INTRODUCTION:The functional single nucleotide polymorphism (SNP) rs767649 in the miR-155 gene has been linked to other neurological disorders, but its association with sporadic Parkinson's disease (PD) remains unclear. METHODS:The rs767649 SNP was genotyped via TaqMan assay. Serum miR-155 levels were measured by RT-qPCR. Statistical analyses included ROC analysis for assessing diagnostic value, Pearson correlation analysis with clinical scores (UPDRS-III, H-Y staging, MoCA), and logistic regression for identifying risk factors of PD. RESULTS:The miR-155 rs767649 A allele served as a protective factor against PD, with AA homozygotes showing the lowest risk. The TT genotype was associated with elevated serum miR‑155, greater motor impairment (UPDRS‑III, H‑Y stage), and reduced cognitive function (MoCA) in PD patients when compared to TA or AA carriers. In PD patients, elevated serum miR-155 levels correlated with disease severity, distinguished patients from healthy controls, and emerged as an independent risk factor for PD. CONCLUSION:The miR-155 rs767649 polymorphism might affect PD susceptibility, and its A allele potentially exerted a protective effect against PD in Han Chinese population. Elevated miR-155 levels appear to be correlated with disease severity and may be an independent risk factor, suggesting its potential as a biomarker for PD diagnosis.

BACKGROUND:Vascular risk factors are increasingly implicated in Parkinson's disease (PD), but the role of altered cerebrovascular dysfunction in early-stage PD remains unclear. Here, we investigated resting-state cerebrovascular reactivity (RS-CVR), cerebral blood flow (CBF), arterial morphological changes, and corresponding alterations in functional connectivity density (FCD) in de novo PD patients with different cognitive status. METHODS:25 de novo PD patients with mild cognitive impairment (PD-MCI), 34 with normal cognition (PD-NC), and 48 healthy controls (HCs) underwent neuropsychological assessments and multimodal MRI. CBF derived from arterial spin labeling, RS-CVR and FCD generated from resting-state functional MRI and the arterial morphology extracted from the magnitude images of multi-echo gradient echo. RESULTS:RS-CVR significantly decreased in PD patients, particularly in the left occipital gyrus and posterior cerebral artery (PCA) territories. Long-range FCD was reduced in the left inferior occipital gyrus in both PD-NC and PD-MCI compared to HCs (p = 0.005, p < 0.001). In PD-MCI, negative correlations between Stroop Color-Word Test time and RS-CVR in the distal right PCA (r = -0.71, pFDR = 0.030) and middle left PCA (r = -0.66, pFDR = 0.044) were observed. A significant correlation was found between decreased long-range FCD in the left inferior occipital gyrus and poorer Trail Making Test Part B performance (r = -0.63, pFDR = 0.029) in the PD-MCI. No significant differences in CBF, but significant dilation of the left PCA and compensatory CBF increases in the corresponding territory in PD-MCI were found (r = 0.57, pFDR = 0.023). DISCUSSION:Microvascular dysfunction, rather than perfusion defects, might underlie early-stage of the de novo PD, especially in the patients with PD-MCI.

BACKGROUND:This study aimed to investigate neuromelanin-sensitive MRI (NM-MRI) characteristics in the substantia nigra pars compacta (SNc) across Parkinson's disease (PD) subtypes and their association with motor and cognitive performance. METHODS:Four groups were included: PD patients with mild motor predominant (PD-MMP, n = 37), intermediate (PD-IM, n = 41), diffuse malignant (PD-DM, n = 12), and healthy controls (HC, n = 51). Clinical evaluations and MRI scans were performed. Signal values from NM-MRI were extracted using SNc and background masks. Contrast-to-noise ratio (CNR) values for the sensorimotor, associative, and limbic territories of the SNc were compared across groups. Pearson correlations assessed the relationship between CNR values and clinical scores in PD patients. RESULTS:CNR values in the whole SNc differed significantly between groups (p < 0.01), with PD-DM showing the greatest reduction. The associative subregion had significantly lower CNR in all PD subgroups compared to HC (ps < 0.01). In the limbic subregion, PD-IM had lower CNR than PD-MMP (p = 0.04). In the sensorimotor subregion, PD-IM and PD-DM had lower CNR compared to HC (p < 0.01). CNR values in the whole SNc weakly correlated with UPDRS motor scores (r = -0.30, p < 0.01) and the Trail Making Test B (r = -0.27, p = 0.01). CONCLUSIONS:Distinct neuromelanin alterations were observed across PD subtypes, with PD-DM showing the most significant NM loss. These findings suggest that regional NM loss is associated with motor and cognitive impairments, reflecting underlying pathological mechanisms in PD.

Introduction: The perioperative efficacy and safety of efgartigimod in patients with thymoma associated myasthenia gravis have not been reported. Case presentation: We described the case of a 47-year-old woman who presented thymoma associated myasthenia gravis. Primarily, the patient was treated with acetylcholinesterase inhibitors, immunosuppressive medications, and intravenous immunoglobulin. Unfortunately, the control of symptoms was unsatisfactory. The patient was treated with recommended dosage of efgartigimod (10 mg/kg administered as a 1 h intravenous infusion once weekly for 2 weeks) combined with immunosuppressive therapy. Consequently, improved outcomes and rapid clinical remission were observed. Then, modified subxiphoid thoracoscopic thymectomy was performed smoothly and the patient was discharged from hospital after recovery in short time. Discussion: Administration of efgartigimod could control symptoms significantly and rapidly. Efgartigimod provides the opportunity of thymectomy in short time. Importantly, there was no any perioperative complication or any adverse event related to efgartigimod. Conclusion: The improved outcomes of the patient with thymoma associated myasthenia gravis highlight the importance of efgartigimod. Large-scale clinical trials are needed to validate the safety and efficacy of efgartigimod during the perioperative period of thymectomy.

Background Patient-reported outcome (PRO) is a distinct and indispensable dimension of clinical characteristics and recent advances have made remote PRO measurement possible. Sex difference in PRO of Parkinson's disease (PD) is hardly extensively researched. Methods A smartphone-based self-management platform, offering remote PRO measurement for PD patients, has been developed. A total of 1828 PD patients, including 1001 male patients and 827 female patients, were enrolled and completed their PRO submission through this platform. Results Sex differences in PROs have been identified. The female group had a significantly lower height, weight, and body mass index (BMI) than the male group (P < 0.001). For motor symptoms, a higher proportion of patients reporting dyskinesia was observed in the female group. For non-motor symptoms, there is a higher percentage (P < 0.001) as well as severity (P = 0.016) of depression in the female group. More male patients reported hyposmia, lisp, drooling, dysuria, frequent urination, hypersexuality, impotence, daytime sleepiness, and apathy than females (P < 0.05). In contrast, more female patients reported headache, palpation, body pain, anorexia, nausea, urinal incontinence, anxiety, insomnia (P < 0.05) than males. Conclusions We provide evidence for sex differences in PD through the data collected from our platform. These results highlighted the importance of gender in clinical decision-making, and also support the feasibility of remote PRO measurement through a smartphone-based self-management platform in patients with PD.

BACKGROUND:The change of microvascular function over the course of Parkinson's disease (PD) remains unclear.OBJECTIVE:We aimed to ascertain regional cerebrovascular reactivity (CVR) changes in the patients with PD at baseline (V0) and during a 2-year follow-up period (V1). We further investigated whether alterations in CVR were linked to cognitive decline and brain functional connectivity (FC).METHODS:We recruited 90 PD patients and 51 matched healthy controls (HCs). PD patients underwent clinical evaluations, neuropsychological assessments, and magnetic resonance (MR) scanning at V0 and V1, whereas HCs completed neuropsychological assessments and MR at baseline. The analysis included evaluating CVR and FC maps derived from resting-state functional magnetic resonance imaging and investigating CVR measurement reproducibility.RESULTS:Compared with HCs, CVR reduction in left inferior occipital gyrus and right superior temporal cortex at V0 persisted at V1, with larger clusters. Longitudinal reduction in CVR of the left posterior cingulate cortex correlated with decline in Trail Making Test B performance within PD patients. Reproducibility validation further confirmed these findings. In addition, the results also showed that there was a tendency for FC to be weakened from posterior to anterior with the progression of the disease.CONCLUSIONS:Microvascular dysfunction might be involved in disease progression, subsequently weaken brain FC, and partly contribute to executive function deficits in early PD. © 2023 International Parkinson and Movement Disorder Society.

BACKGROUND:Various neurologic complications of hyperthyroidism are reported, and most of these complications are reversible with the amelioration of thyrotoxicosis. We report a previously undescribed concurrence of hyperthyroid-associated exercise-induced myalgia and stiffness, pyramidal tract dysfunction, and myoclonic movements that make an initial clinical diagnosis difficult.CASE PRESENTATION:A 17-year-old male was hospitalized in the department of neurology, presenting with a 4-year history of severe exercise-induced myalgia and stiffness, weakness of lower limbs, and myoclonic movements. Laboratory investigations unexpectedly revealed hyperthyroidism. MRI of the brain and spine, electrophysiology, and whole exome sequencing were also performed. Antithyroid therapy led to marked improvement of neurologic symptoms, accompanied by a significant improvement of the time-dependent decline in compound muscle action potentials (CMAP) amplitudes after exercise and normalization of the prolonged QTc interval. Genetic analysis identified a rare variant in SCN5A.CONCLUSION:This case report provides important insights into the relationship between hyperthyroidism and neurologic/cardiac complications, particularly in those with a genetic predisposition. SCN5A mutation possibly plays a role in the complex neurological syndrome associated with hyperthyroidism. Further studies are warranted to better understand the underlying mechanisms and potential therapeutic options for these complex conditions.

Objective To explore the characteristics of subcortical nuclei iron deposition in de novo Parkinson disease（PD） patients with mild cognitive impairment（MCI） by using quantitative sensitivity mapping（QSM）, and the correlation between QSM values（QSMs） and cognitive function in PD patients. Methods From October 2016 to December 2017, 34 de novo PD patients in Zhongshan Hospital, Fudan University were collected. Patients were divided into group PD-MCI（PD with MCI, n=12）and group PD-NC（PD with normal cognition, n=22）, and other 25 healthy people were chosen as control group（HCs）. The QSMs of substantia nigra（SN）, red nucleus（RN）, putamen（PU）, head of caudate nucleus（CN）, globus pallidus（GP） and dentate nucleus（DN） among three groups were compared. Furtherly, the correlations between QSMs in each nucleus and cognitive scales were analyzed. Results The QSMs in the bilateral SN, bilateral RN, bilateral PU, and left DN in group PD-MCI were significantly higher than those in group HCs（P＜0.05）. QSMs in the right RN and right PU in group PD-MCI were significantly higher than those in group PD-NC（P＜0.05）. Correlation analyses showed that QSMs in the bilateral GP and PU were positively correlated with the Trail Making Test-A（right GP: r=0.555, P=0.005; left GP: r=0.470, P=0.020; right PU: r=0.479, P=0.018; left PU: r=0.430, P=0.036）, QSMs in the right RN and left CN were negatively correlated with Animal Fluency Test（right RN: r=﹣0.457, P=0.025;left CN: r=﹣0.524, P=0.010）, and QSMs in the right PU were negatively correlated with Boston Naming Test（r=﹣0.445, P=0.033）. Multiple linear regression analysis showed that the QSM value of right GP had a significant impact on TMT-A（P=0.005）.Conclusions The extensively abnormal iron deposition were found in subcortical nuclei in PD-MCI by using the QSM, and the iron deposition was associated with impaired attention and language functions in PD patients, suggesting that abnormal iron accumulation may participate in the pathophysiological process of cognitive dysfunction in PD.

Presynaptic dopaminergic PET imaging is a useful method for the diagnosis of parkinsonism. Based on the expert consensus on operation and clinical application of dopamine transporter brain PET imaging technology published in 2020, this paper further recommends the relevant elements of result interpretation of presynaptic dopaminergic PET imaging.

Cognitive impairment is a common non-motor symptom in Parkinson's disease (PD), with executive dysfunction being an initial manifestation. We aimed to investigate whether and how longitudinal changes in the prefrontal perfusion correlate with mild cognitive impairment (MCI) in patients with PD. We recruited 49 patients with PD with normal cognition and 37 matched healthy control subjects (HCs). Patients with PD completed arterial spin labeling MRI (ASL–MRI) scans and a comprehensive battery of neuropsychological assessments at baseline (V0) and 2-year follow-up (V1). HCs completed similar ASL–MRI scans and neuropsychological assessments at baseline. At V1, 10 patients with PD progressed to MCI (converters) and 39 patients remained cognitively normal (non-converters). We examined differences in the cerebral blood flow (CBF) derived from ASL–MRI and neuropsychological measures (a) between patients with PD and HCs at V0 (effect of the disease), (b) between V1 and V0 in patients with PD (effect of the disease progression), and (c) between converters and non-converters (effect of the MCI progression) using t -tests or ANOVAs with false discovery rate correction. We further analyzed the relationship between longitudinal CBF and neuropsychological changes using multivariate regression models with false discovery rate correction, focusing on executive functions. At V0, no group difference was found in prefrontal CBF between patients with PD and HCs, although patients with PD showed worse performances on executive function. At V1, patients with PD showed significantly reduced CBF in multiple prefrontal regions, including the bilateral lateral orbitofrontal, medial orbitofrontal, middle frontal, inferior frontal, superior frontal, caudal anterior cingulate, and rostral anterior cingulate. More importantly, converters showed a more significant CBF reduction in the left lateral orbitofrontal cortex than non-converters. From V0 to V1, the prolonged completion time of Trail Making Test-B (TMT-B) negatively correlated with longitudinal CBF reduction in the right caudal anterior cingulate cortex. The decreased accuracy of the Stroop Color-Word Test positively correlated with longitudinal CBF reduction in the left medial orbitofrontal cortex. In addition, at V1, the completion time of TMT-B negatively correlated with CBF in the left caudal anterior cingulate cortex. Our findings suggest that longitudinal CBF reduction in the prefrontal cortex might impact cognitive functions (especially executive functions) at the early stages of PD.

A long-running debate concerns whether dopamine or noradrenaline deficiency drives response disinhibition in Parkinson’s disease (PD). This study aimed to investigate whether damage to the locus coeruleus (LC) or substantia nigra (SN) might impact inhibitory functions of the fronto-subthalamic hyperdirect or fronto-striatal indirect pathway. Patients with PD (n = 29, 13 women) and matched healthy controls (n = 29, 15 women) participated in this cross-sectional study. LC and SN integrity was assessed using neuromelanin-sensitive MRI. Response inhibition was measured using fMRI with a stop-signal task. In healthy controls, LC (but not SN) integrity correlated with the stopping-related activity of the right inferior frontal gyrus (IFG) and right subthalamic nucleus (STN), which further correlated with stop-signal reaction time (SSRT). PD patients showed reduced LC integrity, longer SSRT, and lower stopping-related activity over the right IFG, pre-supplementary motor area, and right caudate nucleus than healthy controls. In PD patients, the relationship between SSRT and the fronto-subthalamic pathway was preserved. However, LC integrity no longer correlated with the stopping-related right IFG or right STN activity. No contribution of SN integrity was found during stopping. In conclusion, LC (but not SN) might modulate inhibitory functions of the right IFG-STN pathway. Damage to the LC might impact the right IFG-STN pathway during stopping, leading to response disinhibition in PD.

1 病例资料 1.1 患者病史 患者女性,61岁,主因"双下肢乏力3个月余,四肢远端麻木2个月"于2021年11月30日于上海市徐汇区中心医院神经内科住院.患者8月下旬起无明显诱因下出现双下肢乏力,可独自行走,自感运动耐量下降,休息后未见好转.9月初自觉四肢末端麻木,下肢麻木逐渐加重,从足底上升至膝部.

Maintaining and manipulating sequences online is essential for daily activities such as scheduling a day. In Parkinson's disease (PD), sequential working memory deficits have been associated with altered regional activation and functional connectivity in the basal ganglia. This study demonstrates that the substantia nigra (SN) integrity correlated with basal ganglia function and sequencing performance in 29 patients with PD (17 women) and 29 healthy controls (HCs; 18 women). In neuromelanin-sensitive structural magnetic resonance imaging (MRI), PD patients showed smaller SNs than HCs. In a digit-ordering task with functional MRI (fMRI), participants either recalled sequential digits in the original order (pure recall) or rearranged the digits and recalled the new sequence (reorder and recall). PD patients performed less accurately than HCs, accompanied by the caudate and pallidal hypoactivation, subthalamic hyperactivation, and weakened functional connectivity between the bilateral SN and all three basal ganglia regions. PD patients with larger SNs tended to exhibit smaller ordering-related accuracy costs (reorder and recall vs pure recall). This effect was fully mediated by the ordering-related caudate activation. Unlike HCs, the ordering-related accuracy cost correlated with the ordering-related caudate activation but not subthalamic activation in PD patients. Moreover, the ordering-related caudate activation correlated with the SN area but not with the daily dose of D2/3 receptor agonists. In PD patients, the daily dose of D2/3 receptor agonists correlated with the ordering-related subthalamic activation, which was not related to the accuracy cost. The findings suggest that damage to the SN may lead to sequential working memory deficits in PD patients, mediated by basal ganglia dysfunction.SIGNIFICANCE STATEMENT We demonstrate that damage to the SN correlates with basal ganglia dysfunction and poor sequencing performance in PD patients. In neuromelanin-sensitive MRI, PD patients showed smaller SNs than healthy controls. In a digit-ordering task with fMRI, PD patients' lower task accuracy was accompanied by the caudate and pallidal hypoactivation, subthalamic hyperactivation, and weakened functional connectivity between the SN and basal ganglia. PD patients with larger SNs exhibited greater ordering-related caudate activation and lower ordering-related accuracy cost when sequencing digits. PD patients with more daily exposure to D2/3 receptor agonists exhibited greater ordering-related subthalamic activation, which did not reduce accuracy cost. It suggests that the SN may affect sequencing performance by regulating the task-dependent caudate activation in PD patients.

Objectives: Freezing of gait (FOG) is generally considered as an independent symptom of Parkinson's disease (PD) with a complex pathophysiology. There is a wide range of associated clinical features of FOG reported from different studies without consistent conclusion. Thus, a multicenter, cross-sectional study was designed to investigate the prevalence and clinical features of FOG together with its unique contribution quality of life in Chinese PD patients.Methods: Eight hundred and thirty eight PD patients were consecutively recruited into this study from 12 hospital centers in six provinces in China. Clinical information, including motor and neuropsychological features as well as pharmacological details, was collected.Results: Of 827 PD patients, 245 (29.63%) reported FOG. The prevalence of FOG was strongly correlated with modified H-Y stages and symptomatic duration (p < 0.01). 84.90% freezers experienced FOG during turning and 88.98% experienced when initiating the first step. Compared with non-freezers, freezers reported longer disease duration (7.73 ± 5.44 vs. 4.69 ± 3.94, p < 0.000), higher frequent PIGD phenotype (61.22 vs. 35.91%, p < 0.000), higher scores of UPDRS III (32.85 ± 15.47 vs. 22.38 ± 12.89, p < 0.000), HAMA (10.99 ± 7.41 vs. 7.59 ± 6.47, p < 0.000), HAMD (15.29 ± 10.29 vs. 10.58 ± 8.97, p < 0.000) and lower MMSE score (25.12 ± 5.27 vs. 26.63 ± 3.97, p < 0.000), and higher daily levodopa dosage (432.65 ± 264.31 vs. 319.19 ± 229.15, p < 0.000) with less frequent initial use of dopaminergic agonist (8.57 vs. 14.78%, p < 0.05). Using binary logistic regression, the associated factors of FOG might be non-tremor dominant onset (OR = 3.817, p < 0.000), the presence of anxiety (OR = 2.048, p < 0.000) and imbalance (OR = 4.320, p = 0.012). Freezers had poorer quality of life than non-freezers and FOG impacted PDQ-8 independently.Conclusion: Nearly one third of the PD patients experienced FOG. Its frequency increased with PD progression and FOG reduced independently the quality of life. Non-tremor dominant, disease progression, and anxiety were risk factors of FOG.

BACKGROUND:Microglia play diverse roles in Alzheimer's disease (AD). Intracellular metabolism has been indicated an important factor in modulating the function of microglia. However, it is not clear whether the intracellular metabolism of microglia changes dynamically in different stages of AD.OBJECTIVE:To determine whether microglia intracellular metabolism changes dynamically in different stages of AD.METHODS:Microglia were extracted from APPSwe/PS1dE9 (APP/PS1) mice and wild-type littermates at 2, 4, and 8 months old by fluorescence-activated cell sorting and used for RNA-sequencing analysis and quantitative PCR. Morphologies of amyloid plaques and microglia were detected by immunofluorescence staining.RESULTS:Compared with control littermates, the microglia of APP/PS1 mice exhibited significant transcriptional changes at 2-month-old before microglia morphological alterations and the plaque formation. The changes continued drastically following age with defined morphological shift of microglia and amyloid plaque enhancement in brains. Further analysis of those genotype and age dependent transcriptomic changes revealed that differentially expressed genes were enriched in pathways related to energy metabolism. Compared with wild-type mice, there were changes of some vital genes related to glucose metabolism and lipid metabolism pathways in APP/PS1 mice at different ages. Glucose metabolism may play a major role in early activation of microglia, and lipid metabolism may be more important in later activation period.CONCLUSION:Our results showed that microglia actively participate in the pathological progress of AD. The intracellular metabolism of microglia changed significantly in different stages of AD, even preceding amyloid-β deposition.

Abstract Background Some neuropsychological diseases are associated with abnormal thiamine metabolism, including Korsakoff–Wernicke syndrome and Alzheimer’s disease. However, in vivo detection of the status of brain thiamine metabolism is still unavailable and needs to be developed. Methods A novel PET tracer of 18F-deoxy-thiamine was synthesized using an automated module via a two-step route. The main quality control parameters, such as specific activity and radiochemical purity, were evaluated by high-performance liquid chromatography (HPLC). Radiochemical concentration was determined by radioactivity calibrator. Metabolic kinetics and the level of 18F-deoxy-thiamine in brains of mice and marmosets were studied by micro-positron emission tomography/computed tomography (PET/CT). In vivo stability, renal excretion rate, and biodistribution of 18F-deoxy-thiamine in the mice were assayed using HPLC and γ-counter, respectively. Also, the correlation between the retention of cerebral 18F-deoxy-thiamine in 60 min after injection as represented by the area under the curve (AUC) and blood thiamine levels was investigated. Results The 18F-deoxy-thiamine was stable both in vitro and in vivo. The uptake and clearance of 18F-deoxy-thiamine were quick in the mice. It reached the max standard uptake value (SUVmax) of 4.61 ± 0.53 in the liver within 1 min, 18.67 ± 7.04 in the kidney within half a minute. The SUV dropped to 0.72 ± 0.05 and 0.77 ± 0.35 after 60 min of injection in the liver and kidney, respectively. After injection, kidney, liver, and pancreas exhibited high accumulation level of 18F-deoxy-thiamine, while brain, muscle, fat, and gonad showed low accumulation concentration, consistent with previous reports on thiamine distribution in mice. Within 90 min after injection, the level of 18F-deoxy-thiamine in the brain of C57BL/6 mice with thiamine deficiency (TD) was 1.9 times higher than that in control mice, and was 3.1 times higher in ICR mice with TD than that in control mice. The AUC of the tracer in the brain of marmosets within 60 min was 29.33 ± 5.15 and negatively correlated with blood thiamine diphosphate levels (r = − 0.985, p = 0.015). Conclusion The 18F-deoxy-thiamine meets the requirements for ideal PET tracer for in vivo detecting the status of cerebral thiamine metabolism.

Sleep disorders are common non-motor symptoms in patients with Parkinson’s disease (PD). The characteristics and impact of multiple comorbid sleep disorders remain to be elucidated. Our goal was to investigate the characteristics of various sleep disorder comorbidities, and their association with motor complications and the impact on the quality of life in PD patients. In this multicenter, observational, cross-sectional study, data concerning the clinical characteristics of complicated sleep disorders were collected from PD patients treated at 40 different hospitals in Shanghai. Sleep disorders were evaluated using the PD Sleep Scale-2, Epworth Sleepiness Scale, Rapid Eye Movement Sleep Behavior Disorder Questionnaire-Hong Kong, and the International Restless Legs Scale. Among the 1006 subjects evaluated, 77.53% exhibited signs of sleep disorders, and most had multiple sleep disorders ( n = 502, 49.9%). A smaller percentage of patients with sleep disorders had a single disorder ( n = 278, 27.6%). Furthermore, an increased number of sleep disorders, including nighttime problems, excessive daytime sleepiness, rapid eye movement sleep behavior disorder, and restless legs syndrome was a significant contributor to a poor quality of life ( β = 4.33, CI: 3.33–5.33, P for trend <0.001), even when controlling for multiple factors. Moreover, motor complications partially mediated this relationship (indirect effect: β = 0.355, 95% boot CI: 0.134, 0.652).Our study showed that a large proportion of PD patients suffer from multiple comorbid sleep disorders, which greatly decreases the quality of life in PD patients and is partially mediated by motor complications.

We aimed to investigate neuromelanin‐sensitive magnetic resonance imaging (NM‐MRI) features in the locus coeruleus of de novo Parkinson's disease patients with different cognitive states and to determine whether these features are associated with cognitive impairment.

目的 探讨以双侧丘脑病变导致认知功能减退起病的硬脑膜动静脉瘘(dAVFs)的临床、影像学特点和鉴别诊断、诊治方法.方法 分析1例dAVFs患者的临床资料,结合国内外文献进行分析讨论.结果 本例患者临床表现为进展性的认知功能减退,MRI T2相见双侧丘脑高信号,经DSA确诊为dAVFs,行血管内栓塞治疗后症状基本恢复.本研究系统检索了具有相似影像学表现的dAVFs相关文献报道30例,其临床表现以记忆力减退最为显著,部分伴有精神行为异常,经介入治疗或手术治疗大多预后良好.结论 以双侧丘脑受累表现为认知功能减退的dAVFs报道较少,临床中出现类似病例应考虑到该诊断.

This study aims to develop a new evaluation method for quickly and conveniently screening cognitive impairment in the elderly. The five-minute cognitive test (FCT) was designed to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function. Subsequently, FCT efficiencies in differentiating normally cognitive ability from cognitive impairment were explored and compared with that of the Mini-Mental Status Evaluation (MMSE). Equipercentile equating method was utilized to create a crosswalk between scores of the FCT and MMSE. Further, the association of scores of the FCT and MMSE with hippocampal volumes was investigated. There were 241 subjects aged 60 years or above enrolled in this study, including 107 adults with cognitive abilities in normal range, 107 patients with mild cognitive impairment (MCI), and 27 patients with mild Alzheimer disease (AD). The AUC of FCT for detection of cognitive impairment (MCI and mild AD) was 0.885 (95% CI 0.838 to 0.922). The sensitivity and specificity of FCT for the diagnosis of cognitive impairment were 80.6% and 84.11 %, respectively. FCT’s diagnostic performance was superior to that of MMSE in the same cohort. Mean completion time of FCT was 339.9 ± 67.7 seconds (5-6 min). In addition, a conversion table between scores on the FCT and MMSE was created. Further, the FCT scores were positively correlated with hippocampal volumes. The FCT is a novel, reliable, and valid cognitive screening test for the detection of dementia at early stages.