Search Results (706)

Background/Objectives: Liuwei Dihuang (LWDH) is a classical plant-derived herbal formula widely used for cognitive decline. This study aimed to evaluate its efficacy and safety in cognitive disorders and to explore its potential pharmacological mechanisms using network pharmacology. Methods: We searched 11 databases through November 2024 for randomized controlled trials comparing LWDH plus conventional therapy with conventional therapy alone in cognitive disorders. Meta-analysis was performed for clinical outcomes, and herb–compound–target and disease-target datasets were integrated to identify core molecular modules. Results: Twelve randomized controlled trials involving 1137 participants were included. Adjunctive LWDH was associated with improvements in Mini-Mental State Examination scores (MD = 2.34, 95% CI 0.88–3.79), activities of daily living, and quality of life. However, substantial heterogeneity and methodological limitations, including unclear randomization and blinding, were observed across studies, indicating a potential risk of bias. Fewer adverse events were reported in the LWDH plus conventional treatment group, although reporting quality was limited. The overall risk of bias was judged as “some concerns”. Network pharmacology analysis identified a broad set of overlapping genes between LWDH-associated targets and cognitive disorder-related genes, which were further refined through filtering procedures. Subsequent analyses suggested associations with pathways related to neurodegeneration, apoptosis, and central nervous system function; however, these findings are exploratory and based on in silico predictions. Conclusions: LWDH may be associated with potential adjunctive benefits in cognitive disorders. However, given the methodological limitations and clinical heterogeneity of the included studies, the findings should be interpreted with caution. The proposed pharmacological mechanisms are exploratory and require further validation. Well-designed randomized controlled trials are needed to establish more robust evidence. Full article

Background and Objectives: To evaluate the impact of Holmium Laser Enucleation of the Prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP) on cognitive function and psychological well-being three months post-surgery. Materials and Methods: This prospective observational cohort study involved 150 patients undergoing surgical treatment for BPH; 132 patients (66 HoLEP, 66 TURP) completed baseline and 3-month follow-up evaluations. The Montreal Cognitive Assessment (MoCA) served as the primary measure of cognitive function, while the Mini-Mental State Examination (MMSE) functioned as a secondary measure. The Beck Anxiety Inventory and Beck Depression Inventory were utilized to assess individuals’ mental states. We employed repeated-measures General Linear Models, adjusted for age and educational attainment, to examine temporal variations. Results: Baseline demographic, clinical, cognitive, and psychological characteristics were comparable among the groups. The modified analysis revealed no significant interaction between time and surgical procedure for MoCA (p = 0.405), indicating that both groups exhibited comparable cognitive trajectories. No significant differences were seen between the groups in the adjusted MoCA scores (p = 0.162). A minor, statistically insignificant temporal effect was observed (p = 0.058; partial η² = 0.028). Educational attainment independently forecasted cognitive performance (p = 0.024). The MMSE demonstrated a slight temporal effect (p = 0.015) with no interaction of approaches. Anxiety and depressive symptoms persisted uniformly and comparably among the groups. Conclusions: Three months post-surgery, neither HoLEP nor TURP was associated with a notable deterioration in cognitive performance. The surgical modality did not independently influence cognitive trajectory after adjusting for demographic variables. Contemporary endoscopic BPH surgery appears to be neurocognitively safe during the medium-term postoperative period. Full article

Background and Objectives: Whether post-stroke oral hesitation carries different clinical implications by lesion location is unclear. We compared oral hesitation and its relationship with chewing, cognition, and aspiration risk between frontal and parietal lobe stroke. Materials and Methods: We retrospectively analyzed 242 patients (35 frontal, 207 parietal) from 946 consecutive stroke admissions (2016–2020) with isolated lesions and videofluoroscopic swallowing study within one month. Oral hesitation, chewing, Clinical Dysphagia Scale (CDS), and Mini-Mental State Examination (MMSE) were recorded. Penetration-Aspiration Scale (PAS) scores were categorized as Normal (1), Penetration (2–5), or Aspiration (6–8). Multivariable logistic regression adjusting for age, sex, stroke type, and lesion side was performed. Firth’s penalized estimation was used for models with quasi-separation. Results: Groups were demographically comparable in age (68.1 ± 15.0 vs. 71.7 ± 12.2 years; p = 0.206) and female sex (48.6% vs. 42.0%; p = 0.590). Oral hesitation was significantly more prevalent in the frontal group (liquid: 80.0% vs. 23.2%, p < 0.001; semisolid: 68.6% vs. 26.6%, p < 0.001). Frontal patients scored worse on six of seven CDS subcomponents (p < 0.01), yet chewing was uncorrelated with oral hesitation or residue (p > 0.3), unchanged after MMSE adjustment. In parietal patients, chewing correlated with all outcomes (ρ = 0.19–0.30, p < 0.01). In parietal stroke, oral hesitation was linked with liquid aspiration (64.3% vs. 35.7%; OR = 3.25, p = 0.001) and semisolid airway invasion (OR = 2.70, p = 0.005); these associations remained significant after multivariable adjustment and FDR correction. No such association was detected in the frontal group, although this finding is limited by the smaller sample size. Conclusions: Oral hesitation may carry different clinical implications by lesion site. In parietal stroke, it was associated with chewing impairment and higher aspiration risk, suggesting a possible sensorimotor contribution. Frontal group findings were underpowered and should be considered exploratory. Lesion-specific interpretation warrants larger-cohort confirmation. Full article

Background: Sleep disturbance is highly prevalent in dementia syndromes and increasingly viewed as a correlate of disease expression, not just ageing. This study investigated associations between subjective sleep quality, cognitive performance, and structural MRI markers in a dementia syndromes sample, comparing Alzheimer’s disease (AD) and non-AD groups, with exploratory inclusion of objective sleep and nocturnal blood pressure in a sub-sample. Methods: Observational cross-sectional design with 128 memory clinic patients (41 AD, 87 non-AD). Subjective sleep quality assessed via Pittsburgh Sleep Quality Index (PSQI). Cognitive measures: Mini-Mental State Examination (MMSE) for global cognition, Symbol Digit Modalities Test (SDMT) for processing speed, Trail Making Tests (TMT-A/B), and CLOX-1/2 for executive function. MRI markers: Scheltens scale (medial temporal atrophy), Fazekas scale (white matter hyperintensities). An exploratory sub-sample (N = 24) included additional nocturnal and daytime blood pressure monitoring; these data were analyzed descriptively and are reported as hypothesis-generating only. Analyses: group comparisons, Spearman correlations, hierarchical and logistic regression models in the full sample, and descriptive analyses with Spearman correlations in the exploratory sub-sample. Results: The AD group reported poorer sleep quality (higher PSQI) and worse cognitive performance across domains compared with the non-AD group (p < 0.001). Higher PSQI scores were associated with poorer cognitive outcomes, particularly executive function and processing speed, after adjustment for demographics and structural MRI markers (e.g., β = −0.181 to −0.425 for MMSE/SDMT). In the exploratory sub-sample (N = 24), PSQI was correlated with SDMT (ρ = −0.653) and TMT-A (ρ = 0.788). Conclusions: Subjective sleep quality was associated with cognitive performance in individuals with dementia syndromes after accounting for structural MRI markers. These findings suggest that subjective sleep disturbance may represent a complementary clinical dimension warranting further longitudinal research, including evaluation of whether sleep-focused interventions may offer clinical benefits. Full article

Mild cognitive impairment (MCI) represents an intermediate stage between normal cognitive function and dementia. Delaying the onset or progression of dementia has therefore become a key research priority. Although previous studies have examined the individual effects of fish oil or pine bark extract on cognitive decline, their findings remain inconclusive. In this study, we compared the effects of fish oil alone versus fish oil combined with pine bark extract on cognitive function and the oxidative status in patients with MCI. Participants aged 55–75 years with MCI were enrolled in a 24-week, double-blind, parallel-group trial, and they were randomly assigned to either a fish oil group (F group, n = 14), which received one fish oil capsule (350 mg eicosapentaenoic acid and 250 mg docosahexaenoic acid) and one placebo capsule, or a fish oil combined with pine bark extract group (F+P group, n = 14), which received one fish oil capsule and one pine bark extract capsule (100 mg). Compared to the baseline, the F group showed a significant decrease in Clinical Dementia Rating scores and a significant increase in Mini-Mental State Examination scores. In the subdomain analysis of the Cognitive Abilities Screening Instrument, the F group demonstrated a significant increase in the drawing score, whereas the F+P group showed a significant increase in the short-term memory score. Regarding the antioxidant status, compared to the baseline, the F group exhibited a significant increase in plasma thiobarbituric acid reactive substance (TBARS) levels and erythrocytic superoxide dismutase activity, whereas catalase (CAT) activity significantly decreased. After 24 weeks, plasma TBARS levels showed no significant change, while CAT activity was significantly higher in the F+P group than in the F group. These findings suggest that combined supplementation with fish oil and pine bark extract may be associated with potential improvements in short-term memory performance and antioxidant status in middle-aged and older adults with MCI, although the results should be interpreted cautiously. Full article

Background: Language impairment is a core feature of Major Neurocognitive Disorder (MND), yet the domain-specific relationship between language functioning and everyday functional status remains insufficiently characterized. Methods: We conducted a retrospective observational study in 125 older adults diagnosed with MND according to DSM-5 criteria with mild-to-moderate cognitive impairment measured with Mini-Mental State Examination (MMSE). Language performance was assessed using semantic, phonemic verbal fluency and confrontation naming. Functional status was evaluated using basic (BADL) and instrumental activities of daily living (IADL). Ordinal logistic regression models examined associations between language domains and functional outcomes, adjusting for global cognitive status (MMSE), demographic variables, multimorbidity, and depressive symptoms. Model fit was evaluated using the Akaike Information Criterion. Results: Semantic fluency emerged as the best-performing predictor of BADL across all hierarchical models, remaining statistically significant after full adjustment for MMSE and clinical covariates (β ≈ 0.60, p < 0.05). Phonemic fluency showed the most robust association with IADL, with a stable effect across models, reaching a trend toward statistical significance in the fully adjusted analyses (β ≈ 0.22–0.27, p = 0.069). Naming ability did not influence functional outcomes. All observed associations persisted after controlling for MMSE, demographic variables, multimorbidity, and depressive symptoms. Conclusions: Language abilities showed differential associations across language domains with functional status in this sample of patients with MND. Semantic fluency was associated with basic self-care, while phonemic fluency showed a trend toward association with instrumental daily activities. These relationships remained observable after adjustment for global cognitive impairment, suggesting verbal fluency as a potentially sensitive marker of functional vulnerability. Full article

Background/Objectives: Swift achievement of an optimal functional status after stroke may substantially reduce patients’ stay in a medical facility and enable their return home. The study aimed to assess the functional status in patients after their first stroke, depending on the time after stroke incident and the patient’s length of stay in the stroke rehabilitation ward. Methods: The data from 229 patients, aged 69.4 ± 11.3 years (120 men and 109 women), formed part of the analysis. Based on medical records, basic socio-demographic, clinical data, and the results of the tests—Mini Mental State Examination (MMSE), Barthel Index (BI), Time Walk Test 10 m (TWT), Trunk Control Test (TCT), Up and Go Test (TUG), and Berg Balance Scale (BBS)—were collected. Results: The risk groups for patients with longer post-stroke rehabilitation stays and poorer rehabilitation outcomes included women, older adults, those with poorer functional status, and patients admitted to the stroke rehabilitation ward after a longer period of time after stroke. Conclusions: The functional status and the length of stay in the post-stroke rehabilitation ward should be monitored and analyzed to find and support groups of patients who may rehabilitate more slowly and stay longer in the ward. A shorter patient stay can allow for more effective management of beds in the post-stroke rehabilitation wards. Full article

Background: Frailty is a common finding in elderly subjects with severe aortic stenosis (AoS) and a strong predictor of mortality and disability after aortic valve surgery. The atherogenic index of plasma (AIP) is related to different cardiovascular (CV) risk factors, which in turn are correlated to the progression of frailty as well as of AoS. Aim: to analyze the association of AIP with different CV risk factors and frailty scores and its value as a determinant of mortality in older adults with severe AoS. Methods: The association of AIP with a multidimensional assessment of frailty by using Fried criteria and the following indices; timed up-and-go test (TUG) for gait function; Charlson Index (CI), basic activities of daily living (BADL) and instrumental activities of daily living (IADL) for disability; mini–mental state examination for cognitive function evaluation (MMSE); Geriatric Depression Score for mood disorder (GDS); Mini Nutritional Assessment (MNA) for nutritional status was assessed in 102 elderly AoS patients (33 males; mean age 83 ± 6 yrs). Moreover, the relationship between AIP and demographic, lifestyle, traditional CV risk factors and CV mortality was also evaluated. Results: Significant relationships between AIP and glycemia and inflammatory parameters (CRP, ESR and fibrinogen) as well as with troponin I were found. Moreover, AIP significantly correlates with CI, BADL, IADL and MNA. However, the Kaplan–Meier analysis did not show any significant difference for survival rates according to AIP intervals of risk, whereas ejection fraction remained the only significant determinant after multivariate adjustment for mortality at the Cox proportional hazard models analysis in this patient population. Conclusions: Higher AIP is significantly associated with cardiometabolic risk and increased physical dysfunction risk and frailty in AoS pts, evidencing its potential use as a simple biomarker in this clinical setting, although it did not represent a significant determinant for mortality in this population. Full article

Background: Early screening of cognitive impairment is essential for timely clinical intervention; however, conventional cognitive tests such as the Mini-Mental State Examination (MMSE) rely on fixed thresholds that may not be optimal in real-world screening settings. Methods: This study developed a threshold-aware multimodal screening framework integrating MMSE item-level scores with wearable-derived sleep and physical activity lifelog data. A dataset of 174 adults was analyzed and categorized into cognitively normal (CN), mild cognitive impairment (MCI), and dementia, with MCI and dementia combined as an impaired group. A CatBoost-based binary classification model was trained using five-fold cross-validation. The optimal decision threshold was determined by maximizing balanced accuracy using out-of-fold predictions. Results: The optimized threshold (0.49) achieved an accuracy of 0.818 and a balanced accuracy of 0.728 on the validation set. The recall values were 0.885 for CN and 0.571 for the impaired group, with an area under the ROC curve of 0.676. Feature importance and stability analyses showed that variability-related sleep and activity features were consistently selected across folds. Conclusions: These findings suggest that threshold optimization combined with multimodal lifelog integration may improve the interpretability of screening decisions. Variability-based lifelog features may provide complementary information alongside MMSE, although their role remains exploratory and requires further validation in larger and longitudinal cohorts. Full article

Background: In the context of global population aging, nutritional risk has emerged as an important factor associated with both physical and mental health among older adults. This study aimed to examine the associations between nutritional risk, depression, and cognitive function in older adults and to explore potential variations across residential area, educational attainment, employment status, frailty status, and activities of daily living (ADL). Methods: Data were obtained from 9955 community-dwelling older adults aged 65 years and older who participated in the 2023 National Survey of Older Koreans. Nutritional risk was assessed using the DETERMINE checklist (21-point scale), a multidimensional screening tool reflecting dietary, functional, and social risk factors. Depression was measured using the Short-form Geriatric Depression Scale (15-point scale), and cognitive function was assessed using the Korean version of the Mini-Mental State Examination-2 (K-MMSE-2; 30-point scale). Hierarchical multiple linear regression, correlation, subgroup, and sensitivity analyses were conducted, adjusting for sociodemographic characteristics, health behaviors, and geriatric factors. Results: Correlation analyses showed significant associations between nutritional risk and cognitive function (r = −0.191, p < 0.05), nutritional risk and depression (r = 0.440, p < 0.05), and depression and cognitive function (r = −0.259, p < 0.05). Higher nutritional risk scores were significantly associated with greater depressive symptoms (B = 0.314, p < 0.001) and lower cognitive function (B = −0.051, p < 0.05). While some subgroup differences were observed, not all interaction effects reached statistical significance, and these findings should be interpreted with caution. Conclusions: These findings suggest that nutritional risk is associated with depressive symptoms and cognitive function in older adults. Given that the DETERMINE checklist reflects multidimensional vulnerability, the results should be interpreted as indicating broader risk contexts rather than direct nutritional status alone. These findings highlight the importance of integrated, multidimensional approaches to support older adults at nutritional risk in community settings. Full article

Background and Objectives: Postoperative delirium and postoperative cognitive dysfunction are common complications in older adults undergoing elective non-cardiac surgery, associated with increased morbidity and mortality, functional decline, and prolonged hospital stay. Prolonged preoperative fasting may intensify inflammatory responses and insulin resistance. Preoperative oral carbohydrate loading within ERAS protocols may modulate this response and reduce cognitive risk. Materials and Methods: A scoping review was conducted following the methodological recommendations of Arksey and O’Malley, the Joanna Briggs Institute, and PRISMA-ScR. A systematic search was performed in PubMed and Scopus for studies published up to September 2025. Randomized controlled trials and observational studies including adults ≥ 65 years undergoing elective non-cardiac surgery were included if they evaluated fasting modifications or preoperative carbohydrate loading and reported postoperative delirium or cognitive dysfunction. Results: A total of eight publications were included: four randomized controlled trials, one prospective cohort study, two cross-sectional studies, and one descriptive/correlational study. Populations included older adults undergoing elective abdominal, orthopedic, colorectal, or hip surgery, as well as hospitalized elderly surgical patients. Interventions included oral carbohydrate loading, assessment of preoperative nutritional status, and enteral versus parenteral nutrition. Only four of the eight included studies directly evaluated neurocognitive outcomes. Postoperative delirium was assessed in three studies, using the Confusion Assessment Method in two studies and the Delirium Rating Scale in one study. Postoperative cognitive dysfunction was evaluated in one study using a Mini-Mental State Examination-based cognitive assessment, while the remaining four studies did not assess neurocognitive outcomes and instead focused on metabolic, inflammatory, or perioperative well-being outcomes. Conclusions: Available evidence suggests that perioperative fasting protocols and preoperative carbohydrate loading may influence metabolic and inflammatory responses related to postoperative neurocognitive outcomes in older adults. However, evidence remains limited and heterogeneous. Findings are exploratory and hypothesis-generating, highlighting the need for well-designed trials assessing neurocognitive outcomes in geriatric surgical populations. Full article

Purpose: No prior clinical studies have quantitatively evaluated the effect of low-dose radiation therapy (LDRT) on Alzheimer’s disease (AD) brain changes using multi-modal MRI. This study examined the feasibility of using conductivity, diffusion, and brain tissue volume measures to detect treatment effects in patients with AD receiving LDRT. Methods: Nine patients with mild AD were enrolled in three groups. Three patients in each group were assigned to the control group (0 cGy) and the treated groups [24 cGy/6 fractions (4 cGy for each fraction) and 300 cGy/6 fractions (50 cGy for each fraction)]. Conductivity, diffusivity, and brain tissue volume were acquired at baseline and 6 months post-treatment and were evaluated to assess within-group MRI changes and evaluate associations between MRI measures and Mini-Mental State Examination (MMSE) scores. Results: Region-of-interest (ROI) analyses identified substantial changes in high-frequency conductivity (HFC) (e.g., left insula), cerebrospinal fluid (CSF) volumes (e.g., anterior cingulate, limbic regions), and diffusion tensor imaging (DTI) metrics, such as axial diffusivity (AxD) and fractional anisotropy (FA), in fusiform, thalamic, hippocampal, and occipital areas. Correlation analysis showed strong associations between MRI measures and cognition, most notably HFC in the left fusiform gyrus (r = 0.843, p = 0.0043) after treatment. Diffusion indices across multiple regions also showed significant positive or negative correlations with MMSE. Conclusions: This exploratory clinical study demonstrates that LDRT induces measurable physiological and microstructural alterations in the brain detectable via conductivity and diffusion MRI. Conductivity emerged as the sensitive biomarker, showing strong cognitive correlations. These exploratory findings suggest that multi-modal quantitative MRI can serve as an effective tool for evaluating treatment response in clinical LDRT for AD. Full article

Background/Objectives: Cognitive impairment is a major concern in aging populations. Early detection through validated neuropsychological tests is essential for dementia risk stratification and preventive interventions. This scoping review (PRISMA-ScR, 2013–2023, registration protocol: 10.17605/OSF.IO/8NHJF) evaluated cognitive testing trends in aging research and identified the most frequently used neuropsychological screening tests in Spanish populations. Methods: Searches in PubMed and Web of Science (March 2024) yielded 730 records; 156 were reviewed in full, and 15 met inclusion criteria for Spanish adults ≥65 years. Results: The Mini-Mental State Examination was the most-used test, followed by verbal fluency and Trail Making Test. No test covered all six DSM-5 cognitive domains, and social cognition was never assessed in any of the studies. The Montreal Cognitive Assessment was underused despite its superior sensitivity. Conclusions: Findings support developing a tailored, multidomain battery combining global and domain-specific tests. Social cognition assessments should be included to ensure a complete cognitive domain coverage. Full article

Background/Objective: Cognitive frailty, the coexistence of physical frailty and cognitive impairment, is a potentially reversible and high-risk state for dementia. This study examined the association between Color Kanji Pick-out Test (CKPT) app performance and cognitive frailty independent of Mini-Mental State Examination (MMSE) scores in community-dwelling older women. Methods: In this cross-sectional study, the participants were 102 community-dwelling older women without dementia and with MMSE scores ≥ 27 (73.6 ± 6.0 years). Reversible cognitive frailty was defined as subjective cognitive decline (≥1 point in the cognitive domain of the Kihon Checklist) plus physical frailty or prefrailty, according to the Japanese Cardiovascular Health Study (J-CHS) criteria. Firth’s penalized logistic regression using three prespecified models, adjusted for age and education, was used to examine the independent associations between CKPT app performance and MMSE scores with reversible cognitive frailty. Results: Fourteen participants (13.7%) met the criteria for cognitive frailty. In separate models, higher CKPT app and MMSE scores were significantly associated with lower odds of cognitive frailty (CKPT: odds ratio [OR] 0.470, p = 0.019; MMSE: OR 0.548, p = 0.020). In a multivariable model including both measures, the CKPT app (OR 0.499, p = 0.031) and MMSE scores (OR 0.553, p = 0.031) remained independently associated with cognitive frailty, and this model had the lowest Akaike information criterion. Conclusions: The CKPT app performance was independently associated with cognitive frailty beyond global cognition. The CKPT app may detect subtle executive and attentional vulnerabilities not captured by the MMSE, supporting practical, objective, early screening and risk stratification of cognitive frailty. Full article

Background and Objectives: Chronic kidney disease (CKD) is an increasingly important global health challenge and is frequently accompanied by psychiatric symptoms, including anxiety. A multidimensional assessment of anxiety in hemodialysis (HD) using the Endler Multidimensional Anxiety Scales (EMAS) has not, to our knowledge, been previously reported. We aim to evaluate the reliability, convergent validity, and exploratory domain-level structure of EMAS in HD patients treated at a dialysis center in Craiova, Romania. Materials and Methods: A total of 103 HD patients underwent clinical and sociodemographic/socioeconomic profiling, cognitive screening using the Mini-Mental State Examination (MMSE), and EMAS administration at two time points (4-week interval) for test–retest evaluation. The anxiety subscale of the Depression, Anxiety, and Stress Scale-21R (DASS-21R) was administered to assess convergent validity. Internal consistency (Cronbach’s α), temporal stability (test–retest correlations and intraclass correlation coefficients), and convergent validity (Pearson correlations) were computed. Exploratory factor analyses were conducted on EMAS domain scores (state, trait, and perceived anxiety domains) as an exploratory structural check. Results: EMAS state and trait anxiety scores were higher in women than in men, while perceived anxiety showed a more heterogeneous pattern across dimensions. Total state anxiety increased with age, particularly after 50 years. Domain-level internal consistency was good for state and acceptable for trait components (standardized α ≈ 0.84 and 0.78 across administrations), whereas perceived anxiety domains showed low cross-domain coherence, consistent with context-specific appraisal. The DASS-21R anxiety subscale showed good internal consistency (α = 0.863). Convergent validity analyses indicated small, domain-specific associations between EMAS scores and DASS-21R anxiety. Domain-level EFA supported a theoretically coherent pattern in which state and trait domains clustered distinctly, while perceived anxiety domains formed a partially separable factor; this pattern was broadly consistent across both administrations. Conclusions: In this HD cohort, EMAS demonstrated good reliability and limited but domain-specific evidence of convergent validity, and exploratory domain-level analyses supported its multidimensional organization. Further studies with larger samples are warranted for item-level structural testing and to inform feasibility-oriented shortening for potential clinical use. Full article