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Cognitive impairment is commonly associated with older people. It can also occur in middle-aged people due to non-communicable diseases. The prevalence of lifestyle-related diseases (non-communicable diseases) has been rapidly increasing in Mongolia. Therefore, we aimed to overview these studies to identify whether the increasing prevalence of non-communicable disease is associated with the risks of cognitive impairment in Mongolians. Published literature between 01 January 1980 and 20 June 2021 were included in the study. We searched articles published in journals registered to PubMed and doctoral and master's dissertations registered in the Central Medical Library of Mongolia using the following keywords: "cognitive impairment", "dementia", "mild cognitive impairment", "Alzheimer", "vascular dementia", “diabetes", "Mongolia", "obesity", "stroke", "hypertension". While there were no internationally published articles in this field, seven studies were either published in local research journals or as doctoral or master’s dissertations. Although few studies have been conducted in Mongolia, people with lifestyle-related conditions such as hypertension and diabetes are strongly associated with a higher risk of cognitive impairment. The increasing prevalence of non-communicable diseases may be one of the factors contributing to the prevalence of vascular cognitive impairment.

Mongolia ranks third in the world in stroke-related deaths. Loss of skeletal muscle mass and function, known as sarcopenia, is associated with a higher risk of various metabolic disorders such as stroke. Thus, screening of sarcopenia is important. Hand-grip strength (HGS) can be used to predict sarcopenia in the short term. In this cross-sectional study, we used data (n=1180, mean age of 39.2 ± 15.2 and 33.2% males) from the Mon-Timeline cohort study, a multidisciplinary, prospective, population-based cohort study in Mongolia. A digital grip strength dynamometer (TKK 5401 GRIP D; Takei, Japan) was used to measure HGS. We performed binary logistic regression analysis between HGS and stroke risk. Suspected sarcopenia was defined when HGS is less than the 25th percentile of HGS. In this study, 3.3% of all participants had a stroke. The incidence of stroke was significantly higher (5.2% and 1.9%) in people with suspected sarcopenia. According to body composition, the incidence of stroke was more frequent in sarcopenic obese people: 1.3%, 2.4%, 2.8% and 6.2% in normal (non-obese and non-sarcopenic), sarcopenic (non-obese), obese (non-sarcopenic) and sarcopenic obese groups, respectively. In regression analysis, the OR (95% CI) was 2.84 (1.44; 5.59) for sarcopenic compared with non-sarcopenic. The adjustments for age, gender, education, body mass index, waist circumference and hypertensive status attenuated the associations, but lower HGS remained significantly associated with a higher risk of stroke. In conclusion, lower HGS was significantly associated with a higher risk of stroke independent of adiposity and hypertensive status in Mongolian adults.

IntroductionWorldwide, 2 million patients aged 18–50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients.Methods and analysisThe Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18–50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence.Ethics and disseminationEthical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.

People with diabetes have a higher risk of cognitive impairment than people without diabetes, and recently it is being considered a complication of diabetes mellitus (DM). Because of drastic lifestyle changes in the Mongolian population, diabetes prevalence is increasing rapidly. The rapid increase of diabetes prevalence and its poor control in Mongolia suggest that there might be significant cognitive impairment in the diabetes population. In this case-control study, we compared the Mini-Mental State Examination score to the risk of cognitive impairment, indicating vascular dementia in people with and without diabetes. Upon obtaining their informed consent, each subject was tested with Mini-Mental State Examination. We involved age and gender-matched diabetic (n = 131) and non-diabetic (n = 131) subjects. The mean age was 61.3 ± 8.5 and 61.0 ± 8.7 in people with and without diabetes, respectively, and 35.9% of the participants were male. According to study groups, the Mini-Mental State Examination scores were significantly different: 26.1 ± 3.7 and 27.5 ± 2.6 for people with and without diabetes, respectively. In logistic regression analysis, age was significantly associated with Mini-Mental State Examination score (Beta coefficient = 1.22; 1.11–1.35, P < 0.001) in people without diabetes after adjustments for potential confounders. However, age was not significantly associated with MMSE scores in people with diabetes mellitus. Thus, diabetes duration and poor control may contribute to developing cognitive impairment in people with diabetes. In conclusion, there might be a high prevalence of vascular dementia in people with type 2 diabetes mellitus. However, since Mini-Mental State Examination is sensitive to dementia and not specific to vascular dementia, further studies involving neuroimaging and neurological examination are needed to fully elucidate the link between type 2 diabetes and vascular dementia in dementia in a Mongolian population.

We conducted an epidemiologic study based on survey neuroscience screening for restless leg syndrome in the Mongolian to determine the prevalence of restless leg syndrome. We used baseline data from the Mon-TimeLine study, a multidisciplinary, prospective, population-based cohort study. The total number of participants (n = 1572) ranged from 18 to 65 years of age. We found the prevalence of restless leg syndrome to be 6.6% (n = 103), among which 4.1% (n = 16) were males and 7.3% (n = 87) were females. The peak prevalence age for both genders was 45–55, and we found a positive correlation with body mass index (P < 0.05). Most cases were mild (44.7%) or moderate (35.9%), but 18.4% and 1% of the cases were severe or very severe, respectively. The severe groups showed a positive association with chronic kidney disease, as well as with gastritis. In conclusion, the prevalence of restless leg syndrome in Mongolia approximates that in other countries.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease caused by selective motor neuron death. We developed a rat model of ALS expressing a human cytosolic copper-zinc superoxide dismutase (SOD1) transgene with two ALS-associated mutations: glycine to alanine at position 93 (G93A) and histidine to arginine at position 46 (H46R). Although the mechanism of ALS is still unclear, there are many hypotheses concerning its cause, including loss of neurotrophic support to motor neurons. Recent evidence suggests that insulin-like growth factors (IGFs) act as neurotrophic factors, and promote the survival and differentiation of neuronal cells including motor neurons. Their ability to enhance the outgrowth of spinal motor neurons suggests their potential as a therapeutic agent for the patients with ALS. In this study, we investigated IGF-II receptor immunoreactivity in the anterior horns of the lumbar level of the spinal cord in SOD1 transgenic rats with the H46R mutation of different ages as well as in normal littermates. The double-immunostaining for IGF-II receptor and glial fibrillary acidic protein (GFAP) demonstrated co-localization on reactive astrocytes ((**)p < 0.001) in the end-stage transgenic rats, whereas it was not evident at the pre-symptomatic stage or at the onset of the disease. Our results demonstrated the IGF-II receptor up-regulation in reactive astrocytes in the spinal cord of transgenic rats, which may reflect a protective response against the loss of IGF-related trophic factors. We suggest that IGF receptors may play a key role in the pathogenesis, and may have therapeutic implications in ALS.