Morphometric measurements of MRI findings in patients with Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) is one of the most common degenerative neurological disorders among elderly people, and is associated with progressive cerebral atrophy. AD is characterized by deterioration of the memory, difficulties with language, alterations in behavior and dysfunction in daily activities. OBJECTIVES: The purpose of the present study was to measure the total volumes of different parts of the brain of AD patients and healthy gender-matched controls using Cavalieri's volume estimate method, and to establish some brain ratios. Moreover, the authors wanted to test this method in measuring the volumes of various parts of the brain from MRI scans. MATERIAL AND METHODS: In this study, the MRI scans of 15 right-handed individuals with probable AD and 10 healthy controls were assessed. Cavalieri's volume estimate method was applied to the brain MRI scans to calculate the volumes of various parts of the brain. RESULTS: While the measurements showed a marked increase in the volume of cerebral ventricles and sulci in AD patients in comparison to the gender-matched controls, the volumes of cortical gray matter and cerebral hemispheric brain matter were reduced considerably. However, no significant differences were detected in the volume of the cerebellum + brainstem or intracranium in AD patients. There were also no major variations between male and female values of the two groups. CONCLUSIONS: Overall, cerebral hemisphere and cortical gray matter atrophies were the most remarkable findings among AD patients in the present study; consequently, expansions of both the ventricles and subarachnoid space were formed. Cavalieri's volume estimate method was very efficient in calculating the volumes of different parts of brain from the MRI scans of both groups.

Prevalence of depression and associated risk factors among the elderly in Middle Anatolia, Turkey.

AIM: The present cross-sectional study was carried out to determine the prevalence of depression among the elderly, and to examine the relationship between depression and dependency in activities of daily living. MATERIAL-METHODS: According to the records of the Beylikova Community Health Center, there were 251 individuals aged 65 years and older living in the town center, and 203 (80.8%) of them had been reached. The depression status was assessed by using the Geriatric Depression Scale (GDS), Katz's Activities of Daily Living (ADL) Scale, and Lawton and Brody's Instrumental Activities of Daily Living (IADL) Scale. Among the statistical analyses, the χ(2) -test and Spearman's correlation analysis were used. A value of P < 0.05 was considered statistically significant. RESULTS: The prevalence of depression was found to be 45.8% (93 persons). The prevalence of depression was significantly higher in women, in those with a history of any chronic disease and in those living alone. The scores on the GDS and thus the severity of depression decreased with increasing scores on ADL and IADL scales (for each, P < 0.05). CONCLUSION: Depression seen in nearly every second older individual implies that the problem is very common. It was concluded that primary healthcare should be integrated into community-based care, and it would be appropriate to plan early diagnosis and treatment programs for the elderly.

Levels of amyloid beta-42, interleukin-6 and tumor necrosis factor-alpha in Alzheimer's disease and vascular dementia.

Amyloid ß42 (Aß42) and proinflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) have been suggested to contribute to the pathogenesis of Alzheimer's disease (AD) and vascular dementia (VaD). Our aim was to examine whether the changes in these parameters would be able to discriminate the patients with AD from those with VaD and from healthy individuals. We have analyzed the levels of Aß42, IL-6 and TNF-α in the serum of newly diagnosed 28 AD patients, 16 VaD patients and 26 healthy non-demented controls. We also investigated whether there is an association between Aß42, IL-6 and TNF-α levels and mini-mental state examination (MMSE) scores and body mass indexes (BMI) of patients. Our data showed a significant decrease in serum Aß-42 levels in AD patients compared to VaD patients and controls. Levels of IL-6 and TNF-α were not different between AD patients, VaD patients and controls. We observed a correlation between Aß-42 levels and MMSE scores and BMI levels in both AD and VaD patients. However, Aß-42 levels were not correlated with IL-6 and TNF-α levels. Significantly lower levels of Aß42 found in the serum of AD patients than that of VaD patients and controls suggests that it can be a specific biochemical marker for AD.

Sacculocolic reflex in patients with dementia: is it possible to use it for early diagnosis?

Alzheimer disease (AD) is a progressive, irreversible entity associated with behavioral changes, memory loss and disturbance of daily life activities. Current diagnostic tools can detect neuronal degeneration in AD only after irreversible damage that already existed. Vestibular evoked myogenic potentials (VEMP) test utilizes the sacculocolic reflex arc and has been used in neuro-otology practice for many years. In this study, we aim to determine if VEMP can be used for diagnostic purposes at the earliest stages of AD. Twenty patients with AD and ten patients with mild cognitive impairment were enrolled in this study. Control group was 30 healthy volunteers with no neurological or otological diseases. Abnormal VEMP responses were found in most of the patients at different stages of AD. VEMP test may be used for early diagnosis of AD. Also, it may provide a novel advancement in understanding of pathophysiology of this disease.

Evaluation of platelet activation, coagulation, and fibrinolytic activation in patients with symptomatic lacunar stroke.

BACKGROUND: It is unclear whether hemostasis plays a role in the pathogenesis of ischemic stroke subtypes. OBJECTIVE: We aimed to investigate the possible relationship between different hemostatic markers and lacunar stroke. RESULTS: The study consisted of 30 patients with symptomatic lacunar stroke and 30 healthy age-matched healthy individuals. We analyzed the values of "Mean Platelet Volume," D-dimer, "soluble p-selectin," "Plasminogen Activator Inhibitor Type-1" (PAI-1), "Thrombin-Activatable Fibrinolysis Inhibitor" (TAFI), and "Platelet Factor 4" (PF4) in patients with lacunar infarct and compared these values to those of control individuals. There were significant differences for D-dimer, mean platelet volume, thrombin-activatable fibrinolysis inhibitor, and platelet factor 4 values in symptomatic lacunar stroke group compared with the control group (P < 0.01). CONCLUSIONS: Different hemostatic factors may play a role in the pathogenesis of lacunar stroke. Evaluating the role of hemostatic factors on different types of strokes may help us identify new therapeutic strategies and different prognostic stratifications for ischemic stroke.

Prevalence of dementia and associated risk factors in Middle Anatolia, Turkey.

This study aimed to investigate the prevalence of various cognitive disorders in the older population (age 55 years and above) of Eskisehir, Turkey, by conducting a cluster sampled door-to-door survey. A total of 3100 inhabitants were screened with the Mini-Mental State Examination (MMSE) and a questionnaire concerning demographic, occupational and social data. Individuals (n=320) with MMSE scores of 25 were assessed according to the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and were investigated in the more detailed phase 2 study. The overall prevalence of dementia was 8.4%, although it ranged from 2.2% among those aged 55-59 years to 5.3% among those aged 60-64 years, and to 30.4% among those aged 75 or above. Vascular dementia was the most common type (51.1%), followed by Alzheimer's dementia (48.8%). In a very small proportion of individuals (0.1%), dementia was due to other causes such as B12 deficiency, a tumour or hydrocephalus. Significant risk factors for dementia were female sex, low education, age, living in a rural area and a family history of dementia.

Investigation of association between plasminogen activator inhibitor type-1 (PAI-1) gene 4G/5G polymorphism frequency and plasma PAI-1 enzyme activity in patients with acute stroke.

AIM: This study was carried out to determine if there is any association between plasminogen activator inhibitor type-1 (PAI-1) gene 4G/5G polymorphism and plasma PAI-1 enzyme activity in acute stroke patients. METHODS: In this study, 333 genomic DNAs (from 253 acute stroke patients and 80 healthy subjects) were analyzed. Genomic DNAs were prepared from peripheral blood using a saline method. These DNAs were amplified by PCR method using primers specific for 4G and 5G alleles. PCR products were separated by 2% agarose gel electrophoresis and visualized by a charge coupled device (CCD) camera. PAI-1 enzyme activities were measured by ELISA method. The results were evaluated statistically with Student's t-test, chi(2)-test, one-way analysis of variance, and stepwise regression analysis. RESULTS: In this study, frequency of PAI-1 gene 4G5G genotype was found to be low both in patients and controls. PAI-1 enzyme activities were significantly increased in acute stroke patients compared to controls. Although PAI-1 gene 4G5G genotype frequencies were low, the patients carrying this allele had highest plasma PAI-1 enzyme activity; likewise, although PAI-1 gene 4G4G genotype frequencies were high, the patients carrying this allele had lowest plasma PAI-1 enzyme activities. Homocysteine levels had a positive effect of 65% on plasma PAI-1 enzyme activities. CONCLUSION: Consequently, in this study, we may assert that PAI-1 gene, 4G4G and 5G5G genotypes, PAI-1 activity, and homocysteine level determination are significant criteria for identifying patients who are likely to develop stroke; on the other hand, a direct relation does not exist between gene polymorphism and enzyme activity.

The effect of methylprednisolone treatment on cerebral reactivity in patients with multiple sclerosis.

We assessed the effect of intravenous high-dose methylprednisolone (IVMP) on cerebral reactivity in multiple sclerosis (MS) patients during exacerbations by means of functional transcranial Doppler imaging. Forty-eight clinically defined MS patients were evaluated with visual evoked potentials (VEP) and functional transcranial Doppler sonography (TCD) of both posterior cerebral arteries before and after 5 days of 1000 mg IVMP. After treatment, mean Expanded Disability Status Scale score, mean blood flow velocities and mean blood flow velocities at rest and at stimulation, significantly decreased (p < 0.0001, for each). The change in cerebral blood flow velocity ratio (CBFv) with visual stimulation after treatment increased slightly (p = 0.20). All TCD parameters were not significantly correlated with VEP changes. In conclusion, we observed significant changes in CBFv with a non-significant increase in vascular reactivity after treatment with IVMP in exacerbations of MS. Case-control studies are necessary to draw conclusions regarding the beneficial effects of IVMP treatment.