Score Disparity Between the MMSE and the SLUMS

Alzheimer's Disease: A Systems View Provides a Unifying Explanation of Its Development

Alzheimer's disease (AD) is a debilitating neurodegenerative disorder affecting 50 million people globally. It is characterized by the presence of extracellular senile plaques and intracellular neurofibrillary tangles, consisting of amyloid-β and hyperphosphorylated tau proteins, respectively. Despite global research efforts, there is currently no cure available, due in part to an incomplete understanding of the disease pathogenesis. Numerous possible mechanisms, or hypotheses, explaining the origins of sporadic or late-onset AD have been proposed, including the amyloid-β, inflammatory, vascular, and infectious hypotheses. However, despite ample evidence, the failure of multiple trial drugs at the clinical stage illuminates the possible pitfalls of these hypotheses. Systems biology is a strategy which aims to elucidate the interactions between parts of a whole. Using this approach, the current paper shows how the four previously mentioned hypotheses of AD pathogenesis can be intricately connected. This approach allows for seemingly contradictory evidence to be unified in a system-focused explanation of sporadic AD development. Within this view, it is seen that infectious agents, such as P. gingivalis, may play a central role. The data presented here shows that when present, P. gingivalis or its virulence factors, such as gingipains, may induce or exacerbate pathologies underlying sporadic AD. This evidence supports the view that infectious agents, and specifically P. gingivalis, may be suitable treatment targets in AD.

Latest Trends in Outcome Measures in Dementia and Mild Cognitive Impairment Trials

Disease modification trials in dementia and mild cognitive impairment (MCI) have not met with success. One potential criticism of these trials is the lack of sensitive outcome measures. A large number of outcome measures have been employed in dementia and MCI trials. This review aims to describe and analyze the utility of cognitive/clinical outcome measures in Alzheimer’s disease (AD) and MCI trials. Methods: A PubMed search was conducted using relevant MeSH terms and exploded keywords. The search was confined to English language publications of human studies from the last five years which describe the latest trends in the use of outcome measures. Results: Despite broad use, the outcome measures employed are heterogeneous, with little data on correlations between scales. Another problem is that most studies are over-reliant on clinician/researcher assessment and cognitive outcomes, and there is a definite lack of stakeholder input. Finetuning of the paradigm is also required for people with early-stage disease, mild to moderate disease, and advanced dementia, as the outcome measures in these subgroups have varying relevance. Disease modification/prevention is an appropriate goal in early disease, whereas palliation and freedom from discomfort are paramount in later stages. The outcome measures selected must be suitable for and sensitive to these particular care goals. Although there is a shift to enrich MCI cohorts using a biomarker-based approach, the clinical relevance of such outcome measures remains uncertain. Conclusions: Outcome measures in dementia/MCI trials remain inhomogeneous and diverse, despite extensive use. Outcome measures fall within several paradigms, including cognitive, functional, quality-of-life, biomarker-based, and patient-reported outcome measures. The success of future disease-modifying trials is reliant to a large extent on the selection of outcome measures which combine all outcomes of clinical relevance as well as clinical meaning. Outcome measures should be tied to the type and stage of dementia and to the specific interventions employed.

Clinical effect of ultrasound-guided nerve block and dexmedetomidine anesthesia on lower extremity operative fracture reduction

BACKGROUND

Lower extremity fractures are mainly treated by surgical reduction, but this operation is often affected by the patient’s level of agitation and the type of anesthesia used. The main treatment for lower-extremity fractures is operative reduction. However, operations can often be affected by both agitation and the degree of anesthesia. Therefore, it is of great importance to develop an effective anesthesia program to effectively ensure the progress of surgery.

AIM

To discuss the effect of ultrasound-guided nerve block combined with dexmedetomidine anesthesia in lower extremity fracture surgery.

METHODS

A total of 120 hospital patients with lower extremity fractures were selected for this retrospective study and divided into an observation group (n = 60) and a control group (n = 60) according to the anesthesia scheme; the control group received ultrasound-guided nerve block; the observation group was treated with dextromethomidine on the basis of the control group, and the mean arterial pressure, heart rate (HR), and blood oxygen saturation were observed in the two groups.

RESULTS

The mean arterial pressure of T1, T2 and T3 in the observation group were 94.40 ± 7.10, 90.84 ± 7.21 and 91.03 ± 6.84 mmHg, significantly higher than that of the control group (P < 0.05). The observation group’s HR at T1 was 76.60 ± 7.52 times/min, significantly lower than that of the control group (P < 0.05); The observation group’s HR at T2 and T3 was 75.40 ± 8.03 times/min and 76.64 ± 7.11 times/min, significantly higher than that of the control group (P < 0.05). The observation group’s visual analog score at 2 h, 6 h and 12 h after operation was 3.55 ± 0.87, 2.84 ± 0.65 and 2.05 ± 0.40. the recovery time was 15.51 ± 4.21 min, significantly lower than that of the control group (P < 0.05). Six hours post-anesthesia, epinephrine and norepinephrine in the observation group were 81. 10 ± 21.19 pg/mL and 510. 20 ± 98.27 pg/mL, significantly lower than that of the control group (P < 0.05), and the mini-mental state exam score of the observation group was 25. 51 ± 1.15, significantly higher than that in the control group (P < 0.05).

CONCLUSION

Ultrasound-guided nerve block combined with dexmedetomidine has a good anesthetic effect in the operation of lower limb fractures and has little effect on the hemodynamics of patients.

Systematic Review of the Psychometric Properties of the Saint Louis University Mental Status (SLUMS) Examination

OBJECTIVES

This systemic review qualitatively synthesizes existing psychometric support for the Saint Louis University Mental Status (SLUMS) Examination, a cognitive screening measure which presents as a free alternative to other widely used dementia screening measures including the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA).

METHODS

A total of 90 peer-reviewed articles on the SLUMS were identified from PsycINFO and PubMed databases.

RESULTS

Sixty-eight records were identified and reviewed by the lead author for eligibility. Studies that included at least one psychometric property of the SLUMS (n = 20) were included in this review.

CONCLUSIONS

Support for the SLUMS remains preliminary; however, it appears to have adequate validity, and adequate sensitivity and specificity in detecting cognitive impairment. Numerous shortcomings were identified, including lack of sufficient normative data, information on test-reliability, explored factor structure, and limited application of criterion measures (e.g., imaging studies, biomarkers). Research is needed to establish diverse normative samples and describe the reliability and validity of the SLUMS to strengthen the empirical support for its use.

CLINICAL IMPLICATIONS

Until its psychometric properties are better established the SLUMS should be used cautiously when screening for cognitive impairment.

The Increase of HIV-1 Infection, Neurocognitive Impairment, and Type 2 Diabetes in The Rio Grande Valley

The Human Immunodeficiency Virus (HIV-1) infection remains a persistent predicament for the State of Texas, ranking seventh among the most documented HIV cases in the United States. In this regard, the Rio Grande Valley (RGV) in South Texas is considered as one of the least investigated areas of the state with respect to HIV infection and HIV associated comorbidities. Considering the 115% increase in average HIV incidence rates per 100,000 within the RGV from 2007-2015, it is worth characterizing this population with respect to their HIV-1 infection, HIV-1 Associated Neurocognitive Disorders (HAND), and the association of treatment with combined antiretroviral therapy (cART). Moreover, the increased rate of Type-2 Diabetes (T2D) in the RGV population is intertwined with that of HIV-1 infection facing challenges due to the lack of knowledge about prevention to inadequate access to healthcare. Hence, the role of T2D in the development of HAND among the people living with HIV (PLWH) in the RGV will be reviewed to establish a closer link between T2D and HAND in cART-treated patients of the RGV.

Health-related quality of life among elderly individuals living alone in an urban area of Shaanxi Province, China: a cross-sectional study

Objectives

To describe health-related quality of life (HRQoL), sex differences in HRQoL, and factors affecting the HRQoL of elderly people living alone in urban areas of Shaanxi Province, China.

Methods

A cohort was obtained using multistage stratified cluster random sampling. We collected cross-sectional data using surveys. HRQoL was measured using the 36-item Short Form Health Survey. Multivariable multilevel linear regression analysis was used to examine factors associated with mental and physical health component summary scores.

Results

Overall, 442 elderly Chinese individuals who lived alone completed the survey (mean age 73 years, women: 59%). Women were more likely to report better mental health than men. Factors significantly associated with reduced mental health scores were older age, having never been married or being divorced, and having a history of cancer, urinary tract disease, fractures or gastrointestinal disorders. Factors associated with physical health were having never been married or being divorced and having hypertension.

Conclusions

To our knowledge, this is the first study to describe HRQoL in a representative sample of elderly people living alone in urban areas of Shaanxi, China. Poor physical and mental HRQoL in this elderly Chinese population was mainly associated with chronic diseases and demographic factors.

Correlation between cognition and plasma noradrenaline level in Alzheimer's disease: a potential new blood marker of disease evolution

Recent evidence showing degeneration of the noradrenergic system in the locus coeruleus (LC) in Alzheimer's disease (AD) has motivated great interest in noradrenaline (NA) as a potential brain hallmark of the disease. Despite the current exploration of blood markers for AD, the deregulation of the plasma NA concentration ([NA]_plasma) in AD is currently not well understood. This retrospective study includes a cohort of 71 patients (32 AD patients, 22 with other dementia and 17 without dementia) who were given consultations for memory complaints in the Cognitive Neurology Center of Lariboisière (Paris) between 2009 and 2014. As previously described in brain tissue, we show for the first time a linear correlation between [NA]_plasma and Mini Mental State Examination (MMSE) score in AD patients. We observed that high [NA]_plasma in AD patients was associated with higher [Aβ_1-42]_CSF than in other AD patients with [NA]_plasma similar to NC patients. In parallel, we observed a lower (p-Tau/Tau)_CSF in AD patients with low [NA]_plasma than in non-AD patients with [NA]_plasma similar to [NA]_plasma in NC patients. Our data suggest that [NA]_plasma could be a potential biomarker of disease evolution in the context of AD and could possibly improve early diagnosis.