Neurological Sciences最新文献

Background: ‌ Reminiscence therapy(RT) is used in the care of people with dementia to help improve their quality of life, but the efficacy of RT in various cognitive decline populations is unclear, and long-term effects are not sufficiently evidenced.This systematic review and meta-analysis aims to determine the efficacy of RT in improving cognitive decline and provide evidence for its implementation in care.

Methods: A comprehensive search strategy utilizing MeSH terms and free-text keywords was employed to systematically search the Embase, PubMed, and Cochrane databases up to January 24, 2024. Randomized controlled trials(RCTs) investigating RT monotherapy for improving cognitive decline were included. The primary outcomes of interest were the standard Mini-Mental State Examination (MMSE) scores. Additionally, all data analyses will be performed using RevMan5.4 software.

Results: ‌ We identified 612 studies, and 24 studies met the inclusion criteria, involving 2650 participants. This meta-analysis shows that RT significantly improves immediate and long-term cognitive decline with Standardized Mean Difference(SMD) and 95% CI of 0.55 [0.37, 0.73] and 0.50 [0.11, 0.88], respectively. However, there is no significant difference in efficacy between subgroups (P > 0.05).

Conclusion: ‌ Our findings suggestS that RT significantly improves cognitive decline, with no significant differences between subgroups. This suggests that RT is universal in improving cognition and that the way RT is implemented has no significant effect on outcomes. These findings supportS the use of RT as a reliable non-pharmacological treatment option to enhance cognitive function.

Background: Central nervous system symptoms, such as cognitive dysfunction, have been reported in Hereditary Transthyretin Amyloidosis (ATTRv). However, there is a lack of neuroimaging studies investigating structural alterations in the brain related to cognition in ATTRv amyloidosis. This study aimed to investigate cognition and cortical morphology in a cohort of ATTRv patients.

Methods: 29 ATTRv patients and 26 healthy controls completed neuropsychological assessment. 21 of these patients underwent 3T brain MRI, and 23 healthy subjects constituted the control group for MRI. Cortical measures of volume, thickness, fractional anisotropy (FA), and mean diffusivity (MD) were obtained for both groups. Correlation analyses between brain and cognitive measurements were performed.

Results: Patients displayed worse performance than controls in executive functions, verbal and visual memory, visuospatial domains, and language tests. Our study indicated cortical thinning in ATTRv patients in the temporal, occipital, frontal, and parietal areas. The inferior temporal gyrus correlated with verbal memory. Insula and, pars opercularis correlated with both verbal memory and executive function.

Conclusions: Cortical thickness in the inferior temporal gyrus, pars opercularis, and insula were linked to memory and executive function. We observed no correlations between cortical volume measures and cognition. Further investigations are imperative to confirm these findings across different populations.

Background: After stroke, patients must learn to use residual motor function correctly. Consistently, motor learning is crucial in stroke motor recovery. We assessed motor performance, practice-dependent on-line motor learning, and factors potentially affecting them in stroke patients.

Methods: This is a cross-sectional observational study. Twenty-six patients with first brain stroke leading to upper limb motor deficit in the subacute or chronic timeframe were enrolled. They performed a Finger Tapping Task (FTT) with both the affected and unaffected limbs. We assessed how patients learn to perform motor tasks despite the motor deficit and the differences in performance between the unaffected and affected limbs. Furthermore, by randomizing the order, we evaluated the possible inter-limb transfer of motor learning (i.e. transfer of a motor skill learned in one limb to the opposite one). Moreover, sleep, attention, anxiety, and depression were assessed through specific tests and questionnaires.

Results: Improved FTT accuracy and completed sequences for the affected limb were observed, even if lower than for the unaffected one. Furthermore, when patients initially performed the FTT with the unaffected limb, they showed higher accuracy in subsequent task completion with the affected limb than subjects who started with the affected limb. Only anxiety and attentional abilities showed significant correlations with motor performance.

Conclusions: This work provides relevant insights into motor learning in stroke. Practice-dependent on-line motor learning is preserved in stroke survivors, and an inter-limb transfer effect can be observed. Attentional abilities and anxiety can affect learning after stroke, even if the effect of other factors cannot be excluded.

Background: Duloxetine is a serotonin-norepinephrine reuptake inhibitor commonly used to treat depression and neuropathic pain. Duloxetine-associated parkinsonism has been previously reported in only two cases with psychiatric disorders. We present the first case where duloxetine unmasked motor manifestations of subclinical Parkinson's disease.

Case presentation: A 41-year-old male underwent a discectomy for a lumbar herniation. As numbness in the left sole persisted postoperatively, duloxetine (20 mg/day) was initiated seven days after surgery. Two days later, the patient developed a slow gait, difficulty turning, and short steps. Neurological examination revealed resting tremor in the left foot, dystonic posturing of the left little toe, bradykinesia of both hands, reduced gait speed with short steps, and rigidity in the left lower limb and neck. Based on the temporal association, duloxetine-associated parkinsonism was suspected. Four days after discontinuing duloxetine, the patient's gait speed, step length, and right-hand bradykinesia improved, and the foot tremor and toe dystonia resolved. Dopamine transporter single-photon emission computed tomography revealed reduced tracer uptake in the bilateral striatum, leading to a diagnosis of duloxetine-associated parkinsonism and subclinical Parkinson's disease. One year and four months later, gait impairment reappeared, characterized by short steps and slow speed, though without foot tremor or toe dystonia.

Conclusion: In this case, duloxetine appeared to unmask parkinsonism associated with subclinical Parkinson's disease. Potential mechanisms include inhibition of dopamine release due to 5-HT₂ receptor activation, postoperative effects, drug hypersensitivity, or genetic phenotypes in serotonin receptors. This case highlights the importance of considering subclinical Parkinson's disease in patients with duloxetine-associated parkinsonism.

Background: Obstructive sleep apnea (OSA) is a condition that occurs due to complete (apnea) and partial (hypopnea) obstruction in the upper airways during sleep. Hypoxia is one of the key factors contributing to the development of symptoms of obstructive sleep apnea and OSA-related diseases.

Objective: The present study aimed to evaluate time perception differences between patients with OSA and healthy individuals, as well as among different OSA severity groups.

Methods: Twenty severe OSA, twenty moderate OSA, twenty mild OSA patients, and twenty healthy volunteers without OSA were included in the study. Scales were administered to the participants. Time perception tests were administered to evaluate perceptual timing.

Results: In the paced motor timing test, a difference was observed between the OSA ( +) group and the OSA (-) group. In the Time Estimation Test, a difference was observed between the OSA ( +) group and the OSA (-) group and their subgroups.

Conclusion: The internal clock works slower in the OSA ( +) group. When subgroups were compared based on the degree of OSA, the internal clock worked slower as we transitioned from the OSA (-) group to the severe OSA group. It is considered that as you move from the OSA (-) group to the severe OSA group, the switch between pacemaker and accumulator is disrupted due to the decrease in attention. Recurrent hypoxia observed in OSA may alter the perception of time by affecting attention.

Background: Functional motor disorders (FMDs) are prevalent and highly disabling conditions among young adults, leading to reduced independence. Despite advancements in diagnosis and treatment, the economic burden of FMDs remains largely unknown.

Objective: This study evaluates the impact of accurate FMDs diagnosis on direct healthcare costs within the Italian National Health System by comparing healthcare utilization and costs before and after diagnosis.

Methods: This before-after study included 40 patients with a definite diagnosis of FMDs. Retrospective data on healthcare utilization, including diagnostic tests, specialist visits, hospitalizations, Emergency Room (ER) visits, and rehabilitation services, were collected from diaries and documents two years before and after diagnosis.

Results: Healthcare direct costs decreased by 67%, from an average of €4,467 [95% CI 3,604-5,329] to €1,461 [95% CI 945-1,976] after diagnosis. Hospitalization costs fell from €2,618 [95% CI 1,899-3,336] to €492 [95% CI 162-821], and ER costs dropped from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Diagnostic procedure costs decreased significantly, from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Specialist visit costs remained unchanged. Rehabilitation costs increased from €371 [95% CI 194-547] to €635 [95% CI 318-915], but this rise was not statistically significant.

Conclusions: Accurate diagnosis of FMDs significantly reduces healthcare costs by minimizing unnecessary tests, hospitalizations, and ER visits while emphasizing rehabilitation. This highlights the economic and clinical benefits of improved diagnostic accuracy and specific multidisciplinary intervention. Investing in cost-effective diagnostic tools is crucial for earlier diagnosis and reducing delays.

Aim: To explore trends in multiple sclerosis incidence rates in Spain between 1990 and 2019.

Methods: We use data from the Global Burden of Disease Study 2019 to calculate age-standardised incidence rates of multiple sclerosis and identify significant changes over time using the Joinpoint regression model. We also use the Age-Period-Cohort model to understand the separate influences of age, historical period, and birth cohort on these trends.

Results: Between 1990 and 2019, Spain reported 31,152 cases of multiple sclerosis, with an average annual growth rate of 1.3%, slightly higher in men (1.40%) than in women (1.28%). Joinpoint analysis revealed non-parallel trends of incidence between sexes, with men experiencing increases and declines along five differentiated periods, while women showed increasing rates until 2015, followed by stabilization. The incidence of multiple sclerosis increased over time in both sexes achieving an average annual increase of 1.6% for men and 1.4% for women. Individuals born in the early to mid-20th century experienced a different trajectory compared to later generations. For both sexes, their MS risk steadily climbed from the mid-20th century, reaching a peak in the 1970s and 1980s for men and potentially later in the 1990s for women. This peak was then followed by a plateauing of risk in subsequent years.

Conclusions: Overall, this study offers valuable insights into MS incidence trends in Spain, highlighting sex disparities, age effects, and generational patterns. Further research is needed to understand the complex interplay of age, period, and cohort effects, as well as regional and environmental factors contributing to risk of new cases of multiple sclerosis.

Objectives: Benign fasciculation syndrome (BFS) is a challenging clinical condition that causes great concern to patients, as the sudden onset of fasciculations often raises suspicion of the presence or future development of motor neuron diseases. This article hence aims to provide a systematic literature review of clinical studies that investigated the clinical progression of BFS over time.

Methods: We conducted an electronic search of PubMed, Scopus, and Web of Science using the keyword "benign fasciculation syndrome" in article title, abstract, and keywords, with no time or language restrictions, to identify all possible studies with a minimum number of 10 patients that examined the clinical progression of BFS over time.

Results: Three articles with 180 patients, predominantly men (140/180; 78%), could be included in our analysis. In 98.3% of all patients fasciculations persisted over a period of 8 months to several years after the initial diagnosis of BFS, but no patient developed motor neuron dysfunction at follow-up. In the two studies providing details on clinical evolution of symptoms, fasciculations improved in 51.7% of patients and worsened in 4.1%. These results confirm the almost benign nature of BFS, with progression to overt motor neuron disease described only in specific case reports.

Conclusion: Despite its benign nature, BFS does not appear to resolve over time, as fasciculations persist in the vast majority of BFS cases, albeit with some improvements in more than half of patients.