Objective:To explore the relationship between Metabolic Score of Visceral Fat(METS-VF)and new-onset stroke in Chinese middle-aged and elderly individuals aged ≥45 years.Methods:This study is a prospective cohort study that included 3 311 participants from the China Health and Retirement Longitudinal Study(CHARLS)database, with new-onset stroke as the primary endpoint.The association between METS-VF and new-onset stroke was evaluated by Cox proportional hazards model, subgroup analysis and restricted cubic spline(RCS)analysis.Additionally, mediation analysis was used to assess the mediating effect of remnant cholesterol(RC)on the association between METS-VF and stroke.Results:During the 9-year follow-up period, 138(4.2%)middle-aged and elderly individuals experienced stroke.Compared with the lowest quartile group of METS-VF, the fully adjusted HR and 95% CI of new-onset stroke in the second, third and fourth quartiles were 1.78(1.03-3.08), 1.96(1.12-3.44)and 2.19(1.17-4.10), respectively with a statistically significant trend( P for trend<0.05). Mediation analysis indicated that the indirect effect mediated by RC accounted for 13.51% of the association between METS-VF and new-onset stroke( P=0.03), and RCS analysis revealed a linear dose-response relationship between METS-VF and stroke( P for overall=0.022, P for non-linearity=0.198); The results of the subgroup analyses were consistent with the main analyses( P interaction>0.05). Conclusions:METS-VF may serve as a potential biomarker in risk stratification of stroke, with RC partially mediating this association.

Objective:To analyze the perceptions, attitudes toward cognitive screening and associated factors in Chinese population.Methods:It was a cross-sectional study, a total of 1 246 Chinese residents who used smartphones and completed the cognitive screening survey in the Sojump application from February 22 to March 7, 2024 were consecutively selected as the study subjects. The questionnaire content included demographic data, physical examination information, perceptions of cognitive disorders, perceptions, attitudes and suggestions of cognitive screening. A total of 1 273 questionnaires were distributed, and 1 273 were retrieved, of which 1 246 were valid (97.9%). The logistic regression analysis was used to evaluate factors associated with the attitudes toward cognitive screening in the subjects.Results:Of the 1 246 respondents included in the study, 468 were male and 778 were female, with a mean age of (43.9±13.8) years. The respondents covered 26 provincial-level administrative regions in China, including 347 (27.8%) in the east, 429 (34.4%) in the middle and 470 (37.7%) in the west. While 943 respondents failed to comprehend the cognitive screening, 914 considered it necessary. Additionally, 447 respondents recommended initiating cognitive screening at age 50, 927 respondents recommended annual screening, and 924 respondents preferred scale assessment. Female ( OR=2.121, 95% CI: 1.599-2.815), middle-aged and elderly ( OR=1.681, 95% CI: 1.223-2.310), urban residents ( OR=1.426, 95% CI: 1.002-2.029), high per capita monthly household income ( OR=1.253, 95% CI: 1.063-1.477), had complete physical examination ( OR=1.404, 95% CI: 1.015-1.943), better understanding of cognitive disorders ( OR=2.202, 95% CI: 1.750-2.772), and better understanding of cognitive screening ( OR=3.313, 95% CI: 2.227-4.931) showed positive correlations with the attitude favoring cognitive screening (all P<0.05). Conclusion:The perception levels of cognitive screening among Chinese residents are relatively low, but their attitudes are positive. Socio-economic factors, behavioral experiences, and knowledge levels are associated with residents′ attitudes toward cognitive screening.

Objective To investigate the effects of emergency endovascular treatment on the short-term and long-term prognosis of patients with minor stroke(National Institutes of Health stroke scale[NIHSS]score≤5)caused by posterior circulation large vessel occlusion(LVO).Methods A retrospective analysis was performed on consecutive patients with minor stroke caused by posterior circulation LVO admitted to the Department of Neurology,the First Affiliated Hospital of Xi'an Jiaotong University from July 2019 to March 2024.The patients were divided into the emergency endovascular treatment group and the standard medical treatment group according to the treatment method.Baseline and clinical data were collected from all patients enrolled,including age,sex,smoking history,history of alcohol consumption,medical history(hypertension,diabetes,hyperlipidemia,atrial fibrillation,transient ischemic attack[TIA],blood pressure on admission,stroke history,coronary heart disease),intravenous thrombolysis,tandem lesions,posterior circulation Alberta stroke program early CT score(pc-ASPECTS)on admission,NIHSS score on admission and discharge,time from onset to admission,responsible occluded vessel(basilar artery,left vertebral artery,right vertebral artery),vertebral artery development(left vertebral artery dominant,right vertebral artery dominant,bilateral vertebral artery dominant),non-lesion side vertebral artery development(poor,good,not applicable),basilar artery on CT angiography(BATMAN)score,leptomeningeal branch compensation(open,not open),surgery-related indicators(number of thrombectomy passes[≤2 times,＞2 times],rescue interventions[stent placement,balloon dilation,arterial thrombolysis,intra-arterial tirofiban infusion],immediate postoperative modified thrombolysis in cerebral infarction[mTICI]grade≥2b[successful recanalization],anesthesia method[general,local],endotracheal intubation status[yes,no],duration of mechanical ventilation[not using a ventilator or successfully intubation for≤24 hours and＞24 hours]),in-hospital systematic complications(deep-vein thrombosis,urinary tract infection,lung infection).The primary outcome for short-term prognosis was an excellent outcome(modified Rankin scale[mRS]score of 0-1)within 90 days after onset.Secondary outcomes included a good outcome(mRS score of 0-2)within 90days after onset,recurrent ischemic stroke within 90 days after onset,all-cause mortality within 90 days after onset.Safety outcomes were symptomatic intracerebral hemorrhage(sICH)within 24 hours of treatment(NIHSS score increased by≥4 points or increased level of consciousness score by≥1 point compared with admission,with visible hemorrhagic lesions on follow-up CT scan)and early neurological deterioration(END,NIHSS score increased by≥2 points or motor score increased by≥1 point compared with admission,within 24 hours after treatment).Long-term outcome was defined as recurrent ischemic stroke within 1 year after onset.Short-term and safety outcomes were compared between the emergency endovascular treatment group and the standard medical treatment group.Kaplan-Meier survival curves was used to evaluate the effect of emergency endovascular treatment on the long-term prognosis.Based on the mRS score at 90 days from onset,all patients were divided into an excellent outcome(mRS score 0-1)group and a non-excellent outcome(mRS score 2-6)group.Baseline and clinical data were compared across the two groups.Variables with statistically significant differences were included in the multivariate Logistic regression analysis to investigate the influencing factor of 90-day excellent outcomes in patients with minor stroke caused by posterior circulation LVO.Results A total of 56 patients with minor stroke caused by posterior circulation LVO were enrolled,including 18 patients in the emergency endovascular treatment group and 38 patients in the standard medical treatment group.45 patients achieved excellent outcomes and 11 patients achieved non-excellent outcomes.(1)The emergency endovascular treatment group had lower pc-ASPECTS on admission(8.0[7.0,9.0]points vs.9.0[8.0,10.0]points,P=0.043)and There were no statistically significant differences in the excellent outcome rate,good outcome rate,and ischemic stroke recurrence rate within 90 days after onset between the two groups(all P＞0.05).No all-cause mortality occurred within 90 days after onset in either group.In the emergency endovascular treatment group,one patient developed sICH and one developed END within 24 hours after treatment.(3)No recurrent ischemic stroke in the emergency endovascular treatment group within 1 year after onset,while 3cases(7.89%)of recurrence were observed within 1year after onset in the standard medical treatment group.The Kaplan-Meier survival curve analysis showed that there was no statistically significant difference in the incidence of ischemic stroke within one year after onset between the two groups(P=0.341).(4)There were statistically significant differences between patients with excellent outcome and patients with non excellent outcome in drinking history,diabetes history,NIHSS score after discharge,distribution of responsible occlusive vessels,and distribution of vertebral artery development(all P＜0.05).The results of multivariate Logistic regression analysis showed that the NIHSS score at discharge was an independent influencing factor for excellent outcome at 90 days after onset in patients with minor stroke caused by posterior circulation LVO(OR,0.448,95%CI 0.275-0.728,P=0.001).Conclusions This study shows potential safety and effectiveness of emergency endovascular treatment on patients with minor stroke caused by posterior circulation LVO,but it is not superior to standard medical treatment in terms of short-term and long-term outcomes.Further large-sample randomized controlled trials are warranted to validate the findings of this study.

In October 2014,we conducted a community population-based cohort study on cognitive impairment in two villages in Huyi district of Xi'an.All the village residents aged 40 years and above received a face-to-face questionnaire survey and were followed up every two years for cognitive changes.In this special issue,we used this cohort data to explore the relationships between vascular risk factors and cognitive impairment,investigated the predictive value of plasma biomarkers for cognitive impairment,and the effects of vascular risk factors intervention on cognitive impairment.We believe these are important for comprehensively understanding the risk factors for cognitive impairment and guiding its prevention and treatment.

Objective To explore the relationship between blood pressure at baseline and significant decline in cognitive function after 4 years in middle-aged and elderly people in rural Xi'an,and the potential effect of age on the relationship.Methods Data were collected from a cohort of middle-aged and elderly people with cognitive impairment in rural Xi'an,Shaanxi Province.The cohort consisted of people aged≥40 years from a village in Huyi District,Xi'an.The baseline survey was completed between October 2014 and March 2015,and two follow-up visits were conducted in 2016 and 2018.Blood pressure parameters studied included hypertension and high systolic blood pressure(≥140 mmHg vs.＜140 mmHg),and high diastolic blood pressure(≥90 mmHg vs.＜90 mmHg).The Mini-Mental State Examination(MMSE)was used to assess the whole cognitive function,and the decline of MMSE score ≥4 points in 4 years was defined as significant decline of cognitive function.Multivariate Logistic regression was used to analyze the relationship between blood pressure and cognitive function at baseline.Subgroup analysis was used to study the effect of age(＜65 vs.≥65 years)on the relationship.Results We recruited a total of 1 350 subjects in the analysis,including 235 subjects(17.4％)with baseline age ≥65 years and 533 male subjects(39.5％);671 subjects(49.7％)had hypertension,with systolic blood pressure of(131.71±17.79)mmHg;840 subjects(62.2％)had high systolic blood pressure,with diastolic blood pressure of(82.18±10.56)mmHg;395(29.3％)had high diastolic blood pressure.During the 4-year follow-up,56 cases(4.2％)met the criteria for significant decline of cognitive function.We did not find significant association of hypertension and high systolic blood pressure with cognitive decline in the general population,＜65-year-old subgroup,or ≥ 65-year-old subgroup.The incidence of significant cognitive decline was not statistically significant in the total population(3.6％vs.5.6％,P=0.092),the ≥65-year-old subgroup(7.5％vs.8.2％,P=0.855),the normal diastolic blood pressure group,or the high diastolic blood pressure group.However,in the subgroup＜65 years,the incidence of cognitive decline was higher in the high diastolic blood pressure group than in the normal diastolic blood pressure group(2.7％vs.5.1％,P=0.043).Multivariate analysis showed that high diastolic blood pressure was not found to be associated with significant cognitive decline in the total population(OR=1.744,95％CI:0.953-3.192,P=0.071),the subgroup of ≥65 years old(OR=0.858,95％CI:0.221-3.338,P=0.825),or the subgroup of ≥65 years old.In the＜65 age group,high diastolic blood pressure was significantly associated with cognitive decline(OR=2.051,95％CI:1.005-4.186,P=0.048).Conclusion High diastolic blood pressure is associated with 4-year cognitive decline in people aged 40-65 years,but not in those aged ≥65.No association is found between hypertension or high systolic blood pressure and significant cognitive decline.

Objective By comparing the prevalence and mortality of dementia among rural people in Xi'an in 1997 and 2014 to clarify the epidemiological changes of dementia among rural people in the city over 17 years.Methods In 1997 and 2014,people aged 55 and above in villages in Xi'an were selected by random cluster sampling method,and face-to-face questionnaire survey was conducted by combining centralized and home visits.Dementia and its subtypes were diagnosed by"the three-step method";the changes of dementia prevalence and mortality were compared between the two surveys.Results The prevalence of dementia among rural residents aged 55 and above in Xi'an was 3.49％in 1997,with age-gender standardized prevalence of 2.08％.In 2014,the prevalence of dementia was 4.25％,with age-gender standardized prevalence of 2.78％.Over the 17 years,the prevalence of dementia increased by 1.79 times(OR=1.79,95％CI:1.20-2.65,P=0.004),with a 1.9-fold increase in females and a 1.67-fold increase in males.The mortality of dementia patients was 61.76‰ and age-gender standardized mortality was 60.20‰ in 1997,while the mortality was 35.71‰ and age-gender standardized mortality was 34.18‰ in 2014.The mortality of dementia decreased by 33％over the 17 years(HR=0.33,95％CI:0.15-0.74,P=0.007).Conclusion The prevalence of dementia in rural areas of Xi'an increased significantly over the 17 years,but the mortality rate decreased,and this trend was more obvious in women.

Objective To investigate the relationship between baseline serum lipid levels and cognitive decline after a 4-year follow-up in a cohort of middle-aged and elderly people in rural Xi'an.Methods The data were collected from the cognitive impairment cohort of middle-aged and elderly people in rural areas of Xi'an,Shaanxi Province.The cohort selected the population ≥40 years old in two villages of Huyi District,Xi'an,as the research subjects.The baseline survey was completed from October 2014 to March 2015,and two follow-up visits were conducted in 2016 and 2018.The Mini-Mental State Examination(MMSE)was applied to assess the overall cognitive function.The MMSE score dropping between the 2014 and 2018(△MMSE)≥2 points were defined as cognitive decline.Baseline lipid levels[total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-c),low-density lipoprotein cholesterol(LDL-c)]were converted into three classification data based on 25％quantile and 75％quantile[Q1(≤25％)vs.Q2-Q3(25％-75％)vs.Q4(≥75％)],and using the Q2-Q3 group as the reference group.The relationship between serum lipid levels and cognitive decline at baseline was analyzed by multivariate Logistic regression.Interaction effect analysis and subgroup analysis were made to investigate the interaction effect of age(＜65 years vs.≥65 years)on the relationship between serum lipid and cognitive decline.Results There were 1 349 participants with complete baseline data,and 235(17.42％)were ≥65 years old at baseline;230 cases(17.05％)had cognitive decline.No significant association was found between TC,TG,LDL-c,HDL-c and cognitive decline in subgroups＜65 years of age.In the subgroup ≥65 years of age,the Q1(≤4.37 mmol/L)group of TC was not significantly associated with the risk of cognitive decline compared with the Q2-Q3(4.37-5.61 mmol/L)group of TC,but the Q,(≥5.61 mmol/L)group of TC was significantly associated withan increased risk of cognitive decline(OR=2.519,95％CI:1.217-5.214,P=0.013).Age had an interactive effect on the relationship between the Q4 group of TC and cognitive decline(OR=2.202,95％CI:1.111-4.363,P=0.024).Compared with the Q2-Q3(1.03-2.01 mmol/L)group of TG,the Q,(≤ 1.03 mmol/L)group of TG was associated with a lower risk of cognitive decline(OR=0.318,95％CI:0.120-0.838,P=0.020).Age had an interactive effect on the relationship between the Q1 group of TG and cognitive decline(OR=0.344,95％CI:0.132-0.896,P=0.029).However,there was no significant correlation between the Q4(≥2.01 mmol/L)group of TG and the risk of cognitive decline.Compared with the Q2-Q3(2.70-3.81 mmol/L)group of LDL-c,the Q1(≤ 2.70 mmol/L)group of LDL-c was not significantly associated with the risk of cognitive decline,but the Q4(≥3.81 mmol/L)group of LDL-c had significant association with an increased risk of cognitive decline(OR=2.367,95％CI:1.143-4.900,P=0.020).Age had an interactive effect on the relationship between the Q4 group of LDL-c and cognitive decline(OR=2.237,95％CI:1.134-4.415,P=0.020).No significant association was found between HDL-c and cognitive decline.Conclusion No significant association was found between HDL-c and cognitive decline at baseline.The relationship of TC,TG and LDL-c with cognitive decline was affected by age.Only in participants over 65 years old,the risk of cognitive decline was higher in those with high baseline levels of TC and LDL-c.Those with low baseline serum TG levels had a lower risk of cognitive decline.

Objective To investigate the relationship between type 2 diabetes mellitus(T2DM)and cognitive decline.Methods Data were obtained from the cognitive impairment cohort of middle-aged and elderly population in rural areas of Xi'an City.The cohort consisted of residents aged 40 years and older in two villages of Huyi District,Xi'an.The baseline survey was completed between October 2014 and March 2015,with two follow-up visits in 2016 and 2018.The present study was conducted on cognitively normal people at baseline.Individual characteristics,lifestyle,and medical history were collected;physical and biochemical examinations were completed.According to medical history of T2DM and fasting blood glucose,the study population was divided into non-T2DM group,pre-existing T2DM group,and new-onset T2DM group.The Mini-Mental State Examination(MMSE)was used to assess global cognitive function.Participants with a drop of≥2 points in MMSE score from baseline after 4 years were defined as having cognitive decline.Chi-square test and multivariate Logistic regression analysis were employed to analyze the effect of T2DM status on the risk of cognitive decline.Results A total of 1 350 subjects completed the follow-up.In the follow-up population,1 096(81.2％)were free of T2DM,158(11.7％)already had T2DM at baseline,and 96(7.1％)developed new-onset T2DM during the follow-up.Cognitive decline was observed in 230 individuals after 4 years,representing 17.0％of the study population.The new-onset T2DM group had the highest 4-year incidence of cognitive decline(non-T2DM group vs.pre-existing T2DM group vs.new-onset T2DM group:15.7％vs.20.9％vs.26.0％,P=0.014),and the incidence of cognitive decline in the newly-onset T2DM group was significantly higher than that in the non-T2DM group(P=0.009).Multivariate Logistic regression analysis showed that the new-onset T2DM group had an increased risk of cognitive decline compared with the non-T2DM group within 4 years(OR=1.726,95％CI:1.029-2.896,P=0.039).However,no significant difference in 4-year risk of cognitive decline in the pre-existing T2DM group was observed(OR=1.402,95％CI:0.890-2.210,P=0.145).Conclusion Through the 4-year follow-up study of cognitively normal adults aged 40 and above in rural Xi'an,it was found that new-onset T2DM patients face a significantly elevated risk of cognitive decline,suggesting that cognitive decline may occur in the early stage of T2DM.

Objective To explore the relationship between plasma amyloid-β(Aβ)and cognitive impairment.Methods A total of all villagers(aged 40 years and above)from two villages of Xi'an,China,were enrolled.A validated Chinese version of the Mini-Mental State Examination and neuropsychological battery were used to assess cognition.Levels of fasting plasma Aβ1-42 and Aβ1-40 were tested using commercial enzyme-linked immunosorbent assay(ELISA).Relationship between plasma Aβ and cognitive impairment was analyzed using Logistic regression analysis.Results Of the 1 314 enrolled subjects,1 180(89.80％)had normal cognition,85(6.47％)had suspected cognitive impairment,and 49(3.73％)had probable cognitive impairment.Univariate analysis showed that plasma Aβ1-42/Aβ1-40 ratio was higher in the suspected cognitive impairment group than in the probable cognitive impairment group(P＜0.05)and normal cognitive group(P＜0.05);plasma Aβ1-42 level in the suspected cognitive impairment group was higher than that in normal cognitive group(P＜0.05).The level of Aβ1-40 did not differ between the three groups.After correcting for confounding factors(including age,gender,degree of education,cognitive impairment risk factors,habits of living)in the multivariate Logistic regression analysis,the results were consistent with those in the univariate analysis.Conclusion Levels of plasma Aβ1-42 and Aβ1-42/Aβ1-40 ratio were elevated in patients with suspected cognitive impairment,indicating that elevated plasma Aβ1-42 and Aβ1-42/Aβ1-40 ratio may be more pronounced in early stage of cognitive impairment.They may be early biomarkers for cognitive impairment,which can help identify and intervene the disease earlier.

Objective To investigate the relationship between plasma homocysteine(Hcy)levels and cognitive impairment(CI).Methods From November 2018 to January 2019,baseline data and cognitive function were collected from the participants aged≥40 years who lived in two villages in Huyi District,Xi'an,China.Their global cognitive function was assessed by Mini-Mental State Examination(MMSE)and the diagnosis of cognitive impairment was based on international guidelines.Fasting blood was collected in the morning,and plasma Hcy level was measured by the chemiluminometric assay.Multivariate Logistic regression analysis,subgroup analysis,and interaction analysis were performed to investigate the relationship between plasma Hcy and CI.Results A total of 1 805 subjects were included in the analysis.There were 1 056 females(58.5％),age ranged from 40 to 88 years[mean(58.99±9.52)years],and 145 participants(8.0％)were diagnosed as CI.The median plasma Hcy level in the overall population was 14.1(11.6,17.8)μmol/L.There were 729(40.4％)subjects in the HHcy group(＞15.0 μmol/L)and 1 076(59.6％)in the normal group(≤15.0 μmol/L).Univariate analysis showed that the prevalence of CI was higher in the HHcy group than in the normal Hcy group(11.4％vs.5.8％,P＜0.001).In multivariable Logistic regression fully adjusted for potential confounders,each 1 μmol/L increase in plasma Hcy level was associated with a 3.0％increased risk of CI(OR=1.030,95％CI:1.012-1.048,P=0.001).Interaction analysis indicated that sex,age,BMI,systolic blood pressure,history of stroke,and diabetes did not significantly modify this association.Conclusion Elevated plasma Hcy levels are associated with an increased risk of CI in people aged≥40 years.This indicates that HHcy may be a risk factor for CI.