Carbon monoxide (CO) intoxication can lead to various brain lesions, with the globus pallidus being the most common site of injury. Herein, we report a rare case of CO poisoning with acute bilateral hippocampal lesions and delayed midbrain involvement of the substantia nigra. A woman in her twenties who attempted suicide by burning charcoal briquettes presented with a Glasgow Coma Scale score of 3/15. Initial head computed tomography revealed low-density areas in the bilateral globus pallidus and hippocampi. Magnetic resonance imaging (MRI) on day 3 showed high signal intensity in the same regions on diffusion-weighted imaging (DWI), with a corresponding low signal on the apparent diffusion coefficient map and high signal intensity on fluid-attenuated inversion recovery imaging. The patient underwent hyperbaric oxygen therapy (HBOT) and gradually regained consciousness. However, the patient experienced persistent short-term memory loss. Follow-up MRI on day 23 showed improvement in the hippocampal and globus pallidus lesions but revealed new bilateral high-signal lesions in the substantia nigra on DWI. Despite these findings, the patient did not exhibit any extrapyramidal signs. Subsequent HBOT sessions led to further improvements in her cognitive function, as evidenced by an increase in her Mini-Mental State Examination score from 13/30 to 27/30. This case highlights the importance of serial neuroimaging in CO poisoning, as delayed midbrain lesions may occur more frequently than previously thought, even in the absence of overt neurological symptoms. The patient's cognitive recovery and lack of parkinsonism suggests that early intervention with HBOT may help mitigate the long-term consequences of CO-induced brain injury.

Predicting dementia severity changes after shunt surgery for idiopathic normal-pressure hydrocephalus: Role of the tap test and cognitive assessments.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the accumulation of misfolded alpha-synuclein (α-Syn) and the subsequent loss of dopaminergic neurons. Identifying reliable and non-invasive biomarkers is crucial for accelerating early diagnosis and monitoring disease progression. To this aim, we longitudinally investigated α-Syn in salivary extracellular vesicles (SEVs) in PD patients and the correlation with clinical outcomes. SEVs were isolated from PD patients and healthy controls (HCs) saliva using differential ultracentrifugation followed by morphological and molecular characterization. The levels of both total (α-SynTot) and oligomeric (α-SynOlig) α-Syn were quantified by ELISA. We found a significant increase in both α-SynTot and α-SynOlig in PD-derived SEVs compared to HCs, and receiver operating characteristic analysis revealed that α-SynOlig displayed higher sensitivity (65%) for discriminating PD from HCs compared to α-SynTot (59%). Moreover, α-SynOlig levels correlated negatively with Mini-Mental State Examination scores and were higher in patients with motor fluctuations. Finally, we found that α-SynOlig levels did not change after one-year follow-up in patients when also the clinical parameters remained unaltered. These results establish for the first time that SEVs-associated α-SynOlig is a promising, sensitive and non-invasive biomarker for PD diagnosis and clinical correlation studies, bearing higher sensitivity than α-SynTot. Moreover, α-SynOlig levels closely followed the clinical outcomes in PD patients. Finally, these findings strengthen the rationale for the further exploration of SEVs to disclose still unavailable accessible biomarkers for multiple neurological diseases.

Introduction The Mini-Mental State Examination (MMSE) is widely utilized in clinical settings for cognitive screening, yet its diagnostic accuracy is often influenced by demographic factors such as educational attainment. This study investigates the educational gradient in MMSE performance and evaluates whether uniform cutoff scores adequately distinguish cognitively normal (CN), mild cognitive impairment (MCI), and Alzheimer's disease (AD) patients across different educational strata. Methods A total of 300 older adults (CN = 100; MCI = 100; AD = 100) were retrospectively recruited from the Severance Hospital memory clinic, intentionally balanced to ensure statistical power and avoid class-imbalance bias across diagnostic groups. All participants completed the Korean version of MMSE and the Seoul Neuropsychological Screening Battery-II (SNSB-II) and underwent 3T brain MRI for hippocampal volumetry. Education level was categorized as low (≤6 years), medium (7-12 years), and high (≥13 years). MMSE diagnostic accuracy was evaluated using ROC curve analyses stratified by education. Interaction effects were tested via multiple linear regression, and correlations with hippocampal volume were assessed. Results MMSE scores showed a significant educational gradient, with higher education associated with higher performance (p < 0.001). MMSE scores demonstrated a pronounced educational gradient, with particularly reduced performance in individuals with low educational attainment, suggesting potential overestimation of cognitive impairment when uniform MMSE cutoffs are applied. ROC analyses revealed only moderate diagnostic accuracy of MMSE in the higher education groups (AUC = 0.83 and 0.78). The AUC was 0.73 (95% CI 0.58-0.88) in the low-education group; the AUC was 0.83 (95% CI 0.75-0.91) in the middle-education group; and 0.78 (95% CI 0.70-0.87) in the high-education group, suggesting only moderate diagnostic accuracy of MMSE. Conversely, lower education groups showed underperformance potentially unrelated to pathology. Regression models confirmed that education and diagnosis had additive but non-interacting effects on MMSE scores. MMSE correlated strongly with hippocampal volume (r = 0.739, p < 0.001), validating its general neuroanatomical relevance. Conclusion MMSE performance is substantially modulated by education, with uniform cutoffs yielding differential diagnostic validity across educational strata. We suggest education-adjusted interpretation of MMSE and emphasize the need for integrative diagnostic approaches combining cognitive testing with neuroimaging biomarkers.

BackgroundEarly detection of Alzheimer's disease (AD) is critical for effective disease management and treatment. Web-based assessment tools offer advantages by enabling broader accessibility and reducing reliance on specialized clinical infrastructure.ObjectiveThis study aimed to validate a self-administered, web-based cognitive assessment tool for AD screening.MethodsA total of 106 older adults aged 55 to 84 years were recruited and clinically classified as cognitively unimpaired (CU, n = 35), amnestic mild cognitive impairment (aMCI, n = 37), or AD (n = 34). Participants completed Cogscreen, a 10-min web-based cognitive test comprising verbal cued memory and digit symbol substitution tasks.ResultsBoth the verbal cued memory and digit symbol substitution tasks showed significant score differences among CU, aMCI, and AD (p < 0.001). The Cogscreen composite score yielded area under the curve (AUC) values of 0.876 for aMCI (cut-off = 0.64, sensitivity = 0.865, specificity = 0.657) and 0.994 for AD (cut-off = -0.59, sensitivity = 0.971, specificity = 0.971), and outperformed the Mini-Mental State Examination (MMSE) in diagnosing aMCI (AUC = 0.638, p = 0.001). The composite score significantly correlated with the Consortium to Establish a Registry for Alzheimer's Disease assessment packet total score (r = 0.765, p < 0.001) and MMSE score (r = 0.722, p < 0.001).ConclusionsCogscreen is a rapid, self-administered cognitive screening tool for detecting aMCI and AD. It outperforms the MMSE in identifying early cognitive decline and holds potential for detecting even subtler cognitive changes in the future.

BackgroundSubjective cognitive decline (SCD) represents the first early symptomatic stage of Alzheimer's disease (AD).ObjectiveWe aimed to investigate the relationships between features in SCD and to assess the importance of these features in the future development of dementia to inform a targeted management protocol.Methods440 SCD patients underwent neurological and neuropsychological assessments, MRI scans, APOE genotyping, and AD biomarker evaluations. Patients were followed for a median of 10 years. Relationships among features were first assessed univariately, focusing on differences across stratified subgroups. To capture multivariate associations, we applied network analysis using a Markov Random Field. Finally, baseline features were related to dementia progression using an XGboost machine learning model.ResultsWomen comprising 68.9% of the cohort, were generally younger at onset, had lower APOE ε4 prevalence, and differed in neuropsychological performance compared to men. Older patients (age >60) exhibited a higher prevalence of APOE ε4 and cerebral small vessel disease. Patients with depressive symptoms demonstrated lower cognitive performance across multiple domains. Network analysis indicated complex interconnections among gender, cognitive reserve, SCD severity, and depressive symptoms. The XGboost model achieved 74% accuracy in predicting progression to dementia, identifying age at onset, mini-mental state examination scores, and APOE genotype as the most predictive factors.ConclusionsThis study highlights the role of age, gender, APOE genotype, and depressive symptoms in the presentation and progression of cognitive decline. By identifying key predictive features, we propose a personalized management protocol aimed at optimizing care for individuals with SCD.Trial registration number: NCT05569083, registration date: 2019-05-30.

Alzheimer's disease (AD) is a late-onset neurodegenerative disease that affects older people. Deregulations of miRNAs play essential roles in AD pathogenesis; as a re-sult, they might be potential biomarkers for AD development, diagnosis, and treatment. This case-control study aimed to assess the expression of miR-214, miR-204, miR-15a, miR-25, and inves-tigate their correlations with the expression of IL-33, plasma level of Malondialdehyde (MDA), and Mini-Mental State Examination (MMSE) score of the AD patients. Blood samples were obtained from 125 participants, including 75 AD patients and 50 healthy controls. Plasma MDA level was assessed using the ZellBio ELISA kit. Total RNA was extracted from blood lymphocytes using RiboExTM (GeneAll), and expression levels of miRNAs and IL-33 were evaluated by qRT-PCR. Results showed that miR-15a and miR-25, and IL-33 were downregulated in the pa-tients' group, but miR-214 and miR-204 were upregulated. Besides, the plasma level of MDA was significantly higher in the AD patients. A statistically significant negative correlation was observed between miR-15a and IL-33 expression. The MDA level showed a negative correlation with MMSE and a positive correlation with IL-33. Correlations between the miRNAs and MDA or MMSE scores were all non-significant. However, ROC curve analysis revealed that expres-sions of the studied miRNAs, IL-33, and the plasma level of MDA effectively differentiate AD patients from healthy controls. Results showed that expression levels of miR-214, miR-204, miR-25, miR-15a, and IL-33 and MDA plasma levels are deregulated in AD patients, highlighting their potential relation with AD pathogenesis. Expression levels of the studied miRNAs and IL33, and plasma level of MDA might be considered as potential biomarkers for AD development and diagnosis.

The 5-tone music therapy is a traditional Chinese medical practice that uses the therapeutic properties of specific musical notes to regulate physiological functions and promote psychological well-being. The aim of this study was to evaluate the effects of the 5 musical notes therapy on sleep disorders in individuals with Parkinson disease. The data of 74 patients with Parkinson disease who received treatment at our hospital between September 2021 and September 2023 were retrospectively analyzed. The patients who received 5 musical notes therapy were assigned to the study group (n=37), and the patients who received the routine care were assigned to the routine care group (n=37). The Pittsburgh Sleep Quality Index (PSQI), National Institutes of Health Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) scores were assessed and compared between the 2 groups. One month after the intervention, PSQI scores were significantly lower in both groups compared with baseline (P<0.05), with the study group demonstrating a greater reduction than the routine care group (P<0.05). MMSE scores increased significantly (P<0.05), and the study group exhibited higher MMSE scores than the routine care group (P<0.05). The SAS and SDS scores decreased in both groups post-intervention, with greater reductions observed in the study group compared with the routine care group (P<0.05). In addition, NHISS scores were significantly lower in the study group than in the routine care group (P<0.05). No significant differences were observed in the overall incidence of complications between the 2 groups (P>0.05). The application of the 5 musical notes therapy in the management of sleep disorders among patients with Parkinson disease demonstrated significant benefits, including improved sleep quality, enhanced cognitive function, and alleviation of anxiety and depression. This therapeutic approach also contributed to a reduction in NIHSS scores and is recommended for broader clinical implementation.

Probable sarcopenia, indicated by low handgrip strength, is a prevalent condition among hospitalized older adults and may reflect broader functional and nutritional decline. We examined differences in nutritional, functional, and cognitive status between Alzheimer's clinical syndrome (ACS) patients with probable sarcopenia and those without sarcopenia. A cross-sectional analysis was conducted on 194 hospitalized older adults with ACS. Probable sarcopenia was defined using European Working Group on Sarcopenia in Older People (EWGSOP2) handgrip strength thresholds. Patients with probable sarcopenia (n = 137) had significantly lower Mini-Mental State Examination (MMSE) scores, Geriatric Nutritional Risk Index (GNRI), albumin, hemoglobin, and gait speed compared to those without. After age and sex adjustment, MMSE (p = 0.023), GNRI (p = 0.002), hemoglobin (p = 0.022), albumin (p = 0.003), and gait speed (p < 0.001) remained significantly different. In the sex- and age-adjusted multivariable model (adjusted R2 = 0.442), higher nutritional risk (β = 0.26, p = < 0.001), lower MMSE scores (β = 0.17, p = 0.029), polypharmacy (β = -4.20, p = 0.002), and slower gait speed (β = 4.12, p = 0.010) were associated with reduced handgrip strength. In the multivariable binary logistic regression model (adjusted for age and sex), moderate or high nutritional risk and slow gait speed emerged as independent predictors of probable sarcopenia, with OR 5.14 (95% CI 1.34-19.75; p = 0.017) and OR 3.13 (95% CI 1.30-7.52; p = 0.011), respectively. Probable sarcopenia in hospitalized older adults with ACS is highly prevalent and is associated with higher nutritional risk, poorer cognitive and physical function, and polypharmacy; its early recognition may help to guide more targeted nutritional and functional interventions.

BackgroundEarly detection of cognitive impairment is vital for dementia management, especially in Alzheimer's disease. The Clock Drawing Test (CDT) is a widely used screening tool; however, many existing scoring methods lack comprehensive statistical validation and consistent factor structures.ObjectiveWe aimed to evaluate the validity and reliability of a novel scoring method, CDT-14, developed from items predictive of cognitive decline, and to compare its performance with three conventional scoring systems.MethodsWe enrolled 1100 outpatients undergoing cognitive assessments in a cross-sectional study. Scores from CDT-14 and the three conventional methods (Rouleau, Sunderland, Freedman) were compared. Structural validity was examined using confirmatory factor analysis (CFA), and item characteristics were analyzed via item response theory (IRT). Internal consistency was assessed with McDonald's omega. Construct validity and discriminative ability were evaluated through correlations and receiver operating characteristic (ROC) analyses. Participants were classified by Mini-Mental State Examination scores into Normal Cognition, Mild Cognitive Impairment, and Moderate-to-severe Cognitive Impairment.ResultsThe CFA results supported a three-factor model (Circle, Numbering, Hands) with good fit. The IRT analysis indicated high measurement precision in the mild cognitive decline range (θ = -1 to 0). The CDT-14 score exhibited strong internal consistency (ω = 0.835). ROC analyses showed that the CDT-14 score had comparable or superior discriminative accuracy to conventional methods, with practical cut-offs and enhanced performance when adjusted for age and education.ConclusionsThe CDT-14 is a psychometrically robust scoring method providing standardized, sensitive assessment for cognitive screening and longitudinal monitoring in dementia clinical settings.

Alzheimer's disease (AD) is characterized by amyloid-beta plaques, tau tangles, and neuroinflammation. C-X3-C motif chemokine ligand 1 (CX3CL1, also known as fractalkine), a neuroimmune chemokine implicated in AD pathogenesis, shows inconsistent alterations in plasma/serum across studies. Specifically examining age-dependency and diagnostic utility, we investigated plasma CX3CL1 levels across the cognitive continuum (cognitively normal [CN], amnestic mild cognitive impairment [aMCI], AD) in a Chinese cohort. A total of 443 participants, including 130 patients with AD, 72 patients with aMCI, and 99 age-and sex-matched CN controls, as well as a cohort of 142 CN subjects of different ages, were enrolled from Chongqing General Hospital. Plasma CX3CL1 levels were determined using Enzyme-Linked Immunosorbent Assay (ELISA). Apolipoprotein E genotypes (APOE) were performed. The correlations between Plasma CX3CL1 levels and cognition test scores or age were analyzed. The optimal diagnostic sensitivity and specificity were determined using receiver operating characteristic curve analysis. Plasma CX3CL1 levels significantly increased with age in CN individuals. No significant sex difference was found. Plasma CX3CL1 levels did not differ significantly between APOE ε4 carriers and non-carriers. Stepwise elevation across continuum: CX3CL1 levels showed a significant stepwise increase: CN controls (1.73 ± 0.51 ng/mL) < aMCI (2.40 ± 1.06 ng/mL) < AD (4.15 ± 1.24 ng/mL) (p < 0.001 between all groups). This pattern persisted in both male and female subgroups, between the AD group and the aMCI group, between the AD group and the CN control group (p < 0.001), between the aMCI group and the CN control group, and between the male and female subgroups (p < 0.05). CX3CL1 levels negatively correlated with Mini-Mental State Examination (MMSE) scores and positively correlated with age. Plasma CX3CL1 levels exhibit a significant age-dependent increase in cognitively normal individuals, peak in midlife (40-49 years), and demonstrate a stepwise elevation across the AD continuum (CN → aMCI → AD). Strong inverse correlations with cognitive scores in disease groups and high diagnostic accuracy for AD, particularly against CN, support its role as a biomarker reflecting both physiological aging and AD-related pathological decline. Its regulation appears independent of APOE ε4 status. The midlife peak suggests potential relevance for preclinical processes, warranting further investigation of CX3CL1 as a biomarker and therapeutic target.

Association between cognitive status and structural brain changes in Alzheimer's disease: Clinical implication of lightweight deep learning-aided diagnosis.

BackgroundThis study aimed to investigate the association between uric acid (UA) levels and cognitive function in a low-income, rural population in Chinese adults aged ≥60 years without hyperuricemia.MethodsElderly individuals (≥60 years old) without hyperuricemia from rural areas of Tianjin were included in this cross-sectional study. Basic demographic and clinical information were collected, and cognitive impairment was assessed using the Mini-Mental State Examination (MMSE). Binary logistic regression analysis was performed to evaluate the association between UA levels and cognitive impairment, and multivariate linear regression analysis was used to explore the relationship between UA levels and MMSE scores. Subgroup analyses were conducted based on gender and age.ResultsA total of 1,418 participants were included, with 43.1% showing cognitive impairment. Multivariate analysis revealed that the risk of cognitive impairment decreased by 0.2% for each unit increase in UA level and was reduced by 33% in the third quartile of UA levels compared with the lowest quartile (OR = 0.67, 95% CI: 0.49, 0.92, p = 0.014). MMSE scores increased by 0.01 (β = 0.01, 95% CI: 0.002, 0.01, p = 0.006) for each unit increase in UA level. Subgroup analysis showed significant protective associations in men and participants aged 60–69 years. However, no such relationship was found in women or individuals aged ≥70 years.ConclusionThis study highlights the cognitive protective effect of UA in low-income rural Chinese populations aged ≥60 years without hyperuricemia, particularly in men and those aged 60–69 years. These findings underscore the importance of targeted interventions and health education programs to prevent cognitive decline in this vulnerable population.

Cognitive impairment in older adults is influenced by coexisting β-amyloid (Aβ), tau, and cerebral small vessel disease (CSVD). Cerebral microbleeds (CMBs) are associated with Aβ and CSVD, but their role on tau-related neurodegeneration remains unclear. We investigated whether the CMBs modify tau-related disease progression. A longitudinal, prospective cohort study was conducted involving participants with mild cognitive impairment, Alzheimer disease dementia from the memory disorder clinic of the single tertiary center, or cognitively unimpaired from the community. All participants underwent cognitive assessment, MRI, 18F-flutemetamol PET for Aβ, and 18F-MK-6240 PET for tau at baseline. Cognitive tests were performed annually and MRI at 2 years. Cognitive decline was defined by score changes over this period and cortical atrophy as annual cortical thickness change. Linear regression analyses were conducted after stratifying by total or lobar CMB presence. Among the 201 participants (mean age 71.3 ± 7.0 years, 66.7% female), 95 had CMBs and 106 did not. Baseline Aβ or tau burden did not significantly differ between the 2 groups while white matter hyperintensity volume and lacunes were greater in the CMB group. Cross-sectionally, greater tau burden correlated with worse cognition, as measured by the Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) or Mini-Mental State Examination (MMSE) in both groups. Longitudinally, baseline tau burden was associated with CDR-SOB progression in the non-CMB group (β = 1.558, SE = 0.249, p < 0.001), but not in the CMB group (β = -0.031, SE = 0.405, p = 0.940; p-for-interaction = 0.001). Similar group differences were found for MMSE changes (non-CMB: β = -2.365, SE = 0.566, p < 0.001; CMB: β = -0.816, SE = 0.653, p = 0.217; p-for-interaction = 0.073). Stratification by lobar CMBs confirmed significant interaction effects for both CDR-SOB (p-for-interaction = 0.007) and MMSE (p-for-interaction = 0.045) scores. Imaging analysis showed more extensive cortical atrophy in the CMB group, but tau-related cortical atrophy was widespread only in the non-CMB group and minimal in the CMB group. In the non-CMB group, tau burden was strongly associated with cognitive decline and cortical atrophy. By contrast, the CMB group exhibited greater CSVD burden and pronounced neurodegeneration not explained by tau, suggesting that additional mechanisms such as CSVD related to cerebral amyloid angiopathy or neuroinflammation may contribute to disease progression in this group.

Abstract Objectives Stroke is a major cause of long-term disability and cognitive impairment, substantially affecting patients’ quality of life and functional independence. Effective strategies for post-stroke cognitive recovery remain limited. To evaluate the effects of transcranial magnetic stimulation (TMS) combined with reminiscence therapy on cognitive function and functional independence in stroke patients. Methods A retrospective cohort study was conducted at a rehabilitation hospital from March 2017 to October 2024, including patients with ischemic stroke and cognitive impairment who received either routine treatment (n=68) or TMS combined with reminiscence therapy (n=66). Cognitive and functional outcomes were assessed using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), and Functional Independence Measure (FIM). Results Post-treatment, the TMS plus reminiscence therapy group showed significantly higher MMSE (27.42 ± 3.08 vs. 25.18 ± 3.41, p=0.0001) and MoCA scores (20.05 ± 3.99 vs. 18.44 ± 4.05, p=0.0020), and shorter TMT times (65.28 ± 9.75 vs. 72.45 ± 10.32, p&lt;0.001). FIM scores were also higher (92.18 ± 7.06 vs. 88.35 ± 7.15, p=0.0024). No significant differences in adverse events were observed. Conclusions TMS combined with reminiscence therapy may effectively enhance cognitive function and functional independence in patients with post-stroke cognitive impairment.

Background: Studies on the association between cognitive and physical fitness in older adults from particularly vulnerable settings are scarce. This study aims to analyse the relationship between different protocols for assessing physical fitness and the cognitive function of low-income older adults. Methods: A total of 312 adults aged 60-96 years (M age = 72.63, SD= 7.81) living in the urban area of Amazonas, Brazil, participated in the study. The following measures of physical fitness were assessed: body composition, handgrip strength, the Five Times Sit-to-Stand Test and Senior Fitness Tests. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Linear regression models were used to analyse the relationship between physical function measures and cognitive function. Results: For men, only the 30-chair stand test power (β = 0.33, p < 0.001) presented favourable association with cognitive function. For women, significant associations between MMSE score were observed for every fitness test, except for the chair sit-and-reach test. Conclusions: Physical fitness is differently associated with cognitive function among low-income older men and women from Amazonas. Muscular fitness particularly seems to be an important indicator of cognitive function. It should be considered for monitoring, promoting, and managing health-ageing of low-income elderly populations of both sexes.

BackgroundDiabetes is increasingly prevalent among older adults; mild cognitive impairment (MCI) comorbidity in this group represents a major concern. Existing MCI prediction methods are often inaccurate, but machine learning (ML) offers improved potential. This study aimed to identify factors associated with MCI through ML analysis of retrospective data from hospitalized older patients with type 2 diabetes mellitus (T2DM).Material/MethodsThis retrospective study analyzed data from 503 inpatients older than 60 years with T2DM. Patients were classified into MCI (n=102) and normal (n=401) groups based on Mini-Mental State Examination scores. To minimize overfitting and maximize data utilization, 5-fold cross-validation was used for model training and evaluation. Least absolute shrinkage and selection operator regression identified 8 core predictors from clinical data. Logistic regression, eXtreme Gradient Boosting (XGBoost), and random forest algorithms were employed to construct predictive models. Receiver operating characteristic (ROC) curves were used to compare model performance.ResultsKey predictors of early MCI included age, body mass index, glycated hemoglobin, C-reactive protein, waist-to-height ratio, presence of diabetic complications, diabetes duration exceeding 5 years, and low education level. The XGBoost model outperformed other algorithms in ROC analysis: area under the curve, 0.892±0.032; accuracy, 0.851±0.028; sensitivity, 0.843±0.031; specificity, 0.859±0.029; and F1 score, 0.834±0.033.ConclusionsThe XGBoost model, incorporating these identified factors, demonstrated optimal predictive performance for MCI in older patients with T2DM. It may aid clinical risk stratification and provide a quantitative foundation for early intervention.

While perioperative esketamine use has grown increasingly prevalent, evidence supporting its efficacy and safety in elderly patients undergoing laparoscopic prostate cancer surgery remains limited. This retrospective study evaluated intravenous esketamine's performance in this population by analyzing 186 elderly patients treated between 2021 and 2024, divided into a control group (n = 91; conventional anesthesia) and an esketamine group (n = 95; conventional anesthesia plus esketamine). Esketamine infusion was discontinued 30 min before surgery completion. Hemodynamic parameters-heart rate (HR) and mean arterial pressure (MAP)-were recorded at five time points: pre intubation (T1), 1 min post intubation (T2), 1 h intraoperatively (T3), skin closure (T4), and 5 min post extubation (T5). Secondary outcomes included anesthesia duration, extubation time, awakening time, analgesic use, Riker Sedation-Agitation Scale scores, visual analog scale (VAS) pain scores (immediately, and at 6 and 24 h postoperatively), Mini-Mental State Examination (MMSE) scores, postoperative cognitive dysfunction (POCD), and adverse events. Compared with the control group, the esketamine group required significantly less remifentanil, propofol, and muscle relaxant (P < 0.05). Hemodynamically, HR and MAP were higher at T2 and lower at T3 in the esketamine group (P < 0.05). Postoperatively, esketamine prolonged awakening time slightly but reduced agitation and severe coughing (P < 0.05), shortened postanesthesia care unit (PACU) stay (P < 0.05), and improved VAS pain scores (P < 0.05). MMSE scores at 1 and 7 days post surgery were higher, and POCD incidence was lower (P < 0.05). The only notable adverse event difference was a higher rate of mild drowsiness (P < 0.05); other adverse events did not differ. These findings suggest that esketamine may help maintain hemodynamic stability and enhance postoperative recovery in elderly patients undergoing laparoscopic radical prostatectomy, reducing anesthetic requirements and improving cognitive outcomes with minimal additional risk.

BackgroundSleep is essential for brain‐health, including clearance of β‐amyloid (Aβ), tau, and otherpromising diagnostic markers of neurodegeneration and progression in Alzheimer's Disease (AD): cerebrospinal fluid neurofilament‐light chain (NfL), neurogranin‐36 (NG‐36), and Chitinase‐3‐like protein‐1 (YKL‐40). However, it remains unclear which sleep characteristics predict these biomarkers or whether the biomarkers predict cognitive or neuropsychiatric decline after AD onset.MethodsUsing data from a prospective cohort study of mild‐to‐moderate AD (n = 60, 30‐female, mean age 74.7), we analysed non‐rapid eye‐movement sleep spindles and slow oscillations (SO) at baseline and their associations with baseline NfL, YKl‐40, NG‐36, NfL/Aβ42, YKl‐40/Aβ42, and whether these biomarkers predict cognition and mental health from baseline to three‐years follow‐up.Participants underwent baseline polysomnography (PSG) and cerebrospinal fluid draws for amyloid and tau, and neuropsychological assessment at baseline, 12, 24 and 36 months with the Mini‐Mental Status Examination (MMSE), and the Alzheimer's Disease AssessmentScale‐Cognitive Subscale (ADAS‐Cog) and Neuropsychiatric Inventory (NPI) at baseline and 12 months.Spindle and SO detection were performed using in‐house, open‐source software packages developed at Concordia University. Associations between SO and spindle characteristics (duration, density, power, amplitude), biomarkers, and cognition from baseline to 36 months were investigated with false discovery rate‐adjusted robust regression controlling for age, sex, apnea‐hypopnea index.ResultsWe found previously unreported associations between spindle and SO characteristics, NfL, YKl‐40, NG‐36, NfL/Aβ42 (β=‐.0029, p = 0.001), YKl‐40/Aβ42 (β=0.0004, p = 0.003) and cognition in persons with AD. These biomarkers predicted worse cognitive performance (higher ADAS‐cog [β=2.28, p = 0.004], lower MMSE scores [β= ‐2.42, p = 0.01]) from baseline to 36‐months, and a significant increase in neuropsychiatric symptom severity (NPI β=16.93 p <0.001). NfL/Aβ42 mediated the effects of spindle activity on cognitive performance on the ADAS‐cog (p = 0.041) and MMSE (p = 0.0019). Biomarkers also moderated the relationships between spindle and SO activity on cognition, and spindles and SO moderated the relationships between these biomarkers and cognition.ConclusionsOur novel findings demonstrate that spindle and SO activity are associated with NfL, YKl‐40, and NG‐36, and cognitive decline, constituting predictive, non‐invasive biomarkers of neurodegeneration, cognition, and mental health in AD. They may thus provide novel treatment targets for delaying AD progression.

Objective: To evaluate the clinical efficacy of Huoxue Tongqiao (blood‐invigorating and orifice‐unblocking) Decoction (HXTQD) combined with aniracetam in the treatment of post‐ischemic stroke cognitive impairment (PISCI) in elderly patients and to investigate its effects on related serum biochemical markers. Methodology: This was a retrospective study. A total of 80 elderly patients with PSCI admitted to Baoding NO.1 Central Hospital between January 2022 to December 2024 were enrolled and randomly assigned to either the control group or the observation group using a random number table. All patients received standard internal medicine management. In addition, the control group was treated with aniracetam, while the observation group was orally administered HXTQD in combination with aniracetam. Both groups underwent continuous treatment for three months. Traditional Chinese Medicine (TCM) syndrome scores, Montreal Cognitive Assessment (MoCA) scores, Mini‐Mental State Examination (MMSE) scores, Activities of Daily Living (ADL) scores, cerebral hemodynamic parameters (bilateral middle cerebral artery mean flow velocity [Vm], resistance index [RI], pulsatility index PI]) and serum biochemical markers (superoxide dismutase [SOD], glutathione peroxidase [GSH‐Px] and nitric oxide [NO]) were assessed before and after treatment. The overall response rate (ORR) was compared between the two groups. Results: After treatment, both groups showed significant improvements in MoCA, MMSE and ADL scores, Vm and serum levels of SOD, GSH‐Px and NO (all P &lt; 0.05), with the observation group demonstrating significantly greater improvements than the control group (P &lt; 0.05). TCM syndrome scores, RI and PI decreased in both groups, with more pronounced reductions noted in the observation group (P &lt; 0.05, respectively). The ORR in the observation group was 92.50%, significantly higher than the 72.50% in the control group (P &lt; 0.05). No adverse reactions were reported in either group. Conclusion: The combination of HXTQD and aniracetam can significantly improve cognitive function and cerebral perfusion in elderly patients with post‐ischemic stroke cognitive impairment, potentially by regulating serum SOD, GSH‐Px and NO levels.