Alzheimer's disease (AD) so far did not have promising treatment. The accurate and early diagnosis is still the important issue. For these purpose, biomarkers related to diagnosis, clinical course, and other aims have been proposed and reported. Meanwhile, along with the ongoing researches for AD, biomarkers with their own aims are also on the way.

Objective: This study aimed to employ time-resolved spectroscopy (TRS) to explore age-related differences in prefrontal cortex (PFC) activity while subjects performed a working memory task. Methods: We employed TRS to measure PFC activity in ten healthy younger and ten healthy older subjects while they performed a working memory (WM) task. All subjects performed the Sternberg test (ST) in which the memory-set size varied between one and six digits. Using TRS, we recorded changes in cerebral blood oxygenation as a measure of changes in PFC activity during the task. In order to identify left/right asymmetry of PFC activity during the working memory task, we calculated the laterality score, i.e., Δoxy-Hb (right Δoxy-Hb—left Δoxy-Hb); positive values indicate greater activity in the right PFC, while negative values indicate greater activity in the left PFC. Results: During the ST, statistical analyses showed no significant differences between the younger and older groups in accuracy for low memory-load and high memoryload. In high memory-load tasks, however, older subjects were slower than younger subjects (P < 0.05). We found that the younger group showed right lateral responses with a stronger right than left activation in the frontal pole, whereas the older group showed bilateral responses (P < 0.05). Conclusions: The present results are consistent with the hemispheric asymmetry reduction in older adults (HAROLD) model; working memory tasks cause asymmetrical PFC activation in younger adults, while older adults tend to show reduced hemispheric lateralization.

Objective: The frontal lobe may be involved in circuits associated with depression, apathy, aggression, and other psychiatric symptoms. Although white matter changes (WMC) are related to the severity of behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer's disease (AD), it is unclear which part of the WMC may play the most important role in BPSD. This study was designed to investigate the relationship between the location of WMC and the severity of BPSD in AD patients. Methods: Among patients diagnosed with Alzheimer's disease between 2009 and 2014, 387 patients were retrospectively reviewed after those with pre-existing organic brain syndrome, psychiatric diseases, or toxic-metabolic encephalopathy were excluded. Patients' demographic and laboratory data, WMC measured with brain computed tomography and scored using the age-related white matter changes (ARWMC) scale, and neuropsychological tests, including the cognitive abilities screening instrument (CASI), the Mini-Mental State Examination (MMSE), the clinical dementia rating scale with sum-box (CDR-SB), and the neuropsychiatric inventory (NPI) were analyzed. Results: There was no significant difference in the NPI between patients with and without a history of stroke, hypertension, and diabetes. No significant difference in the NPI was identified between different sexes or different Apolipoprotein E (APOE) alleles. The NPI score was significantly correlated with the duration of education (r = -0.4515,P = 0.0172), CASI (r = -0.2915, P < 0.0001), MMSE (r = -0.8476, P < 0.0001), and CDR-SB (r = 2.2839, P < 0.0001). WMC in the right frontal lobe showed a significant difference in NPI in comparison to those without WMC (P = 0.0255). After adjusting for age, duration of education, and CASI, WMC in the right frontal lobe remained significantly associated with the NPI score (β = 3.8934,P = 0.042). Conclusions: WMC involving the right frontal lobe may play an important role in the BPSD in AD patients during their dementia diagnosis. Further studies are necessary to confirm whether controlling the risk factors of WMC can slow the progression of BPSD.

Objective: To study the effects of regional cerebral blood flow (rCBF) perfusion on learning and memory function in special brain areas and its molecular mechanism in rat. Methods: Sixty-four adult male healthy Sprague-Dawley (SD) rats were randomly divided into two groups: A false operation group and an operation group. The false operation group was randomly divided into four subgroups (A₀, B₀, C₀, and D₀) and the operation group was randomly divided into four subgroups (A, B, C, and D), with eight rats in each subgroup. The operation group underwent bilateral common carotid artery permanent ligation, while the other group only underwent a skin incision without the bilateral common carotid artery permanent ligation. Learning memory function of rats in each subgroup was measured using a Y-maze at 4 h, 8 h, 24 h, and 3 days after surgery. The rCBF in the right frontal lobe and hippocampus was detected using the Periflux PF model laser Doppler flowmetry and c-fos, c-jun, Bcl-2, and Bax protein expression in the right frontal lobe and hippocampus was measured using immunohistochemistry. Results: The rCBF in the right frontal lobule division and right hippocampus division was significantly lower in the operation group than in the false operation group (P < 0.05). The error number (EN), time to reach the target, and total reaction time (TRT) for the learning index using the Y-type labyrinth test in the operation group were significantly higher than that in the false operation group (P < 0.05); however, the active avoid rate in the operation group was significantly lower than that of the false operation group. Expression of c-fos and c-jun as well as the average absorbency in the right frontal lobule division and right hippocampus division in the operation group were significantly higher than those in the false operation group (P < 0.05). The number of Bax and Bcl-2-positive cells was significantly higher in the operation group, and the expression ratio of Bax/Bcl-2 in the operation group was significantly higher than that in the false operation group (P < 0.01). Conclusions: rCBF decrease can impair learning and memory function in rats, which may be related to the increased expression of c-fos, c-jun, Bcl-2, and Bax proteins in the t he frontal cortex and hippocampus.

Objective: The authors report an extremely unusual presentation and management of a children pineal mixed germ cell tumor mainly composed of immature teratoma, aiming to summarize main theraptic points by literature review. Methods: A cystic lesion located in the rear of third ventricle in a child was detected 3 years ago with no other therapy performed except for a ventriculo-peritoneal shunt. During the following 3 years, intermitted regular brain MRI demonstrated no evidence of lesion aggrandizement. However from 20 days before admission to our institute the patient began to present acutely with exacerbating clinical symptoms meanwhile brain MRI showed signs of abrupt revulsions of initial lesion without any incentive cause. Neurological examination revealed a significant rising of serum tumor marker level. Then surgical resection was performed immediately after admission which was followed by correlative two-course chemotherapy. Results: Postoperative brain MRI demonstrated totally removing of the lesion in rear of third ventricle. Serum tumor marker level decreased remarkably after surgery and declined to normal level after two-course chemotherapy. No obvious neurological deficit occurred except for short-term memory difficulty which gradually recovered within two weeks. Soon after the second course chemotherapy the patient was currently asymptomatic and returned to school. Conclusions: (1) To ensure definitive diagnosis and proper therapecutic protocols benefit from grasping clinical features of mixed germ cell tumor. (2) Overall preoperative investigation including serum tumor marker level is as critical as neurological imaging examination. (3) Surgical excision is confirmed to be the key modality of treatment. With the regarding of mixed germ cell tumor, never highlight total resection too much. (4) Postoperative adjuvant chemotherapy is recommended as further intensive treatment to improve the prognosis of mix germ cell tumor.

Objective: To evaluate the clinical results of repairing skull defects with biomimetic bone (nano-hap/collagen composites, NHACs) in children. Methods: Thirteen children with skull defects were treated with NHACs in our hospital. The NHACs molded with the help of a 3D printer were used in the operations. Results: All 13 operations were successful, and patients recovered without infection. Only one patient suffered from subcutaneous hydrops post-operation. The implanted NHACs remained fixed well after 1 year, and their CT HU values raised gradually. Skull shapes of children developed normally. Recovery of neurological and cognitive function was significant. Conclusions: NHAC, chosen to repair skull defects in children, can coexist with normal skull and reduce the negative effects on growth and development. NHAC could be a good choice for children with skull defects.

Objective: Taiwan has an increasing aging population like other developed areas. The aging population will lead to an increased prevalence of dementia. Methods: This article will reflect the status of dementia in Taiwan, including updated epidemiology, diagnosis, subtypes, and optimal treatment of dementia. Results: The article also describes and interprets the Taiwan Dementia Policy to establish a clear, large view of the current state of management of dementia in Taiwan and future policy implementation. Conclusion: A comprehensive policy to dementia, from the basic researches to clinical care and treatment, is necessary to the increased aged population in Taiwan.

The apolipoprotein E (APOE) ε4 allelle is a well-established risk factor for cognitive decline. Racial factors may mitigate its effects. However, APOE ε4 has similar effects even among different racial groups. The APOE genotype in patients with Alzheimer's disease may influence therapeutic decisions.

Alzheimer's disease (AD) is the most prevalent type of dementia, and its neuropathology is characterized by the deposition of insoluble β-amyloid (Aβ) peptides, intracellular neurofibrillary tangles, amyloid angiopathy, age-related brain atrophy, synaptic pathology, white matter rarefaction, granulovacuolar degeneration, neuron loss, and neuroinflammation. Although much is known about the neurobiology of AD, very few conventional therapies are available to arrest or slow the disease. There is an urgent need for novel therapeutic approaches for AD. AD subjects have significantly fewer viable precursor cells in the hippocampus compared with age-matched healthy control subjects. However, the viable precursor cells that remain in AD and age-matched healthy control brain specimens can be induced to differentiate. To facilitate or mimic the natural compensatory effect in AD, cell therapy, including endogenous and exogenous stem cells, has been considered in AD. In this review, we focus on the history and development of cell therapy in AD, and consider the role of cell therapy as a potential treatment for AD.

Decompressive craniectomy (DC) is a surgical method for managing highly elevated intracranial increased pressure (ICP) resulted from severe head trauma. This procedure is able to reduce the ICP rapidly and effectively. However, it may lead to kinds of secondary complications, which would cause patient's severe neurological dysfunction or even death. In this paper, we reviewed the literatures about surgical complications secondary to DC, and tried to bring up suggestions on surgical techniques aiming to prevention and treatment of these complications.

Objective: As estimated in a report of global Alzheimer's disease published by Alzheimer's Disease International in 2015, there will be 9.9 million new patients worldwide with Alzheimer's disease in 2015, with a new Alzheimer's patient diagnosed, on average, every 3 seconds. Since Alzheimer's disease is an irreversible disease, the most that can be done for Alzheimer's patients is to merely delay the onset of disease, which to date cannot be completely cured. Therefore, even though great effort is put into caring for the patient, caregivers should not expect any substantial changes. The caring process is a dynamic process that contains negative and positive experiences. During the caring period, not only do caregivers spend a lot of effort and work very hard to help the patient, but in fact care recipients themselves also give energy to caregivers. This study attempts to take a positive energy viewpoint to explore and design a program that is suitable for Alzheimer's caregivers. The aims of the study were as follows: (a) to explore the needs and burdens of Alzheimer's caregivers in the treatment process of patients, (b) to design a program that meets the needs of the caregivers, and (c) to evaluate the effects of implementing a program. Methods: The study is a qualitative study employing in-depth interviews. Interviews were conducted from September 2015 to December 2015; the interview results were reviewed and a positive energy group program was designed. Pre-test and post-test interviews were carried out for the program so as to evaluate the effects of the program. Results: According to the caregiver interview results, we understand the caring needs and caring process of caregivers. From the interview results, we now know that caregivers' continuous care mainly comes from positive energy in psychological, social and relationship aspects. Positive energy seems to have been affecting caregivers' caring ability and willingness. Therefore, a two-stage group activity program was designed to provide a recollective handmade craft group and an art therapy group. Research results of the study show that when the main caregivers of Alzheimer's patients took part in group activities, positive energy in social and relationship aspects increased for the caregiver group too. Conclusions: From these intervention programs caregivers could obtain more knowledge of patient care and these activities could effectively lighten caregivers' b urdens.

Objective: Drainage tubes (e.g., intracranial, abdominal cavity and thoracic) are commonly used to drain blood and fluid collections after surgery. It usually fails due to the lack of fixation perpendicular to the skin and the variety of tube materials. The objective of the article is to describe a new drainage tube device. Methods: This new device consists of a drainage tube fixator and diverter with a rotating handle. The fixator and diverter are fixed to the skin with a pair of wings, and the base comprises acircular arc with chamfering of the edge. The removable stopper and plastic diverter have a memory function. There are 2 holes on either side of the wings, by which they can be sewn to the skin or stapled for strength and stability. Results: The removable limiting stopper and plastic diverter with memory function work together to ensure that the drainage tube is firmly fixed. Therefore, the tube will not move either vertically or horizontally on the skin. Moreover, the device is fit for drainage tubes with different specifications and materials. Conclusions: The limiting stopper can be moved easily, which is conducive to local skin disinfection around the drainage tube. The device deserves clinical promotion.