Objective To investigate the clinical efficacy of sequential acupuncture in treating post-stroke dysphagia. Methods One hundred and ten patients with post-stroke dysphagia were randomly allocated to treatment and control groups, 55 cases each. The control group received routine medication and the treatment group, “cortex-pharynx-tongue root” sequential acupuncture in addition. The pre-/post-treatment difference in the Kubota’s water drinking test score was observed in the two groups and the clinical therapeutic effects were compared between the two groups after 14 days of treatment.Results There was a statistically significant pre-/post-treatment difference in the Kubota’s water drinking test score in the two groups (P<0.01,P<0.05). There was a statistically significant post-treatment differences in the Kubota’s water drinking test score between the treatment and control groups (P<0.05). The total efficacy rate was 89.1% in the treatment group and 67.3% in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusion Sequential acupuncture is an effective way to treat post-stroke dysphagia.

Objective To compare if the Montreal cognitive assessment (MoCA) performed in the morning or afternoon would affect abnormal rate of cognitive function in the elderly with stroke.Methods A total of 378 senile patients (≥ 65 years) with acute ischemic stroke and low NIHSS score (≤ 3) were enrolled in the prospective study,which was held in the Department of Neurology at Cangzhou Hospital of Integrated Traditional Chinese Medicine.MoCA was assessed after one month of hospitalization.Based on the time of MoCA assessment,all patients were randomly divided into the group A (assessed in the morning,9 am-12 am) and the group B (assessed in the afternoon,12 am to 5 pm).Clinical data were collected,and RANKIN scale (mRS) examination was performed.Moreover,patients were further divided into severe cognitive impairment (SCI) subgroup (score ＜ 20),mild cognitive impairment (MCI) subgroup (score 20-25) and no cognitive impairment (NCI) subgroup (score ＞ 26) according to the MoCA score.Results There were 189 patients in the group A (50％),and 189 cases in the group B (50％).There was no significant difference in age,gender,education level,disability (mRS score ＜ 1),history of hypertension,diabetes,hyperlipidemia,smoking and atrial fibrillation between the two groups.Based on the MoCA score,211 cases had NCI,142 had MCI,and 25 had SCI.Compared with patients in group B,patients in group A was associated with significantly higher positive rate of SCI[12.2％ (23/189)vs.1.1％ (2/189),P=0.000],MCI[40.2％ (76/189)vs.34.9％ (66/189),P=0.013]and slightly higher positive rate of NCI[56.6％ (107/189)vs.55.0％ (104/189),P=0.214].Conclusions The test time of MoCA may have an effect on the cognitive function detection rate in elderly patients with stroke,and the time of MoCA examination should be considered in clinical examination.

Mild cognitive impairment (MCI), as a nosological entity referring to elderly people with MCI but without dementia, was proposed as a warning signal of dementia occurrence and a novel therapeutic target. MCI clinical criteria and diagnostic procedure from the MCI Working Group of the European Alzheimer's Disease Consortium (EADC) may better reflect the heterogeneity of MCI syndrome. Beijing United Study Group on MCI funded by the Capital Foundation of Medical Developments (CFMD) proposed the guiding principles of clinical research on MCI. The diagnostic methods include clinical, neuropsychological, functional, neuroimaging and genetic measures. The diagnostic procedure includes three stages. Firstly, MCI syndrome must be defined, which should correspond to: (1) cognitive complaints coming from the patients or their families; (2) reporting of a relative decline in cognitive functioning during the past year by the patient or informant; (3) cognitive disorders evidenced by clinical evaluation; (4) activities of daily living preserved and complex instrumental functions either intact or minimally impaired; and (5) absence of dementia. Secondly, subtypes of MCI have to be recognized as amnestic MCI (aMCI), single non-memory MCI (snmMCI) and multiple-domains MCI (mdMCI). Finally, the subtype causes could be identified commonly as Alzheimer disease (AD), vascular dementia (VaD), and other degenerative diseases such as frontal-temporal dementia (FTD), Lewy body disease (LBD), semantic dementia (SM), as well as trauma, infection, toxicity and nutrition deficiency. The recommended special tests include serum vitamin B12 and folic acid, plasma insulin, insulin-degrading enzyme, Abeta40, Abeta42, inflammatory factors. Computed tomography (or preferentially magnetic resonance imaging, when available) is mandatory. As measurable therapeutic outcomes, the primary outcome should be the probability of progression to dementia, the secondary outcomes should be cognition and function, and the supplement outcome should be the syndrome defined by traditional Chinese medicine. And for APOE epsilon4 carrier, influence of the carrier status on progression rate to dementia and the effect of treatment should be evaluated.

In order to provide the "guiding principles of clinical research on mild cognitive impairment (MCI) (protocol)" edited by Beijing United Study Group on MCI of the Capital Foundation of Medical Developments (CFMD) with evidence support, clinical criteria, subtypes, inclusion and exclusion of MCI, and use of rating scales were reviewed. The authors suggested that MCI clinical criteria and new diagnosis procedure from the MCI Working Group of the European Alzheimer's disease Consortium (EADC) may better reflect the heterogeneity of MCI syndrome. Diagnostic rating scales including Clinical Dementia Rating (CDR), Global Deterioration Scale (GDS), Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and Instrumental Activities of Daily Living (IADL) are very useful in definition of MCI but can not replace its clinical criteria. Absence of major repercussions on daily life in patients with MCI was emphasized, but the patients may have minimal impairment in complex IADL. According to their previous research, the authors concluded that highly recommendable neuropsychological scales with cut-off scores in the screening of MCI cases should include Mini-Mental State Examination (MMSE), logistic memory test such as Delayed Story Recall (DSR), executive function test such as Clock Draw Test (CDT), language test such as Verbal Category Fluency Test (VCFT), etc. And finally, the detection of biological and neuroimaging changes, including atrophy in hippocampus or medial temporal lobe in patients with MCI, was introduced.