Are 5-2-1 Delphi criteria and MANAGE-PD useful screening tools for general neurologists for qualification to device-aided therapies in advanced Parkinson's Disease?

AIM OF STUDY: We sought to compare MANAGE-PD and 5-2-1 Delphi criteria which are two commonly used and approved screening tools in Parkinson's Disease, in order to highlight their strengths and limitations. CLINICAL RATIONALE FOR STUDY: Timely intervention with device-aided therapies is vital as it enables improving motor symptoms, lowering the dosage and side-effects of dopaminergic treatment, and improving patients' and caregivers' quality of life. Various screening tools have been created to help clinicians find the best candidates for device-aided therapies (DAT) for advanced Parkinson's Disease. In this study, we aimed to compare the 5-2-1 Delphi criteria to MANAGE-PD to determine how they could be used specifically to maximise their potential. MATERIAL AND METHODS: All of the patients (260) included in this study were DAT-naive, > 18 years of age, diagnosed with Parkinson's Disease, and had been referred to the Department of Neurology for qualification for advanced therapies over a 4-year period (2019-2022). They were subjected to both 5-2-1 Delphi criteria and MANAGE-PD tools and divided into subgroups based on the results of the screening. The data of patients was then statistically analysed. RESULTS: In the study group, 51 patients (19.5%) met all three of the 5-2-1 criteria, and 123 (47.1%) patients were categorised as '3' in MANAGE-PD, meaning that they may benefit from DAT. Finally, at the local centre level, 64 (24.5%) patients were qualified for DAT. 22 (34.4%) patients who were qualified for DAT by a clinician did not meet the 5-2-1 criteria. CONCLUSIONS: The 5-2-1 scheme based on the data from this study was characterised by a 92.5% specificity level and 65.1% sensitivity level compared to 69.5% specificity and 98.4% sensitivity level of MANAGE-PD. CLINICAL IMPLICATIONS: We found that MANAGE-PD has a better screening potential of DAT admission than 5-2-1 criteria. While both tools are reliable and valuable in daily practice, our study suggests that some patients may be omitted when using only less complicated tools such as 5-2-1 during the assessment.

Insomnia, Fatigue, Bladder Disorders and Mood Disorders among Polish Patients with Multiple Sclerosis: Cross-Sectional Study.

BACKGROUND: To investigate the prevalence of sleep disorders in patients with multiple sclerosis (PwMS) in comparison to healthy controls (HCs), we aim to explore the correlation between sleep disorders and fatigue, bladder dysfunction, mood disorders in PwMS. METHODS: This study involved 175 PwMS and 115 HCs. We conducted a self-administered survey using questionnaires (the authors' questionnaire, the Athens Insomnia Scale (AIS), the Epworth Sleepiness Scale (ESS), the Modified Fatigue Impact Scale (MFIS), the Fatigue Severity Scale (FSS), the Hospital Anxiety and Depression Scale (HADS), and the Numerical Rating Scale (NRS). The neurological disability was determined using Expanded Disability Status Scale. Logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: According to AIS, insomnia was found in 20.6% of PwMS compared to 9.6% of HCs (p < 0.001). Comparing female and male PwMS, we observed that insomnia was more prevalent among female PwMS (25.95% vs. 4.55%, respectively, p < 0.05). Excessive daytime sleepiness was more prevalent in female PwMS (p < 0.05). Female PwMS were more fatigue based on the FSS and the MFIS (p < 0.05). Bladder disorders were observed in 39.43% of PwMS and were significantly linked to MS (p < 0.001). Sleep disturbances were associated with anxiety disorders (OR = 0.22, 95% CI 0.12-0.32 p < 0.001), bladder dysfunction (OR = 0.52 95% CI 0.16-0.87 p < 0.05), and female gender (OR = 0.49, 95% CI 0.037-0.94 p < 0.05). CONCLUSIONS: Insomnia is prevalent among PwMS. Our study revealed independent predictors of sleep disturbances among PwMS: female gender, bladder disorders, and anxiety.

Risk factors for dementia in Parkinson's Disease - the overuse of anticholinergic drugs.

AIM OF THE STUDY: To determine the risk factors for dementia in a group of patients with Parkinson's Disease (PD), especially the effect of the anticholinergic burden assessed according to the Anticholinergic Cognitive Burden scale (ACB) and the CRIDECO Anticholinergic Load Scale (CALS). CLINICAL RATIONALE FOR THE STUDY: To provide information about factors associated with Parkinson's Disease dementia (PDD), especially the anticholinergic burden and testing the effect of both scales in an assessment of the anticholinergic burden in this group of patients. MATERIAL AND METHODS: A retrospective and cross-sectional analysis of medical records of patients with Parkinson's Disease admitted to the Neurology Department of the Medical University of Silesia, Katowice, Poland between 2019 and 2021 was performed. We found 418 patients with a diagnosis of PD, but 80 were excluded due to lack of a cognitive function assessment. Based on MMSE score, the remaining 338 patients were divided into two groups of patients with, and without, PDD. Next, demographic and clinical data was collected. The anticholinergic burden was assessed using the ACB and the CALS scales. According to the authors of these scales, : if a scale score is of three or more points, this should be considered as a significant anticholinergic burden. Multiple logistic regression with backward elimination was used to assess factors significantly related to the presence of dementia, and two different models were used for both scales assessing the anticholinergic burden. RESULTS: 62 (18.3%) patients were diagnosed with PDD. Overall significant anticholinergic burden (≥ 3 points) was found in 31.95% of patients using CALS and in 18.93% using ACB. Anticholinergic burden was higher in patients with dementia (CALS 50 vs. 27.90%, p < 0.001, ACB 43.5 vs. 13.41%, p < 0.001). According to both models, the factors significantly related to dementia were: age (ACB OR 1,114 (1.062-1.170), p < 0.001, CALS OR 1.123 (1.070-1.178), p < 0.001), significant anticholinergic burden (ACB OR 3.433 (1.746-6.750), p < 0.001, CALS OR 2.166 (1.157-4.055), p = 0.016) disease severity in the Hoehn-Yahr scale (ACB OR 1.752 (1.197-2.565), p = 0.004, CALS OR 1.831 (1.256-2.670), p = 0.002) and atrial fibrillation (ACB OR 5.593 (1.417-22.083), p = 0.014, CALS OR 5.159 (1.314-20.254), p = 0.016). CONCLUSIONS AND CLINICAL IMPLICATIONS: The anticholinergic burden is larger in PDD patients compared to PD patients without dementia. CALS or ACB scales are helpful in this risk assessment and might be crucial to avoid the development of PDD, especially in older PD patients with multimorbidities.

Diagnosis of cognitive disorders in primary health care in Poland. / Diagnostyka zaburzen poznawczych w ramach podstawowej opieki zdrowotnej w Polsce.

OBJECTIVES: The aim of this study was to assess the knowledge, attitudes and the rules of proceeding concerning primary health care (PHC) doctors in the field of screening diagnostics for cognitive disorders in elderly people in Poland. METHODS: The study included 175 PHC doctors. A validated anonymous questionnaire was used. The survey was conducted using the PAPI (Paper and Pencil Interviews) and CAWI (Computer Assisted Web Interviews) methods. RESULTS: The vast majority of the respondents (n=159; 91.4%) saw the advisability of screening for cognitive disorders in the age group >65 years of age, but only 53 subjects (30.29%) believed that these tests should be conducted by general practitioners (GPs). According to the surveyed doctors, the main obstacle in the diagnostics of cognitive functions is the lack of time - this was the opinion of 142 (81.14%) respondents. When dementia was suspected, the respondents usually ordered laboratory tests and referred patients to a neurologist (n=111; 63.4%). The Mini Mental Status Examination (MMSE) and the Clock Drawing Test (CDT) were the most popular scales assessing cognitive functions, known by 120 doctors (68.57%), and 122 respondents (69.71%), respectively. CONCLUSIONS: Polish GPs are aware of the necessity of screening for cognitive disorders in seniors. Currently, there are no mechanisms within primary health care system that would enable proper early screening for dementia in people at the high risk (i.e.> 65 years of age). The development of standards for the early detection of cognitive disorders within primary health care system in Poland seems to be an urgent need.

Radiological Benefits of Vitamin D Status and Supplementation in Patients with MS-A Two-Year Prospective Observational Cohort Study.

Current data emphasize the immunomodulating role of vitamin D in enhancing the anti-inflammatory response. Vitamin D deficiency is an established risk factor for developing multiple sclerosis-the autoimmune demyelinating and degenerative disease of the central nervous system. Several studies confirmed that higher vitamin D serum level is associated with better clinical and radiological outcomes in patients with multiple sclerosis, whereas vitamin D supplementation benefits in multiple sclerosis remain inconclusive. Despite that, many experts suggest regular measurements of vitamin D serum levels and supplementation in patients with multiple sclerosis. In this study, 133 patients with multiple sclerosis (relapsing-remitting subtype) were prospectively observed in a 0-, 12- and 24-month time span in a clinical setting. The study group consisted of 71.4% of patients (95 out of 133) supplementing vitamin D. The associations between vitamin D serum levels, clinical outcomes (disability status expressed by EDSS, number of relapses and time to relapse) and radiological outcomes (new T2-weighted lesions and number of gadolinium-enhanced lesions) were evaluated. There were no statistically significant correlations between clinical outcomes and vitamin D serum levels or supplementations. Fewer new T2-weighted lesions were observed in patients with vitamin D supplementations (p = 0.034) in 24 months of observation. Moreover, an optimal or higher level of vitamin D (>30 ng/mL) maintained throughout the entire observation period was associated with a lower number of new T2-weighted lesions in 24 months of observation (p = 0.045). These results support vitamin D implementation commencement and amelioration in patients with multiple sclerosis.

Intravenous Thrombolysis for Acute Ischemic Stroke during the COVID-19 Pandemic-Polish Single-Center Retrospective Cohort Study.

COVID-19 has affected the entire world and has had a great impact on healthcare, influencing the treatment of patients with acute ischemic stroke (AIS). The aim of this study was to determine the impact of the COVID-19 pandemic on the care of patients with AIS. We performed a retrospective analysis of 1599 patients diagnosed with AIS and hospitalized in the authors' institution from January 2018 to December 2021. The final sample consisted of 265 patients treated with thrombolysis without a diagnosis of COVID-19. The initiation of thrombolytic treatment during the pandemic was delayed (2:42 ± 0:51 vs. 2:25 ± 0:53; p = 0.0006). The delay was mainly related to the pre-hospital phase (1:41 ± 0:48 vs. 1:26 ± 0:49; p = 0.0014), and the door-to-needle time was not affected. There were no differences in stroke severity and patients' outcomes. Patients with AIS were less likely to have previously been diagnosed with atrial fibrillation (16.9% vs. 26.7%; p = 0.0383), ischemic heart disease (25.3% vs. 46.5%; p = 0.0003) and hyperlipidemia (31.2% vs. 46.5%; p = 0.0264). Patients treated during the pandemic had higher glycemia (149.45 ± 54. vs. 143.25 ± 60.71 mg/dL; p= 0.0012), while no significant differences in their lipid profiles were found. Conclusions: The COVID-19 pandemic affected the treatment of AIS patients locally at our stroke center. It caused treatment delay and hindered the recognition of risk factors prior to the occurrence of AIS.

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.

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.

Fibromuscular Dysplasia/Carotid Web in Angio-CT Imaging: A Rare Cause of Ischemic Stroke.

Background and Objectives: Carotid web (CaW) is an intimal variant of fibromuscular dysplasia and may constitute as one of rare causes of acute ischemic stroke (AIS). The objective of this study was to determine the prevalence of CaW in patients with AIS or transient ischemic attack (TIA) based on head/neck CT angiography (CTA) in a Polish cohort study. Materials and Methods: A retrospective study was performed by analyzing 1480 electronic clinical and imaging data regarding patients with AIS or TIA, hospitalized in the years 2018-2020 in the authors' institution. The final sample consisted of 181 patients who underwent head/neck CTA; aged 67.81 ± 13.51 years (52% were women). All head/neck CTA studies were independently evaluated by two radiologists. The patient's clinical condition was assessed with the National Institutes of Health Stroke Scale (NIHSS, 5.76 ± 4.05 and 2.88 ± 3.38 at admission and at discharge, respectively). Results: 27 patients were identified with CaW. The prevalence of CaW in the final sample (181 pts with good quality CTA) was 14.9%. In the CaW group, 89% patients had AIS, including 26% diagnosed with recurrent and 11% with cryptogenic strokes. There were no significant differences between the presence of CaW and gender, age, NIHSS score, recurrent or cryptogenic stroke. Conclusions: Our study demonstrated that CaW may be an underrecognized entity leading to cerebrovascular events. The diagnosis of CaW depends on a high level of awareness and a comprehensive analysis of the neuroimaging studies. Our findings support the hypothesis that it is worthwhile to perform CTA to determine the etiology of ischemic stroke, particularly if predicting factors were not identified.

A 50-Year-Old Patient with Guillain-Barré Syndrome after COVID-19: A Case Report.

Severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, causes acute respiratory disease (coronavirus disease 2019; COVID-19). However, the involvement of other mechanisms is also possible, and neurological complications are being diagnosed more frequently. Here, we would like to present a case of a Polish patient with Guillain-Barré syndrome (GBS), after a documented history of COVID-19: A 50-year-old man, 18 days after the onset of COVID-19 symptoms, had progressive quadriparesis preceded by 1-day sensory disturbances. Based on the clinical picture, the results of diagnostic work-up including a nerve conduction study (ENG) that revealed a demyelinating and axonal sensorimotor polyneuropathy, and cerebrospinal fluid (CSF) analysis that showed albumin-cytological dissociation, an acute inflammatory demyelinating polyneuropathy was confirmed, consistent with GBS. Upon a therapeutic plasma exchange (TPE), the patient's condition improved. The presented case of GBS in a patient after mild COVID-19 is the first case in Poland that has supplemented those already described in the global literature. Attention should be drawn to the possibility of GBS occurring after SARS-CoV-2 infection, even when it has a mild course.

Analysis of psychiatric consultations in the department of neurology and stroke unit: diagnosis and therapy. / Analiza konsultacji psychiatrycznych w oddziale neurologii i oddziale udarowym: rozpoznania i terapia.

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.