Wenqi Lü

Background: Insomnia has been recognized as an independent cardiovascular risk factor, but longitudinal evidence remains limited. Methods: We analyzed data from 3635 participants in the HCHS/SOL (Hispanic Community Health Study/Study of Latinos). Insomnia was assessed at baseline using the Women’s Health Initiative Insomnia Rating Scale and evaluated by insomnia group status, symptom severity, specific symptom dimensions, and sleep duration. The primary outcome was incident cardiovascular disease (CVD) over a median follow‐up of 6.05 years, defined using Framingham composite criteria. Cox proportional hazards models were used to estimate adjusted hazard ratio (HR) and 95% CI. Subgroup and interaction analyses examined effect modification by age and sex. Results: Insomnia was independently associated with a 78% increased risk of incident CVD (HR, 1.78 [95% CI, 1.02–3.12], P P P <0.05) but not in women or older individuals. Each 1‐point increase in Women’s Health Initiative Insomnia Rating Scale score was associated with a 5% higher hazard of CVD. And the early morning awakening showed the significant associations with CVD risk. Conclusions: This study first demonstrates a prospective link between insomnia and incident CVD in a large cohort of US Hispanic/Latino adults. Baseline insomnia conferred an increased risk of developing CVD, particularly among men and younger adults. Early morning awakening drove most of this association, underscoring the need for targeted sleep interventions in this population.

Background Behavioural and psychological symptoms of dementia (BPSD) are highly prevalent in people living with dementia. Second-generation antipsychotics (SGAs) are commonly used to treat BPSD, but their comparative efficacy and acceptability are unknown. Methods The standard mean difference (SMD) was used to pool the fixed effects of continuous outcomes. We calculated ORs with corresponding 95% credible intervals (CI) for the categorical variable. Efficacy was defined as the scores improved on the standardised scales. Acceptability was defined as the all-cause dropout rate. Tolerability was defined as the discontinuation rate due to adverse effects (AEs). The relative treatment rankings were reported with the surface under the cumulative curve. The AE outcomes included mortality, cerebrovascular adverse events (CVAEs), falls, sedation, extrapyramidal symptoms and urinary symptoms. Results Twenty randomised controlled trials with a total of 6374 individuals containing 5 types of SGAs (quetiapine, olanzapine, risperidone, brexpiprazole and aripiprazole) with intervention lengths ranging from 6 weeks to 36 weeks were included in this network meta-analysis. For the efficacy outcome, compared with the placebo, brexpiprazole (SMD=−1.77, 95% CI −2.80 to −0.74) was more efficacious, and brexpiprazole was better than quetiapine, olanzapine and aripiprazole. Regarding acceptability, only aripiprazole (OR=0.72, 95% CI 0.54 to 0.96) was better than the placebo, and aripiprazole was also better than brexpiprazole (OR=0.61, 95% CI 0.37 to 0.99). In terms of tolerability, olanzapine was worse than placebo (OR=6.02, 95% CI 2.87 to 12.66), risperidone (OR=3.67, 95% CI 1.66 to 8.11) and quetiapine (OR=3.71, 95% CI 1.46 to 9.42), while aripiprazole was better than olanzapine (OR=0.25, 95% CI 0.08 to 0.78). Quetiapine presented good safety in CVAE. Brexpiprazole has better safety in terms of falls and showed related safety in sedation among included SGAs. Conclusion Brexpiprazole showing great efficacy in the treatment of BPSD, with aripiprazole showing the highest acceptability and olanzapine showing the worst tolerability. The results of this study may be used to guide decision-making.

Background Alzheimer’s disease (AD) is a neurodegenerative disorder characterised by cognitive decline, behavioural and psychological symptoms of dementia (BPSD) and impairment of activities of daily living (ADL). Early differentiation of AD from mild cognitive impairment (MCI) is necessary. Methods A total of 458 patients newly diagnosed with AD and MCI were included. Eleven batteries were used to evaluate ADL, BPSD and cognitive function (ABC). Machine learning approaches including XGboost, classification and regression tree, Bayes, support vector machines and logical regression were used to build and verify the new tool. Results The Alzheimer’s Disease Assessment Scale (ADAS-cog) word recognition task showed the best importance in judging AD and MCI, followed by correct numbers of auditory verbal learning test delay recall and ADAS-cog orientation. We also provided a selected ABC-Scale that covered ADL, BPSD and cognitive function with an estimated completion time of 18 min. The sensitivity was improved in the four models. Conclusion The quick screen ABC-Scale covers three dimensions of ADL, BPSD and cognitive function with good efficiency in differentiating AD from MCI.

Background: Alzheimer’s Disease (AD) is a neurodegenerative disorder characterized by cognitive functional decline accompanied with neuropsychiatric symptoms and impairment of activities of daily living (ADL). Mild Cognitive Impairment (MCI) is considered the prodromal state of AD. Early identification of MCI is a strategy to reduce the burden of caregivers and society. Neuropsychological scales are still the most used method for identification of cognitive decline. The purpose of this study was to simplify the scales by eliminating some insensitive items based on the six years of database and machine learning methods.Method: A total of 458 patients newly diagnosed as AD or MCI were recruited in Memory Clinic, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University from 2014 to 2019. Neuropsychological battery was used to evaluate the cognitive function, neuropsychiatric symptoms and ADL, including Mini‐mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Geriatric Depression Scale (GDS), Boston Naming Test (BNT), Digit Span (DS), Auditory Verbal Learning Test (AVLT), Trail Marking Test (TMT) A and B. Alzheimer’s Disease Assessment Scale (ADAS‐cog), Clinical Dementia Rating (CDR), Instrumental Activity of Daily Living Scale (IADL), Physical Self‐Maintenance Scale (PSMS). XGboost and CART regression tree were used to test all items contained in all scales and try to explore the importance of each item. Sensitivity was reflected by the AUC (Area Under Curve).Result: Of which 236 patients were diagnosed as AD and 222 as MCI. The mean age was 72.99±9.04 years and 51.53% were male. Among all the battery items, ADAs‐cog word recognition task showed the best importance in judging AD and MCI, followed correct numbers of AVLT delay recall, ADAs‐cog orientation, MMSE recall, TMT‐B time. The overall sensitivity for predicting AD or MCI for all items was 0.83. However, in our preliminary screening also showed the 31 items, most of which were based on the ADL scale and neuropsychiatry symptoms, contributed little to distinguishing AD from MCI. After removed these items, the sensitivity became to 0.87.Conclusion: Cognitive assessment such as recall and orientation may be a better strategy than neuropsychiatric symptoms and ADL when identifying AD from MCI.

Potential positive link between cognitive function and dietary restriction has been widely concerned. The present study describes a systematic review and preliminary meta-analysis to assess the eff...

Background: The follow-up study on neuropsychiatric changes after the lifting of coronavirus disease 2019 (COVID-19) quarantine in patients with cognitive impairment and their caregivers is still lacking, and relative information is needed to formulate more comprehensive healthcare prevention measures worldwide.Aims: To provide data on the changes in neuropsychiatric performance after the lifting of COVID-19 quarantine in patients with cognitive disorders and their caregivers.Methods: Two surveys in Chongqing, China were conducted via telephonic interview with 531 patients and their caregivers. The baseline survey was performed from February 11 to 23, 2020, and the follow-up was from October 24 to November 9, 2020. The data of neuropsychiatric symptoms (NPSs), sleep, nutrition, and chronic diseases of patients, as well as the burden of care, anxiety, and depression of caregivers were evaluated.Results: Significant alleviation of NPSs after the lifting of COVID-19 quarantine was observed in patients with mild cognitive impairment (MCI) and dementia (both P < 0.05). Compared with baseline, the prevalence for NPSs of all participants dropped from 57.94 to 38.82%. Among NPS subdomains, apathy displayed the biggest decline at follow-up by 10.72%, followed by nighttime behavior by 8.65%. Mixed effect generalized estimation equation analysis showed significant amelioration in hallucination, depression, apathy, irritability, aberrant motor behavior, and nighttime behavior (all P < 0.05), with the most prominent changes in nighttime behavior and apathy. Among the patients with unsatisfactory control of chronic disease, the medication adherence rate dropped by approximately 30% after the lifting of quarantine. More importantly, around 13% increase of care burden was observed among the caregivers at follow-up, with both depression and anxiety rising by nearly 4%.Conclusion: The prolonged quarantine may exacerbate NPS in patients with memory disorders, while the care burden and mental stability of the caregivers after the pandemic should also be concerned.

Background: Cognitive decline and neuropsychiatric symptoms (NPS) are main clinical manifestations in Alzheimer disease (AD). It is unclear whether the link between specific NPS and cognitive domains exists in AD or mild cognitive impairment (MCI). Our study aimed to examine the association between specific cognitive domain and NPS in AD and MCI, and to evaluate whether this association showed variety in different stages of cognitive impairment.Methods: A total of 458 patients diagnosed as AD or MCI were included in this study. Neuropsychological batteries were applied in the study. The association between NPS and cognitive function were evaluated by multiple linear regression, and its correlation was evaluated by Spearman correlation coefficient.Results: The prevalence of NPS increased with the severity of cognitive impairment, and there were significant differences between MCI and AD. NPS were predominantly associated with cognitive domains, including memory, language, attention, and executive function. Both regression liner analysis and correlation analysis showed delusion, hallucination, and aberrant motor behaviour (AMB) were linked to language and attention. In addition, regression liner analysis illustrated depression, anxiety, and apathy were related to learning and episodic memory. Generally, the delusion, hallucination, and AMB have the broadest impact on cognition.Conclusion: Specific NPS was predominantly associated with different cognitive domains. Symptoms of agitation, delusion and irritability indicate worse cognitive performance. Therefore, cognitive improvement should be a therapeutic strategy in managing NPS in AD.

Background COVID-19 is erupting globally. Mass quarantine had been implemented all around China which could influence the psychological status of patients with memory disorders and their caregivers. Aim To investigate the psychological impact of mass quarantine on patients with memory disorders and their caregivers in China. Methods We completed a cross-sectional study in 787 patients and their caregivers registered from 2010 to 2019 in Memory Clinic, The First Affiliated Hospital of Chongqing Medical University, by telephone interviews. The performance in neuropsychiatric symptoms (NPSs), sleep, nutrition, chronic diseases of patients, and the burden of care, anxiety and depression of caregivers was assessed by six assessment scales (MNA-SF, PSQI, NPI, RSS, PHQ-9 and GAD-7). Results Only 68 (8.6%) patients worried about the outbreak of COVID-19. The prevalence of NPSs among all subjects was nearly 60.0%. Approximately 50.0% of the caregivers reported distress. More than 70.0% of patients remained stable in NPSs. However, anxiety, depression, aberrant motor disorder and delusion were exacerbated (22.9%, 18.6%, 17.1% and 16.8%, respectively). Appetite and eating disorder led alleviation rate by 25.8% while disappearing rate of agitation led by 5.8%. 7.5% of caregivers manifested depressive symptoms while 4.9% expressed anxiety symptoms, and 40.8% showed care burden. The coefficients of RSS and PHQ-9, RSS and GAD-7, RSS and NPI-D, PHQ-9 and GAD-7 were 0.7, 0.5, 0.5 and 0.6, respectively (p < 0.01). Conclusion Changes in NPSs during COVID-19 were observed in some patients with memory disorders and their caregivers, and adherence to medication contributed to the stabilization of NPSs.