The COVID-19 pandemic and neurology: A survey on previous and continued restrictions for clinical practice, curricular training, and health economics

Background and Purpose The COVID-19 pandemic has significantly impacted health systems worldwide. Here, we assessed the pandemic's impact on clinical service, curricular training, and financial burden from a neurological viewpoint during the enforced lockdown periods and the assumed recovery by 2023. Methods An online 18-item survey was conducted by the European Academy of Neurology (EAN) NeuroCOVID-19 Task Force among the EAN community. The survey was online between February and March 2023. Questions related to general, demographic, clinical, work, education, and economic aspects. Results We collected 430 responses from 79 countries. Most health care professionals were aged 35–44 years, with >15 years of work experience. The key findings of their observations were as follows. (i) Clinical services were cut back in all neurological subspecialties during the most restrictive COVID-19 lockdown period. The most affected neurological subspecialties were services for patients with dementia, and neuromuscular and movement disorders. The levels of reduction and the pace of recovery were distinct for acute emergencies and in- and outpatient care. Recovery was slow for sleep medicine, autonomic nervous system disorders, neurorehabilitation, and dementia care. (ii) Student and residency rotations and grand rounds were reorganized, and congresses were converted into a virtual format. Conferences are partly maintained in a hybrid format. (iii) Affordability of neurological care and medication shortage are emerging issues. Conclusions Recovery of neurological services up to spring 2023 has been incomplete following substantial disruption of neurological care, medical education, and health economics in the wake of the COVID-19 pandemic. The continued limitations for the delivery of neurological care threaten brain health and call for action on a global scale

How green facades affect the perception of urban ambiences: Comparing Slovenia and the Netherlands

Green facades are gaining growing attention among the general public and researchers in various disciplines. Vertical greenery systems play an important role as expressive elements of buildings, while at the same time being treated as a special type of green infrastructure with various positive effects, especially in densely built-up urban areas. This study focuses on the perception of green facades in urban ambiences. The emphasis is on visual perception and the evaluation of the pleasantness or visual quality of various spaces based on the presence or absence of green facades. The public perceptions and evaluation of urban open space with the green elements studied was examined in the Netherlands and Slovenia. The online survey included images of various spatial situations about which respondents conveyed their opinions. Two target groups were addressed: the general public and architecture and urban planning students. The results show that in general greener urban environment is perceived as more pleasant, suggesting that most people think vertical greenery also contributes to the quality of urban ambiences. Nonetheless, differences were identified between the residents of the two countries studied and the two groups surveyed

Brain dynamics underlying preserved cycling ability in patients with Parkinson’s disease and freezing of gait

Parkinson’s disease (PD) is generally associated with abnormally increased beta band oscillations in the cortico-basal ganglia loop during walking. PD patients with freezing of gait (FOG) exhibit a more distinct, prolonged narrow band of beta oscillations that are locked to the initiation of movement at ∼18 Hz. Upon initiation of cycling movements, this oscillation has been reported to be weaker and rather brief in duration. Due to the suppression of the overall beta band power during cycling and its continuous nature of the movement, cycling is considered to be less demanding for cortical networks compared to walking, including reduced need for sensorimotor processing, and thus unimpaired continuous cycling motion. Furthermore, cycling has been considered one of the most efficient non-pharmacological therapies with an influence on the subthalamic nucleus (STN) beta rhythms implicative of the deep brain stimulation effects. In the current review, we provide an overview of the currently available studies and discuss the underlying mechanism of preserved cycling ability in relation to the FOG in PD patients. The mechanisms are presented in detail using a graphical scheme comparing cortical oscillations during walking and cycling in PD

Vpliv ozelenjenih fasad na zaznavanje urbanih okolij – primerjava med Slovenijo in Nizozemsko

V splošni javnosti in v raziskavah v raznih strokah pridobivajo ozelenjeni fasadni ovoji stavb vse večjo pozornost. Sistemi vertikalnih ozelenitev imajo pomembno vlogo kot izrazni element stavbe, hkrati pa se obravnavajo kot poseben tip zelene infrastrukture z raznovrstnimi pozitivnimi učinki predvsem na gosto pozidanih urbanih območjih. Raziskava se osredotoča na zaznavo ozelenjenih fasad v urbanih ambientih. Poudarek je na vizualnem zaznavanju in dojemanju prijetnosti ali vizualne kakovosti raznovrstnih prostorov glede na to, ali stavba ima ozelenjeno fasado ali ne. Odnos javnosti in vrednotenje urbanega odprtega prostora s proučevanimi zelenimi elementi smo preverjali na Nizozemskem in v Sloveniji. V spletno anketo so bili vključeni prikazi prostorskih situacij, o katerih so anketiranci izrazili mnenje. Ciljni skupini sta bili širša javnost in študenti arhitekturno-urbanističnih smeri. Kljub splošnemu rezultatu o večji prijetnosti bolj zelenega mestnega okolja, ki kaže na to, da večina ljudi tudi vertikalne ozelenitve dojema kot prispevek h kakovosti urbanih ambientov, se med proučevanima skupinama v posamezni državi pojavljajo razlike

Vascular cognitive impairment and vascular dementia

V razvitem svetu ima 5–10 % prebivalstva nad 65 let demenco, katere pojavnost še vedno narašča. Demence zaradi možganskih žilnih bolezni – vaskularna demenca (VaD) predstavljajo dobro petino vseh vzrokov za demenco. Milejša oblika je vaskularni kognitivni upad (VaKU). Za postavitev diagnoze VaD je pomembno, da sta upad spoznavnih sposobnosti in možgansko-žilna bolezen jasno časovno povezana ter ni popravljivih vzrokov za kognitivni upad. Pri postavitvi diagnoze uporabimo nevropsihološko testiranje in slikovne preiskave. Glavni dejavniki tveganja za VaKU in VaD so starost, ateroskleroza, sladkorna bolezen in arterijska hipertenzija, ki sprožijo kaskado dogodkov v patogenezi kognitivne okvare. Ta je zelo raznolika in poteka z ali brez pridruženih nevroloških simptomov. Klinična slika je odvisna od področja in velikosti možganske spremembe. Pri zdravljenju VaKU in VaD je najbolj pomembna primarna preventiva. Za zdravljenje simptomov VaKU in VaD se uporabljajo enaka zdravila kot za zdravljenje simptomov Alzheimerjeve bolezni. Pomembni sta še rehabilitacija in sekundarna preventiva ponovne možganske kapi. Glavni dejavniki tveganja za VaD so starost, ateroskleroza, sladkorna bolezen in arterijska hipertenzija, ki sprožijo kaskado dogodkov v patogenezi kognitivne okvare. Ta je zelo raznolika in poteka z ali brez pridruženih nevroloških simptomov. Klinična slika je odvisna od področja in velikosti možganske lezije. Pri zdravljenju VaKU in VaD je najbolj pomembna primarna preventiva. Za zdravljenje simptomov VaKU in VaD se uporabljajo enaka zdravila kot za zdravljenje simptomov Alzheimerjeve bolezni. Pomembni sta še rehabilitacija in sekundarna preventiva ponovne možganske kapi.In the developed world, five to ten percent of people older than 65 years have dementia. One fifth of dementia etiologies are due to vascular brain lesions (VaD – vascular dementia). A milder form is called vascular cognitive impairment (VCI). The main clinical criteria for VaD are: 1. cognitive decline verified with standardized cognitive test/scale, 2. evidence of the associated vascular brain lesion, 3. excluded reversible causes of cognitive decline. The main risk factors for VaD are age, atherosclerosis, diabetes and hypertension. They play a key role in pathogenesis of the cognitive impairment. Depending on the damaged brain region, different cognitive domains may be affected with or without other neurological signs. These diversities in the clinical picture challenge the correct diagnosis. Unique feature of VaD is its progression, which can be stopped, if patients receive an appropriate treatment. The treatment of VCI and VaD symptoms is similar to that in Alzheimer’s disease. More importantly, VCI may be slowed down or even stopped with proper secondary stroke prevention and good rehabilitation. The most efficient is primary stroke prevention with healthy lifestyle and treatment of acquired risk factors

Diagnosis, management and impact on patients' lives of cancer-related neuropathic pain (CRNP): A European survey

Objective: This study assessed the impact of cancer-related neuropathic pain (CRNP) on patients and the importance of the patient–healthcare professional (HCP) relationship in diagnosis and management. Methods: A quantitative online survey was conducted involving adult patients from 13 European countries who had been diagnosed with treatable cancer and experienced symptoms of peripheral neuropathy. Results: Of 24,733 screened respondents, 549 eligible persons met the inclusion criteria and completed the questionnaire. Among individuals still experiencing pain, 75% rated it as ‘severe’ or ‘moderate’. In addition, 61% reported a negative impact on day-to-day activities, and 30% said they had stopped working as a result. A third of respondents had received no diagnosis of CRNP despite reporting painful symptoms to an HCP. HCPs spending enough time discussing pain and understanding the impact on patients' lives were each associated with an increased likelihood of a formal CRNP diagnosis. Compared with individuals currently in active cancer treatment, cancer survivors were less likely to have a diagnosis of CRNP or regular pain conversations with HCPs. Conclusion: CRNP remains under-recognised despite its substantial impact on patients' lives. Clinical practice may be improved by strengthening patient–HCP relationships around pain discussions and increasing the focus on pain management among cancer survivors

A multicenter study of genetic testing for Parkinson’s disease in the clinical setting

Abstract Parkinson’s disease (PD) guidelines lack clear criteria for genetic evaluation. We assessed the yield and rationale of genetic testing for PD in a routine clinical setting on a multicenter cohort of 149 early-onset and familial patients by exome sequencing and semi-quantitative multiplex ligation-dependent probe amplification of evidence-based PD-associated gene panel. We show that genetic testing for PD should be considered for both early-onset and familial patients alike, and a clinical yield of about 10% in the Caucasian population can be expected