Tiaoshen acupuncture for primary insomnia: a pilot randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effects of Tiaoshen (regulating the spirit) acupuncture on cognitive function and sleep quality in patients with primary insomnia (PI).@*METHODS@#Sixty patients with PI were randomly divided into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 2 cases dropped off, 1 case was excluded). The patients in the observation group were treated with acupuncture at Baihui (GV 20), Shenting (GV 24), Sishencong (EX-HN 1), and bilateral Benshen (GB 13), Shenmen (HT 7), Neiguan (PC 6), Sanyinjiao (SP 6). The patients in the control group were treated with shallow needling at non-effective points. Each treatment was provided for 30 min, once every other day, 3 treatments per week for 4 weeks. The Montreal cognitive assessment (MoCA), digit span test (DST), trail making test (TMT)-A, Pittsburgh sleep quality index (PSQI), and fatigue scale-14 (FS-14) were used to assess cognitive function and sleep quality before and after treatment, as well as in follow-up of 4-week after treatment completion. Correlation analysis was conducted between the differences in PSQI scores and differences in MoCA scores before and after treatment in the observation group.@*RESULTS@#Compared with before treatment, the total score, visuospatial and executive function score and delayed memory score of MoCA as well as DST backward score were increased (P<0.01), while TMT-A time, PSQI and FS-14 scores were significantly reduced (P<0.01) after treatment and in follow-up in the observation group. Compared with before treatment, the PSQI score in the control group was reduced (P<0.01, P<0.05). After treatment and in follow-up, the observation group had significantly higher total score, visuospatial and executive function score, delayed memory score of MoCA, and DST backward score compared to the control group (P<0.05, P<0.01). In the observation group, the TMT-A time was significantly shorter than that in the control group (P<0.05, P<0.01), and the PSQI and FS-14 scores were significantly lower than those in the control group (P<0.01). In the observation group, there was a negative correlation between the difference in PSQI scores (post-treatment minus pre-treatment) and the difference in MoCA scores (post-treatment minus pre-treatment) (r=-0.481, P<0.01). A similar negative correlation was found between the difference in PSQI scores (follow-up minus pre-treatment) and the difference in MoCA scores (follow-up minus pre-treatment) (r=-0.282, P<0.05).@*CONCLUSION@#Tiaoshen acupuncture could improve cognitive function, enhance sleep quality, and alleviate daytime fatigue in patients with PI. The improvement in cognitive function in patients with PI is correlated with the improvement in sleep quality.

Study to Find Out the Correlation Between Cognitive Defect and Non-alcoholic Fatty Liver Disease

Introduction : Non-alcoholic Fatty Liver Disease (NAFLD), a hepatic manifestation of Metabolic Syndrome, has now become a Global Phenomenon and along with its increasing prevalence various morbidities and mortality are also increasing. Aims and Objectives : The objective of the present study was to establish whether patients with NAFLD, in the absence of other comorbid conditions suffer from cognitive impairment. Materials and Methods : This cross sectional study was conducted at the Department of General Medicine, Calcutta National Medical College and Hospital. 90 patients with NAFLD and 90 healthy controls were recruited after matching all the inclusion and exclusion criteria, from the out patient and in patient department over a period of 1 year starting March, 2019. NAFLD was diagnosed by noninvasive methods including Elastography (fibroscan). Cognition was assessed by MoCA (Montreal Cognitive Assessment test) score. Result : The mean age of cases and control were 49.2 and 48.5 years, respectively. Out of total cases and controls 48.9% was male and 51.1% was female. The mean BMI of the cases and control were 30.21�24 and 22.60�52 Kg/m2, respectively. The mean Elastography score among the cases was 4.91�23 kPa and that among the controls was 3.84�31 kPa. The mean Fibroscan Score among male cases and controls were 4.907�26 kPa and 3.83�35, respectively (p

Association between Apoε4 allele and cardiometabolic and social risk factors with cognitive impairment in elderly population from Bogota / Associação entre o alelo Apoε4 fatores de risco cardiometabólicos e sociais com prejuízo cognitivo em idosos de Bogotá

ABSTRACT Being an ϵ4 carrier in the Apoϵ gene has been suggested as a modifying factor for the interaction between cardio-metabolic, social risk factors, and the development of cognitive impairment. Objective: The main objective of this study was to assess the existence of such interaction in a sample of Bogota's elderly population. Methods: A cross-sectional study was conducted with 1,263 subjects older than 50 years. Each participant was diagnosed by consensus, after neuropsychological and neuropsychiatric evaluations, under a diagnosis of normal cognition, mild cognitive impairment (MCI) according to Petersen's criteria, or dementia according to DSM-IV criteria. Apoϵ was typified and an analysis of MoCA test was performed in each group carrying or not ϵ4 allele. Results: Our study showed that 75% were women with a median age of 68 years (interquartile range 62-74 years) and a median schooling for 6 years (interquartile range 4-12 years). Dementia was related to low education level of ≤5 years OR=11.20 (95%CI 4.99-25.12), high blood pressure (HBP) OR=1.45 (95%CI 1.03-2.05), and age over 70 years OR=7.68 (95%CI 3.49-16.90), independently of being or not an ϵ4 allele carrier. Diabetic subjects with dementia carrying ϵ4 allele showed a tendency to exhibit lower scores on the MoCA test, when compared with noncarriers' diabetic subjects with dementia. Conclusions: The presence of ϵ4 allele does not modify the relationship between cognitive impairment and the different cardio-metabolic and social risk factors, except in diabetic subjects ϵ4 carriers with dementia who showed a tendency to exhibit lower scores of the MoCA test, when compared with noncarriers' diabetic subjects with dementia.

RESUMO Ser um portador ϵ4 no gene Apoϵ tem sido sugerido como um fator modificador da interação entre fatores cardiometabólicos, de risco social e o desenvolvimento de comprometimento cognitivo. Objetivo: O objetivo principal deste trabalho é avaliar a existência de tal interação em uma amostra da população idosa de Bogotá. Métodos: Um estudo transversal foi realizado com 1.263 indivíduos com mais de 50 anos. Cada participante foi diagnosticado por consenso após avaliações neuropsicológicas e neuropsiquiátricas, sob um diagnóstico de cognição normal, comprometimento cognitivo leve de acordo com os critérios de Petersen ou demência de acordo com os critérios do Manual Diagnóstico e Estatístico de Trastornos Mentais (DSM-IV). Apoϵ4 foi tipificada e uma análise do Montréal Cognitive Assessment Test (teste de MoCA) foi realizada em cada grupo portador ou não do alelo ϵ4. Resultados: Nosso estudo mostrou que 75% eram mulheres com idade mediana de 68 anos (intervalo interquartil 62 a 74 anos) e escolaridade mediana de seis anos (intervalo interquartil 4 a 12 anos). A demência estava relacionada ao baixo nível de escolaridade ≤5 anos Odds Ratio (OR)=11,20 (intervalo de confiança — IC95% 4,99-25,12), pressão alta OR=1,45 (IC95% 1,03-2,05) e idade acima de 70 anos OR=7,68 (IC95% 3,49-16,90), independentemente de ser ou não portador do alelo ϵ4. Indivíduos diabéticos com demência portadores do alelo ϵ4 mostraram tendência de exibir pontuações mais baixas no teste MoCA quando comparados com indivíduos diabéticos com demência não portadores do alelo ϵ4. Conclusões: A presença do alelo ϵ4 não modifica a relação entre o comprometimento cognitivo e os diferentes fatores de risco cardiometabólico e social, exceto em diabéticos portadores de ϵ4 com demência, que exibiram tendência a apresentar menores escores no teste MoCA quando comparados com indivíduos diabéticos com demência não portadores do alelo ϵ4.

Associação entre classes funcionais da insuficiência cardíaca com fração de ejeção preservada e comprometimento cognitivo / Association between the functional classification of heart failure with preserved fraction ejection and cognitive impairment

INTRODUÇÃO: A insuficiência cardíaca (IC) é uma síndrome resultante de defeitos estruturais e funcionais da bomba cardíaca, mais de 80% dos pacientes são idosos, com diversas comorbidades associadas. A demência é definida por qualquer desordem onde o declínio significativo do nível prévio de cognição do paciente interfere em sua independência e funcionamento social, doméstico ou ocupacional. A relação entre o comprometimento cognitivo leve e a IC já é bem estabelecida na literatura, porém estudos recentes apontam uma possível relação da IC na patogênese e no agravo da demência. OBJETIVOS: Classificar a limitação funcional de voluntários com IC com fração de ejeção preservada (FEp) e realizar o teste Montreal Cognitive Assessment (MoCA) de memória para analisar se há associação entre as limitações funcionais da IC e o deterioramento cognitivo do paciente. MÉTODOS: Trata-se de um estudo observacional transversal, foram avaliados 27 pacientes com história de ICFEp no ambulatório de Insuficiência Cardíaca do Hospital da Universidade Luterana do Brasil. RESULTADOS: Foram avaliados 27 pacientes, com idade média de 72.4 anos, sendo 18 (66.6%) do sexo feminino, 24 (88.8%) obtiveram escore no MoCA inferior a 26, sendo a média da escala 20.4. Entre os 27 pacientes, quatro apresentavam classe funcional NYHA I, 15 NYHA II, 3 NYHA III e 5 NYHA IV. CONCLUSÃO: O estudo mostra uma tendência de pior desempenho no MoCA entre pacientes com pior classe funcional de IC (NYHA I-II: MoCA 21.4 +/- 4.9 e NYHA III-IV MoCA: 18 +/- 4.2 p:0. 0.087)

INTRODUCTION: Heart failure (HF) is a syndrome resulting from structural and functional defects of cardiac pump, more than 80% of the patients are elderly with diverse associated comorbidities. The dementia is defined by any disorder where the significant decline of the previous cognition level of the patient intervene on his independence and social, domestic or occupational functioning. The link between light cognitive impairment and HF is already well documented in literature, however recent studies point a possible relation of HF in pathogenesis and deteriorating of dementia. OBJETIVE: Rank functional limitation of volunteers with HF with preserved ejection fraction and to apply the Montreal Cognitive Assessment (MoCA) memory test to analyse if there is a association between HF functional limitations and dementia onset/worsening. METHODS: Transversal observational study, 27 patients with HF with preserved ejection fraction were assessed in Universidade Luterana do Brasil's heart failure clinic. RESULTS: Assessing 27 patients, with average age of 72.4 years (+/-7.3), being 18 (66.6%) female, we found 24 (88.8%) with MoCA score lower to 26, being the average score 20.4. Between the 27 patients, 4 had functional class NYHA I, 15 NYHA II, 3 NYHA III and 5 NYHA IV. CONCLUSION: The present study shows a tendency to lower performance in MoCA on patients with worse HF functional classification (NYHA I-II: MoCA 21.4 +/- 4.9 e NYHA III-IV MoCA: 18 +/- 4.2 p:0. 0.087)

Interactive scalp acupuncture for cognitive dysfunction after stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the efficacy of interactive scalp acupuncture, scalp acupuncture alone and scalp acupuncture plus cognitive training for cognitive dysfunction after stroke.@*METHODS@#A total of 660 patients with cognitive dysfunction after stroke were randomly divided into an interactive scalp acupuncture group (218 cases, 18 cases dropped off), a scalp acupuncture group (220 cases, 20 cases dropped off) and a scalp acupuncture plus cognitive training group (222 cases, 22 cases dropped off). All the patients were treated with routine medication and exercise rehabilitation training. The interactive scalp acupuncture group was treated with scalp acupuncture on the parietal midline, and contralateral anterior parietal temporal oblique line and posterior parietal temporal oblique line at the same time of cognitive training; the scalp acupuncture group was treated with scalp acupuncture alone, and the scalp acupuncture plus cognitive training group was treated with scalp acupuncture and cognitive training in the morning and afternoon respectively. All the treatments were given once a day, 6 times a week for 8 weeks. Montreal cognitive assessment (MoCA) scale score was used to evaluate the cognitive function before treatment, 4 weeks and 8 weeks into treatment.@*RESULTS@#Compared before treatment, the total score of MoCA was increased after 4-week treatment and 8-week treatment in the three groups (@*CONCLUSION@#The interactive scalp acupuncture could significantly improve the cognitive function in patients with cognitive dysfunction after stroke, and the efficacy is superior to scalp acupuncture alone and scalp acupuncture plus cognitive training.

Efecto de la hipertensión arterial en la función cognitiva de pacientes de 45 a 65 años. Hospital Luis Vernaza, Guayaquil, Ecuador / Impact of arterial hypertension on the cognitive function of patients between 45 and 65 years. Luis Vernaza Hospital, Guayaquil, Ecuador

Resumen Introducción: El deterioro cognitivo leve es una alteración de la función cognitiva que no afecta de manera negativa a las actividades diarias de la persona. Factores de riesgo modificables como la hipertensión arterial podrían intervenir en el aceleramiento de este proceso y afectar a personas menores de 65 años. Una detección temprana del deterioro cognitivo leve por medio del Montreal Cognitive Assesment (MoCA) en personas con hipertensión arterial ayudaría a idear medidas para su control eficaz. Materiales y métodos: Se diseñó un estudio de tipo observacional transversal. La población se integra con pacientes hipertensos de 45 a 65 años de Guayaquil. De una base de datos de 570 pacientes, se realizó un llamado a sujetos que cumplieran los criterios de inclusión y exclusión, para la evaluación de la función cognitiva por medio del MoCA. Resultados: El 93.3% de los participantes sometidos a la prueba MoCA presentó un puntaje menor de 26. El promedio del puntaje total fue de 18.9 y el 51.6% de los participantes reveló deterioro cognitivo leve. Se obtuvo una correlación negativa del 40% (-0.40) con una p = 0.0015 entre años con hipertensión arterial y el resultado total de la prueba MoCA. Conclusiones: Por medio del MoCA se pudo cuantificar la magnitud del deterioro cognitivo en estos pacientes. Se identificó que la mayoría de los participantes examinados presentaba un puntaje promedio menor del intervalo normal. Las cifras obtenidas de los valores de correlación de Pearson muestran una actividad tendencial y relación de la hipertensión arterial con el deterioro de la función cognitiva.

Abstract Introduction: Mild cognitive impairment is an alteration of cognitive function that does not negatively affect the daily activities of the person. Modifiable risk factors such as hypertension could be involved in the acceleration of this process affecting people under 65 years of age. Early detection of mild cognitive impairment through the Montreal Cognitive Assessment (MoCA) in people with high blood pressure, would help to formulate strategies for its effective control. Materials and methods: A cross-sectional observational study was designed. The population is hypertensive patients between 45 and 65 years old in Guayaquil. From a database of 570 patients, a call was made to patients who met the inclusion and exclusion criteria, for the evaluation of cognitive function through MoCA. Results: 93.3% of the participants who underwent the MoCA test had a score lower than 26. The average of the total score was 18.9, with 51.6% of the participants suffering from mild cognitive impairment. A negative correlation of 40% (-0.40) was obtained with a p = 0.0015 between years with arterial hypertension and the total result of the MoCA test. Conclusions: Through MoCA, the magnitude of cognitive deterioration in these patients could be quantified. It was detected that the majority of the examined participants had a lower average score of the normal range. The figures obtained from the Pearson correlation values show trend activity, relating arterial hypertension and deterioration of cognitive function.

Characteristics Of Cognitive Status Of Epilepsy Patients Treated With Monotherapy Of First-Generation Antiepileptic Drugs

@#Epilepsy is one of the main health problems in neurology that can lead to cognitive decline. Generally, the epilepsy-associated cognitive decline is influenced by demographic, clinical, and treatment characteristics. This study aimed to determine the characteristics of cognitive status of epilepsy patients who received monotherapy using first-generation antiepileptic drugs (AEDs), namely phenytoin, carbamazepine, and valproic acid. It involved 93 epilepsy patients of Mutiara Sukma Mental Hospital (n=38) and Mataram General Hospital (n=55). Besides, 93 healthy patients were assigned as healthy control group (HC) subjects (n=93). Demographic characteristics collected from epilepsy and HC groups were age, gender, and years of education. Clinical characteristics taken from both groups were MoCA-Ina score. Clinical characteristics taken from epilepsy group were age at epilepsy onset, type of seizure (partial vs generalized), etiology (idiopathic vs structural), first-generation AED used, years of treatment, and cognitive status. The result of the study revealed that there were no significant different between the two groups in the means of age and years of education as well as the frequency of male gender (p>0.05). The mean of MoCA-Ina score of epilepsy group was significantly lower compared with HC group (p<0.05). The frequency of cognitive decline among epilepsy patients was 75.3%. The cognitive functions of epilepsy patients using monotherapy with carbamazepine, phenytoin, or valproic acid was significantly lower compared with healthy subjects. We conclude that there was high prevalence of epilepsy-associated cognitive impairment which was associated with male gender.

Cut-off points of the Portuguese version of the Montreal Cognitive Assessment for cognitive evaluation in Parkinson's disease / Valores de corte da versão em português do "montreal cognitive assessment" para avaliação cognitiva na doença de parkinson

ABSTRACT. The Movement Disorder Society has published some recommendations for dementia diagnosis in Parkinson disease (PD), proposing the Montreal Cognitive Assessment (MOCA) as a cognitive screening tool in these patients. However, few studies have been conducted assessing the Portuguese version of this test in Brazil (MOCA-BR). Objective: the aim of the present study was to define the cut-off points of the MOCA-BR scale for diagnosing Mild Cognitive Impairment (PD-MCI) and Dementia (PD-D) in patients with PD. Methods: this was a cross-sectional, analytic field study based on a quantitative approach. Patients were selected after a consecutive assessment by a neurologist, after an extensive cognitive evaluation, and were classified as having normal cognition (PD-N), PD-MCI or PD-D. The MOCA-BR was then applied and 89 patients selected. Results: on the cognitive assessment, 30.3% were PD-N, 41.6% PD-MCI and 28.1% PD-D. The cut-off score on the MOCA-Br to distinguish PD-N from PD-D was 22.50 (95% CI 0.748-0.943) for sensitivity of 85.5% and specificity of 71.1%. The cut-off for distinguishing PD-D from MCI was 17.50 (95% CI 0.758-0.951) for sensitivity of 81.6% and specificity of 76%.

RESUMO. A Movement Disorder Society publicou algumas recomendações para o diagnóstico de demência na doença de Parkinson (DP), propondo o Montreal Cognitive Assessment (MOCA) como ferramenta de triagem cognitiva nesses pacientes. Entretanto, poucos estudos foram aplicados à versão em português (MOCA-BR). Objetivo: o presente estudo tem o objetivo de definir os valores de corte na escala de MOCA-BR para diagnosticar o Comprometimento Cognitivo Leve (DP-CCL) e Demência (DP-D) em pacientes com DP. Métodos: trata-se de um estudo transversal, analítico, com uma abordagem quantitativa. Os pacientes foram selecionados depois de avaliações consecutivas por um neurologista, após avaliação cognitiva extensa, e foram classificados como cognição normal (DP-N), DP-CCL e DP-D e então o MOCA-BR foi aplicado, sendo selecionados 89 pacientes. Resultados: na avaliação cognitiva, foram encontrados 30.3% de DP-N, 41.6% de DP-CCL e 28.1% DP-D. O valor de corte no MOCA-BR para distinguir entre DP-N de DP-D foi 22.5 (IC 95%; 0.748-0.943), sensibilidade de 85.5% e especificidade de 71.1%. Para distinguir DP-P de CCL, o ponto de corte foi de 17.5 (IC 95%; 0.758-0.951), sensibilidade de 81.6% e especificidade de 76%.

Association of the atherosclerosis, small vessel disease, cardioembolism, other causes with the executive function of the montreal cognitive assessment Indonesia in patients with post ischemic stroke

Background: ASCO Phenotype classification is a new classification of stroke based on phenotypic system. ASCO classification can evaluate the etiology of ischemic stroke comprehensively to characterize patients using different grade of evidence for the subtype of ischemic stroke. ASCO classification can predict post ischemic stroke cognitive decline. This Study purpose to evaluate the association between ASCO classification with the executive function in post ischemic stroke patients.Methods: This cross sectional study followed by 28 post ischemic stroke patients (men 16, women 12) over 3 months. Mean age 52.82±8.66. Cognitive function was assessed by Montreal Cognitive Assessment Indonesia (MoCA INA).Results: There were 17 patients with grade 1 atherosclerosis (ASCO A1), ten patients with grade 1 small vessel disease (ASCO S1), one patient with grade 1 cardioembolism (ASCO C1) in post ischemic stroke. Grade 1 atherosclerosis (ASCO A1) was significantly associated with executive function decline (p=0.002), naming decline (p=0.05), abstraction decline (p=0.001), memory decline (p=0.002) and orientation decline (p=0.016)). Grade 1 small vessel disease (ASCO S1) was significantly associated with executive function decline (p=0.001) and memory decline (p = 0.001) and abstraction (p=0.001). Grade 1 cardioembolism 1 (ASCO C1) was not significantly associated with cognitive decline.Conclusions: There was significant association between ASCO classification with the executive function of Montreal Cognitive Assestment Indonesia (MoCA INA) in post ischemic stroke patients.

Comparative evaluation of levetiracetam and valproic acid as monotherapy on cognitive impairment in patients of epilepsy

Background: Cognitive decline with AEDs (Anti-epileptic drugs) is associated with learning and memory deficits especially in the younger age group. The data regarding the impact of levetiracetam and valproic acid as monotherapy on cognition in epileptic patients is scarce. The present study was done for evaluation of cognitive decline associated with the use of AEDs.Methods: Present study was a prospective study on 60 patients on AEDs for a period of 12 weeks. Patients were enrolled from the Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India and divided into group A (levetiracetam) and group B (valproic acid) with 30 patients in each group. Permission from the institutional ethics committee and written informed consent was taken from all the patients. They were analyzed for cognitive impairment using MMSE and MoCA scales at baseline and 12 weeks.Results: The mean duration of disease was 2.13�1 years and 2.08�1 years and mean age of the patients was 14.67�9 years in group A and 16.20�6 years in group B. GTCS was present in 31 patients (52%) followed by partial seizures in 29 patients (48%). The mean change in the MMSE scores from baseline to 12 weeks was significant in group A 1.30�1 (p value <0.05) and change group B was -0.20�4 not statistically significant. The mean change was observed in MoCA scores from baseline to 12 weeks was significant in both groups A and B by 1.17�1 and -0.70�1 respectively (P value <0.05).Conclusions: Patients on levetiracetam showed cognitive improvement, whereas patients on valproic acid showed a decline in the MMSE and MoCA scores.

Java Ginger Bangle / 日本補完代替医療学会誌

The review reveals latest studies of Bangle that has unique ingredients, safety, healthy effect and especially neurotrophin activity. Banglenes have some neurotrophin activity such as neuritogenesis without NGF in vitro, property that enhances hippocampal neurogenesis and crosses the blood-brain barrier (BBB) in vivo. On the other hand, Java ginger bangle (Extract) improves spatial learning in Senescence-Accelerated Mouse. Moreover the human clinical trial for MCI (Mild Cognitive Impairment) have been just started.

acupuncture method for mild cognitive impairment: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of acupuncture method for mild cognitive impairment in the elderly.@*METHODS@#A total of 96 patients were randomly divided into an observation group, a control group and a waiting group, 32 cases in each group. The patients in the observation group were treated with acupuncture at Baihui (GV 20), Shenting (GV 24), Yintang (GV 29) and Sishencong (EX-HN 1), etc, while the patients in the control group were treated with nonpenetrating sham acupuncture at the same acupoints as the observation group. The treatment was given once every other day, three times a week for 8 weeks. The patients in the waiting group only received health guidance for 8 weeks. Montreal cognitive assessment scale (MoCA) and mini-mental state examination (MMSE) were used before and after 8-week treatment in all three groups. The observation group and the control group were followed up for 2 months and evaluated with MoCA and MMSE.@*RESULTS@#The MoCA scores in the observation group after treatment and during follow-up were higher than before treatment (0.05). The MoCA scores in the control group after treatment and during follow-up were higher than before treatment (0.05). The difference before and after treatment in the observation group was higher than the control group and waiting group (0.05). The MMSE scores after treatment and during follow-up were higher than before treatment in the control group (0.05). The difference before and after treatment the observation group and control group was not significant (>0.05), and those in the two groups were higher than the waiting group (<0.01). The difference between follow-up and before treatment in the observation group was higher than the control group (<0.01), and the difference between follow-up and after treatment was lower than the control group (<0.01).@*CONCLUSION@# acupuncture method could improve cognitive impairment in elderly patients with mild cognitive impairment.

Effect of "Tongdu Tiaoshen" needling on cognitive dysfunction in patients with sepsis asso-ciated encephalopathy and its mechanism / 针刺研究

OBJECTIVE: To observe the efficacy of "Tongdu Tiaoshen" (dredging Governor Vessel and regula-ting mind,needling on the cognitive function of patients with sepsis associated encephalopathy (SAE). METHODS: A total of 64 patients with SAE were enrolled in the present study, and randomly and equally divided into a control group and a treatment group. Patients in the control group received conventional medicines and conventional needling treatment. The patients of the treatment group received conventional medicines and "Tongdu Tiaoshen" needling treatment. The treatment was conducted once daily for 10 days. The Montreal Cognitive Assessment (MoCA) scale was used to assess the therapeutic effect after the treatment. Serum interleukin-6 (IL-6) was detected by radioimmunoassay, serum C-reactive protein (CRP) was detected by immuno-scattering method, and arterial blood lactic acid (Lac) content was detected by blood gas analyzer. RESULTS: The effective rate in the treatment group was obviously higher than that in the control group (P<0.01). After the treatment, the MoCA scores were considerably increased in both groups compared with their own pre-treatment (P<0.01), and the MoCA scores in the treatment group were obviously higher than those of the control group in the visual space and executive function, attention and computational power, language, abstraction and delayed recall dimensions (P<0.01). The contents of IL-6, CRP and Lac in both groups were significantly decreased after the treatment relevant to those of their own pre-treatment (P<0.01), and were obviously lower in the treatment group than those in the control group (P<0.01). CONCLUSION: "Tongdu Tiaoshen" needling can significantly improve the cognitive function of SAE patients, which may be associated with its effect in reducing inflammatory reaction of sepsis.

Study of a screening system for mild cognitive impairment based on machine learning model / 上海交通大学学报（医学版）

Objective:To evaluate the reliability and validity of a computerized cognitive assessment system designed for screening mild cognitive impairment (MCI), and compare the screening accuracy among constructed different machine learning classification models. Methods:A group of random stratified samples of over 55 years old residents in the communities, nursing homes and memory-clinics from Shanghai and Henan were selected to assess their cognitive status using Montreal Cognitive Assessment (MoCA) by well-trained investigators. The reliability and validity were assessed by intrinsic consistency analysis and factor analysis, respectively. Taking the results of MoCA as standards, four machine learning classification algorithms, i.e., naïve Bayesian classification model, random forest classifier, Logistic regression classifier, and K-nearest neighbor classifier, were compared in accuracy and area under curve (AUC). Results:A total of 359 participants were included, the median age of whom was 63 years old. And 82.80% of them were secondary school graduates or below. According to the results of MoCA, 147 of them might be MCI. The Cronbach's α and KMO of this system were 0.84 and 0.78, respectively; Bartlett's sphericity test was significant (P<0.05); thirteen common factors could explain 75.10% of the system. The best classification model was naïve Bayesian classification model, and its accuracy and AUC were 88.05% and 0.941, respectively. Conclusion:The new designed computerized cognitive assessment system has been proved to be reliable and valid. The naïve Bayesian classification model has good classification accuracy.

Trastorno neurocognitivo leve en el climaterio con Evaluación Cognitiva Montreal / Mild neurocognitive disorder in the climacteric with Montreal Cognitive Assessment

Las mujeres en climaterio o transición menopáusica frecuentemente reportan quejas de memoria. El Estudio Esmeralda busca relacionar los Síntomas del Climaterio (SC) femenino en sus diferentes etapas: premenopausia (etapa -2, temprana de la transición menopáusica), perimenopausia (etapas -1 y +1ª, tardía de la transición menopáusica y temprana de postmenopausia) y postmenopausia (etapas +1b, +1c y +2, temprana de postmenopausia con tardía de postmenopausia), con posible deterioro del funcionamiento intelectual, que pudiera llevar a sospechar de Trastorno Neurocognitivo leve (TNCl). La muestra final quedó conformada por 100 mujeres con alto nivel de escolaridad entre 40 y 60 años de edad. Se realizó un estudio no experimental transversal con muestreo no probabilístico, utilizando la Evaluación Cognitiva Montreal (MoCA). Se obtuvieron resultados normativos en 43.27% de la muestra y Deterioro Cognitivo Leve (DCL) en 56.73%, encontrando diferencia de medias significativas al nivel 0.05 en las tres etapas de climaterio, resultando la mayor incidencia en perimenopausia, etapa de mayor disminución de estrógenos. Se concluye que cambios en la función intelectual, pueden estar asociados a variación hormonal. Se puede determinar TNCl en forma temprana, en busca de una atención primaria y puesta en marcha de reactivación de funciones intelectuales.

Women in the climacteric stage or menopausal transition, frequently report complaint in memory. Emerald Study search relate feminine climacteric syndrome in their different steps: premenopause (stage -2 early menopausal transition), perimenopause (stages -1 and +1a late menopausal transition and early postmenopause) and postmenopause (stages +1b, +1 c and +2 early postmenopause with late postmenopause), with a possible mild cognitive impairment, that carry on suspect of Mild Neurocognitve Disorder (mNCD). The final sample were 100 women with high schooling level between 40 and 60 years old. A nonexperimental, non-probability cross-sectional study was conducted through the Montreal Cognitive Assessment (MoCA). Normative results were obtained in 43.27% and mNCD in 56.73%, finding difference of significant means at the 0.05 level in the three stages of climacteric, resulting in the highest incidence in perimenopause, stage of greatest decrease in estrogen. It is concluded that changes in intellectual function may be associated with hormonal variation. mNCD can be determined early, in search of primary care and start-up of reactivation of intellectual functions.

A Multicenter, Randomized, Double-blind, Placebo-controlled Clinical Trial for Efficacy of Acetyl-L-carnitine in Patients with Dementia Associated with Cerebrovascular Disease

BACKGROUND AND PURPOSE: Acetyl-L-carnitine (ALC) is a widely used drug for various neurodegenerative diseases including dementia. The aim of the present study was to elucidate the efficacy of ALC in dementia patients with cerebrovascular disease (vascular cognitive impairment; VCI). METHODS: Fifty-six patients were randomized to treatment with 500 mg ter in die ALC, or placebo in this 28-week, double-blind, placebo-controlled trial. The primary outcome measure was the Korean version of Montreal Cognitive Assessment (MoCA-K). RESULTS: Following treatment with ALC, the cognitive function measured by the MoCA-K was significantly improved in the ALC-treated groups. However, other secondary outcomes were not statistically significant between ALC- and placebo-treated groups. In MoCA-K analysis, attention and language sub-items significantly favored the ALC-treated group. CONCLUSIONS: Compared with placebo, treatment with ALC 1,500 mg/day produced significant changes in MoCA-K in dementia patients with VCI. ALC was well tolerated in this population. Despite the study limitations, the findings suggested the potential benefits associated with the use of ALC in dementia patients with VCI.

Multicenter study on the treatment of cerebralcare granule for patients with mild and moderate vascular cognitive impairment / 中华行为医学与脑科学杂志

Objective To explore the improvement of cognitive impairment in patients with mild and moderate vascular cognitive impairment( VCI) treated with cerebralcare granule ( CG) and basic treat-ment.Methods From October in 2014 to December in 2016 year,143 cases of VCI patients were admitted from six hospitals in some areas of Hebei Province as the research objects,and divided into CG treatment group (experimental group,n=98) and conventional treatment group (control group,n=66).Three months and six months after treatment,the score of mental state examination ( MMSE) ,the Montreal cognitive assess-ment scale ( MoCA) and the daily living capacity scale( ADL) of the two groups were compared after 3 and 6 moths of treatment.Results ①The total score of MMSE in the experimental group was higher than that of the control group for six months after treatment, and the difference was statistically significant ( ( 23. 76 ± 4.02) vs (21.52±5.13),P<0.05).②Six months after treatment,the total score of MoCA ((21.06±4.66) vs (18.32±5.20)) and visual spatial/executive function((3.05±1.37) vs (2.42±1.66)),calculation force ((2.24±0.84) vs (1.83±1.05)) and orientation ability((5.20±1.12) vs (4.06±1.35)) scores in the ex-perimental group were significantly higher than those in the control group (P<0.05) .③Six months after treat-ment,the ADL score in the experimental group was lower than that before treatment,and the difference was statistically significant((24.96±8.74) vs (29.20±11.55),P<0.05);while there was no significant difference in the ADL score between the experimental group and the control group after 6 months (P>0.05).Conclusion CG can improve cognitive function in mild to moderate VCI patients,mainly in visual space/execution func-tion,calculation ability and orientation ability,and with the extension of treatment time,the curative effect is more obvious.

Clinical Observation of Grain-sized Moxibustion at Back-Shu Points of Zang-organs for Vascular Cognitive Impairment-no Dementia / 上海针灸杂志

Objective To observe the clinical efficacy and action mechanism of grain-sized moxibustion at Back-Shu points of Zang-organs in treating vascular cognitive impairment-no dementia (VCIND) due to marrow insufficiency. Method Ninety-two patients with VCIND due to marrow insufficiency were randomized into a grain-sized moxibustion group, an electroacupuncture group and a Western medication group. Since the grain-sized moxibustion group and electroacupuncture group each had 1 dropout case, there were 90 valid recruited cases, 30 in each group. Xinshu (BL15) and Shenshu (BL23) were selected as the major points, with Middle Line of Vertex (MS5), Middle Line of Forehead (MS1), Lateral Line 1 of Vertex (MS8), Zusanli (ST36), Sanyinjiao (SP6), Xuanzhong (GB39) and Taixi (KI3) as the adjunct points. The grain-sized moxibustion group and electroacupuncture group respectively received grain-sized moxibustion and electroacupuncture at Xinshu and Shenshu, and the adjunct points were treated with ordinary acupuncture. The intervention was given once a day, successive 5 d a week, and 4 weeks as a course of treatment, for 2 courses in total. The Western medication group was prescribed with oral administration of Piracetam tablet, 0.4 g per dose, 3 times a day, for successive 8 weeks. The clinical efficacies, Montreal Cognitive Assessment (MoCA) and Activities of Daily Living (ADL) scores, homocysteine (Hcy) and folic acid contents in serum were compared among the three groups after 8 weeks. Result The total effective rate was 86.7% (26/30) in the grain-sized moxibustion group, superior to 63.3% (19/30) in the electroacupuncture group and 36.7% (11/30) in the Western medication group (P<0.05,P<0.01). The MoCA and ADL scores and serum contents of Hcy and folic acid were significantly improved after the treatment in the three groups (P<0.01), and the grain-sized moxibustion group was significantly better than the electroacupuncture group and Western medication group (P<0.05,P<0.01), and the electroacupuncture group and superior to the Western medication group (P<0.05). Conclusion Grain-sized moxibustion at Back-Shu points of Zang-organs can produce significant efficacy in treating VCIND due to marrow insufficiency, and the effect is possibly realized by declining Hcy and increasing folic acid levels in blood.

Characteristics of cognitive dysfunction in essential tremor patients / 西安交通大学学报(医学版)

Objective To explore the characteristics and influencing factors of cognitive dysfunction in patients with essential tremor (ET).Methods We recruited ET patients diagnosed by the Department of Neurology of the First Affiliated Hospital of Xi`an Jiaotong University and healthy volunteers who matched the ET patients in age, gender and education level for the study.We recorded all the patients` demographic information, tremor degree, and family history based on the family tree.All the participants were tested by MMSE, MoCA, ADL, HAMD and HAMA.Results There were 88 ET patients and 63 normal subjects included in the study.According to MMSE, 31.82％ of the patients had cognitive dysfunctions, with orientation, short-term memory, calculation ability, language skills, retelling, reading comprehension, three-level command and drawing being significantly lower than those of the healthy volunteers (P<0.01);orientation was the most serious damage in cognitive function domain (K=0.624, S=0.726);three-level command was the least serious damage (K=0.274, S=0.319).According to MoCA, 86.36％ of the ET patients had cognitive dysfunction higher than normal people (P<0.05);visual space and execution, clock drawing task, naming, attention, 100-7, language skills, abstract thinking and orientation were significantly lower than normal people (P<0.01);the most serious damage in cognitive function domain was visual space and execution (K=0.651, S=0.786); the least serious damage cognitive function domain was “100-7” (K=0.406, S=0.484). Education level and age affected cognitive dysfunction (P<0.05). ADL scores showed negative correlation with cognitive function (correlation =－0.375 and －0.383, respectively; P<0.001). After the effects of anxiety and depression were excluded, onset age and tremor grading were correlated with cognitive dysfunction (P<0.05). When the above factors were put into binary Logistic regression model, education level was found to be contributed to the model (P<0.05).Conclusion Patients with ET widely suffer from cognitive impairment. Age, education level, daily life disability, age of onset, and tremor degree classification can affect cognitive dysfunction.

Comparison on effects of piracetam and oxiracetam on elderly cognitive dysfunction after cerebral hemorrhage / 药物评价研究

Objective To compare the effects of piracetam and oxiracetam on elderly cognitive dysfunction after cerebral hemorrhage.Methods Elderly patients (82 cases) with cerebral hemorrhage treated in Tongchuan People's Hospital from January 2012 to December 2015 were selected and divided into two groups according to the different treatment drugs.Two groups were treated by oxiracetam and piracetam respectively.The Montreal cognitive assessment scale (MoCA),simple mental state examination (MMSE),and daily life ability scale (ADL) score of the two groups before and after treatment were compared.The neuron-specific enolase levels and cognitive function after treatment of 1,3,and 6 months were also compared.Results After treatment,MoCA,MMSE,and ADL scores of two groups were significantly improved (P ＜ 0.05),and oxiracetam group were significantly better than piracetam group (P ＜0.05).After treatment 6 months,MoCA,MMSE,ADL effective and total effective rate of the two groups were significantly higher (P ＜0.05),and oxiracetam group were significantly better than those ofpiracetam group (P ＜ 0.05).After treatment for 1,3,and 6 months,the neuron-specific enolase levels were significantly lower than those before treatment (P ＜ 0.05),and in the treatment of 3 and 6 months,oxiracetam group were significantly lower than piracetam group (P ＜ 0.05).The incidence of adverse reactions had no significant difference.Conclusion Oxiracetam can improve the elderly cognitive dysfunction after cerebral hemorrhage,the curative effect was increased with the prolonging of the time,and can reduce the neuron-specific enolase levels,which has high clinical value.