Inter-method reliability of the modified Rankin Scale in patients with subarachnoid hemorrhage

Background and objectives The modified Rankin Scale (mRS) is one of the most frequently used outcome measures in trials in patients with an aneurysmal subarachnoid hemorrhage (aSAH). The assessment method of the mRS is often not clearly described in trials, while the method used might influence the mRS score. The aim of this study is to evaluate the inter-method reliability of different assessment methods of the mRS.Methods This is a prospective, randomized, multicenter study with follow-up at 6 weeks and 6 months. Patients aged >= 18 years with aSAH were randomized to either a structured interview or a self-assessment of the mRS. Patients were seen by a physician who assigned an mRS score, followed by either the structured interview or the self-assessment. Inter-method reliability was assessed with the quadratic weighted kappa score and percentage of agreement. Assessment of feasibility of the self-assessment was done by a feasibility questionnaire.Results The quadratic weighted kappa was 0.60 between the assessment of the physician and structured interview and 0.56 between assessment of the physician and self-assessment. Percentage agreement was, respectively, 50.8 and 19.6%. The assessment of the mRS through a structured interview and by self-assessment resulted in systematically higher mRS scores than the mRS scored by the physician. Self-assessment of the mRS was proven feasible.Discussion The mRS scores obtained with different assessment methods differ significantly. The agreement between the scores is low, although the reliability between the assessment methods is good. This should be considered when using the mRS in clinical trials.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Analyse van cortico-putaminale en thalamo-corticale verbindingen bij de ziekte van Parkinson met behulp van diffusion tensor imaging.

Parkinson’s disease is a neurodegenerative disease, which is caused by loss of dopaminergic neurons in the substantia nigra pars compacta. In Parkinson’s disease, particular symptoms may be related to disturbed function of the premotor cortex, caused by a disruption of the cortico-basal ganglia thalamocortical circuitry. Differences in connections between the premotor cortex (ventral premotor cortex (PMv), dorsal premotor cortex (PMd) and supplementary motor area (SMA)) and putamen, and between premotor cortex and thalamus were quantified using Diffusion Tensor Imaging (DTI) in patients with Parkinson’s disease en healthy controls. To that end we analyzed 15 patients with Parkinson’s disease and 16 healthy controls with DTI. Differences were quantified using probabilistic tractography on a voxel basis. No significant differences were found between patients with Parkinson’s disease and healthy controls in the amount of connections between premotor cortex and putamen en premotor cortex and thalamus. There were more connections between the left SMA and left putamen, compared to left PMd and PMv putamen connections. Both the left and right SMA have more connections with the thalamus, compared to the PMd and PMv. The right PMd had more connections with the right thalamus, compared to the right PMv. These findings may support the view that the SMA has a more prominent role in the cortico-basal ganglia-thalamocortical circuit. Limitations of the DTI protocol used for data acquisition are a reason to be careful in drawing definite conclusions about possible differences.

Supplementary Material for: Anterior Temporal Atrophy and Posterior Progression in Patients with Parkinson's Disease

<b><i>Background:</i></b> Parkinson's disease (PD) is characterized by specific motor and nonmotor impairments. This suggests that PD is characterized by disease-specific regional cortical atrophy. Given the change of symptoms over time, a concurrent increase in regional atrophy may further be assumed to reflect the dynamic process of disease progression. <b><i>Methods:</i></b> In this study we retrospectively collected T1-weighted MRI scans from previous studies performed in our center, enabling the comparison of gray matter atrophy in 77 PD patients with 87 controls using voxel-based morphometry (VBM). This large VBM analysis provided the opportunity to investigate cortical atrophy in relation with disease progression. <b><i>Results:</i></b> We found significant PD-related reductions of gray matter density bilaterally in the anterior temporal cortex, the left inferior frontal and left extrastriate visual cortex, independent from normal aging. The anterior temporal cortex did not show major progression, whereas particularly the posterior parts of the lateral temporal cortex and adjacent extrastriate visual cortex occurred at a later stage of disease. <b><i>Conclusions:</i></b> Temporal pole atrophy as an early sign of PD is consistent with the PD pathology classification of Braak. The initial anterior temporal atrophy with spread to occipitotemporal and posterior parietal regions may subserve ‘emotion-based' sensorimotor transformations and deficits in the visual domain, respectively, which may be regarded as premotor symptoms