Jelena Maric

Glucose Homeostasis in Huntington Disease: Abnormalities in Insulin Sensitivity and Early-Phase Insulin Secretion

BACKGROUND Patients with Huntington disease (HD) develop diabetes mellitus more often than do matched healthy controls. Recent studies in neurodegenerative diseases suggested that insulin resistance constitutes a metabolic stressor that interacts with a preexisting neurobiological template to induce a given disorder. OBJECTIVE To investigate possible changes in insulin sensitivity and secretion, major determinants of glucose homeostasis, in a group of consecutive normoglycemic patients with HD. DESIGN Metabolic investigations. PARTICIPANTS Twenty-nine untreated, nondiabetic patients with HD and 22 control participants matched by age, sex, and socioeconomic background. MAIN OUTCOME MEASURES Glucose tolerance, assessed by means of the glucose curve during oral glucose challenge; insulin sensitivity, assessed using homeostasis model assessment and minimal model analysis based on frequent sampling of plasma glucose and plasma insulin during the intravenous glucose tolerance test; and insulin secretion, determined by means of the acute insulin response and the insulinogenic index. RESULTS The evaluation of insulin sensitivity using homeostasis model assessment demonstrated higher homeostasis model assessment insulin resistance indices, and a lower sensitivity index when the minimal model approach was used, in patients with HD compared with controls (P = .03 and P = .003, respectively). In the assessment of early-phase insulin secretion, the acute insulin response and the insulinogenic index were lower in patients with HD compared with controls (P = .02). The number of CAG repeats correlated significantly only with acute insulin response (P = .003). CONCLUSIONS Besides impairment in insulin secretion capacity, a simultaneous decrease in insulin sensitivity, with an increase in the insulin resistance level, was found in normoglycemic patients with HD compared with controls. These data imply that progression of the insulin secretion defect in HD may lead to a failure to compensate for insulin resistance.

Depression predicts the pattern of cognitive impairment in early Parkinson's disease

OBJECTIVE To estimate the pattern of cognitive impairment in early Parkinsons disease (PD) associated with depression. Also, the prediction of potentially relevant demographic/clinical factors in early PD on cognitive functioning was tested. METHOD The study comprised 80 consecutive early PD patients (16 with major depression (PDMD), 10 PD patients with dysthimic disorder (PDDD), and 54 nondepressed PD patients (PDND)). Thirty_seven healthy subjects matched for age, gender and education were also included in the study. The cognitive evaluation included the comprehensive classical neuropsychological battery and the Cambridge Neuropsychological Test Automated Battery (CANTAB). RESULTS The two different patterns of cognitive impairment in early PD patients were obtained even when the confounding influences of general cognitive abilities and motor slowness were taken in account. One pattern was common to all PD patients either they were depressed or not, and it is conceived etiologically as dysexecutive. The PDDD group presented only the quantitative increment of the common deficit observed in PD. The second pattern was present in PDMD patients, involved episodic/working memory and language deficits alongside with background executive impairment. Depression was extensively associated with the cognitive dysfunction in early PD, whereas severity of the disease, age at onset and treatment were less favorable as predictors. CONCLUSIONS This study provides evidence that the pattern of cognitive impairment in early PD may be predicted by depression severity. Therefore, the recognition and treatment of depressive disorder in early PD is important.

Effects of Acclimation on Cognitive Performance in Soldiers during Exertional Heat Stress

This study investigates the effects of exertional heat stress and acclimation status on physiological and cognitive performance. Forty male soldiers performed an exertional heat stress test (EHST) either in a cool (20 degrees C, 16 degrees C wet bulb globe temperature), or in a hot environment (40 degrees C, 29 degrees C wet bulb globe temperature), unacclimatized, or after 10 days of passive or active acclimation. Mean skin and tympanic (Tty) temperatures and heart rates (HR) measured physiological strain. A cognitive test (the computerized Cambridge Neuropsychological Test Automated Batteries attention battery) is administered before and immediately after EHST. EHST in hot conditions induced physiological heat stress (increase in Tty and HR), which caused mild deficits in attention in U group (decreased number of correct responses, and prolonged movement time). Acclimated (passive and active) soldiers suffered no detrimental effects of exertional heat stress, despite almost the same degree of heat strain, measured by Tty and HR.

Spread of primary dystonia in relation to initially affected region.

AbstractNot only childhoodonset, but also adult-onset primary dystonia may spread to multiple body parts. The relative risk of spread by site of onset of dystonia, important for clinical prognosis and approach, has not been well characterized. The aim of this study was to prospectively follow the spread of dystonia in 132 consecutive patients and to estimate the risk of spread by the site of onset of dystonia. The patients were included in the study if primary focal dystonia was the only sign of neurological disease other than tremor; i.e. in all patients a single body part could be identified as affected at the onset. At the end of the followup (mean duration 7.5 years; range 5.2–13.4 years), 96 patients (73%) remained focal, while 26 (20%) and 10 (7%) progressed to segmental and generalized dystonia, respectively. The highest likelihood for further spread was observed in patients with initial blepharospasm (10 out of 30 patients; 33.3%), followed by dystonia of upper extremities (32.3%), torticollis (19.6%), and laryngeal dystonia (6.7%). In addition to the highest risk for further spread of dystonia, blepharospasm was associated with the fastest rate of spread (the second region affected on average after 1.2 years). Our results demonstrated that the initial site of primary dystonia was relevant for the risk of spread.

EVALUATION OF HOSPITAL OUTDOOR SPACES THROUGH USERS’ PARTICIPATION ANALYSIS

Hospital outdoor spaces (HOS) play an important part of the Healthcare facilities, with a particular impact on the healing process, which is possible to evaluate by their cultural, social, ecological and economic characteristics and values (Ulrich 1984, 2001, Burnett, 1997; Marcus and Barnes, 1999). However, this paper argues that research studies refer to HOS only as residual spaces to support medical activities. Urban theory, policy and scientific research is focusing on the issue of the hospital evaluation, but mainly on interior and spatial characteristics, rather than a hospital outdoor environment. No more than 1000 papers have been published on this topic. This paper discusses quality and significance of HOS in Belgrade, while identifying the problems and potentials of HOS, from the user perspective. The presented paper is established as the part of the larger research done in collaboration of the Faculty of Architecture in Belgrade and Sapienza University of Rome, Faculty of Architecture, which will be presented in a series of four books. The first book (Health Spaces: Hospital outdoor environment) is already published and it offers a general “top-down” interdisciplinary overview of the topic of HOS, given by experts - architects, urban planners and designers. Particularly, this paper is prepared as a foundation for the second book, with the aim to offer a “bottom-up” overview on the topic of HOS given by hospital “community” (doctors, patients, staff, visitors, etc.). Furthermore, this research was also conducted as a part of an academic course: “Participative Urban Design”, with the students at the master level of studies. The methodological framework used in this paper consists of extensive and fundamental literature review. In the frame of participative and collaborative approach, all analyses were conducted in the form of quality assessment, from the perspective of stakeholders, aforementioned as a hospital community. The survey was conducted using specific two-part questionnaire, carefully established within the academic course, as a main tool for reaching the database. Focusing on the case of Belgrade, four major hospitals were chosen as case studies: Clinical center of Serbia, Military Medical Academy, and both Clinical Hospital Centers: “Bežanijska kosa” and “Zvezdara”. The group of 12 students conducted the survey over a period of four weeks, with more than 120 participants from each hospital, gathering both specific and general results. Overall, this paper presents the first assessment of HOS of this kind ever done in Serbia. The results of the research will contribute to improving hospital environment and could present the first step on the path to integrate outdoor spaces into hospital life.