Objective:Mild cognitive impairment(MCI)is characterized by its heterogeneity in pathology, clinical outcomes, and the degree of cognitive impairment.This study aims to identify distinct subtypes of MCI and examine their associated risk of progression to Alzheimer's disease(AD).Methods:Four cognitive domains—memory, language, attention/executive function, and visuospatial ability—were evaluated using seven neuropsychological tests.K-means cluster analysis was employed to categorize MCI into distinct subtypes.Kaplan-Meier survival analysis and Cox regression were utilized to estimate the median survival time and the risk of progression to AD for each subtype, with cognitively normal(CN)individuals at baseline serving as the control group.Only participants with a minimum of two follow-up visits were included in this analysis.Results:A total of 1, 020 subjects with baseline MCI were included in the study, with an age range of 60 to 90 years and a mean age of 73.6 years.Among these subjects, 40.5% were female, and the mean length of education was 16.0 years.The MCI subtypes were classified based on their characteristics as follows: amnestic(n=485), mixed(n=147), and derived normal(n=388).The mixed subtype performed poorly across all neuropsychological tests, particularly demonstrating significantly worse results than the other two subtypes in attention/executive ability and visuospatial functioning.The amnestic subtype primarily exhibited deficits in the memory cognition dimension, while the derived normal subtype scored poorly on the delayed recall aspect of memory cognition.For the survival analysis, a total of 1, 427 subjects were included, with a mean follow-up duration of 50 months.The proportions of subjects who progressed to AD during follow-up were 48.8% for amnestic MCI, 60.0% for mixed MCI, 16.0% for derived normal MCI, and 6.4% for CN individuals at baseline.The mean time to conversion to AD was 29.1 months for amnestic MCI, 19.6 months for mixed MCI, 53.6 months for derived normal MCI, and 85.9 months for CN subjects.There were statistically significant differences in survival time among the subtypes( P<0.001), with the mixed subtype exhibiting the shortest median survival time and the highest risk of progression to AD( HR=20.0, 95% CI: 13.0-30.8).In contrast, the derived normal subtype had the longest survival time and the lowest risk of progression to AD( HR=2.7, 95% CI: 1.7-4.1). Conclusions:MCI subtypes exhibit significant heterogeneity regarding cognitive impairment, progression risk, and time to AD.Individuals with mixed MCI demonstrate the shortest progression time and the highest risk of transitioning to AD.Consequently, early prevention and intervention strategies for AD should prioritize this particular subgroup.

Objective:Mild cognitive impairment(MCI)is characterized by its heterogeneity in pathology, clinical outcomes, and the degree of cognitive impairment.This study aims to identify distinct subtypes of MCI and examine their associated risk of progression to Alzheimer's disease(AD).Methods:Four cognitive domains—memory, language, attention/executive function, and visuospatial ability—were evaluated using seven neuropsychological tests.K-means cluster analysis was employed to categorize MCI into distinct subtypes.Kaplan-Meier survival analysis and Cox regression were utilized to estimate the median survival time and the risk of progression to AD for each subtype, with cognitively normal(CN)individuals at baseline serving as the control group.Only participants with a minimum of two follow-up visits were included in this analysis.Results:A total of 1, 020 subjects with baseline MCI were included in the study, with an age range of 60 to 90 years and a mean age of 73.6 years.Among these subjects, 40.5% were female, and the mean length of education was 16.0 years.The MCI subtypes were classified based on their characteristics as follows: amnestic(n=485), mixed(n=147), and derived normal(n=388).The mixed subtype performed poorly across all neuropsychological tests, particularly demonstrating significantly worse results than the other two subtypes in attention/executive ability and visuospatial functioning.The amnestic subtype primarily exhibited deficits in the memory cognition dimension, while the derived normal subtype scored poorly on the delayed recall aspect of memory cognition.For the survival analysis, a total of 1, 427 subjects were included, with a mean follow-up duration of 50 months.The proportions of subjects who progressed to AD during follow-up were 48.8% for amnestic MCI, 60.0% for mixed MCI, 16.0% for derived normal MCI, and 6.4% for CN individuals at baseline.The mean time to conversion to AD was 29.1 months for amnestic MCI, 19.6 months for mixed MCI, 53.6 months for derived normal MCI, and 85.9 months for CN subjects.There were statistically significant differences in survival time among the subtypes( P<0.001), with the mixed subtype exhibiting the shortest median survival time and the highest risk of progression to AD( HR=20.0, 95% CI: 13.0-30.8).In contrast, the derived normal subtype had the longest survival time and the lowest risk of progression to AD( HR=2.7, 95% CI: 1.7-4.1). Conclusions:MCI subtypes exhibit significant heterogeneity regarding cognitive impairment, progression risk, and time to AD.Individuals with mixed MCI demonstrate the shortest progression time and the highest risk of transitioning to AD.Consequently, early prevention and intervention strategies for AD should prioritize this particular subgroup.

Mild cognitive impairment(MCI)is a prodromal phase of dementia with heterogeneity in etiology, clinical presentation, disease progression, outcome, and prognosis.The number of studies on MCI subtypes is increasing each year.This article discussed the subtypes of MCI from the perspectives of phenotypic characteristics, etiology, progression, outcome, and data-driven approaches, and further summarizes the epidemiological characteristics, influencing factors, and risk of progression to dementia of each subtype.Despite the increasing number of studies on MCI subtyping, research remains limited on the correlation between MCI subtypes from different perspectives, indicating a need for further investigation in order to achieve more accurate and effective diagnosis and treatment of MCI and obtain evidence for dementia prevention.

Objective To understand the transition of cognitive states among older adults and its influencing factors in order to provide a scientific basis for early intervention of cognitive impairment.Methods Based on ADNI data,subjects aged≥60 years and had at least one follow-up were included in this study.Cognition was divided into(normal cognition,CN),(mild cognitive impairment,MCI)and(Alzheimer's disease,AD).A multi-state Markov model was used to explore the transfer rules among the three cognitive states,and to estimate the effects of age,gender,education level,APOE4 allele and marital status.Results A total of 10073 records of 1907 subjects were included.Among them,the baseline age was 73.9±6.45 years old,and the average follow-up was 6.6 times.The intensity of transition from MCI to AD was 2.88 times of its reversal to CN(0.118 vs.0.041).For CN subjects,the probability of remaining at CN after 10 years decreased by 33.6%compared with that after the first year,while the probability of developing MCI and AD increased by 3 times and 55 times,respectively.For MCI subjects,the probability of staying at MCI after 10 years is only 0.238,while the probability of developing AD is 3.95 times that of its reversal(0.608 vs.0.154).In addition,the average residence time of CN and MCI is 18.43 years and 6.30 years,respectively.Multivariate analysis showed that male,older age,low educational level and carrying APOE4 allele increased the risk of MCI.Conclusion The cognitive function of the elderly showed a downward trend overtime.Older age,low educational level,and carrying APOE4 are risk factors for cognitive decline.

Objective:To explore the developmental trajectory of multimorbidity and its impact on new-onset disability to identify homogeneous groups with similar multimorbidity developmental courses and to provide evidence for interventions for disability risk among middle-aged and older adults in China.Methods:Data was retrospectively collected from China Health and Retirement Longitudinal Study with four consecutive surveys (2011-2018). Group-based trajectory modeling was used to fit multimorbidity developmental trajectories, and the impact of multimorbidity trajectories on new-onset disability was analyzed using the time-dependent Cox regression model.Results:A total of 8 580 participants were included in current analysis, and four multimorbidity trajectories were identified: no multimorbidity ( n=2 136, 24.90%), newly-developing ( n=3 758, 43.80%), moderate-developing ( n=2 270, 26.45%) and severe-developing ( n=416, 4.85%). Participants who belong to moderate-developing and severe-developing tended to be female, single, overweight or obese, live in rural areas, have poorer self-rated health and high levels of annual per capita household expenditure, and developed a new-onset disability. After adjusting for demographic and behavioral covariates, compared to the newly-developing, the severe-developing( HR=3.132, 95% CI:1.884-5.207) had the highest risk of disability, followed by the moderate- developing ( HR=1.400, 95% CI:1.026-1.909) and the risk for the no multimorbidity ( HR=0.631, 95% CI:0.424-0.938) was the lowest. Conclusions:There was great heterogeneity in the developmental trajectory of multimorbidity among middle-aged and older adults in China. Data showed that the risk of disability in the developmental trajectory of multimorbidity increases with increasing levels. We think that the elevating developmental trajectory of multimorbidity is a risk factor for developing disability.

The effects of adverse childhood experiences on adult health has aroused increasing concern in the world in recent years, but limited studies have been conducted in China. This study synthesized the measurement of adverse childhood experiences, the association between adverse childhood experiences and the prevalence common chronic diseases in adulthood and possible mechanisms. It was found that though measurement range of adverse childhood experiences might be different among studies, current used measurement scales basically met the requirement of disease prevention. Most categories of adverse childhood experiences were positively related to risk of common chronic diseases, and the relationship was influenced by social economic status, sex and age. However, people with exposure to famine in childhood had lower prevalence of hypertension compared with those without the exposure. The possible mechanisms might be that the occurrence of adverse childhood experiences might damage physiological functions or increase the adoption of poor healthy behaviors and lifestyles, and finally increased the risk of chronic diseases directly or indirectly. While premature death due to adverse childhood experiences might reverse the association because of nonrandom selection. It is necessary for us to select appropriate indexes of adverse childhood experiences and conduct more studies to prove the association between adverse childhood experiences and prevalence of common chronic diseases in adulthood and explore the related mechanism for the better prevention of chronic diseases in China.

Objective To explore how much impact that the educational level may exert on the Montreal Cognitive Assessment Scale (MoCA) for screening mild cognitive impairment (MCI) among the old people.Methods 3 230 participants aged 60+ years in 6 districts of Xiamen were selected using multi-stage stratified randomized sampling.One-way ANOVA and Scheffe were performed using SPSS 23.0 to compare the MoCA scores among different educational level groups.Binary logistic regression was used to analyze differential item functioning (DIF).If the P＜0.000 3 125 (Bonferroni correction),the corresponding item is considered to have DIF.Results The educational level of the elderly in Xiamen is generally lower,with 39.63％(1 133/2 858) illiterate and 28.04％(801/2 858) educated only at primary school,respectively.MoCA scores of elderly with different educational backgrounds were quite different with statistical significance(x2=413.73,P＜0.01),but Scheffe showed that there was no significant difference in MoCA scores between high school educated and undergraduate.Age,gender and MoCA scores of the elderly were significantly correlated (P＜0.01).The items that had DIF included:trail making test,copy cube,numbers of clock,hands of clock,abstraction 1 and 2,and word 1,2,3,and 5 of delayed recall,adding up to 11 items.The items of trail making test and copy cube only have DIF in the people above junior high school education level,while the 2 items of abstraction dimension only show DIF in the people above senior high school education level.Conclusion Most items of MoCA scale are suitable for screening people with all educational levels except when applying trail making test,copy cube and the 2 items of abstract dimension.

Objective To explore how much impact that the educational level may exert on the Montreal Cognitive Assessment Scale (MoCA) for screening mild cognitive impairment (MCI) among the old people.Methods 3 230 participants aged 60+ years in 6 districts of Xiamen were selected using multi-stage stratified randomized sampling.One-way ANOVA and Scheffe were performed using SPSS 23.0 to compare the MoCA scores among different educational level groups.Binary logistic regression was used to analyze differential item functioning (DIF).If the P＜0.000 3 125 (Bonferroni correction),the corresponding item is considered to have DIF.Results The educational level of the elderly in Xiamen is generally lower,with 39.63％(1 133/2 858) illiterate and 28.04％(801/2 858) educated only at primary school,respectively.MoCA scores of elderly with different educational backgrounds were quite different with statistical significance(x2=413.73,P＜0.01),but Scheffe showed that there was no significant difference in MoCA scores between high school educated and undergraduate.Age,gender and MoCA scores of the elderly were significantly correlated (P＜0.01).The items that had DIF included:trail making test,copy cube,numbers of clock,hands of clock,abstraction 1 and 2,and word 1,2,3,and 5 of delayed recall,adding up to 11 items.The items of trail making test and copy cube only have DIF in the people above junior high school education level,while the 2 items of abstraction dimension only show DIF in the people above senior high school education level.Conclusion Most items of MoCA scale are suitable for screening people with all educational levels except when applying trail making test,copy cube and the 2 items of abstract dimension.

Objective To establish a multi-regression workload model based on surgical related factors.Methods The routine surgery workload was measured by the RBRVS development process of Hsiao WC,and multiple regression models were established for the operative factors from the surgical project specifications,pricing regulations and the operative workload.Results Top workload factors of an operation were technical difficulty,surgical classification and time cost.Multiple regression equation R2=0.699.One degree increase of technical difficulty would push up workload by 0.034;one level of operation grade would raise workload by 0.793;and every one hour longer of the operation time would increase workload by 1.025. Conclusions Operations of higher level, technical difficulty and longer time cost should deserve more reimbursement in consideration of both pricing and income distribution.

Objective: To explore the cognitive functions of the elderly aged 60 years and above in Xiamen, and whether TV watching time would affect those functions. Methods: We conducted a cross-sectional study on 3 230 registered individuals aged 60 years and above in Xiamen from July to October in 2016 with a multi-stage random sampling method. Montreal Cognitive Assessment (MoCA) was used to measure cognitive functions and ordinal logistic regression was used to quantify their associations with TV watching time. Results: A total of 2 944 respondents were included in this study. The overall age of them was (70.14±7.81) years. 51.49% (n=1 516) of all participants were men. Overall, the mean scores of MoCA in general and each subdomain cognitive function were 18.65±6.43 (general), 5.43±1.17 (orientation), 2.33±1.95 (memory), 1.80±1.52 (visuospatial), 1.66±1.20 (executive), 4.54±1.71 (attention), and 4.09±1.64 (language). Compared to those who watched TV no more than 2 hours per day, the elderly who did not watch TV had a worse performance in general, orientation, memory, visuospatial, executive, attention, language function, with OR (95%CI) values about 0.50 (0.35-0.71), 0.52 (0.37-0.73), 0.68 (0.48-0.96), 0.67 (0.47-0.96), 0.48 (0.34-0.67), 0.56 (0.41-0.77) and 0.45 (0.33-0.62), respectively. As to respondents who watched TV more than 2 hours but no more than 4 hours per day, they had a better performance in general, executive, attention, language, and orientation function with respective OR (95%CI) values about 1.24 (1.05-1.47), 1.20 (1.02-1.41), 1.41 (1.19-1.67), 1.51 (1.28-1.77) and 1.33 (1.08-1.64). Conclusion The elderly aged 60 years and above in Xiamen City with TV watching time between 2 and 4 hours per day had a good performance in cognitive functions compared to those with more or less TV watching time.