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Background: Excessive daytime sleepiness (EDS) in Parkinson's disease (PD) may occur because of dysfunction on the brain areas in controlling wakefulness; however, the pathophysiology of EDS in PD has not been completely clarified. The Pb component of a middle-latency auditory evoked response (MLR) is generated from the cholinergic ascending reticular activating system (ARAS) projecting to the auditory cortex via the thalamus. We examined the association between EDS and the Pb component in patients with PD., Methods: Participants were 38 patients with nondemented PD and 18 age-matched controls. EDS was evaluated using the Japanese version of the Epworth Sleepiness Scale (JESS). PD patients were classified into the high sleepiness (HS) group and the low sleepiness (LS) group by the score of JESS. MLRs were recorded from the scalp with each earlobe as a reference under presentation of 1-Hz and 65- to 90-dB click sounds., Results: There was no difference in age, duration, and motor function between the HS PD and the LS PD groups. Peak latencies of Pb were not different between PD group and controls; however, Pb amplitudes were significantly increased in the HS PD group compared with the LS PD group and controls., Conclusion: One of the mechanisms of EDS in PD was suggested to be dysregulation of cholinergic neurons from the ARAS projecting to cortical cholinergic neurons., (© 2021 S. Karger AG, Basel.)

Objective: We quantitatively evaluated the gait of Parkinson's disease (PD) patients over a 10-m course during normal walking and during dual-task walking while performing a calculation task, and clarified which parts of white matter lesions (WML) influence gait in PD patients., Methods: Gait parameters, including walking speed, gait cycle, stride length, and left-right instability, were measured in 64 PD patients and 20 controls who walked 10 m with normal gait and as they were performing a calculation task. WML on magnetic resonance imaging (MRI) of PD patients were scored according to Scheltens' criteria, and associations with gait parameters were investigated., Results: Compared to controls, the PD group showed decreased walking speed and narrowed stride (p < 0.05), and the stride length and step time coefficient of variation changed significantly during the calculation task (p < 0.001). Frontal lobe functions correlated positively with walking speed and stride during the calculation task in patients with PD (p < 0.05). The total score for periventricular hyperintensity (PVH) on MRI correlated with walking speed and stride (p < 0.01). Multiple regression analysis revealed significant correlations between walking speed and frontal cap of PVH, and between stride and occipital cap (p < 0.05)., Conclusion: Gait of PD patients deteriorated not only due to motor dysfunction but also due to mental burden in association with frontal lobe function and periventricular lesions of cerebral white matter., (© 2019 S. Karger AG, Basel.)

Background: Since stroke patients with nonvalvular atrial fibrillation (NVAF) have poor outcomes in general, the prediction of outcomes following discharge is of utmost concern for these patients. We previously reported that brain natriuretic peptide (BNP) levels were significantly higher in NVAF patients with larger infarcts, higher modified Rankin Scale (mRS) score, and higher CHADS2 score. In the present study, we evaluated an array of variables, including BNP, in order to determine significant predictors for functional outcome in patients with NVAF after acute ischemic stroke (AIS)., Methods: A total of 615 consecutive patients with AIS within 48 h of symptom onset, admitted to our hospital between April 2010 and October 2015, were retrospectively searched. Among these patients, we enrolled consecutive patients with NVAF. We evaluated the mRS score 3 months after onset of stroke and investigated associations between mRS score and the following clinical and echocardiographic variables. Categorical variables included male sex, current smoking, alcohol intake, hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, peripheral artery disease, use of antiplatelet drugs, anticoagulants, or tissue plasminogen activator (tPA), and infarct size. Continuous variables included age, systolic blood pressure (SBP), diastolic blood pressure, hemoglobin, creatinine, D-dimer, brain natriuretic peptide (BNP), left atrial diameter, left ventricular ejection fraction (EF), and early mitral inflow velocity/diastolic mitral annular velocity (E/e'). We also analyzed the association of prestroke CHADS2, CHA2DS2-VASc, and R2CHADS2 scores, and National Institutes of Health Stroke Scale (NIHSS) score on admission with mRS score 3 months after the onset of stroke. Patients were classified into 2 groups according to mRS score: an mRS score ≤2 was defined as good outcome, an mRS score ≥3 was defined as poor outcome. To clarify the correlations between categorical or continuous variables and mRS score, uni- and multivariate logistic regression models using the stepwise variable selection method were applied., Results: Among 157 patients with NVAF after AIS, 63.7% were male and the mean age was 75.9 years. In univariate regression analysis, poor outcome (mRS score ≥3) was associated with use of tPA, infarct size, age, SBP, BNP, EF, and NIHSS score. In multivariate regression analysis, BNP levels (odds ratio [OR] 6.40; 95% confidence interval [CI] 1.26-32.43; p = 0.0235) and NIHSS score (OR 2.87; 95% CI 1.84-4.47; p < 0.001) were significantly associated with poor outcome (mRS score ≥3) after adjusting for use of tPA, infarct size, age, BNP, EF, and NIHSS score., Conclusions: Apart from NIHSS score, BNP was a very useful predictor for long-term outcomes of patients with NVAF after AIS.
., (© 2017 The Author(s)
. Published by S. Karger AG, Basel.)

Objective: High-frequency electroencephalography (EEG) activity has been observed in association with cognitive processing, including stimulus perception, consciousness and selective attention, in humans. The aim of this study was to compare visual-motor integrated processing between execution and inhibition of a motor response using event-related synchronization (ERS) and desynchronization (ERD) in the 15- to 80-Hz range and to investigate a relationship between event-related potentials (ERPs) and ERS/ERD in 10 normal young subjects., Methods: EEGs were recorded from 21 scalp sites during a visual go/no-go paradigm. For ERPs, 40 artifact-free trials were averaged off-line referenced to linked ear lobes. In the β and γ bands, ERS and ERD were calculated by time-frequency analysis., Results: Go N2 and no-go N2 were elicited 200-250 ms after stimuli, and their distributions were predominant at Fz. Go P3 was predominantly elicited 340-360 ms after stimuli at Pz, whereas no-go P3 was predominantly elicited 360-380 ms after stimuli at Cz. ERD of the β band at Fz and Cz during 300-600 ms showed in the go condition, whereas ERD showed between 39 and 42 Hz at F3 in the no-go condition., Conclusion: Oscillatory cortical response-related β and γ activities differ between the processing of execution and inhibition in motor responses. β ERDs in the sensorimotor areas with go stimuli may be related to motor responses, and γ ERDs in the left frontal area with no-go stimuli may be involved in the processing of inhibition of motor responses. © 2015 S. Karger AG, Basel.

To evaluate the effect of the odor of incense on brain activity, electroencephalograms (EEGs) and event-related potentials (ERPs) in a push/wait paradigm were recorded in 10 healthy adults (aged 23-39 years) with normal olfactory function. EEG was recorded from 21 electrodes on the scalp, according to the International 10-20 system, and EEG power spectra were calculated by fast Fourier transform for 3 min before and during odor presentation. ERPs were recorded from 15 electrodes on the scalp before, during and after exposure to incense with intervals of 10 min. In a push/wait paradigm, two Japanese words, 'push' as the go stimulus and 'wait' as the no-go stimulus, appeared randomly on a CRT screen with equal probability. The subjects were instructed to push a button whenever the 'push' signal appeared. Fast alpha activity (10-13 Hz) increased significantly in bilateral posterior regions during incense exposure compared to that during rose oil exposure. The peak amplitudes of no-go P3 at Fz and Cz were significantly greater during incense inhalation. The latencies of go P3 and no-go P3, and the amplitude and latencies of no-go N2 did not change by exposure to the odors of both incense, rose and odorless air. These results suggest that the odor of incense may enhance cortical activities and the function of inhibitory processing of motor response., (2009 S. Karger AG, Basel.)