The aim of this work was to study the effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) on the subnetwork of subcortical and cortical motor regions and on the whole brain connectivity using the functional connectivity analysis in Parkinson's disease (PD). The high-density source space EEG was acquired and analyzed in 43 PD subjects in DBS on and DBS off stimulation states (off medication) during a cognitive-motor task. Increased high gamma band (50-100 Hz) connectivity within subcortical regions and between subcortical and cortical motor regions was significantly associated with the Movement Disorders Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III improvement after DBS. Whole brain neural correlates of cognitive performance were also detected in the high gamma (50-100 Hz) band. A whole brain multifrequency connectivity profile was found to classify optimal and suboptimal responders to DBS with a positive predictive value of 0.77, negative predictive value of 0.55, specificity of 0.73, and sensitivity of 0.60. Specific connectivity patterns related to PD, motor symptoms improvement after DBS, and therapy responsiveness predictive connectivity profiles were uncovered.
- MeSH
- Electroencephalography methods MeSH
- Deep Brain Stimulation * methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Brain physiopathology diagnostic imaging MeSH
- Subthalamic Nucleus * physiopathology MeSH
- Parkinson Disease * therapy physiopathology MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
We here posit that measurements of midlife cognition can be instructive in understanding cognitive disorders. Even though molecular events signal possible onset of cognitive disorders decades prior to their clinical diagnoses, cognition and its possible early changes in midlife remain poorly understood. We characterize midlife cognition in a cognitively healthy population-based sample using the Cogstate Brief Battery and test for associations with cardiovascular, adiposity-related, lifestyle-associated, and psychosocial variables. Learning and working memory showed significant variability and vulnerability to psychosocial influences in midlife. Furthermore, midlife aging significantly and progressively increased prevalence of suboptimal cognitive performance. Our findings suggest that physiological changes in cognition, measured with simple tests suitable for use in everyday clinical setting, may signal already in midlife the first clinical manifestations of the presymptomatic biologically defined cognitive disorders. This pilot study calls for longitudinal studies investigating midlife cognition to identify clinical correlates of biologically defined cognitive disorders.
- Publication type
- Journal Article MeSH
During the COVID-19 pandemic, research on the relationships between the virus and its human host has become fundamental to understand this pathology and its effects. Attaining this profound understanding is critical for the effective containment and treatment of infections caused by the virus. In this review, we present some possible mechanisms by which psychopathological symptoms emerge following viral infections of the central nervous system (CNS). These proposed mechanisms are based on microbial communication and the induced priming of microglial antibody activation within the CNS through Toll-like receptor signaling. In this process, chronic microglial activation causes increased glutamate release in virally-altered, high-density neuronal structures, thereby modulating cognitive networks and information integration processes. This modulation, in turn, we suggest, affects the accuracy of sensory integration and connectivity of major control networks, such as the default mode network. The chronic activation of immunological responses and neurochemical shifts toward an elevated glutamate/gamma-aminobutyric acid ratio lead to negative reinforcement learning and suboptimal organismic functioning, for example, maintaining the body in an anxious state, which can later become internalized as trait anxiety. Therefore, we hypothesize that the homeostatic relationship between host, microbiome, and virome, would be decisive in determining the efficiency of subsequent immunological responses, disease susceptibility, and long-term psychopathological effects of diseases that impact the CNS, such as the COVID-19.
- Publication type
- Journal Article MeSH
- Review MeSH
At two meetings of a Central European board of multiple sclerosis (MS) experts in 2018 and 2019 factors influencing daily treatment choices in MS, especially practice guidelines, biomarkers and burden of disease, were discussed. The heterogeneity of MS and the complexity of the available treatment options call for informed treatment choices. However, evidence from clinical trials is generally lacking, particularly regarding sequencing, switches and escalation of drugs. Also, there is a need to identify patients who require highly efficacious treatment from the onset of their disease to prevent deterioration. The recently published European Committee for the Treatment and Research in Multiple Sclerosis/European Academy of Neurology clinical practice guidelines on pharmacological management of MS cover aspects such as treatment efficacy, response criteria, strategies to address suboptimal response and safety concerns and are based on expert consensus statements. However, the recommendations constitute an excellent framework that should be adapted to local regulations, MS center capacities and infrastructure. Further, available and emerging biomarkers for treatment guidance were discussed. Magnetic resonance imaging parameters are deemed most reliable at present, even though complex assessment including clinical evaluation and laboratory parameters besides imaging is necessary in clinical routine. Neurofilament-light chain levels appear to represent the current most promising non-imaging biomarker. Other immunological data, including issues of immunosenescence, will play an increasingly important role for future treatment algorithms. Cognitive impairment has been recognized as a major contribution to MS disease burden. Regular evaluation of cognitive function is recommended in MS patients, although no specific disease-modifying treatment has been defined to date. Finally, systematic documentation of real-life data is recognized as a great opportunity to tackle unresolved daily routine challenges, such as use of sequential therapies, but requires joint efforts across clinics, governments and pharmaceutical companies.
- Publication type
- Journal Article MeSH
- Review MeSH
Although deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson's disease (PD) is generally a successful therapy, adverse events and insufficient clinical effect can complicate the treatment in some patients. We studied clinical parameters and cortical oscillations related to STN-DBS to identify patients with suboptimal responses. High-density EEG was recorded during a visual oddball three-stimuli paradigm in DBS "off" and "on" conditions in 32 PD patients with STN-DBS. Pre-processed data were reconstructed into the source space and the time-frequency analysis was evaluated. We identified a subgroup of six patients with longer reaction times (RT) during the DBS "on" state than in the DBS "off" state after target stimuli. These subjects had lower motor responsiveness to DBS and decreased memory test results compared to the other subjects. Moreover, the alpha and beta power decrease (event-related desynchronizations, ERD), known as an activation correlate linked to motor and cognitive processing, was also reduced in the DBS "on" condition in these patients. A subgroup of PD patients with a suboptimal response to STN-DBS was identified. Evaluation of RT could potentially serve as a biomarker for responsiveness to STN-DBS.
- MeSH
- Deep Brain Stimulation * MeSH
- Cognition MeSH
- Humans MeSH
- Subthalamic Nucleus * MeSH
- Parkinson Disease * therapy MeSH
- Reaction Time MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Vitamin D je ve skutečnosti skupina látek známých jako kalciferoly, které se řadí mezi vitaminy rozpustné v tucích či biologicky aktivní steroidy s efektem hormonů. Vitamin D má své receptory v mozku a ovlivňuje syntézu serotoninu i metabolismus dopaminu. V posledních letech přibývá studií, které nacházejí spojitost mezi nedostatkem vitaminu D a duševními poruchami z okruhu kognitivních, psychotických, afektivních i spánkových poruch. Kromě rekapitulace významu vitaminu D v psychiatrii je cílem článku zmapovat saturaci vitaminu D[25(OH)D] u hospitalizovaných pacientů v průběhu jednotlivých měsíců v roce a ověřit hypotézu, že sérová hladina vitaminu D je asociována s počtem slunečních hodin. Do retrospektivní analýzy bylo zařazeno celkem 357 pacientů ve věku 31,6±11,8 let, 149 žen (41,7 %), kteří byli hospitalizováni v letech 2013–2019. Koncentrace 25(OH)D v séru byla stanovena pomocí elektrochemiluminiscence na imunoanalyzátorech Elecsys firmy Roche. Koncentrace 25(OH)D v séru pod 50 nmol/l byla hodnocena jako deficit, 50–75 nmol/l jako suboptimální stav a koncentrace nad 75 nmol/l jako optimální stav. Sérová hladina vitaminu D byla statisticky významně ovlivněna počtem hodin slunečního záření v intervalu leden až srpen a září až prosinec. Průměrná koncentrace 25(OH)D v séru byla 41,8±19,4 nmol/l. Nejvyšší průměrná hodnota byla dosažena v měsíci srpnu 56,0±21,8 nmol/l a nejnižší v březnu 26,4±12,2 nmol/l. Celkem 258 pacientů (72 %) mělo deficit 25(OH)D, 62 pacientů (17,3 %) suboptimální a jen 18 (5 %) mělo optimální koncentrace 25(OH)D v séru. Naše výsledky ukazují nedostatečnou hladinu 25(OH)D v séru u psychiatrických pacientů. Pokud si pacienti nejsou schopni zajistit dostatečný příjem vitaminu D ze slunce či ze stravy, pak se nabízí možnost užití vitaminových doplňků
Vitamin D is in fact a group of substances collectively known as calciferols that belongs to vitamins soluble in fat or biologically active steroids with hormonal effect. Vitamin D receptors were found in brain. Vitamin D has influence on serotonin synthesis and dopamine metabolism. Over a past few years a number of studies found an association between low vitamin D serum levels and cogni-tive, psychotic, affective and sleeping disorders. Apart from a recapitulation of an importance of vitamin D in psychiatry, our article aims at capturing vitamin D [25(OH)D] levels in hospitalized patients during individual months of a year and verifying the hypothesis that vitamin D serum level is associated with a number of sunlight hours. We enrolled in total 357 patients aged 31.6±11.8, 149 women (41.7 %), hospitalized between 2013–2019. Serum concentration of 25(OH)D was determined by imunochemiluminiscence technology of Elecsys imunoassay, Roche company. Concentration 25(OH)D below 50 nmol/l was considered as deficiency, 50–75 nmol/l as suboptimal state and concentration over 75 nmol/l as optimal state. Vitamin D serum level was significantly influenced by a number of sunlight hours in January-August and September-December intervals. Mean serum 25(OH)D concentration was 41.8±19.4 nmol/l. The highest mean concentration was reached in August (56.0±21.8 nmol/l) and the lowest in March (26.4±12.2 nmol/l). Altogether 258 patients (72 %) were considered to be 25(OH)D deficient, 62 patients (17.3 %) suboptimal and only 18 (5 %) reached the optimal serum level of 25(OH)D. Our results present insufficient 25(OH)D serum level in psychiatric patients. Nevertheless, those patients not able to acquire a sufficient dose of 25(OH)D from sun light or diet might profit from usage of vitamin supplements.
- MeSH
- Cholecalciferol * blood deficiency therapeutic use MeSH
- Depressive Disorder MeSH
- Mental Disorders * MeSH
- Animal Experimentation MeSH
- Cognition MeSH
- Humans MeSH
- Vitamin D Deficiency blood physiopathology MeSH
- Psychotic Disorders MeSH
- Risk Factors MeSH
- Sunlight MeSH
- Sleep MeSH
- Vitamin D * blood therapeutic use MeSH
- Recommended Dietary Allowances MeSH
- Check Tag
- Humans MeSH
OBJECTIVE: The influence of demographic variables on the Trail Making Test (TMT) performance in older individuals and empirical findings on clinical validity in predementia states, such as Parkinson's disease mild cognitive impairment (PD-MCI), are limited. The principal aim of this study was to add normative data for the Czech population of older adults and explore the clinimetric properties between PD-MCI and PD patients with normal cognition (PD-NC). METHOD: The study included 125 PD patients classified as 77 PD-MCI and 48 PD-NC and 528 older individuals (60-74 years, further subdivided for normative tables into 60-64, 65-69 and 70-74 age groups) and very old individuals (aged 75-96, further subdivided into 75-79, 80-84, 85-96) cognitively intact Czech adults. RESULTS: Mostly age, to a lesser extent education but not gender, was associated with most TMT basic and derived indices (TMT-B - A). However, the ratio of TMT-B/TMT-A was independent of both age and education. We provide corresponding T-scores that minimize the effect of demographic variables. The results showed a high discriminative validity of TMT basic and derived indices for the differentiation of PD-MCI from PD-NC (all p < .05). The classification accuracy for the differentiation of PD-MCI from controls was optimal for the TMT-B only (80% area under the curve) based on norm adjusted scores. The classification accuracy of the TMT for PD-MCI vs. PD-NC was suboptimal. CONCLUSIONS: The cut-offs and normative standards are useful in clinical practice for those working with PD patients and very old adults.
- MeSH
- Cognition MeSH
- Cognitive Dysfunction psychology MeSH
- Middle Aged MeSH
- Humans MeSH
- Neuropsychological Tests MeSH
- Parkinson Disease * diagnosis psychology MeSH
- Reference Values MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Trail Making Test * MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
Nešpecifické črevné zápaly (IBD) – Crohnova choroba a ulcerózna kolitída – sa spájajú s početnými extraintestinálnymi komplikáciami, vrátane anémie. Málokrvnosť je častým klinickým a laboratórnym nálezom u týchto pacientov, keďže postihuje v priemere asi 1/3 z nich. Za jej najčastejšiu príčinu možno označiť deficit železa a prítomnosť chronického zápalu. Nedostatok železa sa vyvíja nielen ako dôsledok chronických alebo akútnych strát krvi, ale aj nechutenstva s insuficientným príjmom železa v strave, ako aj malabsorbcie železa pri Crohnovej chorobe. Druhou najčastejšou príčinou anemizácie IBD pacientov je chronický zápal, ktorý okrem iných mechanizmov znižuje i kapacitu vstrebávania železa. Málokrvnosť má významný negatívny vplyv na kvalitu života. Deplécia zásob železa sa vyvíja ešte pred klinickou manifestáciou anémie, a preto je dôležité, aby boli IBD pacienti screenovaní na deficienciu železa pri pravidelných kontrolách aktivity ochorenia. Intervaly tohto sledovania by mali byť najmenej jednoročné, a to i v tých prípadoch, keď je IBD pacient v klinickej a laboratórnej remisii svojho ochorenia. Perorálne (p.o.) podávané železo je tradične prvolíniovou terapiou anémie z nedostatku tohto prvku, pričom sa oceňuje jeho ľahká dostupnosť a nízke finančné náklady. Avšak práve u IBD pacientov je p.o. forma podávania železa často suboptimálne tolerovaná pre dyspepsiu, bolesti brucha a hnačky. Okrem toho je známe, že p.o. železo môže zhoršiť priebeh IBD. Kvôli týmto dôvodom sa odporúča podávať železo v intravenóznej (i.v.) forme, ktorá je nielen účinnejšia, ale i lepšie znášaná IBD pacientmi. I.v. železo môže byť bezpečne kombinované s inými formami i.v. liečby IBD, napr. s biologikami. Erytropoetín je efektívny v prípadoch liečby anémie pri chronických zápaloch a odporúča sa u tých IBD pacientov, ktorí vykazujú laboratórne príznaky tohto typu málokrvnosti, ďalej pri poklese hemoglobínu (Hb) pod 10,0 g/dl alebo keď neodpovedajú na i.v. terapiu železom do 4 týždňov. Pokiaľ ide o transfúzie erytrocytovej masy, tieto by nikdy nemali nahrádzať liečbu železom, s výnimkou náhrady strát pri akútnom krvácaní.
Inflammatory bowel diseases (IBD) – Crohn's disease and ulcerative colitis – are commonly associated with a number of extraintestinal complications, including anaemia. Anaemia is considered to be a key symptom and is a common clinical feature of IBD in one-third of patients. Although anaemia in IBD is multifactorial, iron deficiency and anaemia of chronic disease are the most important causes of anaemia in this population. Iron deficiency develops due to several factors, including blood loss from intestinal bleeding, food aversions affecting the amount of dietary iron available and malabsorption of iron in Crohn's disease patients. Anaemia of chronic disease is also caused by inflammation that further blocks iron absorption capacity. Anaemia has an important negative impact on the quality of life. Chronic blood loss results in the depletion of iron stores before anaemia manifests itself, and it is therefore of utmost importance that physicians screen their IBD patients for iron deficiency (at least annually even in patients in clinical remission) and manage it appropriately. Oral iron is traditionally the first-line treatment for reasons of convenience and cost, although it has suboptimal tolerability, particularly in IBD patients, who develop diarrhoea and increased abdominal pain and worsening of the course of IBD. Intravenous iron is highly efficacious, better tolerated and can be safely combined with other i.v. treatments such as biologicals. Erythropoietin is effective for the treatment of the anaemia of chronic disease and should be considered in IBD patients if Hb is less than 10g/dL or if there is no response to i.v. iron therapy within 4 weeks. Only as a very last resort should blood transfusions be considered to replenish iron.
- MeSH
- Anemia diagnosis etiology classification MeSH
- Chronic Disease MeSH
- Crohn Disease diagnosis complications therapy MeSH
- Erythropoietin administration & dosage adverse effects therapeutic use MeSH
- Ferritins isolation & purification MeSH
- Inflammatory Bowel Diseases diagnosis complications therapy MeSH
- Disease Attributes MeSH
- Cognition Disorders MeSH
- Humans MeSH
- Practice Guidelines as Topic MeSH
- Statistics as Topic MeSH
- Tachycardia MeSH
- Transferrin isolation & purification MeSH
- Colitis, Ulcerative diagnosis therapy MeSH
- Fatigue MeSH
- Inflammation complications MeSH
- Iron administration & dosage adverse effects therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Východisko: Test sémantické slovní produkce (kategorie zvířata) je jedním z neuropsychologických testů. Cílem naší studie bylo Zjistit efekt nácviku a spolehlivost opětovného měření minutové slovní produkce jakož i 30sekundové slovní produkce a verze jmenování 12 zvířat u populace seniorů. Metodika: Vyšetřili jsme 23 dobrovolníků (průměrný věk 66,1 ± 7,7; průměrná délka vzdělání 13,4 ± 2,5 let; MMSE > 28) testem sémantické slovní produkce s opakováním po 6 týdnech a 6 měsících. Výsledky: Pokusné osoby vyjmenovaly během jedné minuty (27,1 ± 5,9; 28,1 ± 5,4; 28,0 ± 6,4) zvířat, za 30 sekund (17,7 ± 4,0; 18,4 ± 3,0; 18,6 ± 4,2) a 12 zvířat vyjmenovali za (19,6 ± 9,2; 16,9 ± 4,5; 16,7 ± 6,9) sekund. Efekt nácviku byl detekován pouze při jmenování 12 zvířat při srovnání 1. a 3. testování Wilcoxonovým párovým testem (exact p < 0,001, 95% IS -1 až -5) a znaménkovým testem (p < 0,001). Korelace mezi 1. a 2. resp. 2. a 3. a 1. a 3. vyšetřením byly pro jednominutový test (Pearsonovo r = 0,750, r = 0,525, r = 0,366), pro 30sekundový test (Pearsonovo r = 0,709, r = 0,666, r = 0,562) a pro test 12 zvířat (Spearmanovo rs = 0,469, rs = 0,477, rs = 0,567). Diskuze: Test 12 zvířat se ukázal jako nejvíce citlivý k efektu nácviku. Suboptimální test-retest reliabilitu si vysvětlujeme spíše zvoleným souborem než charakterem testů.
Background: Categorical verbal fluency test (CVFT) is one of many neuropsychological tests. The aim of the study was to evaluate practice effect and test-retest reliability of one minute, 30 seconds and the short version of CVFT (wherein the subjects were asked to recite 12 animals as fast as they were able) in seniors. Methods: We assessed 23 healthy volunteers with mean age 66.1 ± 7.7 years, mean education 13,4 ± 2,5 years, MMSE ? 28 with CVFT and shorter variants and we retested them after 6 weeks and 6 months. Results: Volunteers recited (27.1 ± 5.9; 28.1 ± 5.4; 28.0 ± 6.4) animals during 1 minute and (17.7 ± 4.0; 18.4 ± 3.0; 18.6 ± 4.2) animals during 30 seconds. The mean time to recite 12 animals was (19.6 ± 9.2; 16.9 ± 4.5; 16.7 ± 6.9). The practice effect was detected only in recitation of 12 animals between 1st and 3rd assessment by Wilcoxon signed rank test (p < 0.001; 95% CI -1 to -5) and Sign test (exact p < 0.001). The correlations between 1st and 2nd, 2nd and 3rd respectively 1st and 3rd assessment were for one minute test (Pearson’s r = 0.750, r = 0.525, r = 0.366), for 30 seconds test (Pearson’s r = 0.709, r = 0.666, r = 0.562) and for 12 animals test (Spearman’s rho = 0.469, rho = 0.477, rho = 0.567). Discussion: Twelve animals recitation test was the most sensitive to practice effect. We explain suboptimal test-retest reliability more due to chosen sample than tests properties.
