Neurological Sciences最新文献

Background: Vascular parkinsonism (VP) and the postural instability and gait difficulty (PIGD) subtype of Parkinson's disease (PD) exhibit similar gait characteristics. However, most research emphasizes lower-limb gait parameters, often neglecting the role of cognitive function in gait regulation. Therefore, this study investigates differences in cognitive-motor interactions between VP and PIGD to identifying specific gait biomarkers and develop a diagnostic model.

Methods: We recruited 37 PIGD patients and 37 VP patients between year 2022 to 2024 and used wearable devices to record gait parameters during single-task and dual-task paradigms. Demographic and clinical data were collected from all participants. Statistical analysis was conducted using R software with P < 0.05 as statistically significance.

Results: Multiple gait parameters significantly difference between VP and PIGD groups under both single-task and dual-task paradigms. In both single-task and dual-task gait comparisons, significant differences were observed between VP and PIGD in walk speed, shank swing speed, gait speed, phase coordination index (PCI), and trunk sway maximum (P < 0.05). Corresponding dual-task costs (DTC) also showed significant differences (P < 0.05). ROC curve analysis indicated a good diagnostic performance when combining multiple gait parameters and their DTC with MoCA scores (AUC 0.838, 95% CI 0.745-0.931; AUC 0.880, 95% CI 0.803-0.957). Correlation analysis revealed that several gait and DTC metrics were highly associated with cognitive performance in VP patients.

Conclusion: Our study demonstrates that gait parameters provide reliable diagnostic discrimination between VP and PIGD. Moreover, gait parameters were significantly associated with cognitive function in VP patients.

Objective: To analyze perioperative hormonal changes in male patients with non-functioning pituitary adenomas undergoing transsphenoidal surgery and establish a method for assessing adenopituitary function.

Methods: We retrospectively analyzed preoperative clinical and imaging data, and perioperative anterior pituitary hormone levels of 123 male non-functioning pituitary adenomas patients who underwent surgery from 2012 to 2022. Hormone scores were calculated using an inverse tangent function normalized to normal hormone levels (0-1). Total pituitary hormone score summed six hormones (GH, ACTH, TSH, PRL, FSH, LH) reflecting overall pituitary secretion. ROC curves and AUC were calculated for assessment.

Results: Most hormone levels (except GH, FSH) and total scores decreased postoperatively in large/giant adenoma groups, recovering by 3 months. Significant preoperative and postoperative differences were found in GH, TSH, LH, and total scores (P < 0.05). TSH, PRL, FSH, and total scores showed significant time-related changes, while GH, ACTH, and LH remained stable. Total scores differed significantly between patients with and without preoperative hypopituitarism (P < 0.001 for ACTH, FSH, LH, TSH). Prediction models had AUCs of 0.755 and 0.636 for patients without and with preoperative hypopituitarism, respectively.

Conclusions: Male non-functioning pituitary adenomas patients experienced immediate postoperative hormonal drops, followed by gradual recovery. The total hormone score efficiently assessed pituitary function, simplifying complex hormonal dynamics.

Introduction: Hereditary spastic paraparesis (HSP) are a group of disabling neurological disorders classically defined by progressive spasticity and weakness at lower limbs. Non-motor symptoms may be part of the clinical phenotype. Our aim was to evaluate cognitive abilities, especially executive functions and verbal memory, in different forms of HSP.

Material and methods: This study included 40 patients and 25 matched healthy controls (HC). Among the patients, 18 had SPG4, 6 SPG7, 2 SPG5, 3 SPG11, 3 SPG10, 3 SPG28, and one each had SPG3A, SPG9, SPG15, SPG17 and SPG21. Disease severity was assessed using the Spastic Paraplegia Rating Scale (SPRS). To evaluate cognitive domains, a defined neuropsychological battery was used. Statistical methods included Shapiro-Wilk testing to determine distribution, followed by t-tests, Mann-Whitney U, ANOVA, or Kruskal-Wallis tests as appropriate, with false discovery rate (FDR) correction. Effect sizes were calculated using Cohen's d, rank-biserial correlation (rb) or η². Pearson's (r) or Spearman's rank correlation coefficient (ρ) were used to explore associations.

Results: No significant differences emerged in age or education. While MMSE scores were slightly lower in patients, major impairments were found in executive function, attention, and memory (all p < 0.001, FDR-corrected). Cognitive deficits were independent of mood, fatigue, and pain. Patients with complicated HSP (cHSP) showed greater impairment than those with pure HSP (pHSP). SPG4 patients exhibited specific deficits despite preserved global cognition.

Conclusion: Cognitive impairment is a relevant but underrecognized feature in HSP. Comprehensive neuropsychological testing is critical, as global screening may miss relevant deficits.

Introduction: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system and a leading cause of disability in young adults. Traditional measures of MS-related disability primarily rely on objective clinical evaluations, often neglecting patients' subjective experiences, which are affected by physical, cognitive, and emotional factors. This study aimed to validate the Italian Perceived Disability Scale (IPDS), a 20-item self-report tool designed to assess perceived disability across physical, psychological, and social domains.

Methods: A cohort of 100 individuals with MS underwent the IPDS and a comprehensive clinical and neuropsychological assessment, including the Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A), and the Brief Repeatable Battery of Neuropsychological Tests (BRB-N).

Results: Factor analysis confirmed the five-factor structure of the IPDS, accounting for 75% of the total variance, with excellent internal consistency (Cronbach's alpha = 0.90). The IPDS total score showed significant correlations with EDSS (r = 0.43, p < 0.001), FSS (r = 0.61, p < 0.001), HAM-A (r = 0.41, p < 0.001), and HAM-D (r = 0.48, p < 0.001).

Conclusions: These findings validate the IPDS as a reliable and valuable tool for assessing perceived disability in MS. By capturing patients'subjective experiences, the IPDS offers valuable insights for personalized care and supports the integration of patient-reported outcomes into routine clinical practice. Future research should investigate its sensitivity to longitudinal changes and its applicability across diverse MS populations.

Neurodegenerative disorders like Parkinson's disease (PD) are defined by the gradual degeneration of neurons across various regions of the central nervous system, which ultimately leads to brain dysfunction in the affected patients. The utilization of stem cell-based approaches, encompassing fetal ventral mesencephalic cells, human embryonic stem cells (hESCs), and human induced pluripotent stem cells (hiPSCs), holds great promise for PD patients. The modeling of neurodegenerative diseases using stem cells provides a valuable platform to screen potential therapeutic agents and investigate disease mechanisms. However, the common clinical use of stem cell therapies is hindered by related ethical concerns, the risk of immunological rejection, and the lack of established grafting protocols. The conversion of differentiated adult cells into induced pluripotent stem cells (iPSCs) has sparked renewed optimism for the progress of cell-based replacement therapeutic approaches. This review highlights the recent progress in the application of stem cell technologies, specifically the utilization of hiPSCs, for the treatment of PD. Additionally, the review discusses the potential of hiPSCs in PD, which can facilitate the translation of iPSC-based approaches into clinical settings for PD treatment.

Background: Data regarding management of patients already on an antiplatelet when presenting with an ischaemic stroke or transient ischaemic attack (TIA) are limited. This secondary analysis of the triple antiplatelets for reducing dependency in ischaemic stroke (TARDIS) trial explored clinical outcomes across prior antiplatelet groups.

Methods: TARDIS was an international prospective-randomised open-label blinded-endpoint trial assessing 30 days of triple vs. guideline antiplatelet therapy in patients with acute ischaemic stroke or TIA. The number of pre-stroke/TIA antiplatelet agents was collected pre-randomisation. The primary outcome was the combined incidence of, and dependency from, any recurrent stroke (using the modified Rankin Scale) or TIA within 90 days analysed using ordinal logistic regression with adjustment for prognostic factors. Baseline imaging features of brain frailty were adjudicated centrally by neuroimaging experts.

Results: 1080/3096 (34.9%) participants were on an antiplatelet agent prior to their stroke/TIA and were older, more likely to be male, had more co-morbidities and dependency, and more baseline imaging features of brain frailty than those not on prior antiplatelets. They had a higher incidence of, and dependency from, recurrent stroke or TIA at day 90: 86 (8%) vs. 112 (5.6%), adjusted common OR 1.40, 95%CI 1.02-1.92, p = 0.036; the result was neutralised when adjusted for brain frailty. Randomisation to triple vs. guideline therapy did not influence this effect.

Conclusions: Participants taking prior antiplatelets were frailer and had a higher incidence and severity of recurrent stroke or TIA at 90 days compared with those not on prior antiplatelets prior to adjustment for brain frailty.

Trial registration: ISRCTN47823388.

Background and purpose: In recent years, resting-state functional magnetic resonance imaging (rs-fMRI) has been widely used in the study of Parkinson's disease (PD), but the findings have not yet reached consensus. Besides, no studies have been conducted to standardize meta-analyses by combining the amplitude of low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuation (fALFF), and regional homogeneity (ReHo) functional indicators of PD.

Methods: A whole-brain voxel-wise meta-analysis was performed on resting-state functional imaging studies that explored differences in spontaneous functional brain activity between individuals with PD and healthy controls (HCs) using the Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) software.

Results: A total of 59 independent functional imaging studies (88 datasets) with 2591 individuals with PD and 1804 HCs were included. The results of the main meta-analysis revealed decreased resting-state regional functional activity in the left lenticular nucleus, the putamen, and the left supplementary motor area in PD patients compared to HCs, and no brain regions with significantly increased functional activity were identified. In the subsequent jackknife sensitivity analyses, these results showed high robustness and no significant heterogeneity or publication bias was observed.

Conclusion: This functional meta-analysis not only revealed robust and consistent brain regions with altered spontaneous functional activity in PD, but also helped to deepen our understanding of the complex neuropathological mechanisms of PD.

Introduction: The Romberg Test (RT) is a traditional bedside test of static balance. However, its nonspecific original description and focus on proprioceptive deficits have limited its diagnostic utility for vestibular dysfunction. We used gyroscopic measurements of trunk sway at the body's center of mass, time to fall, and a Subjective Instability score (SI) to gain more detailed insights than the binary outcomes typically used in clinical practice.

Objective: To evaluate whether specific patterns of sway and sway perception during the RT and its variants differentiate individuals with vestibular and proprioceptive deficits from healthy controls (HC).

Methods: We assessed 18 patients with chronic imbalance, divided into three groups: unilateral vestibular loss, bilateral vestibular loss, and isolated sensory predominant peripheral neuropathy (SPPN). Six healthy individuals served as HCs. All participants underwent clinical history, physical examination, and ancillary nerve conduction and vestibular tests when appropriate. Each performed eight stance tasks with simultaneous SI scoring and trunk sway recording.

Results: Trunk sway for eyes closed on foam was significantly greater in vestibulopathy than in neuropathy patients (p < 0.05). Conversely, SPPN patients showed greater imbalance on firm ground (eyes closed) than on foam. SPPN patients also had the greatest mismatch between objective and subjective instability on firm ground. Tandem tasks were less useful for group differentiation. No correlation was found between fall direction and the more hypofunctioning vestibulo-ocular reflex (VOR) side in vestibular patients.

Conclusion: The main distinguishing feature between vestibular and somatosensory ataxia across tasks are the differing sway patterns between firm and foam surfaces.