Computer Aided Written Character Feature Extraction in Progressive Supranuclear Palsy and Parkinson's Disease.

Parkinson's disease (PD) and progressive supranuclear palsy (PSP) are neurodegenerative movement disorders associated with cognitive dysfunction. The Luria's Alternating Series Test (LAST) is a clinical tool sensitive to both graphomotor problems and perseverative tendencies that may suggest the dysfunction of prefrontal and/or frontostriatal areas and may be used in PD and PSP assessment. It requires the participant to draw a series of alternating triangles and rectangles. In the study, two clinical groups-51 patients with PD and 22 patients with PSP-were compared to 32 neurologically intact seniors. Participants underwent neuropsychological assessment. The LAST was administered in a paper and pencil version, then scanned and preprocessed. The series was automatically divided into characters, and the shapes were recognized as rectangles or triangles. In the feature extraction step, each rectangle and triangle was regarded both as an image and a two-dimensional signal, separately and as a part of the series. Standard and novel features were extracted and normalized using characters written by the examiner. Out of 71 proposed features, 51 differentiated the groups (p < 0.05). A classifier showed an accuracy of 70.5% for distinguishing three groups.

Cardiovascular dysautonomia and cognition in Parkinson's Disease - a possible relationship.

Dementia in advanced Parkinson's Disease (PD) is a fatal milestone resulting in reduced life expectancy and nursing home placement. Cognitive impairment and cardiovascular dysautonomia are common and debilitating non-motor symptoms that frequently coexist in PD since the early stages and progress in subsequent years. In particular, blood pressure (BP) abnormalities, including orthostatic hypotension (OH), supine hypertension (SH) and the loss of nocturnal BP fall (non-dipping) in PD have been associated with cognitive deterioration. They usually have multifactorial aetiology, including neuronal (central and peripheral) mechanisms and concomitant intake of medications. BP abnormalities can influence cognition in many ways, including repeated cerebral hypoperfusion leading to cerebral ischaemic lesions, higher burden of white matter hyperintensities, and possible impact on neurodegenerative process in PD. They are often asymptomatic and remain unrecognised, hence 24-hour ambulatory BP monitoring is recommended in patients with clinical symptoms of dysautonomia. Management is challenging and should address the multifactorial nature of BP disturbances. The aim of this review was to present the state of current knowledge regarding the possible relationship between cardiovascular dysautonomia and cognition in PD, its diagnosis and treatment.

Agraphia in patients with frontotemporal dementia and parkinsonism linked to chromosome 17 with P301L MAPT mutation: dysexecutive, aphasic, apraxic or spatial phenomenon?

OBJECTIVES: Patients with frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17) may be agraphic. The study aimed at characterizing agraphia in individuals with a P301L MAPT mutation. METHODS: Two pairs of siblings with FTDP-17 were longitudinally examined for agraphia in relation to language and cognitive deficits. RESULTS: All patients presented with dysexecutive agraphia. In addition, in the first pair of siblings one sibling demonstrated spatial agraphia with less pronounced allographic agraphia and the other sibling had aphasic agraphia. Aphasic agraphia was also present in one sibling from the second pair. CONCLUSION: Agraphia associated with FTDP-17 is very heterogeneous.

Self-awareness of executive dysfunction in Huntington's disease: comparison with Parkinson's disease and cervical dystonia.

This study assessed self-awareness of executive deficits in patients with Huntington's disease (HD) in comparison to patients with Parkinson's disease (PD) and with cervical dystonia (CD). Eighty-nine patient-proxy pairs participated in the study (23 with HD, 25 with advanced PD, 21 with mild PD and 20 with CD). Executive function was assessed with the Stroop test and the Dysexecutive Questionnaire. Insight into executive impairment in HD is mildly affected, when compared to PD and CD.

Poor insight into memory impairment in patients with Huntington disease.

BACKGROUND AND PURPOSE: Patients suffering from Huntington disease (HD) have been shown to present with poor self-awareness of a variety of symptoms. The study aimed to assess the self-awareness of memory impairment in HD in comparison to advanced Parkinson disease (PD), mild PD and cervical dystonia. MATERIAL AND METHODS: Self-awareness was tested in 23 patients with HD by comparing patient and caregiver ratings in reference to clinical control groups (25 patients with advanced PD, 21 with mild PD and 20 with cervical dystonia). Self-awareness was tested using the Self Rating Scale of Memory Functions, which was administered to both the patients and the caregivers. Neuropsychological assessment addressed general cognitive status (Mini-Mental State Examination), verbal learning (Auditory Verbal Learning Test, 15-word list) and mood (Montgomery-Asberg Depression Rating Scale). RESULTS: Patients with HD significantly underestimated their memory dysfunction. Underestimation of memory deficit correlated with disease duration and disease severity in HD. CONCLUSIONS: Huntington disease patients underestimate memory dysfunction. These results add to the previous reports on poor insight in HD in other domains and suggest that anosognosia in HD, albeit usually rather mild, may be a generalized phenomenon.

Self-awareness of motor dysfunction in patients with Huntington's disease in comparison to Parkinson's disease and cervical dystonia.

Individuals suffering from Huntington's disease (HD) have been shown to present with poor self-awareness of a variety of symptoms. The aim of this study was to better assess the self-awareness of motor symptoms and activities of daily living (ADL) impairment in HD, in comparison to Parkinson's disease (PD) and cervical dystonia (CD). In particular, the anosognosia/anosodiaphoria of involuntary movements has been investigated. Self-awareness was tested in 23 patients with HD by comparing patient and caregiver ratings in reference to clinical control groups (25 PD with dyskinesias, PDdys; 21 PD without dyskinesias, PDndys; and 20 with CD). Patients were assessed neurologically by relevant rating scales. Self-awareness was tested using a scale based on 15 films demonstrating 3 types of motor symptoms (chorea/dyskinesias, parkinsonism, torticollis) as well as the Self-Assessment Parkinson's Disease Disability Scale. General cognitive status, verbal learning, cognitive control, and mood were also analyzed. Our results indicate that self-awareness of choreic movements was affected more severely in HD than in PDdys, despite comparable cognitive status. Patient-proxy agreement on ADL impairment was roughly similar in all clinical groups. The results are discussed in the context of orbitofrontal-limbic pathology as a potential trigger of anosognosia/anosodiaphoria in individuals with HD.

Self-awareness of memory function in Parkinson's disease in relation to mood and symptom severity.

OBJECTIVES: In clinical practice, discrepancies are observed between self and proxy reports of various aspects of Parkinson's disease (PD). This study aimed at assessing self-awareness of memory function in PD both by comparing patients' and caregivers' questionnaire ratings of the patients' memory and by correlating subjective ratings with verbal learning results. METHOD: Forty-five patient-proxy pairs participated in the study. Self-Rating Scale of Memory Functions was used as a questionnaire subjective measure. Auditory Verbal Learning Test (AVLT) was applied to assess verbal memory, Stroop test to assess cognitive control and Mini-Mental State Examination (MMSE) for global cognitive assessment. RESULTS: Patient self-reports did not diverge appreciably from proxy reports when global scores were considered, but patient-proxy consistency was low for individual items with the exception of those referring to verbal recall. Both patient and proxy ratings were moderately correlated with the objective measures. Patient-proxy discrepancies were associated with lower verbal learning, poor cognitive control and more severe PD symptomatology. Moreover, depression was associated with patients' overestimation of symptoms. CONCLUSION: Self-awareness of memory function is relatively well preserved in PD, but is negatively affected by depressive symptoms. Patient-proxy discrepancies increase also with disease severity, degree of memory problems and cognitive control deficits. Caregivers seem to be unaware of the specificity of memory problems in PD and report only some of them, mainly those related to verbal recall.

[Screening post-stroke depression using the Hospital Anxiety and Depression Scale]. / Badanie przesiewowe depresji poudarowej z uzyciem Hospital Anxiety and Depression Scale (HADS).

INTRODUCTION: Hospital Anxiety and Depression Scale (HADS) for its simplicity is potentially useful for screening depressive and anxiety disorders in post-stroke patients. To our best knowledge HADS hasn't been assessed in the Polish population of post-stroke survivors. AIM: Assessment of clinical value of HADS in screening depressive and anxiety disorders in post-stroke patients. METHOD: Patients included in this study were admitted do the Department of Neurology of the Medical University of Gdansk between 3rd April and 5th December, after first incident of ischaemic stroke. 116 subjects were included, depression was diagnosed in 29 and anxiety disorder in 16 of patients (13 with comorbid depressive episode). The test was done by 75 patients, 193 visits were assessed, from the following time after stroke: 6 weeks, 12 weeks, 6 months and 12 month. RESULT: Using the cut-off value > or = 7 points, the results were as following: depression subscale--sensitivity: 90.0%, specifity 92.2%, anxiety subscale: sensitivity: 86.5%, specifity 94.9%, which was the most optimal cut-off point. Cronbach a: for the depression subscale was 0.892, for the anxiety subscale was 0.815; each position of the scale correlated with the general result of both scales' result in a degree which increased the Cronbach a value. CONCLUSION: Hospital Anxiety and Depression Scale is useful for screening depression and anxiety in post-stroke patients. It is recommended to lower the cut-off value to 7 points.

Subjective sleep quality alterations at high altitude.

OBJECTIVE: Sleep pattern at high altitude has been studied, mainly with the use of polysomnography. This study aimed to analyze subjective sleep quality at high altitude using the following standardized scales: the Pittsburgh Sleep Quality Index (PSQI) and the Athens Insomnia Scale (AIS-8). METHODS: Thirty-two members of 2 expeditions--28 males and 4 females (mean age 31 years)--participated in this study conducted in Nepal, Himalayas (Lobuche East, 6119 m above sea level [masl]), Kyrgyzstan, Pamirs (Lenin Peak, 7134 masl), and Poland (sea level). The scales were administered twice, at high altitude (mean altitude 4524 masl) and at sea level. RESULTS: Both measures showed a decrease in sleep quality at high altitude (statistical significance, P < .001). Sleep problems affected general sleep quality and sleep induction. Sleep disturbances due to awakenings during the night, temperature-related discomfort, and breathing difficulties were reported. High altitude had no statistically significant effect on sleep duration or daytime dysfunction as measured by PSQI. CONCLUSIONS: The overall results of PSQI and AIS-8 confirm the data based on the climbers' subjective accounts and polysomnographic results reported in previous studies. The introduction of standardized methods of subjective sleep quality assessment might resolve the problem of being able to perform precise evaluations and research in the field of sleep disturbances at high altitude.

The influence of vascular risk factors and white matter hyperintensities on the degree of cognitive impairment in Parkinson's disease.

BACKGROUND AND PURPOSE: Vascular risk factors may contribute to deterioration of cognitive functions in Alzheimer's disease and vascular (or mixed) dementia. Parkinson's disease (PD) is an age-related disorder and vascular risk factors potentially might be the main co-morbidity responsible for motor and cognitive impairment. However, only a few studies focused on this problem have been published. The aim of the study was to assess the contribution of vascular risk factors and white matter abnormalities in magnetic resonance imaging (MRI) on cognitive impairment in PD patients. MATERIAL AND METHODS: Sixty consecutive patients (M: 35, F: 25), mean age 68.36 years (SD: 7.25, range: 51-81) with diagnosis of idiopathic PD underwent a semi-structured questionnaire on demographics and vascular risks factors, neurological, neuropsychological and neuroimaging (MRI) examinations with quantitative assessment according to the scale by Wahlund et al. According to cognitive status they were divided into 3 groups: without cognitive disability (I, n=17), with mild cognitive impairment (II, n=25) and with dementia (III, n=18). RESULTS: There were no significant differences between groups in terms of the number of vascular risk factors (except for the ischaemic heart disease difference between group I and III) and severity of white matter hyperintensities in MRI studies. CONCLUSIONS: Vascular risk factors along with white matter vascular abnormalities probably do not contribute to cognitive impairment in patients with PD. This is in concordance with previously published studies.

[Self-awareness of deficits in Huntington's and Parkinson's disease]. / Samoswiadomosc objawów w chorobach Huntingtona i Parkinsona.

Impaired self-awareness of deficits has been referred to in literature as anosognosia, unawareness, denial of deficits and impaired insight. In this article we briefly present the terminology used in studies of impaired self-awareness in neurological disorders and we review the literature on self-awareness of deficits in Huntington's disease (HD) and Parkinson's diseases (PD) in terms of daily function, motor impairment, cognitive function and social-emotional function in both HD and PD. HD patients may exhibit impaired self-awareness of deficits in all domains, regardless of the cognitive status, while impaired self-awareness of deficits in PD is linked to dementia. Both HD and PD patients may be unaware of involuntary movements. Only one of the reviewed studies aimed at comparing the self-awareness of deficits in PD and HD, which indicates that further research addressing this topic is needed. Next, theoretical explanations of unawareness of involuntary movements based on psychodynamic, cognitive and neurophysiological approaches are presented. Finally, the methodological shortcomings of the reviewed articles are discussed, alongside with the recommendations for future studies.

The pattern of verbal, visuospatial and procedural learning in Richardson variant of progressive supranuclear palsy in comparison to Parkinson's disease. / Specyfika uczenia sie materialu slownego, wzrokowo-przestrzennego oraz proceduralnego w wariancie Richardsona postepujacego porazenia ponadjadrowego w porównaniu z choroba Parkinsona.

OBJECTIVES: Progressive supranuclear palsy (PSP) is regarded either within spectrum of atypical parkinsonian syndromes or frontotemporal lobar degeneration. We compared the verbal, visuospatial and procedural learning profiles in patients with PSP and Parkinson's disease (PD). Furthermore, the relationship between executive factors (initiation and inhibition) and learning outcomes was analyzed. METHODS: Thirty-three patients with the clinical diagnosis of PSP-Richardson's syndrome (PSP-RS), 39 patients with PD and 29 age -and education -matched controls were administered Mini-Mental State Examination (MMSE), phonemic and semantic fluency tasks, Auditory Verbal Learning Test (AVLT), Visual Learning and Memory Test for Neuropsychological Assessment by Lamberti and Weidlich (Diagnosticum für Cerebralschädigung, DCS), Tower of Toronto (ToT) and two motor sequencing tasks. Patients with PSP-RS and PD were matched in terms of MMSE scores and mood. RESULTS: Performance on DCS was lower in PSP-RS than in PD. AVLT delayed recall was better in PSP-RS than PD. Motor sequencing task did not differentiate between patients. Scores on AVLT correlated positively with phonemic fluency scores in both PSP-RS and PD. ToT rule violation scores were negatively associated with DCS performance in PSP-RS and PD as well as with AVLT performance in PD. CONCLUSIONS: Global memory performance is relatively similar in PSP-RS and PD. Executive factors (initiation and inhibition) are closely related to memory performance in PSP-RS and PD. Visuospatial learning impairment in PSP-RS is possibly linked to impulsivity and failure to inhibit automatic responses.

Regional cerebral blood flow in Parkinson's disease as an indicator of cognitive impairment.

OBJECTIVE: To investigate the pattern of regional cerebral blood flow (rCBF) deficits in Parkinson's disease patients in relation to cognitive decline and to assess the clinical usefulness of single photon emission tomography (SPET) scanning in differentiation between Parkinson's disease patients with dementia and those without cognitive deficits. METHODS: We performed Tc-ECD SPET in 60 patients with idiopathic Parkinson's disease (F: 25, M: 35), with average age of 68.4 years (SD+/-7.3, range 51-81 years). All patients were examined neurologically with the assessment of stage and severity of Parkinson's disease (Hoehn-Yahr scale, UPDRS, Schwab-England scale). Detailed neuropsychological examination was performed in each Parkinson's disease patient. On the basis of DSM-IV criteria of dementia and the results obtained in psychological examination, the whole group was divided into three subgroups: I, with no cognitive changes (n = 17); II, with mild cognitive impairment (n = 25); and III, with dementia (n = 18). RESULTS: There was noticeable significant decrease of perfusion in all areas in Parkinson's disease patients when compared to the age-matched control group of healthy volunteers (n = 20). In group III, perfusion was significantly decreased (when compared to groups I and II), particularly in parietal and temporal areas with the predominance of the left side. Regression analysis revealed two independent factors related to dementia: decrease of perfusion within left temporal lobe and its increase within left thalamus. CONCLUSION: Parkinson's disease patients with dementia showed left temporo-parietal hypoperfusion as compared to a group of patients without dementia, which resembles perfusion deficits described in Alzheimer's disease. The hypoperfusion of the left temporal lobe with increase of rCBF within the left thalamus might be clinically useful in discrimination of Parkinson's disease patients with dementia against those without cognitive impairment.

Cerebral blood flow changes in patients with dementia with Lewy bodies (DLB). A study of 6 cases.

BACKGROUND: The aim of this study was to show the application of cerebral blood flow SPECT (rCBF SPECT) study in dementia with Lewy bodies (DLB). MATERIAL AND METHODS: (99m)Tc-ECD regional cerebral blood flow SPECT scanning was performed using a triple head, high resolution gamma camera on a group of six patients who ful- -filled criteria for clinical diagnosis of DLB. All patients were examined neurologically by a neurologist specialized in movement disorders. Detailed neuropsychological examination was performed on each patient with a psychological tests battery by an experienced neuropsychologist. Qualitative and quantitative analysis was performed utilizing an asymmetry index for unilateral perfusion deficits and a comparison to cerebellar perfusion to assess regional cerebral perfusion. A control group of 20 patients was studied to assess normal values, utilizing an asymmetry index for unilateral perfusion deficits, and a comparison to cerebellar perfusion was performed to assess regional cerebral perfusion. RESULTS: In four cases rCBF SPECT images showed patterns of bilateral hypoperfusion of the temporal, parietal and occipital lobes. In two other cases parietal deficits were observed. CONCLUSIONS: Functional neuroimaging with the use of CBF SPECT may contribute to clinical diagnosis of DLB.

[The influence of vascular risk factors and white matter hyperintensities on the degree of motor impairment in Parkinson's disease]. / Wplyw naczyniowych czynników ryzyka i neuroradiologicznych zmian naczyniopochodnych w mózgu na nasilenie zaburzen ruchowych w chorobie Parkinsona.

BACKGROUND AND PURPOSE: The aim of the study was to assess the prevalence of vascular risk factors and white matter hyperintensities (WMH) in patients with Parkinson's disease (PD) and its impact on clinical features such as motor impairment. MATERIAL AND METHODS: 60 patients with PD [25 women and 35 men; mean age 68.4 (51-81) years, mean duration of disease 8.4 (1-27) years] with good response to L-Dopa were studied. Besides neurological examination, the degree of motor impairment was evaluated in all patients using UPDRS, Hoehn-Yahr, and Schwab-England scales. All patients underwent MRI to assess the degree of WMH using Age Related White Matter Changes (ARWMC) Wahlund scale. Moreover, the prevalence of classic vascular risk factors included arterial hypertension, diabetes mellitus t. 1 and 2; plasma cholesterol, cardiovascular diseases, alcohol abuse and smoking was assessed. RESULTS: Presence of at least one vascular risk factor was noted in 19 patients (31.7%). No significant differences were found between the groups of patients with and without vascular risk factors with regard to all clinical parameters and total ARWMC score. These factors did not differ between the groups of patients with more than 3 vascular risk factors and other patients. WMH (ARWMC > or =1) occurred in 33 patients (55%). No significant differences in all analysed clinical factors and the total number of vascular risk factors between the groups with (ARWMC > or =1) and without (ARWMC=0) WMH were found. The group of patients with at least one focus with score of 2 in the Wahlund scale did not differ significantly in all analysed clinical parameters from the rest of the patients. CONCLUSIONS: Our data suggest that the severity of WMH and incidence of vascular risk factors are not significantly related with the degree of motor disability in PD.

[Long-term results of peripheral vascular injuries in patients' limbs following reconstructive surgical procedures and influence on the quality of life]. / Odlegle wyniki leczenia chirurgicznego obrazen naczyn konczyn z ocena wybranych aspektów jakosci zycia.

Major vascular injuries in extremities are rare and constitute problems for surgeons and their sequelae strongly influence remote future of the patients. The aim of study is to evaluate surgical treatment of vascular injuries in extremities and some aspects of quality of life. Since 1983 until 2002 sixty four patients with vascular limbs injuries were treated in the department. Remote evaluation has been performed in 33 persons. Severity of limb injuries was measured by Mangled Extremity Severity Score (MESS). In 20 patients (60.6%) very good and good recent results were obtained, satisfactory in 24.2% and bad results in 15.2% persons. Evaluation of functional status has been made by means of locomotion test and Jebsen-Taylor's test, social approval questionnaire, depression Beck's scale, the scale of hypochondria and by an original questionnaire to evaluate the quality of life. As considerable interdependence has been found between the functional status and the following factors: injury severity expressed in MESS (p < 0.01), clinic reception procedure (p < 0.001), ischemia time (p < 0.01), coincidence of other injuries (fractures and dislocations, muscle, tendon and nerve lesions) (p < 0.01), limb amputation (p < 0.01). Hand function significantly influences the quality of life. Patients who were in shock after trauma in the remote assessment showed susceptibility to the lowered mood and depression (p < 0.05). Quality of life is strongly connected with the features of personality, correlating mainly with the mood and tendencies of concentration upon somatic symptoms. Function of the hand influences strongly the quality of life. Amputated patients may in spite of their crippling limitations are able to adapt to everyday life.

Neuropsychological assessment in myasthenia gravis.

Neuropsychological studies in myasthenia gravis (MG) were undertaken to prove the central nervous involvement. However, they still produce contradictory results. In the present study, a battery of cognitive measures was administered to examine global cognitive functioning, verbal learning, attention, executive function and motor performance. Analysis of partial scores in verbal learning and response fluency trials did not reveal fatigue effect in MG patients. It was shown that in tasks requiring motor, and particularly oculomotor, involvement, the muscle fatigue could account for the deficits observed. Thus, impaired performance on some cognitive measures in MG should be interpreted as an effect of muscle fatigability rather than central nervous system involvement.