Specific patterns of coherence and phase lag index in particular regions as biomarkers of cognitive impairment in Parkinson's disease

INTRODUCTION

Cognitive impairment is a persistent and increasingly reported symptom of patients with Parkinson's disease (PD), significantly affecting daily functioning quality. This study aims to evaluate the functional connectivity of the brain network in patients with Parkinson's disease with various severities of cognitive decline using quantitative electroencephalography (EEG) analysis.

METHODS

Based on the EEG recorded in the resting state, the coherence and phase lag index were calculated to evaluate functional connectivity in 108 patients with Parkinson's disease divided into three groups according to their cognitive condition: dementia due to PD (PD-D), PD and mild cognitive impairment (PD-MCI) and cognitively normal patients (PD-CogN).

RESULTS

It was found that there were significantly different coherence values in the PD-D group compared to PD-CogN in different frequency bands. In most cases, there was a decrease in coherence in PD-D compared to PD-CogN. The most specific changes were revealed in the theta frequency band in the temporal right-frontal left and temporal right-frontal right regions. In the alpha frequency band, the most significant decreases were shown in the occipital right-frontal left and occipital left-frontal right areas. There were also statistically significant differences in phase lag index between many areas, especially in the theta frequency range.

CONCLUSIONS

These findings indicate that the functional connectivity patterns of coherence and phase lag index - found in a particular frequency band and region - could become a reliable biomarker for identifying cognitive impairment and differentiating its severity in PD patients.

Smartphones, the Epidemic of the 21st Century: A Possible Source of Addictions and Neuropsychiatric Consequences

Background and Objectives: Phonoholism is the excessive and harmful use of a smartphone. We are now observing this phenomenon among adults more often. Using a smartphone for several hours may lead to somatic and psychological symptoms, such as headaches and depression. The aim of this study is to assess the prevalence of phonoholism and to assess the association between smartphone overuse and neuropsychiatric disorders. Materials and Methods: A total of 368 people (70.1% were woman), aged between 19 and 82 years (average age 26.1), took part in an anonymous questionnaire consisting of the following elements: Hospital Anxiety and Depression Scale (HADS), Mobile Phone Problem Use Scale (MPPUS-9), and original questions regarding headaches and sleep quality, along with a subjective assessment of the use of smartphones and an objective evaluation based on data from the applications “Stay Free” and “Screen Time”. Results: A total of 61 respondents (16.6%) obtained a score on the MPPUS-9 scale, which revealed their problematic use of mobile devices. Patients with phonoholism had significantly more headaches (85% vs. 58.7%, p = 0.027). Subjects with phonoholism had significantly shorter mean sleep duration (7.14 h vs. 7.42 h, p = 0.0475) and were less likely to feel sleepy during the day (43.33% vs. 59.73%, p = 0.0271). The group with phonoholism had significantly higher scores on the HADS-A anxiety scale (8.29 vs. 10.9, p = 0.015), but a statistical significance was not confirmed for depressive symptoms. Conclusions: The excessive use of the telephone negatively affects both somatic and mental health and can pose a significant clinical problem.

If Not Insulin Resistance so What? - Comparison of Fasting Glycemia in Idiopathic Parkinson's Disease and Atypical Parkinsonism

BACKGROUND

Parkinson's disease (PD) is a synucleinopathy, which presents dysautonomia, as its common non-motor symptom. Some research suggests the existing interplay between the autonomic nervous system dysfunction and glucose metabolism dysregulation in PD.

OBJECTIVE

To determine the prevalence of metabolic disorders with particular emphasis on glucose metabolism in patients with PD and atypical parkinsonism (AP).

PATIENTS AND METHODS

A retrospective study was performed by analyzing 461 clinical data of consecutive patients diagnosed with PD, multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) hospitalized from 2019 to 2021 in the authors' institution. The study group included 350 patients (303 PD, 14 MSA, 33 PSP), aged 65.8 ± 9.7 years (42% were female). Laboratory results (fasting glycemia, lipid parameters, TSH, homocysteine and vitamin D3 levels) were collected. The patient's clinical condition was assessed in III part of Unified Parkinson's Disease Rating Scale (UPDRS p. III), Hoehn-Yahr scale, Mini Mental State Examination (MMSE) and Beck Depression Inventory (BDI).

RESULTS

Impaired fasting glycemia (IGF) was more prevalent in PD than in the PSP (43.43% vs 18.18%; p = 0.043). Similarly, PD presented a higher level of fasting glycemia (102.4 ± 16.7 mg/dl vs 92.2 ± 16.1mg/dl; p = 0.042). According to lipid parameters, patients with PD showed lower LDL cholesterol (92.3 ± 44.3mg/dl vs 119 ± 61.0mg/dl; p = 0.016) and lower BMI compared to patients with PSP (26.1 ± 4.0kg/m² vs 29.3 ± 4.4 kg/m²; p = 0.024), but there were no statistically significant differences in triglycerides (TG) and HDL cholesterol levels. Males with PD presented greater frequency of IFG (35.05% vs 50.6%; p = 0.042), higher fasting glycemia (99.1 ± 14.3mg/dl vs 103.7 ± 14.7mg/dl; p = 0.006), lower total cholesterol, HDL cholesterol, and BMI compared to women with PD.

CONCLUSION

Our investigation supports an association between synucleinopathies and glucose metabolism dysregulation.

Analysis of psychiatric consultations in the department of neurology and stroke unit: diagnosis and therapy

OBJECTIVES

The aim of this study was to analyze psychiatric consultations of patients hospitalized in the Department of Neurology and Stroke Unit (DN/SU) of University Clinical Center in Katowice from 2017 to 2018.

METHODS

A retrospective analysis of psychiatric consultations, psychiatric diagnoses (according to the ICD-10) and treatment recommendations was done.

RESULTS

719 psychiatric consultations were performed in all hospital departments in the analyzed period. 488 (67.87%) consultations were conducted in the Department of Neurology and Stroke Unit. Most patients who required psychiatric consultations were diagnosed with Huntington's disease (n = 25; 37.31%), Parkinson's disease (n = 60; 23.9%) and epilepsy (n=40; 22.73%). The most commonpsychiatric diagnoses included organic mental disorders (n=229; 55.85%), particularly organic mood disorders (n =73; 14.96%) and organic anxiety disorders (n =32;6.56%) whereas in thecase of vascular diseases themost common diagnoses included disturbances of consciousness associated with delirium (n =30; 40.54%). The majority of consultations (n = 388; 79.51%) resulted in the onset or modification of pharmacological treatment. The most frequently prescribed drugs were: neuroleptics (n =174; 35.66%), mostly atypical (n = 152; 87,36%), and antidepressants (n = 230; 47.13%), mostly SSRIs (n = 216; 93.91%). In patients > 60 years of age organic disorders were more prevalent (n =179; 66.30% vs. n = 49; 35.0%) and neuroleptics were more frequently prescribed (n = 131; 42.12% vs. n= 44; 24.86%) compared to patients < 60 years.

CONCLUSIONS

Patients in the department of neurology and stroke unit underwent a psychiatric consultation most frequently. Optimizing the care of aneurological patient is related to close cooperation of a neurologist and a psychiatrist, as well as developing and updating common positions for the management of selected disease entities.

Risk Factors for Apathy in Polish Patients with Parkinson's Disease

Apathy, a feeling of indifference or a general lack of interest and motivation to engage in activity, is one of the most common neuropsychiatric symptoms in Parkinson’s disease (PD). The large variation in prevalence and the underlying pathophysiological processes remain unclear due to heterogeneous PD populations. The purpose of this study was to identify risk factors for apathy, the modification or treatment of which may be clinically relevant and improve quality of life and caregiver burden for patients with Parkinson’s disease. Caucasian subjects with Parkinson’s disease were included in the study. Baseline demographics, neurological deficit, medications taken, cognitive and neuropsychiatric status, and the polymorphisms in the brain-derived neurotrophic factor gene were assessed. Apathy was diagnosed in 53 (50.5%) patients. They were less educated (OR 0.76 CI 0.64–0.89; p = 0.001), more frequently depressed (OR 1.08 CI 1.01–1.15; p = 0.018), and less frequently treated with inhibitors of monoamine oxidase-B (MAOB-I) (OR 0.07 CI 0.01–0.69; p = 0.023). Although apathetic patients were more likely to carry the Met/Met genotype, differences in the brain-derived neurotrophic factor BDNF rs6265 polymorphism between apathetic and non-apathetic PD patients were not statistically significant in multivariate analysis. Some risk factors for apathy may be clinically modifiable. Further studies are needed to assess whether modeling modifiable apathy risk factors will affect the prevalence of this neuropsychiatric symptom in patients with Parkinson’s disease.

Current Knowledge on the Background, Pathophysiology and Treatment of Levodopa-Induced Dyskinesia-Literature Review

Levodopa remains the primary drug for controlling motor symptoms in Parkinson’s disease through the whole course, but over time, complications develop in the form of dyskinesias, which gradually become more frequent and severe. These abnormal, involuntary, hyperkinetic movements are mainly characteristic of the ON phase and are triggered by excess exogenous levodopa. They may also occur during the OFF phase, or in both phases. Over the past 10 years, the issue of levodopa-induced dyskinesia has been the subject of research into both the substrate of this pathology and potential remedial strategies. The purpose of the present study was to review the results of recent research on the background and treatment of dyskinesia. To this end, databases were reviewed using a search strategy that included both relevant keywords related to the topic and appropriate filters to limit results to English language literature published since 2010. Based on the selected papers, the current state of knowledge on the morphological, functional, genetic and clinical features of levodopa-induced dyskinesia, as well as pharmacological, genetic treatment and other therapies such as deep brain stimulation, are described.

The Utility of Next-Generation Sequencing for Identifying the Genetic Basis of Dementia

The clinical manifestations of dementia are often rapidly matched to a specific clinical syndrome, but the underlying neuropathology is not always obvious. A genetic factor often plays an important role in early onset dementia, but there are cases in which the phenotype has a different genetic basis than is assumed. Two patients, at different times, presented to the Memory Clinic because of memory problems and difficulty in performing daily activities and work. Neither caregiver complained of marked behavioural or personality changes, except for apathy. Patients underwent standard dementia evaluation procedures including clinical symptoms, family history, neuroimaging, neuropsychological evaluation, and genetic analysis of selected genes. Based on specific clinical phenotypes and genetic analysis of selected genes, both patients were diagnosed with frontal variant of Alzheimer’s disease. The presence of a rare polymorphism in PSEN2 in both patients allowed the discovery that they belong to the same family. This fact reinforced the belief that there is a strong genetic factor responsible for causing dementia in the family. Next-generation sequencing based on a panel of 118 genes was performed to identify other potential genetic factors that may determine the background of the disease. A mutation in the GRN gene was identified, and the previous diagnosis was changed to frontotemporal dementia. The described cases show how important it is to combine all diagnostic tests available in the diagnostic centre, including new generation genetic tests, in order to establish/confirm the pathological background of clinical symptoms of dementia. If there is any doubt about the final diagnosis, persistent efforts should be made to verify the cause.

Headache Associated with Sexual Activity-A Narrative Review of Literature

Headache associated with sexual activity (HAWSA) has accompanied humanity since ancient times. However, it is only since the 1970s that it has become the subject of more extensive and detailed scientific interest. The purpose of this review is to provide an overview of the development of the concept of HAWSA, its clinical presentation, etiopathogenesis, diagnosis and treatment especially from the research perspective of the last 20 years. Primary HAWSA is a benign condition, whose etiology is unknown; however, at the first occurrence of headache associated with sexual activity, it is necessary to exclude conditions that are usually immediately life-threatening. Migraine, hypnic headache or hemicrania continua have been reported to co-occur with HAWSA, but their common pathophysiologic basis is still unknown. Recent advances in the treatment of HAWSA include the introduction of topiramate, progesterone, and treatments such as greater occipital nerve injection, arterial embolization, and manual therapy. Whether these new therapeutic options will stand the test of time remains to be seen.

Validation of the Polish version of the Unified Dyskinesia Rating Scale (UDysRS)

BACKGROUND

In 2008, the Movement Disorders Society published the Unified Dyskinesia Rating Scale (UDysRS). This has become the established tool for assessing the severity and disability associated with dyskinesia in patients with Parkinson's Disease (PD). We translated and validated the Polish version of the UDysRS, explored its dimensionality, and compared it to the Spanish version, which is the Reference Standard for UDysRS translations.

MATERIAL AND METHODS

The UDysRS was translated into Polish by a team led by JS and GO. The back-translation, completed by colleagues fluent in both Polish and English who were not involved in the original translation, was reviewed and approved by the Executive Committee of the MDS Rating Scales Programme. Then the translated version of the UDysRS underwent cognitive pretesting, and the translation was modified based on the results. The approved version was considered to be the Official Working Document of the Polish UDysRS and was tested on 250 Polish PD patients recruited at movement disorder centres. Data was compared to the Reference Standard used for validating UDysRS translations.

RESULTS

The overall factor structure of the Polish version was consistent with that of the Reference Standard version, as evidenced by the high Confirmatory Fit Index score (CFI = 0.98). The Polish UDysRS was thus confirmed to share a common factor structure with the Reference Standard.

CONCLUSIONS

The Official Polish UDysRS translation is recommended for use in clinical and research settings. Worldwide use of uniform rating measures offers a common ground to study similarities and differences in disease manifestations and progression across cultures.

Detection of postural control in early Parkinson's disease: Clinical testing vs. modulation of center of pressure

INTRODUCTION

Little is known about the early stage balance changes in PD. Many clinicians assume that there are no postural issues in early PD because of failure to identify them on bedside and clinical testing. Here, we quantify balance changes in early and moderate stage PD and compared these values to healthy controls (HC) using clinical assessments of balance and posturography.

METHODS

We compared 15 HC with 15 early PD (PD-II; Hoehn and Yahr stage II) and 15 moderate PD (PD-III; H&Y stage III). Participants performed various clinical tests of balance and a standing postural task on a force platform. We quantified the spatiotemporal parameters of the center of pressure (COP), the sample entropy and power spectral density (PSD) of the COP.

RESULTS

The PSD of the COP differentiated PD-II from HC from 0-0.5 Hz and PD-II from PD-III from 0.5-1 Hz. Specifically, PD-II and PD-III manifested greater power than HC from 0-0.5 Hz, whereas PD-III exhibited greater power than PD-II and HC from 0.5-1.0 Hz (p<0.05). However, there were no significant differences between PD-II and HC in all clinical tests and in spatiotemporal parameters of the COP (p>0.05). Although the sample entropy was significantly lower in the PD groups (p<0.05), entropy failed to differentiate PD-II from PD-III.

CONCLUSION

The low-frequency modulation of the COP in this small cohort differentiated early PD from HC and from moderate PD. Clinicians should be aware that there are early balance deficits in PD. A larger sample size is needed to confirm these findings.

Validation of the Polish version of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS)

BACKGROUND

In 2008, the Movement Disorders Society (MDS) published a new Unified Parkinson's Disease Rating Scale (MDS-UPDRS) as the official benchmark scale for Parkinson's Disease (PD). We have translated and validated the Polish version of the MDS-UPDRS, explored its dimensionality, and compared it to the original English one.

METHODS

The MDS-UPDRS was translated into Polish by a team of Polish investigators led by JS and GO. The back-translation was completed by colleagues fluent in both languages (Polish and English) who were not involved in the original translation, and was reviewed by members of the MDS Rating Scales Programme. Then the translated version of the MDS-UPDRS underwent cognitive pretesting, and the translation was modified based on the results. The final translation was approved as the Official Working Document of the MDS-UPDRS Polish version, and was tested on 355 Polish PD patients recruited at movement disorders centres all over Poland (at Katowice, Gdańsk, Łódź, Warsaw, Wrocław, and Kraków). Confirmatory and explanatory factor analyses were applied to determine whether the factor structure of the English version could be confirmed in the Polish version.

RESULTS

The Polish version of the MDS-UPDRS showed satisfactory clinimetric properties. The internal consistency of the Polish version was satisfactory. In the confirmatory factor analysis, all four parts had greater than 0.90 comparative fit index (CFI) compared to the original English MDS-UPDRS. Explanatory factor analysis suggested that the Polish version differed from the English version only within an acceptable range.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The Polish version of the MDS-UPDRS meets the requirements to be designated as the Official Polish Version of the MDS-UPDRS, and is available on the MDS web page. We strongly recommend using the MDS-UPDRS instead of the UPDRS for research purposes and in everyday clinical practice.

The Influence of Nonpharmacological Complex Therapy Conducted at a Community Day-Care Center on Cognitive function and Mood in Older Adults

Introduction

Nonpharmacological interventions in the elderly may lead to the reduction of cognitive and depressive symptoms. The aim of the study was to evaluate changes in cognitive functions and mood in older adults participating in therapy, conducted in the community day-care center (CD-CC).

Patients and Methods

The study group (SG) included 46 elderly adults (21 M, 25 W), the control group (CG) included 45 adults (12 M, 33 W), who participated in the activities of the University of the Third Age. The following measuring tools were used: Mini-Mental State Examination, Clock-Drawing Test, Verbal Fluency Test, Digit Span Test, Stroop Color and Word Test, Beck’s Depression Inventory, and Hospital Anxiety and Depression Scale. The intervention consisted of CD-CC 6-month nonpharmacological therapy.

Results

In the SG, compared to the CG, the scores on all the cognitive tests were significantly lower, Beck’s Depression Inventory was significantly higher. After intervention, the SG and the CG did not show substantial differences in their scores on the Mini-Mental State Examination, Clock-Drawing Test, and Beck’s Depression Inventory. In the SG, a significant improvement was reported on the Verbal Fluency Test, Beck’s Depression Inventory and Hospital Anxiety and Depression Scale scores.

Conclusion

The CD-CC complex therapy can be helpful for cognitive and emotional elderly functioning.

Delirium Post-Stroke-Influence on Post-Stroke Dementia (Research Study-Part of the PROPOLIS Study)

BACKGROUND

Previous research confirmed association between delirium and subsequent dementia in different clinical settings, but the impact of post-stroke delirium on cognitive functioning is still under-investigated. Therefore, we aimed to assess the risk of dementia among patients with stroke and in-hospital delirium.

METHODS

A total of 750 consecutive patients admitted to the stroke unit with acute stroke or transient ischemic attacks were screened for delirium, during the first seven days after admission. At the three- and twelve-month follow-up, patients underwent cognitive evaluation. The DSM-5 definition for dementia was used. Cases with pre-stroke dementia were excluded from the analysis.

RESULTS

Out of 691 included cases, 423 (61.22%) and 451 (65.27%) underwent cognitive evaluation, three and twelve months after stroke; 121 (28.61%) and 151 (33.48%) patients were diagnosed with dementia, respectively. Six (4.96%) patients with dementia, three months post-stroke did not meet the diagnostic criteria for dementia nine months later. After twelve months, 37 (24.50%) patients were diagnosed with dementia, first time after stroke. Delirium in hospital was an independent risk factor for dementia after three months (OR = 7.267, 95%CI 2.182-24.207, p = 0.001) but not twelve months after the stroke.

CONCLUSIONS

Patients with stroke complicated by in-hospital delirium are at a higher risk for dementia at three but not twelve months post-stroke.

A Rare Mutation in The APOB Gene Associated with Neurological Manifestations in Familial Hypobetalipoproteinemia

Clinical phenotypes of familial hypobetalipoproteinemia (FHBL) are related to a number of defective apolipoprotein B (APOB) alleles. Fatty liver disease is a typical manifestation, but serious neurological symptoms can appear. In this study, genetic analysis of the APOB gene and ophthalmological diagnostics were performed for family members with FHBL. Five relatives with FHBL, including a proband who developed neurological disorders, were examined. A sequencing analysis of the whole coding region of the APOB gene, including flanking intronic regions, was performed using the next-generation sequencing (NGS) method. Electrophysiological ophthalmological examinations were also done. In the proband and his affected relatives, NGS identified the presence of the pathogenic, rare heterozygous splicing variant c.3696+1G>T. Two known heterozygous missense variants-c.2188G>A, p.(Val730Ile) and c.8353A>C, p.(Asn2785His)-in the APOB gene were also detected. In all patients, many ophthalmologic abnormalities in electrophysiological tests were also found. The identified splicing variant c.3696+1G>T can be associated with observed autosomal, dominant FHBL with coexisting neurological symptoms, and both identified missense variants could be excluded as the main cause of observed clinical signs, according to mutation databases and the literature. Electroretinography examination is a sensitive method for the detection of early neuropathy and should therefore be recommended for the care of patients with FHBL.

Case report on novel mutation in SPAST gene in Polish family with spastic paraplegia

Background

Hereditary spastic paraplegia is a large group of degenerative, neurological disorders characterized by progressive lower limb spasticity and weakness. The disease was investigated precisely but still clinicians often make incorrect or late diagnosis. Our aim was to investigate the genetic background and clinical phenotype of spastic paraplegia in large Polish family.

Case presentation

A 37 years old woman presented with 4-year history of walking difficulties. On neurological examination, she had signs of upper motor lesion in lower extremities. She denied sphincter dysfunction and her cognition was normal. Her family history was positive for individuals with gait problems. The initial diagnosis was familial spastic paraplegia. Genetic testing identified a novel mutation in SPAST gene. All available family members were examined and had genetic testing. The same mutation in SPAST gene was identified in other affected family members. All patients caring the mutation presented with different phenotypes.

Conclusion

This study presents a family with spastic paraplegia due to a novel mutation c.1390G›T(p.Glu464Term) in SPAST gene. Affected individuals showed a range of phenotypes that varied in their severity. This case report demonstrates, the signs of hereditary spastic paraplegia can be often misdiagnosed with other diseases. Therefore genetic testing should always be considered in patients with lower limb spasticity and positive family history in order to help to establish the correct diagnosis.

[Quality of life of people with Parkinson's disease in the context of professional work and physiotherapy]

BACKGROUND

Of many diseases and disorders of the nervous system Parkinson's disease (PD) deserves a particular attention for its specific effects having an impact on the ability to undertake different forms of professional and economic activities. Due to the constantly growing incidence rate and the lowering age of patients, PD is becoming more and more serious social problem. The aim of this study was to determine the effects of professional work and physiotherapy on the quality of live in people with Parkinson's disease.

MATERIAL AND METHODS

The research was carried out on 109 people with diagnosed PD of stage II according to the Hoehn and Yahr classification. They were divided into professionally working and non-working subjects and those participating and not participating in physiotherapy programs. The Unified Parkinson's Disease Rating Scale (UPDRS), was used to estimate the patients' clinical status. The Parkinson's Disease Questionnaire (PDQ-39), the Quality of Life Short Form (SF-36) Questionnaire and the Parkinson's Disease Quality of Life Questionnaire (PDQL) were used to estimate the quality of life.

RESULTS

In all groups statistically significant differences were observed in each of the used scale. The PDQ-39 (F = 5.278, p = 0.04), SF physical component (F = 4.24, p = 0.005), SF mental component (F = 3.45, p = 0.021), PDQL (F = 6.57, p = 0.003). The highest quality of life was noticed in people working professionally and participating in physiotherapy programs.

CONCLUSIONS

Professional activity and participation in properly planned physiotherapy help reduce the symptoms and improve the quality of life of people with Parkinson's disease. The study showed that the quality of life of people with PD is determined by professional work and participation in the process of rehabilitation. Med Pr 2017;68(6):725-734.

[Gait disturbances and falls in various types of dementias]

Dementia is a group of symptoms of damage of higher cortical functions. The causes of dementia include brain diseases, most often chronic and progressive, leading to cognitive impairment typical of these disorders. Apart from progressive cognitive deficits, dementias may coexist with mental disorders, sleep disorders, epileptic seizures, parkinsonism and other motor disorders. Motor disorders, including gait disturbances and falls, represent a serious challenge to the health of older adults and contribute to loss of mobility and independence. Analysis of motor disturbances in the population of healthy older adults and those with progressive cognitive impairment is likely to support effective planning of pharmacological therapies and rehabilitation for this group of patients.

Influence of functional movement rehabilitation on quality of life in people with Parkinson's disease

[Purpose] Parkinson's disease is one of the most frequent diseases of the central nervous system. Thorough knowledge of reasons for movement defects may contribute to the ability to quality of life at a good level as far as motor abilities are concerned. The aim of the study was to evaluate the influence of functional movement rehabilitation on the degree of intensity of movement symptoms in Parkinson's disease. [Subjects] The research was carried out in people diagnosed with stage III Parkinson's disease, according to the Hoehn and Yahr scale classification. [Methods] In order to establish the clinical state of patients, parts I, II, and III of the Unified Parkinson's Disease Rating Scale, the Schwab and England Activities of Daily Living scale, and the quality of life in Parkinson's disease questionnaire were applied. The intervention group took part in 60 minutes of functional movement rehabilitation twice a week for a period of 15 weeks. The main emphasis was placed on the ability to cope with everyday activities. [Results] A significant difference in scores for the given scales between before and after research the intervention period was observed in the intervention group. [Conclusion] The obtained results revealed positive that the influence of applied rehabilitation program had a positive influence on the degree of intensity of movement symptoms in people with Parkinson's disease.

The impact of MRI white matter hyperintensities on dementia in Parkinson's disease in relation to the homocysteine level and other vascular risk factors

BACKGROUND

The role of white matter hyperintensities (WMH) and homocysteine (Hcy) and other vascular risk factors in the pathogenesis of Parkinson's disease (PD) dementia (PDD) remains unclear.

OBJECTIVE

The aim of the study was to assess the impact of WMH, Hcy and other biochemical and vascular risk factors on PDD.

METHODS

A total of 192 patients with PD and 184 age- and sex-matched healthy controls were included. A semistructured interview was used to assess demographic and clinical variables with respect to vascular risk factors (arterial hypertension, diabetes mellitus, atrial fibrillation, ischemic heart disease, obliterative atherosclerosis, hypercholesterolemia, smoking, alcohol intake). Unified Parkinson's Disease Rating Scale score, Hoehn-Yahr staging and the Schwab-England activities of daily living scale were used to assess motor abilities and activities of daily living. A complex neuropsychological examination with a battery of tests was used to classify patients into a group with dementia (PDD) and a group without dementia (PD). Neuroradiological examination of MRI scans included visual rating scales for WMH (according to the Wahlund and Erkinjunntti rating scales) and the Scheltens scale for hippocampal atrophy. Blood samples for Hcy, folate, vitamin B12, fibrinogen, lipids, glucose, creatinine, transaminases and thyroid stimulating hormone (TSH) were examined.

RESULTS

Among all patients, 57 (29.7%) fulfilled the diagnostic criteria for dementia. Significantly higher Hcy plasma levels were noted in PD and PDD groups compared to controls (p < 0.05) and in PDD when compared to PD (p < 0.05). According to multivariate regression analysis, WMH (Erkinjuntti scale), high Hcy, low vitamin B12 and folate plasma levels were independent risk factors for PDD. Vascular risk factors did not play any role in the pathogenesis of PDD and WMH.

CONCLUSIONS

WMH along with Hcy, folate and vitamin B12 may impact cognition in PD. Therapy with vitamin B12, folate and catechol-O-methyltransferase inhibitors may play a potential protective role against PDD.

From mild cognitive impairment to Alzheimer's disease - influence of homocysteine, vitamin B12 and folate on cognition over time: results from one-year follow-up

BACKGROUND AND PURPOSE

People with mild cognitive impairment (MCI) have higher risk of developing dementia than the general population. Currently known risk factors for dementia include older age, low education level, gait disorders, hippocampal atrophy, and apolipoprotein E allele. Vascular risk factors may modify the neurodegenerative process. The aim of this study was therefore to assess the influence of vascular (genetic and environmental) risk factors on progression to dementia in an MCI group during a one-year period.

MATERIAL AND METHODS

Fifty-five MCI patients (30 men and 25 women) and 44 controls (25 men and 19 women) matched for age, gender and education were studied. Mild cognitive impairment was diagnosed according to Petersen criteria (Mayo Clinic Group). Neuropsychological evaluation was made. Assessed vascular risk factors included hypertension, cardiovascular disease, diabetes, cigarette smoking, hyperlipidaemia, hyperhomocysteinaemia with vitamin B12 and folate deficiency. Genetic risk factors (APOE polymorphism, C677T and A1298C MTHFR polymorphisms) were also assessed.

RESULTS

Vascular risk factors were found significantly more often in the MCI group (p = 0.041), including APOE4 allele (p = 0.018), hyperhomocysteinaemia (p = 0.012) and folate deficiency (p = 0.023). Discriminant function analysis showed that only age and hypertension are potential factors which may have an influence on progression to dementia in the MCI group within one year of prospective observation.

CONCLUSION

Vascular risk factors are associated with cognitive impairment but do not have a significant influence on progression to dementia in the MCI group.

Interleukin-10 (IL10) and tumor necrosis factor alpha (TNF) gene polymorphisms in Parkinson's disease patients

Recent studies revealed that inflammatory processes might play an important role in the pathogenesis of Parkinson's disease (PD). We hypothesized that genetically determined differences in the immune response, especially in anti- and pro-inflammatory cytokines production might influence the risk for the development and/or onset of sporadic PD. In the present study, we investigated the genetic polymorphisms of the IL10 (-1082 and -519) and TNF (-308) genes in relation to the risk of PD, and their associations with age of PD onset in a group of 316 patients, divided into two subgroups: Group 1: patients with early onset PD (EOPD), i.e. before 50 years of age (102 patients), and group 2: patients with onset of PD after 50 years of age comprising 214 subjects. Control samples were obtained from 300 randomly selected healthy individuals from the same geographical region with no signs of Parkinsonism as evaluated by a neurologist. PCR-RFLP methods were used for genotyping. No statistically significant differences between PD patients and controls were found in the frequency of a single locus of IL10 promoter. We found TNF -308A allele significantly more frequent in EOPD patients compared to the controls (p=0.007). The overrepresentation of the A allele was reflected by a significant increase in AA homozygous individuals in EOPD patients compared to the controls (p=0.0021). The results from our study revealed that the TNF -308AA genotype might increase the risk of early onset of PD.

Vascular risk factors and intensity of cognitive dysfunction in MCI

Patients with Mild Cognitive Impairment (MCI) have a greater risk of developing dementia than general population. Lots of evidence suggests that cardiovascular risk factors appear more often in the MCI than in general population The aim of this study was to evaluate association between cardiovascular risk factors and intensity of cognitive impairment in MCI patients. We evaluated 24 MCI patients (9 women and 15 men) fulfilling Mayo Clinic Group Criteria. Taking under consideration presence of cardiovascular diseases patients were divided into two groups: first group (n=16) MCI with cardiovascular diseases and second group (n=8) MCI without cardiovascular disorders. Cognitive functions were assessed by neuropsychological tests battery including MMSE, Clock Drawing Test, Trail Making Test (TMT), Verbal Fluency Test with letters FAS, Auditory Verbal Learning Test (AVLT). In the MCI group with vascular risk factors we have found more distinct dysfunction of learning new information, recall and short-term memory than in MCI patients without vascular pathology. In conclusion we may suggest that more distinct cognitive deficit may indicate higher risk of developing dementia, that is why patients with MCI should be under special supervision, with at least annual neuropsychological evaluation.

Apolipoprotein E Gene Polymorphism, Total Plasma Cholesterol Level, and Parkinson Disease Dementia

BACKGROUND

Apolipoprotein E gene (APOE) polymorphism is an important determinant for the development of various cardiovascular and neurodegenerative disorders. There have been conflicting reports of association of APOE polymorphism with dementia in Parkinson disease (PD).

OBJECTIVE

To determine the relationship between APOE polymorphisms and plasma cholesterol concentration, and PD with dementia (PDD).

DESIGN

Four-year (1999-2002) case-control study.

SETTING

Academic medical center with inpatient and outpatient movement disorders services. Patients Consecutive white patients of the same ethnic background with PD.

INTERVENTIONS

Strict clinical, neuropsychological, and neuroimaging criteria were used to exclude dementia with Lewy bodies, Alzheimer disease, and vascular dementia. Findings were compared in 2 clinical groups, including 98 patients (47 men and 51 women; mean age, 71 years) with PDD and 100 patients (52 men and 48 women; mean age, 62 years) with PD without dementia.

MAIN OUTCOME MEASURES

Analysis of APOE genotypes and allelic frequency (polymerase chain reaction) and plasma cholesterol concentration (enzymatic assay) were evaluated by a clinician blinded to the clinical diagnosis, and findings were compared between the groups with PDD or PD without dementia. Multiple stepwise regression analysis and the Spearman rank correlation coefficient were used to evaluate relationships between dementia and both APOE polymorphism and cholesterol concentration. Statistical significance was set at P<.05.

RESULTS

Epsilon4 allele frequencies were similar in PDD and PD without dementia (16.8% vs 19%, respectively). Cholesterol concentration, APOE genotypes, and allelic frequencies did not relate to PDD.

CONCLUSIONS

In contrast to Alzheimer disease, when PDD is carefully defined, it is clearly not associated with APOE polymorphisms or with a distinctive plasma cholesterol profile. Ongoing longitudinal follow-up with emphasis on autopsy recruitment will enable further analyses of biochemical alterations underlying PDD.

Corticobasal degeneration -- clinico-pathological considerations

Corticobasal degeneration (CBD) is a rare sporadic 4-repeat tauopathy. We report here the first Polish case of pathologically proven CBD. Our patient developed clumsiness of the right hand at age 63 years. During the course of his illness he suffered from progressive asymmetric parkinsonism unresponsive to dopaminergic therapy. Focal dystonia affecting right upper extremity, non-fluent aphasia, dysphagia, supranuclear vertical gaze palsy, imbalance and myoclonus ensued. The patient died of pneumonia at age 71 years. Head magnetic resonance imaging revealed the presence of asymmetric cortical atrophy contralateral to the clinically more affected right side. Median somatosensory evoked potentials performed bilaterally demonstrated significant reduction of cortical evoked potential amplitudes recorded from the left scalp electrodes. Neuropathological examination showed cortical atrophy of the frontal and parietal lobes with superficial spongiosis and diffuse cortical gliosis. Numerous ballooned neurons were found in frontal and parietal cortices. The most remarkable pathology was extensive tau-immunoreactivity of glial and neuronal cell processes, significantly pronounced in the frontotemporal cortex, basal ganglia, thalamus and brainstem. Recent research studies have resulted in better clinical, pathological and genetic characterization of sporadic tauopathies. It is hoped that similar progress will ensue in the development of symptomatic and eventually curative treatments for these rare conditions.

[12-month outcomes of percutaneous and surgical revascularization in acute coronary syndromes without ST-segment elevation in patients with multivessel coronary artery disease]

Early invasive strategy is one of two methods of treatment of acute coronary syndromes without ST-segment elevation (NSTEACS). We aimed at assessing 12-month outcomes and quality of life in patients with NSTEACS and multivessel coronary artery disease (CAD) who underwent percutaneous or surgical revascularization. Analyzed group comprised 412 patients (92%) who were qualified for invasive treatment based on coronary angiography performed 24 hours after admission and in whom long-term follow up data was available. The inclusion criteria were: rest angina within 24 hours prior to admission and at least one of the following: ST segment depression (> or = 0.5 mm), transient (< 20 min) ST-segment elevation, negative T-waves (> or = 1 mm)in at least 2 contiguous leads, positive serum cardiac markers. Patients with single-vessel CAD or qualified for conservative treatment were excluded from the study. We analysed the rate of adverse cardiac events (death, non-fatal myocardial infarction, unstable angina, repeated revascularization, cardiovascular hospitalization) at one year. The quality of life was assessed using Short-Form-36 (SF-36) questionnaire. The rate of death was 5.3% vs 9.3% (NS), myocardial infarction 3.4% vs 0% (p = 0.054), unstable angina 20.9% vs 2.8% (p = 0.0000), repeated revascularization 12.6% vs 0% (p = 0.0001) and cardiovascular hospitalization 36% vs 22.7% (p = 0.001) in the PCI and CABG group respectively. Physical Component Summary scores were 38.7 +/- 11.6 vs 43.08 +/- 9.5, p = 0.001 in the PCI and CABG group respectively. Mental Component Summary Scores were similar in both groups (46.34 +/- 13.05 vs 45.97 +/- 11.9, NS).

CONCLUSIONS

Overall mortality rate was similar in both groups. PCI patients had more frequent rate of unstable angina, rate of hospitalization and repeat revascularization. This study has shown that there is a significant difference in health-related quality of life 12 months after PCI and CABG. This difference arises from better physical function (Physical Component) for CABG surgery patients compared with PCI patients. Despite impairment of the physical health status, the mental health status (Mental Component) remained similar in both groups.