Neuroimaging determinants of cognitive impairment in the memory clinic: how important is the vascular burden?

While neurodegenerative and vascular neurocognitive disorder (NCD) often co-occur, the contribution of vascular lesions, especially stroke lesions identified on MRI, to global cognition in a real-life memory clinic population remains unclear. The main objective of this retrospective study was to determine NCD neuroimaging correlates: the GM atrophy pattern and vascular lesions (especially stroke lesion localization by voxel-based lesion-symptom mapping, VLSM) in a memory clinic. We included 336 patients with mild or major NCD who underwent cerebral MRI and a neuropsychological assessment. The GM atrophy pattern (obtained by voxel-based morphometry, VBM) and the stroke lesion localization (obtained by VLSM) associated with G5 z-score (a global cognitive score), were included as independent variables with other neuroimaging and clinical indices in a stepwise linear regression model. The mean age was 70.3 years and the mean MMSE score 21.3. On MRI, 75 patients had at least one stroke lesion. The G 5 z-score was associated with GM density in the pattern selected by the VBM analysis (R2 variation = 0.166, p < 0.001) and the presence of a stroke lesion in the region selected by the VSLM analysis (mainly in the right frontal region; R2 variation = 0.018, p = 0.008). The interaction between the two factors was insignificant (p = 0.374). In conclusion, in this first study combining VBM and VLSM analysis in a memory clinic, global cognition was associated with a specific GM atrophy pattern and the presence of a stroke lesion mainly in the right frontal region.

In Individuals With Subjective Cognitive Decline, Age, Memory and Speed Scores at Baseline Predict Progression to Cognitive Impairment.

Some patients with subjective cognitive decline (SCD) progress to neurocognitive disorders (NCD), whereas others remain stable; however, the neuropsychological determinants of this progression have not been identified. Our objective was to examine baseline neuropsychological indicators that could discriminate between stable SCD Versus progression toward an NCD. We retrospectively included patients consulting for SCD at a university medical center's memory center (Amiens, France) who had undergone 3 or more neuropsychological assessments. Among the 80 patients with SCD, 11 had progressed to an NCD. The combination of age, memory, and speed scores at the baseline assessment predicted the progression of SCD with a sensitivity of 91%, and a negative predictive value of 98%. The present results constitute a first step (pending prospective studies) toward helping physicians to identify cases of SCD at risk of progression and, in particular, identifying patients with SCD who will not progress by examining baseline neuropsychological indicators. ClinicalTrials.gov ID: NCT04880252.

The collaborative roles of stakeholders in supporting the adoption of sustainability in SMEs.

There is growing concern among governments around the world about the need to enhance the social and environmental performance of small and medium enterprises (SMEs), seen as key actors in efforts to achieve national sustainability goals. However, despite efforts made to promote their role in this area, SMEs still struggle to integrate social and environmental concerns into their business practices. Barriers that impede the integration of sustainable development in SMEs include a limited awareness of the impacts and benefits associated with sustainability, a lack of time and resources, and a lack of skills and expertise. The aims of this study are to examine the key collaborative roles that a range of stakeholders can play to support sustainability adoption in SMEs and to understand how these roles contribute to overcoming barriers to adoption. Building on thirteen case studies, this study found that stakeholders play five different and complementary collaborative roles in supporting sustainability practices within SMEs, namely that of trainer, analyst, coordinator, specialist, and financial provider. The study shows that these five roles can be performed by a wide range of local stakeholders and can contribute to overcoming different barriers to the integration of sustainability practices within SMEs. These findings demonstrate that one key way for governments to improve the sustainability performance of SMEs may be to facilitate and shape the development of stakeholder networks capable of performing these five critical roles as part of efforts to promote sustainability adoption within firms.