Developing a Brief Neuropsychological Battery for Early Diagnosis of Cognitive Impairment

ObjectivesEarly diagnosis of cognitive impairment is increasingly emphasized in the literature to facilitate timely preventive interventions. Although bedside cognitive tests such as the Montreal Cognitive Assessment (MoCA) are widely used for such early diagnostic purposes, they may not have comparable performance to a full neuropsychological battery (FNB) in diagnosing early cognitive impairment. This study investigated whether a small subset of neuropsychological tests can be added on to MoCA to match its performance to that of the FNB in discriminating mild cognitive impairment and dementia (MCI/dementia) from normal cognition.DesignCross-sectional diagnostic study.SettingAlzheimer's Disease Centers across the United States.ParticipantsOlder participants (≥50 years) who completed MoCA and the FNB (N = 9187).MeasuresThe study sample was split into two: the derivation sample (n = 1837) was used to develop a brief neuropsychological battery that best discriminated MCI/dementia (using the best-subset approach with 10-fold cross-validation); while the validation sample (n = 7350) verified its actual performance in discriminating MCI/dementia.ResultsA 3-item neuropsychological battery was identified, comprising MoCA, Benson Complex Figure Recall, and Craft Story 21 Delayed Recall. It had excellent performance in discriminating MCI/dementia from normal cognition (area under the receiver operating characteristic curve [AUROC] 90.0%, 95% confidence interval [CI] 89.2%-90.7%), which was comparable to that of the FNB (AUROC 88.4%, 95% CI 87.6%-89.2%). By contrast, MoCA alone had significantly worse AUROC (86.9%, 95% CI 86.0%-87.7%) than that of the FNB.Conclusions/ImplicationsUsing rigorous methods, this study developed a brief neuropsychological battery that maintained the brevity of a bedside cognitive test, while rivaling the diagnostic performance of an FNB in early cognitive impairment. This brief battery offers a viable alternative when the FNB is needed but cannot be feasibly administered in nonspecialty clinics. It can have a wider health systems effect of improving patients’ access to accurate diagnosis in early cognitive impairment and facilitating timely interventions to delay the progression of cognitive impairment.     

益气养阴活血利水法联合康柏西普对非增殖期糖尿病视网膜病变患者视网膜电图的影响

目的:观察益气养阴活血利水法联合康柏西普对非增殖期糖尿病视网膜病变(NPDR)患者视网膜电图(ERG)的影响。方法:60例(82眼)NPDR患者,采用随机数字表法分为两组,对照组30例(40眼)玻璃体腔注射康柏西普,每月1次,治疗组30例(42眼)在对照组的基础上加用益气养阴活血利水中药口服治疗。治疗3个月后,观察两组患者BCVA、ERG,OCT检测两组患者CMT情况。结果:两组患者治疗前后不同时间BCVA、暗适应及明适应ab波振幅、CMT差异有统计学意义(P<0.05),治疗后不同时间两组患者BCVA、明暗适应ab波振幅、CMT相比,差异均有统计学意义(P<0.05)。结论:益气养阴活血利水法联合康柏西普较单纯康柏西普治疗能更好的减轻NPDR患者视网膜水肿,提高视力、暗适应及明适应a、b波振幅,降低CMT。     

Role of Superb Microvascular Imaging in Differentiating Between Malignant and Benign Solid Breast Masses

IntroductionThe purpose of this study was to evaluate the diagnostic performance of superb microvascular imaging (SMI) in breast lesions.Materials and MethodsEighty-five solid breast lesions were studied with color Doppler flow imaging (CDFI), power Doppler imaging (PDI), monochromatic SMI (mSMI), and contrast-enhanced ultrasonography (CEUS). The penetrating vessels (PVs) and microvascular morphologic and distribution features of the breast tumors were evaluated for each modality.ResultsThe diagnostic accuracies of CDFI, PDI, mSMI, and CEUS were calculated and compared. Surgical pathologic analysis showed 47 benign and 38 malignant lesions. Compared with CDFI and PDI, mSMI and CEUS detected more PVs in breast lesions. The microvascular architecture showed significant differences between benign and malignant lesions. Benign lesions mainly displayed avascular, line-like, and branch-like patterns, and malignant lesions tended to display root hair-like and crab claw-like patterns. mSMI and CEUS identified more root hair-like and crab claw-like patterns in malignant lesions than CDFI and PDI. The sensitivity, negative predictive value, and accuracy of mSMI findings in diagnosing malignancy based on PVs and vascular patterns were both higher than those of CDFI and PDI.ConclusionsmSMI is equal to CEUS and superior to CDFI and PDI in identifying microvascular and discriminating malignant and benign breast masses.     

The Role of Contrast-Enhanced Ultrasound in Managing Vascular Pathologies

IntroductionUltrasound is a useful first-line imaging modality for diagnosing and monitoring vascular pathologies. Compared with other modalities, it is relatively low cost, requires no ionizing radiation, is often available at bedside, and is noninvasive. However, the modality can have limitations when differentiating normal from pathologic tissues. In this review, we discuss the role of contrast-enhanced ultrasound (CEUS) in carotid, aortic, and peripheral vascular conditions.DiscussionCEUS is a developing modality that supersedes standard vascular ultrasound imaging and complements other modalities such as computed topography and magnetic resonance angiograms. Administered intravenously, the contrast are microbubbles filled with gas, surrounded by a stabilizing shell. They have the ability to enhance the quality of images and quantify vascular pathologies by acting as intravascular tracers of ultrasound energy. Based on these properties, CEUS has the potential to play a pivotal role in the management of vascular pathologies through its utility in detection, diagnosis, risk-stratification, follow-up, and monitoring.ConclusionStudies have suggested that CEUS is superior compared with standard ultrasound and on-par with computed topography angiograms in the detection of vascular pathologies, concluding that CEUS should be part of standardized routine practice.     

芪参益气滴丸对急性心肌梗死PCI术后患者血清学指标及预后的影响

摘 要 目的:探讨芪参益气滴丸对急性心肌梗死PCI术后患者各血清学指标及预后的影响。方法:选取110例急性心肌梗死患者为研究对象，所有患者均接受PCI术治疗，根据入院单双号将受试者分为对照组（n=55）和研究组（n=55），对照组患者术后给予常规西药治疗，研究组患者在对照组的基础上口服芪参益气滴丸治疗，比较两组患者的治疗总有效率、治疗前后各炎性因子水平及各血管内皮功能指标变化，随访1年后，比较两组不良心血管事件发生率。结果:研究组患者治疗总有效率显著高于对照组（P＜0.05）；与治疗前相比，治疗后两组患者各炎性因子水平均明显降低，且研究组显著低于对照组（P＜0.05）；与治疗前相比，治疗后两组患者各血管内皮功能指标均明显改善，且研究组显著优于对照组（P＜0.05）；研究组患者不良心血管事件发生率显著低于对照组（P＜0.05）。结论:芪参益气滴丸可有效改善患者的血管内皮功能，抗炎作用显著，减少不良心血管事件发生率，疗效确切，对改善急性心肌梗死PCI术后患者预后具有积极意义。     

低温等离子射频消融术联合顺铂注射液治疗喉癌的疗效观察

目的探讨低温等离子射频消融术联合顺铂注射液治疗喉癌的临床疗效及对患者血管内皮生长因子C(VEGF-C)和PTEN基因的影响。方法选取2017年1月至2018年8月间麻城市人民医院收治的150例喉癌患者,采用随机数表法分为观察组和对照组,每组75例。对照组患者采用喉镜下CO2激光切除术联合顺铂注射液治疗,观察组患者采用低温等离子射频消融术联合顺铂注射液治疗,比较两组患者的治疗效果、血清VEGF-C和PTEN及不良反应。结果观察组患者的临床疗效为72.0%,高于对照组患者的41.3%,差异有统计学意义(P<0.05)。治疗前,两组患者的血清VEGF-C和PTEN比较,差异无统计学意义(P>0.05)。治疗后,两组患者的血清VEGF-C和PTEN均下降,且观察组患者均低于对照组患者,差异均有统计学意义(均P<0.05)。观察组患者总生存时间及无瘤生存时间均高于对照组患者,差异均有统计学意义(均P<0.05)。两组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论低温等离子射频消融术联合顺铂注射液治疗喉癌,可降低患者的VEGF-C和PTEN水平,治疗效果较好,建议临床推广。     

On Psychological Continuity and Dementia

This letter responds to the article “On the Authority of Advance Euthanasia Directives for People with Severe Dementia: Reflections on a Dutch Case,” by Henri Wijsbek and Thomas Nys, in the September-October 2022 issue of the Hastings Center Report.     

Strategies for the use of Ginkgo biloba extract,EGb 761®, in the treatment and management of mild cognitive impairment in Asia: Expert consensus

BackgroundMild cognitive impairment (MCI) is a neurocognitive state between normal cognitive aging and dementia, with evidence of neuropsychological changes but insufficient functional decline to warrant a diagnosis of dementia. Individuals with MCI are at increased risk for progression to dementia; and an appreciable proportion display neuropsychiatric symptoms (NPS), also a known risk factor for dementia. Cerebrovascular disease (CVD) is thought to be an underdiagnosed contributor to MCI/dementia. The Ginkgo biloba extract, EGb 761^®, is increasingly being used for the symptomatic treatment of cognitive disorders with/without CVD, due to its known neuroprotective effects and cerebrovascular benefits.AimsTo present consensus opinion from the ASian Clinical Expert group on Neurocognitive Disorders (ASCEND) regarding the role of EGb 761^® in MCI.Materials & MethodsThe ASCEND Group reconvened in September 2019 to present and critically assess the current evidence on the general management of MCI, including the efficacy and safety of EGb 761^® as a treatment option.ResultsEGb 761^® has demonstrated symptomatic improvement in at least four randomized trials, in terms of cognitive performance, memory, recall and recognition, attention and concentration, anxiety, and NPS. There is also evidence that EGb 761^® may help delay progression from MCI to dementia in some individuals.DiscussionEGb 761^® is currently recommended in multiple guidelines for the symptomatic treatment of MCI. Due to its beneficial effects on cerebrovascular blood flow, it is reasonable to expect that EGb 761^® may benefit MCI patients with underlying CVD.ConclusionAs an expert group, we suggest it is clinically appropriate to incorporate EGb 761^® as part of the multidomain intervention for MCI.