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.

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.

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.

Application of MoCA and MMSE in screening for cognitive impairment in acute ischemic stroke / 中华行为医学与脑科学杂志

Objective To compare the applicability of the Beijing Version of the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) in screening for cognitive impairment in patients with acute ischemic stroke for 2-3 weeks.Methods MoCA and MMSE were conducted in 201 patients with acute ischemic stroke within 2 to 3 weeks after the onset of stroke.With MoCA＜23 and MMSE ＜26 as the cut off value,we assessed the clinic effect of the MoCA and MMSE and explored the correlation between two instruments.Results The average scores of MoCA and MMSE scale were (20.5±4.3) and (25.4±3.5) points.The prevalence of cognitive impairment evaluated with MoCA and MMSE were 57.2％and 43.3％,respectively.MoCA showed significant correlation with MMSE score (Pearson's correlation coefficient=0.833,P＜0.001),and an agreement with Kappa values of 0.532 (P＜0.01) in screening for cognitive impairment.Conclusions The prevalence of cognitive impairment assessed with MoCA is higher than that of with MMSE when using MoCA＜23 and MMSE＜26 as the cut off values.Both instruments show a good agreement for screening cognitive impairment in acute ischemic stroke within 2 to 3 weeks following the disease onset.

A Comparison of the Performances on the MMSE, HDS-R, and MoCA According to the CDR Sum of Boxes in Amnestic Mild Cognitive Impairment and Vascular Mild Cognitive Impairment

BACKGROUND: O'Bryant et al. (2008) argued that the CDR Sum of Boxes (CDR-SB) can be used to distinguish MCI from very early dementia in patients with CDR-GS of 0.5. They reported that the optimal CDR-SB cut-off score was 2.5. The present study was conducted to examine whether the subgroups classified with CDR-SB scores showed the corresponding group differences on the cognitive tests. METHODS: The subjects were 45 amnestic multi-domain MCI (amMCI) and 53 vascular MCI (VaMCI) with CDR-GS of 0.5. Each patient group was classified into "mild (0.5-2.0)" and "severe (2.5-4.0)" subgroups based on the CDR-SB. As the result, 4 groups were formed such as mild amMCI (n=23), severe amMCI (n=22), mild VaMCI (n=29), and severe VaMCI (n=24). The subjects were given the MMSE, HDS-R, and MoCA. The MANCOVA was conducted separately for each test with a Bonferroni correction for multiple comparisons. RESULTS: Severe groups of both amMCI and VaMCI showed significantly lower performances than two mild groups in MMSE, HDS-R, and MoCA. It was found that "serial 100-7" was a good item to discriminate between the mild and severe groups in both amMCI and VaMCI. Items measuring "orientation" or "naming" showed significant subgroup differences in the amMCI, whereas items related to "memory," "visuospatial construction," or "frontal/executive function" showed significant subgroup differences in the VaMCI. CONCLUSION: These results showed that there were significant differences in cognitive functions between the two subgroups with CDR-GS of 0.5. The results about the items discriminating between subgroups in amMCI and VaMCI were consistent with the previous findings about the progression of cognitive impairments in AD and VaD. Therefore, these results support the use of CDR-SB as a guideline for distinguishing MCI from early dementia.

Estudos de adaptação do montreal cognitive assessment (MoCA) para a população portuguesa / Adaptation studies of the montreal cognitive assessment (MoCA) to the portuguese population

O Montreal Cognitive Assessment (MoCA) é um instrumento de rastreio cognitivo mais sensivel que o Mini-Mental State Examination (MMSE) aos estádios mais ligeiros de declínio, nomeadamente ao Défice Cognitivo Ligeiro (DCL), que frequentemente progride para Demência. Este trabalho descreve as etapas do processo de adaptação transcultural do MoCA para a população portuguesa e analisa a equivalência entre a versão original e a versão final portuguesa. O processo envolveu a tradução, retroversão, aperfeiçoamento linguístico do instrumento e manual, estudos com a versão experimental, revisão e ajustamento necessários para finalizar a versão portuguesa, e análise da equivalência com a original. Os estudos realizados evidenciaram as boas proriedades psicométricas dos resultados com a versão portuguesa do MoCA, a sua validade, utilidade clínica e equivalência com a prova original, nos diversos níveis considerados. O MoCA é um instrumento privilegiado na detecção precoce do declínio cognitivo e está convenientemente adaptado para a população portuguesa.

The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument with greater sensitivity than the Mini-Mental State Examination (MMSE) to milder stages of cognitive decline, especially to Mild Cognitive Impairment (MCI), which often progress do Dementia. This paper describes the stages of cultural adaptation of MoCA to the Portuguese population and analyzes the equivalence between the original and the Portuguese final version. The process involved translation, linguistic improvement of the instrument and manual, studies with the experimental version, revision and adjustments required to finalize the Portuguese version, and analysis of equivalence to the original version. Studies corroborate MoCA's good psychometric properties, its validity, clinical utility, and equivalence to the original instrument in various levels considered. The MoCA is a privileged instrument for early detection of cognitive decline that is properley adapted to the Portuguese population.

Advance in Evaluation and Rehabilitation of Mild Cognitive Impairment after Stroke(review) / 中国康复理论与实践

@#This paper reviewed the Methods of evaluation and rehabilitation of mild cognitive impairment (MCI) after stroke. The Results showed that the Methods of evaluation included Mini Mental State Examination(MMSE), three Methods designed by The National Institute for Neurological Disorders and Stroke(NINDS) and The Canadian Stroke Network(CSN), and Montreal Cognitive Assessment (MoCA) and category test. The MoCA as the focus is brief, practical and effective as the major advantages. Many Methods of rehabilitation existed are still lack of evidence to support their efficacy.

The application of the Montreal cognitive assessment for elderly in China / 中华行为医学与脑科学杂志

Objective To explore the cognitive changes of patients with MCI using the Montreal Cognitive Assessment(MOCA) for elderly preliminarily.Methods 85 normal controls (NC),117 subjects with mild cognitive impairment (MCI) and 73 patients with Alzheimer's disease (AD) were assessed with the MOCA.Results There were significant differences among the three groups in all items of MOCA(F=258.66,P＜0.01).Significant differences were observed in almost all the sub-tests between MCI group and NC group or MCI group and AD group(visuopatial F=54.86,P＜0.01;naming F=17.30,P＜0.01;attention F=82.50,P＜0.01;language F=25,88,P＜0.01;abstraction F=15.00 ,P＜0.01;delayed recall F=130.49,P＜0.01;orientation F=176.09,P＜0.01.).The most significant differences were found in delayed recall and orientation among three groups(F=176.09,P＜0.01;F=130.49,P＜0.01.).At 26 cut-point,The results of screening of the MOCA agree with the gold standard of clinical diagnose for the patient with MCI.The agreement rate for observation was 0.93.The agreement rate by chance was 0.61.The Kappa was 0.85.Conclusions The MOCA appropriately define MCI,NC and AD in their cognitive function,it has good discriminant validity.The test of delayed recall and orientation may be more sensitive in the detection of the older people.The MOCA is a useful screening instrument for the patient with MCI.