Validering van de Seven Minute Screen voor gebruik in de geheugenpolikliniek

Cognitive tests play a crucial part in the assessment of dementia. In 1998 the Seven Minute Screen was developed by Solomon and colleagues. The test was originally designed to distinguish between Alzheimer’s disease (AD) and normal ageing, and research showed that the instrument is highly sensitive to AD. Subsequent research also proved the diagnostic accuracy of the Seven Minute Screen in the detection of other common types of dementia, such as vascular dementia, frontotemporal dementia and dementia with Lewy bodies. This article reports new research on the predictive validity of the Seven Minute Screen using 289 cognitively intact subjects, 175 patients with MCI and 563 patients with dementia in the setting of a memory clinic. In addition, a comparison is made with the Mini Mental State Examination (MMSE). The study demonstrates that the Seven Minute Screen is a valuable screening instrument for all common types of dementia, and it has added value to the MMSE. The sensitivity for dementia is 96?% and the specificity 93?%, in comparison to 69 and 98?% for the MMSE (<?24). The sensitivity for the various types of dementia is consistently high, ranging from 92?% for a subcortical dementia to 97?% for AD. The Seven Minute Screen requires little training, and combines a short administration time with a high diagnostic accuracy. This makes the Seven Minute Screen useful for application in memory clinics.     

The Clinical Utility of Informants' Appraisals on Prospective and Retrospective Memory in Patients with Early Alzheimer's Disease

Increasing studies suggest the importance of including prospective memory measures in clinical evaluation of dementia due to its sensitivity and functional relevance. The Prospective and Retrospective Memory Questionnaire (PRQM) is originally a self-rated memory inventory that offers a direct comparison between prospective and episodic memory. However, the informant''s report has been recognized as a more valid source of cognitive complaints. We thus aimed to examine the validity of the informant-rated form of the PRMQ in assessing memory function of the patients and in detecting individuals with early dementia. The informants of 140 neurological outpatients with memory complaints completed the Taiwan version of the PRMQ. Tests of prospective memory, short-term memory, and general cognitive ability were also administered to non-demented participants and patients with early stages of Alzheimer''s disease (AD). Results showed significant relationships between the PRMQ ratings and objective cognitive measures, and showed that higher ratings on the PRMQ were associated with increasing odds of greater dementia severity. Receiver operative characteristic (ROC) curves showed an adequate ability of the PRMQ to identify patients with dementia (93% sensitivity and 84% specificity). Hierarchical regression revealed that the PRMQ has additional explanatory power for dementia status after controlling for age, education and objective memory test results, and that the prospective memory subscale owns predictive value for dementia beyond the retrospective memory subscale. The present study demonstrated the external validity and diagnostic value of informants'' evaluation of their respective patients'' prospective and retrospective memory functioning, and highlighted the important role of prospective memory in early dementia detection. The proxy-version of the PRMQ is a useful tool that captures prospective and episodic memory problems in patients with early AD, in combination with standardized cognitive testing.     

Delirium en centros residenciales para personas mayores. Estudio de la prevalencia y los factores asociados

Objectives

To study the prevalence of delirium in the residential environment and to analyse the associated clinical, functional and mental factors.

Material and methods

A cross-sectional epidemic study was conducted on a population of elderly persons institutionalised in 2011 in 6 nursing homes in Asturias. Socio-demographic, clinical, functional (Barthel Index [BI]) and mental (Mini-Mental State Examination [MMSE]) variables were collected. Delirium was defined by the Confusion Assessment Method.

Results

A total of 505 elderly were included in the study (age 83.30 ± 7.33 years, with 67.70% women), and scores on the MMSE of 17.19 ± 10.35 and a BI score of 55.11 ± 35.82. The prevalence of delirium was 11.70%. On examining the risk of delirium among the studied variables, there was statistical significance when considering: BI, MMSE, dementia, pressure ulcers, or urinary catheter, and the prescribing of clomethiazole, ACTH-I or trazodone. In the analysis of the variables in the logistic regression with BI, diagnosis of dementia, the prescribing of clomethiazole or trazodone, in the equation, there was a statistical significance associated with delirium.

Conclusions

The prevalence of delirium in a residential environment in our study population was 11.7%. The results show that BI, diagnosis of dementia, and prescribing of clomethiazole or trazodone were associated with risk of delirium in institutionalised patients.     

Detection of Alzheimer's disease and dementia in the preclinical phase: population based cohort study

ObjectivesTo evaluate a simple three step procedure to identify people in the general population who are in the preclinical phase of Alzheimer''s disease and dementia.DesignThree year population based cohort study.SettingKungsholmen cohort, Stockholm, Sweden.Participants1435 people aged 75-95 years without dementia.AssessmentsSingle question asking about memory complaints, assessment by mini-mental state examination, and neuropsychological testing.ResultsNone of the three instruments was sufficiently predictive of Alzheimer''s disease and dementia when administered separately. After participants had been screened for memory complaints and global cognitive impairment, specific tests of word recall and verbal fluency had positive predictive values for dementia of 85-100% (95% confidence intervals range from 62% to 100%). However, only 18% of future dementia cases were identified in the preclinical phase by this three step procedure. Memory complaints were the most sensitive indicator of Alzheimer''s disease and dementia in the whole population, but only half the future dementia cases reported memory problems three years before diagnosis.ConclusionThis three step procedure, which simulates what might occur in clinical practice, has a high positive predictive value for dementia, although only a small number of future cases can be identified.

What is already known on this topic

Alzheimer''s disease is characterised by a preclinical phase, during which cognitive deficits are seen before diagnosisElderly people with subjective memory complaints and objective global cognitive impairment have a high risk of developing Alzheimer''s disease and dementia

What this study adds

This three step procedure (self report of memory complaints, test of global cognitive functioning, and then domain specific cognitive tests) has a positive predictivity of 85-100% for Alzheimer''s disease and dementia at three yearsHowever, only 18% of people in the preclinical phase can be identified using this procedureAbout half of the people in the preclinical phase of Alzheimer''s disease and dementia do not report problems with their memory three years before diagnosis     

Classification trees as an alternative to linear discriminant analysis

Linear discriminant analysis (LDA) is frequently used for classification/prediction problems in physical anthropology, but it is unusual to find examples where researchers consider the statistical limitations and assumptions required for this technique. In these instances, it is difficult to know whether the predictions are reliable. This paper considers a nonparametric alternative to predictive LDA: binary, recursive (or classification) trees. This approach has the advantage that data transformation is unnecessary, cases with missing predictor variables do not require special treatment, prediction success is not dependent on data meeting normality conditions or covariance homogeneity, and variable selection is intrinsic to the methodology. Here I compare the efficacy of classification trees with LDA, using typical morphometric data. With data from modern hominoids, the results show that both techniques perform nearly equally. With complete data sets, LDA may be a better choice, as is shown in this example, but with missing observations, classification trees perform outstandingly well, whereas commercial discriminant analysis programs do not predict classifications for cases with incompletely measured predictor variables and generally are not designed to address the problem of missing data. Testing of data prior to analysis is necessary, and classification trees are recommended either as a replacement for LDA or as a supplement whenever data do not meet relevant assumptions. It is highly recommended as an alternative to LDA whenever the data set contains important cases with missing predictor variables.     

The psychometric properties of the Dutch version of the Telephone Interview Cognitive Status (TICS)

The Telephone Interview Cognitive Status (TICS) is an instrument to screen for dementia in older persons by telephone. Although the psychometric properties of the TICS have been studied in various countries, the quality of the Dutch version of the TICS was yet unknown. This paper presents the Dutch version of the TICS and reports on its reliability and validity among 51 patients of Maastricht University Hospital, The Netherlands. The Pearson and intra-class correlations for test-retest reliability were 0.93 and 0.92, respectively. The Pearson and intra-class correlations for inter-rater reliability were 0.91 and 0.90, respectively. Sensitivity and specificity were studied in relation to the Mini Mental State Examination (MMSE, cut-off point 23/ 24) and the diagnosis of dementia as assessed according to DSM-IV criteria. When using the TICS cut-off point of 26/27, the coefficients for sensitivity and specificity were at least 0.80. The percentages ROC under the curve were 90% and 93% with the MMSE and the diagnosis dementia as criterion, respectively. We conclude that the Dutch version of the TICS is an acceptable instrument for screening for dementia in older persons, particularly when face-to-face contact is not possible.     

生长型分类方案不同导致森林生态系统植物功能性状的统计偏差

将植物划分为不同的生长型来统计植物功能性状特征，是当前植物性状研究中常用的方法；但生长型分类方案的不同很可能造成植物功能性状统计分析的偏差，对此偏差的评估却尚未见报道。根据植物志描述及野外调查实际情况，将生长型划分为3种不同的分类方案：分类1：根据植物志信息划分为传统意义的乔木和灌木；分类2：根据树高和胸径划分乔木、小乔木和灌木；分类3：仅根据树高划分乔木层与灌木层的乔木和灌木。以东部亚热带常绿阔叶林区域的浙江金华北山35种优势阔叶木本植物的枝叶性状为研究对象，比较不同生长型分类对植物枝叶性状统计数据的影响。结果表明：（1）与传统的分类1相比，分类2对乔木植物枝叶性状影响的显著程度要高于分类3，而对灌木植物枝叶性状的影响程度低于分类3；但不同生长型分类方案中乔木和灌木的枝叶性状总体差异不显著。而与分类2小乔木相比，分类1以及分类2内部的乔木和灌木生长型的性状与分类2小乔木差异非常明显；（2）将不同生长型植物再划分为不同生活型后，不同生长型分类方案对性状统计的影响增大。无论是常绿还是落叶生活型的小乔木，其与不同生活型乔木和灌木的性状差异仍然显著。可见，不同的生长型分类方案可造成植物功能性状统计的差异；把小乔木植物这一功能类群划分出来，能更好地反映森林生态系统性状特征的差异性。     

Using classification trees to detect induced sow lameness with a transient model

Feet and legs issues are some of the main causes for sow removal in the US swine industry. More timely lameness detection among breeding herd females will allow better treatment decisions and outcomes. Producers will be able to treat lame females before the problem becomes too severe and cull females while they still have salvage value. The objective of this study was to compare the predictive abilities and accuracies of weight distribution and gait measures relative to each other and to a visual lameness detection method when detecting induced lameness among multiparous sows. Developing an objective lameness diagnosis algorithm will benefit animals, producers and scientists in timely and effective identification of lame individuals as well as aid producers in their efforts to decrease herd lameness by selecting animals that are less prone to become lame. In the early stages of lameness, weight distribution and gait are impacted. Lameness was chemically induced for a short time period in 24 multiparous sows and their weight distribution and walking gait were measured in the days following lameness induction. A linear mixed model was used to determine differences between measurements collected from day to day. Using a classification tree analysis, it was determined that the mean weight being placed on each leg was the most predictive measurement when determining whether the leg was sound or lame. The classification tree’s predictive ability decreased as the number of days post-lameness induction increased. The weight distribution measurements had a greater predictive ability compared with the gait measurements. The error rates associated with the weight distribution trees were 29.2% and 31.3% at 6 days post-lameness induction for front and rear injected feet, respectively. For the gait classification trees, the error rates were 60.9% and 29.8% at 6 days post-lameness induction for front and rear injected feet, respectively. More timely lameness detection can improve sow lifetime productivity as well as animal welfare.     

比较MoCA和MMSE在卒中后认知功能筛查中的应用

目的：比较蒙特利尔认知评估量表（Montreal Cognitive Assessment,MoCA）和简易智能量表（mini-mental state examination,MMSE）在急性缺血性脑卒中后认知损害筛查中的应用。方法：对65例缺血性脑卒中患者在发病14天内应用简易精神状态检查量表（Mini-mental State Examination,MMSE）和MoCA进行神经心理评估。其中12例患者在发病3-6个月后应用MMSE、MoCA和神经心理成套测验进行神经心理评估。以MMSE〈23分、MoCA〈21为分界值,受教育年限小于12年加1分,文盲加2分。结果：MMSE的平均分值为25.2±4.3,MoCA的平均分值为18.6±5.7。37例患者MoCA评分显示有认知损害,但其中19例患者（29%）MMSE评分显示正常。28例MoCA评估显示认知正常的患者的MMSE评分均显示认知正常。视空间与执行功能、注意和语言重复测试受损最常见,定向和命名受损较少。在3-6个月的随访期内,12例患者中1例诊断为血管性痴呆患者的MoCA的分值上升1分,MMSE分值无变化;5例认知正常患者、3例轻度认知损害无痴呆的患者和3例中度认知损害无痴呆的患者MMSE和MoCA平均分值均有不同程度的上升,视空间与执行功能平均得分值在2次检测中无明显变化。结论：MoCA较MMSE检出血管性认知功能障碍患者敏感性更高,对认知变化更为敏感。     

Self-Reported Hindering Health Complaints of Community-Dwelling Older Persons: A Cross-Sectional Study

Purpose

Proactive care for community-dwelling older persons targeting self-reported hindering health complaints might prevent a decline in function. We investigated the spectrum of self-reported hindering complaints of community-dwelling older persons, the association with functional outcomes, and help-seeking behavior for these complaints.

Methods

Within the ISCOPE trial, participants (aged ≥75 years) received the ISCOPE screening questionnaire, including the open-ended question “At the moment, which health complaints limit you the most in your day-to-day life?”. After coding the answers with the ICPC-1-NL, we examined the prevalence and the association between the number and type of complaints and functional outcomes (Groningen Activities Restriction Scale, quality of life measured on Cantril’s Ladder, Mini-Mental State Examination, Geriatric Depression Scale-15, and De Jong Gierveld Loneliness Scale). Electronic patient registers were searched for the most reported complaints.

Results

7285 participants (median age: 81.0 years [IQR 77.8–85.3], 38.6% males) reported 13,524 hindering complaints (median 1, range 0–18); 32.7% reported no complaints. Participants mostly reported problems with walking/standing (22.1%), pain (20.8%) or weakness/tiredness (8.5%). These complaints were mentioned in the electronic patient registers in 28.3%, 91.3% and 55.5%, respectively. Higher numbers of hindering complaints were related to poorer scores on the number of domains with problems, Cantril’s Ladder for quality of life, Groningen Activities Restriction Scale, Geriatric Depression Scale, and De Jong Gierveld Loneliness Scale. Self-reported weakness, problems with walking/standing, visual limitations, cognitive problems, dyspnea and back complaints were associated with poorer scores on the number of domains with problems, Groningen Activities Restriction Scale, MMSE or Geriatric Depression Scale.

Conclusion

One third of the participants reported no hindering complaints. Problems with walking/standing, pain, and weakness/tiredness were most reported, but not always found in electronic patient registers. A higher number of, and specific self-reported hindering complaints, were associated with poorer scores on functional outcomes. It may be helpful for general practitioners to ask about these complaints and their influence on daily life.     

Telefonisch Interview Cognitieve Status (TICS): psychometrische aspecten

The psychometric properties of the Dutch version of the Telephone Interview Cognitive Status (TICS). The Telephone Interview Cognitive Status (TICS) is an instrument to screen for dementia in older persons by telephone. Although the psychometric properties of the TICS have been studied in various countries, the quality of the Dutch version of the TICS was yet unknown. This paper presents the Dutch version of the TICS and reports on its reliability and validity among 51 patients of Maastricht University Hospital, the Netherlands. The Pearson and intra-class correlations for test-retest reliability were 0,93 and 0,92, respectively. The Pearson and intra-class correlations for inter-rater reliability were 0,91 and 0,90, respectively. Sensitivity and specificity were studied in relation to the Mini Mental State Examination (MMSE, cut-off point 23/24) and the diagnosis of dementia as assessed according to DSM-IV criteria. When using the TICS cut-off point of 26/27, the coefficients for sensitivity and specificity were at least 0,80. The percentages ROC under the curve were 90% and 93% with the MMSE and the diagnosis dementia as criterion, respectively. We conclude that the Dutch version of the TICS is an acceptable instrument for screening for dementia in older persons, particularly when face-to-face contact is not possible.     

Neuropsychiatric symptoms of dementia: psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI)

Behavioral and psychological symptoms are highly prevalent in dementia. The Neuropsychiatric Inventory was constructed to measure these symptoms. Data from three studies are presented concerning psychometric aspects of the NPI Dutch version. The NPI was compared to the Revised Memory and Behavioral Problems Checklist (RMBPC) and the Mini Mental State Examination (MMSE). In the three selected patient samples prevalence of behavioral or psychological symptoms was as high as 90%. Interrater agreement (n = 19) was very high (kappa > .90). Factor analysis (n = 199) supports NPI construct validity. The NPI items correlated reasonably high (R = .35 - .60) with the relevant RMBPC subscales (n = 24). Although some NPI items did, the NPI total score was not significantly related to the MMSE. The NPI Dutch version can be scored objectively and it is a valid rating scale for measuring a wide range of behavioral and psychological symptoms of dementia.     

随机森林算法基本思想及其在生态学中的应用——以云南松分布模拟为例

通常来讲,生态学者对于解释生态关系、描述格局和过程、进行空间或时间预测比较感兴趣。这些工作可以通过模拟输出值(响应)与一些特征值(即解释变量)的关系来实现。然而,生态数据模拟遇到了挑战,这是因为响应变量和预测变量可能是连续变量或离散变量。需要解释的生态关系通常是非线性的,并且解释变量之间具有复杂的相互作用关系。响应变量和解释变量存在缺失值并不是不常有的现象,奇异值也经常出现在生态数据中。此外,生态学者通常希望生态模型即要易于建立又易要于解释。通常是利用多种统计方法来分析处理各种各样情景中出现的独特的生态问题,这些模型包括(多元)逻辑回归、线性模型、生存模型、方差分析等等。随机森林是一个可以处理所有这些问题的有效方法。随机森林可以用来做分类、聚类、回归和生存分析、评估变量的重要性、检测数据中的奇异值、对缺失数据进行插补等。鉴于随机森林本身在算法上的优势,将就随机森林在生态学中的应用进行总结,对建模过程进行概述,并以云南松分布模拟研究为例,对其主要功能特点进行案例展示。通过对随机森林的一般术语、概念和建模思想进行介绍,有利于读者掌握本方法的应用本质,可以预见随机森林在生态学研究中将得到更多的应用和发展。     

Polymorphism of Apolipoproteine E in Relation with Alzheimer and Vascular Dementia

Summary 1. The epsilon 4 allele of the apolipoprotein E gene increases the risk of late onset familial and sporadic Alzheimer disease. Relation of epsilon 4 allele of the apolipoprotein E gene to various types of dementia and the onset of dementia were analyzed in the present study.2. The study comprised 139 patients (50 men and 89 women) with dementia, mean age 73.61 years (range 47–98). The diagnosis of dementia was made according to Diagnostic and Statistical Manual of Mental Disorders, and subtypes diagnoses were made according to NINCDS-ADRDA and NINDS-AIREN criteria. Minimental State Examination (MMSE) was used for the screening of dementia. Apolipoprotein E polymorphism was determined by the PCR-RFLP technique-polymerase chain reaction and subsequent digestion with specific restriction endonuclease. For statistical analyses chi-square test and the crude Gart′s odds ratio (OR) and 95% confidence intervals (CI) were used.3. From 139 dementia patients (MMSE ≤24 points) in 61 (45%) Alzheimer disease (AD) was present, in 44 patients (31%) vascular dementia (VD), and in 34 (24%) mixed dementia (MD) were revealed. In comparison with control group the presence of at least one ApoE-ɛ4 allele was significantly higher only in the group with AD (p < 0.001), (OR=2.76; 95%: 1.42–5.36). The frequency of ɛ4 allele carriers was significantly overrepresented in AD group compared with VD (χ²=5.94; p=0.0148). Differences between AD and MD or VD and MD were not confirmed.     

Apolipoprotein E4 and memory decline in the elderly

The objective of this study was to investigate whether the association between Apolipoprotein E4 (ApoE4) and memory decline is modified by baseline general cognitive impairment and age in a population-based elderly sample. Subjects were participants in the Longitudinal Aging Study Amsterdam (LASA). The study sample consisted of 1,243 subjects, 62-85 years old, with a Mini-Mental State Examination (MMSE) score between 21-30 and known ApoE phenotypes. Memory performance was measured with a short version of the Auditory Verbal Learning Test (AVLT) at baseline and repeated after three years (N = 854). Memory decline was defined as a decrease of at least one standard deviation from the mean change score on immediate recall, delayed recall and retention. ApoE4 was associated with memory decline in cognitively impaired subjects (MMSE 21-26), but not in cognitively normal subjects (MMSE 27-30). In particular cognitively impaired E4 carriers older than 75 years were at high risk of memory decline. Contrary to AD studies, our study suggests that the risk of ApoE4 on memory decline does not decrease with ageing.     

The Influence of Multimorbidity on Clinical Progression of Dementia in a Population-Based Cohort

Introduction

Co-occurrence with other chronic diseases may influence the progression of dementia, especially in case of multiple chronic diseases. We aimed to verify whether multimorbidity influenced cognitive and daily functioning during nine years after dementia diagnosis compared with the influence in persons without dementia.

Methods

In the Kungsholmen Project, a population-based cohort study, we followed 310 persons with incident dementia longitudinally. We compared their trajectories with those of 679 persons without dementia. Progression was studied for cognition and activities of daily life (ADLs), measured by MMSE and Katz Index respectively. The effect of multimorbidity and its interaction with dementia status was studied using individual growth models.

Results

The mean (SD) follow-up time was 4.7 (2.3) years. As expected, dementia related to both the decline in cognitive and daily functioning. Irrespective of dementia status, persons with more diseases had significantly worse baseline daily functioning. In dementia patients having more diseases also related to a significantly faster decline in daily functioning. Due to the combination of lower functioning in ADLs at baseline and faster decline, dementia patients with multimorbidity were about one to two years ahead of the decline of dementia patients without any co-morbidity. In persons without dementia, no significant decline in ADLs over time was present, nor was multimorbidity related to the decline rate. Cognitive decline measured with MMSE remained unrelated to the number of diseases present at baseline.

Conclusion

Multimorbidity was related to baseline daily function in both persons with and without dementia, and with accelerated decline in people with dementia but not in non-demented individuals. No relationship of multimorbidity with cognitive functioning was established. These findings imply a strong interconnection between physical and mental health, where the greatest disablement occurs when both somatic and mental disorders are present.     

血清NGF、BDNF、GFAP水平与老年血管性痴呆严重程度的相关性分析

目的:探讨血清神经生长因子(Nerve Growth Factor,NGF)、脑源性神经营养因子(Brain Derived Neural Nutrition Factor, BDNF)、胶质纤维酸性蛋白(Glial Fibrillary Acidic Protein,GFAP)水平与老年血管性痴呆严重程度的相关性。方法:选择我院2016年1月至2018年12月收治的81例老年血管性痴呆患者,根据简易精神状态检查表(MMES)评分将其分为三组,以MMSE评分21～26分者为轻度组(26例),10～20分者为中度组(28例),0～9分者为重度组(27例),同时选择来院体检的50例健康者作为对照组,检测和比较各组的血清NGF、BDNF、GFAP水平,分析血清NGF、BDNF、GFAP水平与老年血管性痴呆患者MMSE分值的相关性。结果:老年血管性痴呆者的血清NGF、GFAP水平明显高于对照组(P0.05),血清BDNF水平明显低于对照组(P0.05)。轻度组、中度组、重度组的血清NGF、GFAP、BDNF水平对比差异均有统计学意义(P0.05):NGF水平:轻度组中度组重度组,BDNF水平:轻度组中度组重度组;GFAP水平:轻度组中度组重度组。血清NGF、BDNF水平与MMSE分值评分呈显著正相关(r_1=0.652,r_2=0.671,P0.05),血清GFAP水平与MMSE分值呈显著负相关(r3=-0.681,P0.05)。结论:血清NGF、BDNF、GFAP水平均与老年血管性痴呆的严重程度密切相关,可能用于评估老年血管性痴呆病情的严重程度。     

Small Clusters of Fast-Growing Trees Enhance Forest Structure on Restored Bottomland Sites

Despite the diversity of trees in bottomland forests, restoration on bottomland sites is often initiated by planting only a few species of slow‐growing, hard mast–producing trees. Although successful at establishing trees, these young forests are slow to develop vertical structure, which is a key predictor of forest bird colonization. Furthermore, when natural seed sources are few, restored sites may be depauperate in woody species. To increase richness of woody species, maximum tree height, and total stem density, I supplemented traditional plantings on each of 40 bottomland restoration sites by planting 96 Eastern cottonwood (Populus deltoides) and American sycamore (Platanus occidentalis) in eight clusters of 12 trees. First‐year survival of cottonwood stem cuttings (25%) and sycamore seedlings (47%) was poor, but survival increased when afforded protection from competition with weeds. After five growing seasons, 165 of these 320 supplemental tree clusters had at least one surviving tree. Vegetation surrounding surviving clusters of supplemental trees harbored a greater number of woody species, increased stem density, and greater maximum tree height than was found on paired restoration sites without supplemental trees. These increases were primarily accounted for by the supplemental trees.     

CART算法在原发性肝癌放疗后HBV再激活的应用

为了建立乙型肝炎病毒(Hepatitis B virus,HBV)再激活的预测模型,提出CART(classification and regression tree)特征选择方法应用在原发性肝癌患者精确放疗后HBV再激活的危险因素分析中,进而建立基于CART和Bayes算法的HBV再激活预测模型。实验结果显示:CART算法划分了多组具有优秀分类能力的特征节点集(危险因素),尤其当特征节点集为HBV DNA水平、外放边界、放疗总剂量、V20和KPS评分时,在CART和Bayes预测模型中的分类正确性分别为88.51%和86.69%,得到HBV再激活正确性贡献度的排序为KPS评分全肝平均剂量V20放疗总剂量V10;当甲胎蛋白AFP出现时,增加了HBV再激活的预测正确性。     

The Montreal Cognitive Assessment (MoCA) - A Sensitive Screening Instrument for Detecting Cognitive Impairment in Chronic Hemodialysis Patients

Background

Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) therapy have an increased risk of developing cognitive impairment and dementia, which are known relevant factors in disease prognosis and therapeutic success, but still lack adequate screening in clinical routine. We evaluated the Montreal Cognitive Assessment (MoCA) for suitability in assessing cognitive performance in HD patients in comparison to the commonly used Mini-Mental State Examination (MMSE) and a detailed neuropsychological test battery, used as gold standard.

Methods

43 HD patients and 42 healthy controls with an average age of 58 years, were assessed with the MoCA, the MMSE and a detailed neuropsychological test battery, covering the domains of memory, attention, language, visuospatial and executive functions. Composite scores were created for comparison of cognitive domains and test results were analyzed using Spearman''s correlation and linear regression. Cognitive dysfunction was defined using z-score values and predictive values were calculated. Sensitivity and specificity of the MoCA were determined using receiver operating characteristic (ROC) analysis.

Results

HD patients performed worse in all cognitive domains, especially in memory recall and executive functions. The MoCA correlated well with the detailed test battery and identified patients with cognitive impairment with a sensitivity of 76.7% and specificity of 78.6% for a cut-off value of ≤24 out of 30 points. In the detailed assessment executive functions accounted significantly for performance in the MoCA. The MMSE only discriminated weakly between groups.

Conclusions

The MoCA represents a suitable cognitive screening tool for hemodialysis patients, demonstrating good sensitivity and specificity levels, and covering executive functions, which appear to play an important role in cognitive performance of HD patients.