Validity and reliability of the Turkish version of the Informant Assessment of Geriatric Delirium Scale.

Background and purpose:

Delirium is a common complication developing in el­der­ly patients. Therefore, it is important to diagnose delirium earlier. Family caregivers play an active role in early diagnosis of de­lirium and build a bridge between health pro­fessionals and patients. The purpose of this research was to achieve the validity and reliability of the Turkish version of the Informant Assessment of Geriatric Delirium Scale (I-AGeD).

This is a methodological study. The sample comprised 125 caregivers ac­cepting to participate in the study and offering care to older patients with hip fracture aged ≥60 years. Data were gathered preoperatively and on postoperative days 0, 1 and 2. After achieving the linguistic and content validity of the scale, the known-groups comparison was used to achieve its construct validity. The ROC curve analysis was made to determine the sensitivity and specificity of the scale. Item-total correlations, item analysis based on the difference between the upper 27% and lower 27%, Kuder–Richardson 20 (KR-20) coefficient and parallel forms reliability with the NEECHAM Confusion Scale were adapted to assess discriminant indices of the items in the I-AGeD.

The item-total correlation coeffi­cients of the scale ranged from 0.54 to 0.89 and KR-20 coefficient ranged from 0.09 to 0.91 depending on the measurement times. According to the ROC curve analysis, the sensitivity and specificity of the scale were ≥ 91% and ≥ 96% respectively. The parallel forms reliability analysis showed a highly significant, strong negative relation at each measurement between the I-AGeD and the NEECHAM Confusion Scale. 

The I-AGeD is valid and reliable to diagnose delirium in older Turkish patients in perioperative processes.

Normalized Theta but Increased Gamma Activity after Acetylcholinesterase Inhibitor Treatment in Alzheimer's Disease: Preliminary qEEG Study.

Acetylcholinesterase inhibitors (AChE-I) are the core treatment of mild to severe Alzheimer's disease (AD). However, the efficacy of AChE-I treatment on electroencephalography (EEG) and cognition remains unclear. We aimed to investigate the EEG power and coherence changes, in addition to neuropsychological performance, following a one-year treatment. Nine de-novo AD patients and demographically-matched healthy controls (HC) were included. After baseline assessments, all AD participants started cholinergic therapy. We found that baseline and follow-up gamma power analyzes were similar between groups. Yet, within the AD group after AChE-I intake, individuals with AD displayed higher gamma power compared to their baselines (P < .039). Also, baseline gamma coherence analysis showed lower values in the AD than in HC (P < .048), while these differences disappeared with increased gamma values of AD patients at the follow-up. Within the AD group after AChE-I intake, individuals with AD displayed higher theta and alpha coherence compared to their baselines (all, P < .039). These increased results within the AD group may result from a subclinical epileptiform activity. Even though AChE-I is associated with lower mortality, our results showed a significant effect on EEG power yet can increase the subclinical epileptiform activity. It is essential to be conscious of the seizure risk that treatment may cause.

Senior Moments Are Never-ending Times When You Are Old (Are They?): First Step of Turquoise Project.

Introduction: The number of dementia patients in Turkey is increasing, as well as all over the world. However, we do not know how much society knows about dementia. The aim of this study is to evaluate people's concept of dementia, their awareness of dementia research and treatment, whether dementia and forgetfulness are considered normal in old age, and whether having dementia is associated with a lack of mental abilities. Methods: A Dementia Awareness Questionnaire was created in the form of a self-report questionnaire, consisting of 20 questions and using a five-point Likert-type answering method in order to question participants' information about dementia. In addition, we asked for demographic information such as age, gender, occupation, education level of the participants, as well as whether they have had relatives diagnosed with a neurodegenerative disease. The surveys were administered online. Results: A total of 1551 participants from 53 cities were included in the study. Approximately half of the participants did not know the definition of dementia, 20.9% thought that dementia and Alzheimer's disease were the same; 50.4% considered forgetfulness, and 55.2% considered dementia as a natural consequence of aging. While 34.5% of the participants thought that dementia patients could be dangerous, 10.3% thought they could not continue living as a part of society. While 38.5% of healthcare professionals do not know the definition of dementia, 18.5% of them say that dementia and Alzheimer's disease are the same, 58.5% think that dementia patients are not fit to make their own decisions, 40.6% believe that dementia patients have criminal liability. 15.8% of healthcare professionals thought that dementia is only seen in elderly people; 21.4% thought that dementia, and 49.2% thought that forgetfulness was a result of normal aging. Conclusion: Our study confirms that dementia is still an unknown concept in society and among healthcare professionals. It is widely believed that forgetfulness and dementia are part of normal aging, and there is no cure for dementia. This study, which we have done in order to understand the level of dementia awareness in Turkish society, reveals the necessity for research on dementia and studies on how to increase dementia awareness.

Innovations in Neurophysiology and Their Use in Neuropsychiatry.

Many structural and functional tests are used to explore the nature of neurodevelopmental and neurodegenerative diseases. Cognitive involvement has become more and more remarkable in many neurological and psychiatric diseases. This condition evoked a paradigm shift, and today disorders are addressed from a neuroscientific perspective, including silent symptoms. The spatial resolution of structural studies is lacking and is combined with the unique temporal resolution of EEG methods. In our current clinical practice, EEG does not have definitive diagnostic value in psychiatric disorders, but it helps to make a correct diagnosis by excluding other neurological diseases. However, the use of EEG for research purposes is promising in both groups. In this review; there is up-to-date information on the use of electrophysiological examinations in neurological diseases, especially Alzheimer's disease, Parkinson's disease, Frontotemporal dementia, and psychiatric disorders such as schizophrenia, mood disorders, attention deficit and hyperactivity disorder, and obsessive-compulsive disorder, to define the point we have reached in our journey to understand these disorders.

Clinical-epidemiological and radiological characteristics of stroke patients: A multicentre study.

INTRODUCTION AND AIM: Stroke is the leading cause of disability in adults and the second most common cause of death, at a rate of 11.8% worldwide. The purpose of this study was to examine the aetiological, demographic, and clinical characteristics of patients admitted to hospital because of acute strokes. MATERIALS AND METHODS: This multicentre study retrieved information for all patients admitted to hospital because of an acute cerebrovascular event over a six-month period, and sociodemographic, aetiological, and clinical characteristics were recorded. RESULTS: A total of 1136 patients, 520 of whom were women (45.7%), with a mean age of 70.3 ± 12.8 years, were included in the study. Of these, 967 were diagnosed with ischaemic stroke (IS) (85.1%), 99 with haemorrhagic stroke (HS) (8.7%), and 70 with transient ischaemic attack (6.1%). The most common risk factor for stroke was hypertension (73%). Carotid disease and hyperlipidaemia rates were higher in patients with HS. Numbers of functionally dependent patients with severe neurological status according to the National Institutes of Health Stroke Scale and modified Rankin scale were significantly higher in the HS group (P < .001). When IS was classified according to the Trial of Org 10172 in Acute Stroke Treatment, small vessel disease emerged as the most common cause (41%). The most common lesion localisations were the parietal lobe (23%) in the IS group and the thalamus (35.3%) in the HS group. Eighty-eight patients (7.7%), 62 (6.4%) in the ischaemic subgroup, and 26 (26.3%) in the haemorrhagic subgroup, died within the first month. CONCLUSION: Current and accurate evaluations of stroke aetiology are essential for stroke prevention and treatment planning. This study, shows that no change occurred in the aetiology of stroke and epidemiological characteristics and that accurate identification of modifiable stroke risk factors is still a major goal.

Diagnostic Utility of Measuring Cerebral Atrophy in the Behavioral Variant of Frontotemporal Dementia and Association With Clinical Deterioration.

Importance: The presence of atrophy on magnetic resonance imaging can support the diagnosis of the behavioral variant of frontotemporal dementia (bvFTD), but reproducible measurements are lacking. Objective: To assess the diagnostic and prognostic utility of 6 visual atrophy scales (VAS) and the Magnetic Resonance Parkinsonism Index (MRPI). Design, Setting, and Participants: In this diagnostic/prognostic study, data from 235 patients with bvFTD and 225 age- and magnetic resonance imaging-matched control individuals from 3 centers were collected from December 1, 1998, to September 30, 2019. One hundred twenty-one participants with bvFTD had high confidence of frontotemporal lobar degeneration (FTLD) (bvFTD-HC), and 19 had low confidence of FTLD (bvFTD-LC). Blinded clinicians applied 6 previously validated VAS, and the MRPI was calculated with a fully automated approach. Cortical thickness and subcortical volumes were also measured for comparison. Data were analyzed from February 1 to June 30, 2020. Main Outcomes and Measures: The main outcomes of this study were bvFTD-HC or a neuropathological diagnosis of 4-repeat (4R) tauopathy and the clinical deterioration rate (assessed by longitudinal measurements of Clinical Dementia Rating Sum of Boxes). Measures of cerebral atrophy included VAS scores, the bvFTD atrophy score (sum of VAS scores in orbitofrontal, anterior cingulate, anterior temporal, medial temporal lobe, and frontal insula regions), the MRPI, and other computerized quantifications of cortical and subcortical volumes. The areas under the receiver operating characteristic curve (AUROC) were calculated for the differentiation of participants with bvFTD-HC and bvFTD-LC and controls. Linear mixed models were used to evaluate the ability of atrophy measures to estimate longitudinal clinical deterioration. Results: Of the 460 included participants, 296 (64.3%) were men, and the mean (SD) age was 62.6 (11.4) years. The accuracy of the bvFTD atrophy score for the differentiation of bvFTD-HC from controls (AUROC, 0.930; 95% CI, 0.903-0.957) and bvFTD-HC from bvFTD-LC (AUROC, 0.880; 95% CI, 0.787-0.972) was comparable to computerized measures (AUROC, 0.973 [95% CI, 0.954-0.993] and 0.898 [95% CI, 0.834-0.962], respectively). The MRPI was increased in patients with bvFTD and underlying 4R tauopathies compared with other FTLD subtypes (14.1 [2.0] vs 11.2 [2.6] points; P < .001). Higher bvFTD atrophy scores were associated with faster clinical deterioration in bvFTD (1.86-point change in Clinical Dementia Rating Sum of Boxes score per bvFTD atrophy score increase per year; 95% CI, 0.99-2.73; P < .001). Conclusions and Relevance: Based on these study findings, in bvFTD, VAS increased the diagnostic certainty of underlying FTLD, and the MRPI showed potential for the detection of participants with underlying 4R tauopathies. These widely available measures of atrophy can also be useful to estimate longitudinal clinical deterioration.

Assessment of the relation between the neutrophil to lymphocyte ratio and severity of ischemic stroke in a large cohort.

AIM OF STUDY: The NLR is a simple and inexpensive parameter that is useful as a marker of subclinical inflammation. The purpose of this study was to investigate the clinical characteristics of patients diagnosed with acute cerebral ischemia at the time of initial evaluation in the emergency department. PATIENTS AND METHODS: The study was designed as a multicentre cross-sectional study of acute ischemic stroke patients. Neurological evaluations were assessed using the NIHSS and mRS. Evaluations included the results of patients' laboratory tests performed at the time of presentation to the emergency department. RESULTS: Seven hundred and thirty-five ischemic stroke patients were included in the study. Stroke cases assessed by the mRS as mild or severe showed significant differences with respect to age, leukocyte counts, neutrophil counts, NLR, LDL cholesterol values, and serum glucose values (P = .001). When analysed using NIHSS, lymphocyte levels were significantly higher in very severe stroke cases compared with mild, moderate, and severe cases. NLR was also significantly higher in very severe stroke cases and severe stroke cases as compared with the mild and moderate stroke groups. Neurological evaluations assessed using the mRS showed a mild positive correlation with neutrophil and leukocyte count and a weak correlation with the NLR. CONCLUSION: The NLR exhibited a significant correlation with the results of the mRS and NIHSS. The NLR measured in the very early period was also significantly associated with clinical condition. These results suggest that high NLR values may be a marker of stroke' severity.What's known Stroke is an important disease that has a significant impact on mortality and morbidity and is closely related to the aging world population. In recent years, highly innovative approaches have been developed in the treatment of stroke. Although a long distance has been covered in the early diagnosis of stroke, the ability to predict the severity of the disease with many parameters is still up to date. What's new At the time of admission, in the absence of infection, parameters such as leukocytelymphocyte count and NLR may be telling about stroke severity. Demonstrating the utility of these simple, practical, inexpensive and naninvasive parameters to predict stroke severity can contribute to the scoring to be established at the time of initial diagnosis.

Monthly Pulse Methylprednisolone Therapy is Effective in Preventing Permanent Disease Progression in Secondary Progressive Multiple Sclerosis.

INTRODUCTION: Secondary progressive multiple sclerosis (SPMS) is the phase in which disability continues to worsen with or without accompanying attacks. Monthly methylprednisolone pulse therapy can be used in the secondary progressive phase. The purpose of the present study was to evaluate the effects of methylprednisolone pulse therapy on the basis of clinical and MRI parameters in patients with SPMS. METHODS: This was a multi-center, examiner-blinded, prospective study. Patients with SPMS with EDSS scores of 3 or more, using one or none of azathioprine, interferon or glatiramer acetate, were evaluated. Patients were given IVMP (1 dose of 1 g IV) once a month for 24 months. EDSS scores, MRI findings, quality of life, and adverse events were evaluated. RESULTS: Ninety-seven SPMS patients were included in the study. Significant decreases in new/enlarging, Gd-enhanced, and spinal lesions were observed from baseline to year 2. EDSS scores remained stable at the end of the second year. Monthly high-dose IVMP resulted in a significant decrease in attacks. CONCLUSION: This study is important in terms of emphasizing that this therapeutic option should not be overlooked, since monthly pulse therapy can halt or even reverse progression, regarded as a natural course in SPMS, albeit to a small extent.

Auditory brain oscillatory responses in drug-naïve patients with Parkinson's disease.

Parkinson's Disease (PD) is a common neurodegenerative disorder affecting the function of dopaminergic cells in basal ganglia. Besides the motor symptoms, tremor, and dysfunction of sensory systems. In the literature, there was limited studies which investigates the basic sensorial processing in PD. Therefore, we aimed to establish the sensorial processing of simple auditory stimulations in naïve PD comparing to healthy controls (HC) via delta, theta, and alpha brain oscillatory responses. 12 naïve PD and 12 HC participated to the study. Brain responses recorded via the 64-channel electroencephalography (EEG) system in an electromagnetically and acoustically isolated room. The auditory stimuli (1500 Hz, 60 dB SPL, 500 ms) were delivered to the subjects via a headphone. The inter-stimulus interval was ranged between 2.5-4.5 s. The peak-to-peak maximum amplitudes were measured in the delta, theta and alpha frequency bands on 11 electrodes (including the frontal, central and parietal areas) for the statistical analysis in which one-way ANOVA test was employed for the comparisons between PD and HC. For the delta oscillatory responses, PD group has bigger amplitudes in frontal, central and parietal areas in comparison with HC. For the theta and alpha oscillatory responses, PD group has bigger amplitudes in parietal areas in comparison with HC. As a result, amplitudes of brain oscillatory responses in PD group were significantly bigger than the HC. In this context, decreased inhibitory mechanisms of cortical auditory processing due to the dysfunction of the dopaminergic activity may lead the increased evoked responses in PD group.

Monthly methylprednisolone in combination with interferon beta or glatiramer acetate for relapsing-remitting multiple sclerosis: A multicentre, single-blind, prospective trial.

OBJECTIVES: Multiple sclerosis is usually clinically characterized by repeated subacute relapses followed by remissions. Corticosteroids are used for relapses, and this treatment has been shown to increase the speed of recovery from these. We aimed to evaluate the efficacy and safety of pulsed methylprednisolone given every month as an add-on therapy to interferon beta or glatiramer acetate in patients with relapsing-remitting multiple sclerosis. PATIENTS AND METHODS: This was a multi-center, examiner-blinded, prospective study. Absolute annualized relapse rates and Expanded Disability Status Scale scores were calculated. RESULTS: 103 patients were given intravenous methylprednisolone (1 dose of 1g IV) once a month for 12 months as add-on therapy and were assessed during this period. The decrease in the absolute annualized relapse rate was 0.69, and 72 patients were relapse-free at the end of the year. Sixty-nine of the 103 patients had the same Expanded Disability Status Scale scores at the end of one year, while 21 were less disabled, and 13 sustained disability progression. Health related quality of life measured using the MS Quality of Life scale improved significantly during the study period. CONCLUSION: The addition of monthly pulsed methylprednisolone to subcutaneous interferon beta or glatiramer acetate therapy significantly reduced the relapse rate and may also be beneficial in terms of disease progression. These combinations were also safe, and most patients tolerated methylprednisolone as an add-on to interferon beta or glatiramer acetate.

Importance of diaphragm thickness in amyotrophic lateral sclerosis patients with diaphragm pacing system implantation.

INTRODUCTION: Severe respiratory failure develops as a result of the involvement of the respiratory muscles in patients with amyotrophic lateral sclerosis (ALS). Implantation of diaphragm pacing system (DPS) has been carried out on ALS patients since 2005 to avoid these situations, but the importance of diaphragm thickness has not yet been established clearly. MATERIAL AND METHOD: We retrospectively evaluated 34 ALS patients who had previously implanted DPS to detect the importance of diaphragm thickness. We investigated the effect of diaphragm thickness, which was measured by preoperative thorax computerized tomography on preoperative respiratory function tests (RFT), arterial blood gas (ABG) analysis, postoperative 3- and 6-month oxygen saturations and mortality. RESULTS: The right diaphragm thickness was calculated as 4.60 (2.95-6.00) mm, while the left diaphragm thickness was 4.10 (2.77-6.00) mm. Six patients died during the follow-up period. We did not detect a significant relationship between ABG parameters, RFT and diaphragm thickness. However, according to our observations, the diaphragm thickness was significantly related to mortality. The right diaphragm was significantly thinner in cases that required preoperative respiratory support and had percutaneous endoscopic gastrostomy. When the cut-off values for the diaphragm thickness were accepted as 3.50 mm, significantly higher mortality among patients below this was observed. CONCLUSION: Diaphragm thickness is an important criterion in cases for which DPS implantation is planned. We consider that avoidance of DPS implantation is more suitable for cases with a diaphragm thickness below 3.50 mm because of mortality.

Paced auditory serial addition test: National normative data.

OBJECTIVES: The presence and monitoring of cognitive impairment is frequently overlooked in a disease such as multiple sclerosis (MS), which has the potential to affect the physical, social, and socioeconomic lives of individuals in early adulthood. The purpose of this study was to establish Paced Auditory Serial Addition Test (PASAT) normative data for the healthy Turkish population. PATIENTS AND METHODS: Three hundred eighty-five healthy volunteers were enrolled. Thirty-two subgroups were established, comprising four age groups (18-25, 26-35, 36-45, and 46-55), four education groups (5 years of education, 8 years, 11 years and 15 years) and two gender groups (male and female). The PASAT test was applied to the entire study group. RESULTS: PASAT score decreased with age, although the difference between the age groups did not achieve statistical significance. Very strong significant correlation was determined between education level and PASAT performance. PASAT scores increased with the number of years of education. CONCLUSION: This study provides normal PASAT values in the Turkish population on the basis of age, gender, and level of education. These data can be used as control values in clinical practice.

Management of free-floating thrombus within the arcus aorta and supra-aortic arteries.

INTRODUCTION: Clinical management strategy and the best treatment option of free floating thrombus (FFT), detected in patients with acute ischemic cerebrovascular diseases is still uncertain due to the rarity of these conditions. Recent studies emphasize that FFT within cerebral vessels may not be a surgical emergency since complete dissolution without any further neurologic progression occurred in 86% of patients treated medically. The aim of this study was to investigate the effect of medical treatment on the fate of thrombus and the clinical status in acute cerebrovascular event patients with detected FFT in the artery feeding the compromised brain territory at the time of diagnosis. MATERIALS AND METHODS: We have retrospectively reviewed the initial and follow up computed tomography angiography, diffusion-weighted magnetic resonance imaging examinations of 37 acute ischemic stroke patients with detected FFT and treated medically. The patients were evaluated for any change of the FFT, residual stenosis after the FFT shrunk or disappeared and neurologic outcome. RESULTS: FFT was located in cervical carotid artery, intracranial artery and arcus aorta in 23, 6 and 5 of the patients respectively. Dissection accompanied the FFT in 3 patients. Recanalization was maintained in 34 patients however, three of them suffered from new infarctions. A total occlusion was detected in three patients. Two of them had new infarcts while one was stable during clinical follow-up period. CONCLUSION: The results of our retrospective study have shown that FFT in the proximal aorta and supra-aortic arteries tend to resolve with anticoagulant and/or antiplatelet treatment without causing recurrent adverse events in most of the cases. Furthermore, resolution of the clot seems to provide a safer ground for a recanalization procedure like stenting or endarterectomy if needed.