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IntroductionAlthough mild cognitive impairment (MCI) diagnosis is mainly based on cognitive assessment, reliable estimates of structural changes in specific brain regions, that could be contrasted against normal brain aging and inform diagnosis, are lacking. This study aimed to systematically review the literature reporting on MCI-related brain changes.MethodsThe MEDLINE database was searched for studies investigating longitudinal structural changes in MCI. Studies with compatible data were included in the meta-analyses. A qualitative review was conducted for studies excluded from meta-analyses.ResultsThe analyses revealed a 2.2-fold higher volume loss in the hippocampus, 1.8-fold in the whole brain, and 1.5-fold in the entorhinal cortex in MCI participants.DiscussionAlthough the medial temporal lobe is likely to be more vulnerable to MCI pathology, atrophy in this brain area represents a relatively small proportion of whole brain loss, suggesting that future investigations are needed to identify the source of unaccounted volume loss in MCI.

Highlights Overall, COVID-19 has had massive impacts on mental health care internationally. Most mental health systems were under-resourced and under-prepared, both to manage existing clients and to manage new clients. There were significant differences between sites, depending on the explosivity of COVID-19 and the readiness of the mental health system. Integrated, community mental health systems exhibited greater adaptability in contrast to services which depended on face-to-face and hospital-based care. There is an urgent requirement to use the lessons of COVID to drive the next wave of mental health reform, which should prioritise local, community and digital solutions.

Highlights COVID-19 has become the epitome of complex health problems where evidence-based medicine should be completed with other scientific approaches to facilitate informed planning. Rapid response prioritisation should incorporate systems thinking and healthcare ecosystem approaches as well as new methods to collect expert knowledge using new technologies. Digital conferencing has proven feasible and usable to get a quick and transparent appraisal of the evolution of the active period of COVID-19 worldwide. The current international typology for staging pandemics could be adapted to three phases: preparatory, active (including initiation, acceleration and deceleration) and recovery. This facilitates international comparisons in complex areas such as mental health. The severity of the outbreak, the containment measures and the societal response varied greatly across sites and countries. Using a “glocal” approach for understanding this variation is vital to assess the impact of COVID-19 in health care.

Background While acceleration in age-related cerebral atrophy has been well documented in Alzheimer’s disease, the cerebellar contributions to this effect have not been thoroughly investigated. Objective This study investigated cerebellar volume and atrophy rate using magnetic resonance imaging in individuals with normal cognition (CN), mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Methods Two hundred and twenty nine CN, 398 MCI and 191 AD participants of stage one ADNI database with screening scans were evaluated for cerebellar volume. Of those, 758 individuals with 2 or more follow up scans were categorized into stable, converted and reverted CN, MCI and AD and evaluated for cerebellar atrophy rate. Results Cerebellar volume was 2.5% larger in CN than in those with AD but there were no differences between CN and MCI and MCI and AD in cross-sectional analysis. Similarly, the atrophy rate was 49% larger in AD and 64% larger in MCI who converted to AD but no difference was detected between CN and MCI. There were no association between education and APOEe4 and cerebellar volume or cerebellar atrophy across the diagnostic groups. Conclusion Cerebellar atrophy contributes to Alzheimer’s clinical progression but mostly at the late stage of the disease. However, even in the late stage shrinkage rate is less than the average of the shrinkage in the cerebrum and is not associated with AD moderators. This suggests that cerebellar involvement is secondary to cerebral involvement and can be due to network connection spread regardless of the primary pathology.

Heroin avoidance may be achieved by MMT or ABT; however, the neural mechanism underlying these therapeutic methods differs.

Objectives: To investigate the cross-sectional association between measures of menstruation history (including menopausal status, age of menopause, age of menarche and duration of reproductive stage) and brain volume.Methods: Women (aged 45 to 79) from the UK Biobank were included (n = 5072) after excluding those who had (1) hysterectomy or bilateral oophorectomy, (2) ever used menopausal hormone therapy, (3) ever had a stroke, or (4) were perimenopausal. Multiple linear hierarchical regression models were computed to quantify the cross-sectional association between measures of menstruation history and brain volume. Sensitivity analysis based on propensity matching for age (and other demographic/health covariates) were applied to estimate differences in brain volumes between matched premenopausal and postmenopausal women.Results: Postmenopausal women had 1.06% (95% confidence interval [CI]; 1.05 -1.06) and 2.17% (95% CI, 2.12 -2.22) larger total brain (TBV) and hippocampal volumes (HV), respectively, than premenopausal women. Sensitivity analysis with age matched samples produced consistent results (i.e. TBV: 0.82%, 95% CI, 0.25 -1.38 ; HV: 1.33%, 95% CI, 0.01 -2.63). For every year increase in age above 45, postmenopausal women experienced 0.23% greater reduction in TBV than premenopausal women (95% CI, -0.60 --0.14), which was not observed for HV. Moreover, every 1 year delayed onset of menopause after 45 was associated with 0.32% (95% CI, -0.35 --0.28) and 0.31% (95% CI, -0.40 --0.22) smaller TBV and HV, respectively. Every additional year in age of menarche was associated with 0.10% (95% CI, 0.04 -0.16) larger TBV, which was not detected for HV. Similarly, every 1 year increase in duration of reproductive stage was associated with 0.09% smaller TBV (95% CI, -0.15 --0.03) , which was not detected for HV.Conclusions: Menopause may contribute to brain volume beyond typical aging effects. Furthermore, early age of menarche, delayed age of menopause and increasing duration of reproductive stage were negatively associated with brain volume. Further research is required to determine whether the negative association between age of menopause and HV is potentially an indicator of future vulnerability for dementia.

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