Pál Salacz

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.

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.

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 Cohens 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 Cohens 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.

Darier's Disease Associated with Cutis Verticis Gyrata, Hyperprolactinaemia and Depressive Disorder

Cutis verticis gyrata (CVG) is a descriptive term for a thickened scalp condition in which deep furrows, cere-briform or gyriform convoluted ridges are seen (1). It has been classified into primary and secondary types (2). The secondary form has been linked to local inflammatory skin conditions and to systemic illnesses, such as amy-loidosis, myxoedema, acanthosis nigricans, acromegaly and pachydermoperiostosis. Chromosomal abnormalities such as Turner syndrome, Klinefelter syndrome, and fragile sites on chromosomes X, 12, and 9 have also been associated with CVG (3–6). Darier’s disease (DD) is an autosomal dominantly inheredited skin disorder, characterized by loss of adhesion between epidermal cells and abnormal keratinization. The disorder is caused by mutations of the

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.

Pszichiátriai tünetekkel jelentkező neuroszifilisz négyéves utánkövetése

Absztrakt: A szerzők pszichiatriai tunetekkel jaro neuroszifiliszes esetet kozolnek. Az idősodő ferfit zavart, kritikatlan viselkedes, maniform allapot es megaloman teveszmek miatt vettuk fel az első alkalommal. Felvetelkor jobb centralis facialis paresis, tremor es parkinsonismus volt eszlelhető. Akut kepalkoto es rutin laborvizsgalatok a tudatzavart egyertelműen magyarazo elterest nem igazoltak. A pszichiatriai kezeles hatasara a delirium megszűnt. Ezutan antipszichotikummal kezelt maniform allapot dominalta a kepet, majd gyors kognitiv leepulest es a motoros tunetek progressziojat eszleltuk. A koponya-MRI-vizsgalat corticalis es hippocampusatrophiat, feherallomanyi hiperintenzitasokat talalt. A liquorban pleocytosist, emelkedett osszfeherjeszintet talaltunk; a neuroszifilisz diagnozisat szerologiai vizsgalatokkal tamasztottuk ala. Penicillinkezelest kovetően a kognitiv tunetek enyhultek, a pszichiatriai tunetek remisszioba kerultek. Negy evvel a diagnozist kovetően a kognitiv hanyatlas fokozatos progre...

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.

[Diabetes mellitus and Alzheimer's disease].

The incidence of Alzheimers 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 Alzheimers disease. Hence, even though Alzheimers disease can only be influenced to a limited extent, optimal treatment of diabetes mellitus may have also a positive effect on Alzheimers 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 Alzheimers disease.