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Frederiksen KS, Cooper C, Frisoni GB, Frölich L, Georges J, Kramberger MG, Nilsson C, Passmore P, Mantoan Ritter L, Religa D, Schmidt R, Stefanova E, Verdelho A, Vandenbulcke M, Winblad B, Waldemar G. A European Academy of Neurology guideline on medical management issues in dementia. Eur J Neurol 2020; 27:1805-1820. [PMID: 32713125 PMCID: PMC7540303 DOI: 10.1111/ene.14412] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Dementia is one of the most common disorders and is associated with increased morbidity, mortality and decreased quality of life. The present guideline addresses important medical management issues including systematic medical follow-up, vascular risk factors in dementia, pain in dementia, use of antipsychotics in dementia and epilepsy in dementia. METHODS A systematic review of the literature was carried out. Based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, we developed a guideline. Where recommendations based on GRADE were not possible, a good practice statement was formulated. RESULTS Systematic management of vascular risk factors should be performed in patients with mild to moderate dementia as prevention of cerebrovascular pathology may impact on the progression of dementia (Good Practice statement). Individuals with dementia (without previous stroke) and atrial fibrillation should be treated with anticoagulants (weak recommendation). Discontinuation of opioids should be considered in certain individuals with dementia (e.g. for whom there are no signs or symptoms of pain or no clear indication, or suspicion of side effects; Good Practice statement). Behavioral symptoms in persons with dementia should not be treated with mild analgesics (weak recommendation). In all patients with dementia treated with opioids, assessment of the individual risk-benefit ratio should be performed at regular intervals. Regular, preplanned medical follow-up should be offered to all patients with dementia. The setting will depend on the organization of local health services and should, as a minimum, include general practitioners with easy access to dementia specialists (Good Practice statement). Individuals with dementia and agitation and/or aggression should be treated with atypical antipsychotics only after all non-pharmacological measures have been proven to be without benefit or in the case of severe self-harm or harm to others (weak recommendation). Antipsychotics should be discontinued after cessation of behavioral disturbances and in patients in whom there are side effects (Good Practice statement). For treatment of epilepsy in individuals with dementia, newer anticonvulsants should be considered as first-line therapy (Good Practice statement). CONCLUSION This GRADE-based guideline offers recommendations on several important medical issues in patients with dementia, and thus adds important guidance for clinicians. For some issues, very little or no evidence was identified, highlighting the importance of further studies within these areas.
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Affiliation(s)
- K. S. Frederiksen
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - C. Cooper
- Department of Clinical Educational and Health PsychologyUniversity College LondonLondonUK
| | - G. B. Frisoni
- Memory ClinicUniversity Hospital of GenevaUniversity of GenevaGenevaSwitzerland
| | - L. Frölich
- Department of Geriatric PsychiatryZentralinstitut für Seelische Gesundheit MannheimMedical Faculty MannheimUniversity of HeidelbergMannheimGermany
| | | | - M. G. Kramberger
- Department of NeurologyCenter for Cognitive ImpairmentsUniversity Medical Center Ljubljana, and Medical facultyUniversity of LjubljanaLjubljanaSlovenia
| | - C. Nilsson
- Department of Neurology and Rehabilitation MedicineSkåne University HospitalLundSweden
- Clinical Memory Research UnitDepartment of Clinical SciencesLund UniversityMalmöSweden
| | | | - L. Mantoan Ritter
- Epilepsy CentreKing's College NHS Foundation TrustKing´s College LondonLondonUK
| | - D. Religa
- Division of Clinical GeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetNeo, StockholmSweden
- Karolinska University HospitalTheme AgingHuddingeSweden
| | - R. Schmidt
- University Clinic for NeurologyMedical University of GrazGrazAustria
| | - E. Stefanova
- Medical FacultyNeurology clinic CCSUniversity of BelgradeBelgradeSerbia
| | - A. Verdelho
- Department of Neurosciences and Mental HealthCHLNorte‐Hospital de Santa MariaIMMISAMBFaculty of MedicineUniversity of LisbonLisbonPortugal
| | - M. Vandenbulcke
- Department of NeurosciencesKU LeuvenGeriatric PsychiatryUniversity Hospitals LeuvenLeuvenBelgium
| | - B. Winblad
- Karolinska University HospitalTheme AgingHuddingeSweden
- Division of NeurogeriatricsDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetBioClinicumSolnaSweden
| | - G. Waldemar
- Department of NeurologyDanish Dementia Research CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
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Shiganova TA, Mikaelyan AS, Moncheva S, Stefanova K, Chasovnikov VK, Mosharov SA, Mosharova IN, Slabakova N, Mavrodieva R, Stefanova E, Zasko DN, Dzhurova B. Effect of invasive ctenophores Mnemiopsis leidyi and Beroe ovata on low trophic webs of the Black Sea ecosystem. Mar Pollut Bull 2019; 141:434-447. [PMID: 30955754 DOI: 10.1016/j.marpolbul.2019.02.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/23/2019] [Indexed: 06/09/2023]
Abstract
The study focuses on the impact of life excretion and mucus released by the "biological pollutants" invasive ctenophore Mnemiopsis leidyi and its predator Beroe ovata on the marine environment and lower trophic levels of the Black Sea ecosystem (bacteria, pico-phytoplankton, nano-autotrophic/heterotrophic flagellates, micro-phytoplankton, chlorophyll a, primary production (PP), micro-zooplankton). The chemical and biological variables were analysed in two sets of lab experiments with natural communities from mesotrophic (Gelendzhik) and eutrophic (Varna) coastal waters. While both species altered the chemical properties of experimental media, exerting structural and functional changes in the low food-web biological compartments, the results showed a stronger effect of B. ovata, most likely related to the measured higher rate of excretion and amount of released mucus. In addition the alterations in the Gelendzhik experiment were more pronounced, indicating that environmental implications on lower food-web are more conspicuous in mesotrophic than in eutrophic coastal waters.
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Affiliation(s)
- T A Shiganova
- Shirshov Institute of Oceanology, Russian Academy of Sciences, 36, Nahimovskiy prospekt, Moscow 117997, Russia.
| | - A S Mikaelyan
- Shirshov Institute of Oceanology, Russian Academy of Sciences, 36, Nahimovskiy prospekt, Moscow 117997, Russia.
| | - S Moncheva
- Institute of Oceanology BAS, 40 Parvi Mai street, 9000 Varna, Bulgaria
| | - K Stefanova
- Institute of Oceanology BAS, 40 Parvi Mai street, 9000 Varna, Bulgaria
| | - V K Chasovnikov
- Shirshov Institute of Oceanology, Russian Academy of Sciences, 36, Nahimovskiy prospekt, Moscow 117997, Russia
| | - S A Mosharov
- Shirshov Institute of Oceanology, Russian Academy of Sciences, 36, Nahimovskiy prospekt, Moscow 117997, Russia
| | - I N Mosharova
- Shirshov Institute of Oceanology, Russian Academy of Sciences, 36, Nahimovskiy prospekt, Moscow 117997, Russia
| | - N Slabakova
- Institute of Oceanology BAS, 40 Parvi Mai street, 9000 Varna, Bulgaria
| | - R Mavrodieva
- Institute of Oceanology BAS, 40 Parvi Mai street, 9000 Varna, Bulgaria
| | - E Stefanova
- Institute of Oceanology BAS, 40 Parvi Mai street, 9000 Varna, Bulgaria
| | - D N Zasko
- Shirshov Institute of Oceanology, Russian Academy of Sciences, 36, Nahimovskiy prospekt, Moscow 117997, Russia
| | - B Dzhurova
- Institute of Oceanology BAS, 40 Parvi Mai street, 9000 Varna, Bulgaria
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3
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Petrović I, Stefanova E, Marković V, Dragašević-Mišković N, Filippi M, Kostić V. Neuroimaging of cognitive-affective disorders in Parkinson’s disease. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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4
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Rakocevic-Stojanovic V, Peric S, Madzarevic R, Dobricic V, Ralic V, Ilic V, Basta I, Nikolic A, Stefanova E. Significant impact of behavioral and cognitive impairment on quality of life in patients with myotonic dystrophy type 1. Clin Neurol Neurosurg 2014; 126:76-81. [PMID: 25215445 DOI: 10.1016/j.clineuro.2014.08.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 08/15/2014] [Accepted: 08/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess an impact of cognitive and behavioral impairment on QoL in a larger cohort of patients with DM1. METHODS Sixty six genetically confirmed DM1 patients (22 with juvenile (jDM1) and 44 with adult form (aDM1) of the disease) were recruited. Following behavioral tests were used: Hamilton scales for depression and anxiety (HamD and HamA), Daytime Sleepiness Scale (DSS), and Krupp's Fatigue Severity Scale (FSS). Patients also underwent detailed classic neuropsychological investigation and Cambridge Neuropsychological Test Automated Battery (CANTAB). Individualized Neuromuscular Quality of Life questionnaire (INQoL) was used as a measure of QoL. RESULTS Patients with jDM1 scored lower than aDM1 patients regarding total INQoL score and all INQoL subdomains, except for myotonia. Significant predictors of total INQoL score in patients with jDM1 were severity of fatigue (β=+0.60, p<0.01) and percentage of correct responses on Spatial Recognition Memory test from CANTAB that measures visuospatial abilities (β=-0.38, p<0.05). The most important predictors of total INQoL score in patients with aDM1 were severity of fatigue (β=+0.36, p<0.05) and level of education (β=-0.29, p<0.05). CONCLUSION Our results showed clear influence of different central manifestations on QoL in patients with both aDM1 and jDM1.
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Affiliation(s)
- V Rakocevic-Stojanovic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - S Peric
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia.
| | - R Madzarevic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - V Dobricic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - V Ralic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - V Ilic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - I Basta
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - A Nikolic
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
| | - E Stefanova
- Institute of Neurology, Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, 6, Dr Subotica Street, Belgrade, Serbia
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5
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Peric S, Mandic Stojmenovic G, Markovic I, Stefanova E, Ilic V, Parojcic A, Misirlic Dencic S, Ostojic M, Rakocevic Stojanovic V, Kostic V. Cerebrospinal fluid biomarkers of neurodegeneration in patients with juvenile and classic myotonic dystrophy type 1. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Petrovic M, Stefanova E, Ziropadja L, Stojkovic T, Kostic V. Non-motor manifestations in Parkinson'/INS;s disease: 5year follow-/INS;up. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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7
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Peric S, Mandic-Stojmenovic G, Markovic I, Stefanova E, Ilic V, Parojcic A, Misirlic-Dencic S, Ostojic M, Rakocevic-Stojanovic V, Kostic V. Cerebrospinal fluid biomarkers of neurodegeneration in patients with juvenile and classic myotonic dystrophy type 1. Eur J Neurol 2013; 21:231-7. [DOI: 10.1111/ene.12237] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 06/05/2013] [Indexed: 01/13/2023]
Affiliation(s)
- S. Peric
- Clinical Center of Serbia; Neurology Clinic; Belgrade Serbia
| | | | - I. Markovic
- School of Medicine; Institute of Medical and Clinical Biochemistry; University of Belgrade; Belgrade Serbia
| | - E. Stefanova
- Clinical Center of Serbia; Neurology Clinic; Belgrade Serbia
- School of Medicine; University of Belgrade; Belgrade Serbia
| | - V. Ilic
- Clinical Center of Serbia; Neurology Clinic; Belgrade Serbia
| | - A. Parojcic
- Clinical Center of Serbia; Neurology Clinic; Belgrade Serbia
| | - S. Misirlic-Dencic
- School of Medicine; Institute of Medical and Clinical Biochemistry; University of Belgrade; Belgrade Serbia
| | - M. Ostojic
- Institute of Orthopedic Surgery and Traumatology; Belgrade Serbia
| | - V. Rakocevic-Stojanovic
- Clinical Center of Serbia; Neurology Clinic; Belgrade Serbia
- School of Medicine; University of Belgrade; Belgrade Serbia
| | - V. Kostic
- Clinical Center of Serbia; Neurology Clinic; Belgrade Serbia
- School of Medicine; University of Belgrade; Belgrade Serbia
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8
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Sorbi S, Hort J, Erkinjuntti T, Fladby T, Gainotti G, Gurvit H, Nacmias B, Pasquier F, Popescu BO, Rektorova I, Religa D, Rusina R, Rossor M, Schmidt R, Stefanova E, Warren JD, Scheltens P. EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol 2013; 19:1159-79. [PMID: 22891773 DOI: 10.1111/j.1468-1331.2012.03784.x] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES The last version of the EFNS dementia guidelines is from 2007. In 2010, the revised guidelines for Alzheimer's disease (AD) were published. The current guidelines involve the revision of the dementia syndromes outside of AD, notably vascular cognitive impairment, frontotemporal lobar degeneration, dementia with Lewy bodies, corticobasal syndrome, progressive supranuclear palsy, Parkinson's disease dementia, Huntington's disease, prion diseases, normal-pressure hydrocephalus, limbic encephalitis and other toxic and metabolic disorders. The aim is to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists and other specialist physicians responsible for the care of patients with dementing disorders. It represents a statement of minimum desirable standards for practice guidance. METHODS The task force working group reviewed evidence from original research articles, meta-analyses and systematic reviews, published by June 2011. The evidence was classified (I, II, III, IV) and consensus recommendations graded (A, B, or C) according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided. RESULTS AND CONCLUSIONS New recommendations and good practice points are made for clinical diagnosis, blood tests, neuropsychology, neuroimaging, electroencephalography, cerebrospinal fluid (CSF) analysis, genetic testing, disclosure of diagnosis, treatment of behavioural and psychological symptoms in dementia, legal issues, counselling and support for caregivers. All recommendations were revised as compared with the previous EFNS guidelines. The specialist neurologist together with primary care physicians play an important role in the assessment, interpretation and treatment of symptoms, disability and needs of dementia patients.
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Affiliation(s)
- S Sorbi
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy.
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9
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Papassotiropoulos A, Stefanova E, Vogler C, Gschwind L, Ackermann S, Spalek K, Rasch B, Heck A, Aerni A, Hanser E, Demougin P, Huynh KD, Luechinger R, Klarhöfer M, Novakovic I, Kostic V, Boesiger P, Scheffler K, de Quervain DJF. A genome-wide survey and functional brain imaging study identify CTNNBL1 as a memory-related gene. Mol Psychiatry 2013; 18:255-63. [PMID: 22105620 PMCID: PMC3554877 DOI: 10.1038/mp.2011.148] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Unbiased genome-wide screens combined with imaging data on brain function may identify novel molecular pathways related to human cognition. Here we performed a dense genome-wide screen to identify episodic memory-related gene variants. A genomic locus encoding the brain-expressed beta-catenin-like protein 1 (CTNNBL1) was significantly (P=7 × 10(-8)) associated with verbal memory performance in a cognitively healthy cohort from Switzerland (n=1073) and was replicated in a second cohort from Serbia (n=524; P=0.003). Gene expression studies showed CTNNBL1 genotype-dependent differences in beta-catenin-like protein 1 mRNA levels in the human cortex. Functional magnetic resonance imaging in 322 subjects detected CTNNBL1 genotype-dependent differences in memory-related brain activations. Converging evidence from independent experiments and different methodological approaches suggests a role for CTNNBL1 in human memory.
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Affiliation(s)
- A Papassotiropoulos
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland.
| | - E Stefanova
- Institute of Neurology, CCS, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - C Vogler
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - L Gschwind
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - S Ackermann
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - K Spalek
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - B Rasch
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland,Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - A Heck
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - A Aerni
- University of Basel, Psychiatric University Clinics, Basel, Switzerland,Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - E Hanser
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Department Biozentrum, University of Basel, Basel, Switzerland
| | - P Demougin
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Department Biozentrum, University of Basel, Basel, Switzerland
| | - K-D Huynh
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Department Biozentrum, University of Basel, Basel, Switzerland
| | - R Luechinger
- Institute for Biomedical Engineering, University and ETH Zürich, Zürich, Switzerland
| | - M Klarhöfer
- Division of Radiological Physics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - I Novakovic
- Institute of Biology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Kostic
- Institute of Neurology, CCS, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - P Boesiger
- Institute for Biomedical Engineering, University and ETH Zürich, Zürich, Switzerland
| | - K Scheffler
- MRC Department, MPI for Biological Cybernetics, Tübingen, Germany,Department of Neuroimaging and MR-Physics, University of Tübingen, Tübingen, Germany
| | - D J-F de Quervain
- University of Basel, Psychiatric University Clinics, Basel, Switzerland,Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland,University of Basel, Psychiatric University Clinics, Basel 4055, Switzerland. E-mail:
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10
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Kostic VS, Agosta F, Pievani M, Stefanova E, Jecmenica-Lukic M, Scarale A, Spica V, Filippi M. Pattern of brain tissue loss associated with freezing of gait in Parkinson disease. Neurology 2012; 78:409-16. [DOI: 10.1212/wnl.0b013e318245d23c] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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11
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Ziropadja L, Stefanova E, Petrovic M, Stojkovic T, Kostic VS. Apathy and depression in Parkinson's disease: the Belgrade PD study report. Parkinsonism Relat Disord 2011; 18:339-42. [PMID: 22166396 DOI: 10.1016/j.parkreldis.2011.11.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 10/17/2011] [Accepted: 11/18/2011] [Indexed: 12/19/2022]
Abstract
Apathy and depression are among the most common psychiatric and behavioral disorders associated with Parkinson's disease (PD). The objective of this study was to examine the prevalence and demographic and clinical correlates of apathy and depression in a clinical population-based sample of patients with PD and to assess whether apathy may present as a primary behavioral disturbance independent from depression and cognitive impairment. A series of 360 PD patients underwent psychiatric investigation with the Starkstein's Apathy Scale (AS), and the 17-item Hamilton Depression Rating Scale (HDRS-17), motor scoring with Hoehn and Yahr (HY) staging, and the Unified Parkinson's Disease Rating Scale (UPDRS); and cognitive screening with the Mini-Mental State Examination (MMSE) on the same day. Apathy coexisted with depression in 133 (36.9%) of PD patients, compared with depression without apathy in 16 (4.4%), apathy without depression in 84 (23%), and neither apathy nor depression in 127 PD patients (35.2%). Apathy was associated with higher axial UPDRS impairment score, lower MMSE score, higher l-dopa dosage, and earlier HY stages, while depression was predicted by the more advanced HY stages and younger age of PD patients. These findings suggest that apathy and depression may be separable in PD, although both are common in patients with PD. Therefore these two conditions should be systematically screened and considered in the care and management of PD.
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Affiliation(s)
- Lj Ziropadja
- Faculty of Philology, University of Belgrade, Belgrade, Serbia
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12
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Papassotiropoulos A, Henke K, Stefanova E, Aerni A, Müller A, Demougin P, Vogler C, Sigmund JC, Gschwind L, Huynh KD, Coluccia D, Mondadori CR, Hänggi J, Buchmann A, Kostic V, Novakovic I, van den Bussche H, Kaduszkiewicz H, Weyerer S, Bickel H, Riedel-Heller S, Pentzek M, Wiese B, Dichgans M, Wagner M, Jessen F, Maier W, de Quervain DJF. A genome-wide survey of human short-term memory. Mol Psychiatry 2011; 16:184-92. [PMID: 20038948 PMCID: PMC3030750 DOI: 10.1038/mp.2009.133] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Recent advances in the development of high-throughput genotyping platforms allow for the unbiased identification of genes and genomic sequences related to heritable traits. In this study, we analyzed human short-term memory, which refers to the ability to remember information over a brief period of time and which has been found disturbed in many neuropsychiatric conditions, including schizophrenia and depression. We performed a genome-wide survey at 909 622 polymorphic loci and report six genetic variations significantly associated with human short-term memory performance after genome-wide correction for multiple comparisons. A polymorphism within SCN1A (encoding the α subunit of the type I voltage-gated sodium channel) was replicated in three independent populations of 1699 individuals. Functional magnetic resonance imaging during an n-back working memory task detected SCN1A allele-dependent activation differences in brain regions typically involved in working memory processes. These results suggest an important role for SCN1A in human short-term memory.
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Affiliation(s)
- A Papassotiropoulos
- Division of Molecular Psychology, University of Basel, Basel, Switzerland. or
| | - K Henke
- Department of Psychology, University of Bern, Bern, Switzerland
| | - E Stefanova
- Institute of Neurology, CCS, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Aerni
- Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - A Müller
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - P Demougin
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - C Vogler
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - J C Sigmund
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - L Gschwind
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - K-D Huynh
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - D Coluccia
- Division of Psychiatry Research, University of Zurich, Zurich, Switzerland
| | - C R Mondadori
- Division of Neuropsychology, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - J Hänggi
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - A Buchmann
- Division of Psychiatry Research, University of Zurich, Zurich, Switzerland
| | - V Kostic
- Institute of Neurology, CCS, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - I Novakovic
- Institute of Biology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - H van den Bussche
- Institute of Primary Medical Care, University Medical Center, Hamburg-Eppendorf, Germany
| | - H Kaduszkiewicz
- Institute of Primary Medical Care, University Medical Center, Hamburg-Eppendorf, Germany
| | - S Weyerer
- Central Institute of Mental Health, Mannheim, Germany
| | - H Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - S Riedel-Heller
- Public Mental Health Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - M Pentzek
- Department of General Practice, Dusseldorf University Medical Center, Dusseldorf, Germany
| | - B Wiese
- Institute for Biometrics, Hannover Medical School, Hannover, Germany
| | - M Dichgans
- Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - M Wagner
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - F Jessen
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - W Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - D J-F de Quervain
- Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland,Division of Cognitive Neuroscience, University of Basel, Birmannsgasse 8, Basel 4055, Switzerland. E-mail:
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13
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Mijajlovic M, Petrovic I, Svetel M, Stefanova E, Stojkovic T, Kostic V. PO06-MO-03 Diagnosisng Parkinson's disease with transcranial brain parenchyma sonography. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70694-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Jevtović D, Vanovac V, Veselinović M, Salemović D, Ranin J, Stefanova E. The incidence of and risk factors for HIV-associated cognitive-motor complex among patients on HAART. Biomed Pharmacother 2008; 63:561-5. [PMID: 19026516 DOI: 10.1016/j.biopha.2008.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 09/26/2008] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While highly active antiretroviral therapy (HAART) allows for the considerable decline in the incidence of HIV-related opportunistic infections and tumors, its effect on treating HIV infection of the brain, such as HIV-associated dementias (HADs), remains unclear. METHODS A cross-sectional study of consecutive series of 96 patients from the Serbian HIV/AIDS cohort, treated with HAART in our HIV unit was performed to evaluate the incidence of and risk factors for cognitive/motor complex during HAART. CD4+T cell counts and pVL values at the time of neurological evaluation were parameters of the response to HAART. The mini-mental test and neurologic examination were performed at one point of time during treatment to reveal cognitive and/or motor disorders. RESULTS After mean HAART duration of 47 months, unimpaired cognition, minor cognitive impairment, and HIV-associated dementia were recorded in 56 (58.3%), 27 (28.1%), and 13 (13.5%), respectively. Motor abnormalities had 39 (40.6%) patients. Of these, 21, 12, and 6 patients belong to the subgroups with normal cognition, minor cognitive impairment and HAD patients, respectively. Factors predictive for HAD were age over 40 (OR 3.7, 95% CI 1.07-13.28, P=0.039), and AIDS diagnosis prior to HAART initiation (OR 14.19, 95% CI 1.76-114.16, P=0.013). Conversely, factors shown to be protective against HAD were the usage of AZT and NNRTIs, as components of HAART regimens (OR 0.18, 95% CI 0.046-0.76, P=0.019, and OR 0.14, 95% CI 0.034-0.6, P=0.008). CONCLUSION Cognitive/motor complex has still remained a significant neuropathology among late presenters and elder HIV/AIDS patients. Certain HAART regimens containing AZT, and/or NNRTIs, could be protective for these patients.
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Affiliation(s)
- Dj Jevtović
- HIV/AIDS Department, Institute for Infectious and Tropical Diseases, Belgrade University School of Medicine, Clinical Centre of Serbia, Bulevar Oslobodjenja 16, 11000 Belgrade, Serbia.
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Mijajlović M, Dragašević N, Stefanova E, Petrović I, Svetel M, Kostić VS. Transcranial sonography in spinocerebellar ataxia type 2. J Neurol 2008; 255:1164-7. [DOI: 10.1007/s00415-008-0862-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 12/06/2007] [Accepted: 01/08/2008] [Indexed: 12/25/2022]
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16
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Stefanova E, Wall A, Almkvist O, Nilsson A, Forsberg A, Långström B, Nordberg A. Longitudinal PET evaluation of cerebral glucose metabolism in rivastigmine treated patients with mild Alzheimer’s disease. J Neural Transm (Vienna) 2005; 113:205-18. [PMID: 16049637 DOI: 10.1007/s00702-005-0312-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Accepted: 03/25/2005] [Indexed: 10/25/2022]
Abstract
In this study 11 patients with mild Alzheimer's disease (AD) were treated with the cholinesterase inhibitor rivastigmine (mean dose 8.6 +/- 1.3'mg) for 12 months and underwent positron emission tomography (PET) studies of cerebral glucose metabolism (CMRglc) and neuropsychological testing at baseline and after 12 months. An untreated group of 10 AD patients served as control group. While the untreated AD patients showed a significant decline of CMRglc in the temporo-parietal and frontal cortical regions after 12 months follow-up the rivastigmine-treated patients showed no decline in CMRglc in corresponding cortical brain regions. Furthermore, a significant dose-related increase in CMRglc was recorded in the right frontal association region after 12 months rivastigmine treatment. A positive correlation was observed between changes in CMRglc and several cognitive tests in patients receiving higher doses (10.5-12'mg) of rivastigmine. These results suggest a stabilization effect of rivastigmine on CMRglc in mild AD patients receiving long-term rivastigmine treatment.
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Affiliation(s)
- E Stefanova
- Division of Molecular Neuropharmacology, Neurotec Department, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Almkvist O, Darreh-Shori T, Stefanova E, Spiegel R, Nordberg A. Preserved cognitive function after 12 months of treatment with rivastigmine in mild Alzheimer's disease in comparison with untreated AD and MCI patients. Eur J Neurol 2004; 11:253-61. [PMID: 15061827 DOI: 10.1046/j.1468-1331.2003.00757.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cholinesterase inhibitors (ChEIs) have shown positive symptomatic effects on cognition, activities of daily living, and behavior in patients with Alzheimer's disease (AD). Rivastigmine is a slowly reversible ChEI that inhibits acetylcholinesterase and butyrylcholinesterase. We evaluated the effects of long-term rivastigmine treatment on cognitive function and plasma levels of ChE activity, and the relationship between ChE activity and cognition. Patients with mild AD (n = 11) treated with rivastigmine for 12 months were compared with matched groups of untreated patients with AD (n = 21) or mild cognitive impairment (MCI; n = 22) representing the natural course of the pre-clinical and very early stage of disease. For untreated AD patients, neuropsychological assessment was made at baseline and 12 months. Determination of ChE activity in plasma and assessment of global cognition, episodic memory, visuospatial ability, and attention were performed at 0 (baseline), 3, 6, and 12 months for treated AD patients and untreated MCI patients. At 12 months, cognitive function was slightly improved or maintained in mild AD patients treated with rivastigmine. In contrast, cognition was markedly worsened in untreated AD patients and unchanged or slightly worsened in untreated MCI patients. In the group of treated AD patients, there was a significant correlation between plasma ChE inhibition and cognition, particularly in relation to attention. This effect was most apparent at 3 months of treatment. In conclusion, a clear beneficial effect of rivastigmine was shown on cognitive function for patients with mild AD and plasma values of ChE inhibition were associated with attention.
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Affiliation(s)
- O Almkvist
- Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
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Stefanova E, Blennow K, Almkvist O, Hellström-Lindahl E, Nordberg A. Cerebral glucose metabolism, cerebrospinal fluid-beta-amyloid1-42 (CSF-Abeta42), tau and apolipoprotein E genotype in long-term rivastigmine and tacrine treated Alzheimer disease (AD) patients. Neurosci Lett 2003; 338:159-63. [PMID: 12566177 DOI: 10.1016/s0304-3940(02)01384-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated cerebral glucose metabolism (CMRglc) and cerebrospinal fluid (CSF) levels of tau and beta-amyloid(1-42) (Abeta42), in relation to apolipoprotein E (ApoE) genotype, in patients with mild Alzheimer disease (AD) treated with rivastigmine (n=11) and tacrine (n=16) for 1 year; and two untreated AD groups. The rivastigmine-treated AD patients showed a significant increase in CMRglc as compared to both tacrine-treated and untreated AD subjects. The rivastigmine-treated AD group showed no change in CSF-tau levels after 1 year, while in contrast a significant increase as seen in tacrine-treated and untreated AD patients. The CSF-tau changes were mainly seen in ApoE epsilon4 carriers. There was no significant change in Abeta42 after 1-year treatment with either rivastigmine or tacrine. This study shows that the two long-term cholinesterase inhibitor treatments exert different effects on biological markers for AD.
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Affiliation(s)
- E Stefanova
- Karolinska Institutet, Department of Clinical Neuroscience Occupational Therapy and Elderly Care Research (NEUROTEC), Division of Molecular Neuropharmacology, Huddinge University Hospital, B84, 141 86, Stockholm, Sweden
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Kostić VS, Marinković J, Svetel M, Stefanova E, Przedborski S. The effect of stage of Parkinson's disease at the onset of levodopa therapy on development of motor complications. Eur J Neurol 2002; 9:9-14. [PMID: 11784369 DOI: 10.1046/j.1468-1331.2002.00346.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to ascertain whether the stage of Parkinson's disease (PD) (according to the Hoehn and Yahr staging system) would affect the length of time between the introduction of levodopa therapy and appearance of levodopa-associated motor complications. Forty patients with clinically definite PD were studied. In all, clinical and therapeutic data were collected from the time of diagnosis to the time of levodopa-associated motor complications (i.e. dyskinesia, motor fluctuations). In 17 patients, levodopa could be started in Hoehn and Yahr stage I (H & Y-I; 16.2 months after the onset of PD), whilst in 13 patients levodopa could be started in H & Y-II (19.6 months after the onset of the disease) and in 10 in H & Y-III (45.1 months after the onset of PD). Cox proportional hazard regression model shows that the PD patients in whom the initial levodopa treatment was introduced at stage III develop both dyskinesias and motor fluctuations significantly earlier than the patients whose levodopa started in stage I and II of PD. The median interval to develop dyskinesias was 66, 72 and 24 months for patients in whom levodopa was introduced in stage I, II and III, respectively. These values were 64, 55 and 14 months for motor fluctuations. These findings add to the clinical arguments that favour an essential role of severity of PD at levodopa initiation as a risk factor for the development of levodopa-associated motor complications.
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Affiliation(s)
- V S Kostić
- Institute of Neurology CCS, Belgrade, Yugoslavia.
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Abstract
A 19-year-old man developed the Kleine-Levin syndrome three weeks after the head trauma and subsequent neurosurgical evacuation of right-sided, fronto-temporal epidural hematoma. The expression of periodic episodes was observed for hypersomnolence and, to a lesser degree, for behavioral disturbances, while the hyperphagia was constantly present during a period of 1.5 years. These clinical features were associated with the focal, right-sided hypothalamic lesion and ipsilateral posttraumatic parenchymal temporal lobe damage on NMR imaging.
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Affiliation(s)
- V.S. Kostic
- Institute of Neurology, Clinical Center of Serbia, Belgrade, Yugoslavia
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Abstract
The frequency and type of dystonic movements, as well as brain abnormalities, as depicted with magnetic resonance imaging (MRI), which might correlate with dystonia, were studied in 27 consecutive patients with a neurologic form of Wilson's disease (WD) and optimized treatment. Dystonia was found in 10 patients (37%), being generalized in half of them, while two patients had segmental, two patients multifocal dystonia, and one patient bilateral foot dystonia. Dystonia was a presenting sign in four patients and developed later in the course of the disease in six patients, despite the administered therapy for WD. Putamen was the only structure significantly more frequently lesioned in dystonic (80%) in comparison to WD patients without dystonia (24%), suggesting a relation between abnormalities in this brain region and dystonic movements in WD.
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Affiliation(s)
- M Svetel
- Institute of Neurology CCS, Belgrade, Yugoslavia
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Milovic A, Pavlovic D, Ocic G, Smiljkovic P, Stefanova E, Djordjevic J, Zugic S, Smiljkovic T, Tomic G. 3-12-21 Risk factors and neurological findings in multi-infarct dementia. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stefanova E, Ocić G, Žiropadja L, Tomić G, Milović A, Golubović S, Zlatić G, Djordjević J, Pavlović D, Smiljković P, Žugić S. 5-12-29 Explicit and implicit memory deficits in Alzheimer's disease. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)86341-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ocić G, Stefanova E, Djordjević J, Pavlović D, Tomić G, Smiljković P, Žugić S. 3-12-27 Cognitive disturbances in Alzheimer's disease and vascular dementia. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pavlović D, Ocić G, Stefanova E, Filipović S, Djordjević Z. [Application of LNNB in patients with closed brain injury]. SRP ARK CELOK LEK 1994; 122:161-164. [PMID: 17977417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Closed brain injury (CBI) has become epidemiological problem with important neuropsychological consequences that, although often not obvious without formal testing, are of great influence on cognitive and social functioning of these patients. We applied Luria Nebrasca Neuropsychological Battery (LNNB) to 24 victims of moderate and severe CVI after they regained proper orientation for time and place, and 75 to 180 days later. There were 18 male and 6 female patients, age from 16 to 55 years. The most impaired functions on first testing were rhythm perception, which can be taken as a measure of attention, memory, Intellectual processes, visual function and arithmetics (in the descending order of scores). On retesting we noted significant recovery in rhythm perception, visual functions, intellectual processes, motor functions, receptive speech and arithmetics. Disorders of attention and concentration showed widespread influence on other neuropsychological functions as a nonspecific factor, especially in spontaneous recovery that stresses the importance of specific rehabilitation measures for attention and concentration. LNNB showed great opportunities for assessment of wide spectrum of neuropsychological functions both in initial and later phases, and also in planning of cognitive and social rehabilitation.
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