The validity and reliability of the Turkish version of Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) in patients with mild and moderate Alzheimer's disease and normal subjects.

OBJECTIVES: The cognitive subscale of the Alzheimer's Disease Assesment Scale (ADAS-Cog) is the most widely used test in clinical trials dealing with Alzheimer's disease (AD). The aim of this study was to investigate the validity and reliability of the Turkish version of ADAS-Cog. METHODS: Twenty-nine patients with AD, fulfilling NINCDS-ADRDA criteria of probable AD, who were in stage 3-5 according to the Global Deterioration Scale (GDS), and 27 non-demented control subjects with similar age, gender and educational status were recruited for the study. The Turkish version of ADAS-Cog, Standardized Mini Mental Status Examination (MMSE) and Short Orientation-Memory-Concentration Test (SOMCT) were applied to both of the groups. Inter-rater reliability, internal consistency, test-retest reliability; face validity, differential validity and convergent validity were statistically analyzed. RESULTS: Both MMSE and ADAS-Cog have significantly differentiated patients with AD and control subjects (p < 0.001). A significant correlation was established between MMSE and ADAS-Cog scores in AD group (r: -0.739). ADAS-Cog was also highly significantly correlated with GDS (r: 0.720) and SOMCT (r: 0.738). For the group with AD, control and whole cohort coefficients of internal consistency, Cronbach's alpha: 0.800, 0.515, 0.873 were found respectively. Inter-rater reliability for total ADAS-Cog score was found as ICC: 0.99 and 0.98 and test-retest reliability was found as ICC: 0.91 and 0.95 for demented and nondemented subjects, respectively. CONCLUSION: The Turkish version of ADAS-Cog has been found to be highly reliable and valid in differentiating patients with mild and moderate AD from nondemented subjects.

Cross-facial nerve grafting as an adjunct to hypoglossal-facial nerve crossover in reanimation of early facial paralysis: clinical and electrophysiological evaluation.

Reanimation of a spontaneous and synchronous smile, and sufficient depressor mechanism of the lower lip presents a surgical challenge in facial paralysis. Hypoglossal-facial nerve crossover and cross-facial nerve grafting are the best options if the mimetic muscles around the mouth are still viable in patients in whom the facial nerve was sacrificed at the brainstem. Although good muscle tone and facial motion have been obtained by hypoglossal-facial nerve crossover, smile is dependent on conscious tongue movement. Cross-facial nerve grafting provides a voluntary and emotion-driven smile, but requires two coaptation sites, which leads to substantial axonal loss and a long regeneration time. This method was not successful in activating the depressor mechanism. The first stage is the classic "baby-sitting" procedure, in which the bulk of the mimetic muscles was maintained by the rapid reinnervation of the hypoglossal-facial nerve crossover during the regeneration period of the cross-facial nerve graft, and temporalis muscle transfer to the eyelids is performed. During the second stage, the cross-facial nerve graft that used the thickest zygomaticobuccal branch on the healthy side was coapted with the corresponding branches on the paralyzed side. The hypoglossal-facial nerve crossover continued to innervate the depressor muscles. Good spontaneous smile and sufficient depressor mechanism were achieved by cross-facial nerve grafting and hypoglossal-facial nerve crossover respectively, and these techniques are demonstrated by the authors clinically and electrophysiologically.

Total tongue reconstruction with free functional gracilis muscle transplantation: a technical note and review of the literature.

The tongue is one of the most difficult structures of the body to reconstruct if more than 85% to 90% of it has been resected. A functional neotongue requires both soft-tissue bulk and restoration of muscle function. The innervated gracilis muscle flap folded on itself was used to reconstruct a total glossectomy defect. The genioglossus muscle, which makes the greatest contribution to swallowing, and the mylohyoid muscle, which elevates the larynx to prevent aspiration, were simulated with the design and placement of the gracilis muscle. The muscle was placed and secured longitudinally from the remnant of the tongue base and pharynx to the mandible, and then folded on itself and attached to the hyoid bone. The obturator nerve to the gracilis was coapted with the hypoglossal nerve. The patient was able to resume oral feeding without aspiration. Electromyographic results demonstrated reinnervation of the flap with active elevation of the mouth base. The patient died 1 year postoperatively because of recurrence of her disease. This type of design and placement of gracilis muscle transplantation is recommended.

Effects of oestrogen replacement therapy on pattern reversal visual evoked potentials.

As a result of a regression in the ovarian functions, oestrogen level in circulation during the menopause drops to 1/50 of its value in the normal reproductive cycle. Excitatory oestrogen increases the sensitivity of the central nervous system to catecholamines by changing the opening frequency of voltage-related L-type calcium channels and augmenting the effect of glutamate; in addition it inhibits the formation of gamma-amino butyric acid (GABA) by the inhibition of glutamate decarboxylase enzyme. It is argued that oestrogen increases transmission in the optic pathways and that oestrogen is responsible for the shorter latency values and higher amplitudes of visual evoked potentials in women. We recorded the monocular pattern reversal visual evoked potentials (PRVEP) of both eyes of 54 post-menopausal women before treatment and of 30 of them after replacement therapy with Tibolon, and of 24 women receiving placebo treatment. The explicit values of P100 latency of right and left eyes before treatment were 98.8 +/- 3.5 and 99.0 +/- 3.3 ms, respectively. The explicit values of P100 latency of right and left eyes after placebo treatment were 98.6 +/- 3.7 and 98.8 +/- 4.0, respectively. The explicit values of P100 latency of right and left eyes after replacement treatment were 94.6 +/- 3.7 and 94.8 +/- 4.0, respectively. We found a statistically significant decrease in the mean PRVEP latencies and a statistically significant increase in mean amplitudes after replacement treatment (P < 0.001) compared with those before treatment and those after placebo treatment. We attributed the changes in PRVEP values after replacement treatment to the action of Tibolon, which acted as a natural sex steroid and speeded the visual transmission time via the widespread receptors in the central nervous system. It is concluded that PRVEP is an objective electrophysiological assessment method in evaluating the efficiency of hormone replacement therapy in post-menopausal women.

IgG index in acute idiopathic peripheral facial palsy.

OBJECTIVES: Etiologic hypotheses in acute idiopathic peripheral facial palsy (AIPFP) mostly point to an immunologic dysfunction, probably virus-induced. Though various immunologic abnormalities are reported, the problem is still unsolved. We investigated intrathecal immunoglobulin synthesis in AIPFP as a clue for central nervous system (CNS) immunopathology. MATERIAL AND METHODS: We studied IgG index in 24 patients with AIPFP, 10 with other neurological diseases (OND) and 17 with multiple sclerosis (MS). CSF and serum IgG were measured by radial immunodiffusion technique. IgG index is calculated according to Tibbling's formula. RESULTS: IgG indexes were abnormal in 6 patients with AIPFP, 3 with OND and 10 with MS patients. There was no statistical difference between AIPFP and OND groups, while marked difference existed between AIPFP and MS groups. CONCLUSION: Though IgG indexes were high in 25% of AIPFP patients, statistical analyses did not show any significance of this finding. Lack of a positive result might reflect non-existence of an extensive immunologic pathology within CNS, excluding a very limited one.

Changes in pattern reversal evoked potentials during menstrual cycle.

Hormonal changes that occur during the menstrual cycle of women influence the visual function of females. Estrogen is reported to cause a decrease in the visual transmission time by increasing the sensitivity of receptors in the optic pathways to dopamine. The aim of this study was to search if pattern reversal evoked potentials (PRVEPs) changed during the different phases of the menstrual cycle. PRVEPs of both eyes of 30 healthy women were recorded in 4 different phases of the menstrual cycle, namely, menstrual, follicular, ovulatory and luteal. The highest mean PRVEP latency and the lowest mean P100 amplitude were recorded during the menstrual phase. The mean PRVEP latency recorded during the ovulatory phase (when estrogen level rises to 3-5 times that of other phases' without an increase in progesterone levels) was statistically significantly shorter than that of other phases' (p<0.05). Although not statistically significant, the mean P100 amplitude recorded during the ovulatory phase was higher than the other phases. Looking at these results, sex steroids seemed to affect the generation of PRVEPs. The significant decrease in PRVEP latencies when estrogen levels peaked was thought to be due to facilitating effect of estrogen on the neural transmission of the visual pathways.