Mini-Mental State Examination Score Research Articles

Cross-sectional association between plasma aldosterone concentration and cognitive performance by mini-mental state examination in community dwellers

BackgroundAldosterone is the effector hormone in the renin angiotensin aldosterone system and existing data suggest aldosterone affect cognitive function. However, the relationship between plasma aldosterone concentration (PAC) and cognitive performance remains unexplored in community dwellers. Therefore, we aimed to explore whether PAC is associated with cognitive performance in this population.MethodsWe cross-sectionally enrolled adults using multistage random sampling from Emin, China in 2019. Participants underwent questionnaires and data collection. Cognitive status was assessed using mini-mental state examination (MMSE) questionnaire. Multi-variable linear and logistic regression were used to explore the association between log PAC and log MMSE score, and between tertiled PAC (the higher PAC as the exposure) and low cognitive performance, respectively, in total, apparently healthy and diseased participants. Subgroup analyses also were performed by age, gender, BMI, living region, ethnicity and education attainment status.Results27,707 subjects were included, of whom, 12,862 were apparently healthy and 14,845 had disease. Log-PAC was positively associated with log-MMSE score in the multivariable linear regression in the total (B = 0.01, 95%CI: 0–0.01, p < 0.001), apparently healthy (B = 0.01, 95%CI: 0–0.01, p = 0.007) participants, and the diseased without taking medicine (B = 0.01, 95%CI: 0.01–0.02, p = 0.004) participants. In logistic regression, the highest third tertile of PAC group showed significantly lower odds for the presence of low cognitive performance in total (OR = 0.83, 95%CI: 0.73–0.93, p = 0.002) and diseased without taking medicine participants (OR = 0.70, 95%CI: 0.57–0.86, p < 0.001). Various sub-group analysis showed largely consistent results with the main analysis.ConclusionThere was a positive correlation between plasma aldosterone and cognitive functions in community dwellers, whereas further studies are need when considering the cross-sectional nature of the current study.

Association between vertebral fractures and brain volume: insights from a community cohort study.

Vertebral fractures (VF) due to osteoporosis impact morbidity and quality of life in the elderly. The relationship between VF and changes in brain structure remains underexplored. This study aimed to investigate the association between VF and gray matter volume (GMV) reductions in specific brain regions and to explore potential sex differences. Data from 1,751 participants (571 males, 1,180 females; mean age 64.9, range 18-97) in the fourth survey of the population-based Research on Osteoarthritis/Osteoporosis Against Disability study (2015-2016) were used. Participants were classified into those with and without VF (VF + and VF - groups) based on Genant's semiquantitative method, assessed by spine radiographs. Voxel-based morphometry was applied to MRI images to measure GMV, and a general linear model analysis was performed to compare GMV between groups, adjusting for age, sex, total brain volume, and Mini-Mental State Examination scores as covariates. Additionally, a two-way analysis of variance was conducted on the significant GMV cluster, with sex and VF presence as independent variables, to explore interaction effects. The VF+ group consisted of 113 participants, while the VF- group included 1,638 participants.The analysis identified a significant cluster with reduced GMV in the VF + group compared to the VF - group. This cluster included the right hippocampus, right amygdala, and right parahippocampal gyrus. Further analysis revealed that males in the VF + group exhibited more pronounced GMV reductions in the significant cluster compared to females. These findings suggest that VF is associated with significant reductions in brain regions critical for memory, emotional processing, and visuospatial memory, with more severe effects observed in males.

Impact of thoracoscopic segmental lung resection versus wedge on early post-operative recovery and short-term prognosis in elderly patients with early non-small cell lung cancer: A retrospective non-randomised controlled cohort study.

The post-operative rehabilitation and prognostic indexes of thoracoscopic segmental resection and wedge resection in the treatment of early-stage non-small cell lung cancer (NSCLC) were retrospectively analysed. The objective of this study was to provide a theoretical basis for the treatment of early-stage NSCLC in the elderly. One hundred and twenty elderly patients diagnosed with early-stage NSCLC in our hospital from January 2018 to December 2021 were selected as study subjects. The patients were divided into the thoracoscopic segmental lung resection group and the thoracoscopic wedge resection group. Various clinical data were compared between the two groups of patients. In the thoracoscopic wedge resection group, operation time, anaesthesia time, intraoperative blood loss, post-operative chest tube volume, chest tube indwelling time and hospital stay were significantly higher compared to the thoracoscopic segmental lung resection group. Patients undergoing segmental resection also had higher Visual Analogue Scale scores and serum indices. In addition, the mini-mental state examination scores were lower in the segmental resection group compared to the wedge resection group. Thoracoscopic segmental resection and thoracoscopic wedge resection were both safe and feasible for the treatment of NSCLC. However, thoracoscopic segmental resection had the advantage of effectively reducing the amount of intraoperative bleeding, shortening the operation time and having less impact on lung function and physical function. This was conducive to the patient's faster recovery after surgery.

Volume Changes in Brain Subfields of Patients with Alzheimer’s Disease After Transcranial Ultrasound Stimulation

Background/Objectives: Alzheimer’s disease (AD) is characterized by progressive brain atrophy marked by cognitive decline and memory loss, which significantly affect patients’ quality of life. Transcranial ultrasound stimulation (TUS) is a potential physical treatment for AD patients. However, the specific brain regions stimulated by TUS and its therapeutic effects remain unclear. Methods: In this study, magnetic resonance imaging (MRI) and FreeSurfer segmentation were employed to assess alterations in the brain volume of AD patients after TUS. Results: Our findings revealed significant volume increases in the corpus callosum (CC) and lateral orbitofrontal cortex (lOFC) in the TUS group. Moreover, the volumetric changes in the CC were strongly correlated with improvements in the Mini-Mental State Examination score, which is a widely used measure of cognitive function of AD patients. Conclusions: TUS has the potential to alleviate disease progression and offers a non-invasive therapeutic approach to the improvement of cognitive function in AD patients.

Circular RNA circ_0061183 regulates microglial polarization induced by airborne ultrafine particles in HMC3 cells via sponging miR-98-5p

Airborne ultrafine particulate matter (PM0.1) can enter the brain, induce microglia activation, and promote the development of Alzheimer’s disease (AD). Circular RNAs (circRNAs) are also involved in AD pathogenesis. However, the role of AD-related circRNAs in PM0.1-induced microglia activation remains unclear. Therefore, we explore cytotoxicity, microglia activation, and AD-associated circRNA expression in human microglial HMC3 cells treated with PM0.1, and further examined circRNA expression in mice and cognitively impaired individuals. The results revealed that PM0.1 exposure decreased cell viability, increased lactate dehydrogenase activity, caused microglia activation, elevated microglial M1 maker expression, downregulated microglial M2 maker expression, and reduced AD-related circ_0061183 expression in vitro. Functionally, circ_0061183 silencing enhanced microglia activation and microglial M1 polarization, but inhibited microglial M2 polarization. Mechanistically, circ_0061183 can bind to miR-98-5p to co-regulate M2 microglial-related IL10 expression, which may affect transforming growth factor-β signaling to regulate PM0.1-inhibited microglial M2 polarization. Moreover, circ_0061183 downregulation was observed in the brain of PM2.5-exposed mice and AD mice and in the blood of cognitively impaired individuals. Furthermore, circ_0061183 was positively related to mini–mental state examination scores and amyloid-β42 peptide expression in elderly individuals. Overall, the current work offers epigenetic insights into the regulatory mechanisms of circRNAs on microglial activation caused by environmental pollutants.

Predictors of Hospital Readmission, Institutionalization, and Mortality in Geriatric Rehabilitation Following Hospitalization According to Admission Reason.

Older adults following an inpatient geriatric rehabilitation (GR) program commonly experience adverse health outcomes such as hospital readmission, institutionalization, and mortality. Although several studies have explored factors related to these outcomes, the influence of admission reason on the predictive factors of adverse health outcomes in the rehabilitation process remains unclear. Therefore, this study aimed to identify predictive factors for adverse health outcomes in inpatients attending GR according to their admission reason. This retrospective study included patients with orthogeriatric (OG) conditions and patients with hospital-associated deconditioning (HAD) admitted to GR after an acute hospitalization between 2016 and 2020. Patients were evaluated by a comprehensive geriatric assessment at admission, including sociodemographic data, social resources, clinical data, cognitive, functional and nutritional status, and physical performance measurements. Adverse health outcomes were collected (hospital readmission, institutionalization, and mortality). Univariate analyses and multivariate backward binary logistic regressions were used to determine predictive factors. In this study, 290 patients were admitted for OG conditions, and 122 patients were admitted due to HAD. In patients with OG conditions, lower Mini-Mental State Examination (MMSE) predicted institutionalization and mortality. Lower Mini Nutritional Assessment-Short Form predicted institutionalization, whereas lower Barthel Index and lower Tinetti-Performance-Oriented Mobility Assessment scores were associated with higher mortality. In patients with HAD, higher age-adjusted comorbidity index predicted hospital readmission and mortality, and lower Short Physical Performance Battery scores predicted institutionalization and mortality. Finally, lower MMSE scores, worse values in Older Americans Resources and Services Scale and male gender were associated with a higher risk of institutionalization. Predictive factors for hospital readmission, institutionalization, and mortality in patients with OG conditions and HAD during GR were different. Some of those predictors, such as nutritional status and physical performance, are modifiable. Understanding predictive factors for adverse outcomes, and how these factors differ by admission diagnosis, improves our ability to identify patients most at risk. Early identification of these patients could assist with prevention efforts and lead to a reduction of negative outcomes.

Core blood biomarkers of Alzheimer's disease: A single-center real-world performance study.

The new criteria for Alzheimer's disease pave the way for the introduction of core blood biomarkers of Alzheimer's disease (BBAD) into clinical practice. However, this depends on the demonstration of sufficient accuracy and robustness of BBADs in the intended population. To assess the diagnostic performance of core BBADs in our memory clinic, comparing them with cerebrospinal fluid (CSF) analysis. Real-world cross-sectional observational study. Memory Clinic of Fondazione IRCCS "San Gerardo dei Tintori," Monza, Italy. n = 102 consecutive outpatients (mean age: 71.0 ± 7.6 years) with cognitive impairment undergoing routine lumbar puncture. CSF Aβ40, Aβ42, tTau, and pTau181 levels were measured. Plasma biomarkers were evaluated using Lumipulse® G600II. Logistic regression and Receiver Operating Characteristic (ROC) analysis were used to assess biomarker performance. The diagnosis of Alzheimer's disease was based on CSF Aβ42/40 ratio. Plasma pTau217 demonstrated the highest diagnostic accuracy (AUC=0.91), followed by pTau181 (AUC=0.88) and Aβ42/40 (AUC=0.83). In robustness analyses, only pTau217 and pTau181 performance remained consistent, while that of Aβ42/40 ratio declined with added random variability. pTau217 significantly outperformed other BBAD, with the exception of pTau181. pTau BBAD were significant predictors of baseline Mini-Mental State Examination scores. Plasma pTau217, measured with Lumipulse®, is a robust and reliable BBAD for detecting amyloid pathology in a memory clinic setting, offering a practical and less invasive alternative to traditional CSF testing.

Microstructural white matter injury contributes to cognitive decline: Besides amyloid and tau.

Cognitive decline and the progression to Alzheimer's disease (AD) are traditionally associated with amyloid-beta (Aβ) and tau pathologies. This study aims to evaluate the relationships between microstructural white matter injury, cognitive decline and AD core biomarkers. We conducted a longitudinal study of 566 participants using peak width of skeletonized mean diffusivity (PSMD) to quantify microstructural white matter injury. The associations of PSMD with changes in cognitive functions, AD pathologies (Aβ, tau, and neurodegeneration), and volumes of AD-signature regions of interest (ROI) or hippocampus were estimated. The associations between PSMD and the incidences of clinical progression were also tested. Covariates included age, sex, education, apolipoprotein E4 status, smoking, and hypertension. Higher PSMD was associated with greater cognitive decline (β=-0.012, P < 0.001 for Mini-Mental State Examination score; β<0, P < 0.05 for four cognitive domains) and a higher risk of clinical progression from normal cognition to mild cognitive impairment (MCI) or AD (Hazard ratio=2.11 [1.38-3.23], P < 0.001). These associations persisted independently of amyloid status. PSMD did not predict changes in Aβ or tau levels, but predicted changes in volumes of AD-signature ROI (β=-0.003, P < 0.001) or hippocampus (β=-0.002, P = 0.010). Besides, the whole-brain PSMD could predict cognitive decline better than regional PSMDs. PSMD may be a valuable biomarker for predicting cognitive decline and clinical progression to MCI and AD, providing insights besides traditional Aβ and tau pathways. Further research could elucidate its role in clinical assessments and therapeutic strategies.

Progressive ataxia, cognitive decline, urinary incontinence, and unexplained hydrocephalus: a rare case of idiopathic normal pressure hydrocephalus in epileptic patient

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) poses diagnostic challenges due to its overlapping symptoms with other neurodegenerative disorders. The clinical trial of gait disturbance, cognitive impairment, and urinary incontinence often mimics other conditions, making accurate diagnosis crucial. Case presentation: A 67-year-old male with a 40-year history of epilepsy presented with progressive gait abnormalities, cognitive decline, and bladder incontinence over 5 years. Initial evaluation revealed a magnetic gait, impaired short-term memory, and a Mini-Mental State Examination score of 17/30. MRI and CT scans showed ventriculomegaly without elevated cerebrospinal fluid (CSF) pressure. A lumbar puncture with a positive CSF tap test confirmed iNPH, and ventriculoperitoneal shunt surgery was performed, resulting in significant improvement in symptoms. Discussion: iNPH is characterized by the triad of gait disturbance, cognitive impairment, and urinary incontinence. Its diagnosis is primarily based on clinical presentation and neuroimaging. The CSF tap test is a crucial diagnostic tool, and shunt surgery remains the standard treatment. This case underscores the need for a high index of suspicion for iNPH in patients with atypical presentations and emphasizes the importance of long-term follow-up to monitor treatment efficacy. Conclusion: This case highlights the complexity of diagnosing iNPH, particularly in patients with comorbid conditions such as epilepsy. Thorough diagnostic evaluations and timely intervention are critical for improving patient outcomes. Long-term monitoring is essential to assess the effectiveness of treatment and manage potential complications.

Plasma Osteoprotegerin and Cognitive Impairment after Ischemic Stroke.

Plasma osteoprotegerin (OPG) has been linked to poor prognosis following stroke, but its impact on post-stroke cognitive impairment (PSCI) is unknown. The purpose of our work was to analyze the relationship of OPG with PSCI. Our study included 613 ischemic stroke subjects with plasma OPG levels. We used the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to assess PSCI. PSCI was defined as MMSE score <25 or MoCA score <23. As assessed by the MMSE score, the adjusted odds ratio for PSCI in the highest OPG tertile was 1.77, with a 95% confidence interval of 1.09 to 2.89 (Ptrend=0.021), compared to that in the lowest tertile. We observed a positive linear relationship of plasma OPG levels with 3- month PSCI (P for linearity=0.046). Incorporating plasma OPG into conventional risk factors enhanced PSCI risk reclassification (all P <0.05). Consistent results were discovered when PSCI was evaluated using the MoCA score. High plasma OPG levels were related to an elevated risk of 3-month PSCI, indicating that OPG might be an effective biomarker for predicting PSCI.

Comparative the efficacy and safety of Gosuranemab, Semorinemab, Tilavonemab, and Zagotenemab in patients with Alzheimer’s disease: a systematic review and network meta-analysis of randomized controlled trials

ObjectiveThe aim of this study was to compare the efficacy and safety of anti-tau protein monoclonal antibodies for Alzheimer’s disease (AD). Tau protein aggregation, a key pathological feature of AD, is closely associated with neurodegeneration and cognitive decline. Targeting tau protein has emerged as a promising therapeutic strategy. By investigating the effects of monoclonal antibodies on cognitive function, disease progression, and overall quality of life in patients with AD, which can provide valuable insights into their potential as a therapeutic option for this devastating neurodegenerative disorder.MethodsThe randomized controlled trials (RCTs) investigating the efficacy of Gosuranemab, Semorinemab, Tilavonemab, and Zagotenemab in Alzheimer’s disease (AD) were systematically searched across PubMed, Embase, Web of Science and Cochrane Library, up to May 2024. The control group included placebo. The efficacy indicators were change in the Mini Mental State Examination (MMSE), Clinical Dementia Rating Scale Sum of Boxes (CDR-SB), Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog), Alzheimer’s Disease Cooperative Study-Activities of Daily Living Scale (ADCS-ADL) from baseline until the time of efficacy observation. Statistical analysis was conducted using Stata 14 and RevMan 5.4. The purpose of data processing, including generating network evidence plots, surface under the cumulative ranking curve (SUCRA) ranking, league plots, and funnel plots, is to visually summarize and evaluate the relative effectiveness and safety and potential publication bias of multiple interventions. Mean differences (MD) and 95% confidence interval (95%CI) as effect sizes to analyze continuous variables.ResultsThis study encompassed six RCTs involving 2,193 patients. Semorinemab were more effective than placebo in MMSE and ADAS-Cog scores (MDs ranging between 0.52 and 3.21; MDs ranging between 0.17 and 3.30). Placebo showed relatively good efficacy according to SUCRA ranking on change in CDR-SB and ADCS-ADL scores (75.7 and 79.5%). Tilavonemab and Semorinemab exhibited efficacy similar to that of a placebo in the analysis of the two indicators. Tilavonemab showed a lower incidence of AE, SAE, fall, and urinary tract infections than placebo, and the differences were statistically significant. Most safety analysis results showed no statistical difference.ConclusionThe results indicated that anti-tau protein monoclonal antibodies, such as Semorinemab and Tilavonemab, showed promise in terms of efficacy and safety for managing AD. Further studies are needed to confirm these findings, assess long-term effects, and refine treatment protocols.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/#myprospero, CRD42024583388.

Sleep spindles and slow oscillations predict cognition and biomarkers of neurodegeneration in mild to moderate Alzheimer's disease.

Changes in sleep physiology can predate cognitive symptoms by decades in persons with Alzheimer's disease (AD), but it remains unclear which sleep characteristics predict cognitive and neurodegenerative changes after AD onset. Using data from a prospective cohort of mild to moderate AD (n=60), we analyzed non-rapid eye movement sleep spindles and slow oscillations (SOs) at baseline and their associations with baseline amyloid beta (Aβ) and tau and with cognition from baseline to 3-year follow-up. Higher spindle and SO activity predicted significant changes in Aβ and tau at baseline, lower Alzheimer's Disease Assessment Scale Cognitive Subscale (better cognitive performance) score, and higher Mini-Mental State Examination score from baseline to 36 months. Spindles and SOs mediated the effect of phosphorylated tau 181 (pTau181)/Aβ42 on cognition, while pTau181/aβ42 moderated the effect of spindles and SOs on cognition. Our findings demonstrate that spindle and SO activity during sleep constitute predictive and non-invasive biomarkers of neurodegeneration and cognition in AD patients. Sleep spindles predict long-term cognitive performance in AD. Sleep spindle and SOs can be predictive, non-invasive biomarkers for AD. Sleep may be one of the most important modifiable risk factors for AD progression. Sleep microarchitecture is a novel therapeutic target for preserving brain heath. Sleep physiology can provide novel therapeutic targets to slow AD progression.

Highly specific amyloid and tau PET ligands for ATN classification in suspected Alzheimer's disease patients.

This study aims to accurately classify ATN profiles using highly specific amyloid and tau PET ligands and MRI in patients with cognitive impairment and suspected Alzheimer's disease (AD). It also aims to explore the relationship between quantified amyloid and tau deposition and cognitive function. Twenty-seven patients (15 women and 12 men; age range: 64-81years) were included in this study. Amyloid and tau PET scans were performed using 18F-NAV4694 and 18F-MK6240, respectively. For each patient, amyloid and tau PET images were visually assessed and classified as either amyloid-positive or amyloid-negative, and as 18F-MK6240 Braak stage 0 (tau-negative) or Braak stages I-VI (tau-positive). Voxel-based morphometry of three-dimensional T1-weighted MRI was used to evaluate neurodegeneration. Amyloid and tau depositions were quantified using the Centiloid scale and standardized uptake value ratio (SUVR), respectively. Global cognitive function was assessed with the Mini-Mental State Examination (MMSE). Patients were categorized into seven ATN profiles. Six patients (22%) exhibited a normal AD biomarker profile, 15 patients (56%) fell within the Alzheimer's continuum, and 14 patients (52%) were diagnosed with AD. Additionally, six patients (22%) displayed non-AD pathological changes. Positive and negative findings of amyloid and tau PET were concordant in 24 patients (89%). Among the 14 patients diagnosed with AD, the Centiloid scale for amyloid deposition did not show a significant negative correlation with MMSE scores (r = 0.269, p = 0.451). In contrast, the SUVR for tau deposition in the neocortex exhibited a significant negative correlation (r = -0.689, p = 0.014), while tau deposition in the mesial temporal region did not show a significant correlation (r = 0.158, p = 0.763). Highly specific amyloid and tau PET scans, along with MRI, can be utilized to accurately classify ATN profiles in patients with cognitive impairment and suspected AD. The discordance in amyloid and tau PET findings in three patients allowed for a more precise AD diagnosis. Furthermore, tau PET imaging provided insight into the propagation of tau deposition in the neocortex beyond the mesial temporal region, which is associated with cognitive decline.

Can hearing screening criteria at general health checkups be an indirect indicator of frailty and cognitive deficit in the older population? - with prevalence estimates based on updated World Health Organization hearing loss classification.

This study aimed to reestimate the prevalence of hearing loss based on the updated World Health Organization hearing loss classification and investigate whether existing hearing screening criteria could efficiently screen for frailty or cognitive deficit. Data collected from community dwellers aged 40-91 years included 2325 samples. Health checkup hearing screening used were as follows: (A) 30 dB both at 1 and 4 kHz and (B) 30 dB at 1 kHz and 40 dB at 4 kHz were used. For participants aged ≥60 years, frailty according to the modified Cardiovascular Health Study criteria and cognitive deficit defined by a Mini-Mental State Examination score <28 were assessed. Logistic regression was performed to obtain odds ratios for frailty and cognitive deficit. The rates of hearing loss using the updated World Health Organization classification in men were 8.6, 24.1, 54.2, 79.0 and 96.0% in their 40s, 50s, 60s, 70s and 80s and 3.7, 12.7, 36.4, 72.1 and 90.4% in women, respectively. Failing hearing screening using criterion A was associated with an increased risk of frailty, a sex-adjusted odds ratio of 4.136 (95% confidence interval, 2.182-7.838) and an increased risk of cognitive deficit: 1.753 (95% confidence interval, 1.346-2.283). After adjusting for age and sex, the effects on frailty and cognitive deficit were no longer significant. The results were similar when criterion B was used. Because of the high prevalence of hearing loss and the ability to utilize existing devices and methodologies, hearing screening for the elderly should be reviewed. Geriatr Gerontol Int 2025; ••: ••-••.

Relationship between multiple morbidities and performance on the Timed Up and Go test in elderly patients: a cross-sectional study

ObjectiveTo investigate how various morbidities affect older patients’ performance on the Timed Up and Go (TUG) test.DesignCross-sectional study.SettingThe seven government hospitals of Lahore, Pakistan, included are major tertiary care centres,...

Hypertension moderates the relationship between plasma beta-amyloid and cognitive impairment: a cross-sectional study in Xi’an, China

BackgroundPlasma beta-amyloid (Aβ) are important biomarkers for Alzheimer’s disease and cognitive impairment (CI), but results are controversial. It remains unclear whether hypertension modulates their relationship. This cross-sectional study investigates whether hypertension moderates the relationship between plasma Aβ and cognitive impairment (CI).MethodsThis cross-sectional study included 1488 subjects ≥ 40 years from rural areas of northwestern China. CI was defined as a Mini-Mental State Examination score lower than the cutoff. Firstly, plasma Aβ40, Aβ42, Aβ42/Aβ40 were analyzed as restricted cubic spline. Then, categories of combined plasma Aβ were created by making bisection of plasma Aβ according to average and combining them as L-Aβ40 and L-Aβ42, H-Aβ40 and L-Aβ42, L-Aβ40 and H-Aβ42, H-Aβ40 and H-Aβ42. Decreased plasma Aβ40 was defined as &amp;lt; 25th percentile. Multivariate logistic regression examined the relationship between plasma Aβ and CI in total population, the hypertension subgroup and the non-hypertension subgroup.Results737 participants (49.5%) had hypertension and 189 participants (12.7%) had CI. Simultaneously elevated plasma Aβ40 and Aβ42 was associated with CI in hypertension (H-Aβ40 and H-Aβ42 vs. L-Aβ40 and L-Aβ42, 21.1% vs.10.7%, P = 0.033; OR = 1.984 [95% CI, 1.067–3.691], P = 0.030) but not in the non-hypertension. Decreased plasma Aβ40 was associated with CI in the non-hypertension (14.9% vs. 9.2%, P = 0.026; OR = 1.728 [95% CI, 1.018–2.931], P = 0.043) but not in the hypertension.ConclusionHypertension is an important modulator in the relationship between plasma Aβ and CI. Simultaneously elevated plasma Aβ40 and Aβ42 in the hypertension, and decreased plasma Aβ40 in the non-hypertension, may be risk factors for CI. These findings emphasize the need to consider hypertension in CI detection.

Different Imaging Evaluating Performances Between Glymphatic System and Motor Symptoms and Levodopa Responsiveness of Parkinson Disease.

Parkinson disease (PD) is defined by its unique motor symptoms, where responsiveness to levodopa (L-DOPA) is fundamental for management. Recent research has highlighted a significant relationship between PD symptoms and glymphatic dysfunction. This study endeavors to clarify the connection between glymphatic system functionality and initial motor symptoms in PD, utilizing imaging biomarkers to determine its predictive capacity for L-DOPA responsiveness (LR). Retrospective study of 86 PD patients with 3.0-T MRI scans (July 2019 to March 2021), assessing the diffusion tensor image analysis along the perivascular space (DTI-ALPS) methods, enlarged perivascular spaces (ePVSs) load, and choroid plexus volume (CPV). Analyzed metrics versus the third part of the Unified Parkinson Disease Rating Scale (UPDRSIII) scores and %LR using linear regression, creating a %LR prediction model for the L-DOPA challenge. Explored relationships with age, sex, Hoehn and Yahr stage, Montreal Cognitive Assessment scores, and Mini-Mental State Examination score. Examined DTI-ALPS index, ePVSs, and CPV interrelations. Pre-L-DOPA, UPDRSIII inversely correlated with DTI-ALPS index (P=0.049), positively with bilateral basal ganglia ePVSs (P<0.001). Age-adjusted BG-ePVSs-UPDRSIII link (P<0.001). Post-L-DOPA, UPDRSIII correlated similarly and CPV was positive. %LR positively linked to DTI-ALPS index (P<0.001), negatively to BG-ePVSs (P=0.04), CPV (P<0.001). Adjusted %LR-DTI-ALPS index positive (P=0.005), %LR-CPV negative (P=0.04). DTI-ALPS index, CPV predicted LCT outcomes (%LR ≥33%) with area under the curves 0.78, 0.79; accuracies 86.01%, 81.4%. The combined model area under the curve is 0.82, with an accuracy of 87.2%. Significant linear correlations were observed (CPV-DTI-ALPS, CPV-ePVSs, DTI-ALPS-ePVSs). A study affirms the link between glymphatic impairment, motor symptoms, and L-DOPA responses in PD. As glymphatic function declines, symptoms worsen, and L-DOPA effectiveness diminishes. The DTI-ALPS index and CPV emerge as potential predictors of PD patient LCT outcomes.

Decreased serum PF4 levels correlate with cognitive decline and CSF biomarkers in Alzheimer's disease in a Chinese cohort.

Platelet factor 4 (PF4), a chemotactic factor secreted from the α-granules of platelets, has recently been proved to mitigate neuroinflammation and improve aging-related cognition decline, which may be involved in Alzheimer's disease (AD). This study aims to investigate the alterations of serum PF4 levels in AD, the correlation between serum PF4 and β-amyloid (Aβ) and tau levels in cerebrospinal fluid (CSF), and the potential diagnostic utility of PF4 in AD. A cross-sectional study was conducted involving 38 amyloid-positive AD patients and 50 cognitively normal controls. The levels of serum PF4 were detected using the Human CXCL4/PF4 enzyme-linked immunosorbent assay (ELISA) Kit. The levels of CSF Aβ42, Aβ40, p-tau181, and t-tau were measured on the fully-automated Lumipulse G1200 platform via commercially available kits. The levels of serum PF4 were significantly decreased in AD patients (5163.51 (3198.24-6301.15) vs. 5859.29 (4126.06-8006.70), Z=-2.30, P=0.021). The negative correlation between AD diagnosis (β=-1972.292, P=0.009) and PF4 levels retained after the adjustments of age, sex, APOE ε4 status, platelet count, platelet distribution width (PDW), and comorbidity of dyslipidemia in the multiple linear regression analysis. Further analysis showed that serum PF4 levels were positively correlated with CSF Aβ42 levels and Mini-Mental State Examination (MMSE) scores, and negatively correlated with CSF t-tau levels. Besides, the area under the curve (AUC) of serum PF4 for AD (AUC=0.6437, P=0.022) was comparable to that of CSF Aβ40 (AUC=0.6400) yet lower than those of CSF Aβ42, ptau181, and t-tau. The AUC slightly increased when combining serum PF4 with other CSF AD biomarkers separately. The serum levels of PF4 were decreased in AD patients and were significantly correlated with the cognitive function and CSF levels of Aβ42 and t-tau. PF4 may become a promising anti-aging and therapeutic target for AD, which is worthy of further study.

Efficacy of Cerebral Oxygen Saturation Monitoring for Perioperative Neurocognitive Disorder in Adult Noncardiac Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Perioperative neurocognitive disorders are common perioperative complications associated with various poor outcomes. Regional cerebral oxygen saturation (rSO2) monitoring is a noninvasive technique based on near-infrared spectroscopy detection. Due to the considerable controversy among currently published studies on the application of intraoperative rSO2 monitoring in adult patients undergoing elective noncardiac surgery, this study aims to conduct a systematic review and meta-analysis to provide more comprehensive and robust evidence to support clinical decision-making. This study conducted a systematic literature search of databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, from their inception to May 1, 2024. The eligible randomized controlled trials included adult patients undergoing elective noncardiac surgery under general anesthesia who received optimized anesthesia management guided by rSO2 monitoring and those in the control group who received routine anesthesia management under standard monitoring or blinded rSO2 monitoring. The primary outcomes were the incidence of perioperative neurocognitive disorders, including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), and Mini-Mental State Examination (MMSE) scores. Secondary outcomes included the incidence of intraoperative cerebral desaturation and length of hospital stay (LOS). The pooled results showed that compared to the control group, optimized anesthesia management guided by intraoperative rSO2 monitoring significantly reduced the incidence of POCD within 7days postoperatively and may reduce the incidence of POCD at 3months and longer periods postoperatively. However, it may not reduce the incidence of POD within 7days or longer periods postoperatively, improve MMSE scores, reduce the incidence of intraoperative cerebral desaturation, or shorten LOS. Given the substantial heterogeneity in the pooled results for MMSE scores within 7days postoperatively and LOS, and the limited number of studies reporting the incidence of POD, POCD, and MMSE scores after 7days postoperatively, the related results should be interpreted with caution. Despite the presence of heterogeneity and the inclusion of a limited number of studies for some outcomes, it is still recommended that clinical anesthesiologists routinely perform intraoperative rSO2 monitoring and optimize intraoperative anesthesia management based on the monitoring results to maximize rSO2 and improve cerebral perfusion, thereby improving patients' neurocognitive outcomes. Further large-scale, high-quality studies are needed to confirm the conclusions of this study.

Carotid Artery Compression in Preventing Postoperative Cognitive Dysfunction in Patients Undergoing Mitral Valve Replacement Surgery: A Randomized Clinical Trial

Background: The efficacy of manual carotid artery compression in reducing cerebral embolization during cardiac surgeries is a topic of debate. Aim: This study aimed to assess the safety and efficacy of carotid artery compression in preventing postoperative cognitive dysfunction (POCD) in patients undergoing mitral valve replacement surgery. Methodology: This randomized, double-blind, parallel-group clinical trial enrolled 120 adult patients scheduled for mitral valve replacement surgery. The patients were randomly assigned to two groups of 60 patients each. Group C underwent carotid artery compression using three fingers (index, middle, and ring fingers) along the path of the artery for 20 seconds following aortic declamping, while group NC did not undergo carotid artery compression. The study's primary outcome was the incidence rate of POCD at 5-7 days and the Mini-Mental State Examination score. Secondary outcomes included the incidence rate of POCD after 6 weeks postoperatively and transcranial Doppler readings. Results: The incidence rates of POCD at 5-7 days and after 6 weeks postoperatively were comparable in both groups (p=0.163 and 0.364, respectively). Additionally, the Mini-Mental State Examination score and transcranial Doppler results were comparable between the groups before and after surgery. The incidence of cognitive dysfunction in the NC group at 5 days postoperatively was significantly associated with older age, shorter surgical duration, and reduced middle cerebral artery velocity by transcranial Doppler.Conclusion: Carotid artery compression does not prevent cognitive dysfunction after mitral valve replacement surgery. However, no additional harm is associated with carotid compression.