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Dementia is one of the age-related diseases with the fastest increase in incidence. With the increasingly severe aging problem of the population, it further exacerbates the demand and burden of the healthcare system. Red blood cell distribution width (RDW) is an easily obtainable blood routine indicator that reflects the variability of red blood cell size. As an early marker of dementia risk, researches have shown an association between white matter hyperintensities (WMHs) and RDW. This article reviews the relationship between RDW and WMHs.
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Cognitive impairment is a common dysfunction after central nervous system disease or injury, which seriously affects the daily life of patients and brings heavy economic burdens to the family and society. Neurofeedback training (NFT) based on electroencephalography (EEG) is a non-invasive method of neuroregulation, which can improve cognitive function and behavior by autonomously adjusting brain function through feedback. This paper reviews the application of EEG signal-based neurofeedback training in cognitive rehabilitation, and discusses the current problems and future development trends in this field, so as to provide new ideas for clinical research and treatment of cognitive disorders.
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Iron is an essential metal element for human body. It is involved in many important biological metabolic processes. Iron metabolism in the central nervous system has a strict regulatory mechanism. Iron deposition occurs when the homeostasis of iron metabolism is disrupted, leading to an increase in neuronal iron uptake and a decrease in iron discharge. Aging cells develop specific iron deposition, and excessive iron produce reactive oxygen species, which can damage DNA. Highly reactive aldehydes result in irreversible modification of proteins. Stored proteins were stimulated to release iron, which in turn produces more reactive oxygen species, ultimately leading to iron-mediated cell death and neurological dysfunction. The widely used methods for assessing iron deposition include susceptibility weighted imaging and quantitative susceptibility mapping. Abnormally elevated brain iron deposition has been observed in a variety of central nervous system diseases, especially in Parkinson disease. Iron deposition plays an important role in early diagnosis, differential diagnosis, disease evaluation and monitoring and therapeutic effect evaluation of Parkinson disease. This article reviews the research progress of iron deposition in Parkinson disease.
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Objective:To investigate the relationship between white blood cells, neutrophil-lymphocyte ratio(NLR), platelet-lymphocyte ratio(PLR) and monocyte-lymphocyte ratio(MLR) with patients suffering from first episode depression.Methods:This retrospective study was conducted among inpatients of Hebei General Hospital from January 2021 to December 2021.Ultimately, 193 patients with first-episode depression were enrolled.According to the score of Hamilton depression scale-24 (HAMD-24), the patients were divided into mild-moderate depression group(20≤HAMD-24<35 score, n=98) and severe depression group (HAMD-24 score ≥35, n=95). White blood cells and the counts of each cell subtype were detected and the NLR, MLR and PLR were calculated.SPSS 25.0 statistical software was used to analyze the data.Mann-Whitney U test was used to compare differences in the two groups and Binary Logistic regression analyses were performed to recognize the predictive factors of the severity of first episode depression. Results:(1) The white blood cells and NLR in the severe depression group were significantly higher than those in the mild-moderate depression group (white blood cells: 5.77(2.05)×10 9/L vs 5.11(1.31)×10 9/L; NLR: 1.86 (1.04) vs 1.57(0.55), P<0.05). There were no significant differences in PLR and MLR between the two groups ( P>0.05). (2)Multiple regression analysis of NLR, white blood cells and HAMD-24 score showed that there were significant differences in the effect of different white blood cells and NLR levels on HAMD-24 score( B=1.398, P=0.003; B=2.624, P=0.001). (3)Binary Logistic regression revealed that white blood cell count and NLR were risk factors for the severity of depression patients( OR were 1.612 and 2.336, respectively, P<0.05). Conclusion:The results suggest that white blood cells and NLR may be relate with the severity of first episode depression.
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Microglia are the main innate immune cells in the central nervous system, which play a variety of roles in the development of the central nervous system and the occurrence of diseases. Recent studies have found that microglia play an important role in the occurrence and development of vascular cognitive impairment (VCI), which can lead to cognitive decline by activating neuroinflammation, oxidative stress, and destroying the blood-brain barrier. This article reviews the role of microglia in the pathophysiology of VCI, aiming to provide a new basis for targeting microglia to treat VCI.
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As a multifunctional signal molecule, fibroblast growth factor 21 (FGF21) has been proved to have a variety of biological effects, including anti-inflammatory, antioxidant stress, and neuroprotection. This article reviews the latest research progress on the protective effect of FGF21 in ischemic stroke and its relationship with cognitive impairment.
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Atherosclerosis (AS) is one of the pathological bases of ischemic stroke. AS caused by elevated low-density lipoprotein cholesterol levels is the main causative factor. However, recent studies have found that the traditional blood lipid indicators can not fully reflect the risk of stroke in high-risk populations. Non-traditional blood lipid parameters are developed from traditional blood lipid parameters, including remnant cholesterol (RC), non-high density lipoprotein cholesterol and a variety of blood lipid ratios, which may play a role in the prevention and treatment of cerebrovascular diseases. Among them, RC is increasingly recognized as a biomarker driving the residual risk of AS. It has been confirmed that RC is closely associated with the risk of cerebrovascular disease in the primary and secondary prevention studies of stroke.
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Vascular cognitive impairment (VCI) is a syndrome from mild cognitive impairment to dementia caused by various vascular risk factors and cerebrovascular diseases. Early detection and definite diagnosis can significantly improve the outcomes of patients with VCI. This article reviews the evaluation and diagnosis of VCI.
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Stroke-like symptoms and cognitive impairment caused by cerebral small vessel diseases will bring heavy burden to families and society. Therefore, early diagnosis and treatment of cerebral small vessel diseases are particularly important. This article reviews the diagnosis and treatment of cerebral small vessel diseases.
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Objective:To explore the correlation between middle cerebral artery (MCA) pulsatility index (PI) and total magnetic resonance imaging (MRI) burden in elderly patients with cerebral small vessel diseases (CSVD).Methods:A total of 203 CSVD inpatients aged 60 years and above who were hospitalized in the Department of Neurology of Hebei General Hospital from March 2017 to December 2020 were enrolled. The clinical data, transcranial Doppler ultrasound parameters and brain MRI data were collected. According to the total burden score, the patients were divided into low burden group (0-1 point) and high burden group (2-4 points). Univariate and multivariate Logistic regression analysis was used to analyze the correlation between MCA PI and total MRI burden in the elderly patients with CSVD. Subsequently, the receiver operating characteristic curve was used to evaluate the value of MCA PI for predicting the high MRI burden of CSVD in the elderly.Results:Hypertension ( OR=2.569, 95% CI 1.068-6.182, P=0.035), systolic blood pressure ( OR=1.033, 95% CI 1.006-1.061, P=0.016), creatinine ( OR=1.044, 95% CI 1.009-1.079, P=0.013) and MCA PI ( OR=1.125, 95% CI 1.087-1.166, P<0.001) were independently correlated with the increasing total MRI burden in the elderly patients with CSVD. Spearman rank correlation analysis revealed that there was strong and positive correlation between MCA PI and high MRI burden in the elderly patients with CSVD ( r=0.65, P<0.001). The analysis showed that when the cut-off for MCA PI was 1.11, it could identify high MRI burden of CSVD in the elderly. The area under the curve was 0.908 (95% CI 0.864-0.953, P<0.001). The sensitivity and specificity were 0.852 and 0.880, respectively. The positive predictive value was 92.38%, and the negative predictive value was 77.70%. Conclusion:The MCA PI is positively correlated with total MRI burden in the elderly patients with CSVD, and has a higher value in predicting the total MRI burden in the elderly CSVD patients, which probably bring brighter prospects for its clinical application.
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White matter lesions (WMLs) are the extensive damage of periventricular and subcortical white matter caused by different etiology.Previous studies have shown that WMLs is associated with cognitive function, motor function, mood and urination function.Parkinson disease (PD) is a common chronic degenerative disease of the central nervous system.Recently, evidences showed that PD patients have a high susceptibility to WMLs which participates in the progression of motor and cognitive impairment.PD patients have higher risk of WMLs because of cardiovascular autonomic nerve dysfunction, long-term dopamine (DA) treatment and β-amyloid peptides (Aβ) deposition along vessels.Furthermore, recently, more and more evidences showed that WMLs could impact on the motor and cognitive symptoms of PD.WMLs had a significant influence on axial motor symptoms, and was related to executive function, attention, memory, visual-spatial ability and other cognitive impairment.Moreover, the severity of WMLs affects drug and surgical efficacy of patients with PD.Taking active measures to slacken the WMLs progression of PD will contribute to improve symptoms and curative effect.This article summarized the roles of WMLs in the occurrence and development of PD, in order to provide theoretical basis for prevention, diagnosis and treatment of PD.
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Vascular cognitive impairment (VCI) is the second most common type of dementia after Alzheimer's disease. As the pathway between the central nervous system and gastrointestinal tract, brain-gut axis has become one of the research hotspots in the pathogenesis of many diseases. Intestinal flora imbalance may mediate or affect vascular risk factors such as atherosclerosis, hypertension, metabolic diseases, and ischemic stroke, and finally accelerate the occurrence and development of VCI. This article reviews the literature on intestinal flora and VCI as well as its main risk factors, in order to provide new ideas for the prevention and treatment of VCI.
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Post-stroke anxiety is one of the most common and important complications in patients with stroke, which can seriously affect the rehabilitation, daily life and work of patients with stroke. This article reviews the epidemiology, clinical characteristics, risk factors and predictors, pathophysiological mechanism, prevention and treatment of post-stroke anxiety.
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Carotid atherosclerosis (CAS) is closely associated with the decline of cognitive function in the elderly, which can lead to persistent or progressive cognitive function and neurological dysfunction. Vascular cognitive impairment (VCI) is considered to be an intervenable disease. Studies have shown that CAS is one of the main causes of VCI. Further study on the relationship between CAS and VCI will help to better prevention and treatment of VCI.
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Objective:To investigate the correlation between total MRI burden and serum uric acid level in patients with cerebral small vessel disease(CSVD) and its gender differences.Methods:A total of 217 patients with CSVD were retrospectively included as the research objects, and the clinical data such as serum uric acid value were collected.The imaging findings of patients with CSVD were evaluated by MRI, and the total MRI burden score of CSVD was calculated.According to the total MRI burden score of CSVD, patients with CSVD were divided into mild-to-moderate burden group ( n=133) and severe burden group ( n=84). SPSS 20.0 software was used for data analysis and processing.Logistic regression was used to analyze the relationship between uric acid and the total MRI burden score of CSVD. Results:The serum uric acid of severe burden group was higher than that of mild-to-moderate burden group((326.94±70.95)μmol/L, (293.42±80.52)μmol/L, P=0.002). The multivariate logistic regression analysis showed that the elevated level of serum uric acid was an independent risk factors for total MRI burden of CSVD ( β=0.005, OR=1.005, 95% CI=1.001-1.009, P=0.019). The patients with CSVD were equally divided into four group based on the serum uric acid concentration.After controlling the confounding factors, with the increase of uric acid level, the risk of aggravating total MRI burden score of CSVD increased, and the difference was statistically significant( P=0.001). Serum uric acid(for each quartile increase)was an independent risk factor for total MRI burden in male patients with CSVD( β=0.482, OR=1.619, 95% CI=1.125-2.330, P=0.010), while there was no significant difference in female patients( P=0.070). Conclusion:Serum uric acid level is a risk factor for increasing the total MRI burden in male patients with CSVD, but this effect is not found in female patients with CSVD.
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Objective:To explore the correlation between enlarged perivascular spaces and other imaging markers of cerebrovascular disease in patients with ischemic stroke.Methods:Totally 287 patients with ischemic stroke hospitalized in neurology department from January 2018 to January 2019 were selected. According to the severity of EPVS in different parts of the brain, the correlations between the severity of EPVS in different parts of the brain and cerebral microbleeds (CMBs), white matter hyperintensity (WMH), lacunar infarcts (LIs) were analyzed. SPSS 22.0 software was used for analysis. Chi-square test, independent sample t-test, rank-sum test and non parametric Mann-Whitney U test were used for group comparison, and Logistic regression analysis was used for multivariate analysis. Results:EPVS was common and severe in patients with ischemic stroke. Periventricular white matter hyperintensity(PWMH)( β=1.604, P<0.001, OR=4.971, 95% CI=2.015-12.263), CMBs ( β=1.224, P=0.018, OR=3.339, 95% CI=1.232-9.383) and LIs ( β=0.626, P=0.047, OR=1.871, 95% CI=1.009-3.470) were independent risk factors for BG-EPVS. PWMH ( r=0.614), DWMH ( r=0.622), LIs ( r=0.532) were positively correlated with the severity of BG-EPVS (all P<0.01). Conclusion:The imaging makers of CSVD are related to BG-EPVS, which can affect the severity of brain BG-EPVS in patients with ischemic stroke.
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Endovascular thrombectomy (EVT) has become an effective treatment for acute large vessel occlusive ischemic stroke. Because there are many common etiologies and pathogenesis between cerebral small vessel disease (CSVD) and large vessel disease, patients with large vessel occlusive ischemic stroke are often accompanied by imaging manifestations of CSVD. In recent years, with the wide application of EVT in the treatment of acute ischemic stroke, more and more studies have investigated the relationship between CSVD and the outcome of patients treated with EVT. This article reviews the relationship between various imaging phenotypes of CSVD and the outcome of acute ischemic stroke patients treated with EVT and its possible mechanism.
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Neutrophil to lymphocyte ratio (NLR) can provide information of local or systemic inflammation and immune status. With the increasing attention to the role of inflammatory and immune factors in vascular cognitive impairment (VCI), it is very important to find new serum inflammatory markers for early identification and intervention of VCI. This article reviews the related research on NLR, VCI and their risk factors, expounds the role of inflammation in the pathogenesis of VCI, and provides help for the diagnosis and prevention of VCI.
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Objective:To explore the effect of iron overload on the cognitive function of rats and its possible internal mechanism.Methods:Thirty 8-week-old male Sprague Dawley rats of SPF degree were randomly divided into 2 groups, iron overload group(IO group) and control group(Sham group), with 15 in each group.The rats in IO group were injected intraperitoneally iron dextran(100 mg/(kg·d)) for 28 days.The cognitive function of rats was detected by Morris water maze method. Western blot method was used to detect the expression of TfR1 and autophagy-related protein p-AMPK, LC3 and Beclin1 in the hippocampus of rats. Immunofluorescence was used to observe the expression of LC3 and Beclin1 in the hippocampus of rats. HE staining was used to observe the morphological changes of neurons in the hippocampus. Transmission electron microscopy was used to observe the number of autophagosomes and the morphology of endoplasmic reticulum in hippocampus.The software of SPSS 20.0 was used for repeated measurement ANOVA and t-test. Results:Morris water maze test showed that there were significant interaction between the group factor and training time factor of escape latency( F=3.55, P<0.01). And the simple effect analysis showed that compared with the Sham group((28.09±18.41)s, (21.42±15.53)s, (16.96±8.35)s, (10.24±3.75)s), the average escape latency of rats(2nd-5th day) in IO group((56.68±30.65)s, (58.21±36.09)s, (36.58±13.54)s, (27.29±14.30)s )were significantly longer ( t=8.57, 6.81, 9.51, 7.12, P<0.01). The platform was removed on 6th day of the space exploration experiment, compared with the Sham group ((41.89±3.89)%), the percentage of time spent in the target quadrant of IO group ((25.46±3.56)%) was significantly decreased( t=24.06, P<0.01). Western blot showed that the relative expression levels of (TfR1 (2.10±0.48), p-AMPK (0.74±0.10), LC3 (1.11±0.40), Beclin1 (1.05±0.20)) in IO group in the hippocampus of the rats were significantly higher than those of the Sham group(TfR1(0.11±0.18), p-AMPK(0.19±0.02), LC3(0.22±0.11), Beclin1(0.17±0.02))( t=1.58, 14.58, 10.06, 20.65, P<0.01)). HE staining showed that compared with the Sham group, the neuron in the hippocampus of the IO group were sparsely arranged, morphologically irregular, and the number of the neurons was significantly reduced. Transmission electron microscopy showed that compared with the Sham group, the number of autophagosomes in the hippocampus of IO group was increased. Conclusion:Iron overload may exert its neurotoxic effect by increasing the level of autophagy in the hippocampus, causing cognitive dysfunction.
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Objective:To investigate the risk factors for anterior circulation and posterior circulation symptomatic intracranial atherosclerotic stenosis (sICAS).Methods:The clinical data of patients admitted to Hebei General Hospital for ischemic stroke or transient ischemic attack (TIA) and diagnosed with sICAS by digital subtraction angiography from May 2019 to May 2020 were retrospectively included. The patients were divided into anterior circulation group and posterior circulation group according to the stenosis sites, and the distribution of sICAS and its risk factors were analyzed.Results:A total of 134 patients with sICAS were enrolled, including 82 males (61.2%) and 52 females (38.8%). Their age was 60.28±11.46 years; 115 (85.8%) had ischemic stroke and 19 (14.2%) had TIA. There were 92 patients (68.7%) in the anterior circulation group and 42 (31.3%) in the posterior circulation group. Body mass index (BMI), systolic and diastolic blood pressure levels, as well as the proportion of patients with hypertension, diabetes, smoking and drinking in the posterior circulation group were significantly higher than those in the anterior circulation group (all P<0.05). Multivariate logistic regression analysis showed that higher BMI (odds ratio [ OR] 1.191, 95% confidence interval [ CI] 1.029-1.379; P=0.019), hypertension ( OR 4.073, 95% CI 1.135-14.616; P=0.031) and diabetes ( OR 2.783, 95% CI 1.149-6.738; P=0.023) were independently correlated with the posterior circulation sICAS. Conclusions:Compared with anterior circulation, high BMI, hypertension and diabetes are the independent risk factors for posterior circulation sICAS.