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Advanced Neurology BRRS: A screening and monitoring tool for better prognosis in AD

improvement in the patient’s condition, for example, a the disease, the compensatory ability deteriorates and
patient under 65 years old who scored in the weight item eventually reaches a point of exhaustion due to extensive
in S but whose body mass index (BMI) has returned neurodegeneration . Based on these findings, we suggest
[32]
0
to normal at present, the improvement can only help to scoring each brain region by assessing the functional
potentially slow down the rate of disease deterioration, connectivity, structural connectivity, and compensation
making no difference to the reduction of the high AD patterns as follows: (1) Functional damage (add 100
risk level that has resulted from the former morbid state. points); (2) structural damage of white matter (add 100
Consequently, the S assessment of the weight items in the points); structural damage of gray matter (add 100 points);
n
aforementioned case should be as follows: (1) If <65 years (3) functional compensation (add 100 points); structural
old but with normal BMI, no extra points will be added compensation (add 100 points); and (4) decompensation
or deducted; (2) if over 65 years old, the weight item will or the disappearance of previously observed compensation
be graded according to the over 65-year-old standard. (add 100 points for each disappearance). The gray and
As far as other items are concerned, for the same reason, white matters are evaluated separately because there is
once any item in O has scored points, there is no need to no causal relationship in the damages between the two
reappraise it at further tracing, that is, points should not in AD. Meanwhile, white matter hyperintensity (WMH),
be deducted, and the score should remain unchanged. Due which represents vascular pathology and decreasing blood
to the minimal change in the original score regardless of flow and is considered a manifestation of cerebral small
whether the patient’s condition becomes better or worse, it vessel disease [33,34] , is associated with an increased risk of
can be said to be a reliable index to assess the baseline risk developing AD . Hence, if WMH is observed, add 100
[35]
level of AD patients. points. In every S evaluation, score the changes as follows:
n
Part V consists of items related to the aberrant brain (1) Grade all changes in each brain region based on the
alterations of AD-spectrum patients who are detected standard and (2) no extra points added or deducted with
by neuroimaging techniques. As a brief scale for ease of the disappearance of WMH that was previously observed.
use and promotion, we choose MRI, the most commonly It is known that the development of a disease is
used imaging modality for AD patients in current clinical influenced by the interactions among various factors
practice, of difference sequences (i.e., sMRI, fMRI, and and the modifiable network of interlocking feedback
diffusion tensor imaging [DTI]) for evaluation at the loops [12,36,37] . However, the intention of introducing the
structural and functional levels. The evaluation standard BRRS is to provide a preliminary screening and monitoring
is based on the MRI features of AD that has been tool that can be conveniently and effectively applied in
comprehensively summarized from the previous studies clinical settings with little additional burden added and
(additional information can be found in Tables S1-S3). It time consumed. Therefore, we propose a method with
has been proven that different network types and functions similar items but a larger value for each item to ensure
may exist in the same region of the brain whose alterations the ability to distinguish patients with a higher risk of
are not linear across the AD continuum [5,20] . Besides, the AD progression, thus serving as a replacement for the
stimulation of non-invasive techniques, such as repetitive extremely complex weighted coefficient in the interactions.
transcranial magnetic stimulation and transcranial pulse
stimulation (TPS), targets the surface area of the brain and 4. Discussion
is unable to differentiate between gray and white matters 4.1. Advantages and characteristic of BRRS
or between network modules or types [13,26] . Therefore,
part V focuses on six brain regions, including the limbic, The BRRS may be used as a supplementary method for
frontal, parietal, temporal, and occipital regions as well diagnosing AD with the following advantages: (1) Enabling
as the cerebellum. Neural plasticity, which represents the objective quantification of individual differences in terms
adaptability and flexibility of the brain, contributes to a of AD risk factors and neuroimaging abnormalities;
compensatory phenomenon against impairment in the (2) enabling early identification of patients at increased
AD spectrum, including the abnormal hyperactivation risk of rapid deterioration from those diagnosed in the
or increased connectivity in multiple brain regions . same stage; (3) enabling individually tailored intervention
[27]
This compensatory phenomenon can be viewed as a based on individual’s respective scored items; (4) enabling
process of brain reconstruction or function remodeling convenient monitoring and assessment of individual’s
to sustain optimal network functioning [28,29] ; on the trajectories of brain changes, disease development, and
other hand, it can also be explained as a pathological therapeutic effect at follow-up; (5) reducing the time
state that may lead to further brain damage as a result consumed and errors in calculation with the same but
of neuronal excitotoxicity [30,31] . With the progression of larger valued items, and enabling efficient judgment from

Volume 1 Issue 3 (2022) 6 https://doi.org/10.36922/an.v1i3.208