Isolated, subtle, neurological abnormalities in neurologically and cognitively healthy aging subjects

The aim of this study is to describe the frequency of isolated, subtle, neurological abnormalities (ISNAs) in a large population of neurologically and cognitively healthy subjects and to compare ISNAs to various types of MRI-detected cerebrovascular lesions and subcortical brain atrophy in different age classes. 907 subjects were selected from a large, prospective hospital-based study. At baseline neurological examination, 17 ISNAs were selected. Primitive reflexes were the most common ISNAs (35.8 %), while dysphagia was the most rarely encountered (0.3 %). Measures of small vessel disease, i.e., deep and subcortical white matter hyperintensity and lacunar infarcts as well as subcortical atrophy, were variously associated with ISNAs. In the adult group, the ISNAs were associated with hypertriglyceridemia, TIA, and subcortical lacunar infarcts, while in the elderly-old group they were associated with arterial hypertension, subcortical white matter hyperintensity, and subcortical atrophy. An increased risk of ISNAs was associated with lacunae and white matter hyperintensity in the parietal region. This study shows that white matter hyperintensity, lacunae, and subcortical atrophy are associated with an increased risk of ISNAs in cognitively and neurologically healthy aging subjects. ISNAs are not benign signs. Therefore, adults and elderly people presenting with ISNAs should have access to accurate history and diagnosis to prevent progression of small vessel disease and future neurological and cognitive disabilities

The link between anesthesiology and neurology: a mindful cooperation to improve brain protection

Preventing neurological injury is mandatory during the perioperative period of any kind of surgery and in the care of critically ill patients in the intensive care unit. During daily practice, both anaesthesiologists and neurologists focus on brain protection as an integral part of systemic homeostasis maintenance. This article highlights the intriguing overlap between anaesthesiology and neurology in clinical practice along with its potential implications for outcome. Moreover, it focuses on the importance of the complementary expertise of both specialists in maintaining cerebral homeostasis, with the aim of improving outcome. A review of available evidence on anaesthesiology and neurology interplay in clinical practice along with its potential implications for outcome has been conducted. Clinical vigilance and the use of shared monitoring and diagnostic technology could allow early recognition and treatment of cerebral dysfunction occurring in the perioperative period or in the critical care setting, thus reducing morbidity and mortality. In order to improve patient safety and outcome, neurologists and anaesthesiologists should more closely and successfully collaborate, using shared monitoring tools and integrating traditional areas of expertise. Daily activity, education, research and training programs in anaesthesia and neurology could benefit from a stronger relationship with each other

Isolated, subtle, neurological abnormalities in neurologically and cognitively healthy aging subjects

The aim of this study is to describe the frequency of isolated, subtle, neurological abnormalities (ISNAs) in a large population of neurologically and cognitively healthy subjects and to compare ISNAs to various types of MRI-detected cerebrovascular lesions and subcortical brain atrophy in different age classes. 907 subjects were selected from a large, prospective hospital-based study. At baseline neurological examination, 17 ISNAs were selected. Primitive reflexes were the most common ISNAs (35.8 %), while dysphagia was the most rarely encountered (0.3 %). Measures of small vessel disease, i.e., deep and subcortical white matter hyperintensity and lacunar infarcts as well as subcortical atrophy, were variously associated with ISNAs. In the adult group, the ISNAs were associated with hypertriglyceridemia, TIA, and subcortical lacunar infarcts, while in the elderly–old group they were associated with arterial hypertension, subcortical white matter hyperintensity, and subcortical atrophy. An increased risk of ISNAs was associated with lacunae and white matter hyperintensity in the parietal region. This study shows that white matter hyperintensity, lacunae, and subcortical atrophy are associated with an increased risk of ISNAs in cognitively and neurologically healthy aging subjects. ISNAs are not benign signs. Therefore, adults and elderly people presenting with ISNAs should have access to accurate history and diagnosis to prevent progression of small vessel disease and future neurological and cognitive disabilities

Modulation of action tremor by repetitive transcranial magnetic stimulation in multiple sclerosis patients

Background: Patients affected by Multiple Sclerosis (MS) can show a tremor of their upper limbs, mostly during the performing of finalised action (action tremor) or at the maintaining of a position against gravity (postural tremor), as key clinical feature of their disease. Objectives: In order to reduce the tremor, patients underwent to repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex of left hemisphere. Methods: Eight patients affected by a middle form of MS were enrolled into the study. A standard neurological examination was carried out and the individual degree of disability was established employing the Expanded Disability Status Score (EDSS). At EDSS patients scored from 1.5 to 6.5, mean 4.6 ±1.9 SD. Tremor was rated according to the Fahn-Tolosa Marin Rating Scale. rTMS was delivered at 1 Hz frequency, along ten subsequent, separate sessions lasting ten minutes each one (i.e. 600 pulses). All subjects were aware about the aim of the study and fulfilled a formal consent. They were free to interrupt the study at any time. Before the first session, at the fifth day and at the last day of stimulation, kinematics of upper limb movements were recorded. Patients were asked to perform a continuous pointing, moving back and forth, as fast as possible, their right index finger between two black spots depicted on a working table, placed 15 cm apart. Task lasted six minutes divided in six parts, lasting one minute each one, divided by a resting period of 30 sec. Movements were recorded by means of a optoelectronic device (ELITE system) working at the sampling rate of 100 Hz. At the end of the last session a new clinical assessment was carried out. Results: Movement time, peak of velocity and acceleration and deceleration were analysed. Number of peaks of deceleration during the targeting phase was considered as the key marker of the tremor. Results of kinematics showed an overall improvement of symptoms including a decrease of time of movement execution and time of the deceleration phase as consequence of the reduction of number of peak of deceleration (i.e. tremor). Conclusions: Reduction of tremor became apparent at the clinical evaluation. Moreover, tremor was effectively influenced by rTMS and patients reported a subjective improvement of their symptoms. We concluded that this technique could be useful in order to reduce disability in MS patients

Vascular Risk Factors, Vascular Diseases, and Imaging Findings in a Hospital-based Cohort of Mild Cognitive Impairment Types

Background: Mild Cognitive Impairment (MCI) is a transitional state between normal cognition and dementia.Objective: The aim of this study is to investigate the role of vascular risk factors, vascular diseases, cerebrovascular disease and brain atrophy in a large hospital-based cohort of MCI types including 471 amnestic MCI (a-MCI), 693 amnestic MCI multiple domain (a-MCImd), 322 single non-memory MCI (snm-MCI), and 202 non amnestic MCI multiple domain (na-MCImd). For comparison, 1,005 neurologically and cognitively healthy subjects were also evaluated.Method: Several vascular risk factors and vascular diseases were assessed. All participants underwent neurological, neuropsychological and behavioural assessments as well as carotid ultrasonography and standard brain MRI. Multinomial logistic regression models on the MCI cohort with the NCH group and a-MCI type as reference categories were used to assess the effects of the variables evaluated on the estimated probability of one of the four MCI types.Results: This study demonstrates that cerebrovascular disease contributes substantially to the risk of non-memory MCI types and a-MCImd type, and that brain atrophy is present in all MCI types and is greater in multiple domain types particularly in the na-MCI type.Conclusion: Improving detection and control of cerebrovascular disease in aging individuals should be mandatory. Since the incidence of MCI and dementia will be expected to rise because of the progressive life expectancy, a better management of cerebrovascular disease could indeed prevent or delay the onset of MCI, or could delay progression of MCI to dementia

Prevalence and profile of mild cognitive impairment in Parkinson's disease

BACKGROUND/AIMS: The frequency of mild cognitive impairment (MCI) in Parkinson's disease (PD) ranges from 19 to 40%, and this is probably due to methodological differences between the studies. The aim of this study was to evaluate the frequency and profile of MCI in a large sample of nondemented PD subjects and neurologically healthy subjects (NHS). METHODS: A total of 872 subjects (582 controls and 290 PD) were included. The association between MCI and PD was tested, using logistic regression models; odds ratios (OR) with 95% confidence intervals (CI) were calculated. RESULTS: Fifty-three percent of PD subjects and 45% NHS met the criteria for MCI (p = 0.001). The PD subjects showed a higher frequency of nonamnestic MCI (naMCI), compared to NHS (23.8 vs. 14.4%, p ≤ 0.0001). In comparison to NHS, PD was associated with a univariate OR of 1.9 (95% CI = 1.3-2.8) for naMCI, and this association was marginally significant after multiple comparisons (multivariate OR = 1.5, 95% CI = 0.96-2.3, p = 0.077). CONCLUSION: The association between PD and the impairment of nonmemory domains is probably due to frontal-subcortical involvement, which characterizes the disease

Metabolic syndrome, mild cognitive impairment and dementia: data from the cognitive impairment through aging

mild cogntiive impairmen

Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

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