Objective To explore the effectiveness and safety of deep brain magnetic stimulation technique (dTMS) for treatment of Alzheimer's disease (AD).Methods Totally 116 patients with AD were randomly divided into 4 groups:(1) dTMS:given dTMS really stimulation therapy,(2)medication group:treatment with donepezil 5 mg/d,(3) combination treatment group:given dTMS and donepezil therapy,(4) blank control group:given pseudorandom stimulation treatment.33 healthy control cases were given dTMS's stimulation treatment.The treatment course was 6 months.Application of mini mental state examination scale (MMSE),the Montreal cognitive assessment scale (MoCA),Hamilton Depression Scale (HAMD),ischemic scale (HIS),Boston naming test,activity of daily living(ADL) and neuropsychological questionnaire (NPI) were used to evaluate the cognitive function.All the participants received blood tests and ECG in order to evaluate the safety of dTMS.Results After 6 months treatment,compair with the blank control group,all scale scoresof dTMS group,medication group and combined treatment group were improved significantly in MMSE (t=2.49,2.46,2.20),MoCA(t=2.59,2.39,2.87),ADL(t=2.35,2.17,2.83),NPI(t=3.05,2.40,2.65) and sub-cognitive scale score (all P＜0.05).All scale scores of combination treatment group were better than dTMS group and medication group (P＜0.05).There's no significant difference between drug treatment groups and dTMS group (P＞0.05).After 6 months treatment,compared with healthy control group,the scale scores were aggravated in 4 groups of AD (P＜0.05)Conclusions dTMS can be effective and safe in the treatment of AD patients with cognitive and noncognitive symptoms.

Objective To explore patients' recognition and demand for enhanced-CT examination-related knowledge. Method A self-designed questionnaire was used to investigate the recognition and demands for the knowledge among 295 patients who receiving enhanced-CT examination for the first time. Results The awareness rate of enhanced-CT examination related knowledge was 19.0%~51.5%and the demand rate was 62.4%~87.1%. The routes by which the patients acquired the knowledge included lecturing by medical staff personnel, reading the handouts and watching video. Conclusions The level of patients'recognition about the enhanced-CT examination related knowledge is low, but their demands for it is high. Therefore, the medical personnel should improve patients'awareness of enhanced-CT examination related knowledge in various ways.

Objective To investigate the diagnostic significance of the difference values between Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)in elderly patients with dementia.Methods 331 elderly patients with dementia were collected from outpatients in our hospital.There were 148 people with Alzheimer's disease (AD),87 cases with vascular dementia (VaD),44 cases with mixed dementia (MD),41 cases with frontotemporal dementia (FTD) and 11 cases with dementia with Lewy bodies (DLB).MMSE and MoCA were applied to test the cognitive impairment separately.Results The difference values between MMSE and MoCA was (3.3±1.7) points,(6.6±2.1) points,(6.6±2.1) points,(5.4±2.3) points,(6.1 ± 1.9) points in AD,VaD,MD,FTD and DLB group respectively,and there were statistical differences among the five groups (F=46.420,P=0.000).Statistical differences were found in the difference values between MMSE and MoCA between dementia patients with AD and non-AD (t=-13.429,P=0.000).According to receiver operating characteristic curve (ROC curve),the optimal cut off point of the difference values between MMSE and MoCA for differential diagnosis between AD and non-AD dementia was 5 points,with 79.8％ sensitivity and 78.4％ specificity,and area under the curve was 0.848 (95％CI:0.807-0.890).Conclusions The difference values between MMSE and MoCA may be one of parameters for differential diagnosis between AD and non-AD dementia.

Objective To study the effect of the quality control circle in reducing not using needed security signs of emergency nursing. Methods A panel for quality control circle was set up to implement quality control circle activities in order to promote the use of drug signs, anti-accident signs, hospital infection signs and nursing security signs. The un-qualified rate of the sign uses were compared between pre-and post-implication of quality control circle. Result The un-qaulified rate of drug sign uses was significantly decreased after the implementation (P<0.01). Conclusion The quality control circle can be effective for improving the rate of using nursing signs and thus enhancing nursing quality.

Objective To explore the clinical utility of arterial spin-labeling (ASL) magnetic resonance(MR)imaging for the detection of cerebral blood flow (CBF) abnormalities in patients with Alzheimer disease(AD). Methods Twenty-two subjects with probable AD and twenty normal control subjects underwent ASL and structural MR imaging. Among them, 16 AD patients and 11 control subjects were also examined with single photon emission computed tomography(SPECT). The CBF images were obtained by processing ASL perfusion data. The CBF values of bilateral frontal lobe, temporal lobe, temporoparietal junction, parietal lobe, occipital cortices and hippocampal areas were measured by CBF images. And the CBF values of cerebral structures between AD and control subjects were compared. Results ASL perfusion imaging in AD revealed marked hypoperfusion mainly in temporal lobe (72.7%), temporoparietal junction (54.5%), parietal lobe(45.5%). The brain regions involved were similar to those seen with SPECT. The CBF values of bilateral frontal lobe, temporal lobe, temporoparietal junction, parietal lobe and hippocampal areas were significantly decreased compared with control subjects (all P<0.05). The CBF values of right frontal lobe, left temporoparietal junction, left parietal lobe in patients with AD were positively correlated with the mini-mental state examination score (r= 0.49, 0.54, 0.64, all P<0.05). Conclusions ASL MR imaging can show regional hypoperfusion in AD patients, which is similar to that seen with SPECT. The results suggest ASL MR imaging is an useful tool for assessment of cerebral blood flow in patients with AD.

Objective:To investigate the clinical phenotypes, imaging features and pathogenic variants of POLR3B gene related autosomal recessive cerebellar ataxia with hypogonadism.Methods:A female proband from a Chinese non-consanguineous family was admitted to Department of Neurology, China-Japan Friendship Hospital in March 2016, performed detailed physical and auxiliary examinations and excluded acquired causes of cerebellar ataxia. Genomic DNA was extracted from peripheral blood of the proband and conducted whole exome sequencing (WES) and verified in her asymptomatic parents. Potential pathogenic variants were validated by Sanger sequencing.Results:The proband exhibited progressive unsteady walk, cognitive impairment, dysarthria and dysphagia, dystonia, congenital cataract, hypogonadism as well as delayed puberty, amenorrhea and short stature and was effectively treated by hormone therapy. Magnetic resonance imaging of her brain showed diffused hypomyelination of white matter, relatively sparing the thalamus, globus pallidus, and optic radiations, as well as cerebellar atrophy and thin corpus callosum. X ray of her chest revealed thoraco-lumbar scoliosis. WES identified compound heterozygous mutations c.479A>C (p. E160A) and c.2657G>C (p.R886T) of POLR3B gene in this patient, and they were novel mutations, which were respectively inherited from her father and mother validated by Sanger sequencing. Bioinformatic analysis predicted these two mutations were pathogenic.Conclusion:The clinical and imaging features of POLR3B-associated leukodystrophy with hypogonadism were considerably evident, diagnosis and treatment of which should be conducted as early as possible.

Objective:To investigate the clinical phenotypes, imaging features and pathogenic variants of ANO10 gene related autosomal recessive spinocerebellar ataxia-10 (SCAR10).Methods:A cohort of 30 probands of autosomal recessive cerebellar ataxia pedigrees from China-Japan Friendship Hospital from 2018 to 2020 were collected. Friedreich ataxia and other causes of acquired ataxia were excluded, then probands were detected by whole-exome sequencing (WES), and potential pathogenic variants were confirmed by Sanger sequencing and validated in all family members. Clinical phenotypes and auxiliary examinations of the patients were analyzed in detail.Results:A pedigree of SCAR10 caused by ANO10 gene mutations was identified through WES. The 40-year-old male proband of this pedigree carried compound heterozygous mutations: c.1219-2A>C and c.1163-2A>G of the ANO10 gene, both of which were novel mutations, and Sanger sequencing revealed these two mutations were respectively inherited from his healthy parents. Bioinformatic analysis predicted these two mutations were pathogenic. The proband exhibited progressive unsteady walk, dysarthria, mild cognitive impairment. His plasma total coenzyme Q 10 was decreased (0.76 μg/ml). Brain magnetic resonance imaging showed remarkable cerebellar atrophy. Conclusions:Through WES, a SCAR10 patient caused by novel compound heterozygous mutations of ANO10 gene was identified, which is rare in China. The main clinical manifestation was progressive cerebellar ataxia and cognitive decline, and brain image showed remarkable cerebellar atrophy.

Objective To evaluate the clinical efficacy and safety of akatinol memantine in the treatment of Alzheimer's disease (AD).Methods Two hundred and forty-one patients with AD were randomly assigned to receive 10 mg of donepezil daily or 20 mg of memantine daily for 24 weeks.The primary efficacy variables were the Clinician' s Interview-Based Impression of Change Plus (CIBIC-Plus),the Alzheimer Disease Assessment Scale-cognition (ADAS-cog) and the Activities of Daily Living (ADL).The secondary efficacy variables were the Neuropsychiatric Inventory (NPI) and the Mini-Mental Status Examination (MMSE).Results Two hundred and seven patients completed the study and were evaluated at week 24.Both memantine and donepezil had significant efficacies at the end point, according to the ADAS-cog, the ADL, the NPI and the MMSE.Patients receiving memantine had a similar outcome as those receiving donepezil, according to the results of all the variables changes (CIBIC-Plus: memantine 3.4±0.8vs donepezil 3.5±0.8; ADAS-cog: memantine-4.7±5.8 vs donepezil-4.6±6.5; ADL: memantine -2.4±6.7 vs donepezil-2.2±5.3 ; NP1: memantine-5.8±9.0 vs donepezil-3.1±8.5 ; MMSE:memantine 1.7±3.1 vs donepezil 1.8±2.8, all P >0.05).The adverse events were as following: donepezil group 41.88% and memanintine group 30.58%.Conclusion The memantine as a new drug for AD, has the similar efficacy as donepezil, and it is safe.

Objective:To analyze the characteristics of the apolipoprotein E(Apo E)genotype and cognitive impairment in patients with cerebral microbleeds(CMBs)and positive β-amyloid(Aβ)by using [18F]-AV45 positron emission tomography(PET).Methods:From September 2015 to May 2018, 152 patients with cognitive impairment and CMBs on the susceptibility-weighted imaging(SWI)sequence of head MRI at the neurology department of our hospital, assessed by mini-mental status examination(MMSE)score ≤26 and Montreal cognitive assessment(MoCA)≤25, were consecutively recruited in this retrospective study.After assessment with the inclusion and exclusion criteria, 69 patients aged 68.8±9.3 years were considered eligible for further analysis.Patients were divided into the Aβ-positive group(Aβ + Group, n=37)and the Aβ-negative group(Aβ -Group, n=32)after cognitive assessment, ApoE genotyping and [18F]-AV45 PET examination.Twenty-one healthy elderly controls(HC Group)who took health examination during the same period were enrolled.The results of cognitive assessment and Apo E genotyping were compared between the three groups. Results:The positive rate of the ApoE ε4 allele was 35.6%(32/90), 56.8%(21/37), 18.8%(6/32), and 23.9%(5/21)in the Aβ + , Aβ -and HC groups, respectively, with statistical significant differences between the groups( χ2=12.467, P<0.01). There were significant differences in the positive rate of the ApoE ε4 allele between the Aβ + and HC groups and between the Aβ + and Aβ -groups( χ2=5.880 and 10.407, P<0.05 and P<0.01). The percentage of patients with deep cerebral microbleeds was higher(56.3% or 18/32 vs.8.1% or 3/37, χ2=18.784, P<0.01)and of patients with lobar hemorrhage was lower(12.5% or 4/32 vs.45.9% or 17/37, χ2=9.066, P<0.01)in the Aβ -group than in the Aβ + group, while there was no significant difference in the percentage of patients with mixed cerebral microbleeds between the Aβ -and Aβ + groups( χ2=1.556, P>0.05). There were significant differences in cognitive function between the Aβ + and HC groups, in memory, executive function, visuospatial ability and language between the Aβ + and Aβ -groups, and in executive function, visuospatial ability and attention between the Aβ -and HC groups. Conclusions:Cognitive impairment is more extensive and severe in CMBs patients with Aβ deposition and is associated with positive ApoE ε4.

Objective To investigate and compare the language features among patients with behavioral variant frontotemporal dementia(bv-FTD),Alzheimer's disease(AD) and healthy controls,and to determine the clinical value of language tests in the diagnosis and differential diagnosis of the two kinds of dementia diseases.Methods A total of 17 bv-FTD patients,18 AD patients and 18 healthy controls were enrolled in Beijing hospital from Nov.2012 to Dec.2013.The language performances in four aspects of listening,speaking,reading and writing by seven items of listening comprehension,repetition,naming,speaking,read aloud,reading comprehension and writing were compared by using the one-way analysis of variance(ANOVA)and least significant difference(LSD)tests.Results There were significant differences among the three groups in speaking general scores (AD 128± 46,bv-FTD 113 ± 19,controls 158 ± 13) (F =23.34,P =0.049) and in writing (AD 8 ± 5,bv-FTD 8 ± 4,controls 11 ± 1) (F =27.07,P =0.000).A t rend of statistical difference was observed in general scores of listening comprehension(F =20.96,P =0.060).No difference was found in general scores of repetition,in naming,in reading aloud and in reading comprehension(all P ＞ 0.05).As compared with controls,bv-FTD patients were comprehensively impaired in sub-items of listening comprehension,in naming and in speaking(all P ＜0.05).As compared with controls,AD patients were significantly impaired in a few sub-items of listening comprehension,in naming and in speaking(P ＜0.05).There were significant differences in naming objects,grammar and word finding between AD patients and bv-FTD patients(51± 19 vs.47±13,6±1 vs.6±1,6±1 vs.6±1,P=0.037,0.010 and 0.021,respectively).Conclusions The detailed language examinations are helpful for screening AD and bv-FTD.However,the values are limited in the differential diagnosis between the two types of dementia diseases.It is necessary to combine the detailed language examinations with other tests.