Cognitive impairment in cerebral small vessel disease induced by hypertension

Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension and cerebral small vessel disease remains unclear.Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease.Chronic hypertension and lifestyle factors are associated with risks for stro ke and dementia,and cerebral small vessel disease can cause dementia and stroke.Hypertension is the main driver of cerebral small vessel disease,which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction,leukoaraiosis,white matter lesions,and intracerebral hemorrhage,ultimately res ulting in cognitive decline and demonstrating that the brain is the to rget organ of hypertension.This review updates our understanding of the pathogenesis of hypertensioninduced cerebral small vessel disease and the res ulting changes in brain structure and function and declines in cognitive ability.We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.

Clinical Report on the Treatment of Post-stroke Cognitive Impairment Based on Microbe-Gut-Brain Axis Theory

Based on the close relationship between MGBA and PSCI,one PSCI related case is reported,and it is emphasized to improve clinicians'understanding of MGBA theory in the treatment of PSCI,thereby providing new ideas for exploring pathogenesis and treatment of PSCI.

Association of chronic obstructive pulmonary disease with mild cognitive impairment and dementia risk:A systematic review and meta-analysis

BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common public health issue that has been linked to cognitive dysfunction.AIM To investigate the relationship between COPD and a risk of mild cognitive impairment(MCI)and dementia.METHODS A comprehensive literature search of the PubMed,Embase,Google Scholar,and Cochrane Library electronic databases was conducted.Pooled odds ratios(OR)and mean differences(MD)with 95%confidence intervals(CIs)were calculated using a random or fixed effects model.Studies that met the inclusion criteria were assessed for quality using the Newcastle Ottawa Scale.RESULTS Twenty-seven studies met all the inclusion criteria.Meta-analysis yielded a strong association between COPD and increased risk of MCI incidence(OR=2.11,95%CI:1.32-3.38).It also revealed a borderline trend for an increased dementia risk in COPD patients(OR=1.16,95%CI:0.98-1.37).Pooled hazard ratios(HR)using adjusted confounders also showed a higher incidence of MCI(HR=1.22,95%CI:-1.18 to-1.27)and dementia(HR=1.32,95%CI:-1.22 to-1.43)in COPD patients.A significant lower mini-mental state examination score in COPD patients was noted(MD=-1.68,95%CI:-2.66 to-0.71).CONCLUSION Our findings revealed an elevated risk for the occurrence of MCI and dementia in COPD patients.Proper clinical management and attention are required to prevent and control MCI and dementia incidence in COPD patients.

Depressive Symptom Endorsement among Alzheimer’s Disease, Vascular Dementia and Mild Cognitive Impairment

Background: The Geriatric Depression Scale (GDS) is widely used to assess depressive symptoms in clinical and research settings. This study utilized a 4 factor solution for the 30-item GDS to explore differences in the presentation of depressive symptoms in various types of cognitive impairment. Method: Retrospective chart review was conducted on 254 consecutive cases of community dwelling elderly newly diagnosed with mild Alzheimer’s Dementia (AD) n = 122, mild Vascular Dementia (VaD) n = 71 or Amnestic Mild Cognitive Impairment (aMCI) n = 32 and Non-Amnestic MCI (nMCI) n = 29. Results: Analysis revealed no significant differences (p 05). No statistically significant differences were found between VaD and nMCI or between the MCI groups. Conclusions: Support is provided for the use of GDS subscales in a wide range of cognitively impaired elderly. This study suggests in mild dementia the number and type of depressive symptoms vary significantly between AD and VaD. There are indications that aMCI patients are similar in their symptom endorsement to AD and nMCI are similar to VaD which is consistent with some of the notions regarding likely trajectories of the respective MCI groups.

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.

Disrupted functional connectivity of default mode network and executive control network in patients with vascular cognitive impairment, no dementia

Objective： To investigate functional connectivity within default mode network （DMN） and ex-ecutive control network （ECN） in vascular cognitive im-pairment, no dementia （VCIND）. Methods： Twenty-eight VCIND patients and sixteen healthy controls were recruit-ed. A seed-based connectivity analysis was performed us-ing data from resting-state functional magnetic resonance imaging （fMRI）. Based on previous fndings, posteriorcingulate cortex （PCC） and dorsolateral prefrontal cortex （DLPFC） were chosen as regions of interest to study these networks.One-sample t-test and two-sample t-test were used for statistical analysis. Results： Compared with thecontrols, the VCIND group exhibited increased functional activity in such DMN regions as the left inferior temporal gyrus, parahippocampal gyrus, and medial frontal gyrus. The VCIND group had decreased functional connectivity of DMN at right superior frontal gyrus, left mid-cingu-late area, the medial part of left superior frontal gyrus, and bilateral medial frontal gyrus. The VCIND group also showed decreased functional connectivity of ECN pri-marilyat left inferior parietal gyrus, right angular gyrus, right middle occipital gyrus, and right middle frontal cor-tex. Conclusions： Increased functional connectivity with-in DMN and decreased functional connectivity within ECN suggested dysfunction of these two networks, which mightbe associated with the cognitive defcitsin patients with VCIND. These fndingsmay help usunderstandthe pathogenesis and clinical characteristics of VCIND.

Assessment of sensory impairment in older adults with dementia

Background:Over 55 million people worldwide are living with dementia.The rate of cognitive decline increases with age,and loss of senses may be a contributing factor.Objectives:This study aimed to analyze hearing,olfactory function,and color vision in patients with dementia.Materials and methods:The sample comprised 40 patients with dementia and 37 cognitively normal controls aged 41–85 years.All participants underwent conventional pure-tone audiometry and a screening version of the Hearing Handicap Inventory for Adults,the Odorized Markers Test of olfactory function and the Ishihara color vision test.The effects of comorbidities and lifestyle factors were also assessed.Results:Patients with dementia had significantly worse hearing at almost all frequencies tested and significantly greater olfactory impairment than cognitively normal controls.Color vision impairment was found in less than 8%of the sample,with no significant difference between the groups.Impairment of two senses(hearing and olfaction)was significantly more common in patients with dementia than in controls.Conclusion:Individuals with dementia were found to have sensory decline,namely hearing and olfactory impairment.Color vision was rarely impaired in the sample.Participants with dementia tended to have more multisensory impairments than controls.

Comparative efficacy and safety of cognitive enhancers for treating vascular cognitive impairment: systematic review and Bayesian network meta-analysis

Objective: To assess and compare the clinical efficacy and safety of cognitive enhancers(donepezil, galantamine, rivastigmine, and memantine) on cognition, behavior, function, and global status in patients with vascular cognitive impairment.Data sources: The initial literature search was performed with PubMed, EMBASE, the Cochrane Methodology Register, the Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health(CINAHL) from inception to January 2018 for studies regarding donepezil, galantamine, rivastigmine, and memantine for treatment of vascular cognitive impairment.Data selection: Randomized controlled trials on donepezil, galantamine, rivastigmine, and memantine as monotherapy in the treatment of vascular cognitive impairment were included. A Bayesian network meta-analysis was conducted. Outcome measures: Efficacy was assessed by changes in scores of the Alzheimer's Disease Assessment Scale, cognitive subscale, Mini-Mental State Examination, Neuropsychiatric Inventory scores and Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input, Activities of Daily Living, the Clinical Dementia Rating scale. Safety was evaluated by mortality, total adverse events(TAEs), serious adverse events(SAEs), nausea, vomiting. diarrhea, or cerebrovascular accidents(CVAs). Results: After screening 1717 citations, 12 randomized controlled trials were included. Donepezil and rivastigmine(mean difference(e) = –0.77, 95% confidence interval(CI): 0.25–1.32; MD = 1.05, 95% CI: 0.18–1.79) were significantly more effective than placebo in reducing Mini-Mental State Examination scores. Donepezil, galantamine, and memantine(MD = –1.30, 95% CI: –2.27 to –0.42; MD = –1.67, 95% CI: –3.36 to –0.06; MD = –2.27, 95% CI: –3.91 to –0.53) showed superior benefits on the Alzheimer's Disease Assessment Scale–cognitive scores compared with placebo. Memantine(MD = 2.71, 95% CI: 1.05–7.29) improved global status(Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input) more than the placebo. Safety results revealed that donepezil 10 mg(odds ratio(OR) = 3.04, 95% CI: 1.86–5.41) contributed to higer risk of adverse events than placebo. Galantamine(OR = 5.64, 95% CI: 1.31–26.71) increased the risk of nausea. Rivastigmine(OR = 16.80, 95% CI: 1.78–319.26) increased the risk of vomiting. No agents displayed a significant risk of serious adverse events, mortality, cerebrovascular accidents, or diarrhea.Conclusion: We found significant efficacy of donepezil, galantamine, and memantine on cognition. Memantine can provide significant efficacy in global status. They are all safe and well tolerated.

Relationship between β-amyloid protein 1-42, thyroid hormone levels and the risk of cognitive impairment after ischemic stroke

BACKGROUND Post-stroke cognitive impairment(PSCI)is not only a common consequence of stroke but also an important factor for adverse prognosis of patients.Biochemical indicators such as blood lipids and blood pressure are affected by many factors,and the ability of evaluating the progress of patients with PSCI is insufficient.Therefore,it is necessary to find sensitive markers for predicting the progress of patients and avoiding PSCI.Recent studies have shown thatβ-amyloid protein 1-42(Aβ1-42)and thyroid hormone levels are closely related to PSCI,which may be the influencing factors of PSCI,but there are few related studies.AIM To investigate the relationship between serum levels of Aβand thyroid hormones in acute stage and PSCI and its predicted value.METHODS A total of 195 patients with acute cerebral infarction confirmed from June 2016 to January 2018 were enrolled in this study.Baseline data and serological indicators were recorded to assess cognitive function of patients.All patients were followed up for 1 year.Their cognitive functions were evaluated within 1 wk,3 mo,6 mo and 1 yr after stroke.At the end of follow-up,the patients were divided into PSCI and non-PSCI according to Montreal cognitive assessment score,and the relationship between biochemical indexes and the progression of PSCI was explored.RESULTS Compared with patients with non-PSCI,the levels of Aβ1-42,triiodothyronine(T3)and free thyroxin were lower in the patients with PSCI.Repeated measures analysis of variance showed that the overall content of Aβ1-42 and T3 in PSCI was also lower than that of the non-PSCI patients.Further analysis revealed that Aβ1-42(r=0.348),T3(r=0.273)and free thyroxin(r=0.214)were positively correlated with disease progression(P<0.05),suggesting that these indicators have the potential to predict disease progression and outcome.Cox regression analysis showed that Aβ1-42 and T3 were important factors of PSCI.Then stratified analysis showed that the lower the Aβ1-42 and T3,the higher risk of PSCI in patients who were aged over 70,female and illiterate.CONCLUSION Aβ1-42 and T3 have the ability to predict the progression of PSCI,which is expected to be applied clinically to reduce the incidence of PSCI and improve the quality of life of 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.

Jidong cognitive impairment cohort study: objectives, design, and baseline screening

The risk of dementia increases in patients with cognitive impairment.However,it is not clear what factors contribute to the onset of dementia in those with cognitive impairment.In this prospective cohort study,we will investigate the every-five-year incidence of cognitive impairment and prognostic factors for cognitive impairment.The Jidong cognitive impairment cohort was established from April 2012 to August 2015,during which we recruited 5854 healthy participants(55.1%male)older than 45 years(mean,57 years).Participants received a health examination in the Staff Hospital,Jidong Oilfield Branch,China National Petroleum Corporation.Baseline data and blood samples were collected.Cognitive impairment was evaluated using the Mini-Mental State Examination,and was defined as a Mini-Mental State Examination score of less than 24.Dementia was assessed using the criteria of Diagnostic and Statistical Manual of Mental Disorders(Fourth edition),the International Working Group criteria,and the Mini-Mental State Examination score.The follow-up will continue until December 2024,during which a prognostic model will be constructed.The primary outcome is the presence/absence of dementia and the secondary outcome is quality of life.Baseline screening results showed the following:(1)Cognitive impairment was apparent in 320 participants(5.5%).These participants will be excluded from the Jidong cohort study,and the remaining participants will be followed up.(2)Of the 320 participants with cognitive impairment,there was a significantly higher prevalence of illiteracy than other education levels(35.9%,P<0.05).Age,arterial hypertension,alcohol consumption,and passive smoking differed significantly between the cognitive impairment and healthy groups(P<0.05).Multivariate logistic regression models showed that age(odds ratio[OR]=1.059,95%confidence interval[CI]:1.044-1.074)and arterial hypertension(OR=1.665,95%CI:1.143-2.427)were risk factors for mild cognitive impairment.With the increase of educational level(illiteracy,primary school,junior high school,high school,university,and above),cognitive impairment gradually decreased(OR<1,P<0.05).(3)This cohort study has initially screened for several risk factors for cognitive impairment at baseline,and subsequent prospective data will further describe,validate,and evaluate the effects of these risk factors on cognitive impairment and dementia.These results can provide clinical evidence for the early prevention of cognitive impairment and dementia.The study was approved by the Ethics Committee of Kailuan General Hospital of Tangshan City and the Medical Ethics Committee,Staff Hospital,Jidong Oilfield Branch,China National Petroleum Corporation on July 12,2013(approval No.2013 YILUNZI 1).

Progression of Cognitive Deficit in Older People with Mild Cognitive Impairment Treated with Cerebrolysin

Objectives: Although people with amnestic mild cognitive impairment (aMCI) benefit from cerebrolysin treatment, some still develop dementia. The aim of the current study was to identify most informative clinical assessment tests to predict the therapy efficacy in aMCI subjects treated with cerebrolysin. Methods: We studied patients with amnestic mild cognitive impairment (aMCI;n = 53) who had regular neurocognitive and clinical psychiatric assessments and were treated with cerebrolysin i.v. infusions 20 × 30 ml twice a year over three years period. Data were analyzed using non-parametric statistics, cluster and linear discriminant analyses. Results: Combined mathematical modeling enabled to predict cognitive decline from aMCI to dementia in the cerebrolysin-treated patients based on their initial neurocognitive assessment scores. We identified a “dementia risk group” with fast cognitive decline (i.e. low efficacy of the treatment). Lower baseline scores in the Mattis Dementia Rating Scale Memory subtest, Mini-Mental State Examination (MMSE), 10 word list immediate recall, and Frontal Assessment Battery tests when accompanied by higher depression score (Hamilton Depression Rating Scale) suggest poor prognosis for aMCI patients treated with cerebrolysin. Changes in scores on the MMSE, Boston naming test, Digit span forward, and Wechsler scale subtest “Categorical associations” during the treatment course are more characteristic for patients who convert to dementia than their initial scores. Conclusions: aMCI subjects treated with cerebrolysin with lower baseline cognitive functioning and subclinical depression have poor prognosis in terms of converting to dementia. Changes in the MMSE, Boston naming test, Digit span forward, and Wechsler scale subtest “Categorical associations” scores during the treatment course are more informative to identify patients who will develop dementia than their initial scores.

Neuropsychological Profile and Performance Variability in Vascular Cognitive Impairment

Background: Cognitive impairment from cerebrovascular disease varies in scope. Methods: We studied healthy elderly individuals and those with mild cognitive impairment (MCI) or mild dementia attributed to vascular pathology, in order to assess the diagnostic utility of intra-individual variability across neuropsychological domains and the cognitive profile of vascular cognitive disorders. A large battery of tests was used to create z-scores for seven neuropsychological domains by principle components analysis. Results: We did not find group differences in the average intra-individual variance across neuropsychological domains. We did find group differences in the within-domain variability for Language, reflecting increased performance variability in those participants with vascular pathology. There was a lower inter-correlation of domain scores in the MCI group than in the mild vascular dementia (VD) group. The MCI group had the largest deficits in Executive Function, Fluency and Memory relative to the healthy control (HC) group. The VD group evidenced a broad range of further cognitive decline relative to the MCI group, with the largest difference on Visuoconstruction. Conclusions: While intra-individual performance variability may increase early in the course of cognitive decline from vascular pathology, this is not because of greater across-domain variability or because impairments occur in only one particular cognitive domain or small cluster of inter-related domains. Early cognitive change includes decreased executive function that cannot be attributed to slow information processing or response time.

Sphenoid wing meningioma presenting as cognitive impairment

额叶脑膜瘤可仅表现出类似痴呆的心理症状。我们报告一例42岁的男性。患者最初被认为患有痴呆,最终确诊为蝶骨嵴脑膜瘤所致的痴呆。蝶骨嵴脑膜瘤的症状隐匿,往往会延误诊断,会被误认为是痴呆的表现。由于认知障碍比较复杂而且容易被忽视,所以准确评估患有脑部巨大肿瘤患者的神经心理功能是非常重要的。

Cognitive and Functional Profiles in Mild-to-Moderate Alzheimer’s Disease and Mild Cognitive Impairment Compared to Healthy Elderly

Background: Amnestic mild cognitive impairment (aMCI) and mild-to-moderate Alzheimer’s disease (AD) are clinically distinct but impact cognitive and functional ability similarly. Comprehensive assessment of cognitive and functional deficits may prove useful in informing differential diagnosis in early stages of dementia and in informing endpoint selection in therapeutic AD trials. Objective: The objective of this study was to characterize patterns of cognitive and functional impairment in aMCI and mild-to-moderate AD subjects compared to cognitively intact healthy elderly (HE). Methods: Thirty-one healthy elderly, 20 aMCI and 19 AD participants were administered a cognitive test battery that included the ADAS-Cog and functional assessments. Z-scores were calculated for all endpoints based on the HE reference group. Results: Cognitive deficits were observed in AD and aMCI participants relative to the referent group. On average, aMCI participants performed 1 - 2 standard deviations below HE on cognitive tests, and AD participants performed 2 - 3 standard deviations below HE. Domain-specific functional deficits among AD participants (z- score -0.4 to -6.4) were consistently greater than those of aMCI participants (z-score 0 to -1.7). Conclusion: This study provides further support for comprehensive assessment and monitoring of cognitive and functional domain scores in the diagnosis and treatment of aMCI and mild AD. Domain-specific cognitive scores may be more useful than composite scores in characterizing impairment and decline. Measuring domains such as attention, processing speed and executive function may increase the sensitivity of detecting disease progression and therapeutic effects, particularly in mild-moderate AD where memory decline may be too slow to detect drug effects during a typical clinical trial.

P25/CDK5-mediated Tau Hyperphosphorylation in Both Ipsilateral and Contralateral Cerebra Contributes to Cognitive Deficits in Post-stroke Mice

Objective Post-stroke cognitive impairment(PSCI)develops in approximately one-third of stroke survivors and is associated with ingravescence.Nonetheless,the biochemical mechanisms underlying PSCI remain unclear.The study aimed to establish an ischemic mouse model by means of transient unilateral middle cerebral artery occlusions(MCAOs)and to explore the biochemical mechanisms of p25/cyclin-dependent kinase 5(CDK5)-mediated tau hyperphosphorylation on the PSCI behavior.Methods Cognitive behavior was investigated,followed by the detection of tau hyperphosphorylation,mobilization,activation of kinases and/or inhibition of phosphatases in the lateral and contralateral cerebrum of mice following ischemia in MACO mice.Finally,we treated HEK293/tau cells with oxygen-glucose deprivation(OGD)and a CDK5 inhibitor(Roscovitine)or a GSK3βinhibitor(LiCl)to the roles of CDK5 and GSK3βin mediating ischemia-reperfusion-induced tau phosphorylation.Results Ischemia induced cognitive impairments within 2 months,as well as causing tau hyperphosphorylation and its localization to neuronal somata in both ipsilateral and contralateral cerebra.Furthermore,p25 that promotes CDK5 hyperactivation had significantly higher expression in the mice with MCAO than in the shamoperation(control)group,while the expression levels of protein phosphatase 2(PP2A)and the phosphorylation level at Tyr307 were comparable between the two groups.In addition,the CDK5 inhibitor rescued tau from hyperphosphorylation induced by OGD.Conclusion These findings demonstrate that upregulation of CDK5 mediates tau hyperphosphorylation and localization in both ipsilateral and contralateral cerebra,contributing to the pathogenesis of PSCI.

Cognitive Profiles and Subtypes of Patients with Mild Cognitive Impairment: Data from a Clinical Follow-Up Study

Background: Mild cognitive impairment (MCI) is a heterogeneous condition with a variety of clinical outcomes, the presence of which correlates with risk of Alzheimer’s disease as well as pre-clinical stages of other dementia subtypes. The aims of this study were to assess the specific patterns of cognitive profiles and to identify changes from baseline to 24 weeks in patients with MCI using detailed neuropsychological testing. Methods: We consecutively recruited 120 MCI patients at baseline according to the Petersen’s clinical diagnostic criteria, who were admitted to the Dementia and Memory Clinics. We analyzed patients who fulfilled both inclusion and exclusion criteria for MCI and classified them into four subtypes according to deficits in major cognitive domains;amnestic MCI single domain (aMCI-s), amnestic multiple domain MCI (aMCI-m), non-amnestic single domain MCI (naMCI-s) and non-amnestic multiple domain MCI (naMCI-m). Four groups of MCI were evaluated by a detailed neuropsychological battery test. Results: 83 patients with MCI at the 24-week follow-up were classified into four subtypes. The most frequent subtype was amnestic multi-domain MCI, with the frequency of MCI subtypes as follows: aMCI-s (n = 21, 25.3%), aMCI-m (n = 53, 63.9%), naMCI-s (n = 5, 6.0%) and naMCI-m (n = 4, 4.8%). In the major cognitive items of the SNSB-D, there were significant changes between the initial and follow-up tests in the domains of language, memory and the fron-tal/executive function (p < 0.05), except for attention, in all MCI patient subtypes. At 24-weeks follow-up, the conversion rate to Alzheimer’s disease was 2.4% (n = 2) from a subtype of amnestic multi-domain MCI. Conclusions: Our study revealed the most frequent subtype of MCI to be multiple domain amnestic MCI, with this subtype having a higher tendency of conversion to Alzheimer’s disease.

Development of Nursing Protocol for Preventing Interruptions during Clinical Examinations and Treatments in the Early Days of Hospitalization for 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 interruptions during clinical examinations and treatments performed in the early days of hospitalization for acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the research, 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 11 nurses in dementia care 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, 73 subjects (84.9%) considered effective for patients, in terms of prevention of interruptions during clinical examinations and treatments in the early days of hospitalization. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 84.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We consider that this nursing protocol will be useful especially for newly graduated/employed nurses as a procedure manual which can reduce their anxiety or stress caused by lack of knowledge or experiences.