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Addenbrooke’s cognitive examination (ACE) is a cognitive screening tool that has developed through three stages: ACE, ACE-Revised (ACE-R), and ACE-Ⅲ. In addition, mini-Addenbrooke’s Cognitive Examination (M-ACE) and ACE mobile are the additional versions that is derived from ACE-III. ACE and its related versions show better performance than Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in detecting mild cognitive impairment in different neurological disorders. It has been translated into numerous languages, including Chinese. Through reviewing the history, validity, and comparison with other cognitive tests of Chinese versions of ACE, it aims to facilitate the clinical and scientific use, further development, improvement, and validation of Chinese versions of ACE in various neurological disorders and ultimately promote early identification and management of cognitive impairment in China.

Background:Identifying risk factors and mortality of individuals with Alzheimer’s disease (AD) could have important implications for the clinical management of AD.Objective:This pilot study aimed to examine the overall mortality of AD patients over a 10-year surveillance period in Shanghai, China. This study is an extension of our previous investigation on mortality of neurodegenerative diseases.Methods:One hundred and thirty-two AD patients recruited from the memory clinics of two hospitals in Shanghai in 2007 were followed up until December 31, 2017 or death, representing a follow-up period of up to 10 years. Overall standardized mortality ratios (SMRs) were calculated, and predictors for survival at recruitment were estimated.Results:Sixty-seven patients had died by December 31, 2017, and the SMR at 10 years of follow-up was 1.225 (95% confidence interval 0.944–1.563). Employing Cox’s proportional hazard modeling, lower Mini-Mental State Examination score, and comorbid diabetes predicted poor survival in this cohort.Conclusion:This pilot study suggests a similar survival trend of patients with AD compared to the general population in Shanghai urban region. Poor cognitive status and comorbid diabetes had a negative impact on the survival of AD patients.

Background Cholinesterase inhibitors and memantine have been approved for management of Alzheimer’s disease (AD), but there has been no consensus about the choice of various types and doses of drugs at different stages. Hence, we compared and ranked the efficacy and tolerability of these available drugs. Methods We searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) published from database inception to July 21, 2017. The primary outcomes were the mean overall changes in cognitive function and responders who had any adverse events. We conducted a random-effects network meta-analysis. Results Forty-one RCTs were included in this study. Compared with placebo, galantamine 32 mg daily (standardized mean difference – 0.51, 95% credible interval – 0.67 to − 0.35), galantamine 24 mg daily (− 0.50, − 0.61 to − 0.40), and donepezil 10 mg daily (− 0.40, − 0.51 to − 0.29) were probably the most effective agents on cognition for mild to moderate AD, and memantine 20 mg combined with donepezil 10 mg (0.76, 0.39 to 1.11) was recommended for moderate to severe patients. Memantine showed the best profile of acceptability. Rivastigmine transdermal 15-cm2 patch was the best optional treatment both in function and global changes. None of the medicines was likely to improve neuropsychiatric symptoms through this analysis. Conclusions Pharmacological interventions have beneficial effects on cognition, function, and global changes, but not on neuropsychiatric symptoms, through current network meta-analysis. The choice of drugs may mainly depend on the disease severity and clinical symptoms. Electronic supplementary material The online version of this article (10.1186/s13195-018-0457-9) contains supplementary material, which is available to authorized users.

This study was designed to examine the feasibility of a caregiving self-management support program developed for caregivers of relatives with dementia in Shanghai. A total of 41 caregivers were recruited for a quasi-experimental study. The experimental group of 26 participants attended six bi-weekly social support group sessions. The control group of 15 participants received three monthly telephone instructions. All of participants received an illustrated caregiver educational booklet and three educational presentations during a six-month follow-up period. The results demonstrated a stronger sense of self-efficacy regarding the gathering of information about dementia care in both study groups compared to the baseline data. Caregivers participating in the group sessions reported better health-related quality of life, improved responses to behavioral disturbances, and efficacy in the management of stress than those who received telephone instructions. This study provided some preliminary information regarding ways to improve self-management for the target population in mainland China.

Background Cognitive impairment is one of the non-motor symptoms in Parkinson’s disease (PD). In the present study, we aim to examine the cognitive function of non-demented Parkinson’s disease patients and compare the results between male and female patients as well as control groups in search of any gender effect. Methods Sixty PD Patients (30 males and 30 females) from the Movement Disorders Clinic at Huashan Hospital Affiliated to Fudan University were recruited to participate in the study. One hundred age and gender matched control subjects without neurological or psychiatric disorders were voluntarily recruited. The participants were administered measures of cognition in five domains including memory, language, spatial processing abilities, attention and executive function. Results PD patients attained significantly lower scores in the visual spatial function, language and attention/executive function compared with the control group. Anti-parkinsonian treated patients performed worse in Rey-copy score, Clock Drawing Test (CDT) and Verbal Fluency-City than untreated ones. In regard to gender differences, though no general cognitive differences were found in Mini-mental State Examination (MMSE), men surpassed women on Boston naming test (BNT) while women were superior on Auditory Verbal Learning Test-long (AVLT) delayed cued recall test. Conclusions Cognitive impairments were common in PD patients even in the absence of dementia. PD patients with anti-parkinsonian medication had worse cognitive impairment than untreated patients. Genders may have different manifestations of cognitive impairment in PD patients.

Supplementary 1. Network meta-analysis model. Supplementary 2. References for included trials. Supplementary 3. Summary of included trials and patient characteristics. Supplementary 4. Risk of bias assessment. Supplementary 5. Results from pairwise meta-analysis for each outcome. Supplementary 6. Results from network meta-analysis for each outcome. Supplementary 7. Network plot for each outcome. Supplementary 8. Treatment ranking and rankograms for each outcome. Supplementary 9. Assessment of inconsistency results for each outcome. Supplementary 10. Comparison-adjusted funnel plot for each outcome from the network meta-analysis. Supplementary 11. Subgroup network meta-analysis for secondary outcomes. Supplementary 12. Sensitivity network meta-analysis for primary outcomes. Supplementary 13. Assessment of heterogeneity results for each outcome. (PDF 2427 kb)

Objective: Recently, candidate genetic studies revealed the single nucleotide polymorphisms (SNPs) of CUGBP2 (rs2242451) and DNMBP (rs11190305 and rs3740058) associated with Alzheimer’s disease (AD). Due to genetic heterogeneity and different ethnic background, the purpose of our study was to confirm the association between these 3 SNPs with AD risk in the Chinese Han population. Methods: We investigated 482 sporadic AD (SAD) patients and 813 unrelated cognitive normal controls of the Chinese Han population. The genotypes of the 3 SNPs (rs2242451, rs11190305, rs3740058) were carried out by MassARRAY iPLEX system. Results: The genotype and the allele frequency of rs2242451 were significantly different between AD and control group in total subject (genotype: p=0.019, allele frequency: p=0.022, OR=0.760, 95%CI=0.601- 0.962) with A allele decreasing AD risk. After stratification by age at onset, gender, APOE e4 carrying status and homozygous APOE e4, the protective effect of A allele remained in female and APOE e4e4 non-carrying subgroups. The rs3740058 in DNMBP was significantly differently in genotype between AD and control in APOE e4e4 subgroup, but showed no effect on AD risk, either did rs11190305 polymorphisms in DNMBP. Meta-analysis was performed in rs11190305 and rs3740058 of DNMBP respectively. Positive relationship with AD was found in rs11190305 (OR=1.11, 95%CI=1.01-1.21), but not in rs3740058 (OR=1.05, 95%CI=0.98-1.13). Moreover, the genotypes of these 3 SNPs had no effect on age at onset of AD. Conclusion: The A allele of rs2242451 in CUGBP2 might decrease SAD risk in the Chinese Han population.

Background:This study aims to explore moderation and mediation roles of caregiver self-efficacy between subjective caregiver burden and (a) behavioral and psychological symptoms (BPSD) of dementia; and (b) social support.Methods:A cross-sectional study with 137 spouse caregivers of dementia patients was conducted in Shanghai. We collected demographic information for the caregiver–patient dyads, as well as information associated with dementia-related impairments, caregiver social support, caregiver self-efficacy, and SF-36.Results:Multiple regression analysis showed that caregiver self-efficacy was a moderator both between BPSD and subjective caregiver burden, and social support and subjective caregiver burden. Results also showed a partial mediation effect of caregiver self-efficacy on the impact of BPSD on subjective caregiver burden, and a mediation effect of social support on subjective caregiver burden. Caregiver self-efficacy and subjective burden significantly influenced BPSD and social support.Conclusion:Caregiver self-efficacy played an important role in the paths by which the two factors influenced subjective burden. Enhancing caregiver self-efficacy for symptom management (particularly BPSD) can be an essential strategy for determining interventions to support dementia caregivers in China, and possibly in other countries.

Memory and Executive Screening (MES). (DOC 29 kb)

Background Recent studies highlight a potential role of cholesterol metabolic disturbance in the pathophysiology of Alzheimer disease (AD). The adenosine triphosphate (ATP)-binding cassette transporter 1 (ABCA1) gene resides within proximity of linkage peaks on chromosome 9q influence AD and plays a key role in cellular cholesterol efflux in the brain. Methods We studied the role of R219K and V825I polymorphisms of ABCA1 in modulating the risk of AD in 321 AD patients and 349 comparisons of Chinese Han. Genotyping of R219K and V825I were performed by PCR-restriction fragment length polymorphism analysis. Results The genotype distribution of R219K was different with more RK in total AD group (χ 2 = 8.705, df=2, p=0.013), late-onset AD (LOAD) group (χ 2 = 10.636, df=2, p=0.005), APOE non-ɛ4ɛ4 group (χ 2 = 9.900, df=2, p=0.007), and female AD group (χ 2 = 8.369, df=2, p=0.015). Logistic regression manifested the risk of AD increased in RK carriers in total AD group (Wald = 6.102, df=1, p=0.014, odds ratio [OR]: 1.546, 95% confidence interval [95% CI]: 1.094–2.185), LOAD group (Wald = 7.746, df=1, p=0.005, OR: 1.921, 95% CI: 1.213–3.041), and APOE non-ɛ4ɛ4 group (Wald = 6.399, df=1, p=0.011, OR: 1.586, 95% CI: 1.109–2.266). K allele (RK + KK) also increased the risk of AD compared with RR allele in LOAD group (Wald = 4.750, df=1, p=0.029, OR: 1.619, 95% CI: 1.050–2.497). However, no discrepancy was found in V825I. In R219K, age at onset (AAO) was significantly lower by 4.9 years on average in patients of KK genotype than those of RK in APOE ɛ4 carrying group and higher by 5.5 years in patients of KK genotype than those of RR in APOE ɛ4 noncarrying group. In V825I, AAO was diseased by 4.3 years in II genotype compared with VV genotype in APOE ɛ4 noncarrying group and 3.4 years in APOE ɛ4ɛ4 noncarrying group. Conclusion The results indicated that the RK genotype or K allele (RK + KK) of R219K may relate to the development of AD in the east of China.

The purpose of this study was to develop a Self-Efficacy Questionnaire for Chinese Family Caregivers. Semi-structured interviews with 10 family caregivers of people with dementia were conducted to explore how Chinese caregivers manage caregiving and what difficulties they face. The findings of the study assisted in the development of the instrument. Five categories of caregiver behaviours were identified from the qualitative data: gathering information about treatment, symptoms, and health care; obtaining support; responding to behaviour disturbances; managing household, personal, and medical care; and managing distress associated with caregiving. The challenges of caregiving were also identified, including deterioration of care recipients, particularly their behaviour disturbances, a shortage of supportive resources, stigmatization of dementia among the general population, as well as increased distress and decreased social activities due to increased care demand. The findings were used to develop the Self-Efficacy Questionnaire for Chinese Family Caregivers, and 35 items comprising five subscales (representing the above five categories of caregiver behaviour) were generated.

Background The relationship between alterations in thyroid function and cognitive deficits has been investigated in several previous studies. Hypo-or hyperthyroidism and, to a lesser extent, subclinical thyroid dysfunction can negatively affect cognitive performance. However, limited data are available on the potential association of thyroid function with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) in the elderly Chinese population. Methods In the present study focusing on a population of elderly Chinese individuals ≥ 50 years of age, 77 cognitively normal controls, 64 patients with MCI, and 154 patients diagnosed with AD underwent assessment of thyroid status using thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4) levels as variables. Cognitive function was evaluated with the aid of comprehensive neuropsychological tests, such as the Mini-Mental State Examination (MMSE) and Memory and Executive Screening (MES). Results Overall, 88.1 % of the subjects displayed normal thyroid function, 4.7 % were diagnosed with clinical hypothyroidism, 3.1 % with subclinical hypothyroidism, and 4.1 % with subclinical hyperthyroidism. After adjusting for covariates (age, sex, education years and body mass index), no association was evident between mild cognitive impairment or AD and thyroid dysfunction. However, lower serum TSH was correlated with risk of AD (odds ratio [OR]: 2.78, 95 % confidence interval [95% CI]: 1.11-6.99). Conclusion Neither hypothyroidism nor subclinical hyperthyroidism was associated with AD and MCI in this population-based elderly Chinese cohort. Our findings need to be confirmed in a longitudinal study. Electronic supplementary material The online version of this article (doi:10.1186/s12902-016-0092-z) contains supplementary material, which is available to authorized users.

Ping Wu,1,2 Hong-Lei Li,1 Zhi-Jun Liu,1 Qing-Qing Tao,1 Miao Xu,1 Qi-Hao Guo,1 Zhen Hong,1 Yi-Min Sun1 1Department of Neurology and Institute of Neurology, 2PET Center, Department of Nuclear Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of ChinaObjective: Apolipoprotein E gene (APOE) polymorphisms contributing to the risk of sporadic Alzheimer’s disease (AD) have been identified for decades, but it has not been investigated in large AD samples of Chinese Han population.Methods: We performed a cross-sectional study to explore the effect of APOE polymorphisms on sporadic AD in 875 sporadic AD patients and 1,195 cognitive normal controls of Chinese Han. Genotyping of APOE was determined by multiplex amplification refractory mutation system polymerase chain reaction.Results: APOE ε3ε4 andε4ε4genotypes increased AD risk with dosage effect. The odds ratio (OR) ofε3ε4was 1.89 and the OR ofε4ε4was 15.64 compared with that ofε3ε3 in all the subjects. E2ε3 genotype decreased AD risk in all the subjects (OR=0.64), female subgroup (OR=0.57), and late-onset AD subgroup (OR=0.60). However, neitherε2ε2nor ε2ε4 affected AD risk. About the age at onset (AAO), the influence of APOEε4was only exhibited in late-onset AD subgroup, with 1 year lower inε4-positive ones than negative ones. Further analysis did not show the dosage effect of Ε4 pertinent to AAO, though the AAO ofε4ε4patients decreased by 2years. E2 did not affect the AAO of AD.Conclusion: APOEε4is a strong risk factor of AD risk in Chinese Han population, and APOEε4ε4genotype might be related to the AAO of late-onset AD. Keywords: sporadic, cross sectional study, dosage effect, age at onset

Recently, candidate genetic studies revealed the single nucleotide polymorphisms (SNPs) of CUGBP2 (rs2242451) and DNMBP (rs11190305 and rs3740058) associated with Alzheimer's disease (AD). Due to genetic heterogeneity and different ethnic background, the purpose of our study was to confirm the association between these 3 SNPs with AD risk in the Chinese Han population.We investigated 482 sporadic AD (SAD) patients and 813 unrelated cognitive normal controls of the Chinese Han population. The genotypes of the 3 SNPs (rs2242451, rs11190305, rs3740058) were carried out by MassARRAY iPLEX system.The genotype and the allele frequency of rs2242451 were significantly different between AD and control group in total subject (genotype: p=0.019, allele frequency: p=0.022, OR=0.760, 95%CI=0.601- 0.962) with A allele decreasing AD risk. After stratification by age at onset, gender, APOE ε4 carrying status and homozygous APOE ε4, the protective effect of A allele remained in female and APOE ε4ε4 non-carrying subgroups. The rs3740058 in DNMBP was significantly differently in genotype between AD and control in APOE ε4ε4 subgroup, but showed no effect on AD risk, either did rs11190305 polymorphisms in DNMBP. Meta-analysis was performed in rs11190305 and rs3740058 of DNMBP respectively. Positive relationship with AD was found in rs11190305 (OR=1.11, 95%CI=1.01-1.21), but not in rs3740058 (OR=1.05, 95%CI=0.98-1.13). Moreover, the genotypes of these 3 SNPs had no effect on age at onset of AD.The A allele of rs2242451 in CUGBP2 might decrease SAD risk in the Chinese Han population.

Previous studies have shown that brain functional activity in the resting state is impaired in Alzheimer's disease (AD) patients. However, alterations in intrinsic brain activity patterns in mild cognitive impairment (MCI) patients are poorly understood. This study aimed to explore the differences in regional intrinsic activities throughout the whole brain between aMCI patients and controls.In the present study, resting-state functional magnetic resonance imaging (fMRI) was performed on 18 amnestic MCI (aMCI) patients, 18 mild AD patients and 20 healthy elderly subjects. And amplitude of low-frequency fluctuation (ALFF) method was used.Compared with healthy elderly subjects, aMCI patients showed decreased ALFF in the right hippocampus and parahippocampal cortex, left lateral temporal cortex, and right ventral medial prefrontal cortex (vMPFC) and increased ALFF in the left temporal-parietal junction (TPJ) and inferior parietal lobule (IPL). Mild AD patients showed decreased ALFF in the left TPJ, posterior IPL (pIPL), and dorsolateral prefrontal cortex compared with aMCI patients. Mild AD patients also had decreased ALFF in the right posterior cingulate cortex, right vMPFC and bilateral dorsal MPFC (dMPFC) compared with healthy elderly subjects.Decreased intrinsic activities in brain regions closely related to episodic memory were found in aMCI and AD patients. Increased TPJ and IPL activity may indicate compensatory mechanisms for loss of memory function in aMCI patients. These findings suggest that the fMRI based on ALFF analysis may provide a useful tool in the study of aMCI patients.

To construct the functional networks of human brains by resting-state functional magnetic resonance imaging (fMRI) and examine whether or not the small-world property of functional brain networks changes in patients with Alzheimer disease (AD).A total of 33 AD patients and 20 healthy old volunteers were recruited. Their cognitive functions were evaluated by the mini-mental state examination (MMSE) and Mattis dementia rating scale (DRS). The resting-state BOLD-fMRI data were acquired and preprocessed. Then the correlation coefficient of every pair of 90 regions was calculated and correlation matrix Z (N×N, N = 90) generated by Fisher Z transformation. The small-world property of functional brain networks was tested for AD patients and normal elders according to the definition of small-worldness. The changes of relevant parameters in AD patients were examined by two sample t-tests.Behavioral results: the MMSE scores of AD group and normal controls (NOR) were 20.60 ± 2.30 and 28.20 ± 1.80 respectively. The DRS scores of AD and NOR groups were 96.00 ± 10.82 and 123.22 ± 13.74 respectively. The MMSE and DRS scores were statistically different between two groups. Calculation of small-world parameters: Within the range of 0.1 ≤ Sparsity ≤ 0.4, both groups satisfied the small-world property. However, the clustering coefficient Cp and the average shortest path Lp of AD group were significantly higher than those of NOR group at each threshold (P0.05).The functional brain networks in AD patients still have the property of small-world. But the levels of Cp and Lp are higher in AD patients than those in normal controls. It suggests that the capacity of information transmission in functional brain networks and the ability of information integration in different brain regions in AD patients are impaired. This finding is of great importance in elucidating the pathological mechanisms of AD from the viewpoint of networks.

To provide rationales for the prevention and treatment of elderly patients with cognitive disorders through comparing the comorbidities according to different etiologies and severities.Six groups of different cognitive status were selected. There were 438 normal cognitive subjects (NC) from Jing'an community of Shanghai. Five other groups were from the Memory Clinic at our hospital from June 2006 to June 2010. There were subjective memory complaints (n = 443, SMC), mild cognitive impairment (n = 540, MCI), vascular cognitive impairment-non dementia (n = 119, VCI-ND), Alzheimer's disease (n = 337, AD) and vascular dementia (n = 54, VaD). All participants finished a battery of neuropsychological tests and completed the survey of such comorbidities as stroke, conscious disturbance, hypertension, diabetes, head injuries and excessive drinking.The comorbidity rates of diabetes were 11.4%, 9.9%, 16.1%, 14.2%, 12.4% and 18.5% in 6 groups (NC, SMC, MCI, VCI-ND, AD, VaD) respectively. There were no differences for overall or pairwise chi square tests. The rates of stroke, hypertension and excessive drinking in patients of VCI-ND and VaD were higher than those of SMC, MCI and AD. The comorbidity rates in the VCI-ND and VaD group were 54.6% vs 62.9% for stroke; 61.3% vs 79.6% for hypertension; 22.6% vs 37.0% for excessive drinking. Whereas in the SMC, MCI and AD groups, the rates were 9.4%, 10.9% and 3.0% for stroke; 44.9%, 47.2% and 42.1% for hypertension; 18.0%, 18.3% and 15.1% for excessive drinking. No distinct differences existed for the comorbidity rates among SMC, MCI and AD groups or among different degrees of AD.Etiologies rather than severities determine the different rates of comorbidities in the elders with cognitive impairment.

Comparing the characteristics of cognitive impairment of patients with single subcortical lesion stroke of four different areas, we are to explore the cognitive function of the thalamus and basal ganglia and this is help for early identification of vascular cognitive impairment (VCI).63 patients with single subcortical lesion stroke (including 14 left thalamic stoke group, 17 left basal ganglia stroke group, 15 right thalamic stroke group, 17 right basal ganglia stroke group) and 34 healthy subjects participated in the current study, whose age, sex and education were matched. A comprehensive neuropsychological battery was used for evaluation.Compared to the normal control group, there was an overall decline of cognitive functions in patients with single subcortical lesion stroke in memory, attention/executive function, language, and visuospatial ability (P0.05). The scores of the left thalamic stroke group were worse than the other three stroke groups in language (BNT16.6 ± 2.6), auditory verbal learning test-immediate recall (12.8 ± 4.4), auditory verbal learning test-delayed recall (2.4 ± 2.3), listening recognition (19.1 ± 3.1), structure delayed recall (9.1 ± 4.7) and symbol digit modalities test-recall (0.9 ± 1.1) (P0.05). However, the left basal ganglia stroke group did better in tests manipulated by the right hand [including Trial making test (part A) score (75 ± 22), Trail making test (part B) score (204 ± 81), Clock drawing test (23.5 ± 4.6), Symbol digit modalities test (24 ± 9)] than other three stroke group, as good as the normal group (P0.05).Single subcortical stroke patients may have general, non-selective cognitive impairment. But, different stroke areas have their own characteristics. The scores of the left thalamic stroke group were worse than the other three stroke groups.

To analyze the characterization of cognitive function in Parkinson's disease with dementia and Alzheimer's disease.Cognitive function was examined in Parkinson's disease with dementia (PDD) patients (n = 30), Alzheimer's disease (AD) patients (n = 30) and healthy elderly control subjects (n = 60). Neuropsychological evaluation contained semantic fluency test, phonemic fluency test, action fluency test, objective and action naming tests.In PDD group, the score of semantic fluency test is 9.33 ± 2.78, 6.17 ± 1.67 of phonemic fluency test and 7.03 ± 2.34 of action fluency test, it is 6.90 ± 2.47, 7.87 ± 2.01, 8.30 ± 3.17 of AD group. The score of objective and action naming tests is 36.33 ± 3.39, 17.63 ± 2.17 in PDD group, while AD patients is 33.23 ± 3.56 and 22.33 ± 2.37. The verbal fluency tests and naming tests were impaired in PDD and AD patients compared with the healthy elderly control group (P0.01), phonemic fluency, action fluency and action naming were more impaired in PDD patients compared with the AD group, while semantic fluency and objective naming were more impaired in AD patients (P0.01).Executive function deficit and naming impairment are found in PDD and AD patients, it shows that PDD is characterized by the addition of cortical dysfunction upon a predominant and progressive fronto-subcortical impairment. There is subcortical dysfunction in AD patients.

To understand the nature of subjective memory complaints through comparative study of depression status of patients with subjective memory complaints and mild cognitive impairment.A total of 214 patients were assessed with the Center for Epidemiologic Studies Depression (CES-D) scale, the Geriatric Depression Scale and some neuropsychological tests. Among them, 76 were of subjective memory complaints (SMC), 74 amnestic mild cognitive impairment-single domain (aMCI-s) and 64 amnestic mild cognitive impairment-multiple domain (aMCI-m).According to CESD, 31% of the patients had symptoms of depression. The ratios were 30%, 24% and 39% in SMC, aMCI-s and aMCI-m groups respectively. GDS study showed that 43% of the patients had symptoms of depression. The ratios were 47%, 30% and 53% in SMC, aMCI-s and aMCI-m groups respectively. The ratio in SMC group fell between the other two groups. The total score of CESD (12 +/- 10) or GDS (11 +/- 6) of the SMC group, reflecting the severity of depression, fell between aMCI-s (CESD: 11 +/- 8, GDS: 9 +/- 5) and (CESD: 15 +/- 11, GDS: 12 +/- 7) groups. There was no significant difference between them in comparison with either aMCI-s or aMCI-m group (P0.05). But the total score of CESD or GDS was significantly different between aMCI-m and aMCI-s groups (P0.05). The depression status was worse in aMCI-m group than that in aMCI-s group.There is no significant discrepancy in the incidence and severity of depression between SMC and aMCI groups. It indicates that depressive mood is not the specific cause of SMC.

Objective To assess whether quick cognitive screening test (QCST) could quickly identify mild cognitive impairment (MCI).

To analyze the effects of intracranial tumors and tumor resection on patients' memory functions.Four different memory scales were employed to evaluate 58 intracranial tumor patients' memory functions including short-term memory, delayed memory, clue memory and long-term memory. Thirty-five patients received postoperative follow-ups. There were also 18 healthy controls.The extra-cerebral tumor patients presented with delayed memory and long-term memory disorders while intra-cerebral tumor patients suffered from short-term, delayed and severe long-term memory disorders. Patients with dominant hemispheric tumors had more serious memory disorders in all types. Scores obtained after surgery showed an aggravated long-term memory disorder. Sellar region tumors and transsphenoidal tumor resection had no effects upon memory functions.Intracranial tumors cause memory disorders. Tumors with different locations and characters have different memory impairments. Intra-cerebral tumors result in more severe memory impairment than extra-cerebral tumors. And dominant hemispheric tumors are worse than non-dominant hemispheric tumors. Tumor resection decreases long-term memory functions.

To explore the clinical characteristics of the Memory Clinic patients at Huashan Hospital and to provide suggestions for future research, we retrospectively reviewed the demographic, cognitive and aetiological data from 2,789 consecutive patients who attended the Memory Clinic of the Department of Neurology at Huashan Hospital from April 2003 to April 2008. The demographical distribution of the patients was as follows: there were more females (58%) than males; 58% of the patients were older than 70 years of age; and most patients (77%) had six or more years of education. The distribution of the diagnoses was as follows: degenerative or vascular dementia, 46.4%; mild cognitive impairment, 22.8%; subjective cognitive impairment, 21.7%; neurosis, 3.3%; organic cognitive impairment, 3.9%; unspecified dementia, 1.2%; and pure amnesia, 0.7%. These results showed that older patients with relatively high levels of education comprised the majority of our sample and a high percentage of the patients showed absent or mild cognitive impairment. Accordingly, future studies should focus on early diagnosis and treatment for dementia. Detailed neuropsychological tests and follow-up assessments are becoming increasingly important in the diagnosis of memory diseases in China.

To assess whether quick cognitive screening test (QCST) could quickly identify mild cognitive impairment (MCI).QCST and a full set of standardized neuropsychological tests, including mini-mental state examination (MMSE) and montreal cognitive assessment (MoCA) were performed. A total number of 121 cases of MCI [41 cases of amnestic MCI-single domain (aMCI-s); 44 of amnestic MCI-multiple domain (aMCI-m); 36 of nonamnestic MCI (naMCI)], 79 cases of mild Alzheimer's disease (AD) and 186 healthy elderly volunteers were employed in the present study. All the participants (55-85 years old) had an educational level no less than 5 years. QCST subtests included word list recall, naming test, animal fluency test, similarity test, color trail-1min, clock drawing test, finger construction test, and digit span test. The total score of QCST was 90 points, 10 points for each index of subtests.The total scores of QCST in MCI, AD and the control groups were (58.13+/-8.18), (44.53+/-10.54) and (72.92+/-6.85) points, respectively. According to the educational level, the cut off scores of participants with an educational level of 5-8 years, 9-12 years and more than 13 years were 63, 65 and 68 points, respectively. The sensitivity and specificity of QCST in detection of MCI were 87.6% (85.7% for aMCI-s, 90.1% for aMCI-m and 89.5% for naMCI) and 84.3%, respectively. The area under the curve was 0.923 (95% CI: 0.892-0.953). Delayed memory, color trail-1min and similarity test could help distinguish between aMCI and naMCI.QCST may have a good sensitivity and specificity for MCI detection, which warrants its further clinical application.

To observe whether the severity of white matter lesions (WML) is related to ischemia in elderly.WML were divided into 2 categories (centrum semiovale and periventricular regions) and four grades (grade 0, grade 1, grade 2 and grade 3) according to the severity of WML showing on the FLAIR sequence of MRI using modified Fazekas scale. The values of regional cerebral blood flow (rCBF) within WML and other brain regions were measured using Xenon contrast CT.Mean rCBF (ml x 100 g(-1) x min(-1)) within lesions around periventricular areas, in right and left centrum semiovale were 20.8 +/- 2.8, 22.3 +/- 1.9 and 22.2 +/- 2.1 in grade 0; 20.3 +/- 2.5, 21.3 +/- 1.0 and 21.0 +/- 1.8 in grade1; 16.3 +/- 2.0, 15.6 +/- 1.7 and 15.9 +/- 0.9 in grade 2; 14.1 +/- 2.6, 14.5 +/- 2.2 and 14.2 +/- 1.9 in grade 3 respectively. The severity of WML is associated significantly with reduction of rCBF within lesions both in centrum semiovale and periventricular regions (all P0.05). There was no significant difference in rCBF values between grade 0 and 1, but significant differences existed between grade 0 and grades 2 and 3, between grade 1 and grades 2 and 3 (all P0.05). Statistical significance also existed between the severity of white matter lesions and rCBF in bilateral temporal lobes and lentiform nucleases (P0.05).The severity of WML both in centrum semiovale and periventricular regions is associated significantly with reduction of rCBF within lesions.