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Acute ischemic stroke (AIS) is frequently associated with long-term post-stroke cognitive impairment (PSCI) and dementia. While the mechanisms behind PSCI are not fully understood, the brain and cognitive reserve concepts are topics of ongoing research exploring the ability of individuals to maintain intact cognitive performance despite ischemic injuries. Brain reserve refers to the brain's structural capacity to compensate for damage, with markers like hippocampal atrophy and white matter lesions indicating reduced reserve. Cognitive reserve involves the brain's ability to optimize performance and use alternative networks to maintain function. Advanced methods of MRI and EEG processing may better assess brain reserve and cognitive reserve, with emerging predictive models integrating these measures to improve PSCI prediction. This article provides the design of a hospital-based study investigating the predictive role of functional connectivity and MRI radiomics in assessing PSCI occurrence one year after AIS. One hundred forty-four patients will be enrolled following strict inclusion/exclusion criteria. The patients will undergo comprehensive assessments, including neuropsychological testing, brain MRI, and quantitative EEG (QEEG), across four visits over a year. The primary outcome will be PSCI occurrence, and it will be assessed at six and twelve months after AIS. Secondary outcomes will include PSCI severity, recurrent AIS, and mortality. Statistical analyses will be performed to identify predictive factors using Cox proportional hazards models, and predictive models based on QEEG, MRI radiomics, and clinical data will be built. Early detection of AIS patients prone to developing PSCI might outline more effective therapeutic approaches, reducing the social and economic burden of ischemic stroke. [ABSTRACT FROM AUTHOR]

Background: The Improved Health Care in Neurology and Psychiatry—Longer Life (IHCNP) study was an 18-month prospective, observational, non-interventional research study focused on patients with mild cognitive impairment (MCI) following ischemic stroke. Objectives: Our secondary analysis of the IHCNP data aimed to document the progression of MCI in this patient group. Methods: A total of 100 patients from Romania were recruited, all of whom underwent cognitive assessments using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Rey Auditory Verbal Learning Test (RAVLT). Clinical evaluations were also conducted as part of the study. Baseline cognitive scores were recorded, and subsequent follow-ups documented cognitive changes over time. Results: At baseline, cognitive scores indicated mild impairment, with averages of MMSE 25.41, MoCA 23.27, and RAVLT 33.63. By the end of the study, patients exhibited a significant cognitive decline, with MMSE scores dropping by 8.7%, MoCA by 10.0%, and RAVLT by 29.5% (p < 0.0001 for all measures), reflecting the progressive nature of MCI post-stroke. Conclusions: These findings highlight the importance of early diagnosis and intervention to mitigate cognitive decline in post-stroke patients. The study underscores the need for ongoing cognitive monitoring to improve patient outcomes and manage MCI progression effectively. [ABSTRACT FROM AUTHOR]

Background: Cognitive deficits following ischemic stroke significantly impair quality of life, highlighting the need for effective interventions. This study evaluates the efficacy and safety of extended N-Pep-12 dietary supplementation in enhancing cognitive recovery post-stroke. Methods: In this randomized, open-label, controlled study, 106 patients with supratentorial ischemic stroke were enrolled to receive either 90mg N-Pep-12 or no supplementation daily for 360 days and were followed-up for 360 days. Cognitive function and emotional well-being were assessed using established neuropsychological scales at baseline, 90 days, and 360 days post-stroke. Safety was monitored through adverse events and mortality rates. Results: Significant improvements were observed in the N-Pep-12 group compared to controls, particularly in the Montreal Cognitive Assessment scores at both 90 and 360 days, and in the Digit Symbol Coding scores at 360 days, suggesting enhanced cognitive recovery with extended N-Pep-12 supplementation. A linear regression for a composite outcome analysis at day 360 further confirmed the efficacy of N-Pep-12 in contributing to cognitive improvement. Safety profiles were favorable, with no significant adverse effects attributed to N-Pep-12. Conclusions: Extended dietary supplementation with N-Pep-12 appears to offer a safe and effective approach to support cognitive recovery in ischemic stroke survivors. These findings underscore the potential of the supplement as an add-on intervention for managing post-stroke cognitive impairments. [ABSTRACT FROM AUTHOR]

Background: Ischemic stroke (IS) often leads to cognitive and motor impairments. This study aimed to investigate whether Memory-Guided Saccade Tasks (MGSTs) could be used to assess cognitive function in stroke patients. Methods: A secondary data analysis was conducted on 62 individuals with supratentorial IS. Eye-tracking metrics from MGST were correlated with established neuropsychological assessments, including the Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS). Results: Age correlated negatively with memory-guided saccade (MGS) accuracy (ρ = −0.274) and positively with late errors (ρ = 0.327). Higher Montreal Cognitive Assessment (MoCA) scores were associated with faster corrective saccades (ρ = 0.259). Increased anxiety (HADS-A) and depression (HADS-D) levels correlated with higher early error rates (ρ = 0.325 and ρ = 0.311, respectively). The Color Trails Test and Digit Span test performance also correlated with various MGS parameters. Conclusions: While some correlations were found between cognitive measures and eye-tracking metrics, further research is needed to validate MGST as a tool for cognitive assessment in a more homogenous stroke population. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is a demyelinating central nervous system disease that leads to neurological disability. Brain-derived neurotrophic factors (BDNFs) are neurotrophins involved in neurodegenerative disorders. This study analysed the relationship between serum BDNF, neurological disability and different MS treatments. We included 63 people with MS (PwMS), with relapsing-remitting MS or clinically isolated syndrome, and 16 healthy controls (HCs). We analysed the serum levels of BDNF and MS specific disability tests (Expanded Disability Status Scale, timed 25-foot walk test, nine-hole peg test), at baseline (V0) and after one year of interferon beta1a or teriflunomide treatment (V1). Baseline BDNF values were not different between the PwMS and HCs (p = 0.85). The BDNF levels were higher in PwMS vs. HCs after treatment (p = 0.003). BDNF was not related to last-year relapses or by the disease duration (all p > 0.05). The overall values for the PwMS decreased after one year (p < 0.001). Both treatments implied a similar reduction. BDNF was not related to neurological disability (p > 0.05). BDNF values were not influenced by the lesion burden, active lesions, or new lesions on MRI (p > 0.05). In our cohort, the PwMS had higher BDNF levels compared to the HCs after one year of treatment. BDNF was not related to clinical or paraclinical disease severity signs. [ABSTRACT FROM AUTHOR]

Entrapment neuropathies of the lower limb are a misunderstood and underdiagnosed group of disorders, characterized by pain and dysesthesia, muscular weakness, and specific provoking movements on physical examination. The most frequent of these syndromes encountered in clinical practice are fibular nerve entrapment, proximal tibial neuropathy, sural nerve neuropathy, deep gluteal syndrome or sciatic nerve entrapment, and lateral femoral cutaneous nerve entrapment, also known as meralgia paresthetica. These are commonly mistaken for lumbar plexopathies, radiculopathies, and musculotendinous diseases, which appear even more frequently and have overlapping clinical presentations. A comprehensive anamnesis, physical examination, and electrodiagnostic studies should help clarify the diagnosis. If the diagnosis is still unclear or a secondary cause of entrapment is suspected, magnetic resonance neurography, MRI, or ultrasonography should be conducted to clarify the etiology, rule out other diseases, and confirm the diagnosis. The aim of this narrative review was to help clinicians gain familiarity with this disease, with an increase in diagnostic confidence, leading to early diagnosis of nerve damage and prevention of muscle atrophy. We reviewed the epidemiology, anatomy, pathophysiology, etiology, clinical presentation, and EDX technique and interpretation of the entrapment neuropathies of the lower limb, using articles published from 1970 to 2022 included in the Pubmed, MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Scopus databases. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a significant public health concern, often leading to long-lasting impairments in cognitive, motor and sensory functions. The rapid development of non-invasive systems has revolutionized the field of TBI rehabilitation by offering modern and effective interventions. This narrative review explores the application of non-invasive technologies, including electroencephalography (EEG), quantitative electroencephalography (qEEG), brain–computer interface (BCI), eye tracking, near-infrared spectroscopy (NIRS), functional near-infrared spectroscopy (fNIRS), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and transcranial magnetic stimulation (TMS) in assessing TBI consequences, and repetitive transcranial magnetic stimulation (rTMS), low-level laser therapy (LLLT), neurofeedback, transcranial direct current stimulation (tDCS), transcranial alternative current stimulation (tACS) and virtual reality (VR) as therapeutic approaches for TBI rehabilitation. In pursuit of advancing TBI rehabilitation, this narrative review highlights the promising potential of non-invasive technologies. We emphasize the need for future research and clinical trials to elucidate their mechanisms of action, refine treatment protocols, and ensure their widespread adoption in TBI rehabilitation settings. [ABSTRACT FROM AUTHOR]

Background and Objectives: Stroke survivors commonly experience cognitive deficits, which significantly impact their quality of life. Integrating modern technologies like eye tracking into cognitive assessments can provide objective and non-intrusive measurements. Materials and Methods: This study aimed to evaluate the cognitive and visual processing capabilities of stroke patients using eye-tracking metrics and psychological evaluations. A cohort of 84 ischemic stroke patients from the N-PEP-12 clinical study was selected for secondary analysis, based on the availability of eye-tracking data collected during a visual search task using an adapted Trail Making Test. Standardized cognitive assessments, including the Montreal Cognitive Assessment (MoCA) and digit span tasks, were also conducted. Results: Correlation analyses revealed some notable relationships between eye-tracking metrics and cognitive measures, such as a positive correlation between Symbol Search performance and the number of fixations. Anxiety levels were found to be positively correlated with first fixation duration, while longer first fixation durations were associated with poorer cognitive performance. However, most correlations were not statistically significant. Nonparametric ANOVA showed no significant differences in fixation metrics across the visits. Conclusions: These findings suggest a complex relationship between cognitive status, gaze fixation behavior, and psychological well-being in stroke patients. Further research with larger sample sizes and analysis of saccadic eye movements is needed to better understand these relationships and inform effective interventions for stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Vascular cognitive impairment encompasses several types of deficits, ranging from mild cognitive impairment to dementia. Cognitive reserve refers to the brain's ability to balance damage and improve performance through certain types of brain networks. The purpose of this review was to assess the relationship between reserve in vascular impairment, specifically looking at whether cognitive impairment is influenced by cognitive reserve, identifying significant vascular risk factors and their pathological pathways. To achieve this purpose, a review covering these issues was conducted within the Embase, Cochrane, and PubMed database. A total of 657 scientific articles were found, and 33 papers were considered for the final analysis. We concluded that there is no consensus on the protective effects of brain reserve on cognitive impairment. Stroke and diabetes can be considered significant risk factors for vascular cognitive impairment, while hypertension is not as damaging as blood pressure variability, which structurally alters the brain through a variety of mechanisms. [ABSTRACT FROM AUTHOR]

Background and Objectives: The purpose of this study is to investigate the predictive factors for intrahospital mortality in ischemic stroke patients. We will examine the association between a range of clinical and demographic factors and intrahospital mortality, including age, sex, comorbidities, laboratory values, and medication use. Materials and Methods: This retrospective, longitudinal, analytic, observational cohort study included 243 patients over 18 years old with a new ischemic stroke diagnosis who were hospitalized in Cluj-Napoca Emergency County Hospital. Data collected included the patient demographics, baseline characteristics at hospital admission, medication use, carotid artery Doppler ultrasound, as well as cardiology exam, and intrahospital death. Results: Multivariate logistic regression was used to determine which variables were independently associated with intrahospital death. An NIHSS score > 9 (OR—17.4; p < 0.001) and a lesion volume > 22.3 mL (OR—5.8; p = 0.003) were found to be associated with the highest risk of death. In contrast antiplatelet treatment (OR—0.349; p = 0.04) was associated with lower mortality rates. Conclusions: Our study identified a high NIHSS score and large lesion volume as independent risk factors for intrahospital mortality in ischemic stroke patients. Antiplatelet therapy was associated with lower mortality rates. Further studies are needed to explore the potential mechanisms underlying these associations and to develop targeted interventions to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background and Objectives: Traumatic brain injuries represent an important source of disease burden requiring emergency inpatient care and continuous outpatient tailored rehabilitation. Although most TBIs are mild, patients are still developing post-TBI depression, anxiety, and cognitive impairments. Our secondary retrospective trial analysis aimed to (1) analyze correlations between HADS-Anxiety/HADS-Depression and scales that measure cognitive and motor processes in patients treated with Cerebrolysin compared to the placebo group and (2) compare anxiety and depression scores among the two treatment groups. Materials and Methods: Our secondary retrospective analysis focused on TBI patients with moderate and severe disability divided into two groups: Cerebrolysin (treatment) and saline solution (procedural placebo). We analyzed data from 125 patients. We computed descriptive statistics for nominal and continuous variables. We used Spearman's correlation to find associations between HADS and other neuropsychological scales and the Mann–Whitney U test to compare HADS-Anxiety and HADS-Depression scores among the two study arms. Results: Our sample consisted of patients with a mean age of 45.3, primarily men, and with a 24 h GCS (Glasgow Coma Scale) mean of 12.67. We obtained statistically significant differences for HADS-Anxiety during the second and third visits for patients treated with Cerebrolysin. Our results show that Cerebrolysin has a large effect size (0.73) on anxiety levels. In addition, there are positive and negative correlations between HADS-Anxiety and Depression subscales and other neuropsychological scales. Conclusions: Our secondary database analysis supports the existing body of evidence on the positive effect of Cerebrolysin on post-TBI mental health status. Future confirmatory trials are necessary to clarify the link between the intervention and measured outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Post-stroke depression (PSD) has complex pathophysiology determined by various biological and psychological factors. Although it is a long-term complication of stroke, PSD is often underdiagnosed. Given the diagnostic role of quantitative electroencephalography (qEEG) in depression, it was investigated whether a possible marker of PSD could be identified by observing the evolution of the (Delta + Theta)/(Alpha + Beta) Ratio (DTABR), respectively the Delta/Alpha Ratio (DAR) values in post-stroke depressed patients (evaluated through the HADS-D subscale). Methods: The current paper analyzed the data of 57 patients initially selected from a randomized control trial (RCT) that assessed the role of N-Pep 12 in stroke rehabilitation. EEG recordings from the original trial database were analyzed using signal processing techniques, respecting the conditions (eyes open, eyes closed), and several cognitive tasks. Results: We observed two significant associations between the DTABR values and the HADS-D scores of post-stroke depressed patients for each of the two visits (V1 and V2) of the N-Pep 12 trial. We recorded the relationships in the Global (V1 = 30 to 120 days after stroke) and Frontal Extended (V2 = 90 days after stroke) regions during cognitive tasks that trained attention and working memory. For the second visit, the association between the analyzed variables was negative. Conclusions: As both our relationships were described during the cognitive condition, we can state that the neural networks involved in processing attention and working memory might go through a reorganization process one to four months after the stroke onset. After a period longer than six months, the process could localize itself at the level of frontal regions, highlighting a possible divergence between the local frontal dynamics and the subjective well-being of stroke survivors. QEEG parameters linked to stroke progression evolution (like DAR or DTABR) can facilitate the identification of the most common neuropsychiatric complication in stroke survivors. [ABSTRACT FROM AUTHOR]

Stroke is still a significant health problem that affects millions of people worldwide, as it is the second-leading cause of death and the third-leading cause of disability. Many changes have occurred in the treatment of acute ischemic stroke. Although the innovative concepts of neuroprotection and neurorecovery have been vigorously investigated in a substantial number of clinical studies in the past, only a few trials managed to increase the number of promising outcomes with regard to the multidimensional construct of brain protection and rehabilitation. In terms of pharmacological therapies with proven benefits in the post-ischemic process, drugs with neurorestorative properties are thought to be effective in both the acute and chronic phases of stroke. One significant example is Cerebrolysin, a combination of amino acids and peptides that mimic the biological functions of neurotrophic factors, which has been shown to improve outcomes after ischemic stroke, while preserving a promising safety profile. The purpose of this paper is to offer an overview on the role and impact of Cerebrolysin for ischemic stroke care, by touching on various aspects, from its complex, multimodal and pleiotropic mechanism of action, to its efficacy and safety, as well as cost effectiveness. [ABSTRACT FROM AUTHOR]

(1) Background: interleukin 23 (IL-23) and interleukin 27 (IL-27) modulate the activity of T helper 17 cells (Th17) with critical roles in autoimmune diseases and multiple sclerosis (MS). The genes responsible for cytokine generation are highly influenced by the presence of single nucleotide polymorphisms (SNP) in main regions such as regulatory sequences or in promoter regions, contributing to disease susceptibility and evolution. The present study analyzed the associations of IL-23 and IL-27 SNPs with susceptibility to multiple sclerosis. (2) Methods: We performed a case-control study including 252 subjects: 157 patients diagnosed with MS and 95 controls. We used polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to determine the genotypes for IL-27 T4730C (rs 181206), IL-27 A964G (rs 153109), and IL-23 receptor gene (IL-23R) G1142A (rs 11209026). (3) Results: The IL27-T4730C gene polymorphism was significantly associated with an increased odds of MS under the dominant genetic model (TC + CC variant genotypes, adjusted odds ratio OR = 4.06, 95% CI: 2.14–7.83, p-value = 0.000007, Q-value = 0.000063). Individuals carrying the IL-27 A924G variant (AG + GG) genotype presented higher odds of MS compared to non-carriers under the dominant model (adjusted OR = 1.93, 95% CI: 1.05–3.51, p-value = 0.0324, Q-value = 0.05832) and the allelic genetic model (unadjusted p-value = 0.015, OR = 1.58, 95% CI: 1.09–2.28), while IL-23-R381Q SNP conferred a decreased odds of MS under a codominant model of inheritance (adjusted OR = 0.26, 95% CI: 0.08–0.92, p-value = 0.0276, Q-value = 0.058) and an allelic model (unadjusted p-value = 0.008, OR = 0.23, 95% CI: 0.07–0.75). In an additive model with adjustment for age group (≤40 years vs. >40 years), sex and smoking, patients carrying the G-C (A964G, T4730C) haplotype had a 3.18 increased risk (95% CI: 1.74–5.81, p < 0.001) to develop multiple sclerosis. (4) Conclusions: The results of the current study showed a significant relationship of IL-27-A964G and IL-27-T4730C polymorphisms with increased risk of MS, and also the protective role of the IL-23-R381Q polymorphism. Moreover, the haplotype-based analysis proposed the mutant G-C (A924G, T4730C) as a significant risk haplotype for the development of MS. [ABSTRACT FROM AUTHOR]

Background and objectives: Carpal tunnel syndrome (CTS) is a common pathology, but sometimes the diagnosis is delayed in patients with diabetic neuropathy (DN). The aim of the study is twofold: first, to compare the accuracy of ultrasound (US) with that of electroneurography (ENG) in the diagnosis of CTS associated with DN, using the clinical diagnosis as a reference standard, and second, to investigate the correlation between morphological US parameters and electrodiagnosis (EDX) measurements in patients with CTS and DN. Materials and Methods: This study included patients with DN. They were divided into two groups: Control (patients without CTS) and Cases (patients with CTS). We performed US and ENG in both hands, totaling 56 wrists, with 28 wrists in each group. Results: We found that the difference in the sensory distal latencies between the median and the ulnar nerves (ring finger) exhibited the highest diagnostic accuracy of all the US and ENG parameters, areas under the receiver operating characteristic (AUC) = 0.99 (95% CI 0.97-1), and it was significantly different from the best US diagnostic method. The wrist cross-sectional area (CSA) had the most accurate US diagnosis, while the wrist-to-forearm ratio had the worst AUC. Moreover, in the group of CTS and DN patients, the wrist CSA enlargement was statistically directly proportional to the median compound muscle action potential (CMAP) distal latency and inversely proportional to the antidromic median nerve conduction study (NCS) and the orthodromic median palm-wrist NCS. Conclusions: Both examinations can be used with confidence in the diagnosis of CTS overlapping with DN, but the EDX examination seems to be more accurate. Furthermore, we found a positive correlation between the US and EDX parameters., Competing Interests: The authors declare no conflict of interest.