Vanja Bašić Kes

Evaluation of aging vs dementia by means of neurosonology

Aging is often associated with some cognitive impairment. Greater population life expectancy is one explanation for increased incidence of cognitive impairment cases. Large number of people with cognitive impairment and dementia is becoming one of the most important medical and social problems worldwide. Therefore, prevention of Alzheimer disease is becoming an imperative. Dementia includes a heterogeneous group of disorders, the most common being Alzheimer dementia (AD) and vascular dementia (VD). Most cardiovascular risk factors, such as hypertension, diabetes mellitus, hypercholsterolemia, atrial fibrillation, and smoking are not exclusively risk factors for VD, but also for AD. Intracranial hemodynamics of the aging brain can be assessed by Transcranial Doppler Sonography (TCD), functional TCD with various functional tests, and TCD detection of cerebral emboli. Extracranial circulation can be assessed by means of color Doppler flow imaging (CDFI). New neurosonology techniques and possibilities provide information necessary to closer determine the relation between cognitive deterioration and vascular risk factors, so that the evolution towards dementia could be prevented or at least postponed.

Breath holding index in detection of early cognitive decline

The aim of the study was to evaluate role of breath holding index (BHI) as a functional parameter for intracranial subclinical atherosclerotic changes in recognizing patients who are at risk for developing cognitive impairment of the vascular type. We included 60 volunteers divided into 3 groups according to age and presence of cognitive impairment (healthy subjects 30-40 years old, controls 60-70 years old and subjects with mild cognitive impairment 60-70 years old). We excluded individuals with moderate and severe carotid stenosis. There was a decreasing trend in the mean blood flow velocities of the intracranial blood vessels due to age increase, but it was not statistically significant. BHI values were 1.66±0.20 in the first group, 1.35±0.31 in the second and 0.69±0.30 in the third group. There was a statistically significant difference between the first two groups and the group with a mild cognitive impairment (MCI) in Montreal cognitive assessment (MoCA) score (29±1, 27±1 and 19±1 respectively), no statistically significant difference was found in Mini mental state exam (MMSE) score (29±1, 28±1, and 28±1 respectively). After regressing out age and conventional vascular risk factors, we found a good correlation between the decreasing trend in BHI values and MoCA score, and no statistically significant correlation between the BHI values and MMSE score. Results of our study show that BHI test as a parameter of impaired cerebrovascular reactivity (intracranial small vessel wall dysfunction) might differentiate individuals with early cognitive decline from healthy subjects.

Neurosonology: a means of evaluating normal aging versus dementia

The aging of the population and higher life expectancy have led to an increase in the incidence of cognitive changes and dementia. It is important to differentiate between cognitive changes associated with normal aging and those associated with dementia. Dementia is a syndrome caused by a heterogeneous group of disorders, the most common being Alzheimer’s disease and vascular dementia. While cardiovascular risk factors, such as diabetes mellitus, hypertension, hypercholesterolemia, atrial fibrillation and smoking, are particularly relevant in the development of vascular dementia, they may also play a role in Alzheimer’s disease. The control of these risk factors at an early stage may help to delay the onset and reduce the severity of vasculopathy. Cognitive changes and vasculopathy are correlated with decreased mean blood flow velocities in the main arteries of the brain. Intracranial hemodynamics of the aging brain can sucessfully be assessed by a number of methods, including transcranial Doppler sonogra...

Seksualna disfunkcija i incidencija depresije u bolesnika s multiplom sklerozom

Multiple sclerosis (MS) is one of the most common diseases of the central nervous system and usually occurs at the age when people would be expected to be in the prime of their sexual lives. In everyday practice, sexual dysfunction is underestimated because clinicians mostly concentratenon the classic neurologic deficits and often overlook symptoms that can seriously affect the quality of life. Our study included 98 patients (42 men and 56 women, mean age 35±12 years) with relapse from our MS register, with established diagnosis of relapsing remitting multiple sclerosis accordingnto McDonald criteria. Patients completed the questionnaires (Sexual Satisfaction Scale, SSS and Beck Depression Scale BDS), and underwent neurological assessment (Expanded Disability Status Scale, EDSS). All patients were in the group with EDSS 2 to 4 points (mobile patients). Therenwas no statistically significant difference in BDS and SSS values according to EDSS score. Correlation coefficients were calculated (BDS and SSS) for men (p=0.42) and women (p=0.44), yielding positive correlation. There was no statistically significant difference in BDS and SSS values accordingnto gender, disease duration or immunomodulatory therapy. In our group of patients, despite low EDSS score (fully ambulatory without aid, self sufficient patients) we found positive correlation between sexual dysfunction and depression, showing that even in such patients the quality of life can bendecreased. In conclusion, sexual dysfunction and depression are mostly under-recognized by neurologists because they are not part of routine testing; therefore, some additional questionnaires should be used in the evaluation in MS patients, even those with low EDSS score, in order to improve theirnquality of life.

UTJECAJ GUBITKA SNA NA MOZAK

Each sleep phase is characterized by specific chemical, cellular and anatomic eventsnof vital importance for normal neural functioning. Different forms of sleep deprivation may lead to andecline of cognitive functions in individuals. Studies in this field make a distinction between total sleepndeprivation, chronic sleep restriction, and the situation of sleep disruption. Investigations covering thenacute effects of sleep deprivation on the brain show that the discovered behavioral deficits in most casesnregenerate after two nights of complete sleep. However, some studies done on mice emphasize thenpossible chronic effects of long-term sleep deprivation or chronic restriction on the occurrence of neurodegenerativendiseases such as Alzheimer’s disease and dementia. In order to better understand the acutenand chronic effects of sleep loss, the mechanisms of neural adaptation in the situations of insufficientnsleep need to be further investigated. Future integrative research on the impact of sleep deprivation onnneural functioning measured through the macro level of cognitive functions and the micro molecular andncell level could contribute to more accurate conclusions about the basic cellular mechanisms responsiblenfor the detected behavioral deficits occurring due to sleep deprivation.

The impact of sleep deprivation on the brain

Each sleep phase is characterized by specific chemical, cellular and anatomic eventsnof vital importance for normal neural functioning. Different forms of sleep deprivation may lead to andecline of cognitive functions in individuals. Studies in this field make a distinction between total sleepndeprivation, chronic sleep restriction, and the situation of sleep disruption. Investigations covering thenacute effects of sleep deprivation on the brain show that the discovered behavioral deficits in most casesnregenerate after two nights of complete sleep. However, some studies done on mice emphasize thenpossible chronic effects of long-term sleep deprivation or chronic restriction on the occurrence of neurodegenerativendiseases such as Alzheimer’s disease and dementia. In order to better understand the acutenand chronic effects of sleep loss, the mechanisms of neural adaptation in the situations of insufficientnsleep need to be further investigated. Future integrative research on the impact of sleep deprivation onnneural functioning measured through the macro level of cognitive functions and the micro molecular andncell level could contribute to more accurate conclusions about the basic cellular mechanisms responsiblenfor the detected behavioral deficits occurring due to sleep deprivation.

7 Pain syndromes in patients with multiple sclerosis

chromosome 19q. In some patients CNS white matter abnormalities are very extensive, with clinical symptoms includingmental changes, hypersomnia, stroke-like episodes and seizures. Participants, Materials/Methods: We report two unrelated patients with DM1. Results: One patient, 50-year-old woman, at the time of clinical examination manifested mild temporal and bulbar muscle weakness, slight flexor neck, distal limb weakness, mild intermittent myotonia. She have bilateral cataract, sterility, without cardiac pathology. Elevated CK (274 U/l). Generalized myotonia and myopathic changes in EMG. Skeletal muscle biopsy compatible with myotonic dystrophy. Cerebrospinal fluid (CSF) was normal without immunological activity. The other patient was 37-year-old man. Clinical examination revealed severe temporal, ocular and bulbar muscle weakness, anterior neck and distal limb muscle weakness, mild myotonia as well as the frontal balding, sterility, bilateral cataract, severe myocardiopathy, elevated CK (280 U/l), generalized myotonia and myopathic changes in EMG, muscle biopsy compatible with DM1. CSF was normal. MRI of the brain in two patients: bilateral, multifocal, subcortical white matter changes, paraventricular and in brain steam, hyperintense on T2-weighted and proton density-weighted images. MRI of cervical spinal cord and MRI cerebral angiography were normal. Conclusions: We found definite MRI abnormalities in 2 patients with DM1. The morphology underlying this leucoencephalopathy is unknown. Examination of the CSF gave no evidence of an inflammatory process, excluding multiple sclerosis. These changes are probably with vascular etiology, and they are part from wide spectrum of musltisystemic disorders in DM1.

14 Surveillance of Croatian pregnant women with epilepsy and effects of antiepileptic drugs exposure in their offspring

characteristic for different pathological white matter processes. Conclusion: MRI is a very sensitive but unfortunately relatively unspecific method for evaluation of WML. As mentioned earlier, differential diagnosis of WML is a long list. Due to that the diagnosis of a specific pathological process characterised by one or more lesions in the white matter has to be made by combining clinical aspect and radiological assessment.