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Background: Alzheimer's disease (AD) is a neurodegenerative disorder characterised by cognitive decline, behavioural and psychological symptoms of dementia (BPSD) and impairment of activities of daily living (ADL). Early differentiation of AD from mild cognitive impairment (MCI) is necessary., Methods: A total of 458 patients newly diagnosed with AD and MCI were included. Eleven batteries were used to evaluate ADL, BPSD and cognitive function (ABC). Machine learning approaches including XGboost, classification and regression tree, Bayes, support vector machines and logical regression were used to build and verify the new tool., Results: The Alzheimer's Disease Assessment Scale (ADAS-cog) word recognition task showed the best importance in judging AD and MCI, followed by correct numbers of auditory verbal learning test delay recall and ADAS-cog orientation. We also provided a selected ABC-Scale that covered ADL, BPSD and cognitive function with an estimated completion time of 18 min. The sensitivity was improved in the four models., Conclusion: The quick screen ABC-Scale covers three dimensions of ADL, BPSD and cognitive function with good efficiency in differentiating AD from MCI., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Chitinase activity is increased in Alzheimer's disease (AD). However, the role of chitinase1 in AD is unknown. We investigated the effects of chitinase1 on Alzheimer's pathology and microglia function. Artificial chitinase1 and chitinase inhibitor (chitinase-IN-2) were used to determine the effects of chitinase1 on inflammatory factors and β-amyloid (Aβ) oligomers deposition in D-galactose/AlCl 3 -induced rat model with cognitive impairments. Aβ-treated N9 microglia cells were analyzed to further verify whether the changes in inflammatory factors following chitinase1 treatment were associated with microglia alternative activation. Our data displayed that the activity of chitinase1 was both improved in D-galactose/AlCl 3 -injected rats and Aβ-pretreated microglia. Moreover, there was an improvement in cognitive function in chitinase1-treated AD rats. Furthermore, anti-inflammation factors (Arginase 1, Arg-1, mannose receptor type C 1, MRC1/CD206) were increased and pro-inflammation factors (tumor necrosis factor alpha, TNFα, interleukin 1 beta, IL-1β) were decreased in D-galactose/AlCl 3 -induced AD rats with chitinase1 treatment. A higher level of M2 markers (Arg-1, MRC1/CD206) and a lower level of classic M1 markers (TNFa, IL-1β) were obtained in Aβ-pretreated N9 cells with chitinase1, suggesting that chitinase1 polarized the microglia into an anti-AD M2 phenotype. We also detected that chitnase1 could weaken the deposition of Aβ oligomers in the brain of D-galactose/ AlCl 3 - induced AD rats. In conclusion, Chitinase1 might exert protective effects against AD by polarizing microglia to an M2 phenotype and resisting Aβ oligomer deposition., (Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.)

Objectives: Based on readily available demographic data, neuropsychological assessment results, and comorbidity data, we aimed to develop and validate a 3-year survival prediction model for patients with cognitive impairment. Methods: In this prospective cohort study, 616 patients with cognitive impairment were included. Demographic information, data on comorbidities, and scores of the Mini-Mental State Examination (MMSE), Instrumental Activities of Daily Living (IADL) scale, and Neuropsychiatric Inventory Questionnaire were collected. Survival status was determined via telephone interviews and further verified in the official death register in the third year. A 7:3 ratio was used to divide patients into the training and validation sets. Variables with statistical significance (p < 0.05) in the single-factor analysis were incorporated into the binary logistic regression model. A nomogram was constructed according to multivariate analysis and validated. Results: The final cohort included 587 patients, of whom 525 (89.44%) survived and 62 (10.56%) died. Younger age, higher MMSE score, lower IADL score, absence of disinhibition, and Charlson comorbidity index score ≤ 1 were all associated with 3-year survival. These predictors yielded good discrimination with C-indices of 0.80 (0.73–0.87) and 0.85 (0.77–0.94) in the training and validation cohorts, respectively. According to the Hosmer–Lemeshow test results, neither cohort displayed any statistical significance, and calibration curves displayed a good match between predictions and results. Conclusions: Our study provided further insight into the factors contributing to the survival of patients with cognitive impairment. Clinical Implications: Our model showed good accuracy and discrimination ability, and it can be used at community hospitals or primary care facilities that lack sophisticated equipment. [ABSTRACT FROM AUTHOR]

Background: Screening cognitive impairment is complex and not an appliance for early screening. Gait performance is strongly associated with cognitive impairment. Objectives: We aimed to explore gait indicators that could potentially screen cognitive dysfunction. Methods: A total of 235 subjects were recruited from June 2021 to June 2022. Four gait tasks, including the walking test, the timed "Up & Go" test (TUG), foot pressure balance (FPB), and one-legged standing with eyes closed test (OLS-EC), were performed. Moreover, in the walking test, participants were instructed to walk at their usual pace for the single-gait test. For the dual-task tests, participants walked at their usual pace while counting backward from 100 by 1s. The data were analyzed by the independent sample t-test, univariate and multivariate logistic regression, a linear trend, stratified and interaction analysis, the receiver operating characteristic (ROC) curve, and Pearson's correlations. Results: Among the 235 participants, 81 (34.5%) were men and 154 (65.5%) were women. The mean age of participants was 72 ± 7.836 years. The control, MCI, mild AD, and severe AD groups had means of 71, 63, 71, and 30, respectively. After adjusting for age, sex, education, and body mass index (BMI), the dual-task toe-off-ground angle (TOA) (odds ratio (OR) = 0.911, 95% confidence interval (CI): 0.847, 0.979), single-task TOA (OR = 0.904, 95% CI: 0.841–0.971), and the timed "Up & Go" time (TUGT) (OR = 1.515, 95% CI: 1.243–1.846) were significantly associated with an increased risk of cognitive impairment. In addition, the trend test and stratified analysis results had no significant differences (all p > 0.05). The area under the roc curve (AUC) values of TOA in the dual-task and TUGT were 0.812 and 0.847, respectively. Additionally, TOA < 36.75° in the dual-task, TOA < 38.90° in the single-task, and TUGT > 9.83 seconds (s) are likely to indicate cognitive impairment. The cognitive assessment scale scores were significantly correlated with TOA (all r > 0.3, p < 0.001) and TUGT (all r > 0.2), respectively. Conclusion: TOA and TUGT scores are, in some circumstances, associated with cognitive impairment; therefore, they can be used as simple initial screenings to identify patients at risk. [ABSTRACT FROM AUTHOR]

Background: The follow-up study on neuropsychiatric changes after the lifting of coronavirus disease 2019 (COVID-19) quarantine in patients with cognitive impairment and their caregivers is still lacking, and relative information is needed to formulate more comprehensive healthcare prevention measures worldwide. Aims: To provide data on the changes in neuropsychiatric performance after the lifting of COVID-19 quarantine in patients with cognitive disorders and their caregivers. Methods: Two surveys in Chongqing, China were conducted via telephonic interview with 531 patients and their caregivers. The baseline survey was performed from February 11 to 23, 2020, and the follow-up was from October 24 to November 9, 2020. The data of neuropsychiatric symptoms (NPSs), sleep, nutrition, and chronic diseases of patients, as well as the burden of care, anxiety, and depression of caregivers were evaluated. Results: Significant alleviation of NPSs after the lifting of COVID-19 quarantine was observed in patients with mild cognitive impairment (MCI) and dementia (both P < 0.05). Compared with baseline, the prevalence for NPSs of all participants dropped from 57.94 to 38.82%. Among NPS subdomains, apathy displayed the biggest decline at follow-up by 10.72%, followed by nighttime behavior by 8.65%. Mixed effect generalized estimation equation analysis showed significant amelioration in hallucination, depression, apathy, irritability, aberrant motor behavior, and nighttime behavior (all P < 0.05), with the most prominent changes in nighttime behavior and apathy. Among the patients with unsatisfactory control of chronic disease, the medication adherence rate dropped by approximately 30% after the lifting of quarantine. More importantly, around 13% increase of care burden was observed among the caregivers at follow-up, with both depression and anxiety rising by nearly 4%. Conclusion: The prolonged quarantine may exacerbate NPS in patients with memory disorders, while the care burden and mental stability of the caregivers after the pandemic should also be concerned. [ABSTRACT FROM AUTHOR]

• CHIT1 regulates brain inflammation via HDAC3/NF-κB p65 pathway, contributing to improvement of cognitive impairment. • CHIT1 skews polarization from a pro-inflammatory environment toward an anti-inflammatory one. • CHIT1 has a potential therapeutic value in AD via modulation of inflammation. Chitotriosidase (CHIT1, chitinase 1) is increased in the cerebrospinal fluid and peripheral blood of Alzheimer's disease (AD) patients. Our previous study has shown that CHIT1 provides potential protection through microglial polarization and reduction of β-amyloid (Aβ) oligomers on rat models of AD. Histone deacetylase 3 (HDAC3) plays a significant role in the expression and regulation of proteins related to the pathophysiology of AD. In addition, nuclear factor-kappa B (NF-κB) signaling pathway activation in neurons is associated with the progression of AD. NF-κB activation is regulated by HDAC3 deacetylation. In the present study, we researched the role of CHIT1 in HDAC3/NF-κB signaling in D-galactose (D-gal) and aluminum-exposed rat model with cognitive impairments. Following CHIT1 treatment, we found that the protein and mRNA levels of HDAC3 and NF-κB were reduced, the expression level of IκBα increased, anti-inflammatory factors (Arg-1, IL-10, and CD206) were elevated while pro-inflammatory factors (TNF-a, iNOS, and IL-1β) were decreased in D-gal/aluminum-induced AD rats. These results indicate that CHIT1 can regulate brain inflammation via HDAC3/NF-κB p65 pathway, contributing to improvement of cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Cognitive decline and neuropsychiatric symptoms (NPS) are main clinical manifestations in Alzheimer disease (AD). It is unclear whether the link between specific NPS and cognitive domains exists in AD or mild cognitive impairment (MCI). Our study aimed to examine the association between specific cognitive domain and NPS in AD and MCI, and to evaluate whether this association showed variety in different stages of cognitive impairment. Methods: A total of 458 patients diagnosed as AD or MCI were included in this study. Neuropsychological batteries were applied in the study. The association between NPS and cognitive function were evaluated by multiple linear regression, and its correlation was evaluated by Spearman correlation coefficient. Results: The prevalence of NPS increased with the severity of cognitive impairment, and there were significant differences between MCI and AD. NPS were predominantly associated with cognitive domains, including memory, language, attention, and executive function. Both regression liner analysis and correlation analysis showed delusion, hallucination, and aberrant motor behaviour (AMB) were linked to language and attention. In addition, regression liner analysis illustrated depression, anxiety, and apathy were related to learning and episodic memory. Generally, the delusion, hallucination, and AMB have the broadest impact on cognition. Conclusion: Specific NPS was predominantly associated with different cognitive domains. Symptoms of agitation, delusion and irritability indicate worse cognitive performance. Therefore, cognitive improvement should be a therapeutic strategy in managing NPS in AD. [ABSTRACT FROM AUTHOR]

Increasing evidence suggests that changes in the triggering receptor expressed on myeloid cells 2 (TREM2) is closely correlated with the pathological development of Alzheimer's disease (AD). However, the biological function and related role of this change remain poorly understood. Higher TREM2 expression has been reported in the brain of AD patients than in normal controls. Here, levels of TREM2 gene and protein levels were observed to be higher in both cortex and hippocampus of the Aβ1‐42‐induced AD mice than in those of the wild type mice. Together with in vitro experimental data, we found that the anti‐inflammatory role of TREM2 was, to some extent, limited and potentially counteracted by the hyperactive toll‐like receptor 4 (TLR4) in the AD mice. In this context, Interleukin 4 (IL‐4), as an agonist of TREM2, was administered to the AD mice to persistently activate TREM2. Interestingly, TREM2 activation in IL‐4‐treated AD mice led to an elevation in lysosomes and microtubule‐associated protein 1 light chain 3 (LC3) II/I expression, demonstrating that the level of microglia autophagy was increased. Increased autophagy significantly downregulated the expression levels of caspase recruitment domain‐containing protein 9 (CARD9) and TLR4, potentially weakening the CARD9‐TLR4 pathway and suppressing the TLR4‐mediated pro‐inflammatory effect in IL‐4‐treated AD mice. Furthermore, data acquired from Morris water maze testing indicated that IL‐4 administration could ameliorate cognitive impairment in the AD mice. In conclusion, the findings from in vitro and in vivo experiments suggest that TREM2 might represent a potential drug target to treat neuroinflammation in AD. [ABSTRACT FROM AUTHOR]

Background: To investigate the use and adherence of antidementia drugs in elderly patients with dementia from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University. Methods: Patients were recruited from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University from December 2010 to December 2018. Medical charts were reviewed, including diagnosis, dosage of antidementia medicines, neuropsychological testing scores, and the further questionnaires were conducted via face‐to‐face or telephone, included duration of treatment, types of antidementia drugs, and reasons for treatment discontinuation. Results: The data from 422 patients were analysed retrospectively for this study. Three hundred and fifteen were diagnosed with Alzheimer's disease (AD), 67 with mild cognitive impairment (MCI), and 40 with other types of dementia. From the 422 patients, 26.8% were treated with original donepezil (n = 113), 11.6% with generic donepezil (n = 49), 24.6% with memantine (n = 104), 13.3% with huperzine A (n = 56), and 23.7% with a combination of drugs (n = 100). However, 73% of patients discontinued treatment within 1 year of initiation. Patients treated for more than 36 months (37.8%) were more likely to choose combined medication, as compared with patients treated for less than 36 months. Patients with less than 9 years of education (odds ratio (OR): 2.394; 95% CI: 1.508–3.801) were more likely to discontinue treatment than patients with more than 9 years of education. Patients with elevated physical self‐maintenance scale (PSMS) scores (OR: 1.195; 95% CI: 1.086–1.316) had a high risk of discontinuation. Conclusions: Overall treatment compliance is relatively poor in memory clinics in Chongqing. Our study demonstrates that higher education may lead to better treatment adherence in dementia care. Combination therapy may increase treatment time. However, poorer PSMS scores are a significant risk factor for treatment discontinuation. [ABSTRACT FROM AUTHOR]

Background: Insomnia is a major public health problem affecting older people. This study aimed to investigate the prevalence and clinical risk factors of insomnia in a representative sample of Chinese elderly (≥ 60 years) in Chongqing. Methods: A cross‐sectional study based on comprehensive geriatric assessment was conducted from January 2013 to February 2014. A questionnaire on sleep status was provided to each patient and insomnia was assessed according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria. A multivariate logistic regression model was used to illustrate risk factors correlated with insomnia. Results: Of the total 597 participants, 55.4% suffered from insomnia. The prevalence of insomnia in men and women was 48.2% and 63.2%, respectively. Coronary heart disease, dizziness, chronic pain, anorexia, malnutrition, depression and cognitive decline were identified as risk factors associated with insomnia. Hypertension, diabetes, hyperlipidaemia, headache, age and education level were not observed to be significantly associated with insomnia. Conclusions: Insomnia is highly prevalent among the elderly in Chongqing, and shows a positive correlation to coronary heart disease, dizziness, chronic pain, anorexia, malnutrition, depression, cognitive impairment. Moreover, women are more likely to experience insomnia than men. [ABSTRACT FROM AUTHOR]