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According to the World Health Organization report in 2020, the number of stroke deaths in Mongolia has reached 4,401, accounting for 19.84% of the total deaths, ranking as the second leading cause of death in Mongolia. Furthermore, the prevalence of diabetes has been steadily increasing for the last 20 years. In this case-control study (80 diabetic and 160 non-diabetic subjects), we analyzed data from two tertiary stroke centers over the past six months (June-December 2022). Inclusion criteria included patients over 18 years who presented to the emergency department with an acute ischemic stroke (I63 according to ICD 10). We reviewed and compared the data on clinical assessments such as the National Institutes of Health The Stroke Scale (NIHTSS), Glasgow Coma Scale and Modified Rankin Score, laboratory parameters, and TOAST classification of ischemic stroke between diabetic and non-diabetic patients in Mongolia. The mean age was 39.2±15.2, and 33.2% (n = 392) were male. The duration of diabetes in patients ranged from 0 to 23 years, and the median was 5.0. Mean glycated haemoglobin in subjects was 9.75±2.49%, and only 27.5% (n = 22) had HbA1c below 7.5%. Only BMI was significantly different in patients with diabetes compared to patients without diabetes (27.2±4.4 vs. 28.6±5.2). However, for other parameters, no significant difference was observed, but the NIHTSS at discharge was significantly higher in patients with diabetes. According to the TOAST classification, the risk of ischemic stroke caused by microangiopathy (18% vs 33.8%, p=0.142) and macroangiopathy (44.4% vs 57.5%, p=0.192) was 13-15% higher in people with diabetes than in people without diabetes. In regression analysis, patients with diabetes had a six times greater risk of ischemic stroke caused by atherosclerosis than non-diabetic patients. Most subtypes of stroke that occur in people with diabetes are caused by atherosclerosis, both large and small vessels.

There is no specific treatment for concussion in modern medicine; existing treatments are limited to resting and restoring cognition. For Mongolians, seeking concussion treatment from a bariachi, an advanced practitioner of the baria zasal traditional massage therapy, is very common. The baria zasal technique has been passed down the generations for millions of years, keeping with the Mongolian nomadic culture and way of life. However, this Mongolian treatment is little known or researched internationally. Due to the lack of literature on this subject, conducting a meta-analysis or systematic review was impossible. We reviewed the literature published in Mongolian about this technique. We also searched articles published from 1 January 1921 to 20 June 2021 in PubMed using "concussion", "baria zasal", and "Bariachi" keywords. Although informal observation indicates this is a commonly sought treatment among patients, there are very few published scientific articles about the practice outside the realm of cultural anthropology. This may be due to a few reasons: the informal, semi-religious setting in which the treatment takes place makes it difficult to conduct scientific field research; concussion is a mild traumatic brain injury, making it impossible to identify changes in the brain as a result of the treatment using imaging methods and therefore difficult to verify; and lastly, baria zasal is generally uncontested as a treatment even by Mongolian medical professionals, therefore it has not been the subject of empirical debate. Moreover, it is not classified under a specific system, each bariachi having its technique. As bariachis do not receive formal training, their treatments often depend on instincts, natural talents, and personal abilities. Therefore, it is recommended to study the techniques of baria zasal of concussion to explain its enduring popularity in Mongolia and to ascertain how it interacts with standard western medical treatment.

Cognitive impairment is common in elderly people, so it is considered an ageing disorder. However, cognitive decline, including dementia, can also occur in middle-aged people. Cognitive impairment is associated with multiple risk factors. We hypothesised that tooth loss might also be a potential risk factor among Mongolians, as oral health problems are one of the significant health issues in Mongolia, especially in middle-aged people. In this cross-sectional study, we used the baseline data from the Mon-Timeline cohort study, including people older than 40 years of age (n=279). The amount of tooth loss was assessed by a trained researcher. Mild cognitive impairment (MCI) was defined as those participants scoring a total of £ 24 points based on the Mini-Mental State Examination (MMSE). Unadjusted analysis showed that having more tooth loss (>10) increased the risk of MCI by an odds ratio of 3.03 (1.49-6.17), as compared with having less tooth loss (£10). Even after adjusting for covariates, the association remained significant, suggesting that tooth loss is associated with MCI risk, independent of age, education, and other socioeconomic factors. There was no significant interaction effect of age in the association between tooth loss and MMSE scores. In conclusion, tooth loss may play a role in developing cognitive decline, especially in the early onset of dementia. Further studies are needed to investigate whether early tooth loss at younger ages is associated with dementia, especially among middle-aged people.

Myasthenia gravis (MG) is a rare neuromuscular disorder. Till now, there are no studies on the prevalence and incidence of MG in Mongolia. The current study aimed to elucidate the incidence of MG in Ulaanbaatar, the age of onset, and the gender distribution of Mongolian patients with MG. We conducted a cross-sectional, hospital-based study involving MG patients (n=48) all around Ulaanbaatar from 1 January 2015 to 1 January 2020. The clinical diagnosis was assessed with the Myasthenia Gravis Foundation of America (MGFA) classification system. The disease severity was evaluated by using Osserman’s classification. The diagnosis was confirmed with serological and electrophysiological tests. Statistical analysis was performed using SPSS software. A total of 30 patients with MG were registered for the last five years in Ulaanbaatar. The average annual incidence of MG in Ulaanbaatar was 0.65 per 100,000 populations (95%CI 0.26-1.34), 0.60 in males (95%CI 0.25-1.28), and 0.69 in females (95%CI 0.33-1.46). The cumulative incidence in the study period was 3.2 per 100,000 populations. The ratio of males to females was 1:1,3. The median age for onset of MG was 33 years (ranging from 27 to 46 years); 43.3% of patients had ocular and 56.7% generalized symptoms at the disease onset. Only 23.3% of patients remained with purely ocular symptoms (Osserman I stage). The average incidence of MG between 2015 and 2020 was 6,5 per 1.000.000 population, and the annual incidence was relatively stable. Although ocular and generalized symptoms were observed each in about half of the cases, only one-fourth remained with pure ocular signs at the end of the review period.

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.

Background and ObjectivesThere is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional health care services. We studied the global distribution of risk factors, causes, and 3-month mortality of young patients with ischemic stroke, by performing a patient data meta-analysis from different cohorts worldwide.MethodsWe performed a pooled analysis of individual patient data from cohort studies that included consecutive patients with ischemic stroke aged 18–50 years. We studied differences in prevalence of risk factors and causes of ischemic stroke between different ethnic and racial groups, geographic regions, and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression.ResultsWe included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Black (hypertension, 52.1%; diabetes, 20.7%) and Asian patients (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often the cause of stroke in high-income countries (HICs; both p < 0.001), whereas “other determined stroke” and “undetermined stroke” were higher in low and middle-income countries (LMICs; both p < 0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (odds ratio 2.49; 95% confidence interval 1.42–4.36).DiscussionEthnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial and regional differences in incidence of ischemic stroke. Our results also highlight the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve health care facilities in LMICs.

(1) Background: The “Ger Recommendations” have been advised to promote a healthy diet in Mongolia. These recommendations emphasize the ratio of six macro-food components to ensure proper nutrition. In this study, the ratio of these six groups to the total daily caloric intake was determined. (2) Methods: This study was conducted as part of a study at the Clinical Cohort (“Mon-Timeline”) of the Mongolian National University of Medical Science. A macro-community ratio was calculated using a 24-h dietary recall diary of a total of 498 people. (3) Results: The mean age of the study participants was 43.9 ± 12.9 years. Among them, 21.8% (n = 110) were male. Of the total calories, 44.7% were grains, 29.2% were meat and protein products, 9.3% were fats, 7.1% were dairy products, 6.6% were vegetables, and 3.1% were fruits. According to the ratio of the six groups in the Ger Recommendations, meat and grains exceeded the recommended amount, while fruits, milk, and vegetables were consumed less. It has been observed that the older a person ages, the closer they are to following these recommendations. In terms of gender, women consumed more fruit and milk than men. (4) Conclusions: The ratio of macronutrients in the daily caloric intake of Mongolians is inadequate. Therefore, knowledge about the “Ger Recommendations” needs to be studied in relation to people’s healthy eating knowledge and attitudes. If necessary, the appropriate awareness needs to be increased to educate the public on proper eating habits.

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.