[Mild cognitive impairment: modern aspects of diagnostics and therapy]

Textural features of the frontal white matter could be used to discriminate amnestic mild cognitive impairment patients from the normal population

OBJECTIVE

We aim to develop a radiomics model based on 3-dimensional (3D)-T1WI images to discriminate amnestic mild cognitive impairment (aMCI) patients from the normal population by measuring changes in frontal white matter.

METHODS

In this study, 126 patients with aMCI and 174 normal controls (NC) were recruited from the local community. All subjects underwent routine magnetic resonance imaging examination (including 3D-T1WI ). Participants were randomly divided into a training set (n = 242, aMCI:102, NC:140) and a testing set (n = 58, aMCI:24, NC:34). Texture features of the frontal lobe were extracted from 3D-T1WI images. The least absolute shrinkage and selection operator (LASSO) was used to reduce feature dimensions and develop a radiomics signature model. Diagnostic performance was assessed in the training and testing sets using the receiver operating characteristic (ROC) curve analysis. The area under the ROC curve (AUC), sensitivity, and specificity were also calculated. The efficacy of the radiomics model in discriminating aMCI patients from the normal population was assessed by decision curve analysis (DCA).

RESULTS

A total of 108 frontal lobe texture features were extracted from 3D-T1WI images. LASSO selected 58 radiomic features for the final model, including log-sigma (n = 18), original (n = 8), and wavelet (n = 32) features. The performance of radiomic features extracted from 3D T1 imaging for distinguishing aMCI patients from controls was: in the training set, AUC was 1.00, and the accuracy, sensitivity, and specificity were 100%, 98%, and 100%, respectively. In the testing set, AUC was 0.82 (95% CI:0.69-0.95), and the accuracy, sensitivity, and specificity were 69%, 92%, and 55%, respectively. The DCA demonstrated that the model had favorable clinical predictive value.

CONCLUSIONS

Textural features of white matter in the frontal lobe showed potential for distinguishing aMCI from the normal population, which could be a surrogate protocol to aid aMCI screening in clinical setting.

[Pharmacotherapy approaches to vascular mild cognitive impairment in patients of different age groups]

The article discusses the possibilities of pharmacotherapy of moderate vascular cognitive impairment in different age groups. The results of a double-blind randomized clinical trial «MEMO» using the antioxidant and antihypoxic drug Mexidol are presented. On the basis of cognitive scales, when using a sequential course of parenteral and oral administration of mexidol, its reliable effectiveness was shown in each of the three analyzed groups: 40-60 years old, 61-75 years old and 76-90 years old. Mexidol showed an optimal safety profile in all age groups.

[Observational study of the efficacy and safety of the drug Ampasse in patients with moderate cognitive impairment in chronic cerebral ischemia]

OBJECTIVE

The study of the efficacy and safety of drug Ampasse in the treatment of mild cognitive impairment syndrome (MCI) in patients with chronic cerebral ischemia (CCI) and as an adjuvant therapy in the treatment of chronic pain syndromes of various origins.

MATERIAL AND METHODS

50 patients with an average age of 67±7.4 years with MCI syndrome against the background of CCI, suffering from chronic pain syndromes of various origins, received the drug Ampasse at a dose of 25 mg per day intravenously by bolus for 15 days. At the screening visit, day 15 of therapy, day 30, and day 180 of the observation period, cognitive functions, emotional sphere, severity of pain syndrome, sleep quality, and quality of life were assessed.

RESULTS

In 95% of patients during therapy, an improvement in cognitive functions was noted (increase by 2 points on scales MoCA and MMSE, p<0.05). The maximum severity of cognitive improvement was achieved by the 30th day of observation. By the 180th day of observation, 5% of patients had returned to their original cognitive status, which is probably due to the need for a repeated course of therapy to maintain the clinical effect. The antiamnestic effect of Ampasse was also manifested in patients with a multifunctional amnestic phenotype of MCI, which may indicate a comorbidity with a neurodegenerative disease. A total of 84% of patients experienced a decrease in pain intensity during treatment (decrease by 2.3 points on VAS, decrease in consumption of analgesics by 1.5 tablets per day, p<0.05). This effect persisted throughout the observation period and was associated with improved sleep quality. In the course of treatment, no cases of anxiety or depression were detected. All patients showed an improvement in their quality of life according to the scale SF-36. The use of Ampasse showed a good level of tolerability and safety.

CONCLUSION

The use of Ampasse is effective and safe in the treatment of MCI in CCI and helps to reduce the clinical manifestations of pain syndromes of various origins. The mechanism of the analgesic action of Ampasse, as well as the need for and optimal timing of repeated courses of therapy, require further study.

Medication Rules in Herbal Medicine for Mild Cognitive Impairment: A Network Pharmacology and Data Mining Study

Background

Although traditional Chinese medicine (TCM) has good efficacy in the treatment of mild cognitive impairment (MCI), especially memory improvement and safety, its substance basis and intervention mechanism are particularly complex and unknown. Therefore, based on network pharmacology and data mining, this study aims to explore the rules, active ingredients and mechanism of TCM in the treatment of MCI.

Methods

By searching the GeneCard, OMIM, DisGeNET and DrugBank databases, we obtained the critical targets associated with MCI. We matched the components and herbs corresponding to the important targets in the TCMSP platform. Using Cytoscape 3.7.2 software, we constructed a target-component-herb network and conducted a network topology analysis to obtain the core components and herbs. Molecular docking was used to preliminarily analyze and predict the binding activities and main binding combinations of the core targets and components. Based on the analysis of the properties, flavor and meridian distribution of herbs, the rules of herbal therapy for MCI were summarized.

Results

Twenty-eight critical targets were obtained after the screening. Using the TCMSP platform, 492 components were obtained. After standardization, we obtained 387 herbs. Based on the target-composition-herb network analysis, the core targets were ADRB2, ADRA1B, DPP4, ACHE and ADRA1D. According to the screening, the core ingredients were beta-sitosterol, quercetin, kaempferol, stigmasterol and luteolin. The core herbs were matched to Danshen, Yanhusuo, Gancao, Gouteng and Jiangxiang. It was found that the herbs were mainly warm in nature, pungent in taste and liver and lung in meridian. The molecular docking results showed that most core components exhibited strong binding activity to the target combination regardless of the in or out of network combination.

Conclusion

The results of this study indicate that herbs have great potential in the treatment of MCI. This study provides a reference and basis for clinical application, experimental research and new drug development of herbal therapy for MCI.