magnetic stimulation has shown promising results in the treatment of post-traumatic stress disorder. Transcranial direct current stimulation similar to repetitive transcranial magnetic stimulation, a neuromodulation technique, has shown promise in treatment of neuropsychiatric disorders.Method:A clinical trial was conducted from March 2015 to July 2016 in “KISS nightclub fire” disaster patients diagnosed with post-traumatic stress disorder without complete remission of symptoms, over 18 years, and who maintained pharmacological treatment. Treatment was given using electrodes as cathode (right dorsolateral prefrontal cortex) and anode (contralateral deltoid muscle); a current of 2 mA was used for 25 cm² area (0.08 mA/cm² current density); 30 min once a day for 10 days continuously. Patients assessed pre- and post-intervention, 30 days’ and 90 days’ post-intervention. Post-Traumatic Stress Disorder Checklist, Civilian version, Montreal Cognitive Assessment, and Hamilton Depression and Anxiety Rating Scale were used.Results:One hundred forty-five subjects were screened and eight analyzed; 87.5% were female; 30.88 ± 7.74 years were of mean age. Post-intervention results: no cognitive impairment (Montreal Cognitive Assessment), 60% reduction in Hamilton Depression Rating Scale (moderate depression turns normal) (p < 0.001), 54.39% Hamilton Anxiety Rating Scale reduction (moderate-to-severe symptoms turn into mild symptoms) (p < 0.001), and 20% Post-Traumatic Stress Disorder Checklist, Civilian version scale decrease (high severity post-traumatic stress disorder symptoms turn moderate to moderately high severity) (p < 0.001). Post-traumatic stress disorder symptoms improvement was maintained 30-days post-intervention (Post-Traumatic Stress Disorder Checklist, Civilian version, p = 0.025) and improvement in symptoms of depression (Hamilton Depression Rating Scale, p = 0.006) and anxiety (Hamilton Anxiety Rating Scale, p = 0.028) in 90 days post-intervention.Conclusion:Despite decrease over time, improvement in post-traumatic stress disorder, depression and anxiety symptoms was maintained throughout the first month after treatment. Transcranial direct current stimulation adjuvant can be an alternative treatment to refractory post-traumatic stress disorder, either as monotherapy or as treatment enhancement strategy. They can also be an option for patients who do not want or do not tolerate pharmacological management.

Objective To explore abnormal microstructural changes of white matter in patients with white matter lesions using diffusion tensor imaging(DTI), and to determine the association of such abnormalities of DTI parameters with cognitive function. Methods The objects who have already confirmed with WML were collected from March 2012 to February 2018 through magnetic resonance imaging (MRI) scan from the neurology department of Beijing Tiantan Hospital.Use The hamilton depression scale(HAMD) and the hamilton anxiety scale(HAMA) to eliminate anxiety and depression, and divided into WML-CN group, WML-VCIND group and WML-VAD group with Mini-mental state examination (MMSE), Montreal Cognitive Assessment (MOCA)and clinical dementia rating(CDR). In addition, select the healthy elderly people without WML by MRI scan as the normal control group.All of the subjects were detected with the superconduct magnetic resonance imaging system (German SIEMENS 3.0T ) for the DTI scanning.Original images were processed with VBA.Then explore the changes of FA and MD of DTI in whole brain and regions of interest in NC group, WML-CN group, WML-VCIND group and WWML-VAD group, and its correlation with the severity of cognitive impairment in patients with WML. Results The damage degree of the fiber microstructure of brain white matter was significantly correlated with the total grade point of MoCA (P<0.01). In figure FA, the variance analysis of F test results showed that the significant brain areas were the splenium of the corpus callosum, the genu of corpus callosum, bilateral posterior internal capsule, retrolenticular part of internal capsule, anterior thalamic radiation, partial inferior longitudinal fasciculus and inferior fronto-occipital fasciculus, cingulate, external capsule, upper and posterior part of the radiation crowns, partial superior longitudinal fasciculus, etc.(P<0.05 after FWE correction based on TFCE method). In Figure MD, the variance analysis of F test results showed that the statistically significant brain areas mainly included the left external capsule and hook, partial genu and splenium of corpus callosum, Bilateral, bilateral inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, anterior thalamic radiation, retrolenticular part of internal capsule, cingulate, etc (P<0.05 after FWE correction based on TFCE). Conclusion No matter whether cognitive impairment exists in patient with WML or not, all DTI parameters are different from those of normal people.The integrity of white matter fiber has been damaged with different degrees.The more severe the cognitive impairment in the external manifestations of patients with WML, the greater the damage to the intrinsic white matter microstructure. Key words: White matter lesions; Cognitive impairment; Diffusion tensor imaging; White matter fiber

Objective To study the effect of comprehensive nursing on the cognitive level,mental status,and the ability to live of patients with Alzheimer's disease.Methods Totals of 120 patients with Alzheimer's disease were randomly divided into two groups,each group of the 60 patients.The patients in the control group received conventional care,while the patients in the observation group were given comprehensive nursing.Then,two groups were investigated with the mini mental state examination scale (MMSE),Hamilton rating scale for depression (HAMD),Hamilton rating scale for anxiety (HAMA),and activities of daily living scale (ADL),before and after the intervention.Results No significant difference was found in the scores of patients of the MMSE,ADL,HAMA,and HAMD between two groups before the intervention (P ＞ 0.05).After the intervention,significant difference was found between control group and observation group in the MMSE score [(11.1 ±3.2) vs (23.4 ±2.7);t =22.793,P ＜0.05],ADL score[(24.1 ±4.7) vs (20.2 ± 1.3) ;t =15.251,P ＜ 0.05],HAMA score [(15.0 ± 2.1) vs (7.4 ± 1.6) ;t =22.298,P ＜ 0.05],and HAMD score [(15.8 ± 3.9) vs (7.5 ± 1.4);t =15.516,P ＜ 0.05].No significant difference was found in the change of control group before and after the intervention (P ＞ 0.05),while significant difference was found in the observation group(P ＜0.05).Conclusions The comprehensive nursing can improve the level of awareness,mental state and living ability of patients with Alzheimer's disease,and improve the patient's quality of life. Key words: Alzheimer's disease ; Nursing; Cognitive ; Mental state; Living ability

Objective: Psychiatric disorders like depression and anxiety are known to be more prevalent in patients with chronic hepatitis B than healthy individuals. This increased prevalence may be due to multiple factors such as psychological distress associated with having a chronic disease, necroinflammatory activity in liver, side effects of treatment with antiviral agents or interferons, and/or direct effect of hepatitis viruses on central nervous system. Purpose of this study was to evaluate several risk factors that may be associated with anxiety and depression in patients with chronic hepatitis B. Methods: This study included 195 chronic hepatitis B patients. A psychiatrist made clinical interviews with the patients and filled Sociodemographic Data Form, Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS). Needle biopsies were performed to 175 patients who met biopsy criteria of American Association for the Study of Liver Diseases. Knodell Histological Activity Index was used to evaluate biopsy materials. HBV DNA and ALT levels were measured from patients’ sera. Findings: In the study sample, 119 patients were males and 76 were females. Mean HARS score was 7.3±6.2 and mean HDRS score was 8.8±6.6. Both HARS and HDRS scores were higher in females than males. HARS score was higher in patients with a family history of chronic hepatitis and both HARS and HDRS scores were higher in patients with comorbid medical illness. Alanine aminotransferase, HBV DNA levels, and level of fibrosis in liver biopsy didn’t affect HARS or HDRS scores. Also, there wasn’t a difference in HARS or HDRS scores according to patients’ usage of pegylated interferon, or oral antiviral therapy. Conclusion: Multiple factors affect the relation between chronic hepatitis and psychiatric disorders like anxiety and depression. Results of our study suggest that female sex, presence of a family history for chronic hepatitis B, comorbidity of other medical diseases, and ethnic origin affect more than the level of necro-inflammatory activity and cellular damage in the liver or antiviral treatments.

To explore the change patterns, influencing factors and predictors of quality of life for 4 years in patients with Alzheimer's disease (AD). A total of 96 mild-moderate AD patients on combined therapies of medicine and recuperation were enrolled. Their clinical symptoms were graded by mini-mental state examination (MMSE), activity of daily living (ADL), global deterioration scale (GDS), neuropsychiatric inventory (NPI), Hamilton depression scale (HRSD), Hamilton anxiety scale (HAMA) and Pittsburgh sleep quality index (PQSI). And their qualities of life were evaluated by Quality of Life-Alzheimer's Disease (QOL-AD) at baseline and at the end of 1, 2, 3, 4 year. (1) During a 4-year follow-up, the scores of QOL-AD, MMSE, ADL, GDS, NPI, HRSD, HAMA and PQSI decreased markedly compared with baseline [(17.5±1.9), (12±3), (45±9), (5.2±0.8), (31±11), (20±6), (14±6), (14±4) vs (30.5±4.6), (21±4), (34±10), (3.3±0.9), (22±9), (18±6), (11±4), (12±4) respectively, t=25.31, 15.42, -7.16, -14.83, -5.56, -2.94, -4.45, -5.60, all P<0.01]. With the deterioration of AD, their qualities of life decreased significantly. (2) Spearman's correlation analysis showed that the scores of 4-year QOL-AD were correlated with the 4-year score changes of MMSE, ADL, GDS (r=0.344, 0.368, 0.213; P=0.002, 0.001, 0.047). (3) Multiple Logistic regression model showed that the baseline scores of NPI and HRSD were strong predictors of loss of quality of life (OR=1.697, 1.269; P=0.000, 0.006). And the area under the curve of receiver operating characteristic (ROC) of NPI and HRSD were 0.918 (95% CI: 0.844-0.991) and 0.878 (95% CI: 0.804-0.953) respectively. With the deterioration of AD, the quality of life decreases significantly and has correlations with the score changes of MMSE, ADL and GDS. High scores of NPI and HRSD are the important predictors for a loss of quality of life in AD patients. Early detection and timely interventions are necessary.

Electroencephalographic connectivity predicts clinical response to repetitive transcranial magnetic stimulation in patients with insomnia disorder