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BACKGROUND: This study aimed to investigate the efficacy of circuits-based paired associative stimulation (PAS) in adults with amnestic mild cognitive impairment (aMCI). METHODS: We conducted a parallel-group, randomised, controlled clinical trial. Initially, a cohort of healthy subjects was recruited to establish the cortical-hippocampal circuits by tracking white matter fibre connections using diffusion tensor imaging. Subsequently, patients diagnosed with aMCI, matched for age and education, were randomly allocated in a 1:1 ratio to undergo a 2-week intervention, either circuit-based PAS or sham PAS. Additionally, we explored the relationship between changes in cognitive performance and the functional connectivity (FC) of cortical-hippocampal circuits. RESULTS: FCs between hippocampus and precuneus and between hippocampus and superior frontal gyrus (orbital part) were most closely associated with the Auditory Verbal Learning Test (AVLT)_N5 score in 42 aMCI patients, thus designated as target circuits. The AVLT_N5 score improved from 2.43 (1.43) to 5.29 (1.98) in the circuit-based PAS group, compared with 2.52 (1.44) to 3.86 (2.39) in the sham PAS group (p=0.003; Cohen's d=0.97). A significant decrease was noted in FC between the left hippocampus and left precuneus in the circuit-based PAS group from baseline to postintervention (p=0.013). Using a generalised linear model, significant group×FC interaction effects for the improvements in AVLT_N5 scores were found within the circuit-based PAS group (B=3.4, p=0.017). CONCLUSIONS: Circuit-based PAS effectively enhances long-term delayed recall in adults diagnosed with aMCI, which includes individuals aged 50-80 years. This enhancement is potentially linked to the decreased functional connectivity between the left hippocampus and left precuneus. TRIAL REGISTRATION NUMBER: ChiCTR2100053315; Chinese Clinical Trial Registry.
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OBJECTIVE: To investigate the risk factors and clinical features in ischemic stroke patients with different tongue conditions. METHODS: A total of 168 successive acute ischemic stroke inpatients (within 7 days of stroke onset) were recruited. Patients were assigned to groups according to tongue color (pink, pale, red, purple), tongue coating (no coating, thin coating, thick coating) and sublingual vessel (normal, abnormal). Risk factors and clinical features including National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI), clinical classification, laboratory data and pulmonary infection complications were compared. RESULTS: There were no significant differences in risk factors and clinical features among groups with different tongue colors. The incidence of smoking (4.5%) was lower in the no coating group compared with the thin (30.0%) and thick (39.3%) coating groups (P<0.017). NIHSS (19.05±10.68) in the no coating group was higher than the thin (6.40±6.18) and thick (7.41±7.05) coating groups (P<0.017), BI (20.91±29.99) was lower than the thin (67.61±28.78) and thick (63.02±33.54) coating groups (P<0.017), and the percentage of mRS >3 (90.9%) was higher than the thin (42.2%) and thick (42.9%) coating groups (P<0.017). The percentage of partial anterior circulation infarction patients in the no coating group was higher than the thin coating group (77.3% vs. 42.2%), and the percentage of lacunar infarction patients was lower than the thin coating group (4.5% vs. 37.8%, P<0.017). NIHSS in the abnormal sublingual vessel group was lower than the normal group (5.28±4.38 vs. 10.57±9.58, P=0.000), and BI was higher than the normal group (67.61±29.29 vs. 54.64±36.23, P=0.015). CONCLUSION: Tongue conditions of acute stroke patients were relevant to clinical features.
