Hasegawa Dementia Scale Research Articles

Effect of butylphthalide in patients with vascular cognitive impairment

Purpose: To study the effects of butylphthalide in patients with vascular cognitive impairment. 
 Method: Sixty patients with vascular cognitive impairment were randomly divided into control group and butylphthalide (NBP) group (n = 30). Control group received blood pressure control, blood sugar control, and lipid-lowering therapies, while NBP group received butylphthalide capsules (200 mg, thrice daily). Treatments in both groups lasted for 14 days. Thereafter, Hasegawa Dementia Scale (HDS), Mini-Mental State Examination (MMSE), Activities of Daily Living Scale (ADL), and event-related potential (P300) were used to evaluate the effects of butylphthalide treatment. 
 Result: Following 14 days of treatment, HDS, MMSE and ADL scores of NBP group were significantly higher than those of the control group (p < 0.05). The P300 latency of NBP group was shorter than that of control group, while P300 amplitude was higher than that of control group (p < 0.05). 
 Conclusion: Butylphthalide treatment achieves higher scores of HDS, MMSE and ADL scores, but shorter P300 latency. These results provided good evidence of the effectiveness of butylphthalide therapy in the management of vascular cognitive impairment. However, further clinical trials are recommended prior to application in clinical practice.

Gunao-Yizhi decoction combined with donepezil for vascular dementia: A systematic review and meta-analysis.

Background:Gunao-Yizhi decoction has the effects of supplementing intelligence, strengthening marrow, resolving phlegm, and reducing turbidity. It is clinically used for the treatment of vascular dementia (VaD). However, there is still a lack of systematic evaluation of its efficacy and safety. This review conducted a systematic review of the current evidence on the efficacy and safety of Gunao-Yizhi decoction combined with donepezil for VaD.Methods:China National Knowledge Infrastructure (CNKI), Wanfang database (Wanfang), Chinese Science and Technology Periodical Database (VIP), China Biology Medicine disc (CBM), MEDLINE, EMBASE, and Cochrane Library were searched for randomized controlled trials on Gunao-Yizhi decoction combined with donepezil for VaD. RevMan 5.3 software was used for data analysis.Results:Twelve studies were obtained, including 1036 patients. Compared with donepezil alone, meta-analysis showed that Gunao-Yizhi decoction combined with donepezil could improve clinical efficacy, mini-mental state examination (MMSE) score, Hasegawa dementia scale (HDS), increase the level of superoxide dismutase (SOD) in serum, and reduce the level of malonaldehyde dismutas (MDA) in serum. The GRADE system was adopted to evaluate the outcome index. Clinical efficiency and the MMSE score were evaluated as very-low-quality evidence. HDS score, serum SOD level, and serum MDA level were evaluated as low-quality evidence.Conclusion:Gunao-Yizhi decoction combined with donepezil has a significant prevalence in the treatment of vascular dementia, with no increase in adverse events. Gunao-Yizhi decoction can be recommended for routine use in the treatment of VaD.

Neuropsychiatric Inventory Questionnaire Associated with Cognitive Function, Age, and Duration of Education in Patients with Alzheimer’s Disease

Introduction: Alzheimer’s disease (AD) is the most common cognitive disease, and behavioral and psychological symptoms of dementia (BPSD) can place a heavy burden on families. The presence of these symptoms related to AD is commonly assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). This study sought to clarify the relationship between scores on the 12-domain NPI-Q and individual factors in patients with AD. Methods: Participants were 218 new outpatients with AD at five memory clinics. Cognitive function was assessed using the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental State Examination (MMSE). We examined which individual factors were associated with the total NPI-Q score and the number of domains. We also examined which domains were associated with the factors identified. Results: A higher total NPI score was significantly associated with lower scores on both cognitive assessments and a longer duration of education. Exhibiting symptoms on a greater number of domains was significantly associated with lower scores on both cognitive assessments, longer duration of education, and advanced age. The nighttime disturbances domain was significantly associated with lower scores on both cognitive assessments and advanced age. The delusions domain was significantly associated with lower education. Conclusions: BPSD may appear more easily with reduced quality of life and ongoing dissatisfaction. Effective individualized services are important for patients with AD, and therefore, we should account for age, cognitive function, and duration of education in the services provided.

Meta-Analysis of Naoxintong Capsule for Patients with Vascular Dementia.

Background Vascular dementia (VaD) is the second most common form of dementia among the elderly. There is currently no unequivocal recommendation of an effective treatment option for VaD. Objective The purpose of this study was to evaluate the efficacy and safety of Naoxintong capsule (NXT) in the treatment of VaD patients. Methods We searched for randomized controlled trials (RCTs) published before September 2021 in PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, and Wanfang databases. The trials assessed the efficacy and/or safety of NXT in treating patients with VaD. A meta-analysis was then performed using Stata 14.0 software. Results A total of 33 studies comprising 2,947 patients with VaD were included in this study. The meta-analysis revealed that NXT improved cognitive function in VaD patients, increased the mini-mental state examination (MMSE) score by 3.33 points (WMD = 3.33, 95% CI (2.72, 3.94)), the Montreal Cognitive Assessment (MoCA) score by 4.31 points (WMD = 4.31, 95% CI (2.72, 5.90)), and the Hasegawa dementia scale (HDS) by 2.71 points (WMD = 2.71, 95% CI (1.26, 4.17)). Furthermore, NXT significantly improved the daily lives of VaD patients, lowering the activities of daily living (ADL) score by 5.85 points (WMD = −5.85, 95% CI (−7.03, −4.66)). NXT improved the total effective rate (TER) (OR = 2.62, 95% CI (2.09, 3.29)) of the patients without increasing the occurrence of adverse events (AEs; OR = 0.72, 95% CI (0.43, 1.22)). Subgroup analysis revealed that whether NXT was used alone or in combination with western medicine, it could enhance the overall curative effect. Conclusions NXT may be an effective and safe treatment option for VaD. However, because of the limited number and quality of articles included, this study's findings need to be validated by additional high-quality, large-sample, and multicenter RCTs (Systematic Review Registration Number: PROSPERO; https://clinicaltrials.gov/ct2/show/CRD42021233199).

Effectiveness and safety of moxibustion for vascular dementia: A systematic review and meta-analysis.

Background:Vascular dementia (VD) is the only type of dementia that can be prevented and treated. Compared to conventional treatment methods, moxibustion therapy is more effective for VD. This study evaluated the effectiveness and safety of moxibustion in the treatment of VD through a meta-analysis, to provide a complete overview to the advantages of traditional Chinese medicine and provide guidance for clinical application.Methods:Clinical trials on the therapeutic effects of moxibustion or moxibustion combined with acupuncture on VD were retrieved from the VIP information database, Wanfang, CNKI, PubMed, EMBase, and other resources. The included studies were conducted from January 2000 to October 2020. Among the retrieved studies, the content met the standards upon being collated and extracted, and RevMan5.3 was used for meta-analysis.Results:Thirteen randomized controlled trials (RCTs) were included with 997 patients. The RevMan bias risk assessment revealed that the quality of the studies was generally low. The meta-analysis showed that compared to conventional treatments, moxibution therapy in terms of effective rate, posttreatment Hasegawa Dementia Scale, Mini-Mental State Examination (MMSE), Activity of Daily Living Scale (ADL), Somatostatin (SS), Arginine Vasopressin (AVP), and Syndrome Differentiation Scale of VD were more favorable, and the difference in efficacy was statistically significant. Furthermore, no adverse events were observed in either group. Sensitivity analysis showed strong homogeneity and stable results, whereas funnel plot analysis revealed no significant publication bias.Conclusions:Moxibustion is effective and safe in the treatment of VD, but more high-quality evidence from further studies is required to support this.

Day service use and improved Serial 7 and Verbal fluency scores in patients with Alzheimer's disease.

Day services (DS) are provided as part of the Japanese public nursing care system. Recent studies have suggested a possible relationship between DS use and limited progression of Alzheimer's disease (AD). This study examined in detail the relationship between improvements in cognitive function and DS use in people with AD. We retrospectively analysed Revised Hasegawa Dementia Scale (HDS-R) scores of 208 patients with AD at five memory clinics over a 6-month period. The patients were divided into a group that started using DS (n=132) and a group that did not (n=76) during the study period. We then compared each participant's total and item scores on the HDS-R between the first clinic visit and 6 months later also compared scores between DS users and non-users. DS non-users were younger, predominantly male, had longer school education, and better total HDS-R score at the first visit. After 6 months, DS users showed significantly improved total HDS-R score and individual Serial 7 and Verbal fluency scores. Immediate memory scores were comparable between the first visit and after 6 months. Among the DS users, more frequent participation in DS was significantly associated with improved total HDS-R score. DS use was significantly associated with improved HDS-R scores, especially for the Serial 7 and Verbal fluency tasks, and there was no deterioration in Immediate memory score. These results suggest the usefulness of DS participation as a non-pharmacological therapy.

Non-participation in social activities of rural older adults: Results from the Toyama dementia survey

Objective Social activities play an important role in the maintenance of health and well-being of the older adults. The aim of this study was to identify characteristics of the rural older adults who do not participate by type of social activities.Methods This survey examined 1,537 older adults randomly selected at a sampling rate of 0.5% from among those living in Toyama prefecture of Japan, in 2014. Of the total, 947 ambulatory older adults living in their own homes were analyzed using Poisson regression. Results were presented as prevalence ratio (PR). The level of statistical significance was set at P<0.05 (two-sided test).Results The participants included 426 men (mean age 73.9 ± 6.5 years) and 521 women (mean age 74.8 ± 7.0 years). In terms of work, both men and women did not work at an older age (men PR 1.15 over 75 years old, women PR 1.11 over 70 years old). Men did not work during outpatient treatment (PR 1.09) and the Revised Hasegawa Dementia Scale (HDS-R) 21-25 points (PR 1.09) and 20 points or below. Women who did not drink alcohol did not work (PR 0.93). Both men and women did not participate in residential activities at older ages (men PR 1.12 over 70 years old, women PR 1.11 over 80 years old). Men with 20 points or below on HDS-R (PR 1.16) and with work history of only physical labor (PR 1.12), and women living with family (PR 0.92) were less likely to participate in residential activities. In the hobby group, both men and women with work history of only physical labor were less likely to participate (men PR 1.05, women PR 1.08). Men with education of 9 years or below (PR 1.05) and women living alone (PR 1.07) were less likely to participate. Hobby groups did not relate with age and cognitive decline. In the senior citizens' club, men and women who did not drink alcohol were less likely to participate (men PR 0.91, women PR 0.89). Men who smoked (PR 1.06), men with psychological symptoms (PR 1.09), and women with 20 points or below on HDS-R (PR 1.13) were less likely to participate.Conclusion Factors related to non-participation of older adults in rural cities depended on the type of social activities. In order to promote social activity among the older adults in rural cities, it is important to consider specific measures taking into account the type of social activities.

Decreased cognitive function is associated with preceding severe hypoglycemia and impaired blood glucose control in the elderly individuals with type 1 diabetes.

This investigation aimed to clarify the relationship between cognitive function and blood glucose control in the elderly individuals with type 1 diabetes. In total, 45 patients with type 1 diabetes, age 74.9 ± 6.7years, and HbA1c levels of 7.9 ± 0.9% were studied. Severe hypoglycemia occurred in 33% of patients, and the number of severe hypoglycemia episodes was 0.6 ± 1.2 in the past 5years before the time of the cognitive function tests. We analyzed clinical data and dementia scores on the Revised Hasegawa's Dementia Scale (HDS-R), Mini-Mental State Examination (MMSE), and Dementia Assessment Sheet for Community-based Integrated Care System, and 21 items (DASC-21). There was a significant correlation between HbA1c and HDS-R, MMSE, respectively. There was a significant correlation between the number of severe hypoglycemic episodes and HDS-R, MMSE, and DASC-21, respectively. When the group with experience of severe hypoglycemia was compared to the control group, HDS-R, MMSE, and DASC-21 were meaningfully different after adjusting for age modeling analysis of covariance. In elderly individuals with type 1 diabetes, our results suggest that high HbA1c for the past 5years from the cognitive function test and a history of severe hypoglycemic episodes from the time of disease diagnosis are related to decreased cognitive function.

Development of a Vietnamese version of the Revised Hasegawa's Dementia scale.

ABSTRACTAs the aging population grows worldwide, the problem of age-related health is becoming an important public health concern. Dementia is a devastating disease that places a significant physical, emotional, and financial burden on patients, their caregivers, and society. It is predicted to increase in developing countries. The Revised Hasegawa’s Dementia Scale (HDS-R) has been used in many Asian countries to measure cognitive function. However, there is still no Vietnamese version of the HDS-R. Therefore, this paper describes the development of the HDS-R scale and manual in Vietnamese language. Two Vietnamese researchers translated the HDS-R from English to Vietnamese. To confirm the accuracy of the translation, two other Vietnamese researchers conducted a back-translation. Another pair of Vietnamese researchers compared the back-translated English version to the original one. All six researchers discussed the inconsistencies between English HDS-R scale and manual and derived the most suitable version for the Vietnamese context. In Questions 4 and Question 7, we changed the words from “cherry blossom” and “train” to “daisy flower” and “bicycle” for the first option, and from “plum blossom” to “rose” for the second option. We also changed the expressions in some places in the manual to fit the Vietnamese language. Future studies are needed to validate this version to be able to access cognitive function in both clinical and public healthcare settings.

Plasma folate levels in relation to cognitive impairment: a community-based cohort of older adults in China.

Lower plasma level of folate has been associated with an increased risk of age-related cognitive impairment. However, studies that examined this relation have yielded mixed results. We aimed to examine the prospective association of plasma folate level with risk of cognitive impairment in a community-based prospective cohort of older adults in China. This study included 615 participants (mean age: 76.3years) without baseline cognitive impairment from the Rugao Longevity and Ageing Study (RuLAS). We used logistic regression to examine the prospective association between baseline plasma folate and risk of cognitive impairment in the next two years. Fasting blood samples were collected and assayed for plasma folate level at baseline. Cognitive impairment was defined as Hasegawa Dementia Scale (HDS) score ≤ 21.5 points. During two years' follow-up, 20.7% of the participants developed cognitive impairment. After controlled for age, gender, and plasma homocysteine, ahigher level ofplasma folate was associated with lower odds of cognitive impairment. The corresponding odds ratio (OR) with 95% confidence interval was 0.41 (0.19-0.89) comparing participants atextreme quintiles of plasma folate (median level 17.2 vs. 6.3nmol/L). The associations were similar after further adjustment for major demographic and lifestyle factors (OR = 0.42, 0.18-0.98). Moreover, the inverse association was particularlystronger among males (OR = 0.12, 0.03-0.52) but was non-significant among females. Our findings support a potential beneficial role of higher plasma folate levels in cognitive function in older Chinese adults, particularly among males. Future studies with larger sample size and longer follow-up are warranted to confirm these findings and to identify the optimal plasma folate level for cognitive function.

Most families tend to realize progress of Alzheimer's disease when behavioural and psychological symptoms are obvious.

Alzheimer's disease (AD) is a common cognitive disease that can progress at an accelerating rate. Even with early diagnosis, the families might not recognize AD progressing unless behavioural and psychological symptoms of dementia (BPSD) develop. In many cases, discrepancies could exist between family-assessed AD stage and diagnosed AD stage. This study explored such discrepancies and potential clinical implications. Participants were 161 new outpatients with AD or mild cognitive impairment at four memory clinics whose AD stage was diagnosed using the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental State Examination (MMSE). We classified patients into four groups according to AD severity. Family members completed the Functional Assessment Staging (FAST) scale during an interview. We then assigned patients to three groups according to discrepancies between family-assessed and diagnosed AD stage. Families also completed the Neuropsychiatric Inventory Questionnaire (NPI-Q), which assesses 12 neuropsychiatric domains, in order to examine the presence of BPSD in relation to AD stage. Most families (74%-80%) assessed patients as having milder AD than the diagnosed stage. NPI-Q scores and duration of education significantly affected discrepancies with HDS-R and MMSE scores. The NPI-Q domains of anxiety, apathy/indifference, aberrant motor behaviours, and appetite/eating disturbance significantly affected family-assessed FAST. Families of patients with more years of education assessed the AD stage as more advanced than the diagnosed stage. Surprisingly, living together did not significantly affect the discrepancy. Most families assessed AD as milder than the clinically diagnosed AD stage. In addition, high NPI-Q scores and more years of school education significantly affected the discrepancy. Family-assessed FAST was significantly affected by the NPI-Q domains of anxiety, apathy/indifference, aberrant motor behaviours, and appetite/eating disturbance. These results suggest that obvious BPSD are significant factors for Japanese families to recognize AD progress.

Prevalence and impact of fracture on postmenopausal women with aortic stenosis who underwent transcatheter aortic valve replacement.

Information regarding fracture in patients with transcatheter aortic valve replacement (TAVR) is limited. We investigated the prevalence and impact of fracture in patients with severe aortic stenosis who had undergone TAVR. Of 913 consecutive patients with symptomatic, severe aortic stenosis who underwent TAVR at the Sakakibara Heart Institute between October 2013 and April 2020, 633 women were enrolled. The primary endpoint was all-cause mortality following TAVR. Patients with a history of fracture displayed smaller body mass indices, increased frailty, a higher prevalence of osteoporosis, and stroke history. Notably, 61.7% of patients with a history of fracture reported to have not taken any osteoporosis medications. Estimated all-cause mortality survival rates post-TAVR were significantly lower in patients with fractures than those without fractures. In the multivariate analysis, history of fracture was independently associated with all-cause mortality following TAVR. Furthermore, fracture prevalence was significantly greater in those who had a higher clinical frailty scale score were slower in the 5-m walk test, had more severe dementia as per the revised Hasegawa dementia scale, and performed poorly in the hand grip strength test. History of fracture was an independent predictor for all-cause mortality in patients undergoing TAVR. In addition, our study demonstrated that osteoporotic fracture may be under-treated in this population. History of fracture may be one of the phenotypes of frailty given its significant relationship with frailty markers in this population.

Hospitalization-Associated Disability After Cardiac Surgery in Elderly Patients - Exploring the Risk Factors Using Machine Learning Algorithms.

Background: Hospitalization-associated disability (HAD) is associated with prolonged functional decline and increased mortality after discharge. Therefore, we examined the incidence and risk factors associated with HAD in elderly patients undergoing cardiac surgery in Japan.Methods and Results: We retrospectively examined 2,262 elderly patients who underwent elective cardiac surgery at Sakakibara Heart Institute. HAD was defined as a functional decline between time of admission and discharge measured by the Barthel Index. We analyzed clinical characteristics using machine learning algorithms to identify the risk factors associated with HAD. After excluding 203 patients, 2,059 patients remained, of whom 108 (5.2%) developed HAD after cardiac surgery. The risk factors identified were age, serum albumin concentration, estimated glomerular filtration rate, Revised Hasegawa’s Dementia Scale, N-terminal pro B-type natriuretic peptide, vital capacity, preoperative Short Physical Performance Battery (SPPB) score, operation times, cardiopulmonary bypass times, ventilator times, length of postoperative intensive care unit stay, and postoperative ambulation start day. The highest incidence of HAD was found in patients with an SPPB score ≤9 and in those who started ambulation >6 days after surgery (76.9%).Conclusions: Several risk factors for HAD are components of frailty, suggesting that preoperative rehabilitation to reduce the risk of HAD is feasible. Furthermore, the association between HAD and a delayed start of ambulation reaffirms the importance of early mobilization and rehabilitation.

Cognitive frailty predicting death and disability in Chinese elderly

ABSTRACT Objective: Although multiple sclerosis (MS) is known to be an immune-mediated disease, very little is known about its etiopathogenesis. MicroRNAs (miRNAs) are small non-coding proteins involved in the regulation of gene expression. T-cell activation potential in neurodegenerative diseases has been a research topic of interest in recent years Cytokines play an important role in the course and pathogenesis of MS, The aim of the present study was to analyze expression levels of miR-20, miR-21, miR-26, miR-155, and Let-7, which target the cytokines interleukin IL-17 and IL-23, in order to evaluate the relationship between MS and miRNAs that modulate the expression of cytokines involved in the autoimmune pathway. Methods:The study included 20 relapsing-remitting multiple sclerosis (MS) patients who were at least 18 years of age and were undergoing outpatient immunomodulatory therapy and 20 healthy, unrelated individuals who had no systemic disease and were not taking any medication as a control group. Peripheral blood samples were collected from all participants into EDTA-containing tubes and plasma was isolated for cDNA synthesis . From these cDNA samples, miRNA expression levels were quantitatively analyzed via melting curve analysis using the miScript SYBR Green kit in real-time PCR device. Results: Comparison of miRNA expression levels in the peripheral blood samples and MS patients and healthy subjects revealed that the MS patients had significant upregulation of miR-20 and downregulation of miR-26 and miR-155 compared to the control group (p<0.005). Conclusions:Dysregulation of miRNA expression may play a role in the pathogenesis of MS.

Utility of a shortened Hasegawa Dementia Scale Revised questionnaire to rapidly screen and diagnose Alzheimer's disease.

AimsThe aim of this study was to analyze the sensitivity and specificity of a shortened Hasegawa Dementia Scale Revised (shortened HDS‐R) questionnaire and explore its utility for the rapid screening and diagnosis of Alzheimer’s disease (AD).MethodsWe included 113 patients over the age of 60 years who visited our hospital from June 2018 to January 2021 including 70 subjects with AD and 43 healthy subjects. AD was diagnosed in accordance with the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and the standard HDS‐R questionnaire was used as a neuropsychological examination. The shortened HDS‐R questionnaire was composed of the first seven subdomains (1 to 7) of the HDS‐R questionnaire and excluded subdomains 8 and 9. Magnetic resonance imaging (MRI) was performed to calculate the degree of atrophy of the whole brain, hippocampus, and parahippocampal gyrus.ResultsThe cumulative contribution ratio of subdomains 1 to 7 of the HDS‐R questionnaire was as high as 94%, indicating that the construct validity of the shortened HDS‐R was very good. The correlation coefficient of the total scores of the shortened HDS‐R and the HDS‐R was 0.96, indicating that the criterion‐related validity was also very good. Furthermore, the shortened HDS‐R was significantly negatively correlated with the degree of atrophy in the whole brain, hippocampus, and parahippocampal gyrus, indicating that its concurrent validity was very good in relation to imaging parameters. Cronbach’s α coefficient of the shortened HDS‐R was 0.76, and the correlation coefficient of the item‐total correlation analysis was between 0.68 and 0.76, indicating that this questionnaire has high internal consistency and reliability. The total shortened HDS‐R score of the normal group (17.0 ± 1.9) was significantly higher than that of the AD group (8.6 ± 3.8), demonstrating that the total shortened HDS‐R score can be used to identify healthy individuals and patients with AD. When the cutoff score was 14 of 15, the sensitivity was 92.9% and the specificity was 88.4%. The diagnostic ability of the shortened HDS‐R was 91.2%, which indicates that it is similar to the full HDS‐R questionnaire as an AD screening tool.ConclusionAs a neuropsychological examination questionnaire for the screening and diagnosis of AD, the shortened HDS‐R had very high validity and reliability. Its sensitivity, specificity, and diagnostic ability were similar to those of the gold standard HDS‐R; therefore, it can be considered a concise and useful questionnaire for AD screening and diagnosis in the older population.

Efficacy and safety of Buyang Huanwu-Tang (Boyang Hwano-Tang) in patients with vascular dementia: A protocol of systematic review and meta analysis.

Background:Vascular dementia (VaD) is the second most common type of dementia; it has a significant impact on patients and exerts a great social and economic burden. However, there has been no comprehensive systematic review assessing the efficacy and safety of Buyang Huanwu-Tang (Boyang Hwano-Tang, BHT) for VaD. Therefore, this protocol was developed to conduct a comprehensive systematic review and meta-analysis to evaluate the effectiveness and safety of BHT in the treatment of VaD.Methods:We will perform a comprehensive electronic search including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycARTICLES, Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System, Research Information Service System, Korean Medical Database, KMbase, National Digital Science Library, China National Knowledge Infrastructure, Wanfang database, VIP database, Citation Information by NII, and other sources from their inception to November 25, 2020. This systematic review will include only randomized controlled clinical trials of BHT for VaD. The main outcomes will include the Mini-Mental State Examination, Montreal Cognitive Assessment, and Revised Hasegawa's Dementia Scale. Two researchers will independently conduct study selection, data extraction, and appraise the quality and risk of bias of the included studies. A meta-analysis will be conducted using Review Manager version 5.4. The evidence quality of each outcome will be appraised according to the Grades of Recommendation, Assessment, Development, and Evaluation.Results:This study will provide comprehensive understanding of the efficacy and safety of BHT for the treatment of VaD.Conclusions:The findings of this study will provide reliable evidence for clinical application and further study of BHT for VaD.Ethics and dissemination:Ethical approval is not required because individual patient data will not be included in this study. The study findings will be disseminated through conference presentations.OSF registration DOI:10.17605/OSF.IO/NDYGP

Effect of the Mendelsohn maneuver and swallowing training in patients with senile vascular dementia complicated with dysphagia.

ObjectiveWe investigated the effect of the Mendelsohn maneuver and swallowing training in patients with senile vascular dementia complicated with dysphagia.MethodsWe randomly classified 214 patients with senile vascular dementia and swallowing dysfunction into a control group (CG, n = 106) and observation group (OG, n = 108). Both groups underwent health education, psychological intervention, and training of the oral muscle group. The OG additionally underwent the Mendelsohn maneuver and swallowing training. The Hasegawa Dementia Scale (HDS), China Stroke Scale (CSS), and Neurobehavioral Cognitive Status Examination (NCSE) were used to evaluate dementia, neurological impairment, and cognitive dysfunction, respectively.ResultsThe OG had a higher rate of effective therapy than the CG. After intervention, the OG showed better swallowing function than the CG. At 15 days and 1 month after intervention, the OG had higher video fluoroscopic swallowing exam scores than the CG. The OG had lower serum interleukin (IL)-1, IL-6, and tumor necrosis factor-α levels than the CG. After intervention, the OG had higher HDS and NCSE scores and lower CSS scores than the CG.ConclusionsThe Mendelsohn maneuver and swallowing training can improve swallowing function in patients with senile vascular dementia complicated with dysphagia and help to ameliorate the inflammatory response.

Factors Affecting Quality of Life at Discharge among Patients with Osteoporotic Vertebral Fractures.

This study aimed to identify factors, including physical functions and activities that affect quality of life (QOL) at discharge among patients with osteoporotic vertebral fractures. Patients with osteoporotic vertebral fractures were included in our prospective cohort study. Multiple regression analysis was performed to determine the predictors of QOL at discharge using two models: model 1, basic medical information and physical functions at admission, and model 2, basic medical information, physical function, and activity after 4 weeks of admission. Multiple regression analysis (standard partial regression coefficients) using model 1 identified L2 to L4 bone mineral density (-0.2), Visual Analog Scale for pain during activity at admission (-0.31), and Revised Hasegawa Dementia Scale (HDS-R) score at admission (0.64) as factors affecting QOL at discharge. Multiple regression analysis using model 2 identified HDS-R at admission (0.64), Pain Catastrophizing Scale score at 4 weeks (-0.34), and knee extension muscle strength at 4 weeks (0.28) as factors affecting QOL at discharge. Our results suggest that if patients have high bone mineral density, intense pain, and low cognitive function at admission, then low QOL at discharge will be predicted; however, improvement of pain catastrophizing and knee extension muscle strength during first the 4 weeks of admission may be able to improve QOL at discharge. Because patients in this study were Japanese only, it is important to exercise caution when applying our results to other populations.

Diagnostic accuracy of dementia screening tools in the Chinese population: a systematic review and meta-analysis of 167 diagnostic studies.

The rate of undetected dementia is high in China. However, the performance of dementia screening tools may differ in the Chinese population due to the lower education level and cultural diversity. This study aimed to evaluate the diagnostic accuracy of dementia screening tools in the Chinese population. Eleven electronic databases were searched for studies evaluating the diagnostic accuracy of dementia screening tools in older Chinese adults. The overall diagnostic accuracy was estimated using bivariate random-effects models, and the area under the summary receiver operating characteristic curve was presented. One hundred sixty-seven studies including 81 screening tools were identified. Only 134 studies qualified for the meta-analysis. The Mini-Mental State Examination (MMSE) was the most commonly studied tool, with a combined sensitivity (SENS) and specificity (SPEC) of 0.87 (95%CI 0.85-0.90) and 0.89 (95%CI 0.86-0.91), respectively. The Addenbrooke's Cognitive Examination-Revised (ACE-R) (SENS: 0.96, 95%CI 0.89-0.99; SPEC: 0.96, 95%CI 0.89-0.98) and Montreal Cognitive Assessment (MoCA) (SENS: 0.93, 95%CI 0.88-0.96; SPEC: 0.90, 95%CI 0.86-0.93) showed the highest performance. The General Practitioner Assessment of Cognition (GPCOG), Hasegawa's Dementia Scale and Cognitive Abilities Screening Instrument had performances comparable to that of the MMSE. The cut-off scores ranged widely across studies, especially for the MMSE (range: 15-27) and MoCA (range: 14-26). A number of dementia screening tools were validated in the Chinese population after cultural and linguistical adaptations. The ACE-R and MoCA had the best diagnostic accuracy, whereas the GPCOG, with an administration time < 5minutes, could be considered as a rapid screening tool.

Interactions of Cognitive and Physical Functions Associated with Toilet Independence in Stroke Patients

ObjectivesThe purpose of this study was to clarify the interaction among cognitive and physical functions associated with toilet independence in stroke patients. Materials and methodsWe retrospectively examined 125 stroke patients. We performed decision tree analysis to detect the interaction associated with toilet independent using assessment of motor function on the affected side, muscle strength on unaffected side, trunk function, neglect, motivation, and cognitive function. The interactions detected via decision tree confirmed the existence and influence using logistic regression. ResultsThe verticality test of the Stroke Impairment Assessment Set (3 or ≤2 points) was selected at the first level, and the Revised Hasegawa's dementia scale (≥19 or ≤18 points) and age (≥70 or ≤69 y) were selected at the second level of decision tree. Interaction terms created by these factors were significantly associated with toilet independence after adjusting for the independent influence of each factor using logistic regression. ConclusionsOur results show an interaction of trunk and cognitive functions or trunk function and age associated with toilet independence. The probability of toilet independence dramatically changes if two factors of each interaction were satisfied in stroke patients.