Effect of electronic moxibustion on the volume of hippocampal subregion in patients with amnestic mild cognitive impairment / 中国组织工程研究

BACKGROUND:Current studies have shown that electronic moxibustion can improve memory function in amnestic mild cognitive impairment;however,its mechanism of action needs to be further investigated.The atrophy of hippocampal volume and impairment of functional connectivity are important imaging markers of amnestic mild cognitive impairment.Whether electronic moxibustion can regulate the volume of hippocampal subregion of partients with amnestic mild cognitive impairment is worth studying. OBJECTIVE:To observe the effect of electronic moxibustion on the volume of hippocampal subregions in patients with amnestic mild cognitive impairment. METHODS:Forty patients with amnestic mild cognitive impairment were recruited from April 1,2018 to January 31,2019 at the community service centers around the Second Affiliated Hospital of Shenzhen University(Baoan Hospital of Southern Medical University),Shenzhen,China.They were randomly divided into treatment group(n=20)and control group(n=20).The treatment group was treated with electronic moxibustion of regulating the mind and benefiting the intelligence,while the control group was treated with placebo moxibustion.Moxibustion was given at 45 oC,20 minutes each time,once a day,5 times a week,for 8 weeks in total.Memory evaluation using Rivermead behavioral memory test and magnetic resonance imaging scanning for detecting the hippocampal subregion volume were performed for each patient before and after treatment,and cognitive function of each patient was assessed using Montreal cognitive assessment and mini-mental state examination.Correlation of hippocampal subregion volumes with scores on each scale was analyzed. RESULTS AND CONCLUSION:After treatment,the volumes of the left parasubiculum and the left hippocampal-amygdala migrating area increased in the treatment group but decreased in the control group,and there was a significant difference between the two groups(P＜0.05).Compared with the pre-treatment data,the Rivermead behavioral memory test,Montreal cognitive assessment,and mini-mental state examination scores were significantly higher in the treatment group after treatment(P＜0.05),while there was no significant change in the three scale scores in the control group after treatment(P＞0.05).The three scale scores were higher in the treatment group than in the control group after treatment(P＜0.05).Pearson correlation analysis showed that the changes in the volume of the left parasubiculum was significantly and positively correlated with the Rivermead behavioral memory test scale score in the treatment group(r=0.418,P=0.014).To conclude,electronic moxibustion can improve memory in patients with amnestic mild cognitive impairment,and the mechanism may be the regulation of structural plasticity in hippocampal subregions.

Effect of support surface stability on balance in the elderly with mild cognitive impairment under different visual input conditions / 中国组织工程研究

BACKGROUND:Stability of the support surface and visual input are important factors affecting static balance,but most of the studies on the balance ability of elderly with mild cognitive impairment have focused on the stable hard support surface,and the control of static balance on the unstable support surface under different visual input conditions is not known. OBJECTIVE:To investigate the static balance ability of the elderly with mild cognitive impairment on soft and hard support surfaces under different visual input conditions. METHODS:Twenty-one elderly people with mild cognitive impairment and nineteen elderly people with normal cognition were selected for the study,and the Kistler three-dimensional dynamometer was used to conduct four tests:standing with two feet on hard support surface with eyes open,standing with two feet on soft support surface with eyes open,standing with two feet on hard support surface with eyes closed,standing with two feet on soft support surface with eyes closed,and standing with two feet on soft support surface with eyes closed,and the duration of each test was 30 seconds.The plantar center of pressure data were collected and compared between the two groups under different visual conditions on the soft and hard support surfaces. RESULTS AND CONCLUSION:(1)Under the condition of visual input,the total excursions(soft support surface:P=0.003),the total excursions-medial-lateral sides(soft support surface:P=0.001,hard support surface:P<0.001)and the 95%confidence ellipse area(soft support surface:P=0.001,hard support surface:P<0.001)of the center of pressure in the elderly with mild cognitive impairment on the soft and hard support surfaces were significantly higher than those of the elderly with normal cognition.(2)In the absence of visual input,the root mean square distance(P=0.014),the root mean square distance-medial-lateral sides(P=0.014),and the 95%confidence ellipse area(P=0.001)of center of pressure in the elderly with mild cognitive impairment on the soft support surfaces were significantly higher than those of the elderly with normal cognition,but there were no significant differences between the groups on the hard support surface(P>0.05).(3)These findings confirm that compared with the elderly with normal cognition who could make full use of visual sensory input to maintain body balance on the soft and hard support surfaces,mild cognitive impairment elderly presented a deficit in balance function.In particular,mild cognitive impairment elderly relied more on ankle proprioception to maintain balance when visual interference was present,suggesting that mild cognitive impairment elderly should focus on strengthening ankle proprioceptive training.

Research advances on mild cognitive impairment subtypes and their influencing factors / 中华老年医学杂志

Mild cognitive impairment(MCI)is a prodromal phase of dementia with heterogeneity in etiology, clinical presentation, disease progression, outcome, and prognosis.The number of studies on MCI subtypes is increasing each year.This article discussed the subtypes of MCI from the perspectives of phenotypic characteristics, etiology, progression, outcome, and data-driven approaches, and further summarizes the epidemiological characteristics, influencing factors, and risk of progression to dementia of each subtype.Despite the increasing number of studies on MCI subtyping, research remains limited on the correlation between MCI subtypes from different perspectives, indicating a need for further investigation in order to achieve more accurate and effective diagnosis and treatment of MCI and obtain evidence for dementia prevention.

Influencing factors for mild cognitive impairment among geriatric inpatients / 预防医学

Objective@#To investigate the influencing factors for mild cognitive impairment (MCI) among the elderly inpatients of the department of geriatrics, so as to provide the reference for early screening and prevention of MCI in the elderly population.@*Methods@#Inpatients aged 60 years and older and admitted to the Department of Geriatrics at the First Affiliated Hospital of Xinjiang Medical University were selected as the study subjects. Demographic information, past medical history, activities of daily living (ADL), depressive symptoms were collected through questionnaire surveys. MCI was diagnosed with Montreal Cognitive Assessment in combination with medical history and physical examination. Factors affecting MCI were identified using a multivariable logistic regression model.@*Results@#A total of 1 019 elderly patients were collected, including 472 males (46.32%) and 547 females (53.68%), and had a median age of 73.00 (interquartile range, 14.00) years. Among them, 746 patients had an educational level of junior high school or above, accounting for 73.21%, 446 patients had cerebrovascular disease, accounting for 43.77%, and 220 patients were diagnosed with MCI, with a detection rate of 21.59%. Multivariable logistic regression analysis showed that age (OR=1.354, 95%CI: 1.285-1.426), educational level (primary school, OR=0.345, 95%CI: 0.163-0.731; junior high school or above, OR=0.196, 95%CI: 0.096-0.402), ADL (moderate/severe dependence, OR=4.744, 95%CI: 2.044-11.012) and cerebrovascular disease (OR=2.335, 95%CI: 1.482-3.679) were the influencing factors for MCI among geriatric inpatients.@*Conclusions@#The MCI of the elderly inpatients of the department of geriatrics is related to age, educational level, ADL and cerebrovascular disease. Therefore, targeted health education and cognitive function training should be provided for elderly patients to prevent MCI.

The Associations of Serum Tryptophan and Tyrosine With Alzheimer’s Disease / 生物化学与生物物理进展

ObjectiveA growing body of research suggests a strong link between metabolic imbalance and Alzheimer’s disease (AD). In recent years, the development of metabolomics makes it possible to study the characteristic changes of peripheral metabolism in AD. Serum levels of tryptophan and tyrosine were associated with mild cognitive impairment (MCI) and AD. The purpose of this study is to further characterize tryptophan and tyrosine levels in MCI and AD. MethodsWe stratified 765 participants from the Alzheimer’s Disease Neuroimaging Initiative-1 (ADNI-1) cohort into cognitively normal (CN; n=207), stable mild cognitive impairment (sMCI; n=201), progressive mild cognitive impairment (pMCI; n=171), and dementia due to AD (n=186). Serum tryptophan and tyrosine were analyzed for diagnostic value of MCI and AD. To evaluate the relationships between serum tryptophan and tyrosine and cerebrospinal fluid (CSF) biomarkers, brain structure (magnetic resonance imaging, MRI), cerebral glucose metabolism (18F-fluorodeoxyglucose-positron emission tomography, FDG-PET), and cognitive declines, through different cognitive subgroups. ResultsSerum tryptophan was decreased in patients with AD, pMCI or sMCI compared with CN. Serum tyrosine was decreased in patients with AD or pMCI compared with CN. Serum tryptophan has diagnostic value for pMCI and AD. Serum tyrosine has diagnostic value for AD. ConclusionSerum tryptophan and tyrosine contribute to the early diagnosis of AD. The detection of tryptophan and tyrosine can contribute to the pathogenesis of AD. Serum tryptophan and tyrosine were not significantly associated with core AD markers, cognitive function, brain structure and brain metabolism, so serum tryptophan and tyrosine may not be good peripheral AD biomarkers.

Prevalence and influencing factors of mild cognitive impairment in the elderly in Songjiang District, Shanghai / 环境与职业医学

Background With the aging of China's population, cognitive impairment in the elderly is receiving increasing public attention. Screening and intervention of people with mild cognitive impairment (MCI) are of great significance to prevent and reduce the occurrence of cognitive impairment. Objective To understand the prevalence and explore potential influencing factors of MCI in the elderly in Songjiang District, Shanghai, and to provide scientific basis for promoting early screening of cognitive impairment and precise intervention of MCI in the elderly in this area. Methods A cross-sectional study design was adopted. From August to October 2022, using multi-stage random sampling, 1800 elderly residents aged 60 years and above were screened for cognitive impairment in 6 neighborhood/village committees in 6 towns in Songjiang District. The survey questionnaires included a sociodemographic questionnaire, a health status and lifestyle questionnaire, the Instrumental Activities of Daily Living (IADL), the Patient Health Questionnaire (PHQ-9), and the Mini-Mental State Examination (MMSE). Prevalence rates of MCI among the elderly by selected social demographic characteristics, health status, and lifestyle were estimated, and potential influencing factors of MCI were evaluated by binary logistic regression. Results A total of 209 elderly residents with MCI and 1591 healthy elderly residents were detected, and the prevalence of MCI in the elderly aged 60 and above was 11.6% in Songjiang District. Being physically active (OR=0.556, 95%CI: 0.399, 0.774) reduced the risk of MCI. Illiteracy (OR=1.810, 95%CI: 1.239, 2.644), primary school education level (OR=3.454, 95%CI: 2.342, 5.092), non-participation in social activities (OR=1.945, 95%CI: 1.360, 2.781), IADL damaged (OR=3.173, 95%CI: 2.137, 4.712), and depression (OR=1.957, 95%CI: 1.112, 3.443) increased the risk of MCI (P＜0.05). Conclusion The prevalence of MCI among the elderly in Songjiang District is lower than the national average. Educational level, physical activity, participation in social activities, IADL, and depression may be the influencing factors of MCI in the elderly. It is recommended to carry out early screening, early detection, and early intervention for cognitive impairment in the elderly. Improving involvement in physical exercise and increasing participation in social activities are encouraged. Special attention should be paid to the needs of vulnerable groups such as low education level and disabled elderly during a community MCI intervention program.

Mechanism of Fufang Congrong Yizhi Capsules in treatment of mild cognitive impairment based on network pharmacology / 中国药理学通报

Aim To predict the mechanism of Fufang Congrong Yizhi Capsules (FCYC) in the treatment of mild cognitive impairment (MCI) by network pharmacology method, and further validate it in combination with cellular experiments. Methods TCMSP, Gene-Cards, OMIM and TTD databases, Chinese Pharmacopoeia and related literature were used to screen the active ingredients of FCYC and the targets of MCI treatment. The TCM-compound-target-disease network and PPI of intersection targets were constructed, and the GO and KEGG analysis were performed by the Ehamb bioinformation platform. GO and KEGG analysis were performed through Yihanbo biological information platform. Cell model of MCI was established by PC-12 injury induced by Aβ

Application of auditory verbal learning test-Huashan version in patients with subjective cognitive decline and mild cognitive impairment / 中国康复医学杂志

Objective:To explore the diagnostic value of auditory verbal learning test-Huashan version(AVLT-H)of memo-ry impairment in patients with subjective cognitive decline(SCD)and mild cognitive impairment(MCI). Method:According to the inclusion criteria,the recruited elderly were screened and divided into three groups:normal cognition(NC),SCD and MCI group.The neuropsychological tests including mini-mental state exami-nation(MMSE),Montreal cognitive assessment-Beijing version(MOCA-BJ)and AVLT-H were completed af-ter inclusion.The scores of MMSE,MoCA-B,AVLT-N2,N3,N4,N5,N6 and N7 were recorded and analyzed. Result:There were significant differences in the scores of MMSE,MoCA and AVLT-H among the three groups(P＜0.0167).The adjusted Bonferroni test was used to detect significant differences in post-hoc comparison.There were significant difference in MMSE and MoCA scores between SCD and NC(P＜0.001)and between MCI and NC(P＜0.001).However,no significant difference between MCI and SCD was found.There were sig-nificant difference in N1 score between MCI and NC(P=0.013)and between MCI and SCD(P=0.001),but there was no significant difference between SCD and NC.There were significant difference in AVLT-N2,N3,N4,N5,N6 and N7 scores between MCI and NC(P＜0.001)and between MCI and SCD(P＜0.001),but there was no significant difference between SCD and NC.The area under the curve of MMSE,MoCA and AVLT-H scores were examined using NC group and SCD group as state variables,respectively.For differentiat-ing MCI and SCD,eAVLT-H scores had a larger area under the curve with higher sensitivity and specificity,N1 and N7 had the highest sensitivity.For distinguishing MCI from NC,AVLT-H and MoCA scores had a larger area under the curve with higher sensitivity and specificity,N4,N6 and N7 had the highest sensitivity. Conclusion:AVLT-H,combined with MMSE and MoCA,can improve the defining diagnostic sensitivity of MCI and SCD from normal cognition.It is recommended to routinely use AVLT-H in a routine assessment for MCI and SCD patients.

Progressing researches on brain structural magnetic resonance in the conversion from stable to progressive mild cognitive impairment / 中华行为医学与脑科学杂志

Mild cognitive impairment (MCI) is an unstable cognitive impairment state between normal aging and Alzheimer's disease (AD). The symptoms of MCI are mild and it has four different types of outcomes: reversing normal, maintaining stability, progression and death. However, 2/3 of MCI patients may still progress to dementia. Therefore, early identification of stable MCI (sMCI) and progressive MCI (pMCI) is beneficial for timely intervention, and delaying the progression of MCI, then improving patients' quality of life. Structural magnetic resonance imaging (sMRI) can predict dementia related neurodegeneration and cognitive decline. A large number of studies have found that, in addition to abnormalities in clinical scales, there are significant changes in sMRI during the progression of sMCI to pMCI, mainly including differences in cortical thickness and brain atrophy, hippocampal volume, and structural brain network connectivity. Especially, machine learning methods such as big data based neural convolutional networks are helpful in early prediction of sMCI and pMCI. These studies contribute to the discovery of early imaging markers for the conversion of sMCI to pMCI.

Meta-analysis of the association between late-life depression and mild cognitive impairment / 中国现代医生

@#Objective To systematically evaluate the correlation between elderly depression and mild cognitive impairment.Methods We searched the CNKI,VIP,WanFang Data,Cochrane Library,EMbase,Pubmed,and Web of Science databases using computer,and collected cohort studies on the correlation between elderly depression and mild cognitive impairment.The search time limit was from the establishment of the database to July 6,2023.Two researchers independently completed the literature screening,data extraction,and quality evaluation,and conducted a Meta-analysis using Review Manager 5.4 software.Results A total of 10 articles were included,with a total sample size of 26 813 people.The Meta-analysis showed that there was a correlation between elderly depression and mild cognitive impairment(OR=1.47,95%CI:1.25-1.72,P<0.001).Conclusion Current evidence indicates that elderly depression is one of the risk factors for the development of mild cognitive impairment.This conclusion is limited by the type,quality,and quantity of research,and needs to be validated by more high-quality research.

Asociación entre la salud oral y el deterioro cognitivo leve en adultos mayores / Association between Oral Health and Mild Cognitive Impairment in Older Adults

Introducción: En la medida que se incrementa la población de adultos mayores, aumenta la prevalencia, aumenta la prevalencia del deterioro cognitivo. Recientemente, se ha introducido la mala salud oral entre los factores de riesgo potenciales. Objetivo: Determinar la asociación entre la salud oral y el deterioro cognitivo leve en adultos mayores de una comunidad de la provincia de Santiago de Cuba. Métodos: Se realizó un estudio observacional, analítico y retrospectivo, de tipo casos y controles en el período comprendido entre enero y julio del año 2023. La población de estudio estuvo constituida por 257 adultos mayores que vivían en esta comunidad, de los cuales se escogieron 40 casos con diagnóstico de deterioro cognitivo leve, según los criterios de Petersen. Se seleccionaron tres controles por cada caso, 120 adultos mayores con aproximadamente las mismas características que el caso. Se precisó la fuerza de asociación de cada factor de riesgo. Resultados: Se halló una asociación significativa entre padecer deterioro cognitivo leve y presentar un número de 1 a 9 dientes. El dolor oral se presentó con mayor frecuencia en el 72,5 por ciento de los casos. No recordar la última visita al estomatólogo fue causa de deterioro cognitivo leve en el 42,5 por ciento. Cepillarse irregularmente se asoció 4,1 veces más con el riesgo de desarrollar esta afección. Conclusiones : Existe una asociación entre la salud oral y el deterioro cognitivo leve en los adultos mayores. Tener menos dientes y referir dolor oral fueron factores de riesgo importantes para presentar deterioro cognitivo. La visita al estomatólogo y el cepillado de dientes irregular influyeron negativamente en la enfermedad. Sin embargo, el uso de prótesis dentales fue un factor protector para el deterioro cognitivo leve(AU)

Introduction: Along with the increase in the population of older adults, the prevalence of cognitive impairment is increasing. Recently, poor oral health has been introduced among potential risk factors. Objective: To determine the association between oral health and mild cognitive impairment in older adults in a community in the province of Santiago de Cuba. Methods: An observational, analytical and retrospective case-control study was carried out from January to July 2023. The study population consisted of 257 older adults living in this community, from which 40 cases were selected with a diagnosis of mild cognitive impairment, according to Petersen's criteria. Three controls were selected for each case, 120 older adults with approximately the same characteristics as the case. The strength of association of each risk factor was determined. Results: A significant association was found between having mild cognitive impairment and having 1 to 9 teeth. Oral pain was more frequent in 72.5 percent of the cases. Not remembering the last visit to the dentist was a cause of mild cognitive impairment in 42.5 percent. Irregular brushing was 4.1 times more associated with the risk of developing this condition. Conclusions: There is an association between oral health and mild cognitive impairment in older adults. Having fewer teeth and reporting oral pain were important risk factors for cognitive impairment. Visiting the dentist and irregular tooth brushing had a negative influence on the disease. However, the use of dental prosthetics was a protective factor for mild cognitive impairment(AU)

Evaluación de validez convergente y discriminante de un protocolo de cribado online para detección de deterioro cognitivo leve en personas mayores en Chile

Introducción: La detección temprana del deterioro cognitivo en personas mayores permite disminuir la incertidumbre y mejorar las tareas de intervención. El objetivo de esta investigación fue determinar las características psicométricas de un protocolo de cribado online para detectar tempranamente deterioro leve en personas mayores. Método: el método usado fue de tipo mixta con preguntas de tipo cuantitativas y cualitativas. La muestra fue de 75 personas mayores del gran Concepción, región del Bio-Bio. El protocolo estaba compuesto por: Cuestionario sociodemográfico, Test del Reloj Versión Cacho, Moca, Escala Depresión Yesavage y Test Acentuación de Palabras. El procedimiento consistió en la aplicación del protocolo a través de un Tablet o Laptop, videollamadas. Resultados: Se encontró que el protocolo presenta validez discriminante y convergente. Conclusiones: se concluye que el protocolo de cribado online para detectar tempranamente deterioro leve en personas mayores es válido y fiable. Se discute el uso y la aplicación de un protocolo cribado usando la Teleneuropsicología (TeleNP), en personas mayores

ABTRACT Introduction: Early detection of cognitive impairment in the elderly allows us to reduce uncertainty and improve intervention tasks. The objective of this research was to determine the psychometric characteristics of an online screening protocol for early detection of mild impairment in the elderly. Method: the method used was of a mixed type with quantitative and qualitative questions. The sample consisted of 75 older people from the greater Concepción, Bio-Bio region. The protocol consisted of: Sociodemographic Questionnaire, Cacho Version Clock Test, Mocha, Yesavage Depression Scale and Word Stress Test. The procedure consisted of the application of the protocol through a Tablet or Laptop, video calls. Results: It was found that the protocol presents discriminant and convergent validity. Conclusions: it is concluded that the online screening protocol for early detection of mild deterioration in the elderly is valid and reliable. The use and application of a screening protocol using Teleneuropsychology (TeleNP) in older people is discussed.

Accuracy of the revised Addenbrooke Cognitive Examination (ACE-R) in older adults with low education and mild cognitive impairment: results of a cross-sectional study in two metropolitan areas of Northeast Brazil / Acurácia do Addenbrooke-versão revisada (ACE-R) em idosos com baixa escolaridade e comprometimento cognitivo leve: resultados de um estudo seccional em duas áreas metropolitanas do Nordeste do Brasil

ABSTRACT Objective To determine the diagnostic accuracy of the Addenbrooke's Cognitive Examination (ACE-R) for older adults with low education, without dementia, in two capitals in northeastern Brazil, compared to subjects with MCI. Methods 100 participants were collected from a previous neurological and psychiatric evaluation and were subsequently subjected to the ACE-R. Among them, 18 subjects with amnestic mild cognitive impairment (aMCI), 22 with non-amnestic mild cognitive impairment (naMCI), and 60 healthy controls. Results Optimal ACE-R accuracy yielded excellent values for the comparison between controls and naMCI [Area Under the Curve (AUC) = 0.919)] and controls and aMCI (AUC= 0.921); conversely, very fair accuracy was reported for the comparison between aMCI and naMCI (AUC= 0.578). Conclusions These findings support establishing reliable cutoff scores for cognitive assessment of elderlies with low schooling and cognitive decline, not dementia, taking into consideration ecological and regional variables.

RESUMO Objetivo Determinar a acurácia diagnóstica do Exame Cognitivo de Addenbrooke (ACE-R) para idosos com baixa escolaridade, sem demência, em duas capitais no nordeste do Brasil, comparando a sujeitos com CCL. Métodos Foram coletados 100 participantes a partir de uma avaliação neurológica e psiquiátrica prévia, sendo submetidos aos ACE-R posteriormente. Dentre eles, 18 sujeitos com comprometimento cognitivo leve amnéstico (aCCL), 22 com comprometimento cognitivo leve não amnéstico (naCCL) e 60 controles saudáveis. Resultados Os pontos de acurácia do ACE-R foram considerados excelentes para a comparação entre controles e naCCL [Área sob a curva (AUC) = 0,919)] e controles e aCCL (AUC= 0,921); por outro lado, foi relatada uma baixa acurácia para a comparação entre aCCL e naCCL (AUC= 0,578). Conclusões Os achados dão suporte à necessidade de estudos estabelecendo pontos de corte confiáveis para a avaliação cognitiva de idosos com baixa escolaridade e declínio cognitivo sem demência, levando-se em consideração variáveis ecológicas e regionais.

Predictors of efficacy, tolerability and discontinuation of Transcranial Direct Current Stimulation (tDCS) for Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD): a meta-analysis and meta-regression

Numerous patients with mild cognitive impairment (MCI) or Alzheimer's disease (AD) are refractory to pharmacological treatment, and non-invasive brain neurostimulation has been investigated as another possibility for improving cognition. The performed meta-analysis and meta-regression verified predictors of efficacy, tolerability, and discontinuation of transcranial direct current stimulation (tDCS) for treating MCI or AD. The analyzed studies used the Mini-Mental State Exam, Montreal Cognitive Assessment, or Alzheimer's Disease Assessment Scale - Cognitive Subscale scores as outcome measures. Databases (PubMed, Embase, and Web of Science - primary collection) were searched, resulting in 12 published randomized and controlled trials. The risk of bias assessment was based on Cochrane Review recommendations, considering study characteristics. Other evaluated outcomes were the number of adverse effects (tolerability) and dropouts. Overall and anodal tDCS improved cognition compared to the sham protocol. Group comparisons did not show statistically significant differences for adverse effects and dropouts. Session duration was a response predictor, as stimulations of up to 20 minutes for ten days or more improved the outcome achievement. The AD diagnosis covariate also affected efficacy. The findings should be interpreted carefully in clinical practice because the stimulation effect may vary among subjects.

Alertamientos y movimientos periódicos de las piernas durante las etapas de sueño y deterioro cognitivo leve en adultos mayores. Estudio preliminar / Arousals and periodic leg movements during sleep stages and mild cognitive impairment in older adults: a preliminary study

RESUMEN La fragmentación del sueño puede asociarse con distintas enfermedades, entre ellas, la demencia. En este sentido, la fragmentación de sueño, indicada por el índice de alertamientos y/o movimientos periódicos de las piernas (MPP), podría ser un marcador temprano de deterioro cognitivo leve (DCL), un síndrome precursor de la demencia. El objetivo del presente estudio fue medir el índice de prevalencia de los alertamientos y de los MPP durante el sueño en un grupo control y un grupo con DCL, así como determinar si hay diferencia entre los grupos en ambos índices y establecer si existe una correlación entre los dos fenómenos. En 9 participantes (3 mujeres controles y 3 mujeres con DCL; y 3 hombres con DCL) (edad: 69.1 ± 5; años de educación: 8 ± 2) se registró una noche de polisomnografía. Se obtuvieron los índices por hora de alertamientos y para cada etapa de sueño, así como los MPP globales y por hora; además se realizaron análisis entre y dentro de cada grupo. Se encontró una correlación positiva y un mayor número de MPP que de alertamientos durante toda la noche en los participantes con DCL. Conocer la prevalencia y asociación de ambos fenómenos contribuye en la formulación de una evaluación más cuidadosa y profunda de los adultos mayores en riesgo de desarrollar DCL y/o demencia.

ABSTRACT Sleep fragmentation may be associated with several diseases, including dementia. In this sense, sleep fragmentation, indicated by the rates of arousals and/or periodic leg movements (PLM), could be an early marker of Mild Cognitive Impairment (MCI), a syndromic stage prior to dementia. Therefore, the objective of this study was to compare the index of PLM with that of arousals and correlate both indexes in people with MCI and without MCI during all sleep stages. In 9 participants (3 control women and 3 women with MCI; and 3 men with MCI) (ages: 69.1 ± 5; years of education: 8 ± 2), one night of polysomnography was performed. Hourly rates of arousals and PLM were scored from each sleep stage. Analyses were performed within and between PLM and arousals for each group. Significant differences and a positive correlation were found between the arousal and the PLM rates for the group with MCI during the whole night. Knowledge of the prevalence and the association of both phenomena may contribute to a more careful and thorough evaluation of older adults at risk of developing MCI and/or dementia.

Predictores de riesgo de deterioro cognitivo leve en una población de hipertensos / Predictors of Mild Cognitive Impairment in a Hypertensive Population

RESUMEN Introducción. El estatus cognitivo es considerado un biomarcador del daño vascular encefálico en la hipertensión arterial (HTA). Es fundamental en pacientes con HTA la pesquisa del deterioro cognitivo leve (DCL). Objetivos . Valorar la presencia de factores predictores de DCL en pacientes hipertensos. Material y métodos . Estudio observacional, transversal, en el periodo 2015-2023. Se incluyeron pacientes mayores de 18 años, asistidos en policlínica que hubieran realizado la Evaluación Cognitiva de Montreal (MoCA). Se consideró valor de MoCA alterado uno < 24. Se excluyeron pacientes con dificultades motoras, sensoriales, enfermedad psiquiátrica, analfabetismo. Las variables cualitativas se presentan como frecuencias absolutas y relativas, y para el estudio de asociación se utilizó test de Chi cuadrado. Las variables cuantitativas se presentan como media y desviación estándar, y el estudio de diferencias se realizó con test T de Student para muestras independientes. En el análisis de regresión logística múltiple se colocaron aquellas variables significativas en el análisis univariado por el método Forward. Nivel de significación alfa = 0,05. Resultados . 129 pacientes, mujeres: hombres 2:1; edad promedio 60 años. El 79,1 % tenía HTA grado 3, 30,4 % presentaban más de 20 años de evolución de HTA. El 52,7% tenía escolarización primaria. Un 89,4 % presentaba sobrepeso-obesidad, el 36,4 % tabaquismo, 29,7 % dislipidemia mixta. Un 65,1% presentó un valor de MoCA ≥ 24 y el 34,9 % un valor < 24. En el modelo predictor logístico, las variables evolución en años de HTA, dislipidemia mixta, y enfermedad cerebrovascular fueron predictoras de riesgo de MoCA alterado. El nivel educativo terciario fue factor protector. Conclusión . La identificación de factores predictores de daño cognitivo es prioritaria para una acción preventiva. En este estudio las variables tiempo de evolución de la HTA, dislipidemia mixta, enfermedad cerebrovascular y nivel educativo permitieron predecir mayor riesgo de DCL.

ABSTRACT Background . Cognitive status is considered a biomarker of vascular brain damage caused by hypertension (HTN). Screening for mild cognitive impairment (MCI) is essential in patients with HTN. Objectives . The aim of this study was to evaluate the presence of predictors of MCI in hypertensive patients. Methods . We conducted an observational and cross-sectional study between 2015 and 2023. All the patients > 18 years treated in a clinic and who were evaluated with the Montreal Cognitive Assessment (MoCA) were included. A score < 24 in the MoCA test was considered abnormal. Patients with motor or sensory impairment, psychiatric disorders, or illiteracy were excluded. Qualitative variables are presented as absolute frequencies and percentages, and the chi-square test was used to analyze their association. Quantitative variables are expressed as mean ± standard deviation and were compared with the independent samples t-test. All the variables with statistical significance in the univariate analysis through forward selection were included in the multiple logistic regression analysis. A p value < 0.05 was considered statistically significant. Results . A total of 129 patients were included (women-to-men ratio 2:1; mean age 60 years); 79.1% had stage 3 HTN, time from HTN diagnosis was > 20 years in 30.4%, 52.7% had complete primary education, 89.4% had overweight/obesity, 36.4% were smokers and 29.7% had mixed dyslipidemia. A score ≥ 24 in the MoCA was present in 65.1% and 34.9% had a score < 24. The logistic predictor model identified time from HTN diagnosis, mixed dyslipidemia and cerebrovascular disease as predictors of abnormal MoCA. A tertiary educational level had a protective effect. Conclusion . Identifying predictors of cognitive impairment is a priority to take preventive actions. In this study, time from HTN diagnosis, mixed dyslipidemia, cerebrovascular disease and educational level were associated with cognitive impairment.

Subjective Cognitive and Communicative Complaints and Health-Related Quality of Life in Parkinson's Disease with and without Mild Cognitive Impairment / Quejas subjetivas cognitivas y comunicativas y Calidad de Vida Relacionada con la Salud en la Enfermedad de Parkinson con y Sin Deterioro Cognitivo Leve

ABSTRACT Introduction: Mild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients' subjective cognitive and communicative difficulties has not been explored. Objective: We aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints. Methods: We included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted. Results: PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores. Conclusions: HRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psy-chotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD.

RESUMEN Introducción: El deterioro cognitivo leve (DCL) es frecuente en la enfermedad de Parkinson (EP). Pocos estudios han comparado la calidad de vida relacionada con la salud (CVRS) en pacientes con DCL debido a EP (EP-DCL) sin explorar la relación entre la CVRS y las quejas subjetivas cognitivas y comunicativas de los pacientes. Objetivo: Comparar la CVRS en EP-DCL y EP sin DCL (EP-nDCL) explorando sus posibles relaciones con las quejas subjetivas cognitivas y comunicativas. Métodos: Se incluyó a 29 EP-DCL y 11 EP-nDCL. La CVRS se evaluó con el cuestionario PDQ-39: su dimensión Cognición se usó como medida de las quejas subjetivas cognitivas; su dimensión Comunicación, como medida de las quejas subjetivas comunicativas y su puntuación resumen (PDQ-39 SI), como indicador de CVRS. Se realizaron correlaciones parciales no paramétricas entre el PDQ-39 SI ajustado y las dimensiones Cognición y Comunicación. Resultados: Los pacientes EP-DCL presentaron una peor CVRS y mayores quejas subjetivas cognitivas y comunicativas. En el grupo EP-DCL, tanto las quejas subjetivas cognitivas como las comunicativas mostraron correlaciones directas significativas con la puntuación de CVRS ajustada. Conclusiones: La CVRS de los pacientes con EP-DCL parece estar afectada e influida por las quejas subjetivas en cognición y comunicación. Incluir los resultados de CVRS reportados por los pacientes, proveer rehabilitación cognitiva y del lenguaje y estrategias de psicoterapia para afrontar dicho déficit podrían mejorar el abordaje centrado en el paciente en la EP.

¿Es posible impedir el progreso del deterioro cognitivo leve por medio de tratamientos no farmacológicos? / Is It Possible to Prevent the Progression of Mild Cognitive Impairment Through Non-Pharmacological Treatments?

RESUMEN Introducción: El deterioro cognitivo leve produce ligeras perturbaciones cognitivas y motoras que no afectan a la vida cotidiana durante el envejecimiento; sin embargo, de no controlarse este síntoma, puede aumentar la velocidad del deterioro e incluso pueden manifestarse algunos casos de demencia en los adultos mayores. Objetivo: Describir los tratamientos no farmacológicos para prevenir, controlar y reducir los síntomas del deterioro cognitivo leve. Métodos: Se realizó una búsqueda inicial en las bases de datos PubMed, Lilacs, EBSCO, Scien-ceDirect, Taylor & Francis y ProQuest. Los resultados se filtraron a través del sistema PRISMA y se evaluaron los sesgos mediante el Manual Cochrane de revisiones sistemáticas de intervenciones. Resultados: Se construyeron 4 categorías de tratamientos no farmacológicos con los 50 artículos encontrados en la búsqueda, las cuales contribuyen a controlar y mejorar áreas cognitivas y motoras con el fin de reducir los síntomas del deterioro cognitivo leve. Los tratamientos tienen métodos, instrumentos y objetivos diferentes, por lo que no se pudo realizar un metaanálisis de los estudios. Asimismo, se encontraron limitaciones relacionadas con la muestra, la efectividad de los resultados y la calidad metodológica. Conclusiones: Se encontró que los tratamientos no farmacológicos previenen, mejoran y controlan los síntomas del deterioro cognitivo leve, pero es necesario realizar más estudios con mejores metodologías que corroboren estos resultados.

ABSTRACT Introduction: Mild cognitive impairment produces slight cognitive and motor disturbances without affecting daily life during aging, however, if this symptomatology is not controlled, the speed of deterioration can increase, and even some cases of dementia can appear in the elderly population. Objective: To describe non-pharmacological therapies that seek to prevent, control and reduce the symptoms of mild cognitive impairment. Methods: An initial search was carried out in the databases of PubMed, Lilacs, EBSCO, ScienceDirect, Taylor & Francis and ProQuest. The results found were filtered through the PRISMA system and biases evaluated using the Cochrane Handbook for Systematic Reviews of Interventions. Results: Four categories of non-pharmacological therapies were created, using 50 articles found in the search, which contribute to controlling and improving cognitive and motor areas, in order to reduce the symptoms presented by mild cognitive impairment. The treatments have different methods, instruments and objectives, so that no meta-analysis of the studies could be performed. In addition, limitations related to the sample, the effectiveness of the results and the methodological quality were found. Conclusions: It was found that non-pharmacological therapies prevent, improve and control the symptoms caused by mild cognitive impairment, however, it is necessary to carry out more studies with better methodologies to corroborate these results.

Asociación entre los niveles de vitamina B12 y el deterioro cognitivo en personas mayores / Association between vitamin B12 levels and cognitive impairment in older adults

Resumen Introducción: Aún es controversial si la deficiencia de vitamina B12 se asocia a alteraciones cognitivas. Objetivo: Conocer la asociación entre los niveles séricos de vitamina B12 y el desempeño cognitivo. Métodos: Se incluyeron 241 personas ≥ 60 años con medición de niveles séricos de vitamina B12. Se realizó evaluación física y cognitiva y se formaron tres grupos: cognición normal (CN), deterioro cognitivo leve (DCL) y demencia. Los niveles de vitamina B12 se clasificaron en suficiencia (> 400 pg/mL), deficiencia subclínica (201-400 pg/mL) y deficiencia absoluta (≤ 200 pg/mL). Se realizó análisis de regresión lineal multivariado para evaluar la asociación entre función cognitiva y niveles de vitamina B12 después de controlar las variables confusoras. Resultados: La media de edad fue 81.4 ± 8.0 años; 68 % fue del sexo femenino; 17.8 y 39.8 % presentaron deficiencia absoluta y subclínica de vitamina B12; 80 individuos (33 %) cumplieron los criterios de DCL y 70 (29 %), de demencia. Después de ajustar por edad, sexo y escolaridad, los sujetos con DCL y demencia tuvieron niveles más bajos de vitamina B12 comparados con aquellos con CN (p = 0.019). Conclusiones: Se observó asociación estadísticamente significativa entre el desempeño cognitivo global y los niveles bajos de vitamina B12.

Abstract Introduction: Whether vitamin B12 deficiency is associated with cognitive impairment remains controversial. Objective: To determine the association between vitamin B12 serum levels and cognitive performance. Methods: Two-hundred and forty-one adults aged ≥ 60 years who had serum vitamin B12 serum levels measurement were included. Physical and cognitive evaluation was carried out, and three groups were formed: normal cognition (NC), mild cognitive impairment (MCI) and dementia. Vitamin B12 levels were classified as sufficiency (> 400 pg/mL), subclinical deficiency (201-400 pg/mL), and absolute deficiency (≤ 200 pg/mL). Multivariate linear regression analysis was used to evaluate the association between cognitive function and vitamin B12 levels after controlling for confounding variables. Results: Mean age was 81.4 ± 8.0 years; 68% were females; 17.8 % and 39.8% had absolute and subclinical vitamin B12 deficiency, respectively; 80 individuals (33%) met the criteria for MCI, and 70 (29%), for dementia. Those with MCI and dementia had lower vitamin B12 levels in comparison with those with NC after adjusting for age, gender and educational level (p = 0.019). Conclusions: A statistically significant association was observed between global cognitive performance and levels of vitamin B12.

Revisiting global cognitive and functional state 13 years after a clinical trial of lithium for mild cognitive impairment

Objectives: To re-evaluate a sample of older adults enrolled in a randomized controlled trial of lithium for amnestic mild cognitive impairment (MCI) after 11 to 15 years, re-assessing their current (or last available) global cognitive and functional state. Methods: We recalled all former participants of the Lithium-MCI trial conducted by our group between 2009 and 2012 to perform a single-blinded, cross-sectional evaluation of their global clinical state to compare the long-term outcome of those who received lithium vs. those who received placebo. Results: Of the original sample (n=61), we were able to reach 36 participants (59% of retention), of whom 22 had previously received lithium (61% of the recall sample) and 14 (39%) had received placebo. Since 30.5% of the recalled sample was deceased, psychometric data were collected only for 69.5% of the participants. We found statistically significant differences in current mean Mini Mental State Examination score according to previous treatment group (25.5 [SD, 5.3] vs. 18.3 [SD, 10.9], p = 0.04). The lithium group also had better performance in the phonemic Verbal Fluency Test than the control group (34.4 [SD, 14.4] vs. 11.6 [SD, 10.10], p < 0.001). Differences in these measures also had large effect sizes, as shown by Cohen's d values of 0.92 and 1.78, respectively. Conclusion: This data set suggests that older adults with amnestic MCI who had been treated with lithium during a previous randomized controlled trial had a better long-term global cognitive outcome than those from a matched sample who did not receive the intervention.