Usefulness of the Japanese version of Rapid Dementia Screening Test for mild cognitive impairment in older patients with cardiovascular disease:a cross-sectional study

BACKGROUND Cognitive decline is common among older patients with cardiovascular disease(CVD) and can decrease their self-management abilities. However, the instruments for identifying mild cognitive impairment(MCI) are not always feasible in clinical practice. Therefore, this study evaluated whether MCI could be detected using the Japanese version of the Rapid Dementia Screening Test(RDST-J), which is a simple screening tool for identifying cognitive decline.METHODS This retrospective single-center study included patients who were ≥ 65 years old and hospitalized because of CVD.Patients with a pre-hospitalization diagnosis of dementia were excluded. Each patient's cognitive function had been measured at discharge using the RDST-J and the Japanese version of the Montreal Cognitive Assessment(Mo CA-J), which is a standard tool for MCI screening. The correlation between the two scores was evaluated using Spearman's rank correlation coefficient. Receiver operating characteristic(ROC) analysis was also to evaluate whether the RDST-J could identify MCI, which was defined as a Mo CA-J score of ≤ 25 points.RESULTS The study included 78 patients(mean age: 77.2 ± 8.9 years). The RDST-J and Mo CA-J scores were strongly correlated(r = 0.835, P < 0.001). The ROC analysis revealed that an RDST-J score of ≤ 9 points provided 75.4% sensitivity and 95.2% specificity for identifying MCI, with an area under the curve of 0.899(95% CI: 0.835-0.964). The same cut-off value was identified when excluding patients with a high probability of dementia(RDST-J score of ≤ 4 points).CONCLUSIONS The RDST-J may be a simple and effective tool for identifying MCI in older patients with CVD.

Evaluation of the Clinical Efficacy of Acupuncture and Moxibustion Combined with Repetitive Transcranial Magnetic Stimulation on Cognitive Function and Sleep Disorders in Patients with Mild Vascular Dementia

Objective:To explore the clinical effects of acupuncture and repeated transcranial magnetic stimulation in patients with mild vascular dementia.Method:From May 2020 to May 2021,40 patients with mild vascular dementia in Harbin Fourth Hospital(our hospital)were divided into the experimental group(20 cases,using conventional drugs+acupuncture+repeated transcranial magnetic stimulation)and the control group(20 cases,for example,the application of conventional medication).The improvement of cognitive function score,sleep quality score,quality of life score,and cerebral hemodynamics before and after treatment were compared between the two groups.Result:Before treatment,the difference in cognitive function score,sleep quality score,quality of life score,and cerebral hemodynamic index between the two groups of patients did not form,that is,p>0.05;after treatment,the experimental group5s cognitive function score was(19.45±2.47)points,Sleep quality score(12.18±2.09),quality of life score(33.29±4.08),left cerebral blood flow velocity(65.76±3.32)cm/s,right cerebral blood flow velocity(64.32±3.25)cm/s,more For the control group,P<0.05・Conclusion:In the clinical treatment of patients with mild vascular dementia,based on conventional drugs,combined with acupuncture and repetitive transcranial magnetic stimulation,the patients?cognitive function can be improved,and the quality of sleep and quality of life can be improved.Comprehensive clinical promotion.

Effectiveness of music intervention on cognitive function and neuropsychiatric symptoms in the elderly with dementia:a meta-analysis

Dementia is increasing dramatically with an increasing elderly population.Pharmacological interventions are proven to have limited efficacy to treat many of the features of dementia.In such a situation,non-pharmacological means become important to help people with dementia,especially music therapy.The efficacy of music intervention on cognition has been barely explored in the literature,and the few studies that are available present inconsistent results.The aim of this systematic review is to have a meta-analysis on the effect of music therapy for improvements in cognitive functions as well as neuropsychiatric symptoms in the elderly with dementia.

Individuals with and without normal tension glaucoma exhibit comparable performance on tests of cognitive function

AIM:To evaluate aspects of cognition impacted by individuals with and without normal tension glaucoma.METHODS:Fifty normal tension glaucoma(NTG)and 50 control patients≥50 y of age were recruited from the UCSF Department of Ophthalmology.Demographic data and glaucoma parameters were extracted from electronic medical records for both groups.Tests of executive function[Executive Abilities:Measures and Instruments for Neurobehavioral Evaluation and Research(EXAMINER)]and learning and memory[California Verbal Learning Test–Second Edition(CVLT-II)]were administered to both NTG and controls.Race,handedness,best-corrected visual acuity,maximum intraocular pressure,optic nerve cup-todisc ratio,visual field and optic nerve optical coherence tomography parameters,and a measure of general health(Charlson Comorbidity Index)were compared between NTG and controls as well as within NTG subgroups.Multivariate linear regression was used to compare group performances on the EXAMINER battery and CVLT-II while controlling for age,sex,and years of education.RESULTS:NTG and controls were comparable with respect to age,sex,race,education,handedness,and the Charlson Comorbidity Index(P>0.05 for all).Performance on the EXAMINER composite score and the CVLT-II did not differ between NTG and controls(P>0.05 for both).CONCLUSION:This is the first prospective study in which the cognitive function of subject with NTG were evaluated using a comprehensive,computerized neurocognitive battery.Subjects with NTG do not perform worse than unaffected controls on tests of executive function,learning,and memor y.Results do not suppor t the hypothesis that individuals with NTG are at higher risk for cognitive dysfunction and/or dementia.

Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis?

Low-frequency repetitive transcranial magnetic stimulation（LF-r TMS） to the contralesional hemisphere and intensive occupational therapy（i OT） have been shown to contribute to a significant improvement in upper limb hemiparesis in patients with chronic stroke. However, the effect of the combined intervention program of LF-r TMS and i OT on cognitive function is unknown. We retrospectively investigated whether the combined treatment influence patient＇s Trail-Making Test part B（TMT-B） performance, which is a group of easy and inexpensive neuropsychological tests that evaluate several cognitive functions. Twenty-five patients received 11 sessions of LF-r TMS to the contralesional hemisphere and 2 sessions of i OT per day over 15 successive days. Patients with right- and left-sided hemiparesis demonstrated significant improvements in upper limb motor function following the combined intervention program. Only patients with right-sided hemiparesis exhibited improved TMT-B performance following the combined intervention program, and there was a significant negative correlation between Fugl-Meyer Assessment scale total score change and TMT-B performance. The results indicate the possibility that LF-r TMS to the contralesional hemisphere combined with i OT improves the upper limb motor function and cognitive function of patients with right-sided hemiparesis. However, further studies are necessary to elucidate the mechanism of improved cognitive function.

Validity,reliability,and psychometric properties of a computerized,cognitive assessment test(Cognivue^®)Validity,reliability,and psychometric properties of a computerized,cognitive assessment test(Cognivue^®)

BACKGROUND Cognitive issues such as Alzheimer’s disease and other dementias confer a substantial negative impact.Problems relating to sensitivity,subjectivity,and inherent bias can limit the usefulness of many traditional methods of assessing cognitive impairment.AIM To determine cut-off scores for classification of cognitive impairment,and assess Cognivue®safety and efficacy in a large validation study.METHODS Adults(age 55-95 years)at risk for age-related cognitive decline or dementia were invited via posters and email to participate in two cohort studies conducted at various outpatient clinics and assisted-and independent-living facilities.In the cut-off score determination study(n=92),optimization analyses by positive percent agreement(PPA)and negative percent agreement(NPA),and by accuracy and error bias were conducted.In the clinical validation study(n=401),regression,rank linear regression,and factor analyses were conducted.Participants in the clinical validation study also completed other neuropsychological tests.RESULTS For the cut-off score determination study,92 participants completed St.Louis University Mental Status(SLUMS,reference standard)and Cognivue^®tests.Analyses showed that SLUMS cut-off scores of<21(impairment)and>26(no impairment)corresponded to Cognivue^®scores of 54.5(NPA=0.92;PPA=0.64)and 78.5(NPA=0.5;PPA=0.79),respectively.Therefore,conservatively,Cognivue^®scores of 55-64 corresponded to impairment,and 74-79 to no impairment.For the clinical validation study,401 participants completed≥1 testing session,and 358 completed 2 sessions 1-2 wk apart.Cognivue^®classification scores were validated,demonstrating good agreement with SLUMS scores(weightedκ0.57;95%CI:0.50-0.63).Reliability analyses showed similar scores across repeated testing for Cognivue^®(R2=0.81;r=0.90)and SLUMS(R2=0.67;r=0.82).Psychometric validity of Cognivue^®was demonstrated vs.traditional neuropsychological tests.Scores were most closely correlated with measures of verbal processing,manual dexterity/speed,visual contrast sensitivity,visuospatial/executive function,and speed/sequencing.CONCLUSION Cognivue^®scores≤50 avoid misclassification of impairment,and scores≥75 avoid misclassification of unimpairment.The validation study demonstrates good agreement between Cognivue^®and SLUMS;superior reliability;and good psychometric validity.

Effect of Montessori method on the cognitive and behavioral intervention of senile dementia patients:a meta-analysis

Background:To evaluate the effect of Montessori method on cognitive and behavioral function in patients with senile dementia by meta-analysis.Methods:The randomized controlled trials of the effect of Montessori method on cognitive and behavioral functions of Alzheimer’s patients in PubMed,Cochrane Library,Web of Science,Excerpt Medica Database,The Cumulative Index to Nursing&Allied Health Literature,Chinese BioMedical Literature Database,China National Knowledge Infrastructure,Weipu Information Chinese Periodical Service Platformdatabase and Wanfang database were searched by computer,and the references of relevant literatures were traced.Two researchers independently conducted literature screening,data extraction,evaluation and inclusion in the literature,using RevMan 5.4.1 software for meta-analysis.Results:A total of 11 literatures were included and 936 patients were enrolled.Meta analysis shows that compared with routine nursing,Montessori method is helpful to improve the overall cognitive function(standardized mean difference=1.53,95%confidence interval(1.32,1.73),P<0.01),activities of daily living and reduce the incidence of adverse events(relative risk=0.37,95%confidence interval(0.21,0.63),P<0.01)in patients with Alzheimer’s disease.Conclusion:Montessori method is helpful to improve the overall cognitive function,activities of daily living and reduce the incidence of adverse events in patients with senile dementia.Affected by the included study,it still needs to be confirmed by multi center and large sample randomized controlled study.

Validation of the Trail Making Test B for the Cognitive Assessment of Patients with Cancer in Palliative Care

Introduction: Cognitive impairment is common in patients with cancer;however, studies examining the adaptation and validation of instruments for use in patients with cancer are scarce. Purpose: The purpose of this study was to validate the Trail Making Test B (TMT-B) for use in patients with cancer. Methods: Ninety-four outpatients receiving palliative treatment and 39 healthy companions were assessed. Patients were tested with the TMT-B and answered questions regarding the presence and intensity of pain, fatigue, quality of sleep, anxiety, and depression, at two time points with a 7-day inter-assessment interval. Results: The instrument discriminated between patients, who were slower, and healthy companions with respect to the time required to complete the test, but not in terms of the number of errors. The test was stable for the healthy companions across the two assessments in terms of time to complete the TMT-B and the number of errors;for patients, the instrument was stable only for the number of errors. Performance on the TMT-B did not correlate with pain, fatigue, depression, anxiety, or sensation of rest. Conclusions: TMT-B cannot be considered fully validated. Further studies incorporating and comparing other instruments evaluating executive function and mental flexibility are needed.

Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients

BACKGROUND Efficient detection of delirium and comorbid delirium-dementia is a key diagnostic challenge.Development of new,efficient delirium-focused methods of cognitive assessment is a key challenge for improved detection of neurocognitive disorders in everyday clinical practice.AIM To compare the accuracy of two novel bedside tests of attention,vigilance and visuospatial function with conventional bedside cognitive tests in identifying delirium in older hospitalized patients.METHODS 180 consecutive elderly medical inpatients(mean age 79.6±7.2;51%female)referred to a psychiatry for later life consultation-liaison service with delirium,dementia,comorbid delirium-dementia and cognitively intact controls.Participants were assessed cross-sectionally with conventional bedside cognitive tests[WORLD,Months Backward test(MBT),Spatial span,Vigilance A and B,Clock Drawing test and Interlocking Pentagons test]and two novel cognitive tests[Lighthouse test,Letter and Shape Drawing test(LSD)-4].RESULTS Neurocognitive diagnoses were delirium(n=44),dementia(n=30),comorbid delirium-dementia(n=60)and no neurocognitive disorder(n=46).All conventional tests had sensitivity of>70%for delirium,with best overall accuracy for the Vigilance-B(78.3%),Vigilance-A(77.8%)and MBT(76.7%)tests.The sustained attention component of the Lighthouse test was the most distinguishing of delirium(sensitivity 84.6%;overall accuracy 75.6%).The LSD-4 had sensitivity of 74.0%and overall accuracy 74.4%for delirium identification.Combining tests allowed for enhanced sensitivity(>90%)and overall accuracy(≥75%)with the highest overall accuracy for the combination of MBT-Vigilance A and the combined Vigilance A and B tests(both 78.3%).When analyses were repeated for those with dementia,there were similar findings with the MBTVigilance A the most accurate overall combination(80.0%).Combining the Lighthouse-SA with the LSD-4,a fail in either test had sensitivity for delirium of 91.4 with overall accuracy of 74.4%.CONCLUSION Bedside tests of attention,vigilance and visuospatial ability can help to distinguish neurocognitive disorders,including delirium,from other presentations.The Lighthouse test and the LSD-4 are novel tests with high accuracy for detecting delirium.

Influence of acupuncture on cognitive function and markers of oxidative DNA damage in patients with vascular dementia

OBJECTIVE:To test the influence of acupuncture on cognitive function and a marker of oxidative DNA damage in patients with vascular dementia(VD).METHODS:Sixteen VD patients were evaluated before and after acupuncture,using the Folstein Mini-Mental State Examination-Revised(MMSE-R) to assess cognitive function,and the ADL-R scale to assess independence in activities of daily living(ADL).Life quality was evaluated using the DEMQOL(Dementia quality of life questionnaire) questionnaire,and syndromes and expression of vascular dementia were evaluated with the Scale for the Differentiation of Syndromes of Vascular Dementia(SDSVD).In addition,the urine concentration of 8-hydroxy-2'-deoxyguanosine(8-OHdG)-a marker of oxidative damage-was quantified with enzyme-linked immunosorbent assay.RESULTS:The MMSE-R and DEMQOL scores were higher after acupuncture than before(P<0.05),while there were no obvious differences in the ADL-R or SDSVD scores(P>0.05).The 8-OHdG content in urine significantly decreased after acupuncture(P<0.05).CONCLUSION:Acupuncture reduces the levels of 8-OHdG and improves cognitive function and quality of life in VD patients,suggesting that acupuncture is beneficial at least in part by preventing oxidative damage.

Neuroprotection against vascular dementia after acupuncture combined with donepezil hydrochloride：P300 event related potential

Acupuncture can be used to treat various nervous system diseases.Here,168 vascular dementia patients were orally administered donepezil hydrochloride alone（5 mg/day,once a day for 56 days）,or combined with acupuncture at Shenting（DU24）,Tianzhu（BL10）,Sishencong（Extra）,Yintang（Extra）,Renzhong（DU26）,Neiguan（PC6）,Shenmen（HT7）,Fengchi（GB20）,Wangu（GB12） and Baihui（DU20）（once a day for 56 days）.Compared with donepezil hydrochloride alone,P300 event related potential latency was shorter with an increased amplitude in patients treated with donepezil hydrochloride and acupuncture.Mini-Mental State Examination score was also higher.Moreover,these differences in P300 latency were identified within different infarcted regions in patients treated with donepezil hydrochloride and acupuncture.These findings indicate that acupuncture combined with donepezil hydrochloride noticeably improves cognitive function in patients with vascular dementia,and exerts neuroprotective effects against vascular dementia.

Resveratrol improves cognition and reduces oxidative stress in rats with vascular dementia

Resveratrol possesses beneficial biological effects, which include anti-oxidant, anti-inflammatory and anti-carcinogenic properties. Recently, resveratrol has been shown to exhibit neuroprotective effects in models of Parkinson＇s disease, cerebral ischemia and Alzheimer＇s disease. However, its effects on vascular dementia remain unclear. The present study established a rat model of vascular dementia using permanent bilateral common carotid artery occlusion. At 8-12 weeks after model induction, rats were intragastrically administered 25 mg/kg resveratrol daily. Our results found that resveratrol shortened the escape latency and escape distances in the Morris water maze, and pro- longed the time spent percentage and swimming distance percentage in the target quadrant during the probe test, indicating that resveratrol improved learning and memory ability in vascular dementia rats. Further experiments found that resveratrol decreased malonyldialdehyde levels, and increased superoxide dismutase activity and glutathione levels in the hippocampus and cerebral cortex of vascular dementia rats. These results confirmed that the neuroprotective effects of resveratrol on vascular dementia were associated with its anti-oxidant properties.

Months backward test:A review of its use in clinical studies

AIM: To review the use of the Months Backwards Test(MBT) in clinical and research contexts.METHODS: We conducted a systematic review of reports relating to the MBT based upon a search of Psych INFO and MEDLINE between January 1980 and December 2014. Only reports that specifically described findings pertaining to the MBT were included. Findings were considered in terms of rating procedures, testing performance, psychometric properties, neuropsychological studies and use in clinical populations.RESULTS: We identified 22 data reports. The MBT is administered and rated in a variety of ways with very little consistency across studies. It has been used to assess various cognitive functions including focused and sustained attention as well as central processingspeed. Performance can be assessed in terms of the ability to accurately complete the test without errors("MB accuracy"), and time taken to complete the test("MB duration"). Completion time in cognitively intact subjects is usually < 20 s with upper limits of 60-90 s typically applied in studies. The majority of cognitively intact adults can complete the test without error such that any errors of omission are strongly suggestive of cognitive dysfunction. Coverage of clinical populations, including those with significant cognitive difficulties is high with the majority of subjects able to engage with MBT procedures. Performance correlates highly with other cognitive tests, especially of attention, including the digit span backwards, trailmaking test B, serial threes and sevens, tests of simple and complex choice reaction time, delayed story recall and standardized list learning measures. Test-retest and inter-rater reliability are high(both > 0.90). Functional magnetic resonance imaging studies comparing the months forward test and MBT indicate greater involvement of more complex networks(bilateral middle and inferior frontal gyri, the posterior parietal cortex and the left anterior cingulate gyrus) for backwards cognitive processing. The MBT has been usefully applied to the study of a variety of clinical presentations, for both cognitive and functional assessment. In addition to the assessment of major neuropsychiatric conditions such as delirium, dementia and Mild Cognitive Impairment, the MBT has been used in the assessment of concussion, profiling of neurocognitive impairments in organic brain disorders and Parkinson's disease, prediction of delirium risk in surgical patients and medication compliance in diabetes. The reported sensitivity for acute neurocognitive disturbance/delirium in hospitalised patients is estimated at 83%-93%. Repeated testing can be used to identify deteriorating cognitive function over time.CONCLUSION: The MBT is a simple, versatile tool that is sensitive to significant cognitive impairment. Performance can be assessed according to accuracy and speed of performance. However, greater consistency in administration and rating is needed. We suggest two approaches to assessing performance- a simple(pass/fail) method as well as a ten point scale for rating test performance(467).

The Effects of Task Order Administration on Test Scores from the Trail Making Test: Near-Infrared Spectroscopy Investigations

This research examines the effects of task administration on Trail Making Test performance. The TMT consists of two parts, TMT Part A and TMT Part B. Generally, it has been believed that the order the two parts are completed does not influence test results;however, there is one previous study that has suggested that the order is indeed an influential factor on test scores. To measure frontal lobe function, the present study used near-infrared spectroscopy to measure changes in oxygenated hemoglobin (oxy-Hb) in 48 young, healthy Japanese subjects as they completed Parts A and B. We subtracted the change in oxy-Hb while completing Part A from that while completing Part B (B-A Oxy-Hb) for a comparison to facilitate an investigation of how, or if, the order in which the TMT is taken influences test success. We found that when Part A was completed first, there were only small changes in the B-A oxy-Hb, but when Part B was completed first, there were larger changes. This study indicates that the order the tests are completed in may influence outcomes, thus assessments using the TMT must follow a consistent task order.

Diabetes and cognitive function:An evidence-based current perspective

Several epidemiological studies have clearly identified diabetes mellitus(DM)as a major risk factor for cognitive dysfunction,and it is going to be a major public health issue in the coming years because of the alarming rise in diabetes prevalence across the world.Brain and neural tissues predominantly depend on glucose as energy substrate and hence,any alterations in carbohydrate metabolism can directly impact on cerebral functional output including cognition,executive capacity,and memory.DM affects neuronal function and mental capacity in several ways,some of which include hypoperfusion of the brain tissues from cerebrovascular disease,diabetes-related alterations of glucose transporters causing abnormalities in neuronal glucose uptake and metabolism,local hyper-and hypometabolism of brain areas from insulin resistance,and recurrent hypoglycemic episodes inherent to pharmacotherapy of diabetes resulting in neuronal damage.Cognitive decline can further worsen diabetes care as DM is a disease largely self-managed by patients.Therefore,it is crucial to understand the pathobiology of cognitive dysfunction in relation to DM and its management for optimal long-term care plan for patients.A thorough appraisal of normal metabolic characteristics of the brain,how alterations in neural metabolism affects cognition,the diagnostic algorithm for patients with diabetes and dementia,and the management and prognosis of patients when they have this dangerous combination of illnesses is imperative in this context.This evidence-based narrative with the backup of latest clinical trial reviews elaborates the current understanding on diabetes and cognitive function to empower physicians to manage their patients in day-to-day clinical practice.

Cognitive Functional Impairment and Hemodynamic Changes in Patients with Symptomatic Leukoaraiosis

Objective: The pathogenesis of leukoaraiosis is still unclear. Many studies have determined that changes in the hemodynamics associated with leukoaraiosis, impaired cerebrovascular reserve, and intracranial hypoperfusion can lead to various clinical manifestations such as motor or cognitive impairment. The purpose of this study was to investigate the relationship between cognitive functional changes and imaging characteristics in patients with symptomatic leukoaraiosis, and to observe the corresponding changes in hemodynamics. Methods: A total of 203 Han patients (aged 43 - 93 years) with symptomatic leukoaraiosis were included in this study. Head magnetic resonance imaging was semi-quantified according to the Fazekas grading standard. Then, each patient was evaluated in terms of cognitive (Montreal scale) and executive function (trail-making test A [TMTA] and TMTB). Specifically, the TMTA asks patients to connect points on a piece of paper numbered from 1 to 25 in order and the TMTB asks patients to arrange numbers and letters in alternating order. In the current work, revised versions of these tests used are to include numbers in square and circular shapes where the shapes needed to be arranged in alternating order. The time required to complete the TMTA and TMTB was recorded. The changes in the blood flow velocity of the middle cerebral artery were also observed using routine Transcranial Doppler ultrasound and the breath-holding test. The dynamic curves of blood flow velocity during the breath-holding test were examined. Results: The cognitive and executive functions of patients with leukoaraiosis are related to the classification of image-based disease characteristics. In this sense, the more serious the leukoaraiosis is, the larger the impairment of cognitive and executive function is. According to the breath-holding test, the peak pattern of the blood flow velocity in the middle cerebral artery was significantly different between the various grades of leukoaraiosis. The peak type of Fazekas grade 0 and I was in the same direction, while the peak type of Fazekas grade II and III was significantly opposed (both p Conclusions: The impairment of cognitive and executive functions in patients with leukoaraiosis correlates with the severity of image-based disease manifestations, which are generally depicted as intracranial hypoperfusion.

The heterogeneity of aging brain： altered functional connectivity in default mode network in older adults during verbal fluency tests

Background Successful aging （SA） and mild cognitive impairment （MCI） are heterogeneous groups of aging.To explore the heterogeneity,the functional connectivity was studied in these populations.Methods The present study utilized functional connectivity magnetic resonance imaging （fcMRI） to investigate default mode network （DMN） in 8 healthy subjects of SA,8 subjects of usual aging （UA）,and 8 MCI patients during verbal fluency tests （VFTs）.Functional connectivity （based seeds） of different groups was analyzed by using statistical test.Results Compared with SA and UA groups,MCI subjects exhibited decreased functional connectivity in the DMN regions,including the inferior parietal Iobule and left angular gyrus （t=3.53,P 〈0.001）.Compared with UA and MCI groups,the SA elderly exhibited increased functional connectivity in the precuneus （t=3.53,P〈0.001）.Conclusions These findings suggested that abnormalities of functional connectivity in DMN might be related with semantic memory impairment in aging.Left angular gyrus and precuneus might be the potential imaging-based biomarker for distinguishing heterogeneous process of elderly.

Development of Nursing Protocol for Preventing Discontinuation of Treatments by Methods Other than Physical Restraint during Acute Exacerbation of Chronic Heart Failure in Patients with Impaired Cognitive Function

The purpose of this study is to prepare a nursing protocol for preventing discontinuation of treatments using a method other than physical restraint during acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the study, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 10 nurses in dementia case to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 154 subjects (93.9%) considered effective for patients, in terms of prevention of treatment discontinuation using a method other than physical restraint. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 93.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We also received a comment from the certified nurses that we should include the basic contents for newly graduated nurses. We consider that this nursing protocol will be also useful for newly graduated nurses to acquire knowledge. It helped to standardize nursing care in order to predict potential risks for patients with impaired cognitive function.

Brain Activity Associated with Memory and Cognitive Function During Jaw-Tapping Movement in Healthy Subjects Using Functional Magnetic Resonance Imaging*

Objective： TO determine whether jaw-tapping movement, a classically described as an indication of personal well-being and mental health, stimulates the memory and the cognitive regions of the brain and is associated with improved brain performance. Methods： Twelve healthy right-handed female subjects completed the study. Each patient performed a jaw-tapping task and an n-back task during functional magnetic resonance imaging （fMRI）. The subjects were trained to carry out the jaw-tapping movement at home twice a day for 4 weeks. The fMRI was repeated when they returned. Results： During the first and second jaw-tapping session, both sides of precentral gyrus and the right middle frontal gyrus （BA 6） were activated. And during the second session of the jaw-tapping task, parts of frontal lobe and temporal lobe related to memory function were more activated. In addition, the total percent task accuracy in n-beck task significantly increased after 4 weeks of jaw- tapping movement. After jaw-tapping training for 4 weeks, brain areas related to memory showed significantly increased blood oxygen level dependent signals. Conclusion： Jaw-tapping movement might be a useful exercise for stimulating the memory and cognitive regions of the brain.