Inappropriate sexual behaviors in dementia and treatment approaches [Demansta uygunsuz seksüel davranişlar ve tedavi yaklaşimlari]

Dementias are the most encountered type of neurodegenerative disorders. Behavioral disturbances are common in dementia patients and almost 80% of patients with dementia show behavioral problems. Although inappropriate sexual behaviors are not as common as other behavioral problems seen in dementia, they can cause heavy trouble to patients who are affected and also caregivers. Inappropriate sexual behaviors in dementia have been relatively less investigated among other behavioral disturbances. At the present time, there are some controversies about the definition, types and content of sexual inappropriateness. There are no randomized drug trials for the treatment of inappropriate sexual behaviors in dementia, but the available data suggest efficacy of some commonly used treatment modalities. In this article, we overviewed various aspects of these behaviors and available treatment choices

What might cervical vestibular–evoked myogenic potential abnormalities mean in essential tremor?

2-s2.0-85104291576Aim/background: Essential tremor (ET) is one of the most common movement disorders. However, its pathogenesis is unclear. Human vestibular reflexes are essential not only for gait and posture but also for goal-directed voluntary movements. In this study, cervical vestibular–evoked myogenic potentials (cVEMPs), the electrophysiological equivalent of the vestibulo-collic reflex was studied in ET patients to understand the interaction between the tremor network and the vestibular neural pathways. Methods: cVEMPs were recorded in 40 ET patients and 40 age and sex-matched healthy controls (HCs). The latencies of peaks p13 and n23 and peak-to-peak amplitude of p13-n23 were measured. Results: There was no statistically significant difference between the p13 latencies of the HC and ET groups (p 0.79 and p 0.23 for the right and left sides respectively). n23 latency was shortened bilaterally in the ET group (p 0.009 and p 0.02 for the right and left sides respectively). p13-n23 amplitudes of the ET patients were bilaterally reduced when compared with the HC (p <0.001 and p 0.001 for the right and left sides respectively). Conclusion: Information provided by vestibular afferents is crucial in the control of voluntary movements in humans. Despite this silent but significant effect, the role of the vestibular system in movement disorders is often overlooked. In this study, it was found that cVEMP responses reflecting the activity of the vestibulo-collic pathway were affected in ET which can be either caused by dysfunctional structures or pathways responsible from ET or an additional disorder of vestibular information processing in these patients. © 2021, Fondazione Società Italiana di Neurologia

Evaluation of saccadic and smooth pursuit eye movements at an early stage of essential tremor [Esansiyel tremor erken döneminde sakkadik ve yavaş göz hareketlerinin değerlendirilmesi]

Objectives: Though still unclear cerebellar involvement is accepted as the underlying pathophysiological mechanism of at least advanced stages of essential tremor (ET). Eye movement abnormalities supporting this hypothesis have been reported. We tried to investigate saccadic and pursuit eye movements in ET patients at an early stage of the disease (mean disease duration 20.35 ± 10.51 months). Materials and Methods: Binocular horizontal saccadic and pursuit eye movements were recorded by using a video-based eye tracker in 25 patients with ET and 16 age matched controls. For the saccades peak saccadic velocity, latency and accuracy and for pursuit eye movements gain at three different target velocities (0.1, 0.2 and 0.4 Hz) was taken into consideration. Results: Peak saccadic latency, velocity and accuracy values recorded from the patients during saccadic eye movements were compared with the values gathered from the healthy controls revealing no significant difference (p>0.05). The same was true for pursuit eye movements. Pursuit gain at three different target velocities recorded from ET patients were not statistically different from the healthy controls (p>0.05). Conclusion: Normal eye movements at the early stage of the disease may indicate cerebellar dysfunction to be a late feature of ET. The other explanation can be the heterogeneous nature of the disease, those with abnormal eye findings representing a specific pathological subset. © 2016, Ege University Press. All rights reserved