To investigate the role of the Montreal Cognitive Assessment (MoCA) (Beijing version) and its memory tasks on detecting different mild cognitive impairment (MCI) subtypes including amnestic MCI (aMCI) and nonamnestic MCI (naMCI) in memory clinics. A total of 121 patients with MCI and 53 healthy controls were included. Fifty-six aMCI-multiple domains (amMCI), 32 aMCI-single domain (asMCI), and 33 naMCI patients were diagnosed according to extensive cognitive tests. All participants were administered by the Mini Mental State Examination (MMSE) and the MoCA. Patients with amMCI performed worse than patients with asMCI, naMCI, and healthy controls on the MMSE and the MoCA (p < 0.001). The area under the curve (AUC) value for the MoCA when comparing the amMCI and control groups was 0.884 (p < 0.001), which was superior to that of the MMSE. The AUC value decreased to 0.687 when applied to the naMCI and control groups (p = 0.007), which was still higher than that of the Rey Auditory Verbal Learning Test (RAVLT) or the Rey-Osterrieth complex figure (ROCF). Delayed free recall or category prompted recall in the MoCA had roles in differentiating asMCI and controls groups with AUC value of 0.717 (p = 0.002) and 0.691 (p = 0.005), respectively. The MoCA is a good screening tool for detecting different types of MCI and is suitable for patients in outpatient clinics.

Idiopathic rapid eye movement sleep behavior disorder (iRBD) likely represents the prodromal stage of synucleinopathy. The present study investigated how levels of serum uric acid (UA) affect cognition and motor function in patients with iRBD. A total of 42 patients with iRBD and 45 healthy controls were included. All participants were given cognitive tests and motor assessments. Serum UA concentrations were measured. The patients were further divided into two groups (high or low UA) according to serum UA level. The level of serum UA was similar between the patients with iRBD and the healthy controls, whereas the patients showed impaired executive, memory, and visuospatial functions. The patients with low UA levels had longer durations of RBD. Lower scores involving attention, executive function, and language domain were also found in the patients with low UA, whereas the scores of the patients with high UA were similar to those of the healthy controls. Regarding memory domain, the low UA group had worse scores than the healthy controls, whereas the scores of high UA group fell between those of the low UA group and the healthy controls. Motor function was not affected in any of the groups. UA affects cognitive function but not motor function in patients with iRBD, which could contribute to its antioxidant and neuroprotective roles.

BACKGROUND:Idiopathic rapid eye movement sleep behavior disorder (iRBD) likely represents the prodromal stage of synucleinopathy. The present study was to investigate if there was prospective memory (PM) impairment and the relationship between different PM tasks and traditional cognitive tests in patients with iRBD. METHODS:A total of 28 patients with iRBD, 25 with Parkinson's disease (PD) and 21 healthy controls were included. The Cambridge Prospective Memory Test (CAMPROMPT) was used to measure the PM including time-based (TBPM) and event-based PM (EBPM). Standard cognitive tests were administered to all participants. RESULTS:EBPM scores were lower only in patients with iRBD, while the obvious PM abnormalities were found in patients with PD. The patients with iRBD and PD performed worse on delayed recall of the Rey Auditory Verbal Learning Test (RAVLT) and copy of the Rey-Osterrieth complex figure (ROCF). The EBPM correlated with attention, executive function, and immediate memory besides working memory in patients with iRBD. The PM tasks involved in more memory functions in PD patients. CONCLUSIONS:The patients with iRBD were impaired on both episodic memory and EBPM tasks that correlated with attention, executive function, and immediate memory. The PM abnormality was an early cognitive change in iRBD to which more attention should be paid more attention.

AimWe investigated preclinical abnormalities as revealed by transcranial sonography (TCS) in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) compared with those revealed in patients with multiple system atrophy (MSA) or Parkinson's disease (PD) and in normal controls.MethodsTwenty-two patients with iRBD, 21 patients with MSA, 22 patients with PD, and 21 normal controls were included in this study. All participants underwent one night of video-polysomnography monitoring, and the sleep parameters were analyzed using Polysmith software and by visual analysis. TCS was performed following a standardized procedure. The echogenicity of the substantia nigra and basal ganglia were evaluated.ResultsA greater proportion of PD patients were found to have substantia nigra hyperechogenicity (86.4%) when compared to iRBD patients (31.8%), MSA patients (23.8%), and normal controls (4.8%) (P < 0.001). Fourteen MSA patients (66.7%) and 11 iRBD patients (50.0%) had hyperechogenicity in the basal ganglia, whereas hyperechogenicity in the basal ganglia was less frequent in PD patients (18.2%) and normal controls (9.5%) (P < 0.001). Poor sleep efficiency, less stage II sleep time, and more periodic leg movements were found in MSA and PD patients, whereas iRBD patients had almost normal sleep.ConclusionSome iRBD patients had basal ganglia hyperechogenicity that was similar to that observed in MSA, which may represent another possible convert direction. The present study further confirmed iRBD as a prodromal stage of synucleinopathy. TCS could detect subclinical changes and thus might provide useful markers for identifying individuals at increased risk for developing a synucleinopathy.

Aims: We investigated cognitive abnormalities using standard tests in Chinese patients with idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) compared with those in normal controls.Methods: Twenty-three patients with iRBD and 23 normal controls were included in this study. All of the participants underwent one night of video-polysomnography (PSG) monitoring to certify REM sleep without atonia or abnormal behaviors. The cognitive assessments were administered and scored according to a standard procedure, including global cognitive screening and attention/processing speed, executive function, memory, language, and visuospatial ability testing.Results: Patients with iRBD had similar scores of the Mini Mental State Examination (MMSE) but lower Montreal Cognitive Assessment (MoCA) scores compared with controls (p > 0.05, p = 0.013). The iRBD patients performed poorly on verbal memory tests, which included immediate recall (p < 0.001), delayed recall (p < 0.001), and false recognitions (p = 0.002) of the Rey Auditory Verbal Learning Test (RAVLT). The visual memory and visuospatial abilities were also impaired in iRBD patients, as reflected by the copy (p = 0.005) and immediate (p = 0.004) and delayed (p = 0.003) recall of the Rey-Osterrieth complex figure, although no difference was found after Bonferroni correction. The duration of RBD was 6.98 +/- 8.10 years. After controlling for age, the duration of RBD was only correlated with the Trail Making Test B (r = 0.613, p = 0.045) and block design (r = 0.667, p = 0.025).Conclusions: Impaired verbal memory was observed in iRBD patients who identified as Chinese. MoCA could detect cognitive abnormalities and serve as a screening scale. The present study further confirmed cognitive deficits in iRBD as an early clinical marker in the prodromal stage of synucleinopathy. (C) 2016 Elsevier B.V. All rights reserved.

Objective To investigate the changes of transcranial sonography (TCS) in patients with rapid eye movement sleep behavior disorder (RBD). Methods Fifteen patients fulfilled the diagnostic criteria of RBD according to International Classification of Sleep Disorders (ICSD, 2nd edition). Under the monitor of polysomnography (PSG), the sleep architectures of all RBD cases were evaluated by Polysmith software and visual analysis. Furthermore, all RBD patients and 15 normal controls underwent TCS. Cases with substantia nigra echo intensity over Ⅲ grade and substantia nigra area over 0.20 cm2 were supposed to be hyperechogenicity. Additionally, the width of the third ventricle was measured and whether there was hyperechogenicity in basal ganglia was evaluated. The cognitive functions were evaluated by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Results RBD patients presented typical clinical manifestations and electrophysiologic changes. No significant difference (P = 0.080, 0.109) was found in the comparison of hyperechogenicity rate on substantia nigra (6/15) and basal ganglia (7/15) in RBD patients and normal controls (1/15, 2/15). No significant difference in the comparison of MoCA was found in RBD patients with or without substantia nigra hyperechogenicity (P = 0.075). The RBD patients with hyperechogenicity on basal ganglia had higher MMSE scores than those without hyperechogenicity on basal ganglia, and the difference was significant (P = 0.021). Conclusions RBD which is suggested as the prodromal period of synucleinopathy may present hyperechogenicity in substantia nigra and basal ganglia on TCS. TCS could detect subclinical changes of brain and evaluate the risk of synucleinopathy. DOI: 10.3969/j.issn.1672-6731.2016.04.010

BACKGROUND:Alzheimer's disease dementia (ADD) has become an important health problem in the world. Visuospatial deficits are considered to be an early symptom besides memory disorder.OBJECTIVES:The gesture imitation test was devised to detect ADD and amnestic mild cognitive impairment (aMCI).METHODS:A total of 117 patients with ADD, 118 with aMCI, and 95 normal controls were included in this study. All participants were administered our gesture imitation test, the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Clock Drawing Test (CDT), and the Clinical Dementia Rating Scale (CDR).RESULTS:Patients with ADD performed worse than normal controls on global scores and had a lower success rate on every item (p < 0.001). The area under the curve (AUC) for the global scores when comparing the ADD and control groups was 0.869 (p < 0.001). Item 4 was a better discriminator with a sensitivity of 84.62% and a specificity of 67.37%. The AUC for the global scores decreased to 0.621 when applied to the aMCI and control groups (p = 0.002). After controlling for age and education, the gesture imitation test scores were positively correlated with the MMSE (r = 0.637, p < 0.001), the MoCA (r = 0.572, p < 0.001), and the CDT (r = 0.514, p < 0.001) and were negatively correlated with the CDR scores (r = -0.558, p < 0.001).CONCLUSIONS:The gesture imitation test is an easy, rapid tool for detecting ADD, and is suitable for the patients suspected of mild ADD and aMCI in outpatient clinics.

临床资料 患者男性,24岁,出生史正常,头外伤史(-),家族史(-),智能和体格发育正常.患者在8岁时出现发作性左侧"眼皮跳",继之左侧上、下肢、面部麻木感,头眼左偏,意识丧失,并出现左侧肢体强直阵挛,持续半分钟左右,清醒和睡眠中均有发作,有时继发全身强直阵挛发作.应用包括多种适宜剂量单药或者联合治疗,呈现药物难治性,每周有2～3次发作.于2011年12月1日在中日友好医院就诊.长程录像脑电记录过程中,发作间歇期头皮脑电图表现为右枕部(O2)、顶(P4)、中央(C4)和后颞(T8)为著的癫痫样放电.4d内捕获惯常发作5次,4次为不对称强直,1次为继发全面强直阵挛发作.发作症状与发作期起始脑电均表现为相同的模式.

Objective In the context of worldwide shortage of amytal,explore the intracarotidpropofol test for lateralizing language area and assessing hemispheric memory function.Methods Fourteen patients with refractory partial epilepsy who were candidates for surgical intervention were included in the study.With guide under a digital subtraction angiography,propofol was injected in bilateral intracarotidsequentially.Muscle power deceasing to level 0 at the contralateral limb and eyes gazing to contralateral side were used as the mark of hemispheric anesthesia completely.The immediate language alterations were recorded.To evaluate the bilateral language and memory functions,the visual and auditory memory tasks were performed sequentially once patient could concentrate his attention ; and after limb muscle power recovering to normal level,patients were required to perform a free recall test.Any abnormal responses were recorded.Results Language dominant hemisphere was determined in 14 patients.Nine patients were confirmed as left language dominance,2 patients were right language dominance.The remained 3 patients were considered as bilateral language dominance.Meanwhile,the hemispheric memory function was able be evaluated in 13 patients.More than 67％ memory function was sustained in hemisphere contralateral to mesial temporal lesions.Transient responses including eye pain,facial muscle spasms,laughers and involuntary movements were observed.Conclusion Hemispheric language and memory functions can be assessed with direct intracarotidpropofol injection,and propofol could be an alternative drug to amobarbital used in the Wada test.