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Zafar U, Habib SH, Raza SS. Identification of appropriate tools to gauge brain functions in a clinical setup of a developing country: A pilot study. Pak J Med Sci 2023; 39:1840-1846. [PMID: 37936739 PMCID: PMC10626111 DOI: 10.12669/pjms.39.6.7489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/15/2023] [Accepted: 07/31/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To identify the most appropriate tools to measure functions of the brain that can be utilized in the clinical setups of developing countries. Methods This qualitative research with a three-step approach was carried out from January 2022 to May 2022 at the Institute of Basic Medical Sciences, Khyber Medical University, Pakistan. Firstly, literature was searched to identify main brain faculties, then interviews were conducted with regional field experts to identify appropriate scales for the selected functions. Lastly a rubric was filled using interview transcripts and literature. Results The identified functions were vision, hearing, cognition, motor and emotions. Based on the rubric the best tests were visual fields (17/24), pure tone audiometry (16/24), Mini-Mental State Exam (20/24), Trait Emotional Intelligence Questionnaire (18/24), Romberg's test (19/24) and Manual Muscle Testing (18/24). Conclusion The clinicians in developing countries can utilize the visual fields, pure tone audiometry, Mini-Mental State Exam, Trait Emotional Intelligence Questionnaire, Romberg's test and Manual Muscle Testing for most efficient, feasible, accurate and cost-effective measurement of brain functions.
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Affiliation(s)
- Umema Zafar
- Umema Zafar, MBBS, MPhil, CHPE Department of Physiology, Rehman Medical College, Peshawar, Pakistan
| | - Syed Hamid Habib
- Syed Hamid Habib, MBBS, PhD, PGD, DHPE, CHR, CRSM, CME Department of Physiology. Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Syed Shahmeer Raza
- Syed Shahmeer Raza, MBBS, MPhil, CRSM, ATC Department of Physiology, Gajju Khan Medical College, Swabi, Pakistan
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Evlice A, Sanli ZS, Boz PB. The importance of Vitamin-D and Neutrophil-Lymphocyte Ratio for Alzheimer's Disease. Pak J Med Sci 2023; 39:799-803. [PMID: 37250565 PMCID: PMC10214823 DOI: 10.12669/pjms.39.3.7024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/31/2022] [Accepted: 01/29/2023] [Indexed: 11/02/2023] Open
Abstract
Objective Ischemia and inflammation play a role in the pathophysiology of Alzheimer's disease (AD). Plasma neutrophil-lymphocyte ratio (NLR), and 25- hydroxyvitamin D (vitamin D) were used as a biomarker for inflammation and atherosclerosis. The present study aimed to investigate a link between NLR, vitamin D and ischemia in AD. Methods The subjects with AD and control groups were enrolled to this retrospective study between 2017-2022 at Cukurova University Hospital. The cognitive assessment (MMSE), and blood tests (NLR, vitamin D) were collected from all subjects. In first part of the study, AD (n:132) and the control group (n:38) were compared. In second part of the study, magnetic resonance imaging (MRI) was used for evaluating ischemic lesions with scoring method of Fazekas. The control group (n:38) and AD subjects with mild ischemic lesions (Fazekas-1 and Fazekas-2) (n:64) were excluded. AD subjects with severe ischemic lesions (Fazekas-3) (n:34) and without ischemic lesions (Fazekas-0) (n:34) were compared again. SPSS 20.0 was used for all analyses. The threshold for statistical significance was set at 0.05. Results In the first part of the study, 132 AD patients (69 female and 63 male; mean age 70.83±9.35 (49-87) and age-matched 38 controls were compared. The mean NLR in AD [2.96±2.46 (1.17-19.43)] was higher than the control group [1.9±0.66 (0.9-3.56)] (p=0.005). In the second part of the study, the mean Vitamin D of Fazekas-3 AD group [16.15±9.64 (4.7-35)] was lower than Fazekas-0 AD group [16.27±6.81(4.6-29.7)] (p=0.024). Conclusion NLR was higher in AD while there was no difference between the Fazekas-0 and Fazekas-3 AD groups. Vitamin D was lower in the Fazekas-3 AD group. These data suggested that NLR increased independently of ischemia in AD. Also vitamin D deficiency could trigger ischemia in AD.
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Affiliation(s)
- Ahmet Evlice
- Ahmet Evlice, MD. Department of Neurology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Zeynep Selcan Sanli
- Zeynep Selcan Sanli, MD., Faculty of Medicine, Neurology Clinic Health Sciences University Adana, Adana City Training and Research Hospital, Adana, Turkey
| | - Pinar Bengi Boz
- Pinar Bengi Boz, MD., Faculty of Medicine, Neurology Clinic Health Sciences University Adana, Adana City Training and Research Hospital, Adana, Turkey
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Kaddumukasa MN, Kaddumukasa M, Katabira E, Sewankambo N, Namujju LD, Goldstein LB. Prevalence and predictors of post-stroke cognitive impairment among stroke survivors in Uganda. BMC Neurol 2023; 23:166. [PMID: 37098461 PMCID: PMC10127321 DOI: 10.1186/s12883-023-03212-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/15/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Little is known about the characteristics and determinants of post-stroke cognitive impairment in residents of low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda's Mulago Hospital, located in sub-Saharan Africa. METHODS 131 patients were enrolled a minimum of 3-months after hospital admission for stroke. A questionnaire, clinical examination findings, and laboratory test results were used to collect demographic information and data on vascular risk factors and clinical characteristics. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants' cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. RESULTS The overall mean MoCA score was 11.7-points (range 0.0-28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25-8.33; p = 0.016), functional handicap (mRS 3-5; OR 1.84, 95% CI 1.28-2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14-6.56; p = 0.024) were independently associated with cognitive impairment. CONCLUSIONS Our findings highlight the high burden and need for awareness of cognitive impairment in post stroke populations in the sub-Saharan region and serve to emphasize the importance of detailed cognitive assessment as part of routine clinical evaluation of patients who have had a stroke.
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Affiliation(s)
- Martin N Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Sewankambo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lillian D Namujju
- Department of Electrical and Computer Engineering, College of Engineering, Design, Art and Technology, Makerere University, Kampala, Uganda
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Noh B, Blasco-Conesa MP, Lai YJ, Ganesh BP, Urayama A, Moreno-Gonzalez I, Marrelli SP, McCullough LD, Moruno-Manchon JF. G-quadruplexes Stabilization Upregulates CCN1 and Accelerates Aging in Cultured Cerebral Endothelial Cells. FRONTIERS IN AGING 2022; 2:797562. [PMID: 35822045 PMCID: PMC9261356 DOI: 10.3389/fragi.2021.797562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
Senescence in the cerebral endothelium has been proposed as a mechanism that can drive dysfunction of the cerebral vasculature, which precedes vascular dementia. Cysteine-rich angiogenic inducer 61 (Cyr61/CCN1) is a matricellular protein secreted by cerebral endothelial cells (CEC). CCN1 induces senescence in fibroblasts. However, whether CCN1 contributes to senescence in CEC and how this is regulated requires further study. Aging has been associated with the formation of four-stranded Guanine-quadruplexes (G4s) in G-rich motifs of DNA and RNA. Stabilization of the G4 structures regulates transcription and translation either by upregulation or downregulation depending on the gene target. Previously, we showed that aged mice treated with a G4-stabilizing compound had enhanced senescence-associated (SA) phenotypes in their brains, and these mice exhibited enhanced cognitive deficits. A sequence in the 3'-UTR of the human CCN1 mRNA has the ability to fold into G4s in vitro. We hypothesize that G4 stabilization regulates CCN1 in cultured primary CEC and induces endothelial senescence. We used cerebral microvessel fractions and cultured primary CEC from young (4-months old, m/o) and aged (18-m/o) mice to determine CCN1 levels. SA phenotypes were determined by high-resolution fluorescence microscopy in cultured primary CEC, and we used Thioflavin T to recognize RNA-G4s for fluorescence spectra. We found that cultured CEC from aged mice exhibited enhanced levels of SA phenotypes, and higher levels of CCN1 and G4 stabilization. In cultured CEC, CCN1 induced SA phenotypes, such as SA β-galactosidase activity, and double-strand DNA damage. Furthermore, CCN1 levels were upregulated by a G4 ligand, and a G-rich motif in the 3'-UTR of the Ccn1 mRNA was folded into a G4. In conclusion, we demonstrate that CCN1 can induce senescence in cultured primary CEC, and we provide evidence that G4 stabilization is a novel mechanism regulating the SASP component CCN1.
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Affiliation(s)
- Brian Noh
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Maria P. Blasco-Conesa
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yun-Ju Lai
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Bhanu Priya Ganesh
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Akihiko Urayama
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ines Moreno-Gonzalez
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
- Department of Cell Biology, Faculty of Sciences, Instituto de Investigacion Biomedica de Malaga-IBIMA, Malaga University, Malaga, Spain
- Networking Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Sean P. Marrelli
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Louise D. McCullough
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose Felix Moruno-Manchon
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States
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Pettemeridou E, Kallousia E, Constantinidou F. Regional Brain Volume, Brain Reserve and MMSE Performance in Healthy Aging From the NEUROAGE Cohort: Contributions of Sex, Education, and Depression Symptoms. Front Aging Neurosci 2021; 13:711301. [PMID: 34867265 PMCID: PMC8633314 DOI: 10.3389/fnagi.2021.711301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/08/2021] [Indexed: 11/27/2022] Open
Abstract
Objective: The aim of this study was twofold. First, to investigate the relationship between age, gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) volumes, brain reserve (BR), and specific regions of interest (ROIs) with global cognitive function in healthy older adults participating in a longitudinal study on aging in the island country of Cyprus. Second, to assess the contribution of important demographic and psychosocial factors on brain volume. Specifically, the effects of sex and years of education and the association between depression symptoms on brain volume were also explored in this Mediterranean cohort. Methods: Eighty-seven healthy older adults (males = 37, females = 50) scoring ≥24 on the Mini-Mental State Examination (MMSE) were included, with a mean age of 72.75 years and a mean educational level of 10.48 years. The Geriatric Depression Scale was used to assess depression. T1-weighted magnetic resonance images were used to calculate global and regional volumes. Results: Age was negatively correlated with GM, WM, BR, MMSE scores, and ROIs, including the hippocampus, amygdala, entorhinal cortex, prefrontal cortex, anterior cingulate gyrus, and positively with CSF. Higher MMSE scores positively correlated with GM volume. Women exhibited greater levels of depression than men. Depression was also negatively correlated with GM volume and MMSE scores. Men had greater ventricular size than women and participants with higher education had greater ventricular expansion than those with fewer years in education. Conclusions: The reported structural changes provide evidence on the overlap between age-related brain changes and healthy cognitive aging and suggest that these age changes affect certain regions. Furthermore, sex, depressive symptomatology, and education are significant predictors of the aging brain. Brain reserve and higher education accommodate these changes and works against the development of clinical symptoms.
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Affiliation(s)
- Eva Pettemeridou
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus.,KIOS Innovation and Research Center of Excellence, University of Cyprus, Nicosia, Cyprus.,Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Eleni Kallousia
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Fofi Constantinidou
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus.,Department of Psychology, University of Cyprus, Nicosia, Cyprus
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Taxonomic Distribution of Medicinal Plants for Alzheimer’s Disease: A Cue to Novel Drugs. Int J Alzheimers Dis 2020. [DOI: 10.1155/2020/7603015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Alzheimer’s disease (AD) is a neurodegenerative disorder manifested by decline in memory and mild cognitive impairment leading to dementia. Despite global occurrence of AD, the severity and hence onset of dementia vary among different regions, which was correlated with the customary use of medicinal herbs and exposure level to the causatives. In spite of execution of versatile therapeutic strategies to combat AD and other neurodegenerative diseases, success is only limited to symptomatic treatment. The role of natural remedies remained primitive and irreplaceable in all ages. In some examples, the extracted drugs failed to show comparable results due to lack of micro ingredients. Micro ingredients impart a peerless value to natural remedies which are difficult to isolate and/or determine their precise role during treatment. A variety of plants have been used for memory enhancement and other dementia-related complications since ages. Acetyl choline esterase inhibition, antioxidant potential, neuroprotection, mitochondrial energy restoration, and/or precipitated protein clearance put a vast taxonomic variety into a single group of anti-AD plants. Secondary metabolites derived from these medicinal plants have the potential to treat AD and other brain diseases of common pathology. This review summarizes the potential of taxonomically diverse medicinal plants in the treatment of AD serving as a guide to further exploration.
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