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Introduction. Alexia without agraphia is an impairment of reading ability. Speech, auditory comprehension, repetition and writing are relatively intact. Due to a damage of the splenium of corpus callosum, alexia without agraphia is considered to be an interhemispheric disconnection syndrome. Case Report. We presented a 71-year-old male, with chronic hypertension, diabetes mellitus and dyslipidemia. The magnetic resonance imaging showed a lesion in the left medial temporal region, including the equilateral thalamus, posterior cingulate gyrus, splenium of corpus callosum, lingual occipital gyrus, and the tail of the hippocampus. Lacunar ischemia was found on the right side of cerebellum. The neuro-linguistic diagnostic protocol included the Mini Mental State Examination, Boston Diagnostic Aphasia Examination, Boston Naming Test and phonemic and category fluency tests. We have also designed a clinical protocol for color recognition assessment. The results showed a mild cognitive impairment related to the time and space orientation, delayed memory and reading. On the speech and language levels, a severe acquired alexia without agraphia was registered which was not associated with other language modalities. Conclusion. The neuro-linguistic tests and clinical techniques provide a rather reliable diagnostic criteria, which is the basis for neuro-rehabilitation. The rehabilitation protocol refers to training techniques: tactile-kinesthetic recognition of graphemes and application of various reading techniques, such as letter-by-letter reading, Multiple Oral Re-reading, melodic intonation therapy and oral reading technique in order to facilitate rehabilitation of reading.

Introduction. Cerebral small vessel disease is a neurological con- dition characterized by motor, cognitive and affective disorders, often found on brain magnetic resonance imaging scans in patients with vascular risk factors. Affective disorders may have a major impact on patients’ quality of life, although they are often ignored as an entity in cerebrovascular pathology. Material and Methods. This prospective study included 80 patients with the diagnosis of cerebral small vessel disease admitted at the Clinic of Neurology, Clinical Center of Serbia in the period from January 1, 2017 to January 1, 2019. Baseline demographic data and brain magnetic resonance findings were obtained along with the results of cogni- tive function and affective status tests. Data were analyzed using standard statistical tests. Results. Standard screening tests revealed that 51.25% and 33.75% of our patients with cerebral small vessel disease suffer from apathy and depression, respectively. A sig- nificant correlation was found between the severity of white mat- ter changes on magnetic resonance scans and apathy (p = 0.0092). Additionally, white matter changes were also significantly associ- ated with depression (p = 0.021). Conclusion. Affective disorders are not uncommon in cerebral small vessel disease and apathy was the leading phenomenon among our patients. Since a strong cor- relation was detected between affective disorders and severity of vascular changes on magnetic resonance scans, we may conclude that both apathy and depression are key features of an underlying brain injury, rather than just comorbidity. Uvod. Bolest malih krvnih sudova mozga je neurološko stanje za koje su karakteristični motorni, kognitivni i afektivni poremećaji i koje se često dijagnostikuje na snimcima mozga magnetnom rezo- nancijom kod pacijenata sa vaskularnim faktorima rizika. Promene u afektivnom statusu imaju veliki uticaj na kvalitet života pacijena- ta iako su neretko bile zanemaren fenomen u cerebrovaskularnoj patologiji. Materijal i metode. U prospektivnoj studiji obuhvaćeno je 80 pacijenata sa dijagnozom bolest malih krvnih sudova mozga lečenih i ispitivanih na Klinici za neurologiju Kliničkog centra Sr- bije, u periodu od 1. januara 2017. godine do 1. januara 2019. godine. Analizirani su osnovni demografski podaci, nalaz na magnetnoj rezonanciji mozga i rezultati testova kognitivnih funkcija i afektiv- nog statusa, upotrebom standardnih statističkih metoda. Rezultati. Rezultati testova za apatiju i depresiju ukazali su da je 51,25% bo- lesnika sa ovom bolešću pokazivalo prisustvo apatije, a 33,75% prisustvo depresivnog poremećaja. Dokazana je statistički značajna povezanost između težine lezija bele mase mozga na magnetnore- zonantnim snimcima mozga i apatije (p = 0,0092), odnosno težine lezija bele mase i depresije (p = 0,021). Zaključak. Izmene afektiv- nog statusa nisu retka manifestacija cerebralne bolesti malih krvnih sudova mozga, a najčešći fenomen u našoj grupi bolesnika bila je apatija. Budući da je detektovana značajna povezanost između afek- tivnih poremaćaja i težine vaskularnih lezija na magnetno-rezonan- tnim snimcima mozga, smatramo da su apatija i depresivnost najpre deo kliničke slike ove bolesti a ne jedan od komorbiditeta.

Objective Cerebral small vessel disease (SVD) is associated with late-onset depression and increases the risk for depression after stroke. We aimed to investigate baseline predictors of depression after long-term follow-up in patients with SVD, initially presenting with first-ever lacunar stroke, free of depression and cognitive impairment. Methods A total of 294 patients with SVD were evaluated 3–5 years after the qualifying event. We analyzed baseline demographic data, vascular risk factors, functional status expressed as a score on modified Rankin Scale (mRS), cognitive status, presence of depression, total number of lacunar infarcts and severity of white matter hyperintensities (WMH) on MRI with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores. Results On follow-up, depression was registered in 117 (39.8%) SVD patients. At the baseline, patients with depression compared with non-depressed were older (64.4 vs 60.9 years; p = 0.007), had higher mRS score (2.8 ± 0.7 vs 1.5 ± 0.7; p 2 (HR 2.17, 95%CI 1.74–2.72; p

Objective Although typically linked to aging, small vessel disease (SVD) is also observed in younger adult patients, with common vascular risk factors (RF). We aimed to investigate features of SVD occurrence at an early adult age. Patients and methods Vascular RF, functional and cognitive status and severity of lesions on MRI expressed as total score on Age-Related White Matter Changes (ARWMC) scale were analyzed in 200 consecutive patients with cerebral SVD admitted to a tertiary neurological hospital. Variables were compared between younger (35–55 years) and older (>56 years) patients. Results In this study, 63 (31.5%) of patients were 55 years or younger. Both age groups had comparable RF profiles, but smoking emerged as an independent predictor for SVD at a younger age (OR 2.9; 95% CI 1.5–5.5; p =0.002). Younger patients had better functional (OR 1.8; 95% CI 1.3–2.5; p =0.0001) and cognitive ( χ 2 13.94; p =0.0009) status compared to older patients. However, two thirds of younger patients had some degree of cognitive deficit. Total score on ARWMC scale was lower in younger patients (mean 12.3 in younger versus 15.2 in older, OR 1.11; 95% CI 1.0–1.18; p =0.001). There was a strong correlation in both groups between functional score, cognitive status and ARWMC score ( p Conclusion In our dataset, younger patients with SVD shared common vascular RF with older patients. In the group aged ≤55, better functional and cognitive status and less severe MRI changes were noted. However, a substantial number of younger SVD patients presenting with TIA or ischemic stroke had various deficits.

Background/Aim. Transient global amnesia (TGA) could be related to acute ischemic disturbances in mesial parts of temporal lobes, which are important for memory. Incompetence of internal jugular vein (IJV) valve with venous congestion causes venous microthrombosis of hippocampus. The aim of this study was to investigate the frequency of IJV valve incompetence, as well as other hemodynamic and structural properties of cerebral circulation in TGA patients. Methods. IJV valve competence was investigated in 40 TGA patients and 30 persons of the control group (matched by age and sex), as well as detection of microembolic signals and detection of right to left cardiopulmonal shunt, cerebral vasomotor reactivity and echocardiography by color triplex ultrasonography and transcranial doppler. Results. A significant difference in frequency of IJV valve incompetence was found between the TGA patients and the control persons (55% TGA vs 30% controls; p < 0.001). We did not find a significant structural (plaques frequency) or hemodynamic (flow velocity, pulsatility index) differences on arteries of the neck and cerebral arteries between the TGA patients and the controls, except for the increased pulsatility index on the basilar artery (40% TGA vs 16.6% controls; p < 0.01) and decreased vasomotor reactivity in TGA patients (50% TGA vs 26.6% controls; p < 0.001). Microembolic signals were detected very rarely (17.5% TGA patients vs 13.3% controls; p > 0.05), as well as right to left cardiopulmonal shunt (15% TGA vs 16.6% controls; p > 0.05), indicating that embolism was not important for pathogenesis of TGA. Transesophageal echocardiography confirmed it, because only one TGA patient had a potent foramen ovale. Conclusion. We found a significantly increased frequency of IJV incompetence in the TGA patients, which confirmed the role of vein drainage disturbances in pathogenesis of TGA.

Background and purpose Subcortical white matter (WM) plays an important role in speech production and language processing. Most frequently, cerebral WM lesions are secondary to small vessel disease in patients with vascular risk factors. We report the case of a 53-year-old man with history of hypertension and ischemic subcortical lesions, who presented with speech difficulties and mild cognitive impairment. Methods Language and cognitive assessment included Boston Diagnostic Aphasia Examination, Boston Naming Test, Rey Auditory-Verbal Learning Test, Rey-Osterrieth Complex Figure Test, Trail Making Test A and B, Wisconsin Card Sorting Test, Scale for Evaluation of Perceptive Characteristics of Voice and Speech, and Multidimensional Evaluation of Speech and Voice. Results Brain MRI showed ischemic WM lesions and lacunar infarcts in the brainstem and right cerebellum. Cognitive testing revealed mild cognitive impairment, predominantly affecting attention and executive functions. Speech and language analysis demonstrated dysarthria, dysphonia with hypophonia, and imprecise articulation, as well as short rushes of speech, palilalia and mild subcortical dysphasia. Conclusions Neurolinguistic and acoustic analysis in patients with ischemic WM lesions can provide additional information in the understanding of language and speech disturbances, and can assist in patient management.

Introduction Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary microangiopathy leading to recurrent strokes and vascular dementia in young and middleaged patients. The diagnosis of CADASIL is based on typical clinical presentation and characteristic magnetic resonance imaging (MRI) changes, and has to be confirmed by biopsy of the sural nerve, muscle and skin, as well as by genetic analysis. Mutations within the Notch3 gene were identified as the underlying genetic defect in CADASIL. Case Outline The clinical manifestations of the first presented patient with migraine from the age of thirteen, stroke without vascular risk factors and stepwise progression of vascular dementia comprising the typical clinical picture of CADASIL, were confirmed after seven years with pathological verification. The second presented case did not satisfy the clinical criteria for CADASIL. His stroke was considered to be related with vascular risk factors - diabetes mellitus and hypertension. The aetiological diagnosis was established only when his brother without vascular risk factors presented with similar clinical manifestations. Conclusion Until the development of the new neuroimaging techniques like MRI, pathologic and genetic analysis, CADASIL was considered as a rare disorder. However, the increasing number of CADASIL families has been identified throughout the world showing that this entity is usually underdiagnosed. This article presents three patients from two Serbian families with clinical suspicion of CADASIL verified by pathologic examination. .

Background/Aim. Spasmodic dysphonia (DS) is a disabling speech disturbance appearing as the consequence of dystonic vocal folds contraction. Its intermittent appearance in the laryngeal muscles causes vocal function discontinuation. The quality of life of these patients is significantly disturbed. Surgical and a medical therapy appear to be inadequate and unsuccessful ones of no steady improvement. It is the botulinum toxin therapy that proved to be highly efficacious one, with the established improvement in 80?100% of patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in patients with SD and to show our preliminary results. Methods. The study included 10 patients with adductor spasmodic dysphonia. After diagnostic procedures, botulinum toxin was applied either in one or both vocal folds, in doses of 12?16 units each. In our study we applied indirect technique originally developed by Hocevar and Pirtosek. Perceptive voice and speech analysis was performed prior to and after the instillation of botuline toxin as per structured Scale of pathological characteristics of voice and speech appearing in the spasmodic dysphonia. Results. The majority of our patients experienced both subjective improvement and the improvement in the terms of the quality of life, Voice Henolicap Index ? (VHI) that was rated as rather significant one (t = 3.562; p = 0.006). Conclusion. Regardless unquestionable improvement of definite phonation, further function restitution requires individual vocal therapy and psychotherapy. Vocal therapy includes structural vocal techniques which reduce degree of vocal tension and rapid changes in the power and the height of voice. Further investigations are necessary for the scope of the definition of a standardized therapeutically procedure for spasmodic dysphonia treatment which comprises multidisciplinary approach in diagnosis, therapy and treatment efficacy evaluation.

Neuropsychological deficits associated with unipolar depression are seen in a broad range of cognitive domains. Executive deficits may be prominent in depression. Investigation of executive functions in younger adult patients with unipolar depression has been the focus of our study. Twenty-two consecutively depressive inpatients (24-36 years) and 21 healthy control subjects, matched on age, gender, education and verbal IQ were included in the study. Neuropsychological tests for executive functions were applied to all subjects. Unipolar young depressives showed significantly reduced number of completed categories and more trials for completion of the first category on Wisconsin Card Sorting Test (WCST). No difference of tasks assessing the short-term memory, total errors on WCST, perseverative and non-perseverative errors, and of both phonemic and semantic conditions of verbal fluency was found between groups. The results suggested that unipolar depressives had specific cognitive style characterized by "negative cognitive set" (stronger negative reaction to negative feedback) and by failure to use negative feedback to improve their performance.

Cerebral small vessel disease (SVD) is associated with late-onset depression and increases the risk for depression after stroke. We aimed to investigate baseline predictors of depression after long-term follow-up in patients with SVD, initially presenting with first-ever lacunar stroke, free of depression and cognitive impairment.A total of 294 patients with SVD were evaluated 3-5 years after the qualifying event. We analyzed baseline demographic data, vascular risk factors, functional status expressed as a score on modified Rankin Scale (mRS), cognitive status, presence of depression, total number of lacunar infarcts and severity of white matter hyperintensities (WMH) on MRI with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores.On follow-up, depression was registered in 117 (39.8%) SVD patients. At the baseline, patients with depression compared with non-depressed were older (64.4 vs 60.9 years; p = 0.007), had higher mRS score (2.8 ± 0.7 vs 1.5 ± 0.7; p 0.0001) and had more severe lesions on MRI scales (p 0.0001 for all parameters). On follow-up, depressed patients more frequently exhibited cognitive decline (75.2% depressed vs 56.5% non-depressed; p = 0.003). No difference was detected in risk factor frequency between groups. Multivariate Cox regression analysis adjusted by age and gender revealed independent predictors of depression: baseline mRS2 (HR 2.17, 95%CI 1.74-2.72; p 0.0001) and tARWMC (HR 1.05, 95%CI 1.02-1.09; p = 0.005), and cognitive decline on follow-up (HR 1.80, 95%CI 1.12-2.89; p = 0.015).Baseline functional status and severity of WMH and development of cognitive decline predict the occurence of late-onset depression in patients with SVD.

Introduction: Cerebral small vessel disease (SVD) is a common cause of cognitive impairment and vascular dementia. Objective: We aimed to investigate predictors of cognitive decline in patients with SVD who initially presented with first-ever small subcortical stroke of lacunar type but had normal cognitive status. Methods: A total of 294 patients with SVD were evaluated 3–5 years after initial presentation. We analyzed baseline demographic data, vascular risk factors, functional status expressed as score on modified Rankin Scale, total number of lacunar infarcts, and severity of white matter hyperintensities (WMH) on magnetic resonance imaging with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores. Results: At follow-up, vascular cognitive impairment (VCI) on any type was detected in 188 (63.9%) of SVD patients, with 65 (22.1%) meeting criteria for vascular dementia and 123 (41.8%) presenting with cognitive impairment not dementia. Patients with VCI were older (64.4 ± 10.3 in VCI versus 58.6 ± 10.5 years in non-VCI; p < 0.0001) at the time of initial clinical presentation and more frequently male (57.9% VCI versus 46.2% non-VCI; p = 0.052). No difference was noted in frequency of vascular risk factors in VCI versus non-VCI cases. Multivariate logistic regression analysis adjusted by age and gender identified overall severity of WMH (tARWMC HR 1.42, 95% CI 1.01–2.00; p0.043) and total number of lacunar infarcts (HR 3.06, 95% CI 1.71–5.50, p < 0.001) as independent predictors of cognitive decline. Conclusion: In patients with SVD, independent predictors of VCI were baseline severity of WMH and total number of lacunar infarcts.

Market segmentation implies dividing the market into smaller segments that are homogenous inside, and heterogenous in relation to one another. Market segmentation is a part of strategic marketing, together with targeting and positioning, preceded by marketing research and followed by creating, implementing and controlling the marketing mix. As well as being an essential field of academic research, market segmentation proved to be a very useful concept for managers. The market segmentation concept dates back almost six decades, but issues raised regarding market segmentation more than three decades ago are still relevant and the number of different approaches in answering these questions is high. Preference-based segmentation can also be viewed in this context. Differences in consumers’ preferences are, in fact, one of the vital causes of market segmentation. Preference-based market segmentation can be conducted by using conjoint analysis in combination with cluster analysis. The benefits of such approach are multiple, as they give rise to opportunities for: formulating the questions in a manner similar to real-life purchasing situations; reducing the number of socially desirable answers; introducing several attributes of a given product thus enabling an insight into the relative importance of the product's attributes, and order of preferences for different levels of these attributes, and, based on this, defining different market segments; testing the significance of various other market segmentation criteria (sociodemographic, psychographic and/or behavioural) for profiling the established segments; increasing the comparability of results of different studies; using this approach in planned new product launches and on emerging and developing markets as well as studying the difference between expressed preferences and purchases, in terms of obstacles preventing preferences to transform into purchase phase. Besides theoretical aspects regarding market segmentation and preference-based market segmentation by using conjoint and cluster analysis, this article demonstrates the use of such approach in researching student population in Vojvodina (the northern province of the Republic of Serbia) and this population’s preferences to yoghurt (250 questionnaires handed out, 123 returned filled in, 98 included in the final analysis). In addition to results at the total sample level, two segments were identified and differences between them were investigated. Implications to the questions raised in the theoretical section of the article were sought on the obtained results. The article also seeks to point to the benefits of using this approach in domestic conditions, where its use is almost negligible. DOI: http://dx.doi.org/10.5755/j01.ee.24.4.3118

Dysarthria is a speech disorder associated with impairments of intelligibility, smoothness, loudness, and clarity of articulations. Dysarthria involves disability of reproducing various physical, tonal, and sound features of speech sounds in oral speech; unintelligible and slurred articulation with swallowing of sounds is characteristic. Articulatory movements and speech are slow, patients complain to the sensations of a 'thick' tongue and 'porridge' in the mouth. Patients'phrases are constructed correctly, vocabulary is not affected, and the grammatical structure of words is preserved. Reading, writing, internal speech, and understanding of speech are unaffected. Several types of dysarthria have been described on the basis of the lesion locations. Dysarthria can be associated with lacunar syndromes as well. Mutism represents a condition when patient cannot speak and answer the questions, but remains conscious and is able to produce written speech.

Dysarthria is a speech disorder associated with impairments of intelligibility, smoothness, loudness, and clarity of articulations. Dysarthria involves disability of reproducing various physical, tonal, and sound features of speech sounds in oral speech; unintelligible and slurred articulation with swallowing of sounds is characteristic. Articulatory movements and speech are slow, patients complain to the sensations of a 'thick' tongue and 'porridge' in the mouth. Patients'phrases are constructed correctly, vocabulary is not affected, and the grammatical structure of words is preserved. Reading, writing, internal speech, and understanding of speech are unaffected. Several types of dysarthria have been described on the basis of the lesion locations. Dysarthria can be associated with lacunar syndromes as well. Mutism represents a condition when patient cannot speak and answer the questions, but remains conscious and is able to produce written speech.

Objective Elevated plasma total homocysteine (tHcy) is an independent risk factor for ischemic stroke and has been linked to cerebral small vessel disease (SVD), in particular. Controversy persists as to whether increased tHcy is associated with functional status and cognitive decline in these patients. Methods Plasma tHcy, MTHFR polymorphism, vascular risk factors, functional and cognitive status and severity of lesions on MRI, assessed with the Age-Related White Matter Changes (ARWMC) visual grading scale, were analyzed in 95 patients with SVD and 41 healthy control subjects. Results Plasma tHcy levels were higher in patients with SVD (14.4±5.0μmol/L) compared to healthy SVD-free controls (8.9±3.9μmol/L). In SVD patients, tHcy levels strongly correlated with cognitive status (age-adjusted risk 5.8, 95% CI 1.3–25.3, p =0.015), functional status (age-adjusted risk 3.2, 95% CI 1.2–8.8, p =0.022) and severity of MRI lesions (age-adjusted risk 1.2, 95% CI 1.1–1.4; p =0.004). Only total ARWMC score was independently associated with increased tHcy levels (OR 1.2, 95%CI 1.1–1.4, p =0.004). Independent predictors of WMC occurrence were tHcy levels (OR 1.2, 95%CI 1.1–1.3, p =0.003) and mRS score (OR 2.2, 95%CI 1.2–4.1, p =0.017). Conclusions In patients with cerebral SVD there is a positive association of increased plasma tHcy levels with clinical status and severity of WMC.