Utilization of acute vascular imaging and neurointervention for acute ischaemic stroke patients in 20 Hungarian stroke centers.

BACKGROUND AND PURPOSE: Acute mortality rate of stroke in Hungary is significantly higher than in Western Europe, which is likely to be partially attributable to suboptimal treatment. METHODS: We examined the use of acute vascular imaging and mechanical thrombectomy for acute ischaemic stroke patients. We collected data on 20 consecutive patients from Hungarian stroke centers before 31st August 2016. RESULTS: Out of the reported 410 patients, 166 (40.4%) underwent CT angiography and 44 (10.7%) had mechanical thrombectomy. CONCLUSION: Only about 1/3 of acute ischaemic stroke patients eligible for thrombectomy actually had it. The underlying reasons include long onset-to-door time, low utilization of acute vessel imaging and a limited neuro-intervention capacity needing improvement.

[Four-year follow-up of a neurosyphilis case presenting psychiatric symptoms]. / Pszichiátriai tünetekkel jelentkezo neuroszifilisz négyéves utánkövetése.

The authors present a case of neurosyphilis associated with predominant psychiatric symptoms. The elderly man was admitted because of confused behavior, maniform state, lack of critical judgement and grandiose delusions. On admission, right central facial nerve paresis, hand tremor and parkinsonism were also found. Acute brain imaging and routine laboratory tests failed to identify a firm etiology of the confusional state. The psychiatric treatment resulted in complete recovery from delirium. Afterwards, maniform psychosis dominated the clinical picture for which antipsychotics were administered. Later, rapid cognitive deterioration and progression of motor symptoms were observed. MRI revealed cortical and hippocampal atrophy and white matter hyperintensities. Lumbar puncture found pleocytosis and elevated cerebrospinal fluid protein levels. Neurosyphilis had been confirmed by serologic tests. The cognitive symptoms improved and the psychiatric symptoms remitted under penicillin treatment. Four years after diagnosis, there is a gradual progression in the cognitive decline. Two additional hospitalizations were necessary due to the relapses of psychiatric symptoms. Orv Hetil. 2018; 159(6): 234-238.

[Movement disorders is psychiatric diseases]. / Mozgászavarok pszichiátriai betegségekben.

Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases.

[Pharmacological and other options in preventing dementia: a literature review]. / Demenciák megelozésének gyógyszeres és egyéb lehetoségei: irodalmi összefoglaló

BACKGROUND: At present 34 million people live with Alzheimer's disease around the world. This figure is expected to triple in the next 40 years. The major cause of this increase is the well-known aging of the society in Europe and in the US as well. AIMS AND METHODS: In this paper we review the results of the last 10 years, and discuss those pharmaceutical and other methods, which can be effective in the prevention of dementias. RESULTS: The most important pharmaceutical agents are beta secretase inhibitors, and active and passive immunizations. Several drugs in these groups are in phase III at the moment. The results from studies with intranasal insulin are also encouraging. As a non-drug option Mediterranean diet can be effective. However at present cognitive trainings seem to be the most effective in the prevention of dementias. These remediation therapies are based on the lifelong plasticity of the human brain. CONCLUSIONS: In summary we can conclude that there are promising drug developments in progess for the prevention of dementias, but the breakthrough has not been achieved yet. At present the best option is decreasing risk factors, that is treatment of hypertension, prevention of obesity and diabetes, and cognitive trainings are recommended for prevention.

[Differentiation between mild cognitive impairment and healthy elderly population using neuropsychological tests]. / Az enyhe kognitív deficitben szenvedok differenciálása az egészséges idos populációtól neuropszichológiai tesztek segítségével.

OBJECTIVE: Paired Associates Learning (PAL) test assesses brain functions in those brain regions affected earliest by Alzheimer's dementia. The aim of the present study was to assess the usability of our implementation of the PAL test for screening mild cognitive impairment. METHODOLOGY: Based on Petersen criteria, 14 out of the 63 subjects were diagnosed with mild cognitive impairment. Visuospatial learning was assessed by our implementation of PAL test. The ability of the PAL test to differentiate between study groups was compared to the Addenbrook Cognitive Examination (ACE) and to the Mini Mental State Examination (MMSE). Linear logistic regression was used for statistical analysis, and the results are presented as Receiver Operating Characteristics (ROC) curves. All analyses were performed by SAS 9.2. RESULTS: All the results of neuropsychological tests differed significantly between the study groups. However, considerable difference could be detected between the tests regarding specificity and sensitivity. The PAL test reached the sensitivity of the ACE, while its specificity was slightly under the ACE. DISCUSSION: The PAL test developed in the framework of the present study is found to be able to differentiate between MCI and healthy controls. It outperformed the MMSE in terms of sensitivity and specificity, while it needs comparable time to perform. Its sensitivity, the important parameter for screening, is comparable to ACE, while it needs significantly shorter time and less assistance.

[Depression in neuropsychiatric diseases]. / Depresszió neuropszichiátriai betegségekben.

Depression is frequently observed together with neurological disorders. Moreover this connection is bidirectional in the case of several neurological disorders, as depression can be either a comorbide syndrome or also a risk factor of them. Neurobiological background of depression involves neuroanatomical structures, their interconnected networks, disturbances of neurotransmitters, neurohormonal, neuroimmunological and neurotrophic changes, genetic background. Disfunction of these systems also plays a role in the pathogenesis of comorbid depression of neurological disorders. Interactions and clinical aspects of biological factors involved in the pathogenesis of depression in dementias, Parkinson's disease, cerebrovascular disorders and epilepsy are discussed further. Depression as a result of neurobiological factors responsible for both neurological and psychiatric consequencies of these disorders, are often atypical as a clinical manifestation, however chracteristic for the particular neurological disorder. Evaluation of the biological backgound and clinical features of depression in neurological disorders makes the complex neuropsychiatric approach of these disorders possible.

[Neurological symptoms in psychiatry]. / Neurológiai tünetek a pszichiátriában.

Certain psychiatric diseases have biological pathomechanisms, and as a result they are accompanied by various neurological symptoms. Neurological examination is a simple method to assess these symptoms. Neurological signs come in two varieties; they are either of the hard or the soft type. Hard symptoms appear primarily in organic psychiatric disorders or as side effects of psychiatric therapy. They can also be encountered during neurological diseases of psychiatric patients. Their use in diagnostics and therapy is widely accepted. In contrast, soft neurological symptoms often stay unnoticed, even though they may contain important pieces of information. For this reason they will form the focus of our discussion. Soft neurological symptoms have been studied in different psychiatric disorder-groups. Up to now most attention has been devoted to schizophrenia. The study suggests that the soft symptoms are trait markers of schizophrenia. Furthermore they also signal disease activity and predict the outcome of the disease. Neurological symptoms are also important pointers for psychiatry. However, more systematic studies may increase the theoretical and practical implications of soft symptoms.

[Diabetes mellitus and Alzheimer's disease]. / Diabetes és Alzheimer-kór.

The incidence of Alzheimer's disease and diabetes is increasing with age. Thus, in light of demographic change and aging societies, they are becoming a growing issue for public health. Further, there are linkages between the two diseases. In particular, risk assessment studies suggest that type 2 diabetes mellitus is a risk factor of Alzheimer's disease. Hence, even though Alzheimer's disease can only be influenced to a limited extent, optimal treatment of diabetes mellitus may have also a positive effect on Alzheimer's disease. While the relationship between the two diseases is not yet completely clear, in addition to the known vascular effects of diabetes mellitus recent results shed light on central nervous system effects directly influencing the neurodegenerative process. Treatment of central insulin resistance, a phenomenon explored in recent years, may be a promising avenue, not only in addressing metabolic disorder, but also Alzheimer's disease.

Bifacial weakness with paresthesia ­ a rare Guillain­Barré syndrome subtype associated with SARS-CoV-2 infection / Diplegia nervi facialis paraesthesiával - ritka Guillain-Barré-szindróma-variáns, SARS-CoV-2-infekciót követoen.

Összefoglaló. A COVID-19 világméretu járvány kapcsán már jól ismertek az általános akut tünetek, mint a láz, a száraz köhögés, a nehézlégzés, a tüdogyulladás, a hasi panaszok, a hasmenés, az ízérzés- és szaglásvesztés. Talán kevésbé ismertek a betegség neurológiai szövodményei: az encephalitis, a fejfájás és szédülés, az ischaemiás stroke, az akut haemorrhagiás nekrotizáló encephalopathia, de agitáltság és exekutív funkciózavar is kialakulhat. Hosszabb távon az úgynevezett poszt-COVID-szindróma jelenhet meg, perzisztáló testi panaszokkal, krónikusfáradtság-érzéssel, depresszióval, mentális problémákkal. A perifériás idegrendszeri betegségek közül a Guillain-Barré-szindróma fordul elo gyakrabban. Jelen közleményünkben egy diplegia nervi facialis, dysarthria és négy végtagot érinto szubjektív paraesthesiák miatt hospitalizált 41 éves férfi betegünk esetét ismertetjük, akinek felso légúti tünetekkel és lázzal járó SARS-CoV-2-infekciót 10-14 nappal követoen jelentek meg neurológiai tünetei. Elektrofiziológiai és liquor laboratóriumi vizsgálat során alátámasztott módon, ritka Guillain-Barré-szindróma-variáns - bifacialis paresis paraesthesiával - igazolódott. Fontos, hogy a vírus idegrendszeri szövodményeit is ismerjük, mert az esetszámok a jövoben várhatóan növekedni fognak. Orv Hetil. 2021; 162(45): 1803-1807. Summary. After the worldwide spread of COVID-19, common symptoms are already well known as fever, coughing, shortness of breath, pneumonia, abdominal pain and diarrhea, either loss of olfaction or sense of taste. Neurological complications are perhaps less known as headache, dizziness, agitation, executive dysfunction or, in particular cases, viral encephalitis and acute hemorrhagic necrotizing encephalitis may also occur. In COVID-19 patients, ischemic stroke or cerebral vein thrombosis are also more commonly related to the increased risk of thrombosis. In the long term, so called post-COVID syndrome can emerge in the form of fatigue, depression or many other mental disorders. The most common disease of the peripheral nervous system is Guillain-Barré syndrome. This chapter reviews a case of a 41-year-old man presented to the Department of Neurology with facial diplegia, dysarthria and intermittent paresthesia of the upper and lower extremities. 10-14 days before the onset of neurological symptoms, he has gone through COVID-19 infection that involved fever and upper respiratory tract symptoms. Electrophysiology and liquor samples showed typical signs of a rare Guillain-Barré syndrome subtype - bifacial weakness with paresthesias. We are reviewing the neurological complications of the virus due to the expected increase of case numbers. Orv Hetil. 2021; 162(45): 1803-1807.

Quantitative EEG in early Alzheimer's disease patients - power spectrum and complexity features.

The goal of this study was to investigate the EEG signs of early stage Alzheimer's disease (AD) by conventional analyses and by methods quantifying linear and nonlinear EEG-complexity. The EEG was recorded in 12 mild AD patients and in an age-matched healthy control group (24 subjects) in both eyes open and eyes closed conditions. Frequency spectra, Omega-complexity and Synchronization likelihood were calculated on the data. In the patients a significant decrease of the relative alpha and increase of the theta power were found. Remarkably increased Omega-complexity and lower Synchronization likelihood were observed in AD in the 0.5-25 Hz frequency ranges. It is concluded that both spectral- and EEG-complexity changes can be found already in the early stage of AD in a wide frequency range. Application of conventional EEG analysis methods in combination with quantification of EEG-complexity may improve the chances of early diagnosis of AD.

Decreased Event-Related Beta Synchronization During Memory Maintenance Marks Early Cognitive Decline in Mild Cognitive Impairment.

Mild cognitive impairment (MCI) refers to a measurable deficit in cognition in the absence of dementia or impairment in activities of daily living. Working memory impairment is among the earliest signs of MCI. Oscillatory analysis of working memory might be a potential tool for identifying patients at increased risk of developing dementia. Our study aimed to assess the temporospatial pattern of spectral differences during working memory maintenance between MCI patients and healthy controls and to compare the sources of oscillatory activity between the two groups. Event-related spectral perturbation of 17 MCI patients and 21 healthy control participants was studied with 128-channel EEG during the Sternberg working memory task. Source localization was performed by using the eLORETA software. Among the participants, 13 MCI and 15 control participants underwent a structural brain MRI examination. Event-related synchronization (ERS) in the alpha and beta frequency band was significantly lower in MCI patients compared to healthy control participants during retention. Both study groups showed significant memory load-related enhancement in both frequency band. In the MCI group, source localization revealed significantly attenuated beta oscillatory activity in the inferior and middle temporal gyrus, in the fusiform gyrus, and in the cuneus. Beta ERS correlated significantly with the size of the hippocampus, entorhinal cortex, and parahippocampal gyrus. During the retention period, MCI is characterized by decreased alpha and beta ERS compared to controls indicating early impairment in neural networks serving working memory maintenance. The assessment of electrophysiological changes in the beta frequency range may provide a useful diagnostic tool for the early detection of cognitive impairment.

What can DTI tell about early cognitive impairment? - Differentiation between MCI subtypes and healthy controls by diffusion tensor imaging.

Mild cognitive impairment (MCI) gained a lot of interest recently, especially that the conversion rate to Alzheimer Disease (AD) in the amnestic subtype (aMCI) is higher than in the non-amnestic subtype (naMCI). We aimed to determine whether and how diffusion-weighted MRI (DWI) using the diffusion tensor model (DTI) can differentiate MCI subtypes from healthy subjects. High resolution 3D T1W and DWI images of patients (aMCI, n = 18; naMCI, n = 20; according to Petersen criteria) and controls (n = 27) were acquired at 3T and processed using ExploreDTI and SPM. Voxel-wise and region of interest (ROI) analyses of fractional anisotropy (FA) and mean diffusivity (MD) were performed with ANCOVA; MD was higher in aMCI compared to controls or naMCI in several grey and white matter (GM, WM) regions (especially in the temporal pole and the inferior temporal lobes), while FA was lower in WM ROI-s (e.g. left Cingulum). Moreover, significant correlations were identified between verbal fluency, visual and verbal memory performance and DTI metrics. Logistic regression showed that measuring FA of the crus of fornix along GM volumetry improves the discrimination of aMCI from naMCI. Additional information from DWI/DTI aids preclinical detection of AD and may help detecting early non-Alzheimer type dementia, too.

Changes of EEG spectra and coherence following performance in a cognitive task in Alzheimer's disease.

Electroencephalographic measures combined with cognitive tasks are widely used for the assessment of cognitive and pathophysiological changes in Alzheimer's disease (AD). Instead of the analysis of EEG data obtained during the performance of the task, in this study data recorded in the immediate after-task period were analyzed. It was expected that this period would correspond to the electrophysiological consequences of the cognitive effort. Data of 14 patients with AD (MMS score: 16-24) were compared to that of 10 healthy control subjects. Reverse counting of a fix duration was used as a cognitive task. Changes of relative frequency spectra, and those of inter-and intrahemispheric coherence were analyzed. Relative theta power was significantly higher in AD patients compared to the controls both before and after the task. The performance of the task resulted in an increase of the relative alpha2 band in the AD group, whereas it slightly decreased in the control group. The most prominent coherence differences between AD and controls were found in the alpha1 band, especially for long-range coherence values. Coherence in this frequency band increased in the control group following the task, not seen in the AD group. We conclude that EEG parameters calculated from epochs following the completion of a cognitive task clearly differentiates patients with AD from normal controls. The electrophysiological changes found in AD may correspond to the decrease of functional connectivity of cortical areas and to the malfunctioning of the networks engaged in the cognitive task investigated.

[Quantitative EEG analysis in Alzheimer's disease: spectral, coherence and complexity parameters]. / Kvantitatív EEG Alzheimer-kórban: spektrális-, koherencia- és komplexitás-jellemzok.

In our study we examined the linear and non-linear characteristics of EEG signals derived from patients with Alzheimer's disease (AD) with the future aim of developing a widely available method for monitoring therapy and the progression of the disease or to be used even for the purposes of differential diagnosis. EEG was recorded with eyes closed and eyes open conditions ("resting") in a group of patients with early-stage AD and in healthy control subjects matched by age. In addition to the conventional methods of analysis (frequency spectrum, coherence), the so-called complexity measures developed in recent years (Omega-complexity, synchronised probability) have also been determined. By means of frequency spectrum analysis, we managed to detect the slowdown of EEG in the early stage of dementia, a feature that so far has been associated with the later stages of AD. Coherence was reduced in the majority of frequency bands in the patient group; however, this difference could be observed only in some of the leads. Thus, resting EEG coherence is less suitable for separating various stages than the other methods. Complexity features have shown the most robust changes in Alzheimer's disease in our investigation. Besides the reduction in synchronised probability, significantly higher values of Omega-complexity were obtained in the patient group. This may be associated with the impairment of cortical afferentation (cholinergic and monoaminergic) and with the reduction in the number of neurons and synapses. Our methods have proved to be very sensitive to quantify these changes.

The Differentiation of Amnestic Type MCI from the Non-Amnestic Types by Structural MRI.

INTRODUCTION: While amnestic mild cognitive impairment (aMCI) and non-amnestic mild cognitive impairment (naMCI) are theoretically different entities, only a few investigations studied the structural brain differences between these subtypes of mild cognitive impairment. The aim of the study was to find the structural differences between aMCI and naMCI, and to replicate previous findings on the differentiation between aMCI and healthy controls. METHODS: Altogether 62 aMCI, naMCI, and healthy control subjects were included into the study based on the Petersen criteria. All patients underwent a routine brain MR examination, and a detailed neuropsychological examination. RESULTS: The sizes of the hippocampus, the entorhinal cortex and the amygdala were decreased in aMCI relative to naMCI and to controls. Furthermore the cortical thickness of the entorhinal cortex, the fusiform gyrus, the precuneus and the isthmus of the cingulate gyrus were significantly decreased in aMCI relative to naMCI and healthy controls. The largest differences relative to controls were detected for the volume of the hippocampus (18% decrease vs. controls) and the cortical thickness (20% decrease vs. controls) of the entorhinal cortex: 1.6 and 1.4 in terms of Cohen's d. Only the volume of the precuneus were decreased in the naMCI group (5% decrease) compared to the control subjects: 0.9 in terms of Cohen's d. Significant between group differences were also found in the neuropsychological test results: a decreased anterograde, retrograde memory, and category fluency performance was detected in the aMCI group relative to controls and naMCI subjects. Subjects with naMCI showed decreased letter fluency relative to controls, while both MCI groups showed decreased executive functioning relative to controls as measured by the Trail Making test part B. Memory performance in the aMCI group and in the entire sample correlated with the thickness of the entorhinal cortex and with the volume of the amygdala. CONCLUSION: The amnestic mild cognitive impairment/non-amnestic mild cognitive impairment separation is not only theoretical but backed by structural imaging methods and neuropsychological tests. A better knowledge of the MCI subtypes can help to predict the direction of progression and create targeted prevention.

Monitoring the early signs of cognitive decline in elderly by computer games: an MRI study.

BACKGROUND: It is anticipated that current and future preventive therapies will likely be more effective in the early stages of dementia, when everyday functioning is not affected. Accordingly the early identification of people at risk is particularly important. In most cases, when subjects visit an expert and are examined using neuropsychological tests, the disease has already been developed. Contrary to this cognitive games are played by healthy, well functioning elderly people, subjects who should be monitored for early signs. Further advantages of cognitive games are their accessibility and their cost-effectiveness. PURPOSE: The aim of the investigation was to show that computer games can help to identify those who are at risk. In order to validate games analysis was completed which measured the correlations between results of the 'Find the Pairs' memory game and the volumes of the temporal brain regions previously found to be good predictors of later cognitive decline. PARTICIPANTS AND METHODS: 34 healthy elderly subjects were enrolled in the study. The volume of the cerebral structures was measured by MRI. Cortical reconstruction and volumetric segmentation were performed by Freesurfer. RESULTS: There was a correlation between the number of attempts and the time required to complete the memory game and the volume of the entorhinal cortex, the temporal pole, and the hippocampus. There was also a correlation between the results of the Paired Associates Learning (PAL) test and the memory game. CONCLUSIONS: The results gathered support the initial hypothesis that healthy elderly subjects achieving lower scores in the memory game have increased level of atrophy in the temporal brain structures and showed a decreased performance in the PAL test. Based on these results it can be concluded that memory games may be useful in early screening for cognitive decline.

EEG network connectivity changes in mild cognitive impairment - Preliminary results.

Resting state EEGs were compared between patients with amnestic subtype of mild cognitive impairment (aMCI) and matched elderly controls at two times over a one year period. The study aimed at investigating the role of functional connectivity between and within different brain regions in relation to the progression of cognitive deficit in MCI. The EEG was recorded in two sessions during eyes closed and eyes open resting conditions. Functional brain connectivity was investigated based on the measurement of phase synchronization in different frequency bands. Delta and theta synchronization characteristics indicated decreased level of local and large-scale connectivity in the patients within the frontal, between the frontal and temporal, and frontal and parietal brain areas which was more pronounced 1year later. As a consequence of opening the eyes connectivity in the alpha1 band within the parietal lobe decreased compared to the eyes closed condition but only in the control group. The lack of alpha1 band reactivity following eye opening could reliably differentiate patients from controls. Our preliminary results support the notion that the functional disconnection between distant brain areas is a characteristic feature of MCI, and may prove to be predictive in terms of the progression of this condition.

Association between subjective feelings of distress, plasma cortisol, anxiety, and depression in pregnant women.

OBJECTIVE: Psychosocial stressors are consistently associated with antenatal anxiety and depression, while the impact of cortisol has proved inconsistent. Most studies have focused either on psychological or physiological stress indices. We investigated both subjective and endocrinologic indices of distress in the same subjects. STUDY DESIGN: We performed a cross-sectional study in late pregnancy in 79 women to investigate associations between the factors involved in anxiety and depression. Outcome measures were the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale, a Likert-like scale for fear of delivery, a structured interview to assess health and socioeconomic status, and fasting plasma cortisol levels measured in the morning. RESULTS: High BDI and STAI scores were associated with high levels of perceived stress and fear of delivery, but not with levels of plasma cortisol typical of the gestation phase. A multiple regression analysis revealed that subjective feelings of distress explained over 50% of the variation in BDI and STAI scores. Plasma cortisol was not a significant predictor of psychometric scores and did not show significant correlation with them in correlation analyses, and subjects with low and high cortisol levels showed similar psychometric scores. CONCLUSION: Antenatal depression and anxiety were significantly associated with subjective feelings of distress but not with increased cortisol. This finding may be explained by the blunted cortisol stress responses characteristic of pregnancy. The mechanisms mediating the effects of subjective distress remain obscure: likely candidates include monoamine neurotransmission, and/or stress-induced changes in glucocorticoid receptor expression or distribution.