Prevalence of Dementia and Mild Cognitive Impairment in a Rural Area of Sivas, Turkey.

Introduction The exact prevalence of dementia in Turkey is unknown. The purpose of this study was to determine the frequency of dementia in members of the population aged 60 years and older, as well as the influence of detailed sociodemographic factors on the prevalence rate in Sivas City Center, a large city in the middle of Anatolia, Turkey. Methods This was a cross-sectional, simple random sampling, door-to-door, population-based study. A total of 500 individuals aged 60 and older from the city center region of Sivas, Turkey, were involved. A sociodemographic data form, the Standardized Mini-Mental Test, the clock drawing test, the Cornell Scale for Depression in Dementia, and the Daily Life Activities and Instrumental Daily Life Activities tests were used in the screening phase. Results A total of 500 individuals ranging in age from 60 to 95 years were assessed. A total of 84 participants were diagnosed with dementia. The dementia prevalence was found to be 16.8% in Sivas city province. Dementia was associated with age (p<0.001), female sex (p<0.001), marital status (p<0.001), family income (p<0.001), and the absence of formal education (p<0.001). Conclusions This study is the first community-based study of cognitive impairment in Turkey, with a study design, procedures, and diagnostic criteria designed to determining the rate of dementia. Old age, a higher score on the Cornell Scale for Depression in Dementia, and a low educational level were independent risk factors for dementia. Further studies are required to confirm these results.

Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients.

OBJECTIVE: The inflammatory process is a very important stage in the development and prognosis of acute ischemic stroke (AIS). The monocyte to high-density lipoprotein (HDL) ratio (MHR) is accepted as a novel marker for demonstrating inflammation. However, the role of MHR as a predictor of mortality in patients with AIS remains unclear. METHODS: We retrospectively enrolled 466 patients who were referred to our clinic within the first 24hours of symptom presentation and who were diagnosed with AIS between January 2008 and June 2016. Four hundred and eight controls of similar age and gender were also included. The patient group was classified into two groups according to 30-day mortality. The groups were compared in terms of monocyte counts, HDL, and MHR values. RESULTS: The patient group had significantly higher monocyte counts and lower HDL levels; therefore, this group had higher values of MHR compared to controls. Additionally, the monocyte count and MHR value were higher, and the HDL level was lower in non-surviving patients (p<0.001). The MHR value was also observed as a significant independent variable of 30-day mortality in patients with AIS (p<0.001). The optimum cut-off value of MHR in predicting the 30-day mortality for patients with AIS was 17.52 (95% CI 0.95-0.98). CONCLUSION: Our study demonstrated that a high MHR value is an independent predictor of 30-day mortality in patients with AIS.

The Effect of Eosinopenia on Mortality in Patients with Intracerebral Hemorrhage.

INTRODUCTION: Inflammation may determine the prognosis of intracerebral hemorrhage (ICH), which has high mortality and morbidity rates. Recent studies have increasingly demonstrated eosinopenia as a prognostic factor, particularly in bacteremia, chronic obstructive pulmonary disease, and myocardial and cerebral infarction. Nonetheless, its significance regarding the determination of prognosis in patients with ICH has not yet been clarified. MATERIALS AND METHODS: Our study included 296 patients who presented to our clinic within 24 hours of the onset of symptoms and who were diagnosed with ICH between January 2008 and June 2016, along with 180 age- and sex-matched controls. During their hospitalization, 120 of these 296 patients died. Patients and controls were compared in terms of neutrophil count/percentage and eosinophil count/percentage; these were also compared between nonsurviving and surviving patients. The significance of eosinopenia in predicting mortality was also evaluated. RESULTS: Patients had a significantly higher neutrophil count/percentage and a significantly lower eosinophil count/percentage than controls; these results were similar between nonsurviving and surviving patients (P < .001). Consequently, the patient group was divided into 4 subgroups depending on the presence of eosinopenia and/or neutrophilia. The mortality rate was highest (62%) in the group that had both eosinopenia and neutrophilia. Univariate and multivariate logistic regression analyses indicated that neutrophilia and eosinopenia were independent predictors of mortality in ICH (P = .002; P = .004) DISCUSSION: These results indicate that eosinopenia can occur in patients with ICH and that although the mechanism is unclear, eosinopenia is closely associated with mortality in these patients, particularly when accompanied by neutrophilia.

Validity and Reliability of the Quality of Life in Epilepsy Inventory (QOLIE-31) for Turkey.

INTRODUCTION: The purpose of this study was to evaluate reliability and validity of the 31-item Quality of Life in Epilepsy Inventory (QOLIE-31) in Turkish epileptic patients. METHODS: This study was performed methodologically. To standardize the inventory, using a standard "forward-backward" translation and cultural adaptation procedure the English version of the QOLIE-31 was translated to Turkish. Language equivalence of the scale was provided. The opinions of experts were considered regarding the content validity of the scale. Reliability of the scale was determined with the test-retest reliability, item-total correlation and internal consistency analysis. For the construct validity, QOLIE-31 was compared with Nottingham Health Profile (NHP) scale and pre validity was determined. RESULTS: One hundred and forty-eight epileptic patients (62 females, 86 males), with a mean age of 32.5 (SD: 10.71) years were enrolled in the study. Content Validity Index of instrument was .85. Alpha reliability was .91. Item-total correlations were between .46 and .74 (p=.001). The mean score for the quality of life of epileptic patients was found to be moderate level (56.4; SD: 17.3). The mean score of Seizure Worry subscale was the lowest (48.9, SD: 29.82), while social function subscale (60.1, SD: 20.12) was found to be highest. As expected, correlations between QOLIE-31 and NHP subscales were fairly strong, particularly between those subscales with close or interdependent content. Thus, Emotional Well-Being correlated with NHP Emotional Reactions, Social Isolation and Pain; Social Function with NHP Social Isolation and Physical Mobility; Seizure Worry with NHP Social Isolation and Emotional Reactions; and Cognitive Function with NHP Energy, Emotional Reactions and Pain. CONCLUSION: The Turkish version of the QOLIE-31 questionnaire has good structural characteristics, is a reliable and valid instrument and can be used for measuring the effect of epilepsy on the quality of life.

Dermatoglyphic features in patients with multiple sclerosis.

OBJECTIVE: To examine dermatoglyphic features to clarify implicated genetic predisposition in the etiology of multiple sclerosis (MS). METHODS: The study was conducted between January and December 2013 in the Departments of Anatomy, and Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey. The dermatoglyphic data of 61 patients, and a control group consisting of 62 healthy adults obtained with a digital scanner were transferred to a computer environment. The ImageJ program was used, and atd, dat, adt angles, a-b ridge count, sample types of all fingers, and ridge counts were calculated. RESULTS: In both hands of the patients with MS, the a-b ridge count and ridge counts in all fingers increased, and the differences in these values were statistically significant. There was also a statistically significant increase in the dat angle in both hands of the MS patients. On the contrary, there was no statistically significant difference between the groups in terms of dermal ridge samples, and the most frequent sample in both groups was the ulnar loop. CONCLUSION: Aberrations in the distribution of dermatoglyphic samples support the genetic predisposition in MS etiology. Multiple sclerosis susceptible individuals may be determined by analyzing dermatoglyphic samples.

Injuries in Patients with Epilepsy and Some Factors Associated with Injury.

INTRODUCTION: The aim of the study was to evaluate injuries in patients with epilepsy and some factors associated with injury. METHODS: This study included 126 epileptic patients who attended a neurology outpatient clinic of a hospital between March 2009 and March 2010. Data were collected using a patient information form and an injury evaluation form. The data were evaluated using percentage, mean and the Chi square test. RESULT: 82.5% of patients have sustained injury due to an epileptic seizure. Soft tissue injuries were the most common (70.2%), followed by head injury (61.5%), dental and tongue injury (%58.6), burns (24%), and orthopaedic injury (21.2%). The most common site of burns were the upper extremities and the face (36% and 24%, respectively). Burns occurred during cooking in 32% of cases. Five patients had upper extremity fractures. Four patients faced the risk of bathtub drowning. The injuries usually occurred at home. The significant risk factors for injury were generalized tonic-clonic seizures and high frequency of seizures. Twenty-six patients were taken to the emergency unit due to an injury. CONCLUSION: Injury is a common problem in patients with epilepsy. Dental and tongue injury was the most common seizure-related injury. The risk factors were generalized tonic-clonic seizures, and high frequency of seizures. Patients with epilepsy can lead normal lives but certain precautions are needed to prevent seizure-related injuries.

Life satisfaction level of elderly people: a field study in Sivas, Turkey.

OBJECTIVE: To determine the life satisfaction levels among elderly individuals--age 65 or over--who live with their families and those who dwell in rest house. METHODS: The field-based descriptive study was conducted in the Sivas city of Turkey between May and June 2009, and included 71 elderly people. To form sampling group, random sampling technique was used. Using the Socio-Demographic Information Form and the Life Satisfaction Questionnaire, data was collected by interviewing the aged individually. The data was analysed using SPSS Version 130. RESULTS: Of the study population, 21 individuals lived in rest houses, while 50 lived with their families. Of the subjects 70.4 % were men, 52.1% were between 65-74 years of age, 46.2% suffered from unhappiness due to solitude, while 62.0 % preferred to live with their families. It is determined that considerable number (36.6 %) of the subjects were not satisfied with their lives. CONCLUSION: Interventions need to be planned to improve life satisfaction among elderly people. Proper old age policies containing decisive solutions to the problems of the old people are essential to make them feel part of society.

Serum 25-hydroxyvitamin D levels in restless legs syndrome patients.

OBJECTIVE: Restless legs syndrome is characterised by discomfort during rest and an urge to move the limbs that is accompanied by abnormal sensations. Studies on disease pathophysiology have focused on dopaminergic dysfunction. Vitamin D may play an important role in dopamine function, but the role of vitamin D in restless legs syndrome has not been examined. We compared the serum vitamin D levels of RLS patients and matched controls and explored the correlation of plasma vitamin D levels with disease severity. PATIENTS/METHODS: We measured serum 25-hydroxyvitamin D levels in 36 patients with restless legs syndrome and compared them to 38 healthy control subjects. RESULTS: The mean serum 25-hydroxyvitamin D levels were 7.31±4.63 ng/mL in female patients with restless legs syndrome and 12.31±5.27 ng/mL in female control subjects (p=0.001). We found a significant inverse correlation between vitamin D levels and disease severity in females (p=0.01, r=-0.47). CONCLUSION: The mean serum vitamin D levels were lower in female patients with restless legs syndrome. Low vitamin D levels may cause dopaminergic dysfunction in restless legs syndrome patients. Further studies are required to confirm these results.

The role of event-related potentials in subclinical cognitive dysfunction in essential tremor.

Several studies have reported that patients with essential tremor (ET) may also have mild cognitive impairment. Event-related potentials (ERPs) involve cognitive processes in the brain. No detailed investigation has been conducted into auditory ERPs (AERPs) to detect the subclinical cognitive dysfunction in patients with ET. Therefore, this study aimed to clarify the usefulness of AERPs in ET-related cognitive impairment. The AERPs were obtained by using an oddball paradigm in 27 patients with ET and 27 age-matched control subjects. The mean latency and amplitude of the ERPs were compared between the two groups. The correlation between disease duration and the mean values of all components of the potentials was assessed. The association between tremor severity and potentials was also evaluated. The patients with ET showed significant prolongation of all components of the ERP latencies at each electrode site. The N200 and P300 amplitudes were reduced in the ET group. Interestingly, the significant prolongation of N100 and N200 latencies correlated with disease duration, and N200 latencies appeared significantly longer in patients with severe tremor. Significant differences were found between the components of the AERPs and tremor severity and disease duration. This finding implies that ERPs may be useful in evaluating the cognitive functions in ET and that those AERP abnormalities may appear before clinical presentation.

Cerebral venous sinus thrombosis presenting as transient ischemic attacks in a case with homozygous mutations of MTHFR A1298C and CG677T.

We report a case with recurrent, transient attacks of slurred speech, weakness, and numbness of the right half of the face and the right arm without seizure activity, accompanied by headache and double vision. Neurologic examination revealed bilateral papilledema and right abducens palsy. Brain magnetic resonance imaging revealed thrombosis of the dural venous sinuses and the cortical veins, with no evidence of parenchymal lesion. Homozygous mutations were found for methylenetetrahydrofolate reductase (MTHFR) A1298C and MTHFR CG677T. Anticoagulation with heparin and warfarin resulted in prompt cessation of the transient attacks, as well as the signs and symptoms of increased intracranial pressure. This report documents that, although rare, transient ischemic attacks can result from cerebral venous thrombosis.

Anti-GQ1b-Negative Miller Fisher Syndrome with Acute Areflexic Mydriasis and Cholinergic Supersensitivity.

Miller Fisher syndrome is a rare variant of Guillain-Barré syndrome and it is characterised by ophthalmoplegia, ataxia, and areflexia. Pupillomotor involvement occurs in approximately half of the patients with the disorder. The authors report a patient with acute areflexic mydriasis, external ophthalmoplegia, areflexia, and ataxia. Although the pupils were unreactive to light and near stimuli, administration of 0.1% pilocarpine resulted in marked miosis, suggesting cholinergic supersensitivity. Antibodies against GM1, GD1b, and GQ1b were negative. This is the first report of acute areflexic mydriasis with cholinergic supersensitivity in anti-GQ1b-negative Miller Fisher syndrome.

Isolated cortical vein thrombosis after epidural anesthesia: report of three cases.

Cerebral venous thrombosis rarely develops after lumbar puncture and spinal anesthesia with accidental dural puncture, however, occurrence of isolated cortical vein thrombosis after epidural anesthesia is extremely rare. We report three cases who developed postural headache and isolated cortical vein thrombosis after epidural anesthesia. We postulate that intracranial hypotension is the cause of compensatory venous dilatation and resultant thrombosis.

Familial mediterranean fever and multiple sclerosis--a case report.

A 30-year old man diagnosed with Familial Mediterranean fever (FMF) 2.5 years ago presented with numbness in his left lower extremity and ataxia. Multiple sclerosis (MS) plaques were founded in his spinal and cranial MRI. The diagnosis of MS was established and steroid treatment was started. FMF and MS coexistence is rare, but should not be missed.

Intraerythrocyte antioxidant enzyme activities in migraine and tension-type headaches.

BACKGROUND: The pathophysiology of migraine and other headaches is still unknown, and research is mostly done on neurotransmitter, biochemical and vascular mechanisms. The aim of this study was to examine the role of antioxidant enzymes in the pathophysiology of headache in the interictal period of the pain process. METHODS: In this study, glutathione peroxidase, catalase and superoxide dismutase enzyme activities were investigated in 88 cases, which included 11 migraine cases with aura, 17 migraine without aura, 32 chronic type tension headache and 28 control cases. RESULTS: In migraine cases, superoxide dismutase and glutathione peroxidase enzyme activities were statistically lower than in the tension headache and control groups. The differences between tension-type headache and control groups were found statistically insignificant. CONCLUSIONS: Low intraerythrocytes, superoxide dismutase and glutathione peroxidase levels may play an important role in the etiology of migraine.

Sneddon's syndrome: clinical and laboratory analysis of 10 cases.

Sneddon's syndrome is characterized by livedo reticularis and cerebrovascular lesions. We report the cases of women (mean age, 36.2 +/- 8.1 years) diagnosed with Sneddon's syndrome based on the presence of livedo reticularis and characteristic cerebrovascular findings. Seven of these patients had cerebral infarcts on cranial computed tomography scan. Antiphospholipid antibodies were positive in 6 of these cases. Three cases had abnormal levels of antithrombin III. Analyses of chromosome 6 revealed no abnormalities. In 3 of the cases, investigation of the pedigrees revealed autosomal dominant traits. Two cases had epilepsy, and 3 had migraine. One case with migraine also had myasthenia gravis. In addition, we detected inferior altudinal hemianopia in 2 cases, cognitive functional disorder in 3 and depression in 2. Based on these findings, the entire vascular, haematologic, neurologic, and dermatologic systems should be evaluated in patients diagnosed with Sneddon's syndrome.