Cognitive Impairment in Parkinson's Disease: An Updated Overview Focusing on Emerging Pharmaceutical Treatment Approaches.

Cognitive impairment in patients with Parkinson's disease (PD) is one of the commonest and most disabling non-motor manifestations during the course of the disease. The clinical spectrum of PD-related cognitive impairment includes subjective cognitive decline (SCD), mild cognitive impairment (MCI) and PD dementia (PDD). As the disease progresses, cognitive decline creates a significant burden for the family members and/or caregivers of patients with PD, and has a great impact on quality of life. Current pharmacological treatments have demonstrated partial efficacy and failed to halt disease progression, and novel, effective, and safe therapeutic strategies are required. Accumulating preclinical and clinical evidence shows that several agents may provide beneficial effects on patients with PD and cognitive impairment, including ceftriaxone, ambroxol, intranasal insulin, nilotinib, atomoxetine, mevidalen, blarcamesine, prasinezumab, SYN120, ENT-01, NYX-458, GRF6021, fosgonimeton, INT-777, Neuropeptide S, silibinin, osmotin, cordycepin, huperzine A, fibroblast growth factor 21, Poloxamer 188, ginsenoside Rb1, thioredoxin-1, tangeretin, istradefylline and Eugenia uniflora. Potential underlying mechanisms include the inhibition of a-synuclein aggregation, the improvement of mitochondrial function, the regulation of synaptic plasticity, an impact on the gut-brain axis, the modulation of neuroinflammation and the upregulation of neurotrophic factors, as well as cholinergic, dopaminergic, serotoninergic and norepinephrine neurotransmission. In this updated overview, we aim to cover the clinical aspects of the spectrum of PD-related cognitive impairment and discuss recent evidence on emerging treatment approaches that are under investigation at a preclinical and clinical level. Finally, we aim to provide additional insights and propose new ideas for investigation that may be feasible and effective for the spectrum of PD-related cognitive impairment.

Caregivers' Impression About the Effect of Subthalamic Nucleus Deep Brain Stimulation in the Treatment of Parkinson's Disease.

AIM: To determine caregivers' impressions of the impact of STN-DBS on motor and non-motor symptoms of Parkinson's disease (PD) in patients who underwent subthalamic nucleus deep brain stimulation (STN-DBS), evaluate the relationship of these changes with disease characteristics, and examine their contribution to the daily lives of patients. MATERIAL AND METHODS: The caregivers of patients who underwent STN-DBS were interviewed over the telephone. All telephone interviews were recorded, and changes in the motor and non-motor symptoms of the patients after STN-DBS were evaluated with a standardized questionnaire. RESULTS: Of the 173 patients with PD who underwent STN-DBS between 2005 and 2015, 62 who could be contacted by telephone were enrolled in the study. The mean age of the patients was 59.71 ± 9.78 years (range: 33-77 years). The mean disease duration was 15.62 ± 8.66 years (Range: 4-50 years). STN-DBS was performed on average 3.88 ± 2.6 years earlier (range: 1-11 years). According to the caregivers of the patients, there was a reduction in "off" periods in 79% of the patients, tremor in 58.1%, dyskinesia in 59.6%, depression in 46.8 %, pain symptoms in 41.9%, and improvement in sleep problems in 43.6% after STN-DBS. Moreover, 80.6% of the patients reported an improvement in their daily life activities after STN-DBS. CONCLUSION: From the caregivers' perspective, there was an improvement in the non-motor symptoms as well as the motor symptoms of patients with PD after STN-DBS, and this had a positive effect on the activities of daily lives in the majority of patients. Telephone interviews can be considered as an alternative method in the follow-up of patients with PD, especially when they cannot be assessed face-to-face.

How Telemedicine Can Improve the Quality of Care for Patients with Alzheimer's Disease and Related Dementias? A Narrative Review.

Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer's disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population.

Serum seladin-1 levels in diabetes mellitus and Alzheimer's disease patients.

BACKGROUND: Diabetes mellitus (DM) has been shown to increase the risk of Alzheimer's disease (AD). Downregulation of selective Alzheimer's disease indicator-1 (seladin-1) occurs in the cerebral regions affected by AD. However, inconsistent results have been reported for the relationship between seladin-1 levels and AD. The effect of DM on serum seladin-1 levels in AD is unknown. The present study is aimed to investigate serum seladin-1 levels in diabetic and non-diabetic patients with AD. METHODS: Forty-six patients with AD and 25 healthy volunteers over 65 years of age were included in this study. The patients were divided into three groups-those with AD only, those with DM and AD, and control groups. Demographic characteristics and serum seladin-1 levels were compared among the groups. RESULTS: There was no statistically significant difference in seladin-1 levels in the AD only group compared to the control group (p = 0.376). However, seladin-1 levels were significantly lower in the DM and AD group compared to the AD only and control groups (p = 0.002, p = 0.001; respectively). Negative correlations were present between seladin-1 and fasting glucose, postprandial glucose, HbA1c, and insulin (p < 0.05; all). CONCLUSION: Decreased serum seladin-1 values in the presence of DM and inverse correlations with diabetic parameters in patients with AD, together with a non-significant difference from the control group, suggests that seladin-1 may be altered only in the presence of DM in patients with AD. Lower serum seladin-1 levels may also play a role in the pathogenesis of AD in patients with DM.

Evaluation of sleep in women with menopause: results of the Pittsburg Sleep Quality Index and polysomnography.

OBJECTIVE: To investigate subjective sleep quality among women in the menopausal period and to confirm and diagnose the possible sleep disturbances with polysomnographic (PSG) evaluation objectively. MATERIAL AND METHODS: Sixty-seven women with menopause were enrolled in the study. Sociodemographic characteristics and the features of menopause were recorded. We assessed subjective sleep quality with Pittsburg Sleep Quality Index (PSQI). To confirm sleep disturbances and further diagnose the underlying cause, PSG evaluation was performed to women with PSQI scores of >5 who gave their approval. RESULTS: Mean PSQI score of women with normal PSG evaluation was 12.00±3.16, while it was 11.00±2.32 in women with abnormal PSG evaluation (p=0.466); 59.7% (n=40) of women had poor sleep quality. Among these, 11 (64.7%) had abnormal results in the PSG evaluation and were diagnosed with obstructive sleep apnea syndrome (OSAS); 54.5% had mild OSAS, 27.3% had moderate, and 18.2% had severe OSAS. CONCLUSION: PSQI and PSG evaluations would give a chance to demonstrate sleep problems and shed a light on treatment options according to the underlying causes of sleep disturbances in menopause.

The prevalance of epilepsy among college students in Canakkale, Turkey.

The aim of this study was to investigate the frequency of epilepsy among students of the Canakkale Onsekiz Mart University. This cross sectional epidemiological study was performed on 4762 of 19,988 Canakkale Onsekiz Mart University students in the academic year 2007-2008. Participants that answered "epilepsy" to the question "Do you have any disease diagnosed by a doctor?" in a questionnaire including 4 subgroups were identified. Data were transferred to the Epi-Info Version 6.0 statistics program and controlled data were analyzed in the SPSS 15.0 statistics program. There were 53.1% of female and 46.9% of male students, mean age 20.4 ± 2.1 (range 17-43) years. Twelve (0.25%) students had epilepsy diagnosis, eight (66.7%) female and four (33.3%) male, mean age 20.8 ± 1.8 years. In our study, epilepsy was detected in 0.25% of students (n = 12). Age specific prevalence studies related to epilepsy epidemiology are extremely rare, especially in university students with average intelligence. Thus, we considered that it would be epidemiologically significant to share the results of our cross sectional study with all those involved in epilepsy epidemiology and management.

Tumour necrosis factor alpha, interleukin 10 and interleukin 6 gene polymorphisms of ischemic stroke patients in south Marmara region of Turkey.

BACKGROUND: Stroke is an important cause of adult mortality and morbidity; however its pathogenesis is still unknown. Several studies have examined to determine the role of genetic polymorphism of proinflammatory cytokines in the occurence of stroke. The objective of this study was to evaluate the relationship between three polymorphisms; including tumour necrosis alpha (TNFα)-238 GA, interleukin( IL-10)-1028 GA (rs1800896), IL-6-(rs1800795) and ischemic stroke in a Turkish population. METHODS: Forty two stroke patients and 48 healhty controls were genotyped using PCR analysis for TNFα-238 G/A, IL-10-1028 GA and IL-6-rs1800795 AG polymorphisms. RESULTS: The frequency of the CC and CG, GG genotype of IL-6 gene (rs1800795) were statiscially significiantly higher in IS patients than controls (for C/C genotype, P=0.03, OR=4.3; 95% CI: 1.13 to 16.29 and for C/G genotype, P=0.04, OR=3.6; 95% CI: 1.03 to 12.95, for G/G genotype, P=0.02, OR=0.25; 95% CI: 0.07-0.85 respectively). CONCLUSION: Il-6 CC genotyped was found strongly associated with ischemic stroke than other two polymorpisms TNF-α and IL-10 in our population.

Frequency of migraine in patients with allergic rhinitis.

OBJECTIVES: Allergic rhinitis (AR) is an IgE mediated disease which is released by activation of mast cells and basophils, and often leads to sinus headache. Histamine which is the key mediator in the pathogenesis of AR, also plays an important role in the pathogenesis of migraine with nitric oxide (NO). Aim of our study was to investigate the frequency of migraine in patients with AR. METHODOLOGY: Headache assessment and neurological examination was performed on patients diagnosed as AR in the outpatient ear nose and throat clinic with age-matched controls. Participants with headache were classified according to the International Headache Society criteria, and migraine frequency was investigated in the patients with AR and control groups. RESULTS: Migraine headache was detected in 50% of the patients with AR. Among these, 95% were migraine without aura, and 5% were migraine with aura. Migraine frequency in the control group was 18.75% in the control group, and all was migraine without aura. Migraine frequency in the patients with AR was four times higher when compared with the control group. CONCLUSION: While a histamine and IgE associated common mechanism is responsible in the pathogenesis of AR and migraine, not only sinus headache but also migraine headache should be kept in mind. Headache assessment of the patients with AR, and in case of headache existence, referral of these patients to neurology outpatient clinics for differential diagnosis and, to maintain appropriate therapy should not be forgotten.

Perception of epilepsy in Turkey in the light of two different cities.

The aim of this study was to investigate the perception of epilepsy in Turkey, from west to east, in Kutahya and Yuksekova, two cities of different sociocultural and ethnic status. This was a retrospective comparison study which evaluated the results of two prior studies investigating stigmatization of patients diagnosed with epilepsy and their first-degree relatives in two different cities of Turkey, Kutahya and Yuksekova. The Survey of Epileptic Patient Relatives on the Knowledge, Attitudes, and Behavior Regarding the Disorder was used and included questions on descriptive characteristics, familiarity with epilepsy, attitudes toward epilepsy, and understanding of epilepsy. Data collected by use of the SPSS 15.0 software were analyzed with chi2-test. In Yuksekova group, 88.5% of first-degree relatives of people with epilepsy felt primarily fear when they heard the diagnosis of epilepsy in their relatives; in Kutahya group, the respective rate was 19.1% (p < 0.05). The number of participants who objected their child marrying someone with epilepsy was significantly higher in Yuksekova group (p < 0.05); however, if married, the Yuksekova group significantly stated that they should have a baby, revealing the importance of children as an indicator of power and dignity in the eastern region of Turkey (p < 0.05). Although understanding of epilepsy was favorable, educating the community about epilepsy and personal contacts are the major strategies against epileptic stigmatization.

Two foreign language automatisms in complex partial seizures.

Ictal speech manifestations with or without loss of consciousness can frequently occur in TLE in which sometimes the patient may remain responsive, even in conjunction with automatisms. Foreign language ictal speech automatism (FLISA) is a rare ictal sign in temporal lobe epilepsy arising from the non-dominant hemisphere. While our literature review revealed no report of CPSs with two foreign language ictal speech automatisms, we here represented a rare case of a Turkish woman with TLE experiencing two foreign language ictal speech automatisms.

Susac's syndrome: a case of simultaneous development of all three components of the triad.

Susac's syndrome is characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. We here report a case of 46 year old woman with a sudden diminution in visual acuity at the left eye, headache and decreased hearing at the right ear with mild confusion considered as Susac's syndrome with complete triad. Although it's a relatively rare entity, it should be kept in mind in differential diagnosis of the neurological disorders, especially in women in 20- to 40-year of age presenting with acute hearing loss.

[Epidural abscess due to a Mycobacterium tuberculosis strain with primary resistance to isoniazid and ethambutol]. / Izoniazid ve Etambutole Primer Dirençli Mycobacterium tuberculosis'e Bagli Epidural Apse.

Tuberculosis is primarily characterized by pulmonary involvement, however, one third of the cases exhibit extrapulmonary tuberculosis. In this report, a case of epidural abscess due to Mycobacterium tuberculosis with primary resistance to isoniazid and ethambutol was presented. A 57-year-old male patient was admitted to emergency service with ten days history of weakness in legs, disability of walking and fever. Neurological examination revealed paraplegia of lower extremities, numbness distal to T2 disc level and hyperactivity of deep tendon reflexes indicating transverse myelitis. Laboratory findings were as follows; ESR: 74 mm/hour, CRP: 22 g/L, ALT: 42 IU/L, AST: 45 IU/L and white blood cell count 23.000/mm3 (45% polymorphonuclear leukocyte, 45% lymphocyte, 10% monocyte). Spinal magnetic resonance imaging showed a fusiform abscess localized at anterior epidural space and extending along levels of C5-6 and C6-7. The longitudinal dimension of the abscess was 3 cm. The lesion was hypointense on T1 and hyperintense on T2 weighted MRI images with prominent rim shaped contrast enhancement on contrast-enhanced T1-weighted images. At fourth day of hospitalization the patient underwent neurosurgical management. M.tuberculosis was isolated from the cultures of operation material by Mycobacteria Growth Incubator Tube system (MGIT, BBL; BD, USA) on the 12th day. The isolate was found susceptible to streptomycin and rifampisin, but resistant to isoniazid and ethambutol. The treatment was initiated with rifampicin 600 mg/day, pyrazinamid 2 g/day, ethambutol 1.5 g/day and levofloxacin 500 mg/day. At the end of second month levofloxacin 500 mg/day and rifampisin 600 mg/day combination was sustained and total treatment period was planned as nine months. As far as the national literature was considered, this was the first case of extrapulmonary tuberculosis with primary resistance to isoniazid and ethambutol.

Subjective sleep quality in premenstrual syndrome.

Premenstrual syndrome (PMS) is a cyclical disorder observed in late luteal phase and presenting with behavioral changes that can affect interpersonal relationships and normal daily activity. Sleep disturbances are also common. The aim of this study is to investigate the relationship between PMS and subjective sleep quality with Pitsburg Sleep Quality Index (PSQI) in the Medical Academy students, whom have considerable information about menstruation. PMS was detected with "Premenstrual Syndrome Scale", and PSQI was used to evaluate subjective sleep quality. Chi-square test and Kendall's rank correlation analysis were used in statistical analysis. p values (p < 0.05) were considered as statistical significant. Poor sleep quality was found in the 75.6% of the participants with PMS, and 58.8% of the participants without PMS (p < 0.05). Only component 5 (sleep disorder component) of the PSQI components revealed statistically significant difference (1.7 ± 0.6 in participants with PMS, and 1.5 ± 0.6 without PMS, p < 0.05). There was a positive correlation between total PSQI score and all of its' components, except component 6 (sleeping pill usage component) (p < 0.05). The strongest association was found to be in the component 5 (r = 0.528; p = 0.0001). Results of our study suggested the poor sleep quality due to sleep disorders in women with PMS.

Isolated lingual dystonia induced by speaking: a rare form of focal dystonia.

Focal lingual dystonia is a rare condition that can be misdiagnosed as a psychogenic problem because it may interfere with chewing, swallowing, and speaking. We present a patient with an uncommon type of dystonia (speech-induced primary lingual dystonia), that responded well to botulinum toxin injection.

Lightning strike: a first case of unilateral diaphragmatic paralysis.

Lightning injury is the second most common cause of weather-related deaths in the United States. Despite the several neurological complications such as polyneuropathy, myelopathy, spinal cord injury, motor neuron disease due to the lightning-induced injury, there is no documented case of unilateral diaphragmatic paralysis. We describe the case of a patient with a history of lightning strike at childhood period, prior the onset of isolated, diaphragmatic paralysis, unilaterally. Clinical and electrophysiological findings suggest an injury restricted to the phrenic nerve, unilaterally.

Perceptions of epilepsy of three different groups in Turkey.

OBJECTIVE: Our aim was to investigate epilepsy-related knowledge, behavior, perceptions, and attitudes of people with epilepsy, their relatives, and a control group (390 participants in total) at the State Hospital Neurology Clinic, Yuksekova City, Turkey. METHODS: The Survey of Epileptic Patient Relatives on the Knowledge, Attitudes, and Behavior Regarding the Disorder was used and included questions about descriptive characteristics, familiarity with epilepsy, attitudes toward epilepsy, and understanding of epilepsy. Data on SPSS 15.0 software were analyzed with the χ(2) test. RESULTS: Patients (95.3%), their relatives (89.2%), and controls (63.3%) felt primarily fear when they heard the diagnosis of epilepsy. Most participants would not let their child marry a person with epilepsy, with no statistically significant difference between groups (P>0.05). Patients (66.7%) and relatives (70%) saw no problem in people with epilepsy having children; there was a statistically significant difference between groups on this point because of the control group's response (31.5%) (P<0.05). CONCLUSION: Patients and relatives showed similar attitudes and behaviors, perhaps because they had common information and experience regarding the disorder.