Evaluating cognitive impairment in the early stages of Parkinson's disease using the Cambridge brain sciences-cognitive platform.

BACKGROUND: Non-motor symptoms (NMS) such as cognitive impairment are among common presentations in patients with Parkinson's disease (PD). In parallel with motor symptoms, these impediments can affect PD patients' quality of life. However, cognitive impairment has received less attention in early PD. On the other hand, the relationship between olfactory symptoms and cognitive impairment is unclear in early PD. Considering the importance of accurate and timely assessment of cognitive function in PD patients using readily available/validated tests, this study has employed the Cambridge Brain Sciences-Cognitive Platform (CBS-CP) as a computer-based tool to assess cognitive presentations in early PD patients. METHODS: Thirty-four eligible males and females were assigned to PD and healthy controls (HCs). The cognitive performance was assessed using CBS-CP and Mini-Mental State Examination (MMSE), and olfactory function was measured through the standardized olfactory Quick Smell test (QST). RESULTS: PD patients had poorer performance in all CBS-CP tasks, including short-term memory, attention, and reasoning domains than HCs. Meanwhile, the verbal domain task scores showed no significant difference between groups. PD MMSE results were in the normal range (mean=26.96), although there was a significant difference between the PD and HCs groups (P = 0.000). Our results revealed no correlation between cognitive impairment and olfactory function in PD patients. CONCLUSION: Given the widely studied features of CBS-CP and its reliability across published evidence, CBS-CP appears to be a suitable measurement to evaluate cognitive impairment in early PD with normal MMSE scores. It seems cognitive and olfactory impairments are independent in early PD. DATA AVAILABILITY STATEMENT: The datasets generated during the current study are available from the corresponding author upon reasonable request.

Temporal changes in extra-axial brain hematoma's signal intensity in magnetic resonance images of trauma patients: A preliminary, technical study.

INTRODUCTION: Dating the exact or estimated time of trauma is an important issue facing forensic medicine. Several clinical and radiological methods were used to achieve this purpose. In the recent study, we aimed to track the changes in the signal intensity of the extra-axial brain hematoma using magnetic resonance imaging (MRI) conventional sequences as well as diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC). MATERIALS AND METHODS: Considering inclusion and exclusion criteria, all patients with blunt head trauma were involved. After proper management., stabilization, and resuscitation, the participants were assessed using conventional sequences of MRI and DWI twenty-four hours, forty-eight hours, and three weeks after the injury. Temporal changes of signal intensity were compared by Wilcoxon ranged test. RESULTS: Sixteen patients sustaining blunt head trauma were included in this study. The study showed that during the time, diffusion restriction could be seen in an extraaxial hematoma. At the first 24 hours, the signal of hematoma was void in 87.5% of DWI and 100% of ADC. On the second day, they were hypo-signal in 75% of DWI and 100% 0f ADCs, and after three weeks, 100% of cases were hyper-signal in DWI and hypo-signal ADCs. CONCLUSION: This preliminary study has shown that the DWI can be used to detect and track the extra-axial hematoma. The signal intensity was void during the first twentyfour hours, although it became hypo-signal after 48 hours. Of note, the diffusion restriction is noted after three weeks.

Correlation between contrast enhanced plaques and plaque diffusion restriction and their signal intensities in FLAIR images in patients who admitted with acute symptoms of multiple sclerosis.

INTRODUCTION: One of the most common demyelinating disorders is Multiple Sclerosis (MS), which can lead to extensive disability in patients. Appearance of active lesions can be an important sign of disease development. The correlation between the restriction of DWI signal, contrast-enhancement, and demyelinated plaque's signals were evaluated in this study. MATERIAL AND METHOD: 34 MS patients with 1043 MS-plaques who had acute attacks took part in this study. Three MRI pulse-sequences, FLAIR, DWI, and post-contrast enhanced T1 weighted, were compared. Using the signal intensity of MS-lesions and normal brain tissue in FLAIR images, lesion/noise ratio (LNR) and lesion/white-matter ratio (LWR) were calculated. Sensitivity and specificity of LNR and LWR were estimated to determine a cut off value. RESULTS: 7.86% of MS-plaques were enhanced in T1 contrast-enhanced MRI. 2.4% showed DWI restriction. 0.77% showed both diffusion-restriction and T1 contrast-enhancement, 1.63% indicated diffusion-restriction but no contrast-enhancement and 7.09% showed contrast-enhancement but no diffusion-restriction. Among diffusion-restricted plaques, 32% were enhanced in T1-weighted post-contrast enhanced images and it should be noted that diffusion-restriction was seen in 9.76% of enhanced plaques. The sensitivity and specificity of the DWI restriction and its effectiveness in detecting active-plaques were calculated as 12.31% and 98.26%, respectively. The accuracy of this method in detecting the active MS-plaques estimated as 92.91%. The cut-off value for LWR and LNR was between 0.9-1 and 24-28. CONCLUSION: By calculating LNR and LWR, the FLAIR images can be evaluated to detect new MS-plaques. LWR had higher sensitivity and specificity in comparison to LNR so it is a better index in the detection of active-plaques. Although post contrast T1 is the gold standard for evaluating active plaques, in the case of a contraindication to gadolinium, DWI can offer supplemental information on the diffusion restriction of MS plaques in a non-contrast protocol.

Brain connectivity abnormalities in patients with functional (psychogenic nonepileptic) seizures: A systematic review.

OBJECTIVES: The aim of the current endeavor was to systematically review the existing evidence on brain connectivity abnormalities in patients with functional seizures (FS). METHODS: This systematic review was prepared according to the instructions of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE (accessed from PubMed) and Scopus from inception to April 4, 2020 were systematically searched. The following search strategy was implemented and these key words (in the title/abstract) were used: "connectivity" OR "network" AND "psychogenic" OR "dissociative" OR "nonepileptic". RESULTS: Through the search strategy, we could identify eighteen articles. These studies have applied various methodologies and they could identify a variety of brain connectivity abnormalities in people with FS. However, none of these studies provided a high level of evidence. They were all small studies (none had a sample size of more than 21 patients). In addition, most of the studies did not match their cases and their controls with respect to the psychiatric comorbidities and other significant confounders. CONCLUSION: Abnormal functional connectivity between emotion processing areas of the brain with regions involved in executive control and cognitive performance, and the functional connections of the anterior cingulate cortex are of major interest and may be involved in the pathophysiology of FS. Pursuing the concept of brain connectivity abnormalities in patients with FS and comparing the findings with well-matched controls in well-designed studies may result in a breakthrough in identifying the exact neurobiological origin of FS.

Brain TRODAT-SPECT Versus MRI Morphometry in Distinguishing Early Mild Parkinson's Disease from Other Extrapyramidal Syndromes.

BACKGROUND AND PURPOSE: The clinical differentiation of Parkinson's disease (PD) from other extrapyramidal syndromes has made a challenge in neurology. This study aimed to compare the specificity and sensitivity of brain MRI volumetry and dopamine transporter scans in differentiating PD from other extrapyramidal syndromes in the early stages of the disease. METHODS: This study included 34 patients younger than 70 years old with less than 3 years of extrapyramidal symptoms. Demographic and clinical history of the patients, including age, sex, and disease duration, was gathered. Disease severity was assessed using Unified Parkinson's Disease Rating Scale III (UPDRS III). For all patients, 99m Tc-TRODAT single-photon emission computed tomography (SPECT) and MRI volumetry were performed. Patients were followed up for 1 year and examined for final diagnosis. RESULTS: According to the quantitative 99m Tc-TRODAT analysis, all of the specific binding ratio (SBR) parameters, including right, left, and bilateral SBRs, were significantly higher in the non-Parkinsonian patients. Also, the results indicated a high diagnostic accuracy for both quantitative 99m Tc-TRODAT analysis (about 88% for SBR parameters) and MRI volumetry (71% for bilateral olfactory bulbs volume) in diagnosing PD. Regarding the diagnosis of PD, there were no significant differences between quantitative scan results and olfactory bulb volumetry according to the area under the receiver operating characteristic curves. CONCLUSION: 99m Tc-TRODAT has a higher accuracy in differentiation of early PD from non-Parkinsonian conditions, particularly essential tremor. Olfactory bulbs volumetry by using MRI can also serve as a potential alternative method in this regard.

Clinical grading and color Doppler ultrasonography-based grading of varicocele: how compatible are the two grading systems?

OBJECTIVE: Inhere, we compared two of the most common grading systems based on color Doppler ultrasonography (CDU) and physical examination in patients suspected of varicocele. METHODS: This is a cross-sectional study. Overall, 66 patients clinically suspected of varicocele were visited by an attending urologist and a radiologist for physical examination and CDU. Varicocele was then graded according to the WHO criteria and Sarteschi criteria. For comparing the results of the two grading systems, each grading systems was then categorized into four scoring groups. Clinical- and CDU-based scoring, and mean maximum variceal vein diameter (MMVD) were evaluated and compared. RESULTS: The two scoring systems were statistically similar (p < 0.001). CDU scoring of right and left testicles had significant agreement with clinical scoring of varicocele (κ = 0.723 and κ = 0.809, respectively; p < 0.001). MMDV was associated with clinical (right sided: r = 0.681; left sided: r = 0.797; p < 0.001) and ultrasonography scoring (right sided: r = 0.648; left sided: r = 0.821; p < 0.001). CONCLUSION: Grades zero, one and two in ultrasonographic grading are most compatible with grade zero (sub-clinical) in clinical evaluation; so these grades most probably remain undetected in routine physical examination. Furthermore, grade three in ultrasonography and grade one in clinical grading, grade four in ultrasonography and grade two in clinical grading, and finally grade five in ultrasonography and grade three in clinical grading are most compatible. So, by deducting two grades from the ultrasonography grading of varicocele measured by the Sarteschi method, one can obtain a compatible estimate of the clinical grading.

Association Between Urinary Symptoms and Urinary Tract Infection in Patients With Multiple Sclerosis.

BACKGROUND & OBJECTIVE: Urinary dysfunctions occur in the majority of MS patients and these patients are at higher risks of developing UTI due to multiple reasons. We determined to study the association between different urinary symptoms and UTI in MS patients. MATERIAL & METHOD: Eighty seven MS patients that referred to our medical care center with an acute attack of the disease, from November 2012 to April 2014, were included in the study. Patients were classified into two groups based on their urine culture results: UTI positive and non-UTI patients. The prevalence of different types of urinary symptoms was then compared among the two groups. RESULT: The mean age of our patients was 36.8 years old. From the total 87 patients, 83 (95.4%) were female. Overall 56.3% of patients displayed urinary symptoms. The most prevalent urinary problems were urinary incontinence and frequency (25.3% and 24.1%, respectively). A positive urinary culture was seen in 71.3% of the patients. The prevalence of urinary problems was significantly higher in UTI patients in comparison to non-UTI patients (64.5% and 40% in UTI and non-UTI patients, respectively; p=0.036). Separately none of the different urinary symptoms displayed a significant difference between UTI and non-UTI patients (p>0.05). CONCLUSION: Not a single symptom can be diagnostic of UTI, but MS patient with urinary tract infections do present more urinary symptoms and this can be an indication for further urine analysis and screening measures for MS patients who display more urinary symptoms.

Incidence of testicular microlithiasis in patients with ß-thalassemia major.

We assessed the prevalence of testicular microlithiasis by scrotal ultrasonography in ß-thalassemia major patients older than 10 years and evaluated the association with serum ferritin levels, calcium (Ca), phosphate (Ph), and parathyroid hormone levels (PTH). In this cross-sectional study, 132 male ß-thalassemia major patients from 300 male patients older than 10 years old were randomly evaluated by scrotal ultrasonography. Parathyroid hormone, calcium, phosphate, and serum ferritin levels were also evaluated. All of the patients were urologically asymptomatic. One hundred healthy age-matched subjects were selected as control group. Testicular microlithiasis was found in 16 patients and 1 individual in control group (12.1 vs 1 %; p = 0.003). Testicular microlithiasis was associated with age and high serum ferritin levels, but there was no association between Ca, Ph, and PTH levels; blood transfusion; and oral or subcutaneous iron chelation therapy. Also, there was no significant correlation between hyperparathyroidism, history of viral hepatitis, and splenectomy with testicular microlithiasis. The frequency of testicular microlithiasis in ß-thalassemia major patients was higher than previously reported. A correlation was found between testicular microlithiasis with age and serum ferritin levels, so regular and adequate iron chelator therapy (at least 10-12 h per day for 5-6 days a week) is recommended. We suggest a close observation and treatment with iron-chelating agents of these patients. Since testicular microlithiasis is occasionally associated with germ cell tumors, clinical and sonographic follow-up is recommended.

Aortic arch vessel anomalies associated with persistent trigeminal artery.

Developmental anomalies of the aortic arch vessels and persistent trigeminal artery that is the most common of the four anomalous carotid-basilar anastomoses are repeatedly reported in the literature as separate entities. Herein we report a previously undescribed variant including the coexistence of persistent trigeminal artery, truncus bicaroticus and direct origin of left vertebral artery from aortic arch.