Vascular Cognitive Impairment-no Dementia Research Articles

Study of electronic biofeedback combined with nursing intervention in the treatment of vascular cognitive impairment-no dementia.

To investigate the effects of electronic biofeedback combined with nursing intervention and conventional drug treatment on cognitive function in patients with vascular cognitive impairment-no dementia (VCIND). A total of 102 patients with VCIND treated in the Department of Neurology from January 2021 to May 2022 were enrolled and divided into the routine treatment group and biofeedback group according to different treatment methods. The routine treatment group was given conventional drug therapy and nursing intervention; for the biofeedback group, electronic biofeedback therapy was added, based on the routine treatment group. The Montreal Cognitive Assessment, (MoCA), Alzheimer's Disease Assessment Scale-Cognitive Subscale, (ADAS-cog), and Hamilton Depression Scale (HAMD) were checked before treatment, 2weeks after treatment, and 3months after treatment. At 3months of treatment, the scores of the MoCA and ADAS-cog scales in the biofeedback group were better than those in the routine treatment group, while no difference was detected in the HAMD scores before and after treatment and between the two groups. Electronic biofeedback therapy for VCIND can significantly improve the MoCA score, reduce the ADAS-cog score and improve the cognitive level of patients and can be used as a complementary treatment for VCIND.

Characteristic early changes of Glu and Cho in brain regions affected by different types of subjective cognitive decline and their clinical significance.

To discuss the early changes of Glu and Cho in the affected areas of different types of subjective cognitive decline, including amnestic MCI (aMCl), non-amnestic MCI (naMCI) and vascular cognitive impairment no dementia (VCIND), using Proton Magnetic Resonance Spectroscopy (1H-MRS) technology. Routine head MRI and lH-MRS examinations were performed on 50 clearly diagnosed aMCI patients, 44 naMCI patients, 44 VCIND patients, and 44 elderly individuals with normal cognitive function. Measure the volume of the patient bilateral hippocampus. Using the bilateral hippocampus, left posterior cingulate gyrus (PCG), and frontal lobe as regions of interest, the scope under the peak of N-acetylaspartate (NAA), choline complex (Cho), glutamate (Glu), Metabolic Images (mI), and creatine (Cr) was tested. Perform a correlation analysis between the NAA/Cho/Cr values of the VCIND group and the MoCA score. All experimental subjects were right-handed. The NAACr values in both hippocampus of the VCIND were greatly lower than those in control (P < .05). The NAA/Cr values on both sides of the VCIND were correlated with the MoCA score (P < .05). The NAA/Cr values in the LHp and PCG of subjects in the aMCI and naMCI groups were lower than those in the NC group (P < .05). The NAA/Cr values in the left frontal lobe of the aMCI and naMCI showed no obvious decrease compared to the NC. The Glu/Cr of subjects in the aMCI was lower in the left PCG than those in the naMCI and NC (P < .05). The discrepancy between the naMCI and the NC was P > .05. In the LHp and frontal lobe, in contrast with the naMCI and NC, the mI/Cr values in the LHp and PCG of subjects in the aMCI were higher (P < .05). In the left frontal lobe, relative to the aMCI and NC, the mI/Cr values in the naMCI were higher (P < .05). The changes in the concentration of 1H-MRS metabolites in the hippocampus can indicate the presence of hippocampal neuronal damage before morphological changes occur in the hippocampus. 1H-MRS NAA/Cr can reflect the cognitive function changes of patients to a certain extent. There are regional differences in mI and Glu metabolism in the brain between aMCI and naMCI groups. 1H-MRS provides an effective basis for clinical differentiation between aMCI and naMCI.

Physical activity in vascular cognitive impairment: Systematic review with meta-analysis

BackgroundVascular cognitive impairment (VCI) is the second most common cause of cognitive impairment worldwide and includes a spectrum from vascular cognitive impairment no dementia (VCIND) to vascular dementia (VaD). There is no specific pharmacological treatment approved for VCI. Physical activity has been indicated to be a promising preventive measure for cognition, with direct as indirectly benefits, while improving several modifiable vascular risk factors, so potentially effective when considering VCI. Our aim was to conduct a systematic review with a meta-analysis approaching the potential preventive role of physical activity on VCI. MethodsA systematic search was conducted in 7 databases. A total of 6786 studies were screened and assessed for eligibility, culminating in the inclusion of 9 observational prospective studies assessing physical activity impact irrespectively the type for quality assessment and qualitative and quantitative synthesis. Quantitative synthesis was performed using the reported adjusted HRs. Physical activity was handled as a dichotomous variable, with two groups created (high versus low physical activity). Subgroup analyses were done for risk of bias, VaD and length of follow-up. ResultsThere was considerable methodological heterogeneity across studies. Only three studies reported significant associations. The overall effect was statistically significant (HR 0.68, 95%CI 0.54-0.86, I2 6.8%), with higher levels of physical activity associated with a smaller risk of VCI overtime, particularly VaD. ConclusionsThese findings suggest that physical activity is a potential preventive factor for vascular dementia. Insufficient data is available on VCIND. Randomized studies are desired to confirm these results.

Study of gray matter atrophy pattern with subcortical ischemic vascular disease-vascular cognitive impairment no dementia based on structural magnetic resonance imaging.

This study explored the structural imaging changes in patients with subcortical ischemic vascular disease (SIVD)-vascular cognitive impairment no dementia (VCIND) and the correlation between the changes in gray matter volume and the field of cognitive impairment to provide new targets for early diagnosis and treatment. Our study included 15 patients with SIVD-normal cognitive impairment (SIVD-NCI), 63 with SIVD-VCIND, 26 with SIVD-vascular dementia (SIVD-VD), and 14 normal controls (NC). T1-weighted images of all participants were collected, and DPABI and SPM12 software were used to process the gray matter of the four groups based on voxels. Fisher's exact test, one-way ANOVA and Kruskal-Wallis H test were used to evaluate all clinical and demographic data and compare the characteristics of diencephalic gray matter atrophy in each group. Finally, the region of interest (ROI) of the SIVD-VCIND was extracted, and Pearson correlation analysis was performed between the ROI and the results of the neuropsychological scale. Compared to the NC, changes in gray matter atrophy were observed in the bilateral orbitofrontal gyrus, right middle temporal gyrus, superior temporal gyrus, and precuneus in the SIVD-VCIND. Gray matter atrophy was observed in the left cerebellar region 6, cerebellar crural region 1, bilateral thalamus, right precuneus, and calcarine in the SIVD-VD. Compared with the SIVD-VCIND, gray matter atrophy changes were observed in the bilateral thalamus in the SIVD-VD (p < 0.05, family-wise error corrected). In the SIVD-VCIND, the total gray matter volume, bilateral medial orbital superior frontal gyrus, right superior temporal gyrus, middle temporal gyrus, and precuneus were positively correlated with Boston Naming Test score, whereas the total gray matter volume, right superior temporal gyrus, and middle temporal gyrus were positively correlated with overall cognition. Structural magnetic resonance imaging can detect extensive and subtle structural changes in the gray matter of patients with SIVD-VCIND and SIVD-VD, providing valuable evidences to explain the pathogenesis of subcortical vascular cognitive impairment and contributing to the early diagnosis of SIVD-VCIND and early warning of SIVD-VD.

Exploring the Effect of Enbrel Softgels on PWI Indicators in VCIND Patients.

Objective To investigate the effect of Enbrel softgels on the head nuclear magnetic (PWI) indices in patients with vascular cognitive impairment-no dementia (vascular cognitive impairment-no dementia, VCIND). Methods Patients with confirmed VCIND hospitalized in the Department of Neurology of the Affiliated Hospital of Hebei University from April 2017 to April 2019 were included in the study, and they were divided into experimental and control groups (30 patients in each group) according to the difference of interventions. The PWI examination and neuropsychological assessment were performed at the beginning of the experiment, 12 w after treatment, and 48 w after treatment in the two groups. Score differences between the two groups and the preliminary demonstration of the clinical value of the MMSE and ADAS-Cog in the diagnosis of VCIND. Results (1) The difference in PWI positivity rate between the two groups at the beginning of the experiment was not statistically significant (P > 0.05); the PWI positivity rate in the experimental group at 12 W was significantly lower than that in the control group (P < 0.05); the difference in PWI positivity rate between the two groups at 48 W was not statistically significant (P < 0.05); (2) the MMSE scores of patients in the experimental group at 12 W and 48 W were higher than those in the control group, and the ADAS-Cog scores were lower than those in the control group (P < 0.05). (3) The diagnostic AUCs of MMSE and ADAS-Cog for VCIND were 0.7960 (95% CI = 0.6411–0.9508, P=0.0037) and 0.9291 (95% CI = 0.8390), respectively (95% CI = 0.8390–1.000, P < 0.0001). Conclusion The addition of Enbrel softgels to concomitant therapy in VCIND patients can lead to changes in their PWI imaging indicators, which in turn can have a significant impact on their neuropsychological indicators, and quantitative analysis scales such as the MMSE and ADAS-Cog can be considered for the diagnostic treatment of VCIND.

The Value of Brain Structural Magnetic Resonance Imaging Combined with APOE--ε4 Genotype in Early Diagnosis and Disease Progression of Senile Vascular Cognitive Impairment No Dementia.

Objective To explore the value of brain structure magnetic resonance imaging combined with APOE-ε4 genotype in the early diagnosis and disease progression of elderly patients with vascular cognitive impairment no dementia (VCIND). Methods The first stroke patients admitted to our hospital from March 2017 to December 2018 were collected, including 130 cases of vascular cognitive impairment no dementia (VCIND group) and 50 cases of the control group (NC group). The basic information of all subjects was recorded, and APOE-ε4 alleles of all subjects were detected. The neuropsychological test scale evaluated the cognitive psychology of the subjects, and they were scanned by multi-parameter MRI. After follow-up, VCIND patients were divided into the dementia group and the nondementia group. MRI scans were again performed, and the risk factors of VCIND patients developing dementia were analyzed. Results Compared with the NC group, patients in the VCIND group had shorter years of education, more patients with hypertension, higher levels of homocysteine (Hcy), and lower cognitive ability. Patients with White Matter Volume (WMV), White Matter Hyperintensity (WMH), Lacunar Infarction (LI), elevated Fazekas scores, and APOE-ε4 gene carriers are more likely to develop VCIND. After 12 months of follow-up, compared with the nondementia group, the number of WMV, WMH, Fazekas scores, and APOE-ε4 gene carriers in the dementia group was significantly increased. In addition, the progression-free survival rate of APOE-ε4 gene carriers was significantly lower than that of nonAPOE-ε4 gene carriers. Conclusion Years of education, hypertension, high levels of Hcy, elevated WMV, WMH, LI, and Fazekas scores, and carrying the APOE-ε4 gene are risk factors for VCIND in stroke patients. Craniocerebral structural MRI combined with APOE-ε4 genotype has a diagnostic role in the early diagnosis and disease progression of elderly patients with VCIND.

Functional Connectivity, Physical Activity, and Neurocognitive Performances in Patients with Vascular Cognitive Impairment, No Dementia.

Vascular Cognitive Impairment, No Dementia (VCIND) is a key stage at which early intervention will delay or prevent dementia. The pathophysiology of VCIND posits that a lesion in a single location in the brain has the ability to disrupt brain networks, and the subsequent abnormal Functional Connectivity (FC) of brain networks leads to deficits in corresponding neurobehavioral domains. In this study, we tested the hypothesis that disrupted anterior cingulate cortex and striatal networks mediated the effects of Physical Activity (PA) on neurobehavioral function. In 27 patients with VCIND, FC within the brain networks and neurobehavioral dysfunction were assessed. The relationship between the cognitive scores, FC, and PA was studied. The Fitbit Charge 2 was used to measure step counts, distance, and calories burned. In patients with VCIND, a cross-sectional Spearman's correlation to analyze the relationship among patient-level measures of PA, cognitive function scores, and FC strength within the brain networks. Average step counts and average distance were associated with Trail Making Test B (TMB) time to completion (seconds) and Instrumental Activities of Daily Living (IADL) score (P < 0.05). The average calories burned were associated with IADL score (P = 0.009). The FC within the brain networks anchored by left caudal Anterior Cingulate Cortex (ACC) seeds (x= -5, y= 0, z= 36) and (x= -5, y= -10, z= 47) were positively correlated with average step counts and average distance, were negatively correlated with TMB time to completion (seconds), and were positively correlated with IADL score (P < 0.05). The FC within the brain networks anchored by left subgenual ACC seed (x= -5, y= 25, z= -10) were negatively correlated with average step counts and average distance were positively correlated with TMB time to completion (seconds), and were negatively correlated with IADL score (P < 0.05). The FC within the striatal networks was positively correlated with average calories burned and IADL score (P < 0.05). FC within the brain networks anchored by caudal ACC seeds was positively correlated with more average step counts/average distance and better IADL score; negatively correlated with longer TMB time to completion (seconds), whereas FC of subgenual ACC seed was negatively correlated with the same parameters. FC within the brain networks anchored by putamen rather than caudate or pallidum was positively correlated with average calories burned and IADL score.

Determinants of arterial spin labeling parameters and its association with cerebral small vessel disease and diagnostic groups

AbstractBackgroundCerebral small vessel disease (SVD) may alter cerebral blood flow (CBF) leading to brain changes and hence cognitive impairment and dementia in elderly. CBF and spatial coefficient of variation (sCoV) can be measured quantitatively by Arterial Spin Labelling (ASL). CBF and sCoV have been related to age and systemic vascular risk factors. The relation of CBF and sCoV with location and severity of SVD and etiologic subtypes of cognitive impairment and dementia have not been explored in detail. We aim to investigate the association of demographic, vascular risk factors, location and severity of SVD with ASL parameters. We further investigate the association of ASL parameters with etiologic subtypes of cognitive impairment and dementia in a memory clinic population.MethodWe included 390 subjects (median: 73 11years, women = 52.3%) from an ongoing memory‐clinic based case‐control study. Patients were classified as no cognitive impairment, cognitive impairment no dementia (CIND), vascular CIND (VCIND) and dementia [Alzheimer’s disease (AD) and Vascular Dementia (VaD)]. Cerebral microbleeds (CMBs) and lacunes were categorized into strictly lobar, strictly deep and mixed‐location; ePVS into centrum semiovale and basal ganglia. Total and region‐specific white matter hyperintensities (WMH) volumes were automatically segmented using a validated pipeline. sCoV and CBF were analyzed with ExploreASL from 2D‐EPI pseudo‐continuous ASL images.ResultIncreasing age, male sex, hypertension, hyperlipidemia, history of heart disease and smoking were associated with CBF and sCoV. Increasing numbers of lacunes and CMBs were associated with reduced CBF and increased sCoV. Location‐specific analysis showed mixed‐location lacunes and CMBs were associated with hypoperfusion. Total WMH volume was associated with associated with increased sCoV. Region specific analysis with anterior and posterior WMH volumes showed similar results. No association was observed between ePVS and ASL parameters. Increased sCoV was associated with the diagnosis of VCIND, AD and VaD.ConclusionIncreased sCoV in ASL is associated with SVD, cognitive impairment and dementia, suggesting that SVD may induce brain changes via vascular insufficiency. Thus future research aimed to elucidate the pathophysiology of SVD and vascular insufficiency in elderly may help in developing prevention and treatment strategies.

Glutathione Peroxidase Activity Is Altered in Vascular Cognitive Impairment-No Dementia and Is a Potential Marker for Verbal Memory Performance

Background:Coronary artery disease (CAD) increases risk for vascular cognitive impairment-no dementia (VCIND), a precursor to dementia, potentially through persistent oxidative stress.Objective:This study assessed peripheral glutathione peroxidase activity (GPX), which is protective against oxidative stress, in VCIND versus cognitively normal CAD controls (CN). GPX activity was also evaluated as a biomarker of cognition, particularly verbal memory.Methods:120 CAD patients with VCIND (1SD below norms on executive function or verbal memory (VM)) or without (CN) participated in exercise rehabilitation for 24 weeks. Neurocognitive and cardiopulmonary fitness (VO2 peak) assessments and plasma were collected at baseline and 24-weeks.Results:GPX was higher in VCIND compared to CN (F1,119 = 3.996, p = 0.048). Higher GPX was associated with poorer baseline VM (β= –0.182, p = 0.048), and longitudinally with VM decline controlling for sex, body mass index, VO2 peak, and education (b[SE] = –0.02[0.01], p = 0.004). Only CN participants showed improved VM performance with increased fitness (b[SE] = 1.30[0.15], p < 0.005).Conclusion:GPX was elevated in VCIND consistent with a compensatory response to persistent oxidative stress. Increased GPX predicted poorer cognitive outcomes (verbal memory) in VCIND patients despite improved fitness.

NEURoaid II (MLC901) in cognitively Impaired not demenTEd patientS (NEURITES): A pilot double blind, placebo-controlled randomized trial.

ObjectiveTo investigate the efficacy and safety of MLC901 in vascular cognitive impairment no dementia (VCIND) patients.DesignThis was a multi‐center, double‐blind, randomized, placebo‐controlled pilot study.Setting and participantVCIND patients from hospitals in Singapore (67), Vietnam (19), and the Philippines (17) were recruited and followed‐up from March 2013 to April 2018.MethodsThe primary outcome was executive function as measured by the Verbal Fluency (VF) and 2‐part Color Trails Test (CTT). The mean difference in the scores between baseline and week 12, and baseline and week 24, was compared between MLC901 and placebo using a two‐sample t‐test.ResultsThe trial randomized 103 subjects: MLC901 (n = 57) and placebo (n = 46). The mean age of participants was 68.3 ± 8.4 years and 38.8% were female. Improvement in executive function with MLC901 was not significantly better than placebo at week 12 (CTT1 mean difference [md] 3.8 seconds, 95% confidence interval [CI]: –9.0 to 16.5, CTT2 md 10.9 seconds, 95% CI: –0.2 to 22.0), and at week 24 (CTT1 md 2.8 seconds, 95% CI: –8.4 to 14.0, CTT2 md = 4.4 seconds, 95% CI: –8.2 to 16.9). Improvement in VF from baseline was not significantly different between MLC901 and placebo at weeks 12 and 24. There were no significant differences in adverse events (43.5% vs. 56.1%) or serious adverse events (13% vs. 22.8%) in placebo versus MLC901 groups. In post hoc exploratory analysis, the treatment effect of MLC901 on cognitive function appears more apparent in subjects with existing impairment in executive function: CTT2 (md 14.4 seconds [P = .05] and 9.9 seconds [P = .3] at week 12 and week 24, respectively).ConclusionsWhilst MLC901 appears to be safe, there was no significant cognitive benefit from MLC901 in the study population. Post hoc hypotheses generating analyses suggest that VCIND patients with existing impairment in executive function may show benefit.

Default mode network integrity changes contribute to cognitive deficits in subcortical vascular cognitive impairment, no dementia.

Vascular cognitive impairment, no dementia (VCIND) refers to cognitive deficits associated with underlying vascular causes that are insufficient to confirm a diagnosis of dementia. The default mode network (DMN) is a large-scale brain network of interacting brain regions involved in attention, working memory and executive function. The role of DMN white matter integrity in cognitive deficits of VCIND patients is unclear. Using diffusion tensor imaging (DTI), this study was carried out to investigate white matter microstructural changes in the DMN in VCIND patients and their contributions to cognitive deficits. Thirty-one patients with subcortical VCIND and twenty-two healthy elderly subjects were recruited. All patients underwent neuropsychological assessments and DTI examination. Voxel-based analyses were performed to extract fractional anisotropy (FA) and mean diffusivity (MD) measures in the DMN. Compared with the healthy elderly subjects, patients diagnosed with subcortical VCIND presented with abnormal white matter integrity in several key hubs of the DMN. The severity of damage in the white matter microstructure in the DMN significantly correlated with cognitive dysfunction. Mediation analyses demonstrated that DTI values could account for attention, executive and language impairments, and partly mediated global cognitive dysfunction in the subcortical VCIND patients. DMN integrity is significantly impaired in subcortical VCIND patients. The disrupted DMN connectivity could explain the attention, language and executive dysfunction, which indicates that the white matter integrity of the DMN may be a neuroimaging marker for VCIND.

Effect and Neuroimaging Mechanism of Electroacupuncture for Vascular Cognitive Impairment No Dementia: Study Protocol for a Randomized, Assessor-Blind, Controlled Clinical Trial

Vascular cognitive impairment no dementia (VCIND) is likely to develop into vascular dementia (VD) without intervention. The clinical efficacy of electroacupuncture (EA) for VCIND has been previously demonstrated. However, the neuroimaging mechanism of EA for VCIND has not been elucidated clearly. This trial is designed to provide solid evidence for the efficacy and neuroimaging mechanism of EA treatment for patients with VCIND. This ongoing study is an assessor-blind, parallel-group, randomized controlled trial. 140 eligible subjects will be recruited from the General Hospital of Ningxia Medical University and randomized into either the electroacupuncture (EA) group or the control group (CG). All subjects will receive basic treatment, and participants in the CG will receive health education performed weekly. Except for basic treatment and health education, participants in the EA group will receive treatment 5 times per week for a total of 40 sessions over 8 weeks. The primary outcome in this study is Montreal Cognitive Assessment (MoCA), and the secondary outcomes are Auditory Verbal Learning Test (AVLT), Stroop color-naming condition (STROOP), Rey–Osterrieth Complex Graphics Testing, and resting-state functional magnetic resonance imaging (rs-fMRI). All of the outcome measures will be assessed at baseline and 8 weeks of intervention. The medical abstraction of adverse events will be done at each visit. The results of this trial will demonstrate the efficacy and neuroimaging mechanism of EA treatment for VCIND, thus supporting EA treatment as an ideal choice for VCIND treatment. The trial was registered at the Chinese Clinical Trial Registry on 28 July 2018 (ChiCTR1800017398).

Effect of Chinese reading aloud training on cognitive function in patients with vascular cognitive impairment no dementia

Objective To investigate the effect of Chinese reading aloud training (c-RAT) on cognitive function and activities of daily living in patients with vascular cognitive impairment no dementia (VCIND). Methods From January 2018 to January 2019, totally 80 patients with VCIND in the General Hospital of Xingtai Mining Group were enrolled.Subjects were randomized grouped into c-RAT group (n=43) and control group (n=37). The c-RAT group was asked to read aloud the Chinese paper for 5 days a week for 12 weeks.At the time of enrollment and 12 weeks after the intervention, the Montreal cognitive assessment (MoCA), trail making test (TMT), auditory verb learn test (AVLT), digit symbol substitution test (DSST) and modified Barthel index (MBI) were filled out. Results Compared with control group, the difference of D-value in c-RAT group was statistically significant in MoCA total scores(4.00(2.00), 1.50(0.50), Z=3.012, P=0.003), scores of MoCA-Visual space execution (2.00(1.00), 0.00(2.00), Z=2.787, P=0.008), MoCA-attention (1.00(1.00), 0.00(0.50), Z=2.369, P=0.022), MoCA-language (1.00(1.00), 0.00(0.75), Z=3.049, P=0.000)and MoCA-delayed recall(2.00(2.00), 0.00(1.00), Z=2.043, P=0.014), TMT-A scores (-8.00(23.00), 10.50(30.25), Z=2.120, P=0.039), AVLT scores (1earning)(3.00(2.00), 0.50(0.75), Z=2.266, P=0.039) , AVLT scores (recall)(2.00(1.00), 0.00(1.00), Z=2.974, P=0.003)、AVLT scores (recognition) (2.00(0.00), 0.50(1.50), Z=3.054, P=0.000)and DSST scores ((4.96±0.71), (2.39±0.78), t=2.572, P=0.014), while there were no significant differences in the rest parts of MoCA, TMT-B and MBI(P>0.05). The increased scores in DSST were positively correlated (r=0.205, P=0.006) with the number of reading aloud tasks finished. Conclusion C-RAT can improve general cognition, especially in information processing speed, executive function, attention and auditory memory. Key words: Learning therapy; Mild cognitive impairment; Vascular dementia; Information processing speed

An Assessment of the Relationship between Structural and Functional Imaging of Cerebrovascular Disease and Cognition-Related Fibers.

In order to assess the relationship between structural and functional imaging of cerebrovascular disease and cognition-related fibers, this paper chooses a total of 120 patients who underwent cerebral small vessel disease (CSVD) treatment at a designated hospital by this study from June 2013 to June 2018 and divides them into 3 groups according to the random number table method: vascular dementia (VaD) group, vascular cognitive impairment no dementia (VCIND) group, and noncognition impairment (NCI) group with 40 cases of patients in each group. Cognitive function measurement and imaging examination were performed for these 3 groups of patients, and the observation indicators of cognitive state examination (CSE), mental assessment scale (MAS), clock drawing test (CDT), adult intelligence scale (AIS), frontal assessment battery (FAB), verbal fluency test (VFT), trail making test (TMT), cognitive index (CI), white matter lesions (WML), third ventricle width (TVW), and frontal horn index (FHI) were tested, respectively. The results shows that the average scores of CSE, MAS, AIS, and VFT in the VaD and VCIND group are lower than those of the NCI group and the differences are statistically significant (P < 0.05); the average scores of FAB, TMT, and CI in the VaD group are higher than those of the VCIND group and the differences are also statistically significant (P < 0.05); the average scores of FHI and TVW in the VaD group are lower than those of the VCIND and NCI group with statistically significant differences (P < 0.05); the average scores of WML, CDT, and AIS in the VaD group are higher than those of the VCIND and NCI group with statistically significant differences (P < 0.05). Therefore, it is believed that the structural and functional imaging features of cerebrovascular disease are closely related to cognition-related fibers, and the incidence of white matter lesions is closely related to the degree of lesions and cognitive dysfunction of cerebral small vessel disease, in which a major risk factor for cognitive dysfunction in patients with small blood vessels is the severity of white matter lesions; brain imaging and neuropsychiatric function assessment can better understand the relationship between cerebrovascular disease and cognitive impairment. The results of this study provide a reference for the further research studies on the relationship between structural and functional imaging of cerebrovascular disease and cognition-related fibers.

Apolipoprotein E ε4 allele is associated with vascular cognitive impairment no dementia in Chinese population

BackgroundThe association between apolipoprotein E (APOE) ε4 allele and vascular cognitive impairment no dementia (VCIND) is still controversial. ObjectiveTo examine the relationship between the APOE ε4 allele and patients with VCIND after cerebral infarction. MethodsThis study included first-ever cerebral infarction patients 3–12 months after the attack at the Xuanwu Hospital between June 2012 and December 2014. Patients were divided into VCIND group and normal cognition group (NC group).The APOE ε4 carriers (including ε2/ε4, ε3/ε4 and ε4/ε4 genotypes) and ε4 allele frequency were analyzed in relation to cognition grouping after cerebral infarction. MRI features of infarctions and some known risk factors for VCIND，as confounding factors, were also analyzed for correlation with VCIND at the same time. ResultsParticipants (n = 707) were divided into the VCIND (n = 361) and NC (n = 346) groups. The percentage of APOE ε4 carriers was higher in the VCIND group (23.6%) than in the NC group (12.7%, P < .001).The APOE ε4 allele frequency was higher in the VCIND group (12.5%) than in the NC group (6.7%, P = .001). Regardless of other confounding factors, such as male gender (OR = 1.963, 95%CI: 1.394–2.763, P < .001), age (OR = 1.034, 95%CI: 1.017–1.052, P < .001), education (OR = 0.834, 95%CI: 0.795–0.875, P < .001), hypertension (OR = 2.044, 95%CI: 1.460–2.861, P < .001), hyperlipidemia (OR = 0.682, 95%CI: 0.482–0.965, P = .031), infarction lesion diameter (OR = 1.044, 95%CI: 1.017–1.072, P = .001) and white matter lesions (OR = 1.330, 95%CI: 1.126–1.571, P = .001), the APOE ε4 allele was independently associated with VCIND (OR = 2.244, 95%CI: 1.454–3.463, P < .001). ConclusionThese results confirms the hypothesis that the APOE ε4 allele is a risk factor associated with VCIND after cerebral infarction.

Association Between Insulin Resistance, Plasma Leptin, and Neurocognition in Vascular Cognitive Impairment.

Greater body weight has been associated impairments in neurocognition and greater dementia risk, although the mechanisms linking weight and neurocognition have yet to be adequately delineated. To examine metabolic mechanisms underlying the association between obesity and neurocognition. We conducted a secondary analysis of weight, neurocognition, and the potentially mediating role of metabolic and inflammatory biomarkers among 160 participants from the ENLIGHTEN trial of vascular cognitive impairment, no dementia (CIND). Neurocognition was assessed using a 45-minute assessment battery assessing Executive Function, Verbal and Visual Memory. We considered three metabolic biomarkers: insulin resistance (homeostatic model assessment [HOMA-IR]), plasma leptin, and insulin-like growth factor (IGF-1). Inflammation was assessed using C-reactive protein. Multiple regression analyses were used. Participants included 160 sedentary older adults with CIND. Participants tended to be overweight or obese (mean BMI = 32.5 [SD = 4.8]). Women exhibited higher BMI (p = 0.043), CRP (p < 0.001), and leptin (p < 0.001) compared with men. Higher BMI levels were associated with worse performance on measures of Executive Function (β= -0.16, p = 0.024) and Verbal Memory (β= -0.16, p = 0.030), but not Visual Memory (β= 0.05, p = 0.500). Worse metabolic biomarker profiles also were associated with lower Executive Function (β= -0.12, p = 0.050). Mediation analyses suggested leptin was a plausible candidate as a mediator between BMI and Executive Function. In overweight and obese adults with vascular CIND, the association between greater weight and poorer executive function may be mediated by higher leptin resistance.

Analysis of language tests for vascular cognitive impairment-no dementia

Background Language is a cardinal function that makes human unique. The impairment of language function affects the normal operation and recovery of other nerve functions. However, it is unclear what relationships between language function and other cognitive functions are. Methods We compared performance on the NINDS-CSN-VCIHS test battery between fifty-six people with VCI-ND and fifty control individuals. We used the receiver operating characteristic (ROC) curve to compare tests normally found in the NINDS-CSN-VCIHS with additional neuropsychological tests commonly used in China with respect to their ability to detect individuals with VCI-ND. The tests encompassed cognitive screening (MMSE), memory (AVLT), executive function/attention (STT, SCWT, RME, DOT-A, SDMT), language (ANT, BNT, FFT, ST, VFT) and visuospatial function (CFT). And then, we divided VCI-ND patients into two groups according to language impairment and observed their characteristics. Results Individuals with VCI-ND performed significantly worse than those in the control group in terms of language (P Conclusion BNT test was suitable for language function detection in VCI-ND. VCI-ND patients with language dysfunction was worse than VCI-ND patients without language dysfunction in executive functions.

Transcranial Doppler ultrasound in vascular cognitive impairment-no dementia.

BackgroundAlthough cerebral white matter lesions (WMLs) are considered as a risk factor for vascular dementia, data on their impact on cerebral hemodynamics are scarce. We test and compare transcranial Doppler (TCD) features in WML patients with or without associated cognitive impairment.MethodsA sample of non-demented elderly patients with WMLs was consecutively recruited. Mean blood flow velocity (MBFV), pulsatility index (PI), peak systolic blood flow velocity (PSV), end-diastolic blood flow velocity (EDV), and resistivity index (RI) were recorded from the middle cerebral artery bilaterally. Global cognitive functioning, frontal lobe abilities, functional status, and WML severity were also assessed.Results161 patients satisfying the clinical criteria for vascular cognitive impairment-no dementia (VCI-ND) were age-matched with 97 presenting WMLs without any cognitive deficit. VCI-ND patients exhibited a decrease in MBFV and EDV, as well as an increase in PI, RI, and PSV. Moreover, a significant correlation between all TCD parameters and the severity of executive dysfunction was observed, whereas PI, RI, and EDV were significantly correlated with the WML load.ConclusionsVCI-ND showed a hemodynamic pattern indicative of cerebral hypoperfusion and enhanced vascular resistance. These changes may be considered as the TCD correlate of VCI-ND due to microcirculation pathology. TCD provides useful indices of the occurrence and severity of small vessel disease and executive dysfunction in elderly patients at risk of future dementia.

Effectiveness of acupuncture for vascular cognitive impairment no dementia: a randomized controlled trial

Objective: To evaluate the effectiveness of acupuncture in patients with vascular cognitive impairment no dementia (VCIND) in comparison with citicoline, an agent for cognitive disturbances associated with chronic cerebral disorders. Design: A randomized controlled multicenter trial. Setting: In three hospitals in Beijing, China. Subjects: A total of 216 patients with VCIND were recruited. Interventions: Patients with VCIND (mean age of 65.4 years) were randomized to receive acupuncture (two sessions per week) or oral citicoline (100 mg three times daily) over three months. Main measures: The primary outcome was the change from baseline to three months in cognitive symptom, measured by Alzheimer’s disease Assessment Scale, cognitive subscale (ADAS-cog). Secondary outcomes included changes from baseline to six months in ADAS-cog, executive function measured by the Clock Drawing Test (CDT), and functional disability measured by the Ability of Daily Living (ADL) scale at three and six months. Results: At three months, the acupuncture group had a greater decrease in mean ADAS-cog score (−2.33 ± 0.31) than the citicoline group (−1.38 ± 0.34) with a mean difference of −0.95 (95% CI, −1.84 to −0.07, P = 0.035). The mean change from baseline to six months in ADAS-cog also significantly favored acupuncture treatments (acupuncture change −2.61 vs citicoline −1.25, difference: −1.36 points; 95% CI, −2.20 to −0.51; P = 0.002). There was no difference between the two groups on CDT and ADL scores at either time point. Conclusion: Compared with citicoline, acupuncture has comparable and even superior efficacy with improved cognitive and daily living performance as a complementary and alternative medicine treatment for VCIND.

Efficacy and Safety of Auricular Acupuncture for Cognitive Impairment and Dementia: A Systematic Review.

Objectives To analyze the efficacy and safety of auricular acupuncture (AA) in patients with cognitive impairment and dementia. Methods Twelve electronic databases were searched for randomized controlled trials evaluating effects of AA in patients with cognitive impairment and/or dementia, from their inception to August 2017. The primary outcome was cognitive function, and secondary outcomes were self-care ability, quality of life, clinical efficacy rate, and incidences of adverse events. Results Nine studies were included, and five involving 677 participants were analyzed quantitatively. Compared with Western medications (WM), AA had mixed effects on cognitive functions (Mini-Mental State Examination [MMSE], mean difference [MD] 0.73, 95% confidence interval [CI] −0.02 to 1.48; Hierarchic Dementia Scale [HDS], MD 2.21, 95% CI 1.09 to 3.33); there was no significant improvement in the activities of daily living (ADL) score (MD 0.20, 95% CI −3.51 to 3.91) in patients with vascular dementia (VD). Compared to WM, AA combined with WM showed better clinical efficacy rate (risk ratio [RR] 1.42, 95% CI 1.06 to 1.91) in patients with VD; there was no significant improvement in cognitive functions (MMSE, MD 0.97, 95% CI −0.44 to 2.38; Montreal Cognitive Assessment [MoCA], MD 0.22, 95% CI −1.83 to 2.27) in patients with mild cognitive impairment (MCI). Compared to herbal medicine (HM), AA plus HM showed significant improvements in cognitive function (MMSE, MD 1.31, 95% CI 0.13 to 2.49) in patients with MCI and patients with vascular cognitive impairment, no dementia (VCIND) and in ADL score (MD −6.70, 95% CI −8.78 to −4.62) in patients with MCI. No adverse event associated with AA was reported. Conclusion The evidence reveals mixed efficacy of AA in patients with cognitive impairment and/or dementia. However, the results were inconclusive because of the small number and poor methodological quality of the included studies.