Expert Consensus on the Care and Management of Patients with Cognitive Impairment in China

A digital intelligence visualization health monitoring device for Alzheimer's disease patients based on WBAN technology

Continuous visual health monitoring for Alzheimer's disease (AD) patients, as a lifelong degenerative neurological disorder, is increasingly emphasized in medicine and design. Meanwhile, wireless body area network (WBAN) technology, built on the Internet of Things (IoT), has been widely used in passive human health monitoring through convolutional neural algorithms. However, it is unclear whether the multimodal data collected by WBAN and its visualization and analysis allow AD patients to be more active in their own health and enhance stakeholders' care for AD patients compared to traditional active health monitoring. Therefore, this study aimed to demonstrate this question and a 12-month controlled trial was conducted.16 AD patients collaborated with us and were divided into a traditional physical examination visualization group and a WBAN monitoring visualization group. In the WBAN monitoring visualization group, we innovated a digital kit called AD-Cloud, which consists of a flexible wearable data collection and transmission device with a star topology, a progressive convolutional neural framework for remote data visualization with high arithmetic power, and an interactive mobile application. It is worth emphasizing that we have innovated visualization analysis and presentation methods for behavioral, physiological and psychological as well as WBAN techniques and Progressive Region Enhancement Network (PRENet) for AD patients. Finally, it is shown that in the field of health monitoring visualization, innovative monitoring visualization devices based on WBAN technology are more positive for AD patients than traditional routine medical examinations. Also, the results show that personalized interpretable and recognizable health data allow AD patients to reduce anxiety about their health and adjust their poor physical condition and increase their interest in socializing. Ultimately, by continuously enriching the e-cases of AD patients, AD patients will be able to quickly access effective health support based on the digital ecosystem in the future.

Factors associated with dementia risk reduction lifestyle in mild cognitive impairment: a cross-sectional study of individuals and their family caregivers

OBJECTIVE

A healthy lifestyle has been shown to mitigate cognitive decline in patients with mild cognitive impairment, with family caregivers playing a pivotal role in the patients' lifestyle management. Exploring the level of dementia risk reduction lifestyle and the influencing factors at both the patient and caregiver levels in patients with mild cognitive impairment is crucial for identifying strategies to improve patients' lifestyles and delay disease progression.

METHODS

Using a convenience sampling method, 302 patients with mild cognitive impairment and their family caregivers admitted to the neurology departments of four tertiary care hospitals in China, from December 2024 to February 2025 were recruited and surveyed using a general information questionnaire, the Dementia Risk Reduction Lifestyle Scale (DRRLS), the Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction scale (MCLHB-DRR), the Perceived Social Support Scale (PSSS), and the Mutuality Scale (MS). Multiple linear regression was used to analyze the factors influencing the dementia risk reduction lifestyle of patients.

RESULTS

DRRLS score of 83.61 ± 16.13, multiple linear regression showed that the patient's monthly individual income, the presence of chronic disease, health beliefs, and social support were independent influences on their dementia risk reduction lifestyle. Furthermore, the lifestyle and mutuality of family caregivers were also independent influences on dementia risk reduction lifestyle in patients. The final model explained 75.5% of the variance in the lifestyle.

CONCLUSIONS

Patients with mild cognitive impairment have a general level of dementia risk reduction lifestyle. The characteristics of both patients and caregivers collectively influence the patients' lifestyle. Healthcare providers should conduct early dyadic assessments and develop targeted dyadic intervention strategies based on influencing factors to improve patients' lifestyles and help them delay disease progression.

The effect of inhaled aromatherapy on cognitive function in patients with cognitive impairment: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

Cognitive function is the basis of human thinking and behavior. Cognitive impairment has a serious impact on each individual and imposes a financial burden to families and healthcare systems. Inhalation aromatherapy has advantages, due to its safety, convenience, lack of toxicity, and wide use in the treatment of cognitive impairment. This systematic review was conducted to provide evidence for the use of inhaled aromatherapy in patients with cognitive impairment.

METHODS

We searched nine databases for pertinent Chinese and English studies published through November 2024 studies using inhaled aromatherapy in patients with cognitive impairment. Literature screening and data extraction were performed independently by two researchers and evaluated using the Cochrane Collaboration's quality criteria and were then cross-checked. A meta-analysis was carried out using Cochrane's Review Manager (RevMan, version 5.4), and we followed the PRISMA guidelines.

RESULTS

We included fourteen studies involving 888 patients with cognitive impairment in our study. Meta-analyses indicated that inhaled aromatherapy increased Mini-mental State Examination (MMSE, mean difference MD = 3.89 95 % CI [3.19, 4.58], P < 0.00001) and Montreal Cognitive Assessment Scale (MoCA, MD = 4.11, 95 % CI [3.54, 4.68], P < 0.00001) scores and decreased Homocysteine levels (Hcy, MD = -2.27 95 % CI [-2.80, -1.74], P < 0.00001) in patients with cognitive impairment compared with controls.

CONCLUSION

Inhaled aromatherapy could improve global cognition and lower Hcy in patients with cognitive impairment.

Chronic obstructive pulmonary disease as a risk factor for cognitive impairment: a systematic review and meta-analysis

BACKGROUND

Cognitive impairment is affecting plenty of patients with chronic obstructive pulmonary disease (COPD), and it is the main leading cause of quality of life to varying degrees. However, there are still wide discrepancies in these prevalence rates can be attributed to the diversity in study designs, participant age ranges, inclusion criteria and the methodologies used for assessment. Previous studies revealed the association between COPD and cognitive impairment, but the conclusions remain controversial.

OBJECTIVES

The current systematic review aimed to investigate whether COPD is an independent risk factor for cognitive impairment.

STUDY DESIGN

A systematic review and meta-analysis.

DATA SOURCES

PubMed, Cochrane Library, MEDLINE, Embase, Web of Science, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database and Weipu Database were searched from inception to 1 December 2022.

ELIGIBILITY CRITERIA

The inclusion criteria involved studies that reported cognitive impairment in COPD. We just included cohort designs, published in English or Chinese language.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted and assessed the quality of data using Newcastle-Ottawa Quality Assessment Scale. The outcomes were assessed with random-effects model and reported as the HR with 95% CI using the Review Manager software.

RESULTS

12 studies from 10 articles reporting on 625 644 people were included. The findings indicated that compared with those without COPD at baseline, patients with COPD were associated with an increased risk of cognitive impairment. Subgroup analysis showed the association was not significantly different in sex and age, and the subgroup supports that COPD has a higher risk of non-amnestic mild cognitive impairment (na-MCI) than amnestic MCI.

CONCLUSIONS

Patients with COPD have a higher risk of developing cognitive impairment and are more likely to cause na-MCI compared with those without COPD, and this risk is not affected by gender or age. Therefore, continuous monitoring of cognitive function in COPD is critical.

PROSPERO REGISTRATION NUMBER

CRD42021285913.

Dementia diagnostic and treatment services in the Western Pacific: challenges, preparedness and opportunities in the face of amyloid-targeting therapies

Here we first review the limited available literature addressing the current landscape of specialist assessment services for dementia and cognitive decline and the preparedness for new amyloid-targeting therapies for Alzheimer's disease across the Western Pacific region. Considering the scarcity of literature, as national representatives of Western Pacific nations we were then guided by the World Health Organization's Global Action Plan on Dementia to provide country-specific reviews. As a whole, we highlight that the existing diverse socioeconomic and cultural landscape across the region poses unique challenges, including varying access to services and marked differences among countries in their preparedness for upcoming amyloid-targeting therapies for Alzheimer's disease. Therefore, there is an urgent call for intergovernmental collaboration and investment across the Western Pacific to ensure that for all nations, citizens living with dementia and cognitive decline have access to effective and equitable methods of diagnosis, treatment and care.

Meta-analysis with trial sequential analysis investigating the impact of adjunctive electroacupuncture therapy on vascular mild cognitive impairment

BACKGROUND

To systematically collect, evaluate, and synthesize evidence from randomized controlled trials (RCTs) supporting the use of electroacupuncture (EA) as an additional treatment option for Vascular mild cognitive impairment (VaMCI), a meta-analysis was carried out.

METHODS

Electronic searches of eight databases were used to locate RCTs that evaluated EA as a VaMCI adjuvant therapy. The Cochrane Risk of bias was used to assess the included trials' methodological quality. Review Manager 5.4 was used to analyze the data. Trial sequential analysis (TSA) was conducted with the trial sequential analysis program.

RESULTS

There were 15 RCTs with 1033 subjects in them. Compared to conventional therapy (CT) alone, the Montreal Cognitive Assessment (SMD 0.72, 95 percent CI [0.55, 0.88]), Mini-mental State Examination (SMD 0.73, 95 percent CI [0.60, 0.87]), and activities of daily living (SMD 0.83, 95 percent CI [0.54, 1.12]) were significantly improved while EA was used in conjunction with CT. The current studies exceeded the required information size, according to trial sequential analysis (TSA), demonstrating the reliability of EA adjuvant therapy VaMCI.

CONCLUSIONS

According to the pooled data, EA as an adjunct therapy for the treatment of VaMCI increases clinical efficacy. Although the TSA confirms a stable conclusion, it is encouraged to conduct studies of the highest quality standards.

Nurses' knowledge, attitude and practice regarding non-pharmacologic interventions for behavioral and psychological symptoms of dementia

BACKGROUND

To evaluate the knowledge, attitude and practice of nurses regarding non-pharmacologic therapies for behavioral and psychological symptoms of dementia (BPSD).

METHODS

This cross-sectional, questionnaire-based study enrolled nurses at Peking Union Medical College Hospital (Beijing, China) between September 2022 and October 2022. Correlations between knowledge, attitude and practice scores were evaluated by Pearson correlation analysis. Factors associated with knowledge, attitude and practice scores were identified by multivariable linear regression. Based on a cross-sectional questionnaire survey, this study designed a questionnaire according to the Guidelines for Diagnosis and Treatment of Dementia in China, and randomly selected nurses from Peking Union Medical College Hospital to fill in the questions through the Wen-Juan-Xing online platform from September 2022 to October 2022.

RESULTS

The analysis included 210 nurses (202 females). The average knowledge, attitude and practice scores were 11.06±2.61 (total score: 18), 53.51±5.81 (total score: 60) and 64.66 ± 10.35 (total score: 80) points, respectively. Knowledge score was positively correlated with attitude score (r = 0.416, P < 0.001) and practice score (r = 0.389, P < 0.001); attitude and practice scores were also positively correlated (r = 0.627, P < 0.001). Multivariable analysis demonstrated that age ≥ 40 years-old (vs. ≤30 years-old) was associated with higher knowledge score (β = 1.48, 95% confidence interval [95%CI] = 0.42-2.54, P = 0.006). Age ≥ 40 years-old (β = 1.43, 95%CI = 0.35-2.51, P = 0.010 vs. ≤30 years-old) and bachelor's degree or higher (β = 1.11, 95%CI = 0.12-2.10, P = 0.028 vs. college degree or lower) were associated with higher practice score.

CONCLUSIONS

Older age and higher education level were associated with higher knowledge, attitude and/or practice scores. The findings of this study may help guide the development and implementation of education and training programs to improve the management of BPSD by nurses in China.

Long-Term Visit-to-Visit Blood Pressure Variability and Cognitive Decline Among Patients With Hypertension: A Pooled Analysis of 3 National Prospective Cohorts

BACKGROUND

A limited number of studies investigated the association between blood pressure variability (BPV) and cognitive impairment in patients with hypertension. This study aimed to identify the longitudinal association between BPV and cognitive decline and the role of blood pressure (BP) control in this association.

METHODS AND RESULTS

Participants with hypertension from the HRS (Health and Retirement Study), the ELSA (English Longitudinal Study of Ageing), and the CHARLS (China Health and Retirement Longitudinal Study) were included. Variation independent of the mean (VIM) was adopted to measure BPV. Cognitive function was measured by standard questionnaires, and a standardized Z score was calculated. Linear mixed-model and restricted cubic splines were adopted to explore the association between BPV and cognitive decline. The study included 4853, 1616, and 1432 eligible patients with hypertension from the HRS, ELSA, and CHARLS, respectively. After adjusting for covariates, per-SD increment of VIM of BP was significantly associated with global cognitive function decline in Z scores in both systolic BP (pooled β, -0.045 [95% CI, -0.065 to -0.029]) and diastolic BP (pooled β, -0.022 [95% CI, -0.040 to -0.004]) among hypertensive patients. Similar inverse associations were observed in patients with hypertension taking antihypertensive drugs and in patients with hypertension with well-controlled BP.

CONCLUSIONS

High BPV was independently associated with a faster cognitive decline among patients with hypertension, even those with antihypertensive medications or well-controlled BP. Further studies are needed to confirm our results and determine whether reducing BPV can prevent or delay cognitive decline.

Rural-Urban Differences in Mild Cognitive Impairment Among Patients with Chronic Obstructive Pulmonary Disease in ChengDu, China

Purpose

The rural-urban gap in sociodemographic, lifestyle, and disease-related characteristics among COPD patients is prevalent. These differences may influence the prevalence of mild cognitive impairment (MCI). This study aimed to compare the prevalence and determinants of MCI between rural and urban areas among COPD patients.

Patients and Methods

The cross-sectional study sample comprised 372 COPD patients from China. We evaluated the cognitive function and lung function, collected sociodemographic, lifestyle, and disease-related information, to compare the prevalence of MCI in rural and urban areas. Using multivariate regression analysis to examine the effects of variables to MCI.

Results

The prevalence of MCI in rural areas was higher than that in urban areas (65.4% vs 47.9%, P=0.001). The prevalence in farm laborers was almost twice as high as that of non-farm laborers in urban areas (82.6% vs 43.1%), but no significant difference in rural areas (P=0.066). However, the data were lower in subjects who insisted on long-term home oxygen therapy (39.7%, CI:27.8-51.6, P<0.001), and who with higher monthly household income (49.6%, CI:40.2-58.9) in rural areas, but no significant difference in urban areas (P=0.985 and 0.502). Multivariate logistic regression analysis indicated that participants aged 71 years and above, former smokers were at a high risk of MCI in both urban and rural areas. However, participants who slept for 6-8 hours a day, shopping frequently, or exercised for more than 2 hours a day had a lower risk of MCI in urban areas. But rural participants who insisted on long-term home oxygen therapy had a lower probability of developing MCI.

Conclusion

This study revealed that there were significant differences in MCI among COPD patients in rural and urban areas, especially in exercise, sleeping, shopping, and long-term home oxygen therapy. Medical staff should give health guidance according to the actual situation of patients with COPD.

Effect of self-determination theory-based integrated creative art (SDTICA) program on older adults with mild cognitive impairment in nursing homes: Study protocol for a cluster randomised controlled trial

BACKGROUND

The cognitive benefits of early non-pharmacological approaches have been demonstrated in older adults with mild cognitive impairment (MCI). However, older adults living in nursing homes have more severe cognitive impairment problems and lower initiative and compliance to participate in complex interventions. Hence, it important to investigate more attractive and sustainable methods to prevent or delay cognitive decline. The present study adopts the self-determination theory (SDT) as a theoretical framework to innovatively develop an integrated art-based intervention for older adults with MCI in nursing homes in China and aims to evaluate its effects on cognitive function, mental health, and other health-related outcomes.

METHODS

The study is a nursing home-based, cluster randomised controlled trial (RCT) that targets older adults (aged ≥ 60 years) with MCI in Fuzhou City, China. All nursing homes in the area covered by Fuzhou City are invited to participate. Eligible nursing homes are randomised to one of two groups: intervention group (receive a 14-week, 27-session intervention) and waitlist control group (receive the usual care). The SDT-based integrated creative art (SDTICA) program reasonably adopts the SDT as a theoretical framework to innovatively develop an integrated art-based intervention for older adults with MCI in nursing homes. The primary (global cognitive function and psychological indicator) and secondary (daily activity function, social function, and specific domains of cognitive function) outcomes will be measured at baseline, after the intervention, and during follow-up.

DISCUSSION

This study aims to evaluate the effects of SDTICA program on neuropsychological outcomes in older adults with MCI and provide scientific evidence for art-based non-pharmacologic interventions in nursing homes, which may reduce dementia risk in older adults with MCI.

TRIAL REGISTRATION

The trial was prospectively registered at the Chinese Clinical Trials Registry with the registration number ChiCTR2200061681 on 30 June 2022.

Exploring barriers to dementia screening and management services by general practitioners in China: a qualitative study using the COM-B model

BACKGROUND

Dementia has become a global public health problem, and general practitioners (GPs) play a key role in diagnosing and managing dementia. However, in Chinese primary care settings, dementia is underdiagnosed and inefficiently managed, and dementia screening and management services provided by GPs are suboptimal. The reasons underlying this gap are poorly understood. This study aimed to determine the barriers that hinder GPs from actively promoting dementia screening and management, and thereby provide insights for the successful promotion of dementia screening and management services in primary care.

METHODS

Purposive sampling was used. And focus groups and in-depth interviews were conducted face-to-face among GPs from community health service centers (CHSCs) in South China. Thematic analysis was used to identify barriers to screening and managing dementia and map them to the Capability/Opportunity/Motivation-Behavior model (COM-B model).

RESULTS

Fifty-two GPs were included. The COM-B model found nine barriers to implementing dementia screening and management services in primary healthcare: (1) poor capability: lack of systematic knowledge of dementia and inadequate dementia screening skills; (2) little opportunity: unclear pathways for referral, insufficient time for dementia screening and management, lack of dementia-specific leaders, and no guarantee of services continuity; (3) low motivation: outside of GP scope, worries associated with dementia stigma rooted in culture beliefs, and insufficient financial incentives.

CONCLUSIONS

Our study concluded that GPs were not yet ready to provide dementia screening and management services due to poor capability related to knowledge and skills of dementia, little opportunity associated with an unsupportive working environment, and low motivation due to unclear duty and social pressure. Accordingly, systematic implementation strategies should be taken, including standardized dementia training programs, standardized community-based dementia guidelines, expansion of primary care workforces, development of dedicated leaders, and the eradication of stigma attached to dementia to promote dementia screening and management services in primary care.

Chinese Medicine, Succinum, Ameliorates Cognitive Impairment of Carotid Artery Ligation Rats and Inhibits Apoptosis of HT22 Hippocampal Cells via Regulation of the GSK3β/β-Catenin Pathway

Succinum is an organic mineral formed from the resin of ancient coniferous and leguminous plants, which is applied for tranquilizing mood, promoting blood circulation, and removing blood stasis in Chinese medicine. For quite a long time, the modern research of succinum mainly focuses on the study of physical and chemical properties and authenticity identification while few reports on its medicinal mechanism. In current study, we evaluated different solvent extracts of succinum on carotid artery ligation rats mimicking vascular dementia. It was found that ethyl acetate extracts of succinum significantly improved the learning and memory abilities of model rats and inhibited neuronal apoptosis in the hippocampus. On a mice hippocampal neuronal cell line (HT22), ethyl acetate extracts of succinum also exerted better action trend in inhibiting cell apoptosis induced by oxygen glucose deprivation (OGD). By using XAV-939 on both in vivo and in vitro studies, it was found that ethyl acetate extracts of succinum might exert these functions by regulating the GSK3β/β-catenin pathway. These studies revealed the neuronal function of succinum, which explained the traditional effects of succinum and provided more modern scientific basis for its clinical application.

Development of a Psychometric Test: A Care Risk Scale for Homebound Older People With Dementia

Background

Homebound older people with dementia (OPWD) face a series of care risks due to disease characteristics, care issues, and the family environment. However, China lacks a quantitative assessment tool for care risk. Thus, we attempted to develop a care risk scale for homebound OPWD.

Methods

A care risk scale, with initially 18 items, was designed based on a systematic literature review, expert consultation, and a pilot study with 20 OPWD. The initial scale was validated among 1,045 homebound OPWD in Ningbo, China from November 1, 2020 to July 30, 2021. After removing three items that lacked discrimination power, the reliability and validity of the remaining 15 items was evaluated. Factor extraction was performed via principal axis factoring and Cattell's scree plot analysis, with the resulting factors then being subjected to a varimax rotation.

Results

The final scale consisted of 15 items assessed on a 5-point Likert scale that loaded on to three different factors, including dementia symptoms (four items), family support (four items), and home environment (seven items). These three factors were found to explain 72.9% of the cumulative variance. The overall Cronbach's alpha for the final scale was 0.907. The correlation coefficients in the item-to-total analysis ranged from 0.511 to 0.662.

Conclusion

The validation analysis indicated satisfactory reliability and validity of the 15-item scale for assessing care risk of homebound OPWD. This scale can help long-term care professionals and family caregivers identify care risks and help them take targeted measures to enhance safety of care for OPWD.

Immersive Virtual Reality-Based Cognitive Intervention for the Improvement of Cognitive Function, Depression, and Perceived Stress in Older Adults With Mild Cognitive Impairment and Mild Dementia: Pilot Pre-Post Study

Background

The incidence of dementia is increasing annually, resulting in varying degrees of adverse effects for individuals, families, and society. With the continuous development of computer information technology, cognitive interventions are constantly evolving. The use of immersive virtual reality (IVR) as a cognitive intervention for older adults with mild cognitive impairment (MCI) and mild dementia (MD) is promising, although only few studies have focused on its use.

Objective

The Chinese virtual supermarket (CVSM) IVR system was developed to provide a comprehensive and individual cognitive intervention program for older patients with MCI and MD. The aim of this study was to explore the feasibility and clinical effectiveness of this 5-week IVR-based cognitive intervention.

Methods

A pretest-posttest study design was conducted with 31 older adults with MCI and MD from August 2020 to January 2021. All participants participated in a 5-week immersive virtual cognitive training program using the CVSM system. Feasibility was assessed as the incidence and severity of cybersickness symptoms and participant satisfaction based on questionnaires conducted after the intervention. Clinical effectiveness was evaluated using neuropsychological assessments, including several commonly used measures of cognitive function, depression, perceived stress, and activities of daily living. Measurements were obtained at baseline and after the intervention period.

Results

A total of 18 patients with MCI (mean age 82.94 [SD 5.44] years; 12 females) and 13 patients with MD (mean age 85.7 [SD 4.67] years, 10 females) participated in this pilot study. Both groups showed significant improvements in all cognitive function measurements (P<.001). The MD group had a significantly greater improvement in general cognitive function compared to the MCI group in Montreal Cognitive Assessment Scale, Symbol Digit Modalities Test, Shape Trail Test, and Auditory Verbal Learning Test. Furthermore, an intervention effect was observed in the improvement of perceived stress (P=.048 for MD group, P=.03 for MCI group ).

Conclusions

The use of the CVSM system may be effective in enhancing the cognitive function of patients with MCI and MD, including general cognitive function, memory, executive function, and attention. IVR technology enriches cognitive intervention approaches and provides acceptable, professional, personalized, and interesting cognitive training for older adults with cognitive impairment.

Trial Registration

ClinicalTrials ChiCTR2100043753; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2100043753

Quantitative Electrophysiological Evaluation of the Analgesic Efficacy of Two Lappaconitine Derivatives: A Window into Antinociceptive Drug Mechanisms

Quantitative evaluation of analgesic efficacy improves understanding of the antinociceptive mechanisms of new analgesics and provides important guidance for their development. Lappaconitine (LA), a potent analgesic drug extracted from the root of natural Aconitum species, has been clinically used for years because of its effective analgesic and non-addictive properties. However, being limited to ethological experiments, previous studies have mainly investigated the analgesic effect of LA at the behavioral level, and the associated antinociceptive mechanisms are still unclear. In this study, electrocorticogram (ECoG) technology was used to investigate the analgesic effects of two homologous derivatives of LA, Lappaconitine hydrobromide (LAH) and Lappaconitine trifluoroacetate (LAF), on Sprague-Dawley rats subjected to nociceptive laser stimuli, and to further explore their antinociceptive mechanisms. We found that both LAH and LAF were effective in reducing pain, as manifested in the remarkable reduction of nocifensive behaviors and laser-evoked potentials (LEPs) amplitudes (N2 and P2 waves, and gamma-band oscillations), and significantly prolonged latencies of the LEP-N2/P2. These changes in LEPs reflect the similar antinociceptive mechanism of LAF and LAH, i.e., inhibition of the fast signaling pathways. In addition, there were no changes in the auditory-evoked potential (AEP-N1 component) before and after LAF or LAH treatment, suggesting that neither drug had a central anesthetic effect. Importantly, compared with LAH, LAF was superior in its effects on the magnitudes of gamma-band oscillations and the resting-state spectra, which may be associated with their differences in the octanol/water partition coefficient, degree of dissociation, toxicity, and glycine receptor regulation. Altogether, jointly applying nociceptive laser stimuli and ECoG recordings in rats, we provide solid neural evidence for the analgesic efficacy and antinociceptive mechanisms of derivatives of LA.

Comprehensive Management of Daily Living Activities, behavioral and Psychological Symptoms, and Cognitive Function in Patients with Alzheimer's Disease: A Chinese Consensus on the Comprehensive Management of Alzheimer's Disease

Alzheimer's disease (AD) is the most common cognitive disorder in the elderly. Its main clinical manifestations are cognitive decline (C), behavioral and psychological symptoms (B), and a decline in the activities of daily living (A), also known as ABC symptoms. Early identification and evaluation of ABC symptoms are helpful for establishing the accurate diagnosis, comprehensive treatment, and prognosis of AD. To guide Chinese clinical practice for optimization of the comprehensive management of AD, in 2018, The Academy of Cognitive Disorder of China gathered 22 neurologists and gerontologists in China to build a consensus on the comprehensive management of AD. Based on a review of the evidence, the consensus summarizes the pathogenesis, pathological changes, clinical manifestations, evaluation, diagnosis, drug and non-drug treatment, and patient care for AD. Focus group discussion was used to establish a flowchart of comprehensive ABC management for AD patients. The new consensus provides a feasible AD management process for clinicians.

Effects of Creative Expressive Arts-based Storytelling (CrEAS) programme on older adults with mild cognitive impairment: protocol for a randomised, controlled three-arm trial

INTRODUCTION

Early non-pharmacological interventions can prevent cognitive decline in older adults with mild cognitive impairment (MCI). Creative expression (CrExp) can potentially mitigate cognitive decline and enhance the physical and mental health of older people. However, it is unclear whether activities involving CrExp can improve cognitive function and other health-related outcomes in older adults with MCI. The aim of the present study is to develop a Creative Expressive Arts-based Storytelling (CrEAS) programme that integrates verbal and non-verbal expressive activities and evaluate its effectiveness in improving cognitive function and other outcome indicators so as to explore its possible mechanism from the perspective of neuroimaging.

METHODS AND ANALYSIS

This parallel randomised controlled trial with three arms (one intervention and two control arms) will be conducted over a 24-week period. A total of 111 participants will be enrolled and randomised to the CrEAS, recreation and usual activity groups. The CrEAS programme combines visual arts therapy and storytelling (TimeSlips) under the Expressive Therapy Continuum theoretical framework and provides an opportunity for people with MCI to actively engage in activities to improve cognitive function through verbal and nonverbal CrExp. Global cognitive function, specific domains of cognition (memory, executive function, language and attention) and other health-related outcomes (anxiety, depression and quality of life) will be measured at baseline, at the end of the intervention, and at the 24-week follow-up. Structural/functional brain MRI data will be collected at baseline and immediately after the intervention.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of Fujian Provincial Hospital (K2018-03-061). The study results will be disseminated through peer-reviewed journals and at academic conferences.

TRIAL REGISTRATION NUMBER

ChiCTR1900021526.

Impact of Chronic Stress on Attention Control: Evidence from Behavioral and Event-Related Potential Analyses

Chronic stress affects brain function, so assessing its hazards is important for mental health. To overcome the limitations of behavioral data, we combined behavioral and event-related potentials (ERPs) in an attention network task. This task allowed us to differentiate between three specific aspects of attention: alerting, orienting, and execution. Forty-one participants under chronic stress and 31 non-stressed participants were enrolled. On the performance level, the chronically stressed group showed a significantly slower task response and lower accuracy. Concerning ERP measures, smaller cue-N1, cue-N2, and larger cue-P3 amplitudes were found in the stressed group, indicating that this group was less able to assign attention to effective information, i.e., they made inefficient use of cues and had difficulty in maintaining alerting. In addition, the stressed group showed larger target-N2 amplitudes, indicating that this group needed to allocate more cognitive resources to deal with the conflict targets task. Subgroup analysis revealed lower target-P3 amplitudes in the stressed than in the non-stressed group. Group differences associated with the attention networks were found at the ERP level. In the stressed group, excessive depletion of resources led to changes in attention control. In this study, we examined the effects of chronic stress on individual executive function from a neurological perspective. The results may benefit the development of interventions to improve executive function in chronically stressed individuals.

Grab-AD: Generalizability and reproducibility of altered brain activity and diagnostic classification in Alzheimer's Disease

Alzheimer's disease (AD) is associated with disruptions in brain activity and networks. However, there is substantial inconsistency among studies that have investigated functional brain alterations in AD; such contradictions have hindered efforts to elucidate the core disease mechanisms. In this study, we aim to comprehensively characterize AD-associated functional brain alterations using one of the world's largest resting-state functional MRI (fMRI) biobank for the disorder. The biobank includes fMRI data from six neuroimaging centers, with a total of 252 AD patients, 221 mild cognitive impairment (MCI) patients and 215 healthy comparison individuals. Meta-analytic techniques were used to unveil reliable differences in brain function among the three groups. Relative to the healthy comparison group, AD was associated with significantly reduced functional connectivity and local activity in the default-mode network, basal ganglia and cingulate gyrus, along with increased connectivity or local activity in the prefrontal lobe and hippocampus (p < .05, Bonferroni corrected). Moreover, these functional alterations were significantly correlated with the degree of cognitive impairment (AD and MCI groups) and amyloid-β burden. Machine learning models were trained to recognize key fMRI features to predict individual diagnostic status and clinical score. Leave-one-site-out cross-validation established that diagnostic status (mean area under the receiver operating characteristic curve: 0.85) and clinical score (mean correlation coefficient between predicted and actual Mini-Mental State Examination scores: 0.56, p < .0001) could be predicted with high accuracy. Collectively, our findings highlight the potential for a reproducible and generalizable functional brain imaging biomarker to aid the early diagnosis of AD and track its progression.

Characterizing white matter connectivity in Alzheimer's disease and mild cognitive impairment: An automated fiber quantification analysis with two independent datasets

Alzheimer's disease (AD) is a chronic neurodegenerative disease characterized by progressive dementia. Diffusion tensor imaging (DTI) has been widely used to show structural integrity and delineate white matter (WM) degeneration in AD. The automated fiber quantification (AFQ) method is a fully automated approach that can rapidly and reliably identify major WM fiber tracts and evaluate WM properties. The main aim of this study was to assess WM integrity and abnormities in a cohort of patients with amnestic mild cognitive impairment (aMCI) and AD as well as normal controls (NCs). For this purpose, we first used AFQ to identify 20 major WM tracts and assessed WM integrity and abnormalities in a cohort of 120 subjects (39 NCs, 34 aMCI patients and 47 AD patients) in a discovery dataset and 122 subjects (43 NCs, 37 aMCI patients and 42 AD patients) in a replicated dataset. Pointwise differences along WM tracts were identified in the discovery dataset and simultaneously confirmed in the replicated dataset. Next, we investigated the utility of DTI measures along WM tracts as features to distinguish patients with AD from NCs via multilevel cross validation using a support vector machine. Correlation analysis revealed the identified microstructural WM alterations and classification output to be highly associated with cognitive ability in the patient groups, suggesting that they may be a robust biomarker of AD. This systematic study provides a pipeline to examine WM integrity and its potential clinical application in AD and may be useful for studying other neurological and psychiatric disorders.