异氟醚对老龄大鼠认知功能障碍、GSK-3β及炎性因子的影响

目的观察异氟醚麻醉对老龄大鼠认知功能障碍、糖原合成酶激酶-3β(GSK-3β)及炎性因子的影响。方法雄性SD大鼠50只,18～20月龄,体重350～400g,采用随机数字表法.将其随机分为对照组吸入含有30%氧气的空氧混合气体4 h;异氟醚麻醉组吸入1.5%异氟醚4 h;用Morris水迷宫评测大鼠学习和记忆功能,Westen blot检测观察海马CA1区GSK-3β、IL-1β、IL-6及TNF-α的表达。结果麻醉组大鼠pH、PaCO_2、PaO_2、SaO_2及血糖水平与对照组比较,差异无统计学意义(P>0.05)。麻醉组大鼠GSK-3β、IL-1β、IL-6及TNF-α蛋白水平高于对照组[(2.2±0.3)vs(1.1±0.1)、(3.1±0.2)vs(1.0±0.2)、(4.1±0.3)vs(1.0±0.1)、(3.3±0.1)vs(1.1±0.2)],差异具有统计学意义(P<0.05)。麻醉组大鼠GSK-3β与IL-1β、IL-6、TNF-α蛋白表达呈正相关(r=0.23、0.36、0.19,P均<0.05)。麻醉组大鼠1 d、2d及3d的潜伏期值高于对照组,差异具有统计学意义(P <0. 05),麻醉组大鼠交叉循环次数低于对照组,差异具有统计学意义(P <0.05)。结论异氟醚麻醉诱发老龄大鼠认知功能障碍及炎性反应机制可能与激活GSK-3β活性有关。

Research progresses of resting-state functional MRI in mild cognitive impairment and Alzheimer's disease

Alzheimer's disease(AD)is a prevalent neurodegenerative disease characterized by cognitive decline in the early stage.Mild cognitive impairment(MCI)is considered as an intermediate stage between normal aging and AD.In recent years,studies related to resting-state functional MRI(rs-fMRI)indicated that the occurrence and development process of MCI and AD might be closely linked to spontaneous brain activity and alterations in functional connectivity among brain regions,and rs-fMRI could provide important reference for specific diagnosis and early treatment of MCI and AD.The research progresses of rs-fMRI for MCI and AD were reviewed in this article.

如何对学生学习数学心理障碍进行疏导

部分学生之所以成为学习上的后进生,除了少数是智力方面的原因外,其他主要原因是非智力因素影响.而学习心理上的障碍,就属于非智力因素,它包括意志障碍、情感障碍和思维障碍.

ADAS-Cog中文版区分轻、中度阿尔茨海默病的能力

目的:探讨阿尔茨海默病评定量表认知部分(ADAS-Cog)中文版区分轻、中度AD的能力。方法:199例轻度和106例中度AD患者为研究被试(符合NINCDS-ADRDA很可能AD诊断标准),对所有被试进行ADAS-Cog中文版测试。结果:中度AD患者ADAS-Cog总分及各条目评分明显高于轻度AD被试,GLM分析提示ADAS-Cog评分不受被试年龄与受教育程度的影响,ADAS-Cog能有效反映轻、中度AD患者不同的认知损害模式而不依赖于被试的学历。Logistic回归分析定向力和结构性练习条目评分及ADAS-Cog总分能有效区分轻、中度AD,敏感度为78%-82%,特异度为70%-73%。结论:ADAS-Cog中文版对轻、中度AD具有较好的区分能力,推荐将该量表用于评估药物对中国AD患者认知功能的疗效。

Inter- and intra-hemispheric EEG coherence in patients with mild cognitive impairment at rest and during working memory task

Objective： To assess functional relationship by calculating inter- and intra-hemispheric electroencephalography （EEG） coherence at rest and during a working memory task of patients with mild cognitive impairment （MCI）. Methods： The sample consisted of 69 subjects： 35 patients （n = 17 males, n = 18 females; 52-71 years old） and 34 normal controls （n = 17 males, n = 17 females; 51 -63 years old）. Mini-mental state examination （MMSE） of two groups revealed that the scores of MCI patients did not differ significantly from those of normal controls （P〉0.05）. In EEG recording, subjects were performed at rest and during working memory task. EEG signals from F3-F4, C3-C4, P3-P4, T5-T6 and O1-O2 electrode pairs are resulted from the inter-hemispheric action, and EEG signals from F3-C3, F4-C4, C3-P3, C4-P4, P3-O1, P4-O2, T5-C3, T6-C4, T5-P3 and T6-P4 electrode pairs are resulted from the intra-hemispheric action for delta （1.0-3.5 Hz）, theta （4.0-7.5 Hz）, alpha-1 （8.0-10.0 Hz）, alpha-2 （10.5-13.0 Hz）, beta-1 （13.5-18.0 Hz） and beta-2 （18.5-30.0 Hz） frequency bands. The influence of inter- and intra-hemispheric coherence on EEG activity with eyes closed was examined using fast Fourier transformation from the 16 sampled channels. Results： During working memory tasks, the inter- and intra-hemispheric EEG coherences in all bands were significantly higher in the MCI group in comparison with those in the control group （P〈0.05）. However, there was no significant difference in inter- and intra-hemispheric EEG coherences between two groups at rest. Conclusion： Experimental results comprise evidence that MCI patients have higher degree of functional connectivity between hemispheres and in hemispheres during working condition, It suggests that MCI may be associated with compensatory processes during working memory tasks between hemispheres and in hemispheres. Moreover, failure of normal cortical connections may exist in MCI patients.

Study of virtual reality for mild cognitive impairment:A bibliometric analysis using CiteSpace

Objectives Non-invasive and low-cost virtual reality(VR)technology is important for early evaluation and intervention in mild cognitive impairment(MCI).This study aimed to demonstrate the current status of overseas and domestic research as well as the focus and frontier of VR technology among individuals with MCI through a bibliometric analysis.Methods Studies from the core collection of Web of Science™between 1995 and 2020 were used;furthermore,CiteSpace 5.7 R3 was utilized to analyse information on authors/cited authors,keywords,burst words,and cited references.Results In total,230 publications were identified.Most studies were published in the USA(45 publications)and Italy(41 publications),where Guiseppe Riva ranks first(14 publications),and Tarnanas I is the author with the highest centrality(0.44).The hot topics in VR applications in the MCI population are‘physical activity,’‘people,’‘single-blind,’‘disease,’‘walking,’‘technology,’‘working memory,’and‘risk’in recent years.The keyword‘mild cognitive impairment’has attracted extensive attention since 2012,showing the strongest citation outbreak(8.28).The clustering results of the literature show the research types and emerging trends,including‘exergame,’‘serious games,’‘spatial navigation,’‘activities of daily living,’‘exercise,’‘enriched environment’and‘wayfinding.‘Conclusions Cognitive assessment and nonpharmacological intervention research on patients with MCI have become the focus of dementia prevention in recent years.Virtual technology,combined with traditional methods such as exercise therapy,provides new ideas for innovative cognitive evaluation and cognitive intervention.

Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation

Background Evaluation of patient outcomes following transcatheter aortic valve implantation （TAVI） has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days （range： 192-738 days）, five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.

Cognitive function and adherence to anticoagulation treatment in patients with atrial fibrillation

Background Medication adherence is an integral part of the comprehensive care of patients with atrial fibrillation （AF） receiving oral anticoagulations （OACs） therapy. Many patients with AF are elderly and may suffer from some form of cognitive impairment. This study was conducted to investigate whether cognitive impairment affects the level of adherence to anticoagulation treatment in AF patients. Me- thods The study involved 111 AF patients （mean age, 73.5±8.3 years） treated with OACs. Cognitive function was assessed using the Mini Mental State Examination （MMSE）. The level of adherence was assessed by the 8-item Mot^sky Medication Adherence Scale （MMAS-8）. Scores on the MMAS-8 range from 0 to 8, with scores 〈 6 reflecting low adherence, 6 to 〈 8 medium adherence, and 8 high adherence. Re- sults 46.9% of AF patients had low adherence, 18.8% had moderate adherence, and 33.3% had high adherence to OACs. Patients with lower adherence were older than those with moderate or high adherence （76.6 ±8.7 vs. 71.3 ~ 6.4 vs. 71.1 ± 6.7 years） and obtained low MMSE scores, indicating cognitive disorders or dementia （MMSE = 22.3 ± 4.2）. Patients with moderate or high adherence obtained high MMSE test results （27.5 ±1.7 and 27,5 ± 3.6）. According to Spearman＇s rank correlation, worse adherence to treatment with OACs was determined by older age （rs = -0.372） and lower MMSE scores （rs = 0.717）. According to multivariate regression analysis, the level of cognitive function was a significant independent predictor of adherence （b = 1.139）. Conclusions Cognitive impairment is an independent determinant of compliance with pharmacological therapy in elderly patients with AF. Lower adherence, beyond the assessment of cognitive function, is related to the age of patients.

Acceptability and feasibility of public square dancing for community senior citizens with mild cognitive impairment and depressive symptoms:A pilot study

Objectives:To explore the acceptability and feasibility of public square dancing among community residents with mild cognitive impairment(MCI)and depressive symptoms.Methods:This mixed-method study consisted of a quantitative and a qualitative phase.From January to July 2018,a total of 241 community-dwelling senior citizens who complained of memory loss in one community in the Haidian District in Beijing were approached and screened,and 41 qualified for the study.Among them,35 senior citizens participated in the public square dancing intervention.By the end of the three-month follow-up,31 senior citizens completed the whole study.The Subjective Exercise Experience Scale(SEES)was used to survey senior citizens at the end of the three-month public square dancing intervention and follow-up to measure the participants’subjective exercise experience.Then 15 senior citizens were interviewed to collect attitudes,opinions,and suggestions related to the intervention.Results:During the intervention,90.6%of senior citizens met the requirement for defined hours.All senior citizens continued to dance at the three-month follow-up,and 32.3%met the requirement for defined hours.The scores of psychological well-being(11.03±2.82 vs.14.87±3.93,P<0.001)and fatigue(11.00[8.00,12.00]vs.14.00[9.00,18.00],P<0.001)increased at the end of the three-month follow-up.Qualitative research results extracted four major themes:increased confidence and a sense of accomplishment;easy to learn,close to real life,and sense of belonging;promotes physical and mental health;future expectations include music selection,reduced weather disruption,and self-organizing workouts.Conclusion:Public square dancing proved to be an acceptable,viable,and valuable intervention for MCI residents with depressive symptoms,which could be carried out by nursing staff in the community.Future studies should consider the appropriate population,intensity,and frequency of public square dancing and its effect on specific cognitive functions.

Atrial fibrillation may be a hidden factor for the development of cognitive impairment in patients with heart failure

To the editor We read the article entitled Cognitive impairment in heart failure patients＇ by Leto, et al. with great interest. In this review, they demonstrated pathophysiological determinants of cognitive impairment in heart failure （HF） population.

Neuropsychological alterations in hepatitis C infection:The role of inflammation

About 50% of patients with hepatitis C virus(HCV)infection complain of neuropsychiatric symptoms,"brain fog",weakness,fatigue,and exhibit some degree of quality of life impairment,irrespective of the severity of liver disease.Since the first observation of HCV-related cognitive deficits,10 studies have been published that have evaluated neuropsychiatric performance in patients with HCV infection and different degrees of hepatic impairment.Unfortunately,these have often included patients with cirrhosis,patients who had acquired the infection through previous intravenous drug misuse,who had a history of relatively recent treatment with interferon,or were on psychoactive medication.In addition,different neuropsychological batteries and tests that explored different cognitive domains were used,which makes the results of the studies difficult to compare.Finally,limited information is available on the pathogenesis of HCV-related cognitive impairment.Cerebral and/or systemic inflammation may be important players but their potential role has not been substantiated by experimental data.The present review outlines the available evidence of the presence of cognitive impairment in patients with HCV infection,with a focus on the potential relationship with cerebral and/or systemic inflammation.

Association of cardiovascular system medications with cognitive function and dementia in older adults living in nursing homes in Australia

Objective To examine associations between cardiovascular system medication use with cognition function and diagnosis of dementia in older adults living in nursing homes in Australia. Methods As part of a cross-sectional study of 17 Australian nursing homes examining quality of life and resource use, we examined the association between cognitive impairment and cardiovascular medication use （identified using the Anatomical Therapeutic Classification System） using general linear regression and logistic regression models. People who were receiving end of life care were excluded. Results Participants included 541 residents with a mean age of 85.5 years （± 8.5）, a mean Psychogeriatric Assessment Scale–Cognitive Impairment （PAS-Cog） score of 13.3 （± 7.7）, a prevalence of cardiovascular diseases of 44% and of hypertension of 47%. Sixty-four percent of participants had been diagnosed with dementia and 72% had received cardiovascular system medications within the previous 12 months. Regression models demonstrated the use of cardiovascular medications was associated with lower （better） PAS-Cog scores [Coefficient （β） = -3.7; 95% CI： -5.2 to -2.2; P 〈 0.0001] and a lower probability of a dementia diagnosis （OR = 0.44; 95% CI： 0.26 to 0.75, P = 0.0022）. Analysis by subgroups of medications showed cardiac therapy medications （C01）, beta blocking agents （C07）, and renin-angiotensin system agents （C09） were associated with lower PAS-Cog scores （better cognition） and lower dementia diagnosis probability. Conclusions This analysis has demonstrated an association between greater cardiovascular system medication use and better cognitive status among older adults living in nursing homes. In this population, there may be differential access to health care and treatment of cardiovascular risk factors. This association warrants further investigation in large cohort studies.

FOLLOW-UP STUDY OF THREE COGNITIVE POTENTIALS OF DEPRESSION AND ANXIETY DISORDERS

To investigate the variations of contingent negative variations （ CNV）, P300 and mismatch negativity （MMN） in depression and anxiety disorders. Methods CNV, P300 and MMN were recorded from 44 depressive patients using Nicolet Spirit Instrument, and were compared with that of 32 anxiety patients and 28 normal controls（NC）. 21 of depressive patients and 18 of anxiety patients were followed up by 2.5 months with the same evoked potentials. Results 1. Compared with NC, all patients in acute episode showed decreased M1 of CNV amplitude, delayed P3 latency and decreased P3 amplitude of P300, and delayed MMN latency and decreased MMN amplitude ; 2. The follow-up study of evoked potentials revealed that abnormal P3 of P300 and MMN latencies were significant between depressed patients in remission status and NC group but not P3 of P300 and MMN amplitudes, and M1 of CNV and P3 of P300 amplitudes and P3 of P300 and MMN latencies are not significant between anxiety patients in remission and NC group. Conclusion Delayed P3 of P300 and MMN latencies in depression show state and trait markers, while those variations in anxiety correlate with clinical status of anxiety state.

Effects of creative expression program on the event-related potential and task reaction time of elderly with mild cognitive impairment

Objectives:This study aimed to evaluate the effects of a 16-week creative expression intervention program(CrExp)on the event-related potential(ERP)and task reaction time in older individuals with mild cognitive impairment(MCI).Methods:This study is a randomized controlled clinical trial conducted in the Memory Center of Fujian Provincial hospital.Thirty-six MCI patients were randomly distributed into two groups.One group underwent a 16-week creative expression program(CrExp,n=18)and the other performed as a control group(CG,n=18)by general social activities.The amplitude and latency of ERP-P300 from the central(Cz),parietal(Pz),frontal(Fz)cortices and task reaction time(RT)were assessed at baseline,postinterventi on,and 24-week follow-up.Results:The CrExp group showed greater differences than CG of P300 latency in Cz(F=4.37,P=0.015),Pz(F=2.78,P=0.009),Fz(F=6.45,P=0.031)brain area after 16 weeks of intervention and in Fz(F=3.23,P=0.028),Cz(F=3.79,P=0.024),and Pz(F=5.60,P=0.036)at 24 weeks follow-up.Also,we analyzed the task reaction time between two groups and found that a shorten reaction time at postintervention(F=4.47,P=0.011)and 24 weeks follow-up(F=3.12,P=0.007)in the CrExp group.However,there was no difference in P300 amplitude in either brain area between the two groups.Conclusion:The electrophysiological results of the creative expression cognitive therapy group were more obvious than those of the general cognitive therapy group,and the latency and task reaction time may be considered as supported parameters in diagnosing the effects during non-drug therapy intervention in clinical practice.

Motor vehicle accidents: How should cirrhotic patients be managed?

Motor vehicle accidents (MVAs) are serious social issues worldwide and driver illness is an important cause of MVAs. Minimal hepatic encephalopathy (MHE) is a com- plex cognitive dysfunction with attention deficit, which frequently occurs in cirrhotic patients independent of severity of liver disease. Although MHE is known as a risk factor for MVAs, the impact of diagnosis and treatment of MHE on MVA-related societal costs is largely unknown. Recently, Bajaj et al demonstrated valuable findings that the diagnosis of MHE by rapid screening using the inhibitory control test (ICT), and subsequent treatment with lactulose could substantially reduce the societal costs by preventing MVAs. Besides the ICT and lactulose, there are various diagnostic tools and therapeutic strategies for MHE. In this commentary, we discussed a current issue of diagnostic tools for MHE, including neuropsychological tests. We also discussed the advantages of the other therapeutic strategies for MHE, such as intake of a regular breakfast and coffee, and supplementation with zinc and branched chain amino acids, on the MVA-related societal costs.

＂Eye Caught by Another Eye＂： Locating Experience in Nadine Gordimer＇ s The Lying Days

In one of the first pages and crucial scenes of The Lying Days （1953）, we soon associate the narrating voice with that of a bright, inquisitive child of Scottish descent immersed in the harsh Witwatersrand scenario of a mining estate outskirts in the 1930s, along a path crammed with Jews＇ concession stores and exotic-looking natives. The unruly little girl is Helen Shaw, the late Nadine Gordimer＇s fictional double in her still somewhat neglected first novel, a Bildungsroman where the South African writer coming from Springs admirably capitalized on the ＂camera-eye＂ perspectives and zooming-in on details which had already informed much of her masterly short fiction. The aim of the present paper is to shed light on Helen＇s difficult growth towards sociopolitical and ethical awakening--in a country finding itself more and more trapped in the apartheid grip--by pointing out the earliest, embryonic stages of such a progressive knocking down of epistemic barriers. The author will thus focus on ＂The Mine＂, the first and most concise of the three parts making up the novel, and show how Gordimer＇s acute prose, incisive style, and descriptive strategies prove to be a fitting tool for recording and weighing the experience of an indefatigable observer, a hungry mind in search of erased features, meaningful connections, revealing contexts and subjects

Cognitive impairment in heart failure patients： role of atrial fibrillation

Author＇s reply We read with great interest the letter of Yiginer, et al.regarding the influence of atrial fibrillation （AF） in the development of cognitive impairment in heart failure （HF） patients. The comment is related to the review published in the Journal by Leto, et al. that was a systematic overview about cognition, pathophysiology of cognitive impairment in heart failure patients. In the letter, Yiginer, et al.

Verbal Communication in HIV-1 Patients： A New Perspective on the Study of Cognitive Disorders

The aims were： （1） to study verbal communication skills presenting with verbal communication deficits by applying the MEC in HIV-1 patients, and （2） to analyze the proportion of patients Protocol. The authors evaluated 20 patients over 18 years of age HIV-1 positive; native speakers of Spanish; without alterations in language acquisition, reading, writing or history of neurological or psychiatric disease; patients undergoing antiretroviral treatment （not efavirenz） with viral load 〉 50 copies/mL, and patients not undergoing treatment. Their verbal communication abilities were evaluated with Protocol MEC. The results demonstrate that some of the skills evaluated are more vulnerable in HIV-1 patients. The tasks that showed the most frequent and systematic deficits among patients were discourse-level tasks and those that evaluate lexical semantic processing. The authors compared patients＇ performances with the ＂cut-off＇. The scores were turned into score Z. A hierarchic cluster analysis was carried out to identify subgroups with different profiles according to the areas that were affected. The detection of communication deficit profiles in HIV-1 patients would be the starting point for the identification of disorders and the admission of the patients to health care system. This research constitutes an initial approach towards the identification of clinical profiles among HIV-1 patients.

Advances in the application of Ba Duanjin in the treatment of mild cognitive impairment in the elderly

Mild cognitive impairment,as a preventable component in the development of irreversible Alzheimer's disease,plays an important role in the prevention and control of mild cognitive impairment.As a traditional aerobic exercise,Ba Duanjin has a certain influence on mild cognitive impairment from the perspective of traditional Chinese medicine,specific diseases and neurology.This article summarized the evidence of Ba Duanjin in the application of mild cognitive impairment,in order to provide reference for the clinical application of Ba Duanjin in the future.

What are the benefits of a minimally invasive approach in frail octogenarian patients undergoing aortic valve replacement？

A best evidence topic was devised in light of a structured protocol. What is the advantage of （minl＂mally invasive） approach in （frail patients） undergoing （aortic valve replacement）？ In cardiac outpatient clinic you review an 85-year old male with severe aortic valve stenosis, low left ventricular ejection fraction and creatinine clearance of less than 50 mL/min. Other comorbidities include treated pulmonary hypertension, mild cognitive impairment, marked limitation of ordinary physical activity and depression. You resolve to determine whether to recommend mim＇mally invasive or conventional aortic valve replacement （AVR） or transcathe- ter aortic valve implantation （TAVI）, however you are not sure of the differences of the impact of frailty on preopera- tive risk for each approach; hence you investigate the best evidence on the topic.