Objective To investigate the effect of intranasal instillation of insulin with different doses on cognitive function in patients with Alzheimer disease (AD).Methods Sixty-three AD patients were collectcd.According to the order of doctor's office visiting,they were divided into insulin 1 group (21 cases,intranasal instillation of insulin 20 U,2 times per day),insulin 2 group (21 cases,intranasal instillation of insulin 40 U,2 times per day) and placebo group (21 cases,intranasal instillation of physiological saline,2 times per day).Mini-mental state examination scale (MMSE) and Rivermead behavioural memory test second edition (RBMT Ⅱ) were used to evaluate the improvement of cognitive function after 3 months and 6 months.Results Before treatment,the scores of MMSE and RBMT Ⅱ in insulin 1 group were (20.2 ± 2.3) and (17.2 ± 1.9) scores,in insulin 2 group were (20.7 ± 2.8) and (16.5 ± 1.9) scores.After treatment for 3 months,the scores of MMSE and RBMT Ⅱ in insulin 1 group were (21.8 ± 3.2) and (19.2 ± 2.0) scores,in insulin 2 group were (21.6 ± 3.5) and (18.1 ± 2.0) scores.The scores of MMSE and RBMT Ⅱ in insulin 1 group and insulin 2 group significantly improved compared with those before treatment (P ＜ 0.05 or ＜ 0.01).But the scores of MMSE and RBMT Ⅱ in placebo group were significantly aggravated,(18.9 ± 3.8) scores vs.(20.9 ± 2.5) scores,(15.2 ± 2.1) scores vs.(16.1 ± 2.0) scores,P ＜ 0.05.After treatment for 6 months,the scores of MMSE and RBMT Ⅱ in insulin 1 group were (22.5 ± 3.3) and (20.5 ± 2.0) scores,in insulin 2 group were (22.7 ± 3.1) and(19.8 ± 1.9) scores,and in placebo group were (17.9 ± 4.5) and(14.7 ± 2.0) scores.The scores of MMSE and RBMT Ⅱ in insulin 1 group and insulin 2 group were significantly better than those in placebo group (P ＜ 0.01).Conclusion Intranasal instillation of insulin can improve cognitive disorders in patients with AD.

Helicobacter pylori infection is one of the most common infections in humans.At present, the correlation between Helicobacter pylori infection and ischemic stroke is still controversial. This article reviews the correlation between Helicobacter pylori infection and vascular risk factors and ischemic stroke in recent years.

Objective To investigate the correlation between 24 h ambulatory blood pressure monitoring (ABPM) parameters and white matter hyperintensities (WMHs).Methods A cross-sectional analysis was performed in patients who visited the Department of Neurology,Liaoning People's Hospital,and showed WMHs on the head MRI and completed 24 h ABPM in the same period of hospitalization from September 2016 to October 2018.Periventricular white matter hyperintensities (PVWMHs) and deep white matter hyperintensities (DWMHs) were evaluated using the modified Scheltens scale respectively,and the sum of the two was used as the overall severity score of WMHs.The enrolled patients were grouped according to the tertiles of the overall WMH score.Multivariate ordinal logistic regression analysis was used to investigate independent risk factors affecting overall WMH scores.Multivariate linear regression analysis was used to investigate the influencing factors of PVWMH and DWMH scores.Results A total of 201 patients were enrolled,aged (62.7 ± 10.3) years (range 45-88 years),82 males (40.8％),and 123 patients (61.2％) with hypertension.The total WMH scores were 1-27.According to the tertiles,64 patients (31.8％) were divided into lower tertile group (1-3),65 (32.3％) in the middle tertile group (4-8),and 72 (35.8％) in the higher tertile group (9-27).There was significant difference in age between any two WMH score groups,namely,the high tertile group ＞ middle tertile group ＞ low tertile group (69.5 ± 8.5 years vs.63.1 ±9.2 years vs.54.5 ±6.9 years;all P＜0.001).The proportion of hypertension in the middle tertile group (66.2％) and the higher tertile group (69.4％) were significantly higher than those in the lower tertile group (46.9％;all P＜0.05).The homocysteine in the higher tertile group was significantly higher than that in the lower tertile group (15.6 [12.7-19.7]μmol/Lvs.14.1[12.5-15.9]μmol/L;P ＜0.05).In terms of 24 h ABPM parameters,the 24 h mean systolic blood pressure (24 h SBP) in the higher tertile group was higher than that in the lower tertile group,and the nighttime mean systolic blood pressure (nSBP) level in the higher tertile group was higher than that in the lower and middle tertile groups,the SD of daytime systolic blood pressure (dSBPSD) and the SD of the nighttime systolic blood pressure (nSBPSD) in the higher tertile group were higher than those in the lower tertile group,and dSBPSD of the middle tertile group was higher than of the lower tertile group.The above differences were statistically significant (all P ＜0.05).Multivariate ordinal logistic regression analysis showed that the increased age (odds ratio[OR] 1.143,95％ confidence interval[CI] 1.104-1.185;P＜0.001),24 h SBP (OR 1.026,95％ CI 1.005-1.048;P =0.015),dSBP (OR 1.022,95％ CI 1.001-1.043;P =0.036),nSBP (OR 1.026,95％ CI 1.006-1.046;P=0.011),dSBPSD (OR 1.119,95％ CI 1.023-1.221;P=0.013),and nSBPSD (OR 1.107,95％ CI 1.022-1.200;P=0.013) were independently positively correlated with the overall WMH score.Multivariate linear regression showed that age (β=0.607,95％ CI 0.500-0.714;P＜0.001),24 h SBP (β=0.182,95％ CI 0.075-0.289;P=0.001),dSBP (β=0.156,95％ CI 0.049-0.264;P=0.004),and nSBP (β =0.200,95％ CI 0.092-0.307;P ＜0.001) were independently positively correlated with the PVWMH score;age (β =0.505,95％ CI 0.387-0.622;P ＜0.001),24 h SBP (β =0.132,95％ CI 0.015-0.248;P =0.027),dSBP (β =0.127,95％ CI0.011-0.243;P =0.032),nSBP (β =0.148,95％ CI 0.031-0.265;P =0.013),and nSBPSD (β =0.133,95％ CI 0.016-0.250;P=0.027) were independently positively correhted with the DWMH score.Conclusion The increased age,ambulatory systolic blood pressure level (24 h,daytime,nighttime) and systolic blood pressure variability level (dSBPSD and nSBPSD) were independently associated with the severity of WMHs.

Large artery atherosclerosis and the vascular stenosis caused by it are the important causes of ischemic stroke. Cerebral microbleeds are an imaging manifestation of cerebral small vessel disease. Intracranial large blood vessels and small blood vessels are structurally continuous, simultaneously affected by hemodynamics, and exposed to overlapping risk factors, so both of them may coexist in the same organism. This article reviews the research progress of the relationship between large artery atherosclerosis and cerebral microbleeds in recent years.

Vertebral artery hypoplasia (VAH) may lead to the morphological and hemodynamic changes of the vessels themselves and their adjacent vessels,and may lead to posterior circulation ischemia.Hemodynamic detection is an important means to evaluate the structure and functional status of blood vessels.The combined use of color Doppler flow imaging and transcranial Doppler can not only comprehensively evaluate the morphological and hemodynamic changes of the vertebral basilar artery system,but also comprehensively analyze the significance of the hemodynamic changes of cerebral artery.

Atrial fibrillation is a common clinical type of arrhythmia, which can significantly increase the risk of stroke, and its incidence increases with age. Cerebral small vessel disease refers to a series of clinical, imaging and pathological syndromes caused by various etiologies affecting the small arteries, arterioles, capillaries, venules, and small veins in the brain. Some studies in recent years have shown that there is a certain link between atrial fibrillation and cerebrovascular disease. This article reviews the relationship between atrial fibrillation and cerebrovascular disease.