Neuropsühholoogia

Eesti Arst 2014; 93(5):289–29

Kognitiivse seisundi hindamine neuropsühholoogias

Kognitiivse seisundi hindamine pakub olulist lisainfot paljude neuroloogiliste ja psühhiaatriliste häiretega patsientide seisundi käsitlemisel. Hindamisel kasutatakse erinevaid teste ja katseid, analüüsides nii kvantitatiivseid tulemusi kui ka kvalitatiivset sooritust testide lahendamisel. See aitab täpsustada patsiendi vaimsete võimete taset, kognitiivsete kaebuste olemust ja neid tingivaid põhjusi ning seeläbi hõlbustab ravi planeerimist. Neuropsühholoogilised uuringud on olulised patsiendi funktsionaalse toimetuleku kindlaksmääramisel.Eesti Arst 2014; 93(5):276–28

Role preferences of people with Multiple Sclerosis: image-revised, computerized self-administered version of the control preference scale

Background: The Control Preference Scale (CPS) is the most frequently used measure of patients’ preferred roles in treatment decisions. We revised the original CPS and developed a new computerized patient self-administered version (eCPS). We used the eCPS to assess role preferences, and their determinants, in Italian and German people with multiple sclerosis (MS). Methods: New cartoons were produced, based on MS health professional and patient input/feedback and previous findings, and pilot tested on 26 Italian and German MS patients. eCPS acceptability and reliability (weighted kappa statistic, wK) in comparison to the original tool, was determined in 92 MS patients who received both CPS versions in random order. Results: The new cartoons were well accepted and easily interpreted by patients, who reported they based their choices mainly on the text and considered the images of secondary importance. eCPS reliability was moderate (wK 0.53, 95% confidence interval [CI] 0.40–0.65) and similar to the test-retest reliability of face-to-face administration assessed in a previous publication (wK 0.65, 95% CI 0.45–0.81). Higher education (odds ratio [OR] 3.74, 95% CI 1.00–14.05) and German nationality (OR 10.30, 95% CI 3.10–34.15) were associated with preference for an active role in the logistic model. Conclusions: The newly devised eCPS was well received and considered easy to use by MS patients. Reliability was in line with that of the original version. Role preference appears affected by cultural characteristics and (borderline statistical significance) education.</br

FungalTraits:A user-friendly traits database of fungi and fungus-like stramenopiles

The cryptic lifestyle of most fungi necessitates molecular identification of the guild in environmental studies. Over the past decades, rapid development and affordability of molecular tools have tremendously improved insights of the fungal diversity in all ecosystems and habitats. Yet, in spite of the progress of molecular methods, knowledge about functional properties of the fungal taxa is vague and interpretation of environmental studies in an ecologically meaningful manner remains challenging. In order to facilitate functional assignments and ecological interpretation of environmental studies we introduce a user friendly traits and character database FungalTraits operating at genus and species hypothesis levels. Combining the information from previous efforts such as FUNGuild and Fun(Fun) together with involvement of expert knowledge, we reannotated 10,210 and 151 fungal and Stramenopila genera, respectively. This resulted in a stand-alone spreadsheet dataset covering 17 lifestyle related traits of fungal and Stramenopila genera, designed for rapid functional assignments of environmental studies. In order to assign the trait states to fungal species hypotheses, the scientific community of experts manually categorised and assigned available trait information to 697,413 fungal ITS sequences. On the basis of those sequences we were able to summarise trait and host information into 92,623 fungal species hypotheses at 1% dissimilarity threshold

Riigi roll radikaalselt uuendusliku innovatsiooni leviku võimaldaja ja kiirendajana

Väitekirja elektrooniline versioon ei sisalda publikatsioone“Kuidas toetada innovatsiooni, mis aitaks kaasa ühiskonna ees seisvate suurte väljakutsete lahendamisele?” – see küsimus on viimasel aastakümnel üks peamisi, millega innovatsiooni juhtimise uurijad on tegelenud. Pikka aega on innovatsiooni toetamisel kasutatud peamiselt fiskaalseid toetusmeetmeid, seda eelkõige just teadus- ja arendustöö etapi edendamiseks. Viimastel aastakümnetel on lisandunud jõudsalt nõudluse toetamine ning siht on laienenud katmaks ka uudsete lahenduste turuletulekut. Kas riik võiks aga võtta veelgi aktiivsema rolli? Töös on vaatluse all kolm sellist juhtumit, kus Eesti riik on võtnud rolle, mis ületavad tavapäraseid innovatsioonipoliitika meetmeid. Esimene neist näitab elektromobiilsuse programmi ELMO loomise motivatsiooni, elluviimist ja tulemusi. Erinevaid sektoreid hõlmav ja tugevalt juurdunud tarbimisharjumusi muutev innovatsioon vajab leviku kiirendamiseks ka uudset lähenemist innovatsiooni toetamisel. Väikesel, paindlikul riigil on võimalik kiiresti reageerida ja olla nn. eluslabor (ingl k. living lab). Teine kaasus vaatab süvitsi elektriautode lühirendi teenuse pilootprojekti esmaste kasutajate profiili. Erinevalt küsitlusepõhiste uuringute tulemustest elektriauto ostmise kavatsuste kohta, on lühiajalise rendi puhul kasutajaskond palju mitmekesisem, eelkõige teenust 1-2 korda proovinute osas. Lühirendi püsikasutajate profiil on sarnasem elektriauto ostjatega. See näitab, et lisaks lühirendi kui vajaduspõhise ärimudeli levikule on sel pilootprojektil olnud olnud oluline roll ka võimalikele elektriauto ostjatele proovimisvõimaluse pakkumisel. Kolmas kaasus näitab samuti riigi tavapärasest aktiivsemat rolli innovatsiooni leviku võimaldaja ja toetajana. Maailma Terviseorganisatsiooni paberil rahvusvaheline vaktsineerimistunnistus on kasutusel juba 1962. aastast. Selle digitaliseerimine on tehnoloogiliselt oluliselt lihtsam kui globaalselt praktikas rakendamine. See nõuab rahvusvahelist koostööd mitmel eri tasandil, ning võtmeteguriks on võime luua ja alal hoida erinevate osapoolte usaldust. Kuna iga innovatsiooni levik sõltub usaldusest, siis siit tuleneb ka riigi oluline roll usalduskrediidi pakkujana. Kõik need kaasused omakorda pakuvad õppimiskohti ka innovatsioonipoliitika uuendamiseks.“How to support innovations that could help to solve the societal grand challenges?” – this question has been actively on the innovation management scholars’ agenda for the past decade. For long, the support for innovation has mainly been provided in the form of fiscal incentives and it has focused on the research and development phase. During the last decade the demand side measures supplemented the toolbox, and the focus has broadened to also cover the commercialisation and scaling up of the innovations. But could the government take an even more proactive role? The thesis in holds three case studies that showcase how the Estonian government has taken a role that extend the traditional innovation policy approaches. The first case shows the motivations, setup and outcomes of the Estonian electromobility pilot programme ELMO. An innovation that spans across sectors and challenges well-established consumption patterns requires innovativeness also in the innovation governance. A small and agile country can become a living lab for experimenting with such solutions. The second case takes a closer look at the pilot project of the electric cars short-term rental service’s first users. Unlike the survey-based studies about the intention to buy an electric car, there is more variety in the short-term rental service users, especially among those who have made 1-2 trials. The profile of repeat users is more similar to those of the potential electric cars’ buyers. Hence, in addition to piloting the car-as-a-service business model, the pilot project serves also as the risk-free test and demonstration platform for potential buyers. The third case focuses on the international vaccination certificate, but similarly, the focus lies on the government’s role in enabling and accelerating its diffusion. The current WHO-governed yellow booklet is in place already since 1962. But its digitalisation is technically much easier than achieving its global acceptance. The adoption requires international collaboration at various levels, and the key success factor is the ability to create and uphold trust among the stakeholders. As all innovations require trust for their diffusion, the government’s role as a trust credit provider can be crucial. Additionally, all these cases provide insights for innovating the innovation governance itself

Cognitive Profile and Depressive Symptoms in Patients With Epilepsy

Background and Objective. The aim of the present study was to describe the cognitive profile of patients with focal and generalized epilepsy syndrome in comparison with healthy control subjects and to investigate whether depression was related to neuropsychological functioning in these patients. Material and Methods. A total of 36 patients with focal epilepsy and 26 patients with generalized epilepsy were compared with the control group of healthy volunteers (n=53). A battery of neuropsychological tests assessing verbal and visual spatial memory and executive functioning was carried out in addition to the completion of the Beck Depression Inventory (BDI). Results. The results indicated that patients with epilepsy performed significantly worse than controls on all verbal memory subscales and verbal fluency domains. The patients with focal epilepsy scored significantly worse than the patients with generalized epilepsy. The BDI scores were significantly correlated with several scores of the cognitive test in both patients’ groups but not in the control group. Conclusions. Our results suggest that patients with epilepsy, especially with focal-onset epilepsy, show cognitive disturbances predominantly in the verbal memory domain. In addition, depression was found to have a negative effect on cognitive functioning in patients with epilepsy

Changes in Blood B Cell-Activating Factor (BAFF) Levels in Multiple Sclerosis: A Sign of Treatment Outcome.

Multiple sclerosis (MS) is mediated primarily by autoreactive T cells. However, evidence suggesting the involvement of humoral immunity in brain diseases has increased interest in the role of B cells and their products during MS pathogenesis. The major survival factor for B cells, BAFF has been shown to play a role in several autoimmune conditions. Elevated BAFF levels have been reported in MS animal model and during MS relapse in patients. Moreover, disease-modifying treatments (DMT) reportedly influence blood BAFF levels in MS patients, but the significance of these changes remains unclear. The present study addresses how blood BAFF levels are associated with the clinical course of relapsing-remitting MS and the effectiveness of DMT and short-term steroid treatment. During a prospective longitudinal follow-up of 2.3 years, BAFF was measured in the blood of 170 MS patients in the stable phase and within 186 relapses. BAFF levels were significantly higher in MS patients compared to healthy controls. However, stable MS patients without relapses exhibited significantly higher BAFF levels than relapsing patients. Treatment with interferon-β and immunosuppressants raised BAFF blood levels. Interestingly, a similar effect was not seen in patients treated with glatiramer acetate. Short-term treatment with high doses of intravenous methylprednisolone did not significantly alter plasma BAFF levels in 65% of relapsing-remitting MS patients. BAFF were correlated weakly but significantly with monocyte and basophil counts, but not with other blood cell types (neutrophils, lymphocytes, or eosinophils) or inflammatory biomarkers. To our knowledge, this is the first report demonstrating that higher blood BAFF levels may reflect a more stable and effective MS treatment outcome. These results challenge hypotheses suggesting that elevated blood BAFF levels are associated with more severe disease presentation and could explain the recent failure of pharmaceutical trials targeting BAFF with soluble receptor for MS treatment

Average BAFF plasma levels and disease-modifying treatments (DMT).

<p>Bee Swarm plot of BAFF level in untreated (UT), IFN-β, glatiramer acetate (GA) and immunosuppressant (IS)-treated groups were shown. Means and the results of Tukey HSD test are shown. *Average BAFF values during treatment were used. In case of medication change, the new average BAFF was analysed separately.</p

Patients with multiple sclerosis (MS) characteristics.

<p>¹ Interferon β i.e Betaferon®, Rebif® or Avonex®</p><p>² Glatiramer acetate i.e Copaxone®</p><p>³ Cytostatics includes mitoxantrone and cyclophosphamide</p><p>Patients with multiple sclerosis (MS) characteristics.</p

Average B cell-activating factor (BAFF) levels in the plasma of multiple sclerosis (MS) patients and controls.

<p>Bee Swarm plot of: (A) Plasma BAFF levels in healthy controls (HC group), patients with lower back pain (LBP group), and all MS patients. (B) Plasma BAFF levels in MS patient subgroups: stable MS patients (sRRMS), remission-relapsing MS patients (rrRRMS), and relapsing MS patients (rRRMS). Means and the results of Tukey HSD test are shown. Untreated (□) and IFN-β (●), GA (▽) or immunosuppressant (▲) treated individuals. *Average concentration of BAFF in patients during the follow-up period.</p