Abstract:With the aging of the global population, the prevalence of cognitive dysfunction is projected to increase rapidly in the elderly. Following tumors, cardio-cerebrovascular diseases and diabetes mellitus, cognitive dysfunction related diseases have become a group of important diseases that seriously affect the quality of life of the elderly and bring a heavy burden to the family and society. Strong evidence supports the benefits of changing potential risk factors for cognitive impairment in the elderly. Changes in education, nutrition, health care and lifestyle and control of various controllable risk factors will be powerful strategies to reduce the global burden. In this article, we review the controllable risk factors of cognitive impairment in the elderly in order to provide some help for better prevention of its occurrence and progress.

Abstract:Objective To detect the validity of a task switching paradigm-based cognitive assessment tool. Methods From July 2019 to January 2020,60 middle-aged and elderly people in the community were recruited from the Beijing Aging Brain Rejuvenation Initiative Center of Beijing Normal University, and then they were grouped by demographic information. Our self-designed cognitive tool and other neuropsychological tests [such as mini-mental state examination (MMSE), Rey auditory verbal learning test, trail-making test B (TMT-B), stroop color word test (SCWT) and so on] were used to assess the performances of the subjects in general cognitive function, executive function and other areas of cognition. SPSS statistics 24.0 was used for data analysis. According to the data type, independent sample t test or one-way ANOVA were used for intergroup comparison in demographic variables, and Dunnett′s test for multiple comparisons was conducted for post hoc comparison. Pearson correlation analysis was employed to analyze the correlation in the results from our cognitive test and from above mentioned neuropsychological tests. The consistency of the results of our cognitive test and neuropsychological tests was analyzed by paired samples t test, and the score histogram and cumulative score distribution chart were drawn to show the distribution of the results. Results Pearson correlation analysis indicated that the total score and average reaction time from our cognitive test were significantly correlated with the results of the neuropsychological tests in general cognitive function (MMSE) and executive function (TMT-B and SCWT) (|r |:0.272-0.448, all P<0.05). Furthermore, the results of paired sample t test showed that there were no significant differences between the results of the two evaluation methods (MMSE:t=-0.726, P=0.471; TMT-B:t=-0.530, P=0.598; SCWT time:t=-0.366, P=0.716; SCWT number:t=-0.544, P=0.588). Finally, the independent sample t-test and one-way ANOVA suggested that the results of our cognitive test were not affected by educational levels and genders of the elderly (all P>0.05). Conclusion Our self-designed task switching paradigm-based cognitive tool can well reflect the cognitive level of the subjects, and is suitable as a wildly-used rapid cognitive screening tool.

Abstract:Objective To investigate the correlation between cognitive function and tear secretion in patients with cognitive impairment. Methods A total of 213 inpatients were recruited in this study in the Department of Neurology at the Sixth Medical Center of Chinese PLA General Hospital from June 2021 to June 2022, including 71 with Alzheimer′s disease (AD), 75 with mild cognitive impairment (MCI), and 67 with normal cognition as controls. The cognitive function was assessed using the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). Schirmer test was used to measure tear secretion. SPSS statistics 25.0 was used for data analysis. Depending on data type, comparison between groups was performed using the one-way analysis of variance (ANOVA), Kruskal-Wallis test or χ² test. The correlation of cognitive function with tear secretion was analyzed using Pearson correlation analysis and Spearman′s rank correlation analysis. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the results in tear Schirmer test for cognitive impairment. Results Tear secretion in AD and MCI groups were both lower than control group (P<0.01), the difference being statistically significant. There was no significant difference between the AD and MCI groups (P＞0.05). Analysis showed that results in Schirmer test had positive correlations with MMSE and MoCA scores (r=0.304,0.391;P<0.001 for both), and with each score of MoCA (P＜0.05). The area under curve(AUC) of the Schirmer test for diagnosing AD and MCI was 0.818 (P<0.001) and 0.753 (P<0.001). Conclusion Patients with cognitive impairment have reduced tear secretion, and cognition correlates with tear secretion.

Abstract:Subjective cognitive decline (SCD) is a premorbid condition characterized by a decline in self-perceived memory without objective evidence of impairment of any cognitive domain. Studies have shown that SCD significantly increases the risk of cognitive impairment associated with Alzheimer′s Disease (AD) compared with normal controls. Evidence also indicates that some SCD patients have typical pathological AD changes although they do not have typical clinical manifestations of AD. All such findings suggest that SCD, as a precursor of AD-associated cognitive impairment, may be a golden window for early intervention of cognitive impairment. However, the clinical understanding of SCD is still shallow with no unified diagnostic criteria. In view of this, this review summarizes the clinical characteristics, biological and imaging diagnostic markers and intervention prospects of SCD in recent years to enhance its clinical understanding.

Abstract:Aging is an irreversible life process, and the physiological functions of individuals gradually decline and degenerate with aging. As they age, the elderly experience progressive decline of cognitive functions, including memory. Memory decline in the elderly is often associated with impaired cellular physiological processes in the brain. The energy metabolism disorder exerts direct damage on the memory in the elderly, and the excessive occurrence of neuroinflammation and accumulation of abnormal metabolites seriously damage their brain microenvironment, resulting in the memory decline. From the perspectives of energy metabolism, neuroinflammation and other physiological processes related to memory, this article reviews and discusses research progress in the neurobiological basis of memory decline in the elderly in recent years.

Abstract:Aging is increasing all over the world, and the health problems in the elderly, including dementia, are becoming increasingly prominent, with an increasing number of patients with Alzheimer′s disease (AD). AD essentially, is a condition of neuroinflammation, and is closely related to sleep and immune function, while, insomnia can induce an inflammatory response, destroy the abundance and diversity of intestinal flora, and ultimately promote the development of the disease. Since the pathogenesis of AD is still unclear, the therapeutic effect of Western medicine is relatively disappointing. Here, based on the consistency and correlation between the “Cerebrointestinal axis” theory and the concept of “all diseases are born from spleen and stomach failure” in Traditional Chinese Medicine, we discuss to “Cure from the Spleen” for insomnia so as to reshape the gut microbiota and thus be beneficial to prevent and treat AD.

Abstract:Objective To analyze the effects of chronic diseases, physical function, skeletal muscle index, fat and other factors on elderly male patients with frailty. Methods From April to June 2021, a total of 658 men aged ≥60 years in Beijing communities were enrolled. They were divided into frail group (n=124) and non-frail group (n=534) based on the evaluation with Fried frailty phenotype (FP) scale. Charlson comorbidity index (CCI) was used to assess the chronic diseases. Physical functions were tested, skeletal muscle index, fat mass, and other body compositions were measured with the body composition analyzer. SPSS statistics 26.0 was used for data analysis. Depending on data type, t-test, Mann-Whitney U test andχ² test were performed for comparison between groups. Logistic regression analysis was used to analyze the influencing factors of frailty. Results Univariate analysis showed that frail and non-frail groups differed statistically significantly in age, height, body mass, skeletal muscle index, body fat mass, visceral fat area, basal metabolic rate, protein, bone mineral content, grip strength, walking speed and 5-time chair stand time (P<0.05). CCI of the frail group was significantly higher than that of the non-frail group, and the former showed a higher proportion of hypertension, coronary heart disease, diabetes mellitus, low bone mass, prostatic hyperplasia, chronic bronchitis and chronic renal disease than the latter, the difference being statistically significant (P<0.05). Multivariate logistic regression analysis showed that, after adjusting for age, height and body mass, CCI (OR=1.256,95%CI 1.012-1.558, P=0.039), low bone mass (OR=2.312,95%CI 1.308-4.088, P=0.004), and 5-time chair stand time (OR=1.110,95%CI 1.022-1.205, P=0.013) were independent influencing factors for frailty. Conclusion Increased CCI, low bone mass, and long 5-time chair stand time are strongly associated with frailty.

Abstract:Objective To analyze the risk factors of the vulnerable carotid artery plaques in the middle-aged and elderly people undergoing physical examination and to formulate a predictive nomogram model. Methods A retrospective analysis was performed of the physical-examination data of 1 612 patients who underwent cervical vascular Doppler ultrasonography at Health Management Center of the First Affiliated Hospital of Soochow University from September 2021 to December 2021. According to ultrasonographic findings, the patients were divided into vulnerable plaque group (n=287) and non-vulnerable plaque group (n=1 325). Statistical analysis were done of the general data, results of routine blood test, biochemical and other laboratory indicators of the two groups. The risk factors for the occurrence of vulnerable plaques were screened with univariate analysis and multivariate logistic regression, and a predictive nomogram model for the occurrence of vulnerable plaques was formulated by combining the independent factors, and the predictiveness and discrimination of the model were verified. SPSS 26.0 and R Studio 4.0.2 were used for statistical analysis and graphics. Depending on the data type, t-test andχ² test were used for comparison between groups. Results Compared with the non-vulnerable plaque group, the patients in vulnerable plaque group were older with a higher proportion of males, hypertension and diabetes history, the differences being statistically significant (P<0.05 for all). The vulnerable plaque group were higher than the non-vulnerable plaque group in neutrophil count, monocyte count, neutrophil to lymphocyte ratio, fasting plasma glucose and creatinine, but lower in platelet count, platelet-to-lymphocyte ratio, albumin, total cholesterol and low-density lipoprotein cholesterol, all with statistically significant difference (P<0.05 for all). Multivariate logistic regression analysis showed that age (OR=1.099,95%CI 1.078-1.120,P<0.001), hypertension (OR=1.848,95%CI 1.351-2.527, P<0.001), diabetes mellitus (OR=3.757,95%CI 2.614-5.400, P<0.001), and neutrophil count/lymphocyte count ratio (OR=2.025,95%CI 1.055-3.885, P=0.034) were independent risk factors of vulnerable carotid plaque. The above indicators were used to formulate a regression equation and draw a predictive nomogram for the occurrence of vulnerable plaque, and an internal verification of it was performed. With a parameter of 0.778 for C test, the calibration curve showed good consistency of the model with an area under the receiver operating characteristic curve of 0.781 (95%CI 0.752-0.809). Conclusion The predictive histogram model for the occurrence of vulnerable carotid plaque in middle-aged and elderly patients is good. The predictiveness and discrimination can be used to predict vulnerable carotid plaque in middle-aged and elderly people undergoing physical examination.

Abstract:Objective To evaluate the capacity of renal functional reserve (RFR) in elderly patients with chronic kidney disease (CKD) stage 3. Methods A total of 123 CKD stage 3 patients hospitalized in our department from January 2020 to December 2020 were enrolled as the study subjects. The formula based on serum cystatin C and serum creatinine was used to calculate their glomerular filtration rate (eGFR), and then they were divided into CKD3a group (n=75) and CKD3b group (n=48). RFR was calculated by the difference of eGFR before and after intravenous amino acid infusion. The general clinical data and RFR level were compared between the 2 groups. The incidences of acute renal injury (AKI) and rapid decline of renal function were compared among the patients with different RFR levels during 1 year of follow-up. SPSS statistics 21.0 was used for data analysis. According to the data type, two independent samples t-test, one-way ANOVA or Chi-square test was employed for intergroup comparison. Results The RFR level was 21.61±7.13,12.80±9.33, and 7.23 ± 5.84 ml/(min·1.73m²), respectively for the patients aged 65 to 75,76 to 85 and >85 years, and there were significant differences in pairwise comparison (P<0.05). The RFR level of the CKD3a patients was significantly higher than that of the CKD3b patients [22.43±5.33 vs 9.85±3.40 ml/(min·1.73m²), P<0.05]. The RFR level of CKD3a patients was mainly 10%~20%, accounting for 46.67% (35 cases); the main component of RFR level was <10% in the CKD3b patients (21 patients, 43.75%). The CKD3a patients complicated with diabetes had obviously lower RFR level when compared with those with CKD3a alone [20.06±3.57 vs 26.28±8.15 (ml/min·1.73m²), P<0.05]; and similar result was seen between the CKD3b diabetes patients and those with CKD3b alone [7.57±4.65 vs 10.07±5.31 ml/(min·1.73m²), P<0.05]. In 1 year′s follow-up, the CKD3 patients with RFR<10% had notably higher incidences of AKI [25.64% (10/39) vs 16.33% (8/49) and 14.29% (5/35)] and rapid decline of renal function [28.21% (11/39) vs 12.24% (6/49) and 17.14% (6/35)] than the CKD3 patients with RFR<20% and RFR>20%. Conclusion With the increase of age, the RFR level in elderly CKD3 patients is in a downward trend. The CKD3b patients have lower RFR level than the CKD3a patients. Elderly CKD3 patients with lower RFR level suggest a higher risk of acute renal events.

Abstract:Objective To analyze the characteristics of aspiration pneumonia caused by aspiration secondary bacterial infection, the characteristics of pathogenic bacteria and the treatment plan, so as to provide basis for clinical diagnosis and treatment of aspiration pneumonia. Methods The clinical data of 53 patients who were diagnosed with aspiration pneumonia in the emergency department of Beijing Tsinghua Changgeng Hospital from November 2019 to July 2020 were selected. According to the results of etiology, the patients were divided into 44 cases of Gram negative (G^-) bacteria group and 9 cases of Gram positive (G⁺) bacteria group. Collect patient demographic data, laboratory indicators, pathogen detection results, antibiotic use and effectiveness and other data. SPSS statistics 25.0 was used for data analysis. According to data type, t-test, rank sum test, Fisher exact probability method or Chi-square test was applied. Results The average age of patients in this study was (79.94±1.86) years. 77.4% (41/53) of the patients had neurological dysfunction, and the main clinical manifestations were fever, dyspnea, disturbance of consciousness and cough, accounting for 37.7% (20/53), 28.3% (15/53), 20.78% (11/53) and 13.2% (7/53) respectively. There was a statistically significant difference between the two groups in terms of neurological dysfunction and disease severity (P<0.05). The strains in the G-group were mainly Klebsiella pneumoniae [52.3% (23/44)], Pseudomonas aeruginosa [29.5% (13/44)] and Escherichia coli [18.2% (8/44)], while the strains in the G⁺group were mainly Corynebacterium striatum [22.2% (2/9)] and Staphylococcus aureus [77.8% (7/9)]. The severe group was mainly infected by Klebsiella pneumoniae [51.3%(20/39)]; χ² =9.102, P=0.036]. In terms of efficacy evaluation, the initial effective rate of cefoperazone sulbactam, an antibiotic including β-lactamase inhibitor, was the highest [90.0% (18/20); χ²=14.95,P=0.011]. Conclusion Inhalation pneumonia is more common in elderly patients, especially those with nervous system dysfunction. G^-bacteria are the main pathogens, and Klebsiella pneumoniae is the most common. Antibiotic treatment is an effective treatment plan, and antibiotics including β-lactamase inhibitor can be used as a first-line choice for anti-infection treatment.

Abstract:Atrial fibrillation is the most common arrhythmia in clinical practice and is closely related to stroke and thromboembolism. Atrial fibrillation increases the risk of thrombosis by disrupting physiological haemostatic mechanisms that are understood by reference to Virchow′s triad of “abnormal blood constituents”“vessel wall abnormalities” and “abnormal blood flow”. Left atrial appendage is the main part of atrial fibrillation due to its complex morphological structure and special functional characteristics. A better understanding of the various factors of atrial fibrillation thrombosis contributes to a better stratification of the risk of atrial fibrillation thrombosis and its timely and effective treatment.

Abstract:Osteoporosis and sarcopenia, two chronic diseases with shared risk factors and pathophysiological pathways, are both common to the elderly and postmenopausal women and are often comorbid, seriously affecting the quality of life of the elderly. Therefore, it is very important to explore their relationship and to jointly evaluate the two diseases. This article reviews the relationship between the skeleton and muscles and between osteoporosis and sarcopenia to provide clinical orientation for the diagnosis and treatment of skeletomuscular diseases.

Abstract:At present, the incidence rate of diabetes is in an increasing trend in our country. Diabetes can lead to serious metabolic disorders and various acute and chronic complications. Diabetic retinopathy (DR) is one of the most common microvascular complications. In recent years, the incidence of DR has increased significantly among the patients with type 2 diabetes mellitus, and DR has become one of the main causes of blindness all over the world. The etiology and pathogenesis of DR remain unclear, but many studies have shown that inflammatory cells, inflammatory factors and inflammatory signaling pathways work together to cause inflammatory cascade reaction, which play key roles in the occurrence and development of DR. This article reviews the research progress of inflammatory cells, inflammatory factors and inflammatory signaling pathways in the pathogenesis of DR, and elaborates the mechanism of inflammation in DR in order to further study its prevention and treatment and improve the quality of life in DR patients.

Abstract:Heart diseases are among the common diseases that cause disabilities and deaths in humans. Heart sounds refer to those produced due to the vibrations caused by the valve opening or closure, the blood rushing through the valve openings, or the blood rushing through the aortic wall of the ventricle. Heart sounds are obviously related to the heart structure and function. As a non-invasive auxiliary diagnostic tool, heart sound detection technology plays an important role in the diagnosis and treatment of cardiovascular diseases. Therefore, heart sound monitoring technology has gradually gained attention from scholars at home and abroad, and there have been more and more studies on its clinical application in recent years. This article reviews the relevant literature on the clinical application of heart sound monitoring technology and prospects its application in the emerging mobile health care and perioperative monitoring.