Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 7 Articles
Background: Heterogeneous disease trajectories of mild cognitive impairment (MCI) and dementia are frequently\nencountered in clinical practice, but there is still insufficient knowledge to understand the reasons and mechanisms\ncausing this heterogeneity. In addition to correlates of the disorder, patient characteristics such as their health\nstatus, social environment, comorbidities and frailty may contribute to variability in trajectories over time. The\ncurrent paper outlines the study design and the study population of and provides an overview of the data\ncollected in the Clinical Course of Cognition and Comorbidity in Mild Cognitive Impairment (4C-MCI cohort, n = 315)\nand Dementia (4C-Dementia cohort, n = 331) Study.\nMethods: The two complementary longitudinal cohorts part of the 4C study began enrolment in March 2010.\nParticipants were prospectively recruited from three collaborating Dutch Alzheimer Centers, with three annual\nfollow-up assessments after baseline. Extensive neuropsychological assessments, and detailed profiling of\ncomorbidities, health and frailty at each follow up were the key features of the 4C study. As such, the 4C study was\ndesigned to study if and how patients� comorbidities and frailty are associated with the course of MCI and\ndementia measured with a comprehensive and multidimensional set of outcomes including cognition, daily\nfunctioning, quality of life, behavioral disturbances, caregiver burden, institutionalization and death and whether the\neffects of medical health and frailty differ between MCI and dementia stages of cognitive disorders. Conclusion: Sampled in a clinical setting, the 4C study complements population-based studies on\nneurodegenerative disorders in terms of the type of assessment (e.g. comorbidity, frailty, and functional status were\nrepeatedly assessed). The 4C study complements available clinical cohorts of MCI and dementia patients, because\nthe exclusion criteria were kept to a minimum, to obtain a sample that is representative for the average patient\nvisiting a memory clinic....
Background: Deep brain stimulation (DBS) has been shown to be effective for parkinsonian symptoms poorly\nresponsive to medications. DBS is typically well-tolerated, as are the maintenance battery changes. Here we\ndescribe an adverse event during a battery replacement procedure that caused rapid onset of severe depression.\nCase Presentation: The patient is a 58-year-old woman who was in a serious motor vehicle accident and sustained a\nconcussion with loss of consciousness. Within weeks of the accident she began developing parkinsonian symptoms that\nprogressively worsened over the subsequent 10 years. Responding poorly to medications, she received DBS,\nwhich controlled her movement symptoms. Five years after initiating DBS, during a routine battery change, an apparent\nelectrical event occurred that triggered the rapid onset of severe depression. Anti-seizure and antidepressant medications\nwere ineffective, and the patient was offered a course of electroconvulsive therapy (ECT), which resulted in complete\nreversal of her depressive episode.\nConclusion: Parkinson�s syndrome can be seen after a single closed head injury event. Post-traumatic parkinsonism is\nresponsive to DBS; however, DBS has been associated with an infrequent occurrence of dramatic disruption in mood. ECT\nis a therapeutic option for patients who develop intractable depressive illness associated with DBS....
Epilepsy is a very complex disorder of the central nervous system. It is characterized\nby a sudden, disordered and excessive neuronal shock that causes different clinical\nevidences with specific related electroencephalogram (EEG). Psychogenic Non-Epileptic\nSeizures (PNES) can seriously complicate the diagnosis of epilepsy. The separoxysmal\nevents have the same clinical evidences of epilepsy, such as an impairment\nof the self-control and a range of sensory, motor and mental manifestations, without\nthe typical related electroencephalogram (EEG) because of the absence of an organic\ncause. The overwhelming majority of Psychogenic Non-Epileptic Seizures are related\nto psychological factors like dissociation. This is a defense mechanism used to cope\nstressful events or emotional conflicts. Psychological or psychiatric disorders, like\nPost Traumatic Stress Disorder (PTSD), are frequently associated to Psychogenic\nNon-Epileptic Seizures. In this article, we present a case report of epilepsy combined\nwith Psychogenic Non-Epileptic Seizures. A joint intervention is of great significance\nin this occurrence. The subject received a psychological assessment including psychometric\nand projective tools. He stood MMPI-2, Wais-R, SCL-90, Rorschach test\nand graphic tests. A psychological disorder related to defense mechanisms was identified.\nThe subject presents a tendency to convert his fears and emotive pains in rational\nand more socially acceptable problems, using his body to express his discomfort.\nPatient with epileptic seizures should receive a psychological assessment to exclude\nPsychogenic Non-Epileptic Seizures. Further studies should propose guidelines\nto integrate neurological, psychiatric and psychological intervention....
Obsessive compulsive disorder (OCD) is a common disorder characterised by persistent and unwanted intrusive thoughts, images,\nand urges and repetitive behaviours or mental acts and can cause pervasive impairments. In Bangladesh, the prevalence of OCD\namong children is 2% which is higher than in previous reporting. This study was aimed at looking into the type, frequency, and\nseverity of symptoms of OCD and comorbidity among children and adolescents. A consecutive 60 OCD cases from a child mental\nhealth service with age range of 5ââ?¬â??18 years were recruited and divided into below and above 12 years of age group. The assessment\nwas carried out using standardized Bangla version of Development and Well being Assessment and Childrenââ?¬â?¢s Yale-Brown Obsessive\nCompulsive Scale was administered. Of the obsession, contamination was the highest followed by doubt, and of the compulsion,\nwashing/cleaning was the highest followed by checking, repeating, and ordering rituals. More than half of the subjects had severe\nOCD and comorbidity was present in 58% subjects. Specific phobia, social phobia, major depressive disorder, and tic disorder were\nmore prevalent. These symptoms and comorbidity profile can serve the baseline data for a country like Bangladesh and further\nlarge scale study would better generalize the study results....
Background: Controversial research has indicated potential neuroprotective qualities\nof lithium in the prevention of dementia, but it did not lead to a definite conclusion.\nAim: We seek to examine whether lithium has a protective effect in an elderly\npopulation suffering from bipolar disorder. Patients and Methods: Of a retrospective\ncohort including 433 patient files that met inclusion criteria (age over 65 years\nand bipolar disease coded by ICD), 147 files contained enough relevant data. The patientsââ?¬â?¢\nfiles were divided into lithium users (LU) for those who used lithium for at\nleast a minimum of 3 months and non-users (LNU) for those who did not use lithium\nat all or used it for a period of less than 3 months. We searched for dementia\nincidence in these two groups. Results: 433 files were collected initially through a\ncomputerized search using ICD10 code for bipolar affective disorder. One hundred\ntwenty three files were excluded due to age (younger than 65 years), 7 were excluded\ndue to neurological background, and 49 were excluded due to either a secondary or a\nnot strictly bipolar psychiatric diagnosis. One hundred and seven were excluded due\nto insufficient/uncertain data. The remainders of 147 files were included in the final\nanalysis. Twenty five of the 147 bipolar patients were diagnosed with dementia (17%).\nAmongst the 92 LNU patients, 16 developed dementia (17.4%) and of the 55 LU patients,\n9 developed dementia (16.4%); Pearsonââ?¬â?¢s Ãâ?¡ 2(1) = 0.026, p < 0.05. Our analysis\nshowed no significant difference between the two groups. Conclusions: No cognitive\nprotective qualities of lithium treatment in elderly bipolar patients were demonstrated\nby our study....
Background: In Parkinsonââ?¬â?¢s disease (PD), cognitive impairment is an important non-motor symptom heralding the\ndevelopment of dementia. Effective treatments to slow down the rate of cognitive decline in PD patients with mild\ncognitive impairment are lacking. Here, we describe the design of the Parkinââ?¬â?¢Play study, which assesses the effects\nof a cognitive health game intervention on cognition in PD.\nMethods/Design: This study is a multicentre, phase-II, open-randomized clinical trial that aims to recruit 222 PD\npatients with mild cognitive impairment. Eligible patients have PD, Hoehn & Yahr stages Iââ?¬â??III, are aged between 40\nand 75 years, and have cognitive impairment but no dementia. The intervention group (n = 111) will be trained\nusing a web-based health game targeting multiple cognitive domains. The control group (n = 111) will be placed\non a waiting list. In order to increase compliance the health game adapts to the subjectsââ?¬â?¢ performance, is enjoyable,\nand can be played at home. From each group, 20 patients will undergo fMRI to test for potential functional brain\nchanges underlying treatment. The primary outcome after 12 weeks of training is cognitive function, as assessed by\na standard neuropsychological assessment battery and an online cognitive assessment. The neuropsychological\nassessment battery covers the following domains: executive function, memory, visual perception, visuoconstruction\nand language. A compound score for overall cognitive function will be calculated as the mean score of all test Zscores\nbased on the distribution of scores for both groups taken together. Secondary outcomes at follow-up visits\nup to 24 weeks include various motor and non-motor symptoms, compliance, and biological endpoints (fMRI).\nDiscussion: This study aims at evaluating whether a cognitive intervention among PD patients leads to an\nincreased cognitive performance on targeted domains. Strengths of this study are a unique web-based health\ngame intervention, the large sample size, a control group without intervention and innovations designed to\nincrease compliance....
This paper reviewed genetic, neurodevelopmental, and neurobiological perspectives\nto understand the etiology and relevant treatment approaches of schizophrenia. Although\ngenetic and neurodevelopmental theories provide a substantial contribution\nto the etiology of schizophrenia, neurobiological one has its dominant stance in\nwhich it can explain causative mechanisms of schizophrenia, identify targets for\ntreatment, and predict outcomes well. According to the neurobiology, onset and\ncourse of schizophrenia are well supported by the alterations in neurotransmitters\nsuch as dopamine or serotonin. Based on this mechanism, antipsychotics have been\nwidely used as one of the treatment approaches for schizophrenia. By following up\nthe degree of patients� responses to antipsychotics, treatment outcomes could be\nevaluated or predicted. Although neurobiology seldom provides information about\nidentification or prevention of risk factors about schizophrenia compared to genetic\nand neurodevelopmental approaches, it has well-established scientific foundations,\nability to guide treatment, applicability across age and culture, and usefulness as a\nresearch framework....
Loading....