To evaluate the efficacy of a newly developed auditory-cognitive training system on speech recognition, central auditory processing and cognition among older adults with normal cognition (NC) and with neurocognitive impairment (NCI).A double-blind quasi-experiment was carried out on NC (n = 43) and NCI (n = 33) groups. Participants in each group were randomly assigned into treatment and control programs groups. The treatment group underwent auditory-cognitive training, whereas the control group was assigned to watch documentary videos, three times per week, for 8 consecutive weeks. Study outcomes that included Montreal Cognitive Assessment, Malay Hearing in Noise Test, Dichotic Digit Test, Gaps in Noise Test and Pitch Pattern Sequence Test were measured at 4-week intervals at baseline, and weeks 4, 8 and 12.Mixed design anova showed significant training effects in total Montreal Cognitive Assessment and Dichotic Digit Test in both groups, NC (P < 0.001) and NCI (P < 0.01). The NC group also showed significant training effects in the Malay Hearing in Noise Test (quiet) (P < 0.01), Gaps in Noise Test (P < 0.001) and Pitch Pattern Sequence Test (humming) (P < 0.05). All training effects were sustained up to 4 weeks after the training ended.The present study suggests that the newly developed auditory-cognitive training system has the potential to improve general cognition and some of the auditory processing abilities in both the NC and NCI groups. Because of the short test-retest intervals used in the present study, it is possible that the training effects were influenced by learning effect and, therefore, should be considered cautiously. Geriatr Gerontol Int 2019; 19: 768-773.© 2019 Japan Geriatrics Society.

《中国急性缺血性脑卒中诊治指南2018》根据近年研究进展对急性缺血性卒中的诊断与治疗规范进行了较大的修订和增补。本文结合近4年来公布的新的临床研究证据，对《指南2018》中修订和增补的内容进行解读。

To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia.Validation study.A community clinic and an academic center.Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC).The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD.Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively).MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.

背景 脑卒中后认知障碍（PSCI）会极大限制脑卒中患者各个阶段的康复，并导致患者活动参与能力和生活质量的下降。 目的 基于脑卒中全周期康复理念，通过调查PSCI的发病率，分析不同年龄及疾病时期下的PSCI差异及其潜在影响因素。 方法 采用简单随机抽样的方法，于2022年10月—2023年7月在全国不同地区27家医院的康复科住院抽取脑卒中患者进行横断面分析。根据研究标准最终纳入402例患者，根据我国统计局标准将患者分为青中年组（18~64岁，n=234）和老年组（≥65岁，n=168），根据国际卒中康复联盟定义的脑卒中恢复分期将患者分为急性期组（1~7 d，n=25）、亚急性期组（8~180 d，n=338）、慢性期组（&gt;180 d，n=39）。通过访谈、评估和电子病历系统收集患者的基线资料。使用蒙特利尔认知评估量表（MoCA）评估认知功能，并计算每个认知领域的得分和量表总分。使用美国国立卫生研究院脑卒中量表（NIHSS）、Fugl-Meyer评定量表上肢部分（FMA-UE）、Fugl-Meyer评定量表下肢部分（FMA-LE）、Berg平衡量表（BBS）、改良Barthel指数（MBI）、医院焦虑抑郁量表-焦虑（HADS-A），医院焦虑抑郁量表-抑郁（HADS-D）评估患者的疾病情况和身体功能。采用Spearman秩相关分析探究不同年龄与疾病时期下PSCI与其他临床指标的相关性。 结果 脑卒中患者PSCI患病率为76.4%（307/402），其中老年患者PSCI患病率为81.0%（136/168），青中年患者PSCI患病率为73.1%（171/234）；脑卒中急性期患者患病率为56.0%（14/25），亚急性期患者78.4%（265/338），慢性期患者71.8%（28/39）；不同年龄与疾病时期分组结果显示：老年组患者视空间与执行功能、注意力、计算力、延迟回忆得分及MoCA总分比青中年组更低（P&lt;0.05）；亚急性期组患者视空间与执行功能、语言、延迟回忆得分及MoCA总分低于急性期组（P&lt;0.05）。相关性分析显示，MoCA总分与文化程度（r_s=0.314）、脑卒中类型（r_s=0.114）、FMA-UE（r_s=0.245）、FMA-LE（r_s=0.242）、BBS（r_s=0.265）、MBI（r_s=0.293）呈正相关（P&lt;0.001），与性别（r_s=-0.107）、年龄（r_s=-0.103）、高血压史（r_s=-0.112）、偏瘫侧（r_s=-0.139）、病程（r_s=-0.135）、NIHSS（r_s=-0.107）、HADS-A（r_s=-0.239）、HADS-D（r_s=-0.280）呈负相关（P&lt;0.05）。进一步分层分析显示：青中年组和老年组在文化程度、NIHSS以及FMA-UE、FMA-LE、BBS、MBI、HADS-A、HADS-D均与MoCA总分相关（P&lt;0.05）。急性期患者中，病程、FMA-UE、HADS-A与MoCA总分相关（P&lt;0.05）；亚急性期患者中，年龄、文化程度、高血压、饮酒史、脑卒中类型、偏瘫侧、病程、NIHSS以及FMA-UE、FMA-LE、BBS、MBI、HADS-A、HADS-D与MoCA总分相关（P&lt;0.05）；慢性期患者中，文化程度、高血压、HADS-D与MoCA总分相关（P&lt;0.05）。 结论 PSCI与脑卒中患者年龄、疾病发展时期、文化程度、运动功能、平衡能力、日常生活活动能力和焦虑抑郁水平关系密切，应根据不同分层认知潜在影响因素为患者制定个性化预防策略和干预方案，并在疾病早期至康复后期提高对认知的筛查与重视。

METHODS: RESULTS: CONCLUSIONS: © Copyright by the American Board of Family Medicine.

Measurement error might lead to biased estimates, causing ineffective interventions and service delivery. Identifying measurement error of health-related instruments helps develop accurate assessment of health-related constructs.We compared the internal consistency of eight psychological scales used in health research in groups with adequate versus limited health literacy and in groups with higher versus lower education.Participants ( = 1,005) from a nationally representative internet panel completed eight self-report scales: (1) information avoidance, (2) cognitive causation, (3) unpredictability, (4) perceived severity, (5) time orientation, (6) internal health locus of control, (7) need for cognition, and (8) social desirability. The first four assess beliefs about diabetes and colon cancer. We used the Newest Vital Sign to categorize participants' health literacy (limited vs. adequate). We also categorized participants' education (high school or less vs. more than high school). We compared the Cronbach's alpha for each psychological scale between groups with different health literacy and education levels using the Feldt test.Among all the 13 subscales, scale internal consistency was significantly lower among people with limited health literacy than those with adequate health literacy for five subscales: information avoidance for colon cancer (0.80 vs. 0.88), unpredictability of diabetes (0.84 vs. 0.88), perceived severity for diabetes (0.66 vs. 0.75), need for cognition (0.63 vs. 0.82), and social desirability (0.52 vs. 0.68). Internal consistency was significantly lower among people who had a high school education or less than among those with more than a high school education for four scales: perceived severity of diabetes (0.70 vs. 0.75), present orientation (0.60 vs. 0.66), need for cognition (0.73 vs. 0.80), and social desirability (0.61 vs. 0.70).Several psychological instruments demonstrated significantly lower internal consistency when used in a sample with limited health literacy or education. To advance health disparities research, we need to develop new scales with alternative conceptualizations of the constructs to produce a measure that is reliable among multiple populations. Plain Language Summary: We compared the internal consistency of several psychological scales in groups with adequate versus limited health literacy and higher versus lower education. For several scales, internal consistency was significantly lower among (1) people with limited health literacy compared those who have adequate health literacy and/or (2) people who had a high school education or less compared to those with more than a high school education.