Effect of clinical autonomic dysfunction on cognitive functions in Parkinson’s disease

Objective: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder characterized by tremor, rigidity, bradykinesia, and postural instability. PD also involves nonmotor manifestations such as autonomic failure, cognitive disorders, and sleep disorders. These clinical characteristics are not identical in severity, frequency, and onset time in all PD patients. We assessed whether there is a negative effect on cognition of clinical autonomic dysfunction in PD patients. Methods: This prospective study includes 37 PD patients with autonomic failure. From each patient, a questionnaire (SCOPA-AUT) including symptoms associated with clinical autonomic dysfunction such as constipation, urinary incontinence, orthostatic hypotension, and hyperhydrosis was obtained and the patient’s clinical condition was rated on the Hoehn and Yahr (H-Y) scale in the ON-medication state. The patients’ cognitive function was assessed by the Mini-Mental State Examination (MMSE), Blessed score, Frontal Assessment Battery (FAB), and Digid Span Test (DST) (forward, reverse). Cognitive test scores were compared with SCOPA-OUT scores. Results: Mean age was 66,5±11.2 years. There was no correlation between cognitive test scores and SCOPA -OUT scores (p>0.05). However, H-Y scores were negatively correlated with the DSTf, DSTr, FAB, and MMSE scores (p50.005, r:-0.451; p50.025, r: -0.367; p50.040, r: -0.340; p50.044, r5-0.333, respectively). Conclusions: According to our results, clinical autonomic dysfunction did not seem to ha ve an effect on cognition. In addition, severity of cognitive dysfunction showed a strong negative correlation with the stage of disease

Elevated Red Blood Cell Distribution Width May Be a Novel Independent Predictor of Poor Functional Outcome in Patients Treated with Mechanical Thrombectomy

Purpose Red blood cell distribution width (RDW) evaluates the variation (size heterogeneity) in red blood cells. Elevated RDW has been identified as a predictor of poor functional outcomes for acute ischemic stroke. The association between elevated RDW level and poor functional outcome in stroke patients undergoing mechanical thrombectomy has not been reported before. This study aims to investigate this relationship. Materials and Methods This was a multicenter retrospective study involving the prospectively and consecutively collected data of 205 adult stroke patients who underwent mechanical thrombectomy for anterior circulation large vessel occlusion (middle cerebral artery M1, anterior cerebral artery A1, tandem ICA-MCA, carotid T) between July 2017 and December 2019. RDW cut off levels were accepted as >16%. The effect of elevated RDW on poor functional outcome (modified Rankin scale 3–6) was investigated using bivariate and multivariate regression analysis. Results Elevated RDW was significantly associated with poor functional outcome in bivariate and multivariate analysis (odds ratio [OR] for RDW >16%, 2.078; 95% confidence interval [95% CI], 1.083–3.966; P=0.027 and OR for RDW >16%, 2.873; 95% CI, 1.342–6.151; P=0.007; respectively). Conclusion These findings suggest that elevated RDW may be an independent predictor of poor functional outcomes in ischemic stroke patients undergoing mechanical thrombectomy

Acute Bacterial Parotitis in Intensive Care Patients: Four Case Reports

Acute Bacterial Parotitis (ABP) is an infection seen in very early and old ages. The infection can be prevented by sufficient fluid support, mouth hygiene, oral feeding and avoiding multiple medication use. Parotis ultrasonography can be used for diagnosis. Acute Bacterial Parotitis can be treated in a short time and free of problems with early diagnosis and appropriate antibiotics. Mortality can be seen in cases which are late diagnosed and which are resistant to antibiotic treatment. This article presents four case reports over the age of 65 with a diagnosis of ABP, who are monitored in the intensive care. It is thought that the first case developed ABP because of multiple medication use, liquid restriction and oral feeding difficulty, the second case because of oral feeding difficulty, the third case because of bad mouth hygiene, dementia and not getting enough liquid and the fourth case because of oral feeding difficulty. If the cases with the stated risk factors are carefully followed, intensive care hospitalization period will not be prolonged and mortality rates will not increase

Clinical-epidemiological and radiological characteristics of stroke patients: A multicentre study

Introduction and Aim Stroke is the leading cause of disability in adults and the second most common cause of death, at a rate of 11.8% worldwide. The purpose of this study was to examine the aetiological, demographic, and clinical characteristics of patients admitted to hospital because of acute strokes. Materials and Methods This multicentre study retrieved information for all patients admitted to hospital because of an acute cerebrovascular event over a six-month period, and sociodemographic, aetiological, and clinical characteristics were recorded. Results A total of 1136 patients, 520 of whom were women (45.7%), with a mean age of 70.3 +/- 12.8 years, were included in the study. Of these, 967 were diagnosed with ischaemic stroke (IS) (85.1%), 99 with haemorrhagic stroke (HS) (8.7%), and 70 with transient ischaemic attack (6.1%). The most common risk factor for stroke was hypertension (73%). Carotid disease and hyperlipidaemia rates were higher in patients with HS. Numbers of functionally dependent patients with severe neurological status according to the National Institutes of Health Stroke Scale and modified Rankin scale were significantly higher in the HS group (P < .001). When IS was classified according to the Trial of Org 10172 in Acute Stroke Treatment, small vessel disease emerged as the most common cause (41%). The most common lesion localisations were the parietal lobe (23%) in the IS group and the thalamus (35.3%) in the HS group. Eighty-eight patients (7.7%), 62 (6.4%) in the ischaemic subgroup, and 26 (26.3%) in the haemorrhagic subgroup, died within the first month. Conclusion Current and accurate evaluations of stroke aetiology are essential for stroke prevention and treatment planning. This study, shows that no change occurred in the aetiology of stroke and epidemiological characteristics and that accurate identification of modifiable stroke risk factors is still a major goal

Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio >= 2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF