Neurology

The global incidence rate of frailty syndrome among older adults aged 60 years and over has been estimated to be 43.4 cases per 1000 persons/years. Objectives: This study aimed to determine the prevalence of pre-frailty and frailty syndromes in community-dwelling older adults and assess the correlated sociodemographic factors. Methods: All elderly people recruited in the second phase of the Amirkola Health and Ageing Cohort Project, including 2135 older adults aged ≥60 years living in Amirkola, North of Iran, were invited to participate in this study using the census method. The standard "FRAIL" scale was used to assess the frailty syndrome. The individuals who obtained a score of three or more and one or two were classified as frail and pre-frail cases, respectively. Results: Totally, 2010 older adults with a mean age of 70.41±7.65 years were included in this study. Out of them, 672 (33.4%; 95% CI: 31.37-35.50%) cases met the criteria for frailty syndrome, and 874 (43.5%) individuals were regarded as pre-frail. The prevalence of frailty was significantly higher in females (50.8%; 95% CI: 47.58-54.05%), compared to males (18.7%; 95% CI: 16.41-21.05%). Multivariate logistic regression analysis revealed that age ≥85 (OR=7.27; 95% CI: 4.12-24.46) and female gender (OR=2.67; 95% CI: 2.30-9.95) had the highest effect on frailty in older adults. Conclusion: One out of every three elderly people (aged ≥60) in Amirkola, North of Iran, had frailty syndrome. Older age, female gender, lower education level, low level of satisfaction with income, marital status (single), living alone, and unemployment increased the risk of frailty in older adults.

Background: Cardiovascular diseases are the second leading cause of morbidity and mortality in Kenya. However, there is limited clinico-epidemiological data on stroke to inform decision making. This study sought to establish stroke distribution patterns and characteristics in patients seeking care at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH), with the ultimate aim of establishing the first national stroke registry in Kenya. Methods: This was a prospective multicentre cohort study among stroke patients. The study used a modified World Health Organisation STEP-wise approach to stroke surveillance tool in collecting data on incidence, major risk factors and mortality rate. The Cochran's Mantel-Haenszel chisquared test of conditional independence was used with p-value set at 0.05. Results: A total of 691 patients with confirmed stroke were recruited [KNH 406 (males: 40.9%; females: 59.1%); MTRH 285 (males: 44.6%; females: 55.4%)] and followed over a 12-month period. Overall, ischaemic stroke accounted for 55.6% of the stroke cases, with women being the most affected (57.5%). Mortality rate at day 10 was 18.0% at KNH and 15.5% at MTRH, and higher in the haemorrhagic cases (20.3%). The most common vascular risk factors were hypertension at 77.3% (males: 75.7%; females: 78.5%), smoking at 16.1% (males: 26.6%; females: 8.3%) and diabetes at 14.9% (males: 15.7%; females: 14.4%). Ischaemic stroke was conditionally independent of gender after adjusting for age. Conclusions: To our knowledge this is the first pilot demonstration establishing a stroke registry in sub-Saharan Africa and clearly establishes feasibility for this approach. It also has utility to both inform and potentially guide public policy and public health measures on stroke in Kenya. Important and unexpected observations included the preponderance of women affected by cerebrovascular disease and that cigarette smoking was the second most common risk factor. The latter, over time, will further impact on the clinico-epidemiological profile of cerebrovascular disease in Kenya.

Coronavirus disease 2019 (COVID-19) is an emerging global health emergency caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The global outbreak of SARS-CoV-2 infection has been declared a global pandemic by the World Health Organization (WHO). The clinical presentation of SARS-CoV-2 infection depends on the severity of the disease and may range from an asymptomatic infection to a severe and lethal illness. Fever, cough, and shortness of breath are among the most common symptoms associated with SARS-CoV-2 infection. Accumulating evidence indicates that COVID-19 patients commonly develop neurological symptoms, such as headache, altered mental status, anosmia, and myalgia. In this comprehensive literature review, we have summarized the most common neurological complications and reported neurological case studies associated with COVID-19, and neurological side effects associated with COVID-19 treatments. Additionally, the post-acute COVID-19...

Many infectious agents can cause central nervous system (CNS) diseases in humans. Since microbial agents infecting CNS are numerous and have different features, conventional laboratory tests may not be sensitive enough to identify and characterise viruses and bacteria in human biological specimens. Thus, the need to define methods for the diagnosis of infectious neurological diseases, such as progressive multifocal leukoencephalopathy (PML), is urgent, in order to improve the outcome of the diseases with rapid and accurate detection of the pathogens.

OBJECTIVE To assess the prevalence of distal sensorimotor polyneuropathy (DSPN) in an older population and to examine its relationship with prediabetes. RESEARCH DESIGN AND METHODS Glucose tolerance status was determined in 61- to 82-year-old participants (n = 1,100) of the population-based Cooperative Health Research in the Region of Augsburg (KORA) F4 Survey (2006–2008). Clinical DSPN was defined as bilaterally impaired foot-vibration perception and/or foot-pressure sensation. RESULTS Prevalence of clinical DSPN was similar in subjects with known diabetes (22.0%) and subjects with combined impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) (23.9%). Among prediabetic subgroups, IFG-IGT, but not isolated-IFG and -IGT, was associated with a higher risk of clinical DSPN, compared with normal glucose tolerance. A J-shaped association was observed between clinical DSPN and quartiles of 2-h postchallenge glucose, but not with fasting glucose and HbA1c levels. CONCLUSIONS...

Background The natural history of facioscapulohumeral muscular dystrophy (FSHD) is undefined. Methods An observational cohort study was conducted in 246 FSHD1 patients. We split the analysis between index cases and carrier relatives and we classified all patients using the Comprehensive Clinical Evaluation Form (CCEF). The disease progression was measured as a variation of the FSHD score performed at baseline and at the end of 5-year follow-up (ΔFSHD score). Findings Disease worsened in 79.4% (112/141) of index cases versus 38.1% (40/105) of carrier relatives and advanced more rapidly in index cases (ΔFSHD score 2.3 versus 1.2). The 79.1% (38/48) of asymptomatic carriers remained asymptomatic. The highest ΔFSHD score (1.7) was found in subject with facial and scapular weakness at baseline (category A), whereas in subjects with incomplete phenotype (facial or scapular weakness, category B) had lower ΔFSHD score (0.6) p < 0.0001. Conclusions The progression of disease is different ...

The repeated head trauma experienced by boxers can lead to the development of dementia pugilistica (DP)-punch drunk syndrome. The neuropathology of DP in a classic report by Corsellis et al des- cribes the presence of numerous neurofibrillary tangles in the absence of plaques, in contrast to the profusion of tangles and plaques seen in Alzheimer's disease (AD). The DP cases used in that report were re-investigated with immunocytochemical methods and an antibody raised to the f-protein present in AD plaques. We found that all DP cases with substantial tangle formation showed evidence of extensive #-protein immunoreactive deposits (plaques). These diffuse "plaques" were not visible with Congo-red or standard silver stains. The degree of fl-protein deposition was comparable to that seen in AD. Our data indicate that the present neuropathological description of DP (tangles but no plaques) should be altered to ackn- owledge the presence of substantial ,B- protein deposition (plaques). The molecular markers present in the plaques and tangles of DP are the same as those in AD. Similarities in clinical symptoms, distribution of pathology and neurochemical deficits also exist. Epidemiological studies have shown that head injury is a risk factor in AD. It is probable that DP and AD share common pathogenic mechanisms leading to tan- gle and plaque formation.

To investigate the usefulness of the enzyme salivary alpha amylase as a biochemical marker of sleep deprivation in human subjects. Total 168 healthy school-going adolescents studying in 9th grade were selected randomly from morning shift (n = 84) and dayshift (n = 84) schools. The study was undertaken longitudinally for a period of 2 years. Study encompassed administration of questionnaire and collection of saliva samples from the participants. Activity of salivary alpha amylase (sAA) activity was estimated spectrophotometrically and statistical analysis was performed to determine the association between sAA activity and sleep duration. Excessive daytime sleepiness among students was also studied in association with sAA activity. sAA activity of students was found to have a negative correlation with the duration of sleep and a positive correlation with their level of sleepiness. Morning shift students were found to have significantly less sleep and correspondingly higher sAA activity as compared to dayshift students. A significant increase in the sAA activity was noticed in the second year as the students progressed from 9th to 10th grade. Higher amylase activity was also observed in sleep deprived students suffering from excessive daytime sleepiness irrespective of school timings. Salivary alpha amylase activity increases in saliva in response to sleep deprivation. School timings may modulate sleep duration of students. Present finding reveals that sAA could be an appropriate non-invasive biochemical marker for the objective assessment of sleep deprivation among individuals as well as at population level.

We investigated different dimensions of subjective cognitive decline (SCD) to determine which was the best prognostic risk factor for incident mild cognitive impairment (MCI) among cognitively unimpaired participants. We included 1,167 cognitively unimpaired participants, aged 70 to 95 years, from the Mayo Clinic Study of Aging based on 2 concurrent SCD scales (part of the Blessed memory test and the 39-item Everyday Cognition [ECog] scale, which included a validated 12-item derivative) and a single question assessing worry about cognitive decline. We evaluated multiple ways to dichotomize scores. In continuous models, we compared average scores on 4 ECog domains and multidomain (39- and 12-item) ECog scores. Cox proportional hazards models were used to assess the association between each measure and risk of MCI in models adjusted for objective memory performance, depression, anxiety, sex, ε4 carriership, and medical comorbidities. It was possible to select a substantial group of pa...

Biological pathways that significantly contribute to sporadic Alzheimer's disease are largely unknown and cannot be observed directly. Cognitive symptoms appear only decades after the molecular disease onset, further complicating analyses. As a consequence, molecular research is often restricted to late-stage post-mortem studies of brain tissue. However, the disease process is expected to trigger numerous cellular signaling pathways and modulate the local and systemic environment, and resulting changes in secreted signaling molecules carry information about otherwise inaccessible pathological processes. To access this information we probed relative levels of close to 600 secreted signaling proteins from patients' blood samples using antibody microarrays and mapped disease-specific molecular networks. Using these networks as seeds we then employed independent genome and transcriptome data sets to corroborate potential pathogenic pathways. We identified Growth-Differentiation ...

Disease-modifying therapies are being developed to target tau pathology, and should, therefore, be tested in primary tauopathies. We propose that progressive apraxia of speech should be considered one such target group. In this study, we investigate potential neuroimaging and clinical outcome measures for progressive apraxia of speech and determine sample size estimates for clinical trials. We prospectively recruited 24 patients with progressive apraxia of speech who underwent two serial MRI with an interval of approximately 2 years. Detailed speech and language assessments included the Apraxia of Speech Rating Scale and Motor Speech Disorders severity scale. Rates of ventricular expansion and rates of whole brain, striatal and midbrain atrophy were calculated. Atrophy rates across 38 cortical regions were also calculated and the regions that best differentiated patients from controls were selected. Sample size estimates required to power placebo-controlled treatment trials were cal...

Objective: To determine antemortem MRI findings associated with microinfarcts at autopsy. Methods: Patients with microinfarcts (n 5 22) and patients without microinfarcts (n 5 44) who underwent antemortem MRI were identified from a dementia clinic-based, population-based, and community clinic-based autopsy cohort. The microinfarct and no-microinfarct groups were matched on age at MRI, age at death, sex, APOE status, Mini-Mental State Examination score, and pathologic diagnosis of Alzheimer disease. Brain infarcts were assessed on fluid-attenuated inversion recovery (FLAIR) MRI. White matter hyperintensities on FLAIR MRI and hippocampal volumes on T1-weighted MRI were quantified using automated methods. A subset of subjects with microinfarcts (n 5 15) and a matched group of subjects without microinfarcts (n 5 15) had serial T1-weighted MRIs and were included in an analysis of global and regional brain atrophy rates using automated methods. The presence of cortical (p 5 0.03) and subcortical (p 5 0.02) infarcts on antemortem MRI was associated with presence of microinfarcts at autopsy. Higher numbers of cortical (p 5 0.05) and subcortical (p 5 0.03) infarcts on antemortem MRI were also associated with presence of microinfarcts. Presence of microinfarcts was not associated with white matter hyperintensities and cross-sectional hippocampal volume on antemortem MRI. Whole-brain and regional precuneus, motor, and somatosensory atrophy rates were higher in subjects with microinfarcts compared to subjects without microinfarcts. Microinfarcts increase brain atrophy rates independent of Alzheimer disease pathology. Association between microinfarct pathology and macroinfarcts on MRI suggests either common risk factors or a shared pathophysiology and potentially common preventive targets.

Genetically modified mice represent useful tools for traumatic brain injury (TBI) research and attractive preclinical models for the development of novel therapeutics. Experimental methods that minimize the number of mice needed may increase the pace of discovery. With this in mind, we developed and characterized a prototype electromagnetic (EM) controlled cortical impact device along with refined surgical and behavioral testing techniques. By varying the depth of impact between 1.0 and 3.0 mm, we found that the EM device was capable of producing a broad range of injury severities. Histologically, 2.0-mm impact depth injuries produced by the EM device were similar to 1.0-mm impact depth injuries produced by a commercially available pneumatic device. Behaviorally, 2.0-, 2.5-, and 3.0-mm impacts impaired hidden platform and probe trial water maze performance, whereas 1.5-mm impacts did not. Rotorod and visible platform water maze deficits were also found following 2.5-and 3.0-mm impacts. No impairment of conditioned fear performance was detected. No differences were found between sexes of mice. Inter-operator reliability was very good. Behaviorally, we found that we could statistically distinguish between injury depths differing by 0.5 mm using 12 mice per group and between injury depths differing by 1.0 mm with 7-8 mice per group. Thus, the EM impactor and refined surgical and behavioral testing techniques may offer a reliable and convenient framework for preclinical TBI research involving mice.

Background:Patients with neurologic conditions commonly have depression. Online tools have the potential to improve outcomes in these patients in an efficient and accessible manner. We aimed to identify evidence-informed online tools for patients with comorbid neurologic conditions and depression.Methods:A scoping review of online tools (free, publicly available, and not requiring a facilitator) for patients with depression and epilepsy, Parkinson disease (PD), multiple sclerosis (MS), traumatic brain injury (TBI), or migraine was conducted. MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL Register of Controlled Trials were searched from database inception to January 2017 for all 5 neurologic conditions. Gray literature using Google and Google Scholar as well as app stores for both Android and Apple devices were searched. Self-management or self-efficacy online tools were not included unless they were specifically targeted at depression and on...

Реферат: В обзоре представлены результаты исследований зарубежных и отечественных ученых, отражающие основные достижения в области применения клеточных технологий в терапии болезней нервной системы и лечебного потенциала клеток кордовой крови в экспериментальной и клинической неврологии. Дана классификация клеточных популяций, выделенных из кордовой крови, показана возможность их применения для лечения неврологического дефицита. Рассматриваются различные подходы к трансплантации клеток кордовой крови в зависимости от способа введения и концентрации клеток. Обсуждаются возможные механизмы терапевтического действия этих клеток, а также их способность к миграции в мозг через гематоэнцефалический барьер. Ключевые слова: клеточная терапия, кордовая кровь, стволовые клетки, неврологический дефицит. Реферат: В огляді представлено результати досліджень зарубіжних і вітчизняних вчених, які відображають основні досягнення в галузі застосування клітинних технологій у терапії хвороб нервової системи та лікувального потенціалу клітин кордової крові в експериментальній і клінічній неврології. Подано класифікацію клітинних популяцій, виділених із кордової крові, доведено можливість їх застосування для лікування неврологічного дефіциту. Розглядаються різні підходи до трансплантації клітин кордової крові залежно від способу введення та концентрації клітин. Обговорюються можливі механізми терапевтичної дії цих клітин, а також питання їхньої здатності до міграції в мозок через гематоенцефалічний бар'єр. Ключові слова: клітинна терапія, кордова кров, стовбурові клітини, неврологічний дефіцит.

Реферат: В обзоре представлены результаты исследований зарубежных и отечественных ученых, отражающие основные достижения в области применения клеточных технологий в терапии болезней нервной системы и лечебного потенциала клеток кордовой крови в экспериментальной и клинической неврологии. Дана классификация клеточных популяций, выделенных из кордовой крови, показана возможность их применения для лечения неврологического дефицита. Рассматриваются различные подходы к трансплантации клеток кордовой крови в зависимости от способа введения и концентрации клеток. Обсуждаются возможные механизмы терапевтического действия этих клеток, а также их способность к миграции в мозг через гематоэнцефалический барьер. Ключевые слова: клеточная терапия, кордовая кровь, стволовые клетки, неврологический дефицит. Реферат: В огляді представлено результати досліджень зарубіжних і вітчизняних вчених, які відображають основні досягнення в галузі застосування клітинних технологій у терапії хвороб нервової системи та лікувального потенціалу клітин кордової крові в експериментальній і клінічній неврології. Подано класифікацію клітинних популяцій, виділених із кордової крові, доведено можливість їх застосування для лікування неврологічного дефіциту. Розглядаються різні підходи до трансплантації клітин кордової крові залежно від способу введення та концентрації клітин. Обговорюються можливі механізми терапевтичної дії цих клітин, а також питання їхньої здатності до міграції в мозок через гематоенцефалічний бар'єр. Ключові слова: клітинна терапія, кордова кров, стовбурові клітини, неврологічний дефіцит.

Surgically removing a focus of epileptogenicity attributable to a multiple sclerosis (MS) plaque has not previously been considered a treatment option. Medically intractable partial epilepsy due to a chronically situated MS plaque is uncommon because most cases are self-limiting or managed with antiepileptic medication. We report a case of partial epilepsy resulting from such a plaque situated at the gray-white interface in the anterior prahippocampal gyrus. A favorable outcome was achieved by resection of the epileptogenic area.

Despite the wide diffusion of subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease, systematic practical recommendations for intraoperative electrophysiological monitoring are still lacking. In this paper, a shared protocol for intraoperative electrophysiological monitoring arising from the meetings of a panel of neurophysiologists of the DBS Study Group of the Italian Neurological Society is proposed. Intraoperative monitoring is composed by microrecordings and functional stimulation. In microrecordings, it is recommended to use at least 2-3 electrodes, descending with steps of 0.5-1 mm and waiting at least 60 s before changing the position. Functional stimulation is used to assess the clinical efficacy and the side effects induced by STN-DBS at different positions. Based on the therapeutic window, an algorithm to find the optimal target is proposed. The procedures for intraoperative monitoring for STN-DBS proposed here are safe, relatively cheap, take approximately 30-40 min per side and could offer valuable additional information to the surgeon.

Chronic loss of sleep damages health and disturbs the quality of life. Long-lasting sleep deprivation (SD) as well as sleep abnormalities are substantial risk factors for major depressive disorder, although the underlying mechanisms are not clear. Here, we showed that chronic SD in mice promotes a gradual elevation of extracellular ATP, which activates astroglial P2X 7 receptors (P2X 7 Rs). Activated P2X 7 Rs, in turn, selectively down-regulated the expression of 5-HT 2B receptors (5-HT 2B Rs) in astrocytes. Stimulation of P2X 7 Rs induced by SD selectively suppressed the phosphorylation of AKT and FoxO3a in astrocytes, but not in neurons. The overexpression of FoxO3a in astrocytes inhibited the expression of 5-HT 2B Rs. Down-regulation of 5-HT 2Bs Rs instigated by SD suppressed the activation of STAT3 and relieved the inhibition of Ca 2? -dependent phospholipase A2. This latter cascade promoted the release of arachidonic acid and prostaglandin E2. The depression-like behaviors induced by SD were alleviated in P2X 7 R-KO mice. Our study reveals the mechanism underlying chronic SD-induced depression-like behaviors and suggests 5-HT 2B Rs as a key target for exploring therapeutic strategies aimed at the depression evoked by sleep disorders.

Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the varia...

Heat stroke is the result of high heat stress and determines multiorgan dysfunction with predominant encephalopathy. Heat stroke only rarely leads to permanent neurologic deficits with a propensity to cerebellar dysfunction while memory disorders are very unusual. We report a unique case of a patient who suffered from a heat stroke after strenuous physical activity and sauna, resulting in persistent memory deficit with normal acute and follow-up normal MRI. Neuropsychological assessment suggested an involvement of the hippocampal-depending memory process. This is the only case in literature with long-lasting memory deficit with no MRI abnormalities, following heat stroke after excessive exercise and sauna.

Variations in the cerebellum to plasma ratio at late times in 6-[18F]fluoro-l-DOPA studies are shown to be consistent with competitive binding of large neutral amino acids for a common transporter in the blood—brain barrier and the stability of brain tissue large neutral amino acid level in the presence of plasma level changes. The distribution volume of an inert large neutral amino acid can be estimated from plasma and tissue large neutral amino acid levels and apparent half-saturation concentrations ( Km) of the transporter in the blood—brain barrier. Stability of brain large neutral amino acid levels is supported by literature findings and can be explained by high saturation of the large neutral amino acid transporter at physiologic conditions.

Background of study : Being an Asian country, Pakistan has a high ratio of population infected with the HBV. Various studies carried out in Pakistan have clearly showed that medical students do not have sufficient knowledge about blood borne diseases. Health care workers are predisposed to higher risks of contracting HBV as it is transmitted through blood and body fluids and accidental contact with these fluids is inevitable while treating the patients. This risk is even higher amongst medical students during their clinical years as they have inadequate experience and skills and the exposure to contaminated fluids becomes far more likely.  Objectives of study: To determine knowledge, attitude & practices regarding vaccination against HBV among   MBBS 4 th years students of Nishtar Medical College, Multan. To determine the frequency of 4 th year students vaccinated against HBV Material and Methods : It is a cross sectional study. The sample of study was 167 students. The data was col...

Lesions of the upper extremity, particularly of the hand, are common in congenital insensitivity syndromes. Five cases are described with findings including fractures, infections, stiffness of fingers, self-mutilation, and traumatic amputations. The best form of treatment is preventative, since reconstructive surgery has little to offer. If conservative efforts are of no avail, amputation of the part is, unfortunately, the best way to obtain satisfactory results. (J HAND SURG 9A: 863-9, 1984.

Introduction-In sub-Saharan Africa (SSA), the clinical and progressive diagnostic certainty of AIDS dementia is difficult to establish due to under-medicalization and delays in consultation and especially the diversity of etiologies of demented states. Material and methods: We carried out a retrospective study of 196 patients hospitalized for dementia syndrome between 2016 and 2021 in the neurology department of the University Hospital of Conakry. The criteria labeled in this study are those retained by the DSM-IV and the classification of the American Academy of Neurology (AAN) developed in accordance with the WHO. Results- The HIV etiology was retained in patients aged 44 to 67 (17 women and 19 men). The clinical picture is dominated by severe cognitive disorders, slowing of ideation, memory disorders, reduced motor skills associated with personality change. Neurological examination revealed dysphoric disorders in most patients, sphincter abnormalities in 13 cases and tremor of th...

The incidence of somatosensory, visual half-field and motor deficits contralateral to a hemispheric lesion in a continuous series of 154 left brain damaged and 144 right brain damaged stroke patients were investigated. These contralateral disor- ders were more frequent after lesions of the right hemisphere. This difference cannot be attributed to a bias in patients' selection. It is suggested that left spatial neglect is the factor underlying this hemispheric difference.

Resting-state connectivity has been widely studied in the healthy and pathological brain. Less well-characterized are the brain networks altered during pharmacological interventions and their possible interaction with vigilance. In the hopes of finding new biomarkers which can be used to identify cortical activity and cognitive processes linked to the effects of drugs to treat neurodegenerative diseases such as Alzheimer's disease, the analysis of networks altered by medication would be particularly interesting. Eleven healthy subjects were recruited in the context of the European Innovative Medicines Initiative 'PharmaCog'. Each underwent five sessions of simultaneous EEG-fMRI in order to investigate the effects of donepezil and memantine before and after sleep deprivation (SD). The SD approach has been previously proposed as a model for cognitive impairment in healthy subjects. By applying network based statistics (NBS), we observed altered brain networks significantly...

Somatic mutations that activate phosphoinositide 3-kinase (PI3K) have been identified in the p110-α catalytic subunit (PIK3CA) 1. They are most frequently observed in two hotspots: the helical domain (E545K and E542K) and the kinase domain (H1047R). Although the PIK3CA mutants are transforming in vitro, their oncogenic potential has not been assessed in genetically engineered mouse models. Furthermore, clinical trials with PI3K inhibitors have recently been initiated, and it is unknown if their efficacy will be restricted to specific, genetically defined malignancies. In this study, we engineered an inducible bitransgenic mouse model that develops lung adenocarcinomas initiated and maintained by expression of p110-α H1047R. Treatment of these tumors with NVP-BEZ235, a dual pan PI3K/mTOR inhibitor in clinical development, led to marked tumor regression as shown by PET-CT, MRI and microscopic examination. In contrast, mouse lung cancers driven by mutant K-Ras did not substantially respond to single-agent NVP-BEZ235. However, when NVP-BEZ235 was combined with a MEK inhibitor, ARRY-142886, there was dramatic synergy in shrinking these K-Ras mutant cancers. These in vivo studies suggest Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:

Methylphenidate produces its effects via actions on cortical areas involved with attention and working memory, which have a direct role in time estimation judgment tasks. In particular, the prefrontal and parietal cortex has been the target of several studies to understand the effect of methylphenidate on executive functions and time interval perception. However, it has not yet been studied whether acute administration of methylphenidate influences performance in time estimation task and the changes in alpha band absolute power in the prefrontal and parietal cortex. The current study investigates the influence of the acute use of methylphenidate in both performance and judgment in the time estimation interpretation through the alpha band absolute power activity in the prefrontal and parietal cortex. This is a double-blind, crossover study with a sample of 32 subjects under control (placebo) and experimental (methylphenidate) conditions with absolute alpha band power analysis during a time estimation task. We observed that methylphenidate does not influence task performance (p > 0.05), but it increases the time interval underestimation by over 7 s (p < 0.001) with a concomitant decrease in absolute alpha band power in the ventrolateral prefrontal cortex and dorsolateral prefrontal cortex and parietal cortex (p < 0.001). Acute use of methylphenidate increases the time interval underestimation, consistent with reduced accuracy of the internal clock mechanisms. Furthermore, acute use of methylphenidate influences the absolute alpha band power over the dorsolateral prefrontal cortex, ventrolateral prefrontal cortex, and parietal cortex.

The five senses have specific ways to receive environmental information and lead to central nervous system. The perception of time is the sum of stimuli associated with cognitive processes and environmental changes. Thus, the perception of time requires a complex neural mechanism and may be changed by emotional state, level of attention, memory and diseases. Despite this knowledge, the neural mechanisms of time perception are not yet fully understood. The objective is to relate the mechanisms involved the neurofunctional aspects, theories, executive functions and pathologies that contribute the understanding of temporal perception. Articles form 1980 to 2015 were searched by using the key themes: neuroanatomy, neurophysiology, theories, time cells, memory, schizophrenia, depression, attention-deficit hyperactivity disorder and Parkinson’s disease combined with the term perception of time. We evaluated 158 articles within the inclusion criteria for the purpose of the study. We conclu...

To survey US physicians involved in acute stroke care to determine the proportion of hospitals that currently meet the recommended Brain Attack Coalition (BAC) criteria for Primary Stroke Centers (PSC) and obtain opinions regarding the value of stroke centers. Methods: A survey regarding the BAC guidelines for the establishment of stroke centers was mailed to 3,245 US neurologists, neurosurgeons, and emergency physicians. Results: A total of 1,032 responses were received. Seventy-nine percent (range by specialty 58 to 98%) of respondents believed there was a need for stroke centers. If formal stroke center designation were established, 81% (range 72 to 90%) would like their hospital to become a PSC. Although 77% of respondents believed that their hospital currently met recommended criteria for a PSC, only 7% actually meet all recommended elements. However, 44% of hospitals already provide most acute stroke services. The BAC criteria most frequently lacking were continuing medical education for professional stroke center staff, stroke training for emergency department staff, formal establishment of a stroke unit, and designation of a stroke center director. Conclusions: The majority of emergency medicine and neuroscience physician respondents involved in acute stroke care support the designation of primary stroke centers. Although respondents globally overestimated the extent to which their facilities currently meet BAC recommended criteria for PSC, detailed responses suggested that over 40% of hospitals possess substantial existing acute stroke care resources and are poised to function as PSC with modest additional administrative and financial commitment.

This article is an introduction to a Neurology ® series on quality and safety. It is intended to provide a general background on the quality improvement movement in health care along with an introduction to some of the major issues that are currently important. Issues introduced will be developed in greater detail in future articles. QUALITY IMPROVEMENT: A HISTORICAL PERSPECTIVE Since its inception over 100 years ago, the application of quality improvement (QI) has polarized the stakeholders in medical care. In 1914, Ernest Amory Codman, a surgeon at the Massachusetts General Hospital (MGH), established the first morbidity and mortality conferences. 1 He wanted to compare morbidity and mortality results between institutions. MGH management not only refused, but revoked his staff privileges, forcing his resignation. He responded by starting his own private hospital, the End Result Hospital, and published outcomes and error data on 337 patients from 1911 to 1916. 2 Subsequently, he was a founder of the Hospital Standardization Program, which eventually became The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations [JCAHO]). Adoption of formal QI principles in health care did not occur until decades after they were developed. Leaders of manufacturing and service industries, keen to obtain a competitive advantage, formalized the principles of continuous quality improvement (CQI) and total quality management (TQM) in the 1940s. Formal QI did not enter healthcare until the 1980s, when the JCAHO mandated QI and performance measures (outcomes and process) for hospital accreditation. By the 1990s, QI entered the outpatient arena, as some managed care organizations (MCO) began basing payments to primary care practitioners, in particular, on performance measures such as immunization rates, mammography screening, and other Health Plan Employer Data and Information Set or HEDIS performance measures criteria. Use of HEDIS measures, initially designed for use by purchasers and MCOs, is now widespread among employer-based MCOs and the Center for Medicare & Medicaid Services (CMS).

Measuring and reporting health care quality is increasingly becoming part of clinical practice and reimbursement for specialists, including neurologists. The goal is to improve the value of care. Current major programs tie quality measurements to reimbursement, including programs from the Centers for Medicare and Medicaid Services: the Physician Quality Reporting System, the Electronic Health Record Incentive Program (and Meaningful Use), and Accountable Care Organizations. Many specialty boards, including the American Board of Psychiatry and Neurology, now require clinical practice quality measurements for maintenance of certification. Practitioners may find these programs confusing, overlapping, burdensome, and not clearly relevant to promoting better patient care. Yet, integrating quality metrics into practice has entered the mainstream and is increasingly tied to reimbursement. Further, over the next few years, most programs will switch from bonus incentives for participation to penalties for nonparticipation. This article aims to clarify current and rising quality measurement programs relevant to neurologists.

Measures #1-6 and #9 are designed for any physician caring for patients with a diagnosis of stroke or transient ischemic attack (TIA) in the hospital setting Measures #7-8 are designed for radiologists and other physicians reading the imaging studies of patients with a diagnosis of stroke or TIA in the hospital setting Patients aged 18 years and older These clinical performance measures are designed for individual quality improvement. Some of the measures may also be appropriate for accountability if appropriate sample sizes and implementation rules are achieved.

This article is an introduction to a Neurology ® series on quality and safety. It is intended to provide a general background on the quality improvement movement in health care along with an introduction to some of the major issues that are currently important. Issues introduced will be developed in greater detail in future articles. QUALITY IMPROVEMENT: A HISTORICAL PERSPECTIVE Since its inception over 100 years ago, the application of quality improvement (QI) has polarized the stakeholders in medical care. In 1914, Ernest Amory Codman, a surgeon at the Massachusetts General Hospital (MGH), established the first morbidity and mortality conferences. 1 He wanted to compare morbidity and mortality results between institutions. MGH management not only refused, but revoked his staff privileges, forcing his resignation. He responded by starting his own private hospital, the End Result Hospital, and published outcomes and error data on 337 patients from 1911 to 1916. 2 Subsequently, he was a founder of the Hospital Standardization Program, which eventually became The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations [JCAHO]). Adoption of formal QI principles in health care did not occur until decades after they were developed. Leaders of manufacturing and service industries, keen to obtain a competitive advantage, formalized the principles of continuous quality improvement (CQI) and total quality management (TQM) in the 1940s. Formal QI did not enter healthcare until the 1980s, when the JCAHO mandated QI and performance measures (outcomes and process) for hospital accreditation. By the 1990s, QI entered the outpatient arena, as some managed care organizations (MCO) began basing payments to primary care practitioners, in particular, on performance measures such as immunization rates, mammography screening, and other Health Plan Employer Data and Information Set or HEDIS performance measures criteria. Use of HEDIS measures, initially designed for use by purchasers and MCOs, is now widespread among employer-based MCOs and the Center for Medicare & Medicaid Services (CMS).

Background: Measuring the quality of health care is a fundamental step toward improving health care and is increasingly used in pay-for-performance initiatives and maintenance of certification requirements. Measure development to date has focused on primary care and common conditions such as diabetes; thus, the number of measures that apply to neurologic care is limited. The American Academy of Neurology (AAN) identified the need for neurologists to develop measures of neurologic care and to establish a process to accomplish this. Objective: To adapt and test the feasibility of a process for independent development by the AAN of measures for neurologic conditions for national measurement programs. Methods: A process that has been used nationally for measure development was adapted for use by the AAN. Topics for measure development are chosen based upon national priorities, available evidence base from a systematic literature search, gaps in care, and the potential impact for quality improvement. A panel composed of subject matter and measure development methodology experts oversees the development of the measures. Recommendation statements and their corresponding level of evidence are reviewed and considered for development into draft candidate measures. The candidate measures are refined by the expert panel during a 30-day public comment period and by review by the American Medical Association for Current Procedural Terminology (CPT) II codes. All final AAN measures are approved by the AAN Board of Directors. Parkinson disease (PD) was chosen for measure development. A review of the medical literature identified 258 relevant recommendation statements. A 28-member panel approved 10 quality measures for PD that included full specifications and CPT II codes. The AAN has adapted a measure development process that is suitable for national measurement programs and has demonstrated its capability to independently develop quality measures.

While neuropsychological deficits have been reported in healthy individuals who use cannabis, data in patients with multiple sclerosis (MS) are lacking. Given that MS is associated with cognitive deterioration, the aim of this study was to determine the cognitive effects of inhaled or ingested cannabis in this population. Fifty MS patients (25 cannabis users and 25 non-users) completed the Minimal Assessment of Cognitive Function in MS battery of neuropsychological tests. Cannabis users had significantly poorer performance on measures of information processing speed, executive functions, and visuospatial perception, and were twice as likely to be classified as globally cognitively impaired. Similar results were found after controlling for potential confounding variables. This study provides evidence that prolonged cannabis use in MS patients is associated with poorer performance on cognitive domains commonly affected in this population. The therapeutic benefits patients may derive from using cannabis should be weighed against the associated cognitive side-effects. iii viii Appendix A: Pre-screening Questionnaire……………………………………….

Definición, clasificación y semiología del estado epiléptico. Conceptos actuales A pesar de ser una entidad neurológica reconocida, que amerita tratamiento de urgencia, la definición del estado epiléptico aún carece de un concepto unificado para indicar el momento de inicio de tratamiento. Se han propuesto a lo largo del tiempo múltiples esquemas de clasificación para definir el tipo de tratamiento, etiología y pronóstico. En este articulo se revisan las diferentes propuestas de definición y clasificación desde sus inicios hasta los conceptos actuales propuestos por la Liga Internacional contra la Epilepsia.