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

both total and individual group scores; and (6) adding differences play a key role when designing the training
insignificant burden to the diagnostic process with the ease pattern and determining the training intensity. For
of widespread promotion under the current AD guideline. example, for a patient with only memory deficits, memory
training and early targeted intervention of specific brain
We recommend applying the BRRS to the AD clinical
guideline in pursuit of a better understanding of AD regions are more beneficial and effective than the same
standardized treatment, which can also be given to those
patients. For instance, (1) if patients are in the same stage with significant impairment in other cognitive domains.
but with different S , more attention should be paid to Moreover, evidence has demonstrated that trainings with
0
those with higher scores, that is, those who are prone to higher levels of difficulty are more advantageous to patients
deterioration; (2) if patients are in the same stage and with with better performance of executive function, whereas
the same S , it is necessary to compare the items in each trainings that are less challenging are more suitable for
0
group and determine the most appropriate intervention for patients with poor executive performance . BRRS can
[38]
each patient; (3) if patients are in different stages but with the also help in objectively estimating patients’ executive
same S , it indicates that the patients may share similar AD functioning.
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risk factors and brain damage patterns despite the varying
degrees of severity at the moment; the network impairment It has been verified that high-frequency brain
in SCD, compared with MCI and AD, is still reversible stimulation increases the cortical excitability of the targeted
at the neuronal level; therefore, we advise implementing brain region, whereas low-frequency brain stimulation
[40]
intensive training for SCD patients to prolong and preserve suppresses it ; additionally, there is no significant
cognitive function and moderate training for MCI and AD difference in the clinical effects between single stimulation
patients in case of fluctuations in dynamic compensatory and complex stimulation of multiple regions in relation to
[39]
neural processes and the acceleration of the exhaustion AD’s known brain-affected areas . Cognitive, behavioral,
of compensation in brain functional networks due to and functional measures can be significantly enhanced
excessive brain activity ; and (4) if patients are diagnosed with the stimulation of the targeted brain region at a
[38]
with different stages and S , both the stage and score should certain frequency. Consequently, we suggest formulating
0
be considered when formulating an individually tailored individual stimulation protocol based on each group
intervention plan; after all, an SCD patient who scores 3000 score in part V of the BRRS: (1) if patients are diagnosed
points has a higher risk of disease progression and rapid with only damage without any compensations in the
deterioration than an AD patient who scores 100 in S . brain region (i.e., no score in compensation items), non-
0
excessive, effective frequency may help improve functional
4.2. Clinical application of BRRS performance and prevent the exhaustion of compensation
Although precise standards of the intensity and course ability; (2) if patients have scored in compensation items
of clinical treatment such as TMS, TPS, and cognitive (but not in decompensation), it is urgent to control the
successively developing compensation with a high- or low-
training are still under investigation, the previous frequency protocol in case of exhaustion that will lead to
studies have proven their modulation of cortical areas or
networks for compensation in the AD spectrum . As a further deterioration; (3) if patients have scored in both
[39]
novelty, these therapeutic strategies implemented now damage and compensation items, including structure and
are still in the light of the results of the previous studies network (but not in decompensation), clinicians must pay
close attention to the appearance of any critical patterns
and clinical experience. When designing a specialized (e.g., brain regions continuously lose their flexibility to
treatment plan for individual patients with the assistance disease damage when modules between relevant networks
of BRRS, the total score S and the group score must not be gradually cluster together) , which indicate a high
[41]
overlooked, especially in part V. To ensure the effectiveness potential for decompensation; and (4) long-term intensive
of treatment and prevent unnecessary intervention, the high-frequency stimulation has been suggested as a
predicted improvement before every implementation promising and efficient approach to rescuing the remaining
must be greater than the altered S . With quantitative well-performed function following decompensation [42,43] .
n
data, BRRS provides a reference for clinicians not only to
set a targeted treatment protocol for patients in advance 4.3. Limitations of BRRS
but also to evaluate the curative effect following clinical There are still some limitations of BRRS. First, it is beyond
interventions. Here, we discuss the further application of the scope of this review to explore the weight coefficient of
BRRS in cognitive training and brain stimulation.
each item, which may to some extent affect the accuracy or
Cognitive training has been clinically put into practice credibility of BRRS. Consistent with our findings, a review
for a period of time. It should be emphasized that cognitive has concluded that there is a preferential vulnerability of

Volume 1 Issue 3 (2022) 7 https://doi.org/10.36922/an.v1i3.208