Objective To investigate the clinical validity of the Chinese version of John Hopkins Adapted Cognitive Exam (ACE) for in-patients in neurological intensive care unit (NICU). Methods From May, 2014 to June, 2015, 94 inpatients in NICU and 52 healthy persons were assessed with the Chinese version of ACE and Mini-Mental State Examination (MMSE). Results The total score of ACE correlated with the total score of MMSE (r=0.805, P<0.001). There was a significant difference in the total score and the scores of the subtests of both the ACE and MMSE between the patients and the controls (t>2.458, P<0.05). The area under the receiver operating curve was not different between ACE and MMSE (Z=0.707, P=0.480). Conclusion The Chinese version of ACE can be the tool for assessment of cognition for pa-tients in NICU.

Objective To investigate the effects of Working Memory Training System on working memory impairment after brain injury. Methods From November, 2013 to March, 2015, 20 patients of brain injury with impairment of working memory were divided into training group (n=10) and control group (n=10). The training group was trained with the Working Memory Training System for four weeks, while the control group did not accept any cognitive rehabilitation. They were tested with digital forwards/backwards, space forwards/backwards, n-back test and Everyday Memory Questionnaire before and after training. Results All of the tests improved more in the training group than in the control group (Z>2.014, P<0.05), except that of digital forwards, as well as the score of Everyday Memory Questionnaire (Z=1.970, P=0.049). Conclusion Application of Working Memory Training System can improve the ability of memory in patients with brain injury, both the working memory and everyday memory.

Objective To investigate the clinical efficacy of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery for patients at the early stage of traumatic brain injury (TBI). Methods 72 patients with TBI hospitalized from January, 2013 to October, 2014 and 30 healthy controls matched gender, age and educational background were assessed with the Chinese version of LOTCA battery and Mini-Mental State Examination (MMSE) respectively. Results The score of MMSE and LOTCA were correlated (r=0.56, P<0.01). Compared with the controls, the scores of all the subtests of LOTCA decreased (P<0.01) in the patients, especially the orientation, visuomo-tor organization and thinking operation;with the more incidence of medium and serious dysfunction of all the subtests of LOTCA except perception (P<0.01), in which thinking operation was the most and attention was the least. The area under the receiver operating curve (ROC) was (0.84±0.04) in LOTCA, less than that of (0.91±0.03) in MMSE (P<0.05). Conclusion Cognition is widely impaired in patients after TBI, most involved thinking operation. LOTCA is less effective to identify cognitive dysfunction than MMSE, and can be used as an al-ternation or a supplement.

Objective To test the reliability and validity of the Chinese version of the John Hopkins Adapted Cognitive Exam ( ACE) in NICU patients. Methods The English ACE was translated and adapted into the Chinese version . Cognitive functions of 40 critically ill patients in NICU were assessed with the Chi?nese version of ACE and MMSE battery.The scores of ACE and MMSE were analyzed to test the content va?lidity,construct validity,concurrent validity,internal consistency,inter?rater reliability and test?retest reliabil?ity.Result The correlation coefficient between each factor and the total score ranged from 0.617 to 0.938, and the content validity was good.The ACE was significantly correlated with MMSE( r=0.822, P<0.05). Five factors were extracted by main principle analysis, the cumulative contribution was 85. 90%, the factor loading of each item was all over 0.5,the scale had good construct validity.There existed a good internal con?sistency ( Cronbach’ α=0.756 ) as well as a good inter?rater reliability ( ICC>0.95) and test?retest reliabil?ity (ICC=0.652?0.979) of the Chinese version of ACE.Conclusions The Chinese version of ACE has been proved to be a reliable and valid screening tool for cognitive impairment in NICU patients.

Objective To study the clinical efficacy and safety of iguratimod in the treatment of active rheumatoid arthritis. Methods Ninety patients with rheumatoid arthritis were randomly divided into three groups, with 30 cases in each group. Group A: oral administration of iguratimod, 25 mg two times a day, and oral administration of methotrexate, 10 mg once a week. Group B:oral administration of iguratimod, 25 mg two times a ady. Group C: oral administration of methotrexate, 15 mg once a week. According to the American College of Rheumatology criteria for judging 20%, 50%and 70%(ACR20, ACR 50 and ACR 70) improvement of swollen and tender joint was judged according to the American College Of Rheumatology criteria, and the adverse reactions were observed. Results After the treatment in group A and group B ACR20, ACR50 and ACR70 were higher than those in group C [76.67%(23/30) and 60.00% (18/30) than 40.00% (12/30), 50.00% (15/30) and 33.33% (10/30) than 20.00% (6/30), 23.33%(7/30) and 13.33%(4/30) than 6.67%(2/30)], and in group A was higher than that in group B. The differences were statistically significant (P<0.05). The adverse reaction rate in group A and group B was significantly lower than that in group C:16.67%(5/30) and 13.33%(4/30) than 30.00%(9/30), and the difference was statistically significant (P<0.05); the adverse reaction occurred rate in group A and group B, had no significant difference (P>0.05). Conclusions Monotherapy with iguratimod in the treatment of active rheumatoid arthritis is superior to methotrexate, and has fewer side effects. The combined application of the two drugs is more effective, and can reduce the dose of methotrexate and reduce the incidence of side effects, which is worthy of clinical application.

Objective To evaluate the Montreal cognitive assessment (MoCA) for detecting the mild cognitive impairment (MCI) in brain trauma patients with normal mini-mental state examination (MMSE) scores.Methods Fifty brain trauma patients with normal MMSE scores hospitalized from January 2013 to June 2014 were subjected to the MoCA test.The patients were classified as cognitive impairment group scored less than 26 on the MoCA and cognitive normal group scored 26 or above on the MoCA.Differences in MMSE and MoCA scores of the two groups were compared.Receiver operative characteristic (ROC) curve was used to determine the optimal cut-off scores in screening for MCI.Results Overall MMSE and MoCA scores were (27.84 ± 0.89) points and (23.24 ± 2.90) points.There was a positive correlation between MoCA and MMSE total scores (r =0.355 2,P ＜ 0.05).MCI was found in 79％ of the brain trauma patients using the MoCA.MMSE total score and subscores were all similar between the two groups.MoCA total score and subscores of attention,language,abstraction and delayed recall were much higher in cognitive normal group than in cognitive impairment group (P ＜0.05),but there were no significant differences in visuospatial,naming and oritention domains.Area under the ROC curve for MoCA(0.871 ± 0.038) was larger compared with MMSE (0.796 ± 0.054) (Z =3.592,P ＜ 0.05).The optimal cut-off scores of MoCA and MMSE for the identification of MCI were 25.5 and 28.5 respectively.Conclusions MoCA and MMSE total scores are positively correlated.MoCA is a better detector for the identification of MCI in brain trauma patients than the MMSE.

Delirium and cognitive impairment are common in the intensive care units (ICU). The Confusion Assessment Method Inten-sive Care Unit (CAM-ICU), Intensive Care Delirium Screening Checklist (ICDSC), Cognitive Test for Delirium (CTD), Nursing Delirium Scale (Nu-DESC) and Delirium Rating Scale (DRS) are recommended to assess delirium. CAM-ICU and ICDSC are the best in the reliabili-ty, validity, sensitivity and specification. Mini-Mental State Examination (MMSE), Abbreviated Mental Status Examination (AMSE), the Johns Hopkins Adapted Cognitive Exam are used commonly for cognitive impairment, and Johns Hopkins Adapted Cognitive Exam is one of the suitable scales for ICU as it is simple, comprehensive, and with higher reliability and validity.

Objective To explore the risk factors of dysphagia in the patients with traumatic brain injuries (TBI). Methods 141 TBI patients were assessed with Gugging Swallowing Screen, and divided into the dysphagia (n=36) and normal (n=105) groups. The related factors were compared between 2 groups. Results The frequency increased in severe brain injury, brain stem injury, bilateral brain injury, tracheotomy, nasal-gastric tube insertion and cognitive defect in the dysphagia group compared with those in the normal group (P<0.05). Conclusion The severe brain injury, brain stem injury, bilateral brain injury, tracheotomy, nasal-gastric tube insertion and cognitive defect may be related with the dysphagia post TBI.

Objective To compare the validity of Montreal cognitive assessment (MoCA) versus mini-mental state examination (MMSE) in screening cognition impairment in elderly patients with cranio-cerebral trauma.Methods Cognitive function in 40 elderly patients with cranio-cerebral trauma and 40 healthy elderly individuals were assessed by MoCA and MMSE.Receiver operating characteristic (ROC) curve analysis were performed to determine the optimal sensitivity and specificity of MoCA and MMSE.Results The total score and all the sub-test scores of MoCA were much lower in cranio-cerebral trauma patients than in the control group (all P＜0.05).The total score and orientation,calculation,recall,language sub scores of MMSE were significantly decreased in the elderly patients with cranio-cerebral trauma as compared with those in the controls (P＜0.05),while there were no significant differences in the immediate memory and language scores between the two groups (both P＞0.05).The area under the receiver operating characteristic curve showed that MoCA (0.92±0.03) ＞ MMSE (0.74±0.06) (Z=2.460,P＜0.01).When screening the cognition impairment in elderly patients with cranio cerebral trauma,the best cut-off scores of MoCA and MMSE were 24.5 and 27.5 respectively.Conclusions Cognition impairment is decreased in elderly patients with cranio cerebral trauma.The MoCA is superior to the MMSE as a screening instrument in detecting cognition impairment in elderly patients with cranio-cerebral trauma.

Objective To observe the effect of cognitive rehabilitation training based on games on cognition of the traumatic brain injury (TBI) patients.Methods 60 cases of patients according with the inclusion and exclusion criteria were divided into the control group and the training group with 30 cases in each group.The Montreal cognitive assessment (MoCA) test scores of all patients were lower than 26 points.The training group accepted the cognitive rehabilitation training based on games such as exactly the same game,drum game and picture memory game,while the control group did not accept the training.After one month,all patients accepted the MoCA test again.Then we analyzed the differences of the cognition between the two groups.Results After 30 days of training,all items of the cognitive function increased except the sub-item of abstraction.While in the control group,only the scores of attention,delayed recall,orientation and the total score showed alleviation.And all the scores of the training group were higher than those of the control group except the sub-item of abstraction.Conclusions Cognitive rehabilitation training based on games can effectively improve the cognitive function of TBI patients.