Montreal Cognitive Assessment Scale Research Articles

Effects of early cognitive rehabilitation training on cognitive function and quality of life in critically ill patients with cognitive impairment: A randomised controlled trial

BackgroundPatients often develop cognitive dysfunction during admission to the ICU and after being transferred out of the ICU, which leads to physical disorders, sleep disorders, and psychological stress.Cognitive rehabilitation training can significantly improve patients' planning, decision-making ability, and executive function. ObjectiveThe aim of this study was to explore the role of early cognitive rehabilitation training in improving cognitive impairment in critically ill patients. MethodsThis study was a prospective, randomised, controlled clinical trial conducted from January 2017 to June 2021. Critically ill patients with cognitive impairment admitted to the Department of Intensive Care Medicine of The Third Hospital of Mianyang were randomly divided into the control (n = 68) and intervention groups (n = 68). Cognitive rehabilitation training (including digital operating system training, music therapy, aerobic training, and mental health intervention) was applied to the patients in the intervention group for 6 months, while the control group did not receive any cognitive intervention. Before 3 and 6 months after enrolment, the Montreal Cognitive Assessment and the 36-Item Short Form Health Survey Scale were used to evaluate cognitive function and quality of life, respectively, in both groups. ResultsA total of 136 critical patients were included in the final analysis. There were no significant differences in sex, age, years of education, complications, intensive care unit hospitalisation time, mechanical ventilation time, or the total score of the Montreal Cognitive Assessment scale when transferred out of the intensive care unit in 24 hours between the two groups. Six months later, the results of the follow-up showed that the cognitive function score in the intervention group was significantly higher than that in the control group (26.69 ± 2.49 vs. 23.03 ± 3.79). The analysis of quality of life showed that the scores in all areas in the intervention group improved. There were significant differences in physical functioning (69.02 ± 8.14 vs. 63.38 ± 11.94), role physical (62.02 ± 12.18 vs. 58.09 ± 8.83), general health (46.00 ± 15.21 vs. 40.38 ± 13.77), vitality (61.00 ± 11.01 vs. 54.38 ± 13.80), social functioning (70.00 ± 10.29 vs. 64.41 ± 13.61), role emotional (78.00 ± 8.00 vs. 72.15 ± 12.18), and mental health (71.00 ± 12.33 vs. 55.37 ± 10.76) between the two groups (P < 0.05). ConclusionEarly cognitive rehabilitation training can improve cognitive impairment in critically ill patients and their quality of life.

Real‐world sleep in Parkinson’s disease predicts cognitive dysfunction.

AbstractBackgroundSleep dysfunction is signature of Alzheimer’s disease and Parkinson’s disease (PD), and can signify incipient disease, disease risk, and worsen symptoms over time. How real‐world sleep dysfunction relates to patient self‐report of sleep and clinical cognitive dysfunction is poorly understood, partly because self ‐report is impaired in patients with cognitive decline. We monitored real‐world sleep with wearable actigraphy devices in patients with PD to test the hypothesis that objective patterns of sleep dysfunction are associated with worse cognitive performance.MethodTwenty‐nine participants with idiopathic PD (age = 67.44 ± 5.79, 20 males) completed the Montreal Cognitive Assessment (MoCA) and Epworth Sleepiness Scale (ESS) to capture clinical cognitive decline and self‐reported daytime sleepiness. Sleep was monitored for 4‐weeks using wrist‐worn ActiGraphs. Sub‐scores and total scores of MoCA were compared with Total Sleep Time (TST), Sleep Efficiency (SE), Wakefulness After Sleep Onset (WASO), and Sleep Fragmentation Index (SFI) measured by actigraphy, as well as ESS total using a Pearson correlation.ResultWorse sleep fragmentation (SFI), the percentage of awakenings and movements during sleep, predicted worse cognitive impairment overall (MoCA score: r = ‐0.38, p &lt; .05) and delayed recall (r = ‐0.44, p &lt; .05). Reduced sleep time (TST) and worse sleep quality (SE, WASO) did not worsen patient cognitive impairment. Patient self‐report of sleepiness (ESS) did not associate with worse cognitive outcomes.ConclusionThis pilot analysis identifies sleep fragmentation as a key risk factor for cognitive dysfunction in PD. Patient self‐report of sleep may not reliably reflect chronic sleep disruption and related cognitive dysfunction. Results underscore that objective measures of real‐world dysfunction can help inform clinical care and intervention for patients at risk for cognitive decline and dementia.

Diagnosing Alzheimer Disease: Which Dementia Screening Tool to Use in Elderly Puerto Ricans with Mild Cognitive Impairment and Early Alzheimer Disease?

AbstractBackgroundMost of the time, Alzheimer Disease (AD)’s diagnosis is not made at its earliest periods and prodromal stages, for instance at Mild Cognitive Impairment (MCI) and Early Alzheimer Disease (E‐AD) stage. Commonly, AD’s diagnosis is made when significant impairment interferes with the habitual daily activities (1). Our pilot study, serves to demonstrate a correlation between the screening tools, including the Mini‐mental Status Exam (MMSE), Montreal Cognitive Assessment (MoCA) and Clinical Dementia Rating Scale (CDR), and the biological biomarkers in the cerebral spinal fluid (CSF) (Amyloid Beta 1‐42 (Aβ42 pg/mL), Tau proteins (tTau (pg/mL) and tTau/Aβ42 ratio in Puerto Ricans &gt; 55 years old with MCI and E‐AD. To our knowledge, this is the first study trying to create a correlation between memory tests scores and underlying AD pathology to improve early detection in elderly Puerto Ricans.MethodThirty participants were evaluated including, demographics, clinical characteristics, memory scales and CSF biomarkers. CSF biomarkers (Aβ42, tTau protein, and tTau/Aβ42 ratio) were determined using the Meso Scale Discovery Platform (MSD). Associations between memory scales (MOCA, MMSE, CDR) and CSF markers were performed using Spearman’s rho correlation.ResultOur study revealed statistical association in favor of a direct relationship between MMSE and tTau/Aβ42 ratio in CSF (p= .022, 95.00% CI = [‐.69, ‐.07] (Figure 1). We found a trend towards significance with an inverse relationship with MMSE and Aβ42 (p=.069) (Figure 2) and a direct relationship with MMSE and tTau (p= .098) (Figure 3). Besides, MoCA and tTau/Aβ42 ratio had a statistically significant direct relationship (p = 0.035) (Figure 4). There was no significant statistical association between CDR test with CSF biomarkers in elderly Puerto Ricans.ConclusionMMSE was the dementia screening test consistently identifying a statistically significant or a‐trend‐towards a significant association with the CSF Alzheimer Disease’ s biomarkers (Aβ42, tTau protein, and tTau/Aβ42 ratio) in elderly Puerto Ricans with MCI and E‐AD. Clinically, &gt; 55 y/o Puerto Rican patients with MCI and E‐AD should be screened with MMSE for a higher likelihood of earlier detection and, thus, initiation of disease‐modifying treatment.

Associations between PM2.5 exposure and Alzheimer’s Disease prevalence Among elderly in eastern China

BackgroundStudies showed that PM2.5 might be associated with various neurogenic diseases such as Alzheimer’s Disease (AD). However, this topic had been little studied in Zhejiang province of China. MethodsIn 2018, we established a cohort of AD high-risk population with 1,742 elderly aged 60 and above. In 2020, the cohort was followed up, a total of 1,545 people participated the 2 surveys. Data collection included questionnaires and basic physical examinations. The average residential exposure to PM2.5 for each participant, that in a 5-years period prior to the first survey, was estimated using a satellite-based spatial statistical model. We determined the association between PM2.5 and AD prevalence by cox proportional hazards regression model. ResultsThis study showed that an increase in the PM2.5 level was an important associated risk factor that contributed to AD. The average PM2.5 exposure levels among the study population ranged from 32.69 μg/m3 to 39.67 μg/m3 from 2013 to 2017, which were much higher than 5 μg/m3 that specified in the WHO air quality guidelines. There was an association between PM2.5 exposure and AD, and the correlations between PM2.5 and Mini-Mental State Examination, Montreal cognitive assessment scale scores were statistically significant. An increase in the PM2.5 level by 10 μg/m3 elevated the risk of AD among residents by 2%-5% (HR model 2-model 4 = 1.02 to 1.05, CI model 2-model 4 = 1.01–1.10). The subgroups of male, with old age, with low education levels, used to work as farmers or blue-collar workers before retirement, overweight and obese were associated with a higher effect of PM2.5.ConclusionsReducing PM2.5 exposure might be a good way to prevent AD.

Adjuvant Chinese Medicine for the Treatment of Type 2 Diabetes Mellitus Combined with Mild Cognitive Impairment: A Systematic Review and Meta-Analysis of a Randomised Controlled Trial.

Mild cognitive impairment has a high prevalence in the type 2 diabetic population. Adjuvant therapy with Chinese herbal medicine can effectively improve the clinical symptoms of patients with T2DM combined with MCI. The aim of this study was to systematically evaluate the efficacy and safety of Chinese herbal adjunctive therapy in the treatment of diabetes mellitus combined with cognitive impairment. Information was analysed using the China Knowledge Network, Vip Database, Wanfang Database, China Biomedical Literature Database, PubMed, EMbase, Web of Science, and MedLine Database. The total clinical efficiency, blood glucose, blood lipids, Simple Mental-State Examination Scale (MMSE), Montreal Cognitive Assessment Scale (MoCA), Traditional Chinese Medicine Symptom Score (TCMSS), and incidence of adverse reactions were recorded. The methodological quality of the included studies was evaluated using the application of the Cochrane Collaboration Network Risk Bias Assessment Tool, and meta-analysis was performed using RevMan 5.4 software. Adjuvant treatment with Chinese herbal medicine was effective in improving the clinical outcomes (OR = 5.33, 95% CI (3.62, 7.84), p &lt; 0.00001) and cognitive function by comparing with the control group: MMSE (MD = 1.56, 95% CI (1.29, 1.84), p &lt; 0.00001) and MoCA (MD = 2.77, 95% CI (1.81, 3.73), p &lt; 0.0001); lowered blood glucose: fasting blood glucose (FBG) (MD = -0.27, 95% CI (-0.42, -0.12), p = 0.0006), 2 hPG (MD = -0.28, 95% CI (-0.45, -0.10), p = 0.002), and glycated haemoglobin (HbA1c) (MD = -0.26, 95% CI (-0.39, -0.14), p &lt; 0.001); and improved lipids: total cholesterol (TC) (MD = -0.51, 95% CI (-0.82, -0.21), p = 0.001), triglycerides (TGs) (MD = -0.46, 95% CI -0.46, 95% CI (-0.80, -0.11), p = 0.009), low-density lipoprotein (LDL-C) (MD = -0.28, 95% CI (-0.55, -0.02), p = 0.04), high-density lipoprotein (HDL-C) (MD = 0.17, 95% CI (0.07, 0.28), p = 0.001), reduced TCMSS (MD = -1.84, 95% CI (-2.58, -1.10), p &lt; 0.0001), and incidence of adverse events (OR = 0.46, 95% CI (0.24, 0.88), p = 0.02). In conclusion, through the available evidence, herbal adjuvant therapy for T2DM combined with MCI was observed to be effective and did not significantly increase the adverse effects. Due to the limitation of the number and quality of the included studies, the abovementioned results need to be validated by further high-quality studies.

Cognitive impairment in patients with hypothyroidism and possibilities of its correction

Aim. To identify and correct cognitive impairment in patients with hypothyroidism.Materials and methods. The study included 76 patients with primary hypothyroidism. All patients were divided into 2 groups: compensated and decompensated hypothyroidism. In addition to general clinical, and hormonal blood tests all participants in the study underwent ultrasound of the thyroid gland and ECG, the neurophysiological study of cognitive evoked potentials, and testing according to the Montreal cognitive function assessment scale.Results. In the majority of patients with a lack of thyroid hormones, cognitive impairments were detected, which increase with worsening compensation for hypothyroidism according to the results of Montreal Cognitive Assessment Scale testing. The study of evoked potentials in patients with hypothyroidism revealed an increase in latency and a decrease in the amplitude of the P300 indicator, indicating the presence of cognitive deficit. The addition of ethylmethylhydroxypyridine succinate to hormone replacement therapy in patients with hypothyroidism significantly improves cognitive performance more than hormone monotherapy.Conclusions. This study showed the need to identify cognitive impairments in patients with primary hypothyroidism, and their correction with the help of complex therapy increases the cognitive potential and the effectiveness of their treatment.

Serum Uric Acid Levels in Neurodegenerative Disorders: A Cross-Sectional Study.

Excessive oxidative stress may contribute to neurodegeneration by leading to protein aggregation and mitochondrial dysfunction. Uric acid (UA) is an important endogenous antioxidant that protects against oxidative stress, yet its exact role in neurodegeneration remains unclear. To explore the performance of serum UA in neurodegenerative disorders. A total of 839 controls and 840 patients, including Alzheimer's disease (AD), Parkinson's disease (PD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), motor neuron disease (MND), Creutzfeldt-Jakob disease (CJD), and mixed dementia (MixD) were enrolled. Fasting serum UA levels were measured in all participants and compared between patients and controls. Linear regression models were utilized to explore possible relationships of serum UA with cognition, disease duration, age, and age of onset. Compared to controls (355.48 ± 85.38 μmol/L), serum UA was significantly lower in AD (291.29 ± 83.49 μmol/L, p < 0.001), PD (286.95 ± 81.78 μmol/L, p < 0.001), PSP (313.32 ± 88.19 μmol/L, p < 0.001), FTD (313.89 ± 71.18 μmol/L, p = 0.001), and DLB (279.23 ± 65.51 μmol/L, p < 0.001), adjusting for confounding factors including age, gender, education, etc. In addition, serum UA was positively correlated with cognitive levels in all patients (Mini-Mental State Examination: r = 0.136, p = 0.001; and Montreal Cognitive Assessment Scale: r = 0.108, p = 0.009). Decreased levels of serum UA were correlated with AD, PD, PSP, FTD, and DLB, offering significant potential as a promisingly relevant, less-invasive marker of multiple neurodegenerative disorders.

Relationship between heart rate variability and cognitive function in patients with enlarged perivascular space.

To explore the relationship between heart rate variability (HRV), the brain distribution of enlarged perivascular space (EPVS), and cognitive impairment in patients with EPVS. The clinical and imaging data of 199 patients with EPVS were retrospectively analyzed. EPVS load in the basal ganglia (BG) and centrum semiovale (CS) regions were assessed using the Potter's method. Cognitive function was evaluated using the Montreal Cognitive Assessment Scale. A logistic regression model was used to analyze the relationship between HRV, the brain distribution of EPVS and cognitive function in patients with EPVS. A receiver operating characteristic curve was used to assess the predictive value of HRV for cognitive function in patients with EPVS. Of the 199 patients, 27 and 42 presented with severe BG-EPVS and cognitive impairment, respectively. Significant differences were observed in the root mean square of successive differences of normal-normal (NN) intervals for period of interest (rMSSD), the percentage of adjacent NN intervals greater than 50 ms (PNN50), and the ratio of low-frequency power (LF) to high-frequency power (HF) between the mild and severe BG-EPVS groups (P < 0.05). Patients who presented with and without cognitive impairment differed significantly in the standard deviation of NN intervals (SDNN), rMSSD, PNN50, total power, LF, and LF/HF (P < 0.05). rMSSD (odds ratio [OR] 0.871, 95% confidence interval [CI] 0.768-0.988) and LF/HF (OR 3.854, 95% CI 1.196-12.419) were independent influencing factors of BG-EPVS, and rMSSD (OR 0.936, 95% CI 0.898-0.976) was an independent influencing factor of cognitive impairment in patients with EPVS. The optimal cut-off point was 0.312, with an area under the curve of 0.795 (95% CI 0.719-0.872) for predicting cognitive impairment in patients with EPVS by rMSSD. Reduced HRV is involved in the pathophysiological mechanisms of the formation and development of BG-EPVS and is associated with cognitive impairment in patients with EPVS, independent of CS-EPVS. For patients with HRV changes but without autonomic nervous system symptoms, positive intervention may slow the occurrence or progression of EPVS and cognitive impairment in patients with EPVS.

Impairment of social cognitive functions in the patients with acute ischemic stroke

BACKGROUND. Cognitive impairment is common after a stroke. However, the condition of social cognitive functions, in particular theory of mind, in this group of patients has been studied insufficiently.&#x0D; AIM. To study the frequency and predictors of the development of the social cognitive disorders based on theory of mind impairment in patients with acute ischemic stroke.&#x0D; MATERIAL AND METHODS. Theory of mind impairment was assessed using Reading the Mind in the Eyes test in the acute period of ischemic stroke. National Institutes of Health Stroke scale was used to assess the severity of neurological deficit, modified Rankin scale the degree of disability, Delirium Severity Rating Scale the symptoms of delirium, Buss Perry aggressiveness scale severity of aggressive behavior, Montreal Cognitive Assessment Scale cognitive deficit. The severity of cortical atrophy was evaluated by computed tomography of the brain. The study included 86 patients, 53 males and 33 females. The average age of patients was 64 years. Statistical analysis was performed using the IBM SPSS Statistics 21 software package. Nonparametric statistics methods were used. Binary data were compared using the chi-square parameter, categorical data were compared using the MannWhitney test.&#x0D; RESULTS. Seventy percent of patients suffered from the impairment of social cognitive functions. Independent predictors of the impairment of theory of mind according to linear regression analysis were cognitive dysfunction according to the Montreal Cognitive Assessment Scale (p=0.0001) and the severity of cortical atrophy on computed tomography of the brain (p=0.001).&#x0D; CONCLUSION. Social cognitive impairment is registered in a substantial number of patients in acute period of stroke; its predictors include general cognitive impairment and cortical atrophy of the brain.

Correlation analysis of lipid level and cognitive function in middle-aged and elderly diabetic population from 2 communities in Beijing in 2017

To investigate the relationship between serum lipid level and cognitive function in middle-aged and elderly patients with type 2 diabetes mellitus(T2 DM). A cross-sectional study was implemented in 2017 to explore the correlation between lipid level and cognitive function in middle-aged and elderly diabetic patients. A random sample of 1526 middle-aged and elderly people were recruited from 2 communities in Beijing. Fasting blood samples were collected for blood lipid level detection, and the cognitive function of the subjects was assessed by the Montreal Cognitive Assessment Scale(MoCA). Logistic regression model was used to analyze the correlation between serum lipid levels and mild cognitive impairment(MCI) in elderly and T2 DM patients and control group. Compared with the control group, there were significant differences in blood lipid levels in T2 DM group. The levels of total cholesterol(TC) and high density lipoprotein cholesterol(HDL-C) in T2 DM group were lower than those in the control group, while triglyceride(TG) and low density lipoprotein cholesterol(LDL-C) were higher than those in the control group. Logistic regression analysis showed that high level of TC was a risk factor for MCI in patients with T2 DM, while high level of LDL-C was a protective factor, but no association was observed in the control population. Phenotype of T2 DM may affect the relationship between lipid level and cognitive function in middle-aged and elderly people.

Cognitive Dysfunction and Its Risk Factors in Patients Undergoing Maintenance Hemodialysis.

Cognitive impairment (CI) in Maintenance hemodialysis (MHD) is attracting increasing attention. This study aims to clarify the prevalence and risk factors for cognitive dysfunction in patients on MHD who have no history of stroke. A total of 99 patients with no history of stroke undergoing MHD were enrolled. Global cognitive function was evaluated using the Montreal Cognitive Assessment scale. Attention and executive functions were evaluated by the Digital Span (DS) test and the Color Trail Test (CTT). The Hamilton Depression and Anxiety scales were used to assess depression and anxiety status. The effects of patient background factors, laboratory indicators, anxiety, and depression on cognitive dysfunction were examined by regression analysis. There were 69.70% of the patients had general CI, 65.65% had depression, and 57.57% had anxiety. The forward and backward DS in the cognitively impaired (CI) group were shorter than in the normal cognitive function (NCF) group (P<0.05). Times required for CTT-I, CTT-II, and CTT II - CTT I were longer in the CI group than in the NCF group (P<0.05). Hemoglobin levels were lower, and parathyroid hormone (PTH) and uric acid levels were higher in the CI group than in the NCF group (P<0.05). Hemoglobin levels were negatively correlated with CI in these patients (odds ratio [OR] 0.634, P<0.05) and PTH, and uric acid levels were positively correlated with CI (OR 1.028, P<0.05; and OR 1.011, P<0.05). The proportions of patients with diabetes and depression were higher in the CI group (P<0.05). There was a high prevalence of CI with significant impairment of attention and executive ability in MHD patients who had no stroke history. Hemoglobin may protect cognitive function, while diabetes, PTH, and uric acid levels may be risk factors. Depressive and anxiety states may aggravate CI in MHD patients.

Characteristics of sleep structure in Parkinson's disease patients with hallucinations based on polysomnography.

Hallucination is a common non-motor symptom in patients with Parkinson's disease (PD). Additionally, sleep disorders are associated with an increased risk of hallucinations in PD patients. This study aimed to examine the association between hallucination and objective sleep parameters in PD patients. We retrospectively recruited 278 PD patients who underwent polysomnography and clinical assessments and classified them into non-hallucination and hallucination groups. Hallucinations were observed in 77 older PD patients who had more severe motor symptoms and higher scores on the Non-Motor Symptoms Questionnaire (NMSQ), Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) but lower scores on the Montreal Cognitive Assessment (MOCA) and PD Sleep Scale (PDSS) than PD patients without hallucinations. Analysis of the polysomnographic variables in patients with hallucinations showed that they exhibited a decrease in total sleep time, sleep efficiency (SE), rapid eye movement (REM) sleep time and slow wave sleep (SWS, N3) time and percentage but a significant increase in wake time after sleep onset (WASO), periodic limb movement index (PLMI) scores, and stage 2 NREM (N2)percentage. Logistic regression analysis revealed that higher NMSQ scores, lower MOCA scores, lower SE, and a lower percentage of N3 sleep were associated with hallucinations in PD patients. Our results suggested that PD patients with hallucinations had worse sleep quality and differences in sleep architecture (measured by polysomnography).

Effects of dual-task training in patients with post-stroke cognitive impairment: A randomized controlled trial.

Evidence for the efficacy of cognitive-motor dual-task (CMDT) training in patients with post-stroke cognitive impairment (PSCI) and no dementia is still lacking. More importantly, although some studies on the cognitive effect of CMDT training show an improvement in cognitive performance, the results are still controversial, and the intervention mechanism of CMDT training on cognitive function improvement is not clear. The main purpose of this study was to analyze the effects of CMDT training on cognitive function, neuron electrophysiology, and frontal lobe hemodynamics in patients with PSCI. Here we tested the effects of CMDT training on cognitive function in PSCI patients. Forty subjects who met the criteria of PSCI were randomly assigned to control and experimental groups. CMDT training or cognitive task (CT) training was administered to each patient in the experimental and control groups, respectively. All subjects performed Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scale before and after the intervention, and the event-related potentials (ERP) and functional near-infrared spectroscopy (fNIRS) were used to evaluate the changes in neuron electrophysiology and hemodynamics. Forty patients were randomized across Beijing Rehabilitation Hospital Capital Medical University in Beijing. At the end of the intervention, 33 subjects completed the experimental process. The CMDT group showed significant improvement in the MMSE (P = 0.01) and MoCA (P = 0.024) relative to the CT group. The results of ERP and fNIRS showed that CMDT training could shorten the latency of P300 (P = 0.001) and the peak time of oxygenated hemoglobin (P = 0.004). The results showed that CMDT training shortened the response time of central neurons and significantly increased the rate of oxygen supply to the frontal lobe. CMDT training in patients with PSCI improved global cognitive function, which was supported by the improved neural efficiency of associated brain areas. http://www.chictr.org.cn, identifier ChiCTR2000034862.

Systematic review and meta-analysis of acupuncture in the treatment of cognitive impairment after stroke.

Background:We aim to make a systematic evaluation of the clinical efficacy of acupuncture in the treatment of cognitive impairment after stroke, to provide evidence-based medical evidence for clinical practice.Methods:We searched all the randomized controlled trials of China National Knowledge Infrastructure, Wan fang data knowledge service platform, VIP Chinese periodical service platform full-text Journal Database, Chinese Biomedical Literature Database, Cochrane Library Database, and PubMed Database about acupuncture treatment of post-stroke cognitive impairment (PSCI). Two researchers independently screened the literature and extracted the data according to the inclusion and exclusion criteria. The bias risk assessment manual of Cochrane collaboration Network was used to evaluate the bias risk, and all data were analyzed by Stata16.0.Results:Fourteen articles were included, with a total of 2402 patients. Meta-analysis showed that acupuncture combined with routine therapy could significantly reduce the score of cognitive impairment symptoms compared with the control group. The mini-mental state examination scale (MMSE) score (weighted mean difference [WMD] = 3.23, 95% confidence interval [CI]: 1.89–4.56, P < .01), Montreal cognitive assessment scale (MoCA) score (WMD = 3.41, 95% CI: 0.93–5.89, P < .01), Barthel index of activities of daily living (MBI) score (WMD = 4.59, 95% CI: 1.43–7.75, P < .01), and Lowenstein assessment scale (LOTCA) score (WMD = 8.60, 95% CI: 6.32–10.89, P = .00) were significantly improved in the patients receiving group acupuncture combined with routine therapy.Conclusion:Acupuncture combined with routine therapy seems to be more effective than conventional therapy alone in the treatment of PSCI. However, the differences between different acupuncture types need to be clarified in more high-quality randomized controlled trials.

Aberrant brain functional networks in type 2 diabetes mellitus: A graph theoretical and support-vector machine approach.

ObjectiveType 2 diabetes mellitus (T2DM) is a high risk of cognitive decline and dementia, but the underlying mechanisms are not yet clearly understood. This study aimed to explore the functional connectivity (FC) and topological properties among whole brain networks and correlations with impaired cognition and distinguish T2DM from healthy controls (HC) to identify potential biomarkers for cognition abnormalities.MethodsA total of 80 T2DM and 55 well-matched HC were recruited in this study. Subjects’ clinical data, neuropsychological tests and resting-state functional magnetic resonance imaging data were acquired. Whole-brain network FC were mapped, the topological characteristics were analyzed using a graph-theoretic approach, the FC and topological characteristics of the network were compared between T2DM and HC using a general linear model, and correlations between networks and clinical and cognitive characteristics were identified. The support vector machine (SVM) model was used to identify differences between T2DM and HC.ResultsIn patients with T2DM, FC was higher in two core regions [precuneus/posterior cingulated cortex (PCC)_1 and later prefrontal cortex_1] in the default mode network and lower in bilateral superior parietal lobes (within dorsal attention network), and decreased between the right medial frontal cortex and left auditory cortex. The FC of the right frontal medial-left auditory cortex was positively correlated with the Montreal Cognitive Assessment scales and negatively correlated with the blood glucose levels. Long-range connectivity between bilateral auditory cortex was missing in the T2DM. The nodal degree centrality and efficiency of PCC were higher in T2DM than in HC (P < 0.005). The nodal degree centrality in the PCC in the SVM model was 97.56% accurate in distinguishing T2DM patients from HC, demonstrating the reliability of the prediction model.ConclusionFunctional abnormalities in the auditory cortex in T2DM may be related to cognitive impairment, such as memory and attention, and nodal degree centrality in the PCC might serve as a potential neuroimaging biomarker to predict and identify T2DM.

Investigating oral health-related quality of life in patients with ischaemic stroke in China.

The objective of the study was to explore factors associated with oral health-related quality of life (OHRQoL) in patients with ischaemic stroke in China, guided by the theory of planned behaviour (TPB) and Andersen's oral health outcome model. Recent studies have reported that the prevalence of stroke is increasing and that stroke patients are facing many oral health related problems. This study provided insights into the role of TPB in the OHRQoL among patients with ischaemic stroke. Three hundred eight patients with ischaemic stroke from the Department of Neurology of a third-grade class-A hospital in Xuzhou, China, were enrolled in this cross-sectional study between June and September 2020. They completed a questionnaire that included information on socio-demographic characteristics and health behaviours, the Montreal Cognitive Assessment Scale, the Modified Rankin Scale and the Chinese version of the Oral Health Impact Profile-14 scale (OHIP-14). Structural equation modelling (SEM) was used to examine the association among the selected variables based on the TPB and Andersen's oral health outcome model. Among the participants (mean age 65.6), most (57.5%) were male. Their mean OHIP-14 score was 13.3 ± 7.6. Based on the SEM path diagram, behavioural attitude, subjective norms and perceived behavioural control of oral health were positively associated with intention; intention was associated with OHRQoL. The degree of disability was negatively associated with intention. Cognitive function was positively associated with OHRQoL. The OHRQoL of hospitalised patients with ischaemic stroke in China is fair to poor and affected by their oral health behaviours. Improved oral health behavioural attitude, subjective norms and perceived behavioural control might help them form good intentions and improve their OHRQoL.

Effects of tumor necrosis factor α on the structure of brain networks and cognitive functions in patients with chronic cerebral ischemia

Introduction. The processes of cognitive decline, which are typical for elderly and senile people, as well as for patients with chronic cerebral circulation insufficiency, involve pro-inflammatory cytokines, such as tumor necrosis factor (TNF-), interleukin-6, etc.&#x0D; The aim of this work was to study the association of TNF- with brain network structure and cognitive functions in patients with chronic cerebral ischemia (CCI).&#x0D; Materials and methods. We examined 101 patients with CCI (5085 years old, men and women) who were assessed for the saliva levels of TNF- during cognitive testing. The status of resting-state networks was analyzed in 55 patients using functional magnetic resonance therapy.&#x0D; Results. After cognitive tasks, the saliva level of TNF- increased by 17.6 6.2 pg/mL. Half of the CCI patients older than 60 years showed a significant increase in the level of TNF-. This cytokine correlated with delayed word recall and the ratio of delayed recall to their performance on the Luria Memory Words Test. The change in TNF- saliva levels correlated with the status of the resting-state network, mainly with the salience network. An increase in TNF- levels was associated with a higher frequency of negative correlations than at lower values of TNF- (less than 80 pg/mL). TNF--sensitive connectivities correlated with cognitive tasks, not only memory tests, but also with the Montreal Cognitive Assessment Scale, verbal fluency test scores, etc.&#x0D; Discussion. The study revealed two significant facts: an increase in the TNF- saliva level during cognitive performance and a lower success rate of cognitive performance associated with an increase in the levels of this cytokine. The central mechanism for the implementation of this relationship includes the restructuring of the salience network, namely the additional increase of negative correlations within the connective structure of the salience neural network of the right hemisphere.&#x0D; Conclusions. A change in the saliva level of TNF- affects the connectivity of resting-state networks, mainly the salience network

Clinical symptoms and their relationship with cognitive impairment in elderly patients with depressive disorder.

ObjectiveTo evaluate the correlation between clinical symptoms and cognitive impairment in elderly patients with depressive disorder.MethodsIn this retrospective study, a total of 123 elderly patients with depressive disorder admitted to our hospital from January 2020 to February 2021 were included. Patients' cognitive function was assessed by the Montreal Cognitive Assessment Scale (MoCA). According to the combination of cognitive impairment or not, patients were divided into the combined group (64 cases) and the depressive disorder group (59 cases). In addition, 70 healthy people who came to our hospital for physical examination during the same period were randomly selected as the healthy group.ResultsThe incidence of severe cognitive impairment in the combined group (33, 51.56%) was significantly higher than that in the depression group (19, 32.20%), the difference was statistically significant (P = 0.003). The incidence of somatization symptoms, suicidal tendency, retardation of thinking, diminution of energy, anxiety and sleep disorder in the combined group were higher than that in the depressive disorder group with significant difference [30 (56.88%) vs. 16 (27.12%), P = 0.024; 12 (18.75%) vs. 3 (5.08%), P = 0.021; 33 (51.56%) vs. 14 (23.73%), P = 0.002; 37 (57.81%) vs. 23 (38.98%), P = 0.029; 42 (65.63) vs. 25 (42.37), P = 0.011; 50 (78.13) vs. 42 (71.19), P = 0.031, respectively]. Spearman rank correlation analysis suggested that somatic symptom, mood change, suicidal tendency, retardation of thinking, diminution of energy, anxiety, and sleep disorder were negatively correlated with cognitive impairment, respectively (r =-0.161, −0.672, −0.262, −0.871, −0.421, −0.571, −0.512, P < 0.001).ConclusionThe clinical symptoms of depressive disorder were negatively correlated with cognitive impairment. Somatic symptoms, suicidal tendency, retardation of thinking, diminution of energy, anxiety, and sleep disorder were the risk factors for cognitive impairment.

The microstructural abnormalities of cingulum was related to patients with mild cognitive impairment: a diffusion kurtosis imaging study

ObjectiveOur study aimed to investigate the correlations between microstructural changes of cingulum and patients with mild cognitive impairment (MCI) by diffusion kurtosis imaging (DKI) technique.MethodA total of 104 patients with cerebral small vessel diseases (cSVD) were retrospectively enrolled in this study. According to Montreal Cognitive Assessment Scale (MoCA) scores, these patients were divided into MCI group (n = 59) and non-MCI group (n = 45). The general clinical data was collected and analyzed. The regions of interests (ROIs) were selected for investigation in cingulum. The values of DKI parameters were measured in each ROI and compared between the two groups, the correlations between DKI parameters and MoCA scores were examined.ResultsCompared to non-MCI group, MCI patients had more severe white matter hyperintensities (WMHs) (P = 0.038) and lower MoCA scores (P < 0.01). MCI patients showed significantly decreased fractional anisotropy (FA), axial kurtosis (AK), mean kurtosis (MK), radial kurtosis (RK), and kurtosis fractional anisotropy (KFA) in the left cingulum in the cingulated cortex (CgC) region (all P < 0.0125). In the left CgC region, FA, AK, MK, RK, and KFA were positively correlated with MoCA scores (r = 0.348, 0.409, 0.310, 0.441, 0.422, all P < 0.001). Meanwhile, FA, AK, MK, RK, and KFA were also positively correlated with MoCA scores (r = 0.338, 0.352, 0.289, 0.380, 0.370, all P < 0.001) in the right CgC region.ConclusionDKI technique could be used to explore the microstructural changes of cingulum in MCI patients and DKI-derived parameters might be feasible to evaluate MCI patients.

УМЕРЕННЫЕ КОГНИТИВНЫЕ НАРУШЕНИЯ В ПРАКТИКЕ ВРАЧА-НЕВРОЛОГА

Cognitive impairment and dementia are an relevant problem of modern neurology and psychiatry, which is explained by their wide prevalence, as well as the predicted increase in the number of patients in the future. However, dementia in most cases does not occur acutely, its development is preceded by a long period when cognitive impairments do not disrupt the patient’s everyday and professional life yet. Such cognitive impairments are called “pre-dementia” and are divided into subjective, subtle, and mild. With subjective cognitive impairment, patients present complaints; however, neuropsychological testing does not reveal decreased cognitive functions. Subtle cognitive impairment is accompanied by a decrease in cognitive functions when using highly sensitive scales. This article provides an overview of current data on the definition, classification, diagnosis, and treatment of mild cognitive impairment (MCI) from the point of view of the evidence-based medicine for timely diagnostics of the state and its effective correction. In patients with MCI, in addition to complaints of cognitive deficit, it is detected during screening neuropsychological testing; but unlike dementia, it does not impair the patient’s functionality. MCI is a leading risk factor for future dementia. However, according to research, cognitive deficits can not only progress, but also stabilize and even regress. In this regard, it is important to identify patients with MCI on time, establish nosological affiliation for correcting risk factors and prescribing treatment. The most common causes of MCI can be neurodegenerative disorders (primarily Alzheimer’s disease) and cerebrovascular diseases. The authors present the diagnostic value of popular scales such as the Mini-Mental State Examination, the Montreal Cognitive Assessment Scale and the 3-CT test in the diagnosis of MCI. The possibilities of using biomarkers, such as the determination of beta-amyloid and tau-protein in the cerebrospinal fluid, and the detection of signs of neuronal damage during neuroimaging of the brain, are discussed. It is stated that the most proven methods of influencing cognitive deficits in MCI are non-drug measures.