上海市残疾人群轻度认知功能障碍患病率及相关因素分析

目的 调查残疾人群轻度认知功能障碍(mild cognitive impairment,MCI)患病率并探讨相关危险因素.方法 连续性纳入门诊残疾成人作为研究对象,使用蒙特利尔认知评估量表(MoCA)评估受试者的认知功能,采用Logistic回归模型探讨残疾人群MCI的相关危险因素.结果 共有309名残疾患者参与了本研...     

微生物-肠-脑轴视域下认知障碍的发病机制及中医药治疗进展

认知障碍已成为影响老年人群健康的常见疾病,目前仍缺乏行之有效的治疗手段。微生物-肠-脑轴（MGBA）为认识认知障碍提供了新视域,也为今后认知障碍的临床诊疗提供了新方向。文章从MGBA视域出发,探讨了其在认知障碍发病中的作用,同时也归纳了此视域下中医药治疗认知障碍疾病的最新研究进展。结果表明,MGBA可通过免疫炎症途径、神经途径及内分泌途径影响认知障碍的发生发展。同时,相关中药复方、中药单体及针刺治疗手段已被证明能通过调节MGBA改善认知功能,为中医药治疗认知障碍提供了较好的现代阐释。     

Visuospatial representation in patients with mild cognitive impairment: Implication for rehabilitation

Behavioral and neurophysiological experiments have demonstrated that distinct and common cognitive processes and associated neural substrates maintain allocentric and egocentric spatial representations. This review aimed to provide evidence from previous behavioral and neurophysiological studies on collating cognitive processes and associated neural substrates and linking them to the state of visuospatial representations in patients with mild cognitive impairment (MCI). Even though MCI patients showed impaired visuospatial attentional processing and working memory, previous neuropsychological experiments in MCI largely emphasized memory impairment and lacked substantiating evidence of whether memory impairment could be associated with how patients with MCI encode objects in space. The present review suggests that impaired memory capacity is linked to impaired allocentric representation in MCI patients. This review indicates that further research is needed to examine how the decline in visuospatial attentional resources during allocentric coding of space could be linked to working memory impairment.     

Obesity and Dysmetabolic Factors among Deceased COVID-19 Adults under 65 Years of Age in Italy: A Retrospective Case-Control Study

Background: Italy has witnessed high levels of COVID-19 deaths, mainly at the elderly age. We assessed the comorbidity and the biochemical profiles of consecutive patients ≤65 years of age to identify a potential risk profile for death. Methods: We retrospectively analyzed clinical data from consecutive hospitalized-for-COVID-19 patients ≤65 years, who were died (593 patients) or discharged (912 patients) during February–December 2020. Multivariate logistic regression identified the mortality risk factors. Results: Overweight (adjusted odds ratio (adjOR) 5.53, 95% CI 2.07–14.76), obesity (adjOR 8.58, CI 3.30–22.29), dyslipidemia (adjOR 10.02, 95% CI 1.06–94.22), heart disease (adjOR 17.68, 95% CI 3.80–82.18), cancer (adjOR 13.28, 95% CI 4.25–41.51) and male sex (adjOR 5.24, 95% CI 2.30–11.94) were associated with death risk in the youngest population. In the older population (46-65 years of age), the overweight and obesity were also associated with the death risk, however at a lower extent: the adjORs varyied from 1.49 to 2.36 for overweight patients and from 3.00 to 4.07 for obese patients. Diabetes was independently associated with death only in these older patients. Conclusion: Overweight, obesity and dyslipidemia had a pivotal role in increasing young individuals’ death risk. Their presence should be carefully evaluated for prevention and/or prompt management of SARS-CoV2 infection in such high-risk patients to avoid the worst outcomes.     

Internet use and cognitive frailty in older adults: a large-scale multidimensional approach

Although research on sociodemographic correlates of internet use in older adults without and with pronounced cognitive impairment is already quite extensive, much less is known about the relationship between cognitive frailty (CF) and this behaviour. As CF is associated to multidimensional frailty aspects, this study explored the relationship between internet use and CF, operationalised as Subjective Cognitive Impairment, in older adults by means of a comprehensive explanatory model including sociodemographic factors and multiple frailty measures. The dataset included a sample of community-dwelling 60 + older adults that were included in the Belgian Ageing Studies (BAS) and that completed survey questions on (i) internet use frequency and (ii) internet activities. Multidimensional frailty was measured with the CFAI-Plus. The analysis comprised a structural equation modelling (SEM) procedure. Internet use was frequent; however, it became less frequent with higher CF. Moreover, the latter used less tablets as compared to the no-low CF group. Navigating the web, sharing email and online banking were the most frequently reported activities. Tele-communicating with Skype, online shopping and using e-government services were the least frequent. Age, female gender, lower income and living with a partner were also negatively associated with internet use. To conclude, CF, along with other frailty and sociodemographic factors, was negatively related to internet use in older adults. Future research should focus, amongst others, on the dynamic processes underlying internet use in the population of older adults affected by CF.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-022-00686-2.     

Identifying the regional substrates predictive of Alzheimer's disease progression through a convolutional neural network model and occlusion

Progressive brain atrophy is a key neuropathological hallmark of Alzheimer''s disease (AD) dementia. However, atrophy patterns along the progression of AD dementia are diffuse and variable and are often missed by univariate methods. Consequently, identifying the major regional atrophy patterns underlying AD dementia progression is challenging. In the current study, we propose a method that evaluates the degree to which specific regional atrophy patterns are predictive of AD dementia progression, while holding all other atrophy changes constant using a total sample of 334 subjects. We first trained a dense convolutional neural network model to differentiate individuals with mild cognitive impairment (MCI) who progress to AD dementia versus those with a stable MCI diagnosis. Then, we retested the model multiple times, each time occluding different regions of interest (ROIs) from the model''s testing set''s input. We also validated this approach by occluding ROIs based on Braak''s staging scheme. We found that the hippocampus, fusiform, and inferior temporal gyri were the strongest predictors of AD dementia progression, in agreement with established staging models. We also found that occlusion of limbic ROIs defined according to Braak stage III had the largest impact on the performance of the model. Our predictive model reveals the major regional patterns of atrophy predictive of AD dementia progression. These results highlight the potential for early diagnosis and stratification of individuals with prodromal AD dementia based on patterns of cortical atrophy, prior to interventional clinical trials.     

Brain microstructural alterations of depression in Parkinson's disease: A systematic review of diffusion tensor imaging studies

Depression, a leading cause of disability worldwide, is also the most prevalent psychiatric problem among Parkinson disease patients. Both depression and Parkinson disease are associated with microstructural anomalies in the brain. Diffusion tensor imaging techniques have been developed to characterize the abnormalities in cerebral tissue. We included 11 studies investigating brain microstructural abnormalities in depressed Parkinson''s disease patients. The included studies found alterations to essential brain structural networks, including impaired network integrity for specific cortical regions, such as the temporal and frontal cortices. Additionally, findings indicate that microstructural changes in specific limbic structures, such as the prefronto‐temporal regions and connecting white matter pathways, are altered in depressed Parkinson''s disease compared to non‐depressed Parkinson''s disease and healthy controls. There remain inconsistencies between studies reporting DTI measures and depression severity in Parkinson disease participants. Additional research evaluating underlying neurobiological relationships between major depression, depressed Parkinson''s disease, and non‐depressed Parkinson''s disease is required to disentangle further mechanisms that underlie depression and related somatic symptoms, in Parkinson disease.