VasCog Screen test: sensitive in detecting cognitive impairment in patients who had a stroke or with heart failure

VasCog屏幕测试: 对检测中风或心力衰竭患者的认知障碍敏感

Vascular diseases, such as stroke and heart failure (HF), are associated with cognitive decline. Vascular cognitive impairment (CI) is commonly found in patients who had a stroke and with HF, ranging from mild CI to dementia. Early detection of CI is crucial for effective management and rehabilitation. This study aimed to develop the VasCog Screen test, a screening tool to detect CI in patients who had a stroke and with HF. The VasCog Screen test offers a cognitive screening tool, which is sensitive to cognitive deficits characteristically found in patients who had a stroke and with HF. It was found to have good sensitivity, specificity and classification accuracy. It is easy to administer in busy clinics, enabling early detection of CI and facilitating appropriate interventions.

血管疾病，如中风和心力衰竭 (HF)，与认知下降有关。血管性认知障碍 (CI) 通常在患有中风和HF的患者中发现，范围从轻度CI到痴呆。早期发现CI对于有效管理和康复至关重要。这项研究旨在开发VasCog筛查测试，这是一种筛查工具，用于检测中风和HF患者的CI。VasCog筛查测试提供了一种认知筛查工具，该工具对中风和HF患者特有的认知缺陷敏感。发现它具有良好的敏感性，特异性和分类准确性。在繁忙的诊所中很容易管理，可以及早发现CI并促进适当的干预措施。

REF: Chen NYC, Tan MYL, Xu J, Zuo L, Dong Y. VasCog Screen test: sensitive in detecting cognitive impairment in patients who had a stroke or with heart failure. Stroke Vasc Neurol. Published online April 22, 2024. doi:10.1136/svn-2023-002701 PMID: 38649196

Design of trials in lacunar stroke and cerebral small vessel disease: review and experience with the LACunar Intervention Trial 2 (LACI-2)

腔隙性卒中和脑小血管病的试验设计: 腔隙性干预试验2 (LACI-2) 的回顾和经验

Cerebral small vessel disease (cSVD) causes lacunar stroke (25% of ischaemic strokes), haemorrhage, dementia, physical frailty, or is 'covert', but has no specific treatment. Uncertainties about the design of clinical trials in cSVD, which patients to include or outcomes to assess, may have delayed progress. Based on experience in recent cSVD trials, we reviewed ways to facilitate future trials in patients with cSVD.We assessed the literature and the LACunar Intervention Trial 2 (LACI-2) for data to inform choice of Participant, Intervention, Comparator, Outcome, including clinical versus intermediary endpoints, potential interventions, effect of outcome on missing data, methods to aid retention and reduce data loss. We modelled risk of missing outcomes by baseline prognostic variables in LACI-2 using binary logistic regression.Imaging versus clinical outcomes led to larger proportions of missing data. We present reasons for and against broad versus narrow entry criteria. We identified numerous repurposable drugs with relevant modes of action to test in various cSVD subtypes. Cognitive impairment is the most common clinical outcome after lacunar ischaemic stroke but was missing more frequently than dependency, quality of life or vascular events in LACI-2. Assessing cognitive status using Diagnostic and Statistical Manual for Mental Disorders Fifth Edition can use cognitive data from multiple sources and may help reduce data losses.Trials in patients with all cSVD subtypes are urgently needed and should use broad entry criteria and clinical outcomes and focus on ways to maximise collection of cognitive outcomes to avoid missing data.

脑小血管病 (cSVD) 可导致腔隙性卒中 (缺血性卒中的25%) 、出血、痴呆、身体虚弱或 “隐蔽”，但无特异性治疗。cSVD临床试验设计的不确定性，包括哪些患者或评估结果，可能会延迟进展。基于最近cSVD试验的经验，我们回顾了促进cSVD患者未来试验的方法。我们评估了文献和腔隙性干预试验2 (LACI-2) 的数据，以告知参与者，干预，比较者，结果的选择，包括临床与中间终点，潜在的干预，结果对缺失数据的影响，帮助保留和减少数据丢失的方法。我们使用二元logistic回归模型通过LACI-2基线预后变量对缺失结局的风险进行建模，影像学和临床结局导致更大比例的缺失数据。我们提出了支持和反对广义与狭义进入标准的理由。我们确定了许多具有相关作用模式的可重复用途药物，以在各种cSVD亚型中进行测试。认知障碍是腔隙性缺血性中风后最常见的临床结果，但在LACI-2中，认知障碍的缺失比依赖性，生活质量或血管事件更为常见。使用精神障碍诊断和统计手册第五版评估认知状态可以使用来自多个来源的认知数据，并可能有助于减少数据丢失。迫切需要在所有cSVD亚型患者中进行试验，应使用广泛的进入标准和临床结果，并着重于最大限度地收集认知结果以避免丢失数据的方法。

REF: Blair G, Appleton JP, Mhlanga I, et al. Design of trials in lacunar stroke and cerebral small vessel disease: review and experience with the LACunar Intervention Trial 2 (LACI-2). Stroke Vasc Neurol. Published online April 3, 2024. doi:10.1136/svn-2023-003022 PMID: 38569894

Intelligent cholinergic white matter pathways algorithm based on U-net reflects cognitive impairment in patients with silent cerebrovascular disease

基于u-net的智能胆碱能白质通路算法反映无症状性脑血管病患者的认知功能障碍

The injury of the cholinergic white matter pathway underlies cognition decline in patients with silent cerebrovascular disease (SCD) with white matter hyperintensities (WMH) of vascular origin. However, the evaluation of the cholinergic white matter pathway is complex with poor consistency. We established an intelligent algorithm to evaluate WMH in the cholinergic pathway. We have established the first intelligent algorithm to evaluate the cholinergic white matter pathway with good accuracy compared with the gold standard. It helps more easily assess the cognitive function in patients with SCD.

胆碱能白质通路的损伤是血管源性白质高信号 (WMH) 的无症状性脑血管疾病 (SCD) 患者认知能力下降的基础。然而，胆碱能白质途径的评估是复杂的，一致性差。我们建立了一个智能算法来评估胆碱能途径中的WMH。我们建立了第一个智能算法来评估胆碱能白质通路，与金标准相比具有良好的准确性。它有助于更容易地评估SCD患者的认知功能。

REF: Fei B, Cheng Y, Liu Y, et al. Intelligent cholinergic white matter pathways algorithm based on U-net reflects cognitive impairment in patients with silent cerebrovascular disease. Stroke Vasc Neurol. Published online April 3, 2024. doi:10.1136/svn-2023-002976 PMID: 38569895