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Impact of Diabetes Mellitus Type 2 on the Development of Alzheimer’s Disease 2 型糖尿病对阿尔茨海默病发病的影响
Pub Date : 2024-07-18 DOI: 10.19080/oajnn.2024.19.556004
Maria Isabel Gomez-Coral
Diabetes Mellitus Type 2 (T2DM) and Alzheimer's Disease (AD) are prevalent chronic conditions in the aging population. T2DM is characterized by insulin resistance and chronic hyperglycemia, leading to long-term complications. AD, the most common form of dementia, is marked by progressive cognitive decline, amyloid-beta plaques, and neurofibrillary tangles. Epidemiological evidence suggests a significant correlation between T2DM and an increased risk of AD. This review explores the shared pathophysiological mechanisms linking T2DM and AD, including insulin resistance, oxidative stress, and inflammation. Insulin signaling in the brain is crucial for neuronal survival and cognitive function, and its disruption in T2DM contributes to AD pathology. Chronic hyperglycemia in T2DM induces oxidative stress and the formation of advanced glycation end products (AGEs), exacerbating neuronal damage and cognitive decline. Vascular complications in diabetes further impair cerebral blood flow, promoting neurodegeneration. Clinical implications highlight the necessity for integrated management strategies. Glycemic control, achieved through medications such as metformin and lifestyle interventions, can mitigate cognitive decline. Emerging therapies, including GLP-1 receptor agonists and intranasal insulin, show promise in addressing both metabolic and neurodegenerative aspects. Preventive measures, such as a balanced diet and regular physical activity, are crucial in reducing the risk of T2DM and AD. Future research should focus on understanding the precise mechanisms linking these diseases, optimizing therapeutic approaches, and exploring personalized medicine. This integrated perspective is essential for reducing the combined burden of T2DM and AD, ultimately improving patient outcomes.
2 型糖尿病(T2DM)和阿尔茨海默病(AD)是老龄人口中普遍存在的慢性疾病。2 型糖尿病的特点是胰岛素抵抗和长期高血糖,会导致长期并发症。老年痴呆症(AD)是最常见的痴呆症,主要表现为认知能力逐渐下降、淀粉样蛋白-β斑块和神经纤维缠结。流行病学证据表明,T2DM 与 AD 风险增加之间存在显著相关性。本综述探讨了连接 T2DM 和 AD 的共同病理生理机制,包括胰岛素抵抗、氧化应激和炎症。大脑中的胰岛素信号传导对神经元的存活和认知功能至关重要,T2DM 中的胰岛素信号传导紊乱会导致 AD 病变。T2DM 中的慢性高血糖会诱发氧化应激和高级糖化终产物(AGEs)的形成,加剧神经元损伤和认知能力下降。糖尿病血管并发症会进一步损害脑血流,促进神经退行性变。对临床的影响凸显了综合管理策略的必要性。通过二甲双胍等药物和生活方式干预来控制血糖,可以缓解认知能力下降。包括 GLP-1 受体激动剂和鼻内胰岛素在内的新兴疗法有望同时解决代谢和神经退行性病变问题。均衡饮食和定期体育锻炼等预防措施对于降低 T2DM 和 AD 的风险至关重要。未来的研究应侧重于了解这些疾病的确切关联机制、优化治疗方法和探索个性化医疗。这种综合视角对于减轻 T2DM 和 AD 的综合负担,最终改善患者预后至关重要。
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引用次数: 0
Decoding Attentional Task Performance Using Electroencephalogram Signals 利用脑电信号解码注意力任务表现
Pub Date : 2024-03-06 DOI: 10.19080/oajnn.2024.18.555999
Moemi Matsuo
Background: Electroencephalogram patterns help in evaluating the extent of ischemic brain injury and predicting functional performance. Aim: To determine a possible correlation between attentional task performance and electroencephalogram waves. Methods: The cerebral activity of 12 healthy young adults was investigated using an electroencephalogram while they underwent the TrailMaking Test-A and B as attentional tasks. Results: A significant correlation was observed between a stronger occipital delta power during rest and higher error rates, as well as weaker temporal and central delta power during the Trail-Making Test-B and longer task completion times. Delta waves during both the resting-state and task conditions correlated with task performance, which might be affected by the induced cerebral lobes. Conclusion: The default mode network might predict attention deficits. Our findings further our understanding of the correlation between the default mode network and attentional task performance
背景:脑电图模式有助于评估缺血性脑损伤的程度和预测功能表现。目的:确定注意力任务表现与脑电图波之间可能存在的相关性。方法:对 12 名健康青少年的脑电活动进行分析:使用脑电图对 12 名健康青壮年的大脑活动进行调查,同时让他们接受 "追踪测试-A "和 "追踪测试-B "作为注意力任务。结果观察发现,静息状态下枕部德尔塔波较强与较高的错误率之间存在明显的相关性,而在 "创迹测试-B "中,颞部和中央德尔塔波较弱与较长的任务完成时间之间存在明显的相关性。休息状态和任务条件下的德尔塔波与任务表现相关,这可能受到诱发脑叶的影响。结论默认模式网络可能预示着注意力缺陷。我们的研究结果进一步加深了我们对默认模式网络与注意力任务表现之间相关性的理解
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引用次数: 0
Effects of Levetiracetam on Childhood-onset Refractory Epilepsy Classified by Level of Intellectual Disability 左乙拉西坦对按智力残疾程度分类的儿童起病难治性癫痫的影响
Pub Date : 2023-08-23 DOI: 10.19080/oajnn.2023.18.555988
T. Nakayama
The efficacy of levetiracetam (LEV) for childhood-onset refractory epilepsy was retrospectively evaluated from medical records, based on the level of intellectual disability. The study sample included 84 patients (68 adults, 16 children) with childhood- onset refractory epilepsy who had been treated with LEV (dose: adult, 1000 mg/day; children, 30 mg/kg/day) for approximately 1.7 years. The responder rates (≥ 50% and ≥ 75% reduction in seizure frequency from baseline) were 85.7% and 42.9% for focal seizures in adults with normal intelligence; the responder rates for focal seizures in adults with intellectual disabilities were average 69.0% and 6.9%, respectively. Serious adverse events were not observed. A high level (≧75%) of reduction can be expected for focal seizures in adults with normal intelligence but cannot be expected in adults with intellectual disabilities. Further studies are required to investigate these.
根据患儿的智力残疾水平,对左乙拉西坦(LEV)治疗儿童期难治性癫痫的疗效进行回顾性评价。研究样本包括84例儿童期难治性癫痫患者(68例成人,16例儿童),均接受LEV治疗(剂量:成人,1000 mg/天;儿童,30毫克/公斤/天),持续约1.7年。智力正常的成人局灶性发作的应答率(癫痫发作频率较基线降低≥50%和≥75%)分别为85.7%和42.9%;智力残疾成人局灶性癫痫的应答率平均分别为69.0%和6.9%。未观察到严重的不良事件。对于智力正常的成人,局灶性癫痫发作可达到高水平(≧75%),而智力残疾的成人则不能达到高水平。需要进一步的研究来调查这些问题。
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引用次数: 0
Unlocking the Clinical Manifestations and Classifications of Locked-In Syndrome: A Comprehensive Review 解锁闭锁综合征的临床表现和分类:综合综述
Pub Date : 2023-08-04 DOI: 10.19080/oajnn.2023.18.555987
María Alejandra Nieto‐Salazar
Locked-in syndrome is a rare neurological condition characterized by complete paralysis of all voluntary muscles except for the muscles controlling eye movement. It is caused by damage to the ventral part of the brainstem, often resulting from vascular events. The syndrome is devastating, as patients are fully conscious but unable to communicate verbally or move any body part except for vertical eye movements and blinking. LIS can be classified into subtypes based on the extent of motor involvement, including classic, incomplete, total, and total with anarthria. Diagnosis is challenging but relies on clinical presentation and neuroimaging studies. Differential diagnosis is essential to distinguish LIS from similar conditions with altered consciousness. Prognosis varies depending on the underlying cause, with younger age associated with better outcomes at the onset. Rehabilitation can improve motor function and communication capabilities, leading to a higher quality of life for LIS patients. Early recognition and accurate diagnosis are crucial for implementing appropriate management strategies and improving patient outcomes. Further research is needed to explore therapeutic interventions for enhancing recovery and functional independence in LIS patients.
闭锁综合征是一种罕见的神经系统疾病,其特征是除了控制眼球运动的肌肉外,所有的随意肌都完全瘫痪。它是由脑干腹侧部分的损伤引起的,通常由血管事件引起。这种综合症是毁灭性的,因为患者完全清醒,但无法言语交流,也无法移动身体的任何部位,除了垂直的眼球运动和眨眼。LIS可根据运动受累程度分为不同亚型,包括经典型、不完全性、全身性和全无性。诊断具有挑战性,但依赖于临床表现和神经影像学研究。鉴别诊断是区分LIS与意识改变的类似情况的必要条件。预后因病因而异,发病时年龄越小预后越好。康复可以改善运动功能和沟通能力,从而提高LIS患者的生活质量。早期识别和准确诊断对于实施适当的管理策略和改善患者预后至关重要。进一步的研究需要探索治疗干预措施,以提高LIS患者的恢复和功能独立性。
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引用次数: 0
Diffuse Leptomeningeal Glioneuronal Tumour: An Intriguing Case Report of an Adult Patient with a Previous Optic Astrocytoma 弥漫性轻脑膜胶质细胞瘤:一例既往视神经星形细胞瘤的成人患者的有趣病例报告
Pub Date : 2023-07-12 DOI: 10.19080/oajnn.2023.18.555986
Hojka Rowbottom
Diffuse leptomeningeal glioneuronal tumour (DLGT) represents a rare type of neoplasm with a limited number of cases and an ambiguous prognosis. It is mainly diagnosed in children, more often in boys. The clinical presentation depends on the area of the central nervous system involved. The diagnostic process must be extremely broad. Currently, no therapeutic guidelines exist. In this report, we present a case of a 26-year-old man diagnosed with DLGT, who at the age of 10, had a pilocytic astrocytoma (PA) that was surgically removed and was afterwards treated with radiotherapy. After 16 years, his neurological condition deteriorated and an extensive diagnostic process was conducted, including molecular genetic testing using the next generation sequencing (NGS), that led to the diagnosis of DLGT. To our knowledge, we present the first reported case of a DLGT, diagnosed in an adult, who as a child was treated for a PA, and was not a case of a malignant transformation, but rather a case of two primary tumours of the central nervous system, in whom neurofibromatosis was excluded.
弥漫性轻脑膜胶质神经元肿瘤(DLGT)是一种罕见的肿瘤类型,病例数量有限,预后不明确。它主要在儿童中诊断,更常见于男孩。临床表现取决于中枢神经系统受累的区域。诊断过程必须极其广泛。目前,尚无治疗指南。在本报告中,我们报告了一例26岁的男性诊断为DLGT,他在10岁时患有毛细胞星形细胞瘤(PA),手术切除后接受放疗。16年后,他的神经系统状况恶化,进行了广泛的诊断过程,包括使用下一代测序(NGS)进行分子基因检测,最终诊断为DLGT。据我们所知,我们报告了第一例DLGT病例,诊断为成人,小时候曾接受过PA治疗,不是恶性转化,而是中枢神经系统的两个原发性肿瘤,排除了神经纤维瘤病。
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引用次数: 0
Neuroprotective Strategies for Multiple Sclerosis: Advancing Therapeutic Approaches to Preserve Neuronal Function and Promote Repair 多发性硬化症的神经保护策略:推进保护神经元功能和促进修复的治疗方法
Pub Date : 2023-07-06 DOI: 10.19080/oajnn.2023.18.555985
María Alejandra Nieto‐Salazar
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) characterized by inflammation and demyelination, leading to substantial disability and socioeconomic burden. With the absence of a definitive cure for MS, there is a critical need to explore neuroprotective strategies that can preserve neuronal function and impede disease progression. This article provides a comprehensive review of current knowledge and emerging therapeutic approaches to preserve neuronal function and promote repair in individuals with MS. The review highlights neuroprotective strategies, including immunomodulatory therapies, neuroreparative agents, and lifestyle modifications, that have shown promise in clinical studies. Additionally, the article discusses the potential of personalized treatment approaches based on individual MS profiles and the use of emerging neuroregenerative therapies to improve patients' quality of life and prevent relapses. By enhancing our understanding of these neuroprotective strategies, it is hoped that more effective management of MS can be achieved, reducing the disease's impact on patient's lives.
多发性硬化症(MS)是一种以炎症和脱髓鞘为特征的中枢神经系统(CNS)慢性自身免疫性疾病,导致严重的残疾和社会经济负担。由于MS缺乏明确的治疗方法,因此迫切需要探索能够保持神经元功能并阻止疾病进展的神经保护策略。本文全面回顾了目前的知识和新兴的治疗方法,以保护神经功能和促进ms患者的修复。综述强调了神经保护策略,包括免疫调节疗法、神经修复药物和生活方式改变,这些策略在临床研究中显示出前景。此外,本文还讨论了基于个体MS特征的个性化治疗方法的潜力,以及新兴神经再生疗法的使用,以提高患者的生活质量和预防复发。通过加强我们对这些神经保护策略的理解,希望可以实现更有效的MS管理,减少疾病对患者生活的影响。
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引用次数: 0
An Overview of Delirium in Hospitalized Adults: Prevention, Identification, and Management 住院成人谵妄的概述:预防、鉴定和管理
Pub Date : 2023-06-30 DOI: 10.19080/oajnn.2023.18.555984
M. Gomez
Delirium is described as an acute cognitive and attentional disorder that occurs over a short period. A rigorous cognitive evaluation and an acute history of symptoms are required for a diagnosis. It affects up to 50% of hospitalized patients above 65 years of age, costing well over US$164billion in the USA and more than $182 billion in 18 different European nations combined yearly. Delirium can be prevented by taking necessary precautions. Promising preventive measures, including cognitive stimulation, early mobilization, and medication review, have shown efficacy in reducing the incidence and severity of delirium. However, further research is warranted to deepen our understanding of the intricate interplay of risk factors and to develop precise interventions for effectively preventing and managing delirium. In this comprehensive overview, we explain the significance of early recognition of delirium by identifying the signs, symptoms and how it can be prevented and treated. Specifically, searches were conducted in PubMed and Google Scholar for systematic reviews, meta-analyses, and reviews related to the above information. The pathophysiology of delirium is complex and multifactorial. Understanding the pathophysiology of delirium involves considering various contributing factors, including neurotransmitter imbalances, inflammation, oxidative stress, and neuronal network dysfunction. While several causes exist, up to 39% of delirium episodes are due to adverse drug effects. The diagnosis is based on a comprehensive assessment that integrates clinical history, physical examination, mental status examination, laboratory investigations, and, in some cases, neuroimaging. Several differential diagnoses should be considered when evaluating a patient with delirium, such as dementia, psychosis, and mood disorders. Management of delirium requires a multidimensional approach which includes addressing underlying causes, non-pharmacological and pharmacological interventions. Future research should focus on evaluating the long-term effects of different treatment modalities and identifying personalized approaches for specific patient populations.
谵妄被描述为一种短期内发生的急性认知和注意力障碍。诊断需要严格的认知评估和急性症状史。在65岁以上的住院患者中,有多达50%的人患有此病,在美国每年花费超过1640亿美元,在18个不同的欧洲国家每年总共花费超过1820亿美元。谵妄可以通过采取必要的预防措施来预防。有希望的预防措施,包括认知刺激,早期活动和药物审查,已显示出有效的减少谵妄的发生率和严重程度。然而,进一步的研究是必要的,以加深我们对危险因素错综复杂的相互作用的理解,并制定准确的干预措施,有效地预防和管理谵妄。在这个全面的概述,我们解释通过识别的迹象,症状和如何预防和治疗谵妄早期识别的意义。具体而言,在PubMed和Google Scholar中搜索与上述信息相关的系统评论、元分析和评论。谵妄的病理生理是复杂的、多因素的。理解谵妄的病理生理涉及到各种因素,包括神经递质失衡、炎症、氧化应激和神经网络功能障碍。虽然存在多种原因,但高达39%的谵妄发作是由药物不良反应引起的。诊断基于综合评估,包括临床病史、体格检查、精神状态检查、实验室检查,在某些情况下,还包括神经影像学检查。在评估谵妄患者时,应考虑几种鉴别诊断,如痴呆、精神病和情绪障碍。谵妄的管理需要一个多维的方法,包括解决根本原因,非药物和药物干预。未来的研究应侧重于评估不同治疗方式的长期效果,并确定针对特定患者群体的个性化治疗方法。
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引用次数: 0
Phantom Limb Pain: Current Concepts and Treatment Strategies 幻肢痛:当前的概念和治疗策略
Pub Date : 2023-06-07 DOI: 10.19080/oajnn.2023.18.555982
María Alejandra Nieto‐Salazar
Phantom limb syndrome (PLS) is described as the perception of feelings originating from a limb that has been amputated or is otherwise absent [1]. Despite this physical absence, patients may experience various sensory and motor sensations as if the limb were still present. Phantom limb symptoms encompass a range of sensations, including the missing limb's presence, movements such as wiggling toes or opening and closing the hand, pressure, tingling, itching, temperature changes, and pain [1-3]. Phantom limb pain (PLP) is commonly encountered in these patients, and it can vary in intensity, duration, and quality, ranging from throbbing or stabbing sensations to burning or cramping feelings. There is a high statistical heterogeneity across prevalence studies due to the different time windows assessed [4-10]. However, it is estimated that approximately 60-80% of individuals who have undergone limb amputation may experience phantom limb sensations, and around 50-85% of those individuals may also experience phantom limb pain [11,12]. Several factors have been identified as potential risk factors for developing this type of pain, including the level of amputation, pre-existing pain, post-amputation pain, chronic pain history, and psychological factors (i.e., anxiety, depression, post-traumatic stress disorder) [12,13].
幻肢综合征(Phantom limb syndrome, PLS)被描述为源于截肢或其他缺失肢体的感觉感知[1]。尽管肢体不存在,但患者可能会经历各种感觉和运动感觉,就好像肢体仍然存在一样。幻肢症状包括一系列感觉,包括缺失肢体的存在、脚趾摆动或手的开合、压力、刺痛、瘙痒、温度变化和疼痛等运动[1-3]。幻肢痛(PLP)在这些患者中很常见,其强度、持续时间和质量各不相同,从悸动或刺痛到灼烧或痉挛的感觉。由于评估的时间窗不同,患病率研究的统计异质性很高[4-10]。然而,据估计,大约60-80%的截肢患者可能会有幻肢感觉,其中约50-85%的患者可能还会有幻肢疼痛[11,12]。有几个因素已被确定为发生这种类型疼痛的潜在危险因素,包括截肢程度、先前存在的疼痛、截肢后疼痛、慢性疼痛史和心理因素(即焦虑、抑郁、创伤后应激障碍)[12,13]。
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引用次数: 0
The Integration and Application of Neuropsychology into the Treatment and Care of Patients with Brain Conditions 神经心理学在脑病患者治疗与护理中的整合与应用
Pub Date : 2023-05-30 DOI: 10.19080/oajnn.2023.18.555981
Robert B Sica
Neurological conditions include diseases caused by faulty genes, degenerative diseases, diseases of blood vessels that supply the brain, injuries to the brain, seizure disorders, brain tumors, and brain infections, as well as developmental disorders. All of these conditions have a huge neuropsychological, psychosocial, and quality-of-life impact and represent a global public health challenge [1]. Neurosurgical options for diseases of the nervous system continue to expand in breadth and scope. These advances have been related in large part to progress in technology, translational application of molecular biology, and increased understanding of the physiological processes associated with neurological disease. Unfortunately, interventional surgical brain procedures can result in unavoidable secondary acute and delayed neurocognitive and neurological deficits.
神经系统疾病包括由缺陷基因引起的疾病、退行性疾病、供应大脑的血管疾病、大脑损伤、癫痫、脑肿瘤、大脑感染以及发育障碍。所有这些疾病都具有巨大的神经心理、社会心理和生活质量影响,并代表了全球公共卫生挑战[1]。神经系统疾病的神经外科选择在广度和范围上继续扩大。这些进展在很大程度上与技术进步、分子生物学的转化应用以及对与神经系统疾病相关的生理过程的进一步了解有关。不幸的是,介入脑外科手术可导致不可避免的继发性急性和延迟的神经认知和神经功能缺陷。
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引用次数: 0
Acute Ischemic Stroke Management: A Systematic Review 急性缺血性脑卒中管理:系统综述
Pub Date : 2023-02-28 DOI: 10.19080/oajnn.2023.18.555977
Xiang Li
With the increasing improvement of living standards, stroke also has a very high incidence rate in the world, in which ischemic stroke accounts for 60%-80% [1]. But many people, even medical students, know very little about stroke treatment. Therefore, I intend to write a review of the treatment of Acute Ischemic Stroke (AIS), which will give the reading public a systematic understanding of the treatment of acute ischemic stroke, reduce the public’s fear of stroke, and make patients and their families trust doctors. This article focuses on the treatment options for mild ischemic stroke and heavy ischemic stroke. The treatment options for mild ischemic stroke are thrombolytic therapy or short-term dual antiplatelet therapy [2]; the treatment options for heavy ischemic stroke are bridging therapy or direct endovascular intervention.
随着生活水平的不断提高,中风在世界范围内的发病率也非常高,其中缺血性中风占60%-80%。但是很多人,甚至是医学院的学生,对中风的治疗知之甚少。因此,我打算写一篇关于急性缺血性卒中(AIS)治疗的综述,让读者对急性缺血性卒中的治疗有一个系统的了解,减少公众对中风的恐惧,让患者和家属信任医生。本文重点介绍轻度缺血性脑卒中和重度缺血性脑卒中的治疗方案。轻度缺血性卒中的治疗选择是溶栓治疗或短期双重抗血小板治疗[2];重度缺血性脑卒中的治疗选择是桥接治疗或直接血管内介入治疗。
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引用次数: 0
期刊
Open Access Journal of Neurology & Neurosurgery
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