Role of transcranial brain parenchyma sonography and diffusion tensor imaging in detection of structural laesions of the brainstem raphe in patients with parkinson%s disease and depression

Studije sa transkranijalnom parenhimskom sonografijom (TCS) su pokazale postojanje smanjene ehogenosti ili izostanaka ultrazvučnog signala rafe (BR) u unipolarnoj depresiji i depresiji udruženoj sa Parkinsonovom bolešću (PB) ali i u depresiji u drugim neurodegenerativnim bolestima (Wilsonovoj, Hantingtonovoj, distoniji, ataksiji). Studije sa magnetskom rezonancom i histološke studije podržale su hipotezu o strukturnim promenama BR u depresiji udruženoj sa PB. Cilj ovog rada je bio poređenje specifičnih markera (difuzionog koeficijenta-MD i frakcionalne anizotropije-FA) difuzione tenzor magnetske rezonance (DTI) u predelu BR i različitih regiona sive i bele moždane mase kod pacijenata sa PB sa i bez depresije. Takođe, primenjena je DTI traktografija radi detekcije strukturnih lezija snopova bele moždane mase koji su uključeni u patogenezu depresije u PB. Metodologija U studiju su uključena 33 pacijenta sa PB i depresijom (PB+ D+), 32 PB pacijenta bez depresije (PB+ D-) and 34 zdrava ispitanika (PB- D-). Ispitanici u sve tri grupe su bili upareni po polu, starosti, Hoehn & Yahr stadiju PB, trajanju bolesti i UPDRS skoru. Ehogenost BR i struktura bazalnih ganglija je procenjivana primenom TCS. MD i FA vrednosti su kalkulisane primenom Statistical Parametric Mapping SPM5 softvera u 3 regiona od interesa (ROI) u predelu BR pri čemu ROI A predstavlja celokupnu strukturu BR, ROI B ventralni, a ROI C dorzalni segment BR. Više parenhimskih ROI pozicfionirano je primenom MriCron softvera u različitim regionima sive i bele moždane mase. Primenom metode DTI probabilističke traktografije ispitivane su, merenjem MD i FA vrednosti, strukturne lezije puteva bele moždane mase...Transcranial sonography (TCS) studies showed decreased echogenicity of the brainstem raphe (BR) in unipolar depression and in depression associated with Parkinson's disease (PD). Magnetic resonance imaging and histological studies supported the hypothesis of a structural disruption of the BR in depression in PD. We compared fractional anisotropy (FA) values and mean diffusivity (MD) obtained with diffusion tensor magnetic resonance imaging (DTI) of the BR in depressed and non-depressed PD patients, in comparison to TCS findings, to investigate alterations of the BR. DTI tractography was performed to detect which brain regions and white matter fiber tracts are involved in the pathogenesis of depression in PD. Methodology 33 PD patients with depression (PD+ D+), 32 PD patients without depression (PD+ D-) and 34 healthy individuals (PD- D-) were included. PD patients of both groups were matched for Hoehn & Yahr stage, age, duration of disease and UPDRS score. Echogenicity of BR was rated using TCS. MD and FA values were calculated using SPM5 software, in 3 regions of interest (ROI): ROI A encompassed the whole BR, ROI B the ventral, and ROI C the dorsal part of the BR. Different ROI were placed in various brain regions as well as white matter fiber tracts..

Kliničke i psihijatrijske manifestacije sindroma pečenja usta

According to International Headache Society (IHS) classification, burning mouth syndrome (BMS) is intra oral burning sensation without obvious medical and dental cause. IHS diagnostic criteria of the disorder include the presence of burning oral sensation during the most period of day without obvious changes of oral mucosa. Local and systemic causes have to be excluded by appropriate diagnostic procedures. Subjective feeling of dry mouth, paraesthesia and taste changes could be associated symptoms. Estimated prevalence of BMS in general population varies between 1 and 15% and the disorder is seven times more common in females. This condition is probably of multifactor origin, oft en idiopathic, and its etiology and pathogenesis has not been elucidated completely yet. More recently, increasing attention has been given to the altered perception of sensory functions as well as to the changes in the psychological profile of many BMS patients. As a result, both disturbances should be included in the clinical spectrum of BMS. BMS represents a disorder with a poor prognosis in terms of quality of life and treatment possibilities. As a result, BMS subjects continue to be high consumers of healthcare resources. As in the other chronic pain conditions it has been reported that depression and anxiety are strongly associated with BMS and that they are significantly more frequent in BMS patients than in non-BMS subjects.Prema međunarodnoj klasifikaciji glavobolja Internacionalnog društva za glavobolje (International Headache Society-IHS), sindrom pečenja usta (burning mouth syndrome-BMS) predstavlja osećaj pečenja u usnoj duplji, a bez očiglednog medicinskog ili stomatološkog uzroka. IHS dijagnostički kriterijumi za ovaj poremećaj uključuju prisustvo senzacije pečenja u usnoj duplji za vreme najvećeg perioda dana, bez vidljivih promena sluznice usne duplje. Lokalni i sistemski uzroci moraju biti isključeni primenom odgovarajućih dijagnostičkih procedura. Subjektivni osećaj suvoće usta, parestezija i izmena osećaja ukusa mogu biti udruženi simptomi. Procenjena prevalenca BMS u opštoj populaciji varira između 1 i 15%, a poremećaj je sedam puta češći kod žena. Ovaj poremećaj je verovatno multifaktorijelnog porekla, često idiopatski, a njegova etiologija i patogeneza nisu u potpunosti razjašnjeni. U skorašnjim studijama, posebno se ističe značaj izmenjene percepcije senzornih funkcija i sistema kao i specifična promena psihološkog profi la mnogih pacijenata sa BMS. Zbog toga se preporučuje da oba navedena poremećaja budu uključena u klinički raznovrstan spektar BMS. BMS ima lošu prognozu u pogledu kvaliteta života obolelih i terapijskih mogućnosti, a kao rezultat ovaj poremećaj predstavlja veliki socio-ekonomski i medicinski problem. Kao i kod drugih hroničnih bolnih stanja, postoji značajna udruženost BMS sa depresijom i anksioznošću. Ovi ali i drugi psihijatrijski i psihološki poremećaji su značajno češći kod pacijenata sa BMS u odnosu na zdravu populaciju

Transient ischemic attack (TIA) is an emergency

Transient ischemic attack (TIA) is a warning sign of stroke, and stroke is one of the leading causes of morbidity and mortality in the world. The assessment and management of TIAs can be difficult even for an experienced neurologist. The purpose of this article is to increase the awareness and establish a diagnostic and therapeutic approach to patientswith TIA. In terms of therapy, patients with TIA share the same recommendations as those with acute ischemic stroke. Based on the etiology, therapeutic measures for secondary prevention after a TIA include antithrombotic, antihypertensive, statins therapy, aswell as carotid intervention as appropriate. Itwas shown that early evaluation following appropriate treatment after TIA reduces the risk of the first and early recurrent stroke by about 80%, therefore TIA should be considered as an emergency and should be treated as such

Is the female sex associated with an increased risk for long-term cognitive decline after the first-ever lacunar stroke? Prospective study on small vessel disease cohort

Background: Sex is a significant determinant of survival and functional outcome after stroke. Long-term cognitive outcome after acute lacunar stroke in the context of sex differences has been rarely reported. Methods: A cohort of small vessel disease (SVD) patients presenting with first-ever acute lacunar stroke and normal cognitive status has been evaluated 4 years after the qualifying event for the presence of cognitive impairment (CI) with a comprehensive neuropsychological battery. Differences in baseline clinical and neuroimaging characteristics were compared between sexes in relation to cognitive status. Results: A total of 124 female and 150 male patients were analyzed. No difference was detected between the groups regarding age (p = 0.932) or frequency of common vascular risk factors (p > 0.1 for all). At the baseline assessment, women had more disabilities compared to men with a mean modified Rankin scale (mRS) score of 2.5 (1.5 in men, p < 0.0001). Scores of white matter hyperintensities (WMH) of presumed vascular origin and a total number of lacunes of presumed vascular origin on brain MRI were higher in women compared to men (p < 0.0001 for all). As many as 64.6% of patients had CI of any severity on follow-up, women more frequently (77.4%) than men (54.0%; p < 0.0001). Univariate logistic regression analysis showed that female sex, higher NIHSS and mRS scores, presence of depression, and increasing WMH severity were associated with an increased risk for CI. Multivariate regression analysis indicated that only depression (OR 1.74, 95%CI 1.25–2.44; p = 0.001) and WMH severity (OR 1.10, 95%CI 1.03–1.17; p = 0.004) were independently associated with the CI. Conclusion: At the long-term follow-up, women lacunar stroke survivors, compared to men, more frequently had CI in the presence of more severe vascular brain lesions, but this association was dependent on the occurrence of depression and severity of WMH, and could not be explained by differences in common vascular risk factors. Copyright © 2023 Pavlovic, Pekmezovic, Mijajlovic, Tomic and Zidverc Trajkovi

Level of education and cerebral small vessel disease

Bolest malih krvnih sudova mozga (BMKS) je odgovorna za najveći broj možda- nih udara i vaskularno kognitivno oštećenje i obično je posledica klasičnih vaskularnih faktora rizika. Cilj našeg rada je da se u kohorti bolesnika sa BMKS ispita povezanost stepena obrazovanja i kliničke i radiološke sli- ke BMKS. U studiji je analizirano 424 ispitanika, srednje životne dobi od 62 godine, 53% muškog pola, različitog stepena obrazovanja u trajanju od 8 do 20 godina. Pokazana je statistički značajna povezanost stepena obrazovanja sa postojanjem simptoma depresije (p=0,050), ukupnom težinom lezija na MR moz- ga (p=0,029), kao i ukupnim brojem izolovanih lakunarnih ishemija (p=0,032). Zabeležena je povezanost pola (p=0,055) i lezija u periventrikularnoj regiji (p=0,062) sa stepenom obrazovanja na nivou statističkog trenda. Mehanizmi kojima stepen obrazovanja može uticati na rizik za nastanak vaskular- nih lezija mozga nisu u potpunosti razjašnjenji. Deo ove povezanost se može objasniti nižim socijalno-ekonomskim statusom, povećanom učestalošću vaskularnih bolesti (hipertenzija, dijabetes) i nezdravim navikama (pušenje, visokokalorijska ishrana, sedentarni način života), ali postoje dokazi da je ova korelacija nezavisna od klasičnih vaskularnih faktora rizika. Otkrivanje i rano korigovanje preventibilnih faktora za nastanak vaskularnih lezija mozga od velikog je društvenog značaja, uz potencijal da rane socijalne i eduka- tivne intervencije pozitivno utiču na status cerebralne cirkulacije kasnije u životu.Cerebral small vessel disease (CSVD), the most frequent cause of stroke and vascular cognitive impairment, is typically associated with common vascular risk factors. Our paper aims to analyze the correlation between the level of education and clinical and radiological presentation in a cohort of patients with CSVD. A total of 424 patients have been recruited, with a mean age of 62 years, 53% males, with years of education ranging from 8 to 20. We found a statistically significant correlation between depressive symptoms (p=0.050), total severity of cerebral lesions on MR scans (p=0.029), and the total number of lacunar ischemic lesions (p=0.032). The correlation between sex (p=0.055) and periventricular lesions (p=0.062) with educational status was at the level of the statistical trend. The putative mechanisms of the association between education and the risk for vascular brain lesions were not fully elucidated. Partially, this association can be explained by lower socioeconomic status, increased incidence of vascular diseases (hypertension, diabetes), and unhealthy lifestyle (smoking, poor diet, sedentary lifestyle), however, this association might also be independent of common vascular risk factors. Identification and early management of preventable risk factors for cerebral vascular lesions are of most importance to society, with the potential of early social and educational intervention to positively affect cerebral circulation status later in life

Level of education and cerebral small vessel disease

Bolest malih krvnih sudova mozga (BMKS) je odgovorna za najveći broj možda- nih udara i vaskularno kognitivno oštećenje i obično je posledica klasičnih vaskularnih faktora rizika. Cilj našeg rada je da se u kohorti bolesnika sa BMKS ispita povezanost stepena obrazovanja i kliničke i radiološke sli- ke BMKS. U studiji je analizirano 424 ispitanika, srednje životne dobi od 62 godine, 53% muškog pola, različitog stepena obrazovanja u trajanju od 8 do 20 godina. Pokazana je statistički značajna povezanost stepena obrazovanja sa postojanjem simptoma depresije (p=0,050), ukupnom težinom lezija na MR moz- ga (p=0,029), kao i ukupnim brojem izolovanih lakunarnih ishemija (p=0,032). Zabeležena je povezanost pola (p=0,055) i lezija u periventrikularnoj regiji (p=0,062) sa stepenom obrazovanja na nivou statističkog trenda. Mehanizmi kojima stepen obrazovanja može uticati na rizik za nastanak vaskular- nih lezija mozga nisu u potpunosti razjašnjenji. Deo ove povezanost se može objasniti nižim socijalno-ekonomskim statusom, povećanom učestalošću vaskularnih bolesti (hipertenzija, dijabetes) i nezdravim navikama (pušenje, visokokalorijska ishrana, sedentarni način života), ali postoje dokazi da je ova korelacija nezavisna od klasičnih vaskularnih faktora rizika. Otkrivanje i rano korigovanje preventibilnih faktora za nastanak vaskularnih lezija mozga od velikog je društvenog značaja, uz potencijal da rane socijalne i eduka- tivne intervencije pozitivno utiču na status cerebralne cirkulacije kasnije u životu.Cerebral small vessel disease (CSVD), the most frequent cause of stroke and vascular cognitive impairment, is typically associated with common vascular risk factors. Our paper aims to analyze the correlation between the level of education and clinical and radiological presentation in a cohort of patients with CSVD. A total of 424 patients have been recruited, with a mean age of 62 years, 53% males, with years of education ranging from 8 to 20. We found a statistically significant correlation between depressive symptoms (p=0.050), total severity of cerebral lesions on MR scans (p=0.029), and the total number of lacunar ischemic lesions (p=0.032). The correlation between sex (p=0.055) and periventricular lesions (p=0.062) with educational status was at the level of the statistical trend. The putative mechanisms of the association between education and the risk for vascular brain lesions were not fully elucidated. Partially, this association can be explained by lower socioeconomic status, increased incidence of vascular diseases (hypertension, diabetes), and unhealthy lifestyle (smoking, poor diet, sedentary lifestyle), however, this association might also be independent of common vascular risk factors. Identification and early management of preventable risk factors for cerebral vascular lesions are of most importance to society, with the potential of early social and educational intervention to positively affect cerebral circulation status later in life

Fluoksetin ne remeti motornu funkciju kod bolesnika sa Parkinsonovom bolešću - korelacija raspoloženja i motorne funkcije sa koncentracijom fluoksetina/norfluoksetina u plazmi

Background/Aim. Selective serotonin reuptake inhibitors are the most commonly chosen antidepressants in patients with Parkinson's disease (PD). The aim of our study was to assess the influence of fluoxetine (Flu) on motor functions in patients with PD. Methods. In this prospective, controlled, open-label study, 18 patients with PD and mild depression [(10 ≤ Hamilton Rating Scale for Depression (HDRS) ≤ 23)] without dementia [(25 ≤ Mini-Mental State Examination (MMSE)] were treated with Flu. Both single and repeated dose effects of Flu were assessed on days 1-80. Plasma concentrations of Flu and norfluoxetine (NORFlu) were correlated with the results of selected motor function performance scores: The Unified Parkinsons Disease Rating Score (UPDRS), Finger Tapping Test (FTT) and Purdue Pegboard Test (PPT). Severity of PD, depression and dementia were evaluated using standard tests [(Hoehn and Yahr stages (HY), activity of daily living (ADL), UPDRS, HDRS, MMSE)]. Results. Steady-state for Flu/NORFlu was reached after 18 days of treatment. Such a plateau correlated with significant improvements in both scores of depression and Parkinson's disability (HDRS, UPDRS and ADL, respectively). In addition, FTT and PPT scores also increased until day 18, with further slight fluctuations around the plateau. Optimal motor performances correlated with Flu concentrations of approximately 60-110 μg/L. Conclusion. Flu (20 mg/day) significantly reduced depression in PD patients while it did not impair their motor performances. Because substantial placebo effects may arise in studies of PD and depression, large, prospective, randomized, placebo-controlled clinical trials are warranted.Uvod/Cilj. Selektivni inhibitori ponovnog preuzimanja serotonina su antidepresivi koji se najčešće koriste u lečenju obolelih od Parkinsonove bolesti (PB). Cilj ovog istraživanja bio je da se proceni uticaj fluoksetina (Flu) na motorne funkcije bolesnika sa PB. Metode. U ovom prospektivnom, kontrolisanom, otvorenom kliničkom ispitivanju, 18 bolesnika sa PB i blagom depresijom [10 ≤ Hamiltonova skala za depresiju (10 ≤ HDRS) ≤ 23)], bez demencije [(25 ≤ Mini mental test (MMSE)] lečeni su primenom Flu. Procenjivana su dejstva kako pojedinačne, tako i ponovljene doze Flu od prvog do osamdesetog dana. Plazma koncentracije Flu i norfluoksetina (NORFlu) korelisane su sa rezultatima odeđenih testova za motorne funkcije: skala za procenu težine PB (UPDRS), test spretnosti kucanja (FTT) i Purdue pegboard Test PPT). Izraženost PD, depresije i demencije procenjivane su korišćenjem standardnih testova [(test dnevnih aktivnosti (ADL), Hoehn.-Yahr. stadijumi (HJ), HDRS, MMSE)]. Rezultati. Ravnotežno stanje za Flu/NORFlu postignuto je 18. dana lečenja. Takav plato u koncentraciji Flu/NORFlu bio je praćen značajnim poboljšanjem rezultata, kako testova za depresiju, tako i za izraženost PB (HDRS, UPDRS i ADL, sledstveno). Dodatno, rezultati FTT-a i PPT-a bili su u porastu do 18. dana, sa blagim fluktuacijama oko platoa. Optimalna motorna postignuća zabeležena su pri koncentraciji Flu od oko 60-110 μg/L. Zaključak. Flu (20 mg/dan) značajno redukuje depresiju kod bolesnika sa PB i ne remeti motorne funkcije. S obzirom na mogući placebo efekat u istraživanjima sa PB i depresijom, neophodna su obimnija, prospektivna, randomizovana, placebo- kontrolisana klinička ispitivanja

Post-stroke dementia - a comprehensive review

Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and assess cognition, with few PSD-specific instruments. Choice will depend on purpose of assessment, with differing instruments needed for brief screening (e.g., Montreal Cognitive Assessment) or diagnostic formulation (e.g., NINDS VCI battery). A comprehensive evaluation should include assessment of pre-stroke cognition (e.g., using Informant Questionnaire for Cognitive Decline in the Elderly), mood (e.g., using Hospital Anxiety and Depression Scale), and functional consequences of cognitive impairments (e.g., using modified Rankin Scale). A large number of biomarkers for PSD, including indicators for genetic polymorphisms, biomarkers in the cerebrospinal fluid and in the serum, inflammatory mediators, and peripheral microRNA profiles have been proposed. Currently, no specific biomarkers have been proven to robustly discriminate vulnerable patients (‘at risk brains’) from those with better prognosis or to discriminate Alzheimer’s disease dementia from PSD. Further, neuroimaging is an important diagnostic tool in PSD. The role of computerized tomography is limited to demonstrating type and location of the underlying primary lesion and indicating atrophy and severe white matter changes. Magnetic resonance imaging is the key neuroimaging modality and has high sensitivity and specificity for detecting pathological changes, including small vessel disease. Advanced multi-modal imaging includes diffusion tensor imaging for fiber tracking, by which changes in networks can be detected. Quantitative imaging of cerebral blood flow and metabolism by positron emission tomography can differentiate between vascular dementia and degenerative dementia and show the interaction between vascular and metabolic changes. Additionally, inflammatory changes after ischemia in the brain can be detected, which may play a role together with amyloid deposition in the development of PSD. Prevention of PSD can be achieved by prevention of stroke. As treatment strategies to inhibit the development and mitigate the course of PSD, lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory agents have all been studied without convincing evidence of efficacy. Lifestyle interventions, physical activity, and cognitive training have been recently tested, but large controlled trials are still missing

Role of transcranial brain parenchyma sonography and diffusion tensor imaging in detection of structural laesions of the brainstem raphe in patients with parkinson%s disease and depression

Studije sa transkranijalnom parenhimskom sonografijom (TCS) su pokazale postojanje smanjene ehogenosti ili izostanaka ultrazvučnog signala rafe (BR) u unipolarnoj depresiji i depresiji udruženoj sa Parkinsonovom bolešću (PB) ali i u depresiji u drugim neurodegenerativnim bolestima (Wilsonovoj, Hantingtonovoj, distoniji, ataksiji). Studije sa magnetskom rezonancom i histološke studije podržale su hipotezu o strukturnim promenama BR u depresiji udruženoj sa PB. Cilj ovog rada je bio poređenje specifičnih markera (difuzionog koeficijenta-MD i frakcionalne anizotropije-FA) difuzione tenzor magnetske rezonance (DTI) u predelu BR i različitih regiona sive i bele moždane mase kod pacijenata sa PB sa i bez depresije. Takođe, primenjena je DTI traktografija radi detekcije strukturnih lezija snopova bele moždane mase koji su uključeni u patogenezu depresije u PB. Metodologija U studiju su uključena 33 pacijenta sa PB i depresijom (PB+ D+), 32 PB pacijenta bez depresije (PB+ D-) and 34 zdrava ispitanika (PB- D-). Ispitanici u sve tri grupe su bili upareni po polu, starosti, Hoehn & Yahr stadiju PB, trajanju bolesti i UPDRS skoru. Ehogenost BR i struktura bazalnih ganglija je procenjivana primenom TCS. MD i FA vrednosti su kalkulisane primenom Statistical Parametric Mapping SPM5 softvera u 3 regiona od interesa (ROI) u predelu BR pri čemu ROI A predstavlja celokupnu strukturu BR, ROI B ventralni, a ROI C dorzalni segment BR. Više parenhimskih ROI pozicfionirano je primenom MriCron softvera u različitim regionima sive i bele moždane mase. Primenom metode DTI probabilističke traktografije ispitivane su, merenjem MD i FA vrednosti, strukturne lezije puteva bele moždane mase...Transcranial sonography (TCS) studies showed decreased echogenicity of the brainstem raphe (BR) in unipolar depression and in depression associated with Parkinson's disease (PD). Magnetic resonance imaging and histological studies supported the hypothesis of a structural disruption of the BR in depression in PD. We compared fractional anisotropy (FA) values and mean diffusivity (MD) obtained with diffusion tensor magnetic resonance imaging (DTI) of the BR in depressed and non-depressed PD patients, in comparison to TCS findings, to investigate alterations of the BR. DTI tractography was performed to detect which brain regions and white matter fiber tracts are involved in the pathogenesis of depression in PD. Methodology 33 PD patients with depression (PD+ D+), 32 PD patients without depression (PD+ D-) and 34 healthy individuals (PD- D-) were included. PD patients of both groups were matched for Hoehn & Yahr stage, age, duration of disease and UPDRS score. Echogenicity of BR was rated using TCS. MD and FA values were calculated using SPM5 software, in 3 regions of interest (ROI): ROI A encompassed the whole BR, ROI B the ventral, and ROI C the dorsal part of the BR. Different ROI were placed in various brain regions as well as white matter fiber tracts..