Qihao Guo

Changes in Brain Volume and Cognition in a Randomized Trial of Exercise and Social Interaction in a Community-Based Sample of Non-Demented Chinese Elders

Physical exercise has been shown to increase brain volume and improve cognition in randomized trials of non-demented elderly. Although greater social engagement was found to reduce dementia risk in observational studies, randomized trials of social interventions have not been reported. A representative sample of 120 elderly from Shanghai, China was randomized to four groups (Tai Chi, Walking, Social Interaction, No Intervention) for 40 weeks. Two MRIs were obtained, one before the intervention period, the other after. A neuropsychological battery was administered at baseline, 20 weeks, and 40 weeks. Comparison of changes in brain volumes in intervention groups with the No Intervention group were assessed by t-tests. Time-intervention group interactions for neuropsychological measures were evaluated with repeated-measures mixed models. Compared to the No Intervention group, significant increases in brain volume were seen in the Tai Chi and Social Intervention groups (p < 0.05). Improvements also were observed in several neuropsychological measures in the Tai Chi group, including the Mattis Dementia Rating Scale score (p = 0.004), the Trailmaking Test A (p = 0.002) and B (p = 0.0002), the Auditory Verbal Learning Test (p = 0.009), and verbal fluency for animals (p = 0.01). The Social Interaction group showed improvement on some, but fewer neuropsychological indices. No differences were observed between the Walking and No Intervention groups. The findings differ from previous clinical trials in showing increases in brain volume and improvements in cognition with a largely non-aerobic exercise (Tai Chi). In addition, intellectual stimulation through social interaction was associated with increases in brain volume as well as with some cognitive improvements.

A comparison study of mild cognitive impairment with 3 memory tests among Chinese individuals.

ObjectiveTo examine whether 3 common memory tests differ statistically in terms of mild cognitive impairment (MCI) discrimination rates and conversion rates to Alzheimer disease. MethodsA sample of 329 Chinese patients who consulted our memory clinic in Shanghai were tested using tasks including the auditory verbal learning test (AVLT), the logical memory (LM) test, the Rey-Osterrieth complex figure test, and other neuropsychologic tasks. One hundred and forty-nine of these patients were tested again using the identical tests 2 years later. The diagnose standard of probable Alzheimer disease is the same as the standard of the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer Disease and Related Disorders Association. ResultsThe results of the MCI discrimination rates are as follows: AVLT-II (51%) >AVLT-I (31%) > complex figure test-II (27%) >LM-I (21%)=LM-II (21%) (I—immediate recall; II—delayed recall). The MCI group categorized based on LM-II cutoff has a higher conversion rate per year (24%), but also a higher reversal rate and missed diagnosis rate, whereas the group based on AVLT-II cutoff has a lower conversion rate per year (12%), but also a lower reversal rate and missed diagnosis rate. ConclusionsThe MCI discrimination rate and the conversion rate among different episodic memory tests are differ considerably.

Prevalence and Risk Factors of Poor Sleep Quality among Chinese Elderly in an Urban Community: Results from the Shanghai Aging Study

Background Sleep disorders causes a significant negative effect on mental and physical health, particularly among the elderly. The disease burden and risk factors of poor sleep quality of the elderly need to be verified using a validated form of measurement in urban mainland China. Methods This study included 1086 community residents aged ≥60 years who completed the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Poor sleeper was defined by a CPSQI global score of >5. Subjects also accepted the neurological and neuropsychological assessments, including the Mini-Mental State Examination, Center for Epidemiological Studies Depression Scale, and Zung Self-Rating Anxiety Scale (ZSAS). A history of chronic diseases was confirmed by the medical records of each participant. Results The prevalence of poor sleep quality in this population was 41.5% (95% confidence interval (CI) = 38.6–44.5%), with a higher rate observed in elderly females (45.8% [95% CI = 41.9–49.7%]) than that in elderly males (35.8% [95% CI = 31.4–40.1%]). The prevalence rate increased with age, from 32.1% (95% CI = 27.8–36.4%) in those aged 60–69 years to 52.5% (95% CI = 45.9–59.1%) in those aged ≥80 years (p value for trend<0.001). Multivariate logistic regression analysis indicated that age (OR = 1.03[95% CI = 1.01–1.05], p<0.001), less education duration (OR = 1.04 [95% CI = 1.01–1.08, p = 0.014), living alone (OR = 1.62 [95% CI = 1.02–2.58], p = 0.04), anxiety (ZSAS score: OR = 1.09 [95% CI = 1.05–1.12], p<0.001), number of chronic disease (OR = 1.18 [95% CI = 1.07–1.30], p = 0.14) and arthritis (OR = 1.45[95% CI = 1.05–2.01], p = 0.025) were risk factors of poor sleep quality. Conclusions Poor sleep quality is highly prevalent among elderly Chinese residents in urban Shanghai. Growing attention and comprehensive countermeasures involving psycho-social and personal activities might alleviate the sleep problem in the elderly.

Transcranial Doppler Ultrasound for Screening Cerebral Small Vessel Disease A Community Study

Background and Purpose— We explored the association between pulsatility index (PI) as derived from transcranial Doppler ultrasound with various measures of small vessel disease in the community. Methods— We performed transcranial Doppler and magnetic resonance imaging in 205 consecutive community-dwelling elderly subjects who were participants of the Shanghai Aging Study. We investigated the association between middle cerebral artery (MCA) PI with measures of white matter lesions (WML), lacunes, and microbleeds. Results— Multiple logistic regression found that MCA PI was associated with severe WML (odds ratio, 1.33 per 0.1 increase in PI; 95% confidence interval, 1.04–1.70; P=0.02). At optimal MCA PI cut-off, the area under curve, positive predictive value, and negative predictive value were 0.70 (95% confidence interval, 0.60–0.80), 34.9%, and 85.6%, respectively, for detection of severe WML. No association was found between MCA PI and measures of lacunes or microbleeds. Conclusions— PI correlates with WML severity. With a high negative predictive value, the chance of having severe WML with a normal PI is low. Transcranial Doppler may guide selective magnetic resonance imaging scanning for the detection of WML in the community.

Prevalence of mild cognitive impairment in an urban community in China: A cross-sectional analysis of the Shanghai Aging Study

Substantial variations in the prevalence of mild cognitive impairment (MCI) have been reported, although mostly in Western countries. Less is known about MCI in the Chinese population.

PICALM and CR1 Variants are not Associated with Sporadic Alzheimer's Disease in Chinese Patients

Alzheimers disease (AD) is the most common form of senile dementia, and the overall prevalence increases exponentially with age. It is well known that genetic variants may play an important role in the pathogenesis of this disorder. Recently, two independent large-scale genome-wide association studies (GWAS) identified 3 novel single nucleotide polymorphisms (SNPs) (rs11136000 within CLU, rs3851179 within PICALM and rs6656401 within CR1) that are associated with late-onset AD (LOAD), and these results have been replicated by other studies performed in the Caucasian population. Recently, an independent study failed to verify the association for the SNP within CLU in a Han Chinese population, indicating that there may be genetic heterogeneity in this association. In the present study, we studied the SNPs within PICALM and CR1 in 474 sporadic AD patients (SAD) and 591 unrelated age- and sex-matched healthy controls of Han Chinese descent. Our data revealed that the frequencies of both of these SNPs were not significantly difference between the SAD and control groups. Thus, the association between SNPs within PICALM, CR1, and SAD should be studied further in different ethnic groups.

The Shape Trail Test: application of a new variant of the Trail making test.

Objective The Trail making test (TMT) is culture-loaded because of reliance on the Latin alphabet, limiting its application in Eastern populations. The Shape Trail Test (STT) has been developed as a new variant. This study is to examine the applicability of the STT in a senile Chinese population and to evaluate its potential advantages and disadvantages. Method A total of 2470 participants were recruited, including 1151 cognitively normal control (NC), 898 amnestic mild cognitive impairment (aMCI), and 421 mild Alzheimer disease (AD) patients. Besides the STT, the Mini mental state examination and a comprehensive neuropsychological battery involving memory, language, attention, executive function and visuospatial ability were administered to all the participants. In a subgroup of 100 NC and 50 AD patients, both the STT and the Color Trail Test (CTT) were performed. Results In NC, the time consumed for Part A and B (STT-A and STT-B) significantly correlated with age and negatively correlated with education (p<0.01). STT-A and B significantly differed among the AD, aMCI and NC. The number that successfully connected within one minute in Part B (STT-B-1 min) correlated well with STT-B (r = 0.71, p<0.01) and distinguished well among NC, aMCI and AD. In the receiver operating characteristic curve analysis, the AUCs (area under the curve) for STT-A, STT-B, and STT-B-1min in identifying AD were 0.698, 0.694 and 0.709, respectively. The STT correlated with the CTT, but the time for completion was longer. Conclusion The TMT is a sensitive test of visual search and sequencing. The STT is a meaningful attempt to develop a “culture-fair” variant of the TMT in addition to the CTT.

Association between Tooth Loss and Cognitive Function among 3063 Chinese Older Adults: A Community-Based Study

Background Oral health has been found to be associated with cognitive function in basic research and epidemiology studies. Most of these studies had no comprehensive clinical diagnosis on cognitive function. This study firstly reported the association between tooth loss and cognitive function among Chinese older population. Methods The study included 3,063 community dwelling older adults aged 60 or above from the Shanghai Aging Study. Number of teeth missing was obtained from self-reporting questionnaire and confirmed by trained interviewers. Participants were diagnosed as “dementia”, “mild cognitive impairment (MCI)”, or “cognitive normal” by neurologists using DSM-IV and Petersen criteria. Multivariate logistic regression model was applied to examine the association between number of teeth missing and cognitive function. Results The study participants had an average of 10.2 teeth lost. Individuals with dementia lost 18.7 teeth on average, much higher than those with MCI (11.8) and cognitive normal (9.3) (p<0.001). After adjusted for sex, age, education year, living alone, body mass index, cigarette smoking, alcohol drinking, anxiety, depression, heart disease, hypertension, diabetes, and APOE-ε4, tooth loss of >16 were significantly associated with dementia with an OR of 1.56 (95%CI 1.12-2.18). Conclusion Having over 16 missing teeth was associated with severe cognitive impairment among Chinese older adults. Poor oral health might be considered as a related factor of neurodegenerative symptom among older Chinese population.

Short-Term Delayed Recall of Auditory Verbal Learning Test Is Equivalent to Long-Term Delayed Recall for Identifying Amnestic Mild Cognitive Impairment

Delayed recall of words in a verbal learning test is a sensitive measure for the diagnosis of amnestic mild cognitive impairment (aMCI) and early Alzheimer’s disease (AD). The relative validity of different retention intervals of delayed recall has not been well characterized. Using the Auditory Verbal Learning Test–Huashan version, we compared the differentiating value of short-term delayed recall (AVL-SR, that is, a 3- to 5-minute delay time) and long-term delayed recall (AVL-LR, that is, a 20-minute delay time) in distinguishing patients with aMCI (n = 897) and mild AD (n = 530) from the healthy elderly (n = 1215). In patients with aMCI, the correlation between AVL-SR and AVL-LR was very high (r = 0.94), and the difference between the two indicators was less than 0.5 points. There was no difference between AVL-SR and AVL-LR in the frequency of zero scores. In the receiver operating characteristic curves analysis, although the area under the curve (AUC) of AVL-SR and AVL-LR for diagnosing aMCI was significantly different, the cut-off scores of the two indicators were identical. In the subgroup of ages 80 to 89, the AUC of the two indicators showed no significant difference. Therefore, we concluded that AVL-SR could substitute for AVL-LR in identifying aMCI, especially for the oldest patients.

Application study of quick cognitive screening test in identifying mild cognitive impairment

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. 轻度认知损害(mild cognitive impairment, MCI)可根据认知表现分为遗忘型 MCI (aMCI)和非遗忘型MCI(naMCI)。 本研究旨在编制快速认知筛查测验(quick cognitive screening test, QCST)便于快速全面地识别MCI, 为进一步研究提供依据。 符合 MCI 操作性诊断标准的MCI 组121 例、 符合DSM-IV有关痴呆诊断标准的阿尔茨海默病(AD)组79 例和正常老年人组186 例, 参与了QCST 和标准化全套神经心理测验。 参与者教育程度均在5 年或以上, 年龄55–85 岁。 QCST 项目包括即刻记忆、 延迟回忆、 命名、 动物流畅性、 相似性、 彩色连线B、 画钟、 手指结构、 数字广度等9 个分测验, 每个分测验满分10 分, 总分90 分, 耗时10–15 分钟。 MCI 组、 AD组和正常老年人组QCST总分分别为(58.13±8.18)、 (44.53±10.54)和(72.92±6.85)分。 制定教育程度在5–8年、 9–12 年、 高于13 年3 个组别的QCST 总分的划界分分别为63、 65 和68 分。 QCST 识别 MCI 的敏感性为87.6%, 其中识别aMCI-s、 aMCI-m 和naMCI 的敏感性分别为85.7%、 90.1% 和89.5%, 特异性均为84.3%。 曲线下面积为0.923 (95% CI: 0.892–0.953)。 延迟回忆、 连线和相似性均有助于区分aMCI 与naMCI。 QCST 对MCI 具有较高的敏感性和特异性, 可在临床和流行病学调查方面进行推广应用。ObjectiveTo assess whether quick cognitive screening test (QCST) could quickly identify mild cognitive impairment (MCI).MethodsQCST 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.ResultsThe 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.ConclusionQCST may have a good sensitivity and specificity for MCI detection, which warrants its further clinical application.摘要目的轻度认知损害(mild cognitive impairment, MCI)可根据认知表现分为遗忘型 MCI (aMCI)和非遗忘型MCI(naMCI)。 本研究旨在编制快速认知筛查测验(quick cognitive screening test, QCST)便于快速全面地识别MCI, 为进一步研究提供依据。方法符合 MCI 操作性诊断标准的MCI 组121 例、 符合DSM-IV有关痴呆诊断标准的阿尔茨海默病(AD)组79 例和正常老年人组186 例, 参与了QCST 和标准化全套神经心理测验。 参与者教育程度均在5 年或以上, 年龄55–85 岁。 QCST 项目包括即刻记忆、 延迟回忆、 命名、 动物流畅性、 相似性、 彩色连线B、 画钟、 手指结构、 数字广度等9 个分测验, 每个分测验满分10 分, 总分90 分, 耗时10–15 分钟。结果MCI 组、 AD组和正常老年人组QCST总分分别为(58.13±8.18)、 (44.53±10.54)和(72.92±6.85)分。 制定教育程度在5–8年、 9–12 年、 高于13 年3 个组别的QCST 总分的划界分分别为63、 65 和68 分。 QCST 识别 MCI 的敏感性为87.6%, 其中识别aMCI-s、 aMCI-m 和naMCI 的敏感性分别为85.7%、 90.1% 和89.5%, 特异性均为84.3%。 曲线下面积为0.923 (95% CI: 0.892–0.953)。 延迟回忆、 连线和相似性均有助于区分aMCI 与naMCI。结论QCST 对MCI 具有较高的敏感性和特异性, 可在临床和流行病学调查方面进行推广应用。