Cerebral arterial blood flow,attention,and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage

BACKGROUND Intracerebral hemorrhage mainly occurs in middle-aged and elderly patients with hypertension,and surgery is currently the main treatment for hypertensive cerebral hemorrhage,but the bleeding caused by surgery will cause damage to the patient's nerve cells,resulting in cognitive and motor dysfunction,resulting in a decline in the patient's quality of life.AIM To investigate associations between cerebral arterial blood flow and executive and cognitive functions in depressed patients after acute hypertensive cerebral hemorrhage.METHODS Eighty-nine patients with depression after acute hypertensive cerebral hemorrhage who were admitted to our hospital between January 2019 and July 2021 were selected as the observation group,while 100 patients without depression who had acute hypertensive cerebral hemorrhage were selected as the control group.The attention span of the patients was assessed using the Paddle Pin Test while executive function was assessed using the Wisconsin Card Sorting Test(WCST)and cognitive function was assessed using the Montreal Cognitive Assessment Scale(MoCA).The Hamilton Depression Rating Scale(HAMD-24)was used to evaluate the severity of depression of involved patients.Cerebral arterial blood flow was measured in both groups.RESULTS The MoCA score,net scores I,II,III,IV,and the total net score of the scratch test in the observation group were significantly lower than those in the control group(P<0.05).Concurrently,the total number of responses,number of incorrect responses,number of persistent errors,and number of completed responses of the first classification in the WCST test were significantly higher in the observation group than those in the control group(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery was significantly lower in the observation group than in the control group(P<0.05).The basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery were positively correlated with the net and total net scores of each part of the Paddle Pin test and the MoCA score(P<0.05),and negatively correlated with each part of the WCST test(P<0.05).In the observation group,the post-treatment improvement was more prominent in the Paddle Pin test,WCST test,HAMD-24 score,and MoCA score compared with those in the pre-treatment period(P<0.05).Blood flow in the basilar artery,left middle cerebral artery,right middle cerebral artery,left anterior cerebral artery,and right anterior cerebral artery significantly improved in the observation group after treatment(P<0.05).CONCLUSION Impaired attention,and executive and cognitive functions are correlated with cerebral artery blood flow in patients with depression after acute hypertensive cerebral hemorrhage and warrant further study.

Cocoa Flavanols Intake and Cognitive Functions: a Systematic Review and Meta-analysis of Randomised Controlled Trials

Objective The influence of cocoa flavanols(CFs)on cognitive functions in human has been investigated in some clinical trials,but the results are inconclusive.We conduct this systematic review and meta-analysis of randomized controlled trials(RCTs)to figure out whether CFs intervention have a positive effect on cognitive functions.Methods A comprehensive literature search of articles published until June 2019 was performed in PubMed,Cochrane Library,Medline,and Web of Science.Weighted mean difference(WMD)and 95%confidence interval(95%CI)were calculated to reflect the size of the combined effect.Random effect models were used for all analyses.Results A total of 9 RCT studies were finally enrolled in this meta-analysis.CFs has no notable effect on Trail Making Test-A(TMT-A)(WMD:-5.75s,95%CI:-16.71-5.21),which reflects the shifting subdomain of executive function and global executive function.CFs has no significant effect on Trail Making Test-B(TMT-B)(WMD:-11.32s,95%CI:-26.14-3.50),which reflects another specific aspect of the shifting subdomain.Gross cognitive changed as measured by mini mental state examination(MMSE)which consists of a series of items covering cognitive functions except for the executive function domain,but significantly associated with composite z score of several subdomains tests of executive function(WSD:0.40s,95%CI:0.29-0.46).Conclusion This study suggests CFs may have a positive effect on cognitive function,especially executive function.However,large scale and high quality RCTs are needed to further confirm/refute this conclusion.

Effects of sleep deprivation on cognitive functions

Sleep deprivation （SD） is a common condition that afflicts many people in modem life. Deficits in daytime perfor- mance due to SD are experienced universally. Recent evidence indicates that SD causes impairments in cognitive functions. However, the mechanisms that SD impairs cognitive functions are not clear. This review will focus on the behavioral and neural effects of SD with the aim to elucidate the possible mechanisms of SD-induced deterioration in cognitive functions and to identify directions for future research.

What can atypical language hemispheric specialization tell us about cognitive functions?

Recent studies have made substantial progress in understanding the interactions between cognitive functions, from language to cognitive control, attention, and memory. However, dissociating these functions has been hampered by the close proximity of regions involved, as in the case in the prefrontal and parietal cortex. In this article, we review a series of studies that investigated the relationship between language and other cognitive functions in an alternative way - by examining their functional （co-）lateralization. We argue that research on the hemispheric lateralization of language and its link with handedness can offer an appropriate starting- point to shed light on the relationships between different functions. Besides functional interactions, anatomical asymmetries in non-human primates and those underlying language in humans can provide unique information about cortical organization. Finally, some open questions and criteria are raised for an ideal theoretical model of the cortex based on hemispheric specialization.

Abnormalities of electroencephalography microstates in patients with depression and their association with cognitive function

BACKGROUND A growing number of recent studies have explored underlying activity in the brain by measuring electroencephalography(EEG)in people with depression.However,the consistency of findings on EEG microstates in patients with depression is poor,and few studies have reported the relationship between EEG microstates,cognitive scales,and depression severity scales.AIM To investigate the EEG microstate characteristics of patients with depression and their association with cognitive functions.METHODS A total of 24 patients diagnosed with depression and 32 healthy controls were included in this study using the Structured Clinical Interview for Disease for The Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition.We collected information relating to demographic and clinical characteristics,as well as data from the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS;Chinese version)and EEG.RESULTS Compared with the controls,the duration,occurrence,and contribution of microstate C were significantly higher[depression(DEP):Duration 84.58±24.35,occurrence 3.72±0.56,contribution 30.39±8.59;CON:Duration 72.77±10.23,occurrence 3.41±0.36,contribution 24.46±4.66;Duration F=6.02,P=0.049;Occurrence F=6.19,P=0.049;Contribution F=10.82,P=0.011]while the duration,occurrence,and contribution of microstate D were significantly lower(DEP:Duration 70.00±15.92,occurrence 3.18±0.71,contribution 22.48±8.12;CON:Duration 85.46±10.23,occurrence 3.54±0.41,contribution 28.25±5.85;Duration F=19.18,P<0.001;Occurrence F=5.79,P=0.050;Contribution F=9.41,P=0.013)in patients with depression.A positive correlation was observed between the visuospatial/constructional scores of the RBANS scale and the transition probability of microstate class C to B(r=0.405,P=0.049).CONCLUSION EEG microstate,especially C and D,is a possible biomarker in depression.Patients with depression had a more frequent transition from microstate C to B,which may relate to more negative rumination and visual processing.

Rotating magnetic field inhibits Aβ protein aggregation and alleviates cognitive impairment in Alzheimer’s disease mice

Amyloid beta(Aβ)monomers aggregate to form fibrils and amyloid plaques,which are critical mechanisms in the pathogenesis of Alzheimer’s disease(AD).Given the important role of Aβ1-42 aggregation in plaque formation,leading to brain lesions and cognitive impairment,numerous studies have aimed to reduce Aβaggregation and slow AD progression.The diphenylalanine(FF)sequence is critical for amyloid aggregation,and magnetic fields can affect peptide alignment due to the diamagnetic anisotropy of aromatic rings.In this study,we examined the effects of a moderate-intensity rotating magnetic field(RMF)on Aβaggregation and AD pathogenesis.Results indicated that the RMF directly inhibited Aβamyloid fibril formation and reduced Aβ-induced cytotoxicity in neural cells in vitro.Using the AD mouse model APP/PS1,RMF restored motor abilities to healthy control levels and significantly alleviated cognitive impairments,including exploration and spatial and non-spatial memory abilities.Tissue examinations demonstrated that RMF reduced amyloid plaque accumulation,attenuated microglial activation,and reduced oxidative stress in the APP/PS1 mouse brain.These findings suggest that RMF holds considerable potential as a non-invasive,high-penetration physical approach for AD treatment.

Outcomes of the effect of exercise on cognitive function in patients with depression:A meta-analysis

BACKGROUND Major depressive disorder is a common mental disorder,characterized by a high rate of suicide and recurrence,which is frequently accompanied by cognitive impairments,particularly in executive function,memory,attention,and infor-mation processing speed.As such,improving the cognitive function in patients with depression and enhancing their quality of life are urgent issues.AIM To perform a systematic review and meta-analysis of the effects of exercise on cognitive function in patients with depression.METHODS The PubMed,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang Medical,VIP,and Biomedical Databases for randomized controlled trials(RCTs)databases were searched(from inception to October 19,2023)for studies investigating improvements in cognitive function in patients with depression through exercise.Tools recommended by the Cochrane Handbook for RCT evaluation,and GRADEpro and Stata17 software,were employed for risk of bias assessment,evidence grading,forest plot construction,subgroup and sensitivity analyses,and assessment of publication bias.RESULTS Seventeen RCTs(1173 patients with depression)were included.Exercise had a small but significant positive effect on attention,with an effect size of 0.21,95%CI:0.07-0.34,P<0.01.Specifically,aerobic exercise regimens of 30-60 minute/session,thrice a week,at moderate intensity,and sustained over 3-12 weeks,were associated with the most pronounced benefits(P<0.05),with effect sizes for executive function,memory,and information processing speed of 0.11,95%CI:-0.11-0.32,P=0.34;0.08,95%CI:0.00-0.16,P=0.05;and 0.14,95%CI:0.04-0.25,P=0.01,respectively.The evidence levels for attention,information processing speed,and memory were rated as'low,’whereas that for executive function was rated as'very low’.CONCLUSION Exercise could improve attention and information-processing speed in patients with depression,although improvements in executive function and memory are not significant.

Relationship between intracranial pressure and neurocognitive function among older adults after radical resection of rectal cancer

BACKGROUND Older patients are prone to postoperative cognitive decline after laparoscopic rectal cancer surgery,which may be associated with increased intraoperative intracranial pressure(ICP).This study investigated the correlation between intra-operative ICP changes,as indicated by measurements of the optic nerve sheath diameter(ONSD)using ultrasonography,and subsequent cognitive function to provide better patient care.AIM To evaluate changes in ICP and associated postoperative neurocognition in older adults after laparoscopic radical resection for rectal cancer.METHODS We included 140 patients who visited the Mianyang Central Hospital for malig-nant rectal tumors,measured their ONSDs before surgery and 30 and 60 minutes after the Trendelenburg position during surgery,and evaluated the patients’cog-nitive function 1 day before surgery and 1,4,and 7 days after surgery.The Mini-Mental State Examination(MMSE)and confusion assessment method(CAM)scores of the patients with different ONSDs were compared at different times after surgery.RESULTS In patients with an ONSD greater than 5.00 mm(group A1),the MMSE scores at 1 day and 4 days after surgery were significantly lower than those of patients with an ONSD less than or equal to 4.00 mm(group A2)(P<0.05).The CAM scores of group A1 were significantly higher than those of group A2(P<0.05).The MMSE scores of group A1 on days 1 and 4 after surgery were significantly lower than those 1 day before and 7 days after surgery(P<0.05),while the CAM scores 1 day and 4 days after surgery were significantly higher than those 1 day before and 7 days after surgery.CONCLUSION Decline in cognitive function among older adults after the procedure may be related to intracranial hypertension during surgery.

Cognitive dysfunction in schizophrenia patients caused by downregulation of γ-aminobutyric acid receptor subunits

BACKGROUND The expression pattern of gamma aminobutyric acid(GABA)receptor subunits are commonly altered in patients with schizophrenia,which may lead to nerve excitation/inhibition problems,affecting cognition,emotion,and behavior.AIM To explore GABA receptor expression and its relationship with schizophrenia and to provide insights into more effective treatments.METHODS This case-control study enrolled 126 patients with schizophrenia treated at our hospital and 126 healthy volunteers who underwent physical examinations at our hospital during the same period.The expression levels of the GABA receptor subunits were detected using 1H-magnetic resonance spectroscopy.The recognized cognitive battery tool,the MATRICS Consensus Cognitive Battery,was used to evaluate the scores for various dimensions of cognitive function.The correlation between GABA receptor subunit downregulation and schizophrenia was also analyzed.RESULTS Significant differences in GABA receptor subunit levels were found between the case and control groups(P<0.05).A significant difference was also found between the case and control groups in terms of cognitive function measures,including attention/alertness and learning ability(P<0.05).Specifically,as the expression levels of GABRA1(α1 subunit gene),GABRB2(β2 subunit gene),GABRD(δsubunit),and GABRE(εsubunit)decreased,the severity of the patients’condition increased gradually,indicating a positive correlation between the downregulation of these 4 receptor subunits and schizophrenia(P<0.05).However,the expression levels of GABRA5(α5 subunit gene)and GABRA6(α6 subunit gene)showed no significant correlation with schizophrenia(P>0.05).CONCLUSION Downregulation of the GABA receptor subunits is positively correlated with schizophrenia.In other words,when GABA receptor subunits are downregulated in patients,cognitive impairment becomes more severe.

Computerized cognitive remediation therapy on cognitive impairment and social function in patients with chronic schizophrenia

BACKGROUND Patients with schizophrenia may have various disease manifestations,most of which gradually tend toward incurable chronic decline,leading to mental disability.The basic symptoms of the disease can impair social function,whereas long-term hospitalization produces hospitalization syndrome,causing serious damage to social function.AIM To investigate the effects of Computerized Cognitive Remediation Therapy(CCRT)on cognitive and social functioning in patients with chronic schizophrenia.METHODS A retrospective analysis of 120 patients with chronic schizophrenia in Shanghai Pudong New Area Mental Health Center was performed.They were divided into an intervention group(60 cases treated with CCRT combined with conventional medication)and a control group(60 cases treated with conventional medication).After treatment,effects on cognitive function and social roles were observed in both groups.The Positive and Negative Syndrome Scale(PANSS)was used to assess the patients'psychiatric symptoms.The Wisconsin Card Sorting Test(WCST)was used to assess the patients'cognitive functioning,and the Social Functioning Scale for Psychiatric Inpatients(SSPI)was used to assess the social functioning of the inpatient psychiatric patients.RESULTS No significant differences were observed in the PANSS,WCST,and SSPI intergroup scores before treatment(P>0.05).After 2,4,and 6 wk of therapy,general psychopathological factors,positive symptoms,negative symptoms,and total PANSS scores of PANSS in the intervention group were lower than in the control group(P<0.05).After 2,4,and 6 wk of treatment,the number of false responses,number of persistent bugs,and total responses in the WCST were significantly lower in the intervention group than in the control group(P<0.05),and the amount of completed classification was significantly higher than in the control group(P<0.05).After 2,4,and 6 wk of therapy,the SSPI scores were significantly greater than those of the controls(P<0.05).After 6 wk of treatment,the efficacy rates of the control and intervention groups were 81.67%and 91.67%,respectively.The curative effect in the intervention group was significantly higher than that in the control group(P<0.05).CONCLUSION CCRT can significantly improve cognitive function and social abilities in patients with chronic schizophrenia.

Interconnected Challenges: Addressing the Bidirectional Relationship between Heart Failure and Cognitive Impairment through Targeted Intervention Strategies

This paper examines the bidirectional relationship between heart failure (HF) and cognitive impairment, underscoring the need for integrated intervention strategies to address these interconnected conditions effectively. Cognitive deficits often hinder the effective management of HF, leading to poorer treatment adherence and health outcomes, while the physiological stress of HF can further impair cognitive function, creating a complex interplay that complicates patient care. This study highlights the effectiveness of angiotensin-converting enzyme (ACE) inhibitors and cardiac resynchronization therapy (CRT) in improving both cardiac and cognitive functions. By targeting the underlying physiological and neurobiological mechanisms of HF, these therapies enhance patient outcomes, leading to better adherence to treatment regimens and overall quality of life. Furthermore, the findings suggest that regular cognitive assessments should be integrated into HF management protocols, enabling early identification of cognitive impairment and timely intervention. Incorporating ACE inhibitors and CRT into standard care practices not only addresses the complexities of managing HF and cognitive decline but also fosters a holistic approach to patient health. Ultimately, this multifaceted strategy has the potential to significantly improve health outcomes, enhance the quality of care, and support sustainable management of patients with heart failure and cognitive impairment.

Effects of a Cocktail Supplement of Ginkgo Biloba and Acai Extract on Cognitive Symptoms of Parkinson’s Disease

Parkinson’s Disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms, including cognitive impairment. Current treatments often involve synthetic drugs with significant side effects and potential for dependency. This study investigates the effects of a natural supplement combination of Ginkgo Biloba and Acai Extract on cognitive symptoms in a 77-year-old male with PD. The participant underwent a three-month supplementation regimen, with cognitive function assessed using the Montreal Cognitive Assessment (MoCA) test before and after the intervention. The results indicated an improvement in cognitive scores, suggesting that the combination of Ginkgo Biloba and Acai Extract may offer a promising alternative or adjunct to conventional PD treatments. This study highlights the potential of natural supplements in managing PD symptoms and calls for further research with larger sample sizes to confirm these findings. Human data was performed in accordance with the Declaration of Helsinki by the Roxbury District IRB Board (IRB Number: IRB00011767).

Associations between residence and cognitive function among Chinese older adults: the mediating role of leisure activity

Background:Cognitive function is a current research hotspot,residence may be related to differences in cognitive function,and the mediating role of leisure activities are limited in Chinese research.This study used leisure activities as a mediating variable to investigate the mediating role of leisure activity between place of residence(city-town-rural)and cognitive function among Chinese older,this is where the innovation of the article comes in.Methods:Using cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey,Pearson correlation analyses were employed to examine the relationships among various indicators.Mediation analyses were conducted using the SPSS PROCESS macro program,version 3.5,written by Hayes,to explore the mediating effects of leisure activity between place of residence and cognitive function in older adults.Results:A total of 10955 older adults were included in this study,with a mean age of(84.23±11.57)years.Among them,2739(24.8%)lived in the city,3627(33.1%)in town,and 4615(42.1%)in rural areas;their leisure activity score was(5.34±3.77),and their cognitive function score was(24.69±6.65).Place of residence,leisure activities,and cognitive function were significantly correlated(P<0.01).Using city as a reference,place of residence is negatively associated with cognitive function,and place of residence not only had a direct effect on cognitive function in older adults:town-cognitive function(effect=–0.399;95%confidence interval(CI)=(–0.685,–0.113));rural-cognitive function(effect=–0.42;95%CI=(–0.698,–0.141)).There were also indirect effects on cognitive function through the pathway of leisure activity:town-leisure activity-cognitive function(effect=–0.17;95%CI=(–0.246,–0.1)),rural-leisure activity-cognitive function(effect=–0.199;95%CI=(–0.272,–0.13)).Conclusion:Leisure activities play a partially mediating role between the impact of place of residence and cognitive function in Chinese older adults,and it is vital to pay attention to the impact of place of residence on the cognitive function of older adults in various aspects,and to increase the participation rate of older adults in leisure activities,which is beneficial to the prevention of cognitive decline and the protection of older adult’s physical and mental health.

Clinical Study on the Effect of Continuity of Care in CICU on Improving Cognitive Function and Psychological State in Patients with Heart Failure

Objective:To analyze the effect of continuity of care in the cardiac intensive care unit(CICU)on improving cognitive function and psychological state in patients with heart failure(HF).Methods:A total of 112 chronic HF patients admitted to the CICU of Xuzhou Traditional Chinese Medicine Hospital from July 2022 to August 2024 were selected and randomly divided into two groups using the red and blue ball method:a control group(n=56)and a study group(n=56).The control group received routine CICU nursing management,while the study group received routine CICU nursing combined with continuity of care management.Cognitive function(using the Montreal Cognitive Assessment,MoCA),psychological state(using the Self-Rating Depression Scale,SDS,and Self-Rating Anxiety Scale,SAS),and quality of life(using the Minnesota Living with Heart Failure Questionnaire,MLHFQ)were compared between the two groups.Results:After the intervention,the cognitive function scores of the study group were significantly higher than those of the control group(P<0.05).The SDS and SAS scores of the study group were significantly lower than those of the control group after the intervention(P<0.05).The quality of life in the study group was also significantly better than in the control group(P<0.05).Conclusion:CICU continuity of care can effectively improve cognitive function and psychological state in patients with HF,while also enhancing their quality of life.

Hypidone hydrochloride(YL-0919)ameliorates functional deficits after traumatic brain injury in mice by activating the sigma-1 receptor for antioxidation

Traumatic brain injury involves complex pathophysiological mechanisms,among which oxidative stress significantly contributes to the occurrence of secondary injury.In this study,we evaluated hypidone hydrochloride(YL-0919),a self-developed antidepressant with selective sigma-1 receptor agonist properties,and its associated mechanisms and targets in traumatic brain injury.Behavioral experiments to assess functional deficits were followed by assessment of neuronal damage through histological analyses and examination of blood-brain barrier permeability and brain edema.Next,we investigated the antioxidative effects of YL-0919 by assessing the levels of traditional markers of oxidative stress in vivo in mice and in vitro in HT22 cells.Finally,the targeted action of YL-0919 was verified by employing a sigma-1 receptor antagonist(BD-1047).Our findings demonstrated that YL-0919 markedly improved deficits in motor function and spatial cognition on day 3 post traumatic brain injury,while also decreasing neuronal mortality and reversing blood-brain barrier disruption and brain edema.Furthermore,YL-0919 effectively combated oxidative stress both in vivo and in vitro.The protective effects of YL-0919 were partially inhibited by BD-1047.These results indicated that YL-0919 relieved impairments in motor and spatial cognition by restraining oxidative stress,a neuroprotective effect that was partially reversed by the sigma-1 receptor antagonist BD-1047.YL-0919 may have potential as a new treatment for traumatic brain injury.

Effect of Recurrent Severe Hypoglycemia on Cognitive Performance in Adult Patients with Diabetes: A Meta-analysis

The purpose of this study was to investigate the existence and extent of cognitive impairment in adult diabetes mellitus（DM） patients with episodes of recurrent severe hypoglycemia, by using meta-analysis to synthesize data across studies. PubMed, EMBASE and Cochrane library search engines were used to identify studies on cognitive performance in DM patients with recurrent severe hypoglycemia.Random-effects meta-analysis was performed on seven eligible studies using an inverse-variance method. Effect sizes, which are the standardized differences between the experimental group and the control group, were calculated. Of the 853 studies, 7 studies met the inclusion criteria. Compared with control subjects, the adult DM patients with episodes of recurrent severe hypoglycemia demonstrated a significantly lowered performance on memory in both types of DM patients, and poor performance of processing speed in type 2 DM patients. There was no significant difference between adult DM patients with and those without severe hypoglycemia in other cognitive domains such as general intelligence,executive function, processing speed and psychomotor efficiency. Our results seem to confirm the hypothesis that cognitive dysfunction is characterized by worse memory and processing speed in adult DM patients with a history of recurrent severe hypoglycemia, whereas general intelligence, executive function,and psychomotor efficiency are spared.

Acupuncture at the Taixi(KI3) acupoint activates cerebral neurons in elderly patients with mild cognitive impairment

Our previous ifndings have demonstrated that acupuncture at the Taixi （KI3） acupoint in healthy youths can activate neurons in cognitive-related cerebral cortex. Here, we investigated whether acupuncture at this acupoint in elderly patients with mild cognitive impairment can also activate neurons in these regions. Resting state and task-related functional magnetic resonance imaging showed that the pinprick senstation of acupuncture at the Taixi acupoint differed signiifcantly between elderly patients with mild cognitive impairment and healthy elderly controls. Results showed that 20 brain regions were activated in both groups of participants, including the bi-lateral anterior cingulate gyrus （Brodmann areas [BA] 32, 24）, left medial frontal cortex （BA 9, 10, 11）, left cuneus （BA 19）, left middle frontal gyrus （BA 11）, left lingual gyrus （BA 18）, right medial frontal gyrus （BA 11）, bilateral inferior frontal gyrus （BA 47）, left superior frontal gyrus （BA11）, right cuneus （BA 19, 18）, right superior temporal gyrus （BA 38）, left subcallosal gyrus （BA 47）, bilateral precuneus （BA 19）, right medial frontal gyrus （BA 10）, right superior frontal （BA 11）, left cingulate gyrus （BA 32）, left precentral gyrus （BA 6）, and right fusiform gyrus （BA 19）. These results suggest that acupuncture at the Taixi acupoint in elderly patients with mild cogni-tive impairment can also activate some brain regions.

Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia:A systematic review and network meta-analysis

Background:Exercise is a promising nonpharmacological therapy for cognitive dysfunction,but it is unclear which type of exercise is most effective.The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment(MCI)or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment.Methods:We searched PubMed,Web of Science,Embase,Cochrane Central Register of Controlled Trials,SPORTDiscus,and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia.Primary outcomes included global cognition,executive cognition,and memory cognition.Secondary outcomes included activities of daily living,neuropsychiatric symptoms,and quality of life.Pairwise analyses and network meta-analyses were performed using a random effects model.Results:A total of 73 articles from 71 trials with 5606 participants were included.All types of exercise were effective in increasing or maintaining global cognition,and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition(standard mean difference(SMD)=1.05,95%confidence interval(95%CI):0.56-1.54),executive function(SMD=0.85,95%CI:0.21-1.49),and memory function(SMD=0.32,95%CI:0.01-0.63)in patients with cognitive dysfunction.Subgroup analyses for patients with MCI revealed different effects,and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition(SMD=0.99,95%CI:0.44-1.54)and executive function(SMD=0.72,95%CI:0.06-1.38).However,only resistance exercise showed significant effects on memory function for patients with MCI(SMD=0.35,95%CI:0.01-0.69).Exercise interventions also showed various effects on the secondary outcomes.Conclusion:Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive declin e in patients withcognitive dysfunction,especially in patients with dementia.Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.

Neuroimaging mechanisms of high-frequency repetitive transcranial magnetic stimulation for treatment of amnestic mild cognitive impairment:a double-blind randomized sham-controlled trial

Individuals with amnestic mild cognitive impairment(aMCI)have a high risk of developing Alzheimer’s disease.Although repetitive transcranial magnetic stimulation(rTMS)is considered a potentially effective treatment for cognitive impairment in patients with aMCI,the neuroimaging mechanisms are poorly understood.Therefore,we performed a double-blind randomized sham-controlled trial in which rTMS was applied to the left dorsolateral prefrontal cortex of aMCI patients recruited from a community near the Third Hospital Affiliated to Sun Yat-sen University,China.Twenty-four patients with aMCI were randomly assigned to receive true rTMS(treatment group,n=12,6 men and 6 women;age 65.08±4.89 years)or sham stimulation(sham group,n=12,5 men and 7 women;age 64.67±4.77 years).rTMS parameters included a stimulation frequency of 10 Hz,stimulation duration of 2 seconds,stimulation interval of 8 seconds,20 repetitions at 80%of the motor threshold,and 400 pulses per session.rTMS/sham stimulation was performed five times per week over a period of 4 consecutive weeks.Our results showed that compared with baseline,Montreal Cognitive Assessment scores were significantly increased and the value of the amplitude of low-frequency fluctuation(ALFF)was significantly increased at the end of treatment and 1 month after treatment.Compared with the sham group,the ALFF values in the right inferior frontal gyrus,triangular part of the inferior frontal gyrus,right precuneus,left angular gyrus,and right supramarginal gyrus were significantly increased,and the ALFF values in the right superior frontal gyrus were significantly decreased in the treatment group.These findings suggest that high-frequency rTMS can effectively improve cognitive function in aMCI patients and alter spontaneous brain activity in cognitive-related brain areas.This study was approved by the Ethics Committee of Shenzhen Baoan Hospital of Southern Medical University,China(approval No.BYL20190901)on September 3,2019 and registered in the Chinese Clinical Trials Registry(registration No.ChiCTR1900028180)on December 14,2019.

Hippocampal insulin resistance and the Sirtuin 1 signaling pathway in diabetes-induced cognitive dysfunction

In the peripheral nervous system,the activation of Sirtuin 1 can improve insulin resistance;however,the role played by Sirtuin 1 in the central nervous system remains unknown.In this study,rat models of diabetes mellitus were generated by a single injection of streptozotocin.At 8 weeks after streptozotocin injection,the Morris water maze test and western blot assays confirmed that the diabetic model rats had learning and memory deficits,insulin resistance,and Sirtuin 1 expression could be detected in the hippocampus.Insulin and the insulin receptor inhibitor S961 were intranasally administered to investigate the regulatory effects of insulin signaling on Sirtuin 1.The results showed that insulin administration improved the impaired cognitive function of diabetic model rats and increased the expression levels of phosphorylated insulin receptor,phosphorylated insulin receptor substrate 1,and Sirtuin 1 in the hippocampus.Conversely,S961 administration resulted in more severe cognitive dysfunction and reduced the expression levels of phosphorylated insulin receptor,phosphorylated insulin receptor substrate 1,and Sirtuin 1.The Sirtuin 1 activator SRT2104 and the inhibitor Sirtinol were injected into the lateral ventricle,which revealed that the activation of Sirtuin 1 increased the expression levels of target of rapamycin complex 1,phosphorylated cAMP-response elementbinding protein,and brain-derived neurotrophic factor.Hippocampal dendritic length and spine density also increased in response to Sirtuin 1 activation.In contrast,Sirtinol decreased the expression levels of target of rapamycin complex 1,phosphorylated cAMP-response elementbinding protein,and brain-derived neurotrophic factor and damaged the dendritic structure.These findings suggest that the Sirtuin 1 signaling pathway plays an important role in the development of insulin resistance-related cognitive deficits in diabetic rats.This study was approved by the Animal Ethics Welfare Committee of the First Affiliated Hospital of Hunan University of Chinese Medicine(approval No.ZYFY201811207)in November 2018.