Hippocampal and motor regions contribute to memory benefits after enacted encoding: cross-sectional and longitudinal evidence.

The neurobiological underpinnings of action-related episodic memory and how enactment contributes to efficient memory encoding are not well understood. We examine whether individual differences in level (n = 338) and 5-year change (n = 248) in the ability to benefit from motor involvement during memory encoding are related to gray matter (GM) volume, white matter (WM) integrity, and dopamine-regulating genes in a population-based cohort (age range = 25-80 years). A latent profile analysis identified 2 groups with similar performance on verbal encoding but with marked differences in the ability to benefit from motor involvement during memory encoding. Impaired ability to benefit from enactment was paired with smaller HC, parahippocampal, and putamen volume along with lower WM microstructure in the fornix. Individuals with reduced ability to benefit from encoding enactment over 5 years were characterized by reduced HC and motor cortex GM volume along with reduced WM microstructure in several WM tracts. Moreover, the proportion of catechol-O-methyltransferase-Val-carriers differed significantly between classes identified from the latent-profile analysis. These results provide converging evidence that individuals with low or declining ability to benefit from motor involvement during memory encoding are characterized by low and reduced GM volume in regions critical for memory and motor functions along with altered WM microstructure.

Quantitative Assessment of Resting-State Functional Connectivity MRI to Differentiate Amnestic Mild Cognitive Impairment, Late-Onset Alzheimer's Disease From Normal Subjects.

BACKGROUND: Alzheimer disease (AD) is a neurological disorder with brain network dysfunction. Investigation of the brain network functional connectivity (FC) alterations using resting-state functional MRI (rs-fMRI) can provide valuable information about the brain network pattern in early AD diagnosis. PURPOSE: To quantitatively assess FC patterns of resting-state brain networks and graph theory metrics (GTMs) to identify potential features for differentiation of amnestic mild cognitive impairment (aMCI) and late-onset AD from normal. STUDY TYPE: Prospective. SUBJECTS: A total of 14 normal, 16 aMCI, and 13 late-onset AD. FIELD STRENGTH/SEQUENCE: A 3.0 T; rs-fMRI: single-shot 2D-EPI and T1-weighted structure: MPRAGE. ASSESSMENT: By applying bivariate correlation coefficient and Fisher transformation on the time series of predefined ROIs' pairs, correlation coefficient matrixes and ROI-to-ROI connectivity (RRC) were extracted. By thresholding the RRC matrix (with a threshold of 0.15), a graph adjacency matrix was created to compute GTMs. STATISTICAL TESTS: Region of interest (ROI)-based analysis: parametric multivariable statistical analysis (PMSA) with a false discovery rate using (FDR)-corrected P < 0.05 cluster-level threshold together with posthoc uncorrected P < 0.05 connection-level threshold. Graph-theory analysis (GTA): P-FDR-corrected < 0.05. One-way ANOVA and Chi-square tests were used to compare clinical characteristics. RESULTS: PMSA differentiated AD from normal, with a significant decrease in FC of default mode, salience, dorsal attention, frontoparietal, language, visual, and cerebellar networks. Furthermore, significant increase in overall FC of visual and language networks was observed in aMCI compared to normal. GTA revealed a significant decrease in global-efficiency (28.05 < 45), local-efficiency (22.98 < 24.05), and betweenness-centrality (14.60 < 17.39) for AD against normal. Moreover, a significant increase in local-efficiency (33.46 > 24.05) and clustering-coefficient (25 > 20.18) were found in aMCI compared to normal. DATA CONCLUSION: This study demonstrated resting-state FC potential as an indicator to differentiate AD, aMCI, and normal. GTA revealed brain integration and breakdown by providing concise and comprehensible statistics. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.

Do serum GDNF levels correlate with severity of Alzheimer's disease?

INTRODUCTION: A growing body of evidence that glial cell line-derived neurotrophic factor (GDNF) levels are probably involved in pathogenesis and disease course of Alzheimer's disease (AD) suggested that its blood levels could potentially be used as a biomarker of AD. The aim of this study was to compare serum GDNF levels in patients with AD and age-matched controls. METHODS: Serum concentrations of GDNF were compared in 25 AD patients and 25 healthy volunteers using a double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). Severity of the disease in AD patients was assessed using Functional Assessment Staging (FAST). Cognitive assessment of the patients was done using the Mini-Mental State Examination (MMSE). RESULTS: Mean GDNF levels were found to be 2.45 ± 0.93 ng/ml in AD patients and 4.61 ± 3.39 ng/ml in age-matched controls. There was a statistically significant difference in GDNF serum levels in patients with AD compared to age-matched controls (p = 0.001). Moreover, GDNF serum levels were significantly correlated with disease severity (p < 0.001) and cognitive impairment (p < 0.001). CONCLUSION: This study showed that serum levels of GDNF are significantly decreased in AD patients in comparison with age-matched controls, thus suggesting a potential role of GDNF as a disease biomarker. However, a comprehensive study of changes in serum levels of multiple neurotrophic factors reflective of different neurobiological pathways in large-scale population studies is recommended.

Lessons from COVID-19 pandemic: Clinical experiences on telemedicine in patients with dementia in Iran.

BACKGROUND: One of the impacts of COVID-19 pandemic on health system has been increasing the burden on the patients with dementia and their families. Telemedicine has shown to be a solution for this vulnerable group and can be used for cognitive assessment, medication adjustment, patient referral, reduces the travel time, cost and caregiver burden. Despite the challenges in acceptance for this novel technology in the elderly 1, it can reduce the burden of disease and increase access to specialised services. All these alongside neurologic visit could be provided with a telephone hotline or preferably video-platform tele-visit.2 However, barriers to develop telemedicine include a lack of broadband internet access and the need for insurance coverage.3 The American Academy of Neurology has been developed a comprehensive guideline to implement the tele-visit approach in the COVID-19 crisis with a special approach to neurological examination limitations in the patients.4 Numerous studies evaluated this approach to assess patients including dementia.5 Overall, the patients, caregivers, and the neurologists reported a high satisfaction rate.6 Yaadmaan Institution for Brain, Cognition and Memory Studies with a multidisciplinary team including cognitive neurologist, psychiatrist, psychologist, geriatrician, and clinical pharmacist is the first private referral center for cognitive disorders in Iran. After starting quarantine and tight restrictions and because of too many families who were seeking help for their patients via Yaadmaan helpline, we decided to start Telemedicine method. The approach and compatible examinations have been shown in Table 2 and 3 respectively. In addition, we defined a list of serious states to avoid Telemedicine for patients referal to the hospital in Table 4. Based on our one-year experiences, it seems there are promising results in-terms of feasibility, acceptability and convenience for the patient, caregiver and physician. However, due to the emergence of this pandemic, Telemedicine and its crucial role in Iran has not yet been identified in the insurance and health system appropriately. Even though Telemedicine was started as a practical and urgent solution against COVID-19 restrictions, it is necessary to be evaluated as an alternative method for clinical evaluations of the patients with dementia in Iran in the future.

Effect of memantine on expression of Bace1-as and Bace1 genes in STZ-induced Alzheimeric rats.

Recent studies have showed that the long non-coding RNAs (lncRNAs) expression is dysregulated in different neurodegenerative disorders like Alzheimer's disease (AD). In the present study, the effects of memantine on the level of Bace1-as and Bace1 genes' expression in streptozotocin (STZ)-induced Alzheimer's and memantine treated rats were investigated. The male Wistar rats were randomly divided into four groups: 1-Normal control, 2-Sham-operated control, 3- Alzheimer'scontrol rats (ICV-STZ), 4-Experimental group rats treated by memantine in a dose of 30 mg/kg/day for 28 days in ICV-STZ rats. The expression of Bace1-as and Bace1 genes was measured by quantitative-PCR in the brain and blood tissues. ELISA was used to analyze Bace1 and Aß proteins. Expression of Bace1-as was significantly increased in the brain and blood tissues of the experimental group (p = 0.032 and p = 0.034, respectively). The expression of Bace1 gene showed no significant changes in the brain. Furthermore, the ELISA analysis revealed that Bace1 protein was significantly increased in the plasma of the Alzheimer's control group (p = 0.000) and in the brain tissue of the experimental group (p = 0.000). Additionally, Aß levels had no significant changes between all groups studied. The Bace1 protein may be used as a prognostic biomarker in plasma, or before using memantine as a treatment. Furthermore, Bace1-as gene expression may play a role in monitoring the progression of AD.

Distinct Aspects of Decision Making in Obsessive-Compulsive Disorder: Application of Unconscious Thought Theory.

Individuals with obsessive-compulsive disorder (OCD) rely on "explicit learning" strategies in decision making. It is suggested that periods of brief distraction (in healthy individuals) result in better decisions in complex situations. It can be hypothesized that periods of unconscious thought would not lead to better decisions due to impairment of implicit learning in OCD. A total of 121 OCD patients and 120 healthy participants were presented with a task in which they had to choose between four apartments with multiple attributes. Participants were randomly assigned to one of three conditions: making a decision immediately after being presented with options (immediate), after thinking carefully for 2 minutes (conscious thought [CT]), or after being distracted for 2 minutes (unconscious thought [UT]). Individuals with OCD performed worse than healthy controls in UT condition, although they did better in CT condition. Our study supports the idea of dysfunction in implicit processing and overreliance on explicit processes in OCD.

Prescribing for geriatrics in Tehran; is it appropriate and rational?

Background: The world's population is growing older. Inappropriate and irrational use of drugs in the elderly is a considerable health concern due to consequences such as increased morbidity and adverse drug events. This study aimed to evaluate the rationality of prescribing and determining the extent of inappropriate prescribing in a sample of geriatric patients in Tehran. Methods: This cross sectional study was performed on 1512 prescriptions of patients aged ≥ 65 years from 5 pharmacies affiliated to Tehran University of Medical Sciences in 2014. Prescription of potentially inappropriate medications (PIMs) was investigated using the Beers Criteria along with WHO prescribing indices. Date were analyzed using SPSS software, and significance level was set at less than 0.05. Results: Mean (SD) age of patients was 73.9(6.7) years. A total of 472 (31.2%) patients received at least 1 PIM. Benzodiazepines were the most frequent drug class and general practitioners (GPs) were the most frequent prescriber of PIMs. The highest and the lowest percentage of prescriptions containing brand-names were prescribed by subspecialists (62.5%) and GPs (42.2%), respectively. Antibiotics and injectable medications were prescribed for 26.8% and 28.5% of patients by GPs. Mean (SD) number of drugs per prescription was 3.57 (1.92). Prescriptions containing systemic antibiotics and PIMs had significantly higher mean number of drugs compared to those without these items (both P < 0.001). Conclusion: There is a need for interventions to improve the quality of prescribing for elderly patients, especially by GPs. Also, there are still some problems in rational use of drugs based on prescribing indices, especially, prescribing brand-names and injectable medications.

Plasma microparticles in Alzheimer's disease: The role of vascular dysfunction.

Cerebrovascular lesions, a potent stimulus for endothelial cell activation, trigger cognitive and degenerative changes and contribute to pathology of Alzheimer's disease (AD). Circulating microparticles (MPs) are actively involved in the pathogenesis of AD and cerebrovascular diseases, which share common vascular risk factors. We examined the plasma changes of endothelial MPs (EMPs) and platelet MPs (PMPs) in AD patients with vascular risk factors. The plasma Annexin V+ CD 41a- CD144+ EMPs and Annexin V+ CD41a+ CD144- PMPs of 37 patients with AD, with or without vascular risk factors (hypertension, diabetes, dyslipidemia, stroke, coronary artery disease, and smoking), and 10 age-matched controls were quantified by flow cytometry. Pearson correlation analysis used to evaluate the linear relationship between variables. Significantly higher plasma levels of EMPs were observed in AD patients with vascular risk factors as compared to the patients without vascular risk factors [Mean Difference (MD): 2587.80, 95% confidence interval (CI) 770.30-4404.80], and control subjects (MD: 4990.60, 95% CI, 3054.40-6926.79). Significant correlations were found between circulating EMPs, total MPs, and PMPs. There were no significant correlations between plasma levels of EMPs/ PMPs, and cognitive decline indices. Circulating EMP levels are influenced by AD disease status, and plasma levels of MPs and PMPs are associated with vascular risk factors in patients with AD. EMP phenotyping, as cellular biomarkers of vascular injury/dysfunction, and their effects on cerebral perfusion, and cognitive decline should be further investigated. Graphical abstract Vascular endothelial cell activation results in release of endothelial-derived microparticles (EMPs), which contributing to vascular dysfunction and cognitive decline.

Positive Aspects of Caregiving Questionnaire.

OBJECTIVE: The potential role of positive aspects of caregiving in enhancing caregivers' health is an important issue. The aim of this study was to develop and validate Positive Aspects of Caregiving Questionnaire (PACQ) in caregivers of patients with dementia in Iran. METHODS: Content validation process was used to content valid development. Cronbach α and intraclass correlation coefficient (ICC) were calculated as reliability indices. We used exploratory factor analysis to extract potential latent factors and evaluate the factor structure of PACQ. We assess correlation between PACQ and caregiver burden for divergent validity. For convergent validity, correlation between PACQ and self-rated health was specified. RESULTS: Content validity indices (CVIs), internal consistency, and test-retest reliability were CVI > 0.80, α = 0.785, and ICC = 0.905, respectively. Moreover, item-total correlations confirmed good reliability of PACQ. Two factors were identified by factor analysis in this 10-item measure: patient and caregiver relationship and caregiver's psychological well-being. Divergent validity and convergent validity were established by high negative correlation between positive aspect of caregiving (PAC) and caregiver burden along with significant positive correlation between PAC and self-rated health, respectively. While Cronbach α for the entire scale was 0.785, Cronbach αs for both of the scale components were 0.71. CONCLUSION: The PACQ demonstrated acceptable psychometric properties of reliability and performs well in preliminary tests of validity as a measure of positive aspects of caregiving. This measure can be used to determine the outcome of interventional programs on positive, not only negative, aspect of caregiving.

Avicenna's pharmacological approach to memory enhancement.

In recent decades, the number of patients with dementia has significantly risen. Current treatments for dementia are not curative and there still is place for development of medications. Throughout the ages, several medical disciplines have systematized and codified medical knowledge acquired throughout centuries of trial and error. Revisiting these disciplines might help in gaining insight for development of medications and other therapeutic strategies. The present study aims to show the possible benefits of an immanent understanding of the approach towards memory and dementias taken by humoral medical discourse in the Islamicate world. This study presents how brain function was theorized in the medieval Islamicate world. Afterwards, a brief history of the theory of the inner senses and of humoral medicine is briefly presented. Then the definition of memory and its localization within the brain as theorized in the framework of humoral medicine is closely studied. To demonstrate the possible advantages of the study of the inner logic of humoral medicine, ten medicinal plants are chosen and discussed.

Which variable is the strongest adjusted predictor of quality of life in caregivers of patients with dementia?

BACKGROUND: The central role of family in caregiving for patients with dementia is now widely acknowledged. However, in playing this role, caregivers may neglect their health and quality of life (QOL). The purposes of present study were to measure caregivers' QOL and to determine its adjusted predictors via multiple regression models. METHODS: We used sequential sampling to recruit 153 patients and their caregivers from the Iran Alzheimer Association in our cross-sectional study. A single-item question with a Likert scale was applied to measure QOL. A multiple linear regression model was used to determine the adjusted predictors of QOL. RESULTS: Of the responding caregivers, 22.8% reported their QOL as poor or very poor. Caregiver burden, the main caregiver's age, the Global Deterioration Scale, and the number of caregivers were introduced as adjusted predictors of QOL. CONCLUSIONS: Caregiver burden was proposed as the strongest adjusted predictor for caregivers' poor QOL. Therefore, it seems that interventions to reduce caregiver burden can be effective in enhancing caregivers' QOL.

Early-onset Alzheimer's disease in two Iranian families: a genetic study.

BACKGROUND: Early-onset Alzheimer's disease (EOAD) represents less than 5% of all AD cases. Autosomal dominant EOAD has been defined as the occurrence of at least three cases in three generations. Mutations in the amyloid precursor protein (APP), presenilin-1 and presenilin-2 genes have been recognized to be the cause of EOAD. OBJECTIVE: We investigated the genotype of EOAD in two generations of two families with EOAD living in an Iranian village. METHODS: The polymerase chain reaction method was used to study the presenilin-1 and APP genes in 25 subjects of these generations. RESULTS: A guanine-to-adenine transition in exon 17 of the APP gene resulting in a valine-to-isoleucine substitution at codon 717 was detected in 14 subjects including 6 patients with EOAD. CONCLUSION: This mutation demonstrates the importance of γ-secretase, the necessity of early detection of patients with memory decline in the susceptible population and raising public awareness of consanguinity marriages.

Caregiver burden: the strongest predictor of self-rated health in caregivers of patients with dementia.

OBJECTIVE: People having dementia need help and supervision to perform their activities of daily living. This responsibility is usually imposed on family members who endure a great burden, leading to undesirable health outcomes. The aims of our study were to measure caregivers' health as well as identify its adjusted relevant predictors. METHODS: One hundred and fifty three registered patients and their caregivers from Iranian Alzheimer Association were included in this cross-sectional study through sequential sampling. Self-rated health (SRH) was measured using a single question with Likert-type scale ranging from very bad (1) to very good (5). The multiple linear regression model was applied to determine the adjusted associations between independent variables under study and SRH. RESULTS: The mean caregiver SRH level was 3.03. Of the participant caregivers, 29% were either unsatisfied or very unsatisfied with their health level. In the final regression model, SRH showed a direct significant association with the patient's number of children but an inverse significant association with the marital status (married patients), patient's age, and caregiver burden. CONCLUSIONS: Caregiver burden was not only significantly associated with poor SRH after removing the effect of the other covariates but it was also recognized as the strongest predictor of caregivers' SRH. Therefore, it seems that development of intervention programs, in order to reduce caregiver burden, can be considered as important step in promoting caregivers' health level.

The impact of illiteracy on the assessment of cognition and dementia: a critical issue in the developing countries.

BACKGROUND: Dementia and Alzheimer's disease (AD) is considered a major public health challenge in this decade and in the future. Early detection of AD through appropriate screening tools would be valuable approach in facing the burden of disease specifically in developing societies with insufficient resources. Selecting a screening tool which is non-expensive, non-invasive and implementable by trained primary healthcare providers is the first and probably the most important step in detecting high risk individuals. The goal of this review is to address the key issues in assessment tools in developing countries with a high level of illiteracy. METHOD: We set about a review on literature on the subject of cognitive function assessment among minorities, people with low or no education, and people who live in underdeveloped societies. We also reviewed the studies on validation of such tests in a new society. RESULTS: The most popular assessment tools are more or less biased by the level of education; not all of them are useful for any type of dementia as they assess only some domains of cognitive function. CONCLUSION: Even though people with lower level of education have a higher rate of developing dementia, cognitive function cannot be accurately assessed because of limitations of current available tools. It is strongly suggested that special attention be paid to assess them by functional scales and activity daily living scales. For a more efficient assessment, cognitive tests can also benefit from illustrative questions, proverbs, metaphors, traditions, religious rituals and historical events.

Investigation of Neurocognitive Deficits, Quality of Life, and Functional Performance in Ultra-High-Risk Individuals Compared to Familial High-Risk Individuals for Schizophrenia.

Objective: This study aimed to investigate neurocognitive functioning, quality of life, and global functional performance in Ultra-High Risk (UHR) individuals compared to Familial High-Risk (FHR) individuals for developing schizophrenia. Method : An observational cross-sectional study was conducted using a convenient sampling method at Roozbeh Hospital in Tehran, Iran, from June 2017 to January 2020. The study included 40 UHR individuals based on the Structured Interview for Psychosis Syndrome (SIPS) interview, as well as 34 FHR individuals due to genetic risk. Neurocognitive functioning, quality of life, and global functional performance were assessed by using the Cambridge Automated Neuropsychological Test Battery (CANTAB) and Controlled Oral Word Association Test (COWAT), Quality of Life Scale (QLS), and Global Assessment of Functioning (GAF). Results: UHR individuals for schizophrenia demonstrated significant lower scores in phonemic and semantic verbal fluency (t = 6.218, P < 0.001; t = 4.184, P < 0.001, respectively), more total errors for spatial working memory (t = -5.874, P < 0.001), and fewer problems solved in minimum moves in Stocking of Cambridge (SOC) (t = -2.706, P < 0.01) compared to FHR individuals. Intra-Extra Dimension (IED) did not differ significantly between the two groups. Moreover, the study indicated significant GAF decline (F = 79.257, P < 0.001) and lower total score on the QLS (t = -10.655, P < 0.001) in UHR compared to FHR individuals. Conclusion: It is possible to differentiate UHR individuals from FHR individuals through neurocognitive, quality of life, and global functioning assessment.

Validity and reliability of the Persian version of the Cornell Scale for Depression in Dementia.

The current study aimed to evaluate the validity and reliability of the Persian version of the Cornell Scale for Depression in Dementia (CSDD) in 100 patients aged ≥60 with dementia in Tehran, Iran. Test-retest reliability and internal consistency were analyzed through intraclass correlation coefficient and Cronbach's alpha tests, respectively. The validity was assessed in the areas of face, content and structural validity. The Geriatric Depression Scale (GDS) and The Montgomery-Åsberg Depression Rating Scale (MADRS) were also used to determine the convergent validity. The intraclass correlation coefficient (ICC) was equal to or more than 0.8 between the results of determining depression twice via the CSDD. The internal consistency (Cronbach's α = 0.90) was excellent. The factor analysis, identified five main factors (mood-related signs, behavioral disturbance, physical signs, cyclic functions and ideational disturbance), aside from depression, demonstrated the variance to be 37.88%. Evaluating convergent validity showed satisfactory results (p < 0001). Using the MADRS as standard. the best cut-points for the CSDD via the use of the Youden index were scores of 5.5, 10.5 and 16.5 for mild, moderate and severe depression, respectively. The Persian version of the CSDD is sufficient in terms of validity and reliability for screening depression in the elderly with dementia in Iran.

Validation study of the Persian version of behavioral pathology in Alzheimer's Disease Rating scale (BEHAVE-AD) and the empirical BHAVE-AD (E-BEHAVE-AD).

INTRODUCTION: Behavioral and psychological symptoms of dementia (BPSD) are observed in more than 90% of patients with Alzheimer's disease (AD). BPSDs are remediable if detected early and managed appropriately. Behavioral Pathology in Alzheimer's disease Rating Scale (BEHAVE-AD) and Empirical BEHAVE-AD (E-BEHAVE-AD) were designed to identify BPSD. The aim of this study is to validate and prepare BEHAVE-AD and E-BEHAVE-AD in Persian language for clinical and research applications. METHOD: 120 patients were selected through a combination of intentional and convenience sampling. All participants should fulfill the NINCDS-ADRDA Work Group criteria for a clinical diagnosis of Alzheimer's disease. Functional Assessment Staging Tool (FAST) was used to determine the rate of AD progression. All patients were evaluated using the BEHAVE-AD and E-BEHAVE-AD questionnaires, as well as the Persian version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) and Mini-Mental State Examination (MMSE). The Content Validity Index (CVI) is determined based on the compatibility of the Persian and the original version of the two scales according to the opinion of expert panels. Correlation of MMSE with BEHAVE-AD and E-BEHAVE-AD as well as the BPSD pattern on AD progression continuum by FAST were considered as indices of construct validity. Concurrent validity was estimated by correlating NPI-Q scores with BEHAVE-AD and E-BEHAVE-AD scores. For both scales, interrater reliability was extracted as a reliability index. RESULTS: Pearson correlation coefficients for the BEHAVE-AD scale were as follows: with NPI-Q (r = 0.77, p-value <0.01), with MMSE (r = -0.34, p-value <0.01), indicating concurrent and construct validity, respectively. The result for E-BEHAVE-AD was as follows: with NPI-Q-total (r = 0.59, p-value <0.01), and with MMSE (r = 0.31, p-value <0. 01). BEHAVE-AD and E-BEHAVE-AD scores increased in parallel with AD severity according to FAST, but not on the most severe AD stage. The area under the curve was estimated to be 0.84 (p-value <0.001) for BEHAVE-AD and 0.78 (p-value <0.001) for E-BEHAVE-AD. Correlation between BEHAVE-AD and E-BEHAVE-AD scores ranged from 0.45 to 0.63. The inter-rater reliability index ranged from 0.88 to 0.99 for BEHAVE-AD and from 0.74 to 0.95 for E-BEHAVE-AD. CONCLUSIONS: The Persian version of BEHAVE-AD and E-BEHAVE-AD is valid and reliable for the assessment of BPSD in patients with AD.

Effects of remote combine exercise-music training on physical and cognitive performance in patients with Alzheimer's disease: a randomized controlled trial.

Introduction: This study aimed to investigate the effects of combined remote music and exercise training on the cognitive, psychological, and physical function of patients with Alzheimer's disease (AD). Methods: Forty-one AD patients were randomly allocated to three groups, including control (C), training (T), and training with music (TM) groups. Participants were evaluated by cognitive and performance test batteries before and after the interventions. Both experimental groups performed 36 remote workouts in 3 months online via WhatsApp video call individually with the trainer. Training included simple and varied movements of all physical indicators. The number of sets began with two sets and progressively increased to one set every month, 5-10 repetitions per set. The overload was applied by reducing the break between sets every week. The TM group performed the same exercises while listening to Mozart and traditional Iranian songs. Results: We observed a significant main, group, time, and interaction effect on Romberg (ηp2:0.72), 30 s chair sit and stand (ηp2:0.75), and walking on steppe test (ηp2:0.63). Furthermore, there was a significant main time and interaction effect on push-ups (ηp2:0.43), sit and reach (ηp2:0.64), and MMSE (ηp2:0.76). In all variables, two experimental groups demonstrated substantial improvements than the C group (p < 0.01). In addition, the TM group (27.8%) showed a significant improvement compared to the C group (-6.4%) and the T group (12.2%) in MMSE. Conclusion: Combined remote training with listening to music as adjuvant treatment is an appropriate item to improve the cognitive and physical performance of Alzheimer's patients, especially during the COVID-19 pandemic.

Visual impairment following aluminum phosphide poisoning: A rare case.

Key Clinical Message: Aluminum phosphide poisoning may cause rare visual impairment. In a case, a 31-year-old female, visual loss was linked to shock-induced hypoperfusion, causing oxygen lack and cerebral atrophy, emphasizing the need for identifying atypical symptoms. Abstract: This case report describes the multidisciplinary evaluation of a 31-year-old female patient who suffered from visual impairment as a result of aluminum phosphide (AlP) poisoning. Phosphine, which is formed in the body when AlP reacts with water, cannot cross the blood-brain barrier; therefore, visual impairment seems unlikely to be the direct result of phosphine. To our knowledge, it is the first documented report of such impairment due to AlP.

An Approach toward Artificial Intelligence Alzheimer's Disease Diagnosis Using Brain Signals.

BACKGROUND: Electroencephalography (EEG) signal analysis is a rapid, low-cost, and practical method for diagnosing the early stages of dementia, including mild cognitive impairment (MCI) and Alzheimer's disease (AD). The extraction of appropriate biomarkers to assess a subject's cognitive impairment has attracted a lot of attention in recent years. The aberrant progression of AD leads to cortical detachment. Due to the interaction of several brain areas, these disconnections may show up as abnormalities in functional connectivity and complicated behaviors. METHODS: This work suggests a novel method for differentiating between AD, MCI, and HC in two-class and three-class classifications based on EEG signals. To solve the class imbalance, we employ EEG data augmentation techniques, such as repeating minority classes using variational autoencoders (VAEs), as well as traditional noise-addition methods and hybrid approaches. The power spectrum density (PSD) and temporal data employed in this study's feature extraction from EEG signals were combined, and a support vector machine (SVM) classifier was used to distinguish between three categories of problems. RESULTS: Insufficient data and unbalanced datasets are two common problems in AD datasets. This study has shown that it is possible to generate comparable data using noise addition and VAE, train the model using these data, and, to some extent, overcome the aforementioned issues with an increase in classification accuracy of 2 to 7%. CONCLUSION: In this work, using EEG data, we were able to successfully detect three classes: AD, MCI, and HC. In comparison to the pre-augmentation stage, the accuracy gained in the classification of the three classes increased by 3% when the VAE model added additional data. As a result, it is clear how useful EEG data augmentation methods are for classes with smaller sample numbers.