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Objectives: Cognitive impairment is a prevalent non-motor symptom of Parkinson's disease (PD), significantly impacting patient quality of life. The Clock Drawing Test (CDT) evaluates cognitive abilities, including planning, organization, and executive functions such as attention, memory, and visuospatial skills. This study aimed to determine the sensitivity of the CDT in diagnosing cognitive impairment in PD. Methods: We reviewed the records of 44 PD patients (16 female, 28 male) diagnosed with dementia (30 patients) or mild cognitive impairment (14 patients) between 2018 and 2022. These patients were compared to 106 visitors to the neurological outpatient clinic, serving as a control group. A separate researcher assessed the patients' CDT scores, maintaining confidentiality of all other patient data except age and education level. Results: Among the 44 PD patients, two with mild cognitive impairment were rated as normal, while all PD dementia cases were identified solely through the CDT. In the healthy control group, 72 out of 106 individuals reported no cognitive complaints, whereas 34 individuals (32.1%) reported cognitive complaints as assessed by a blind investigator. The CDT demonstrated a positive predictive value of 55.3% and a negative predictive value of 97.3%. Sensitivity was calculated at 95.5%, and specificity was 67.9%. Conclusion: The findings suggest that the CDT is sensitive in detecting cognitive impairment in PD patients with cognitive deficits. While the CDT serves as an effective rapid screening tool, high scores indicate the absence of cognitive impairment, but low scores alone are insufficient for a definitive diagnosis of dementia. Comprehensive neurological evaluation and detailed cognitive assessment remain essential for confirming dementia diagnoses. [ABSTRACT FROM AUTHOR]

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Objective: Recently understanding genetic forms and pathogenic mutations has been providing growing knowledges about etiopathogenesis of Parkinson's disease. Leucine-rich repeat kinase 2 gene (LRRK2) G2019S mutation is the most commonly reported mutation amongst autosomal dominant and sporadic Parkinson's disease patients. Aims of our study are to identify the frequency of the LRRK2 G2019S mutation in sporadic late onset Parkinson's disease patients from the Eskisehir, diagnostic utility of this mutation and to confer genetic counselling to the mutation carier patients. Methods: We investigated 83 patients with sporadic Parkinson's disease and 50 normal (healthy) controls unrelated to patients. LRRK2 exon 41 was investigated with direct sequencing method. Results: Any point mutation or polymorphism was not detected in the LRRK2 exon 41 amongst patients and control subjects. Conclusion: Our findings suggest that the frequency of LRRK2 G2019S mutation is very lower in Turkish patients with Parkinson's disease. [ABSTRACT FROM AUTHOR]

Although ideomotor limb apraxia is considered to be a typical sign of cortical pathologies such as Alzheimer's disease (AD), it has been also reported in subcortical neurodegenerative diseases and vascular lesions. We aimed to investigate the difference between AD, subcortical vascular dementia (SVaD) and mild cognitive impairment (MCI) patients by means of ideomotor limb apraxia frequency and severity. Ninety-six AD, 72 SVaD, and 84 MCI patients were assessed with the mini-mental status examination (mms mmse), clinical dementia rating (CDR) and the apraxia screening test of TULIA (AST). Apraxia was significantly more frequent in the AD patients (32.3%) than in both of the SVaD (16.7%) and MCI (4.8%) patients. The frequency of apraxia was also significantly higher in SVaD patients than in MCI patients. AD patients had significantly lower apraxia scores than both SVaD and MCI patients. In addition, a significant difference was found between SVaD and MCI patients in terms of apraxia scores. These results suggest that the widespread belief of the association between apraxia and cortical dementias is not exactly correct. The significant difference between both of the dementia groups and the MCI patients suggests that the absence of apraxia can be an indicator for MCI diagnosis [ABSTRACT FROM AUTHOR]

We describe an 61-year-old male with twelve year history of idiopathic Parkinson Disease who underwent for bilaterally STN. 3 days after surgery he was discharged without any complication. Two days later he was admitted to emergency department after a car accident. No abnormality was detected in his neurological examination except symptoms of parkinsonism. Cranial CT of patient revealed a hyperdense left acute subdural hematoma (SDH) with a midline shift of 8 mm. He was hospitalized and follwed-up clinically and radiologically. No increment was detected radiologically in the size of hematoma. Repeated CT scans demonstrated progressive resolution of the hematoma. When SDH was completely absorbed the DBS battery has been run. No side effect was observed and the optimal response of DBS was achieved. Our case showed that although there is a potential risk of electrode displacement due to SDH, urgent surgical evacaution must not be considered immediately. There are no established guidelines for the management of subdural hematoma in patients with DBS implantation. With a subdural hematoma, the brain will shift ventromedially; since DBS leads are tethered to the skull, the ipsilateral lead will have a relative dorsal displacement from its original target site (1). In the literature rewiew the authors stated that, ıf a life-threatening conditions develops due to SDH, surgical evacuation should be recommended as the fisrt option and check the electrodes radiologically and electrophyscology. İn our case, there was no neurological findings depends on subdural hematoma thus only neurological and radiological follow was sufficient. [ABSTRACT FROM AUTHOR]

Marcus Gunn jaw winking synkinesis (MGJWS) is caused by congenital miswiring of a branch of the fifth cranial nerve into the branch of the third cranial nerve supplying the levator muscle. It has been observed in 2-13% of patients with congenital ptosis. Although bilateral cases were reported, most were unilateral and occurred more frequently on the left side than the right. We report two cases of children who presented with ptosis and were diagnosed with MGJWS. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the clinical features of hyperdense internal carotid artery sign (HICAS), hyperdense middle cerebral artery sign (HMCAS) and MCA dot sign to understand their effect on the outcomes of acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator (iv rtPA). Methods: Computed tomography (CT) scans, clinical features and outcomes of 252 patients with anterior circulation acute ischemic stroke treated with iv rtPA were evaluated. Initial CT scans were evaluated for hyperdense artery sign (HAS). Recanalization was evaluated with transcranial Doppler (TCD) in all available patients. Results: 99 of 252 patients had HAS; 12 had HICAS, 64 had HMCAS and 23 had MCA dot sign. None of the HICAS+ patients had a favorable outcome at three months. HMCAS+ patients achieved significantly less favorable outcomes. Mortality increased significantly in HICAS+ and HMCAS+ patients. MCA dot sign did not make a significant difference on baseline neurological status, recanalization, favorable outcome or mortality. At three months, there was no significant differences between HICAS and HMCAS whereas the MCA dot sign patients had better mRS scores compared with HICAS and HMCAS patients. HMCAS presence, baseline glucose levels and baseline NIHSS scores were all independent predictors of poor outcome. Conclusion: In acute ischemic stroke patients treated with iv rtPA, the presence of HICAS or HMCAS was found to be associated with insufficient recanalization and poor outcome, whereas MCA dot sign was a different entity and did not significantly influence the clinical course or outcome. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive impairment is a prevalent non-motor symptom of Parkinson's disease (PD), significantly impacting patient quality of life. The Clock Drawing Test (CDT) evaluates cognitive abilities, including planning, organization, and executive functions such as attention, memory, and visuospatial skills. This study aimed to determine the sensitivity of the CDT in diagnosing cognitive impairment in PD., Methods: We reviewed the records of 44 PD patients (16 female, 28 male) diagnosed with dementia (30 patients) or mild cognitive impairment (14 patients) between 2018 and 2022. These patients were compared to 106 visitors to the neurological outpatient clinic, serving as a control group. A separate researcher assessed the patients' CDT scores, maintaining confidentiality of all other patient data except age and education level., Results: Among the 44 PD patients, two with mild cognitive impairment were rated as normal, while all PD dementia cases were identified solely through the CDT. In the healthy control group, 72 out of 106 individuals reported no cognitive complaints, whereas 34 individuals (32.1%) reported cognitive complaints as assessed by a blind investigator. The CDT demonstrated a positive predictive value of 55.3% and a negative predictive value of 97.3%. Sensitivity was calculated at 95.5%, and specificity was 67.9%., Conclusion: The findings suggest that the CDT is sensitive in detecting cognitive impairment in PD patients with cognitive deficits. While the CDT serves as an effective rapid screening tool, high scores indicate the absence of cognitive impairment, but low scores alone are insufficient for a definitive diagnosis of dementia. Comprehensive neurological evaluation and detailed cognitive assessment remain essential for confirming dementia diagnoses., Competing Interests: None declared., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: Alzheimer's disease (AD) is one of the most common degenerative neurological disorders among elderly people, and is associated with progressive cerebral atrophy. AD is characterized by deterioration of the memory, difficulties with language, alterations in behavior and dysfunction in daily activities., Objectives: The purpose of the present study was to measure the total volumes of different parts of the brain of AD patients and healthy gender-matched controls using Cavalieri's volume estimate method, and to establish some brain ratios. Moreover, the authors wanted to test this method in measuring the volumes of various parts of the brain from MRI scans., Material and Methods: In this study, the MRI scans of 15 right-handed individuals with probable AD and 10 healthy controls were assessed. Cavalieri's volume estimate method was applied to the brain MRI scans to calculate the volumes of various parts of the brain., Results: While the measurements showed a marked increase in the volume of cerebral ventricles and sulci in AD patients in comparison to the gender-matched controls, the volumes of cortical gray matter and cerebral hemispheric brain matter were reduced considerably. However, no significant differences were detected in the volume of the cerebellum + brainstem or intracranium in AD patients. There were also no major variations between male and female values of the two groups., Conclusions: Overall, cerebral hemisphere and cortical gray matter atrophies were the most remarkable findings among AD patients in the present study; consequently, expansions of both the ventricles and subarachnoid space were formed. Cavalieri's volume estimate method was very efficient in calculating the volumes of different parts of brain from the MRI scans of both groups.

Objective: To determine the value of gray-scale and power Doppler ultrasonography in the evaluation of carpal tunnel syndrome (CTS)., Materials and Methods: Median nerves at the carpal tunnel were evaluated by using gray-scale and power Doppler ultrasonography and by using accepted and new criteria in 42 patients with CTS (62 wrists) confirmed by electromyogram and 33 control subjects. We evaluated the cross-sectional area of the nerve just proximal to the tunnel inlet (CSAa), and at mid level (CSAb). We then calculated the percentage area increase of CSAb, and area difference (CSAb-CSAa). We measured two dimensions of the nerve at the distal level to calculate the flattening ratio. The power Doppler ultrasonography was used to assess the number of vessels, which proceeded to give a score according to the vessel number, and lastly evaluated the statistical significance by comparing the means of patients with control subjects by the Student t test for independent samples. Sensitivities and specificities were determined for sonographic characteristics mentioned above. We obtained the receiver operating characteristic (ROC) curve to assess the optimal cut-off values for the diagnosis of CTS., Results: A statistically significant difference was found between patients and the control group for mean CSAb, area difference, percentage area increase, and flattening ratio (p < 0.001, p < 0.001, p < 0.001, p < 0.05, respectively). From the ROC curve we obtained optimal cut-off values of 11 mm(2) for CSAb, 3.65 for area difference, 50% for the percentage of area increase, and 2.6 for the flattening ratio. The mean number of vessels obtained by power Doppler ultrasonography from the median nerve was 1.2. We could not detect vessels from healthy volunteers. Mean CSAbs related to vascularity intensity scores were as follows: score 0: 12.3 ± 2.8 mm(2), score 1: 12.3 ± 3.1 mm(2), score 2: 14.95 ± 3.5 mm(2), score 3: 19.3 ± 3.8 mm(2). The mean PI value in vessels of the median nerve was 4.1 ± 1., Conclusion: Gray-scale and power Doppler ultrasonography are useful in the evaluation of CTS.

This study aimed to investigate the prevalence of various cognitive disorders in the older population (age 55 years and above) of Eskisehir, Turkey, by conducting a cluster sampled door-to-door survey. A total of 3100 inhabitants were screened with the Mini-Mental State Examination (MMSE) and a questionnaire concerning demographic, occupational and social data. Individuals (n=320) with MMSE scores of 25 were assessed according to the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and were investigated in the more detailed phase 2 study. The overall prevalence of dementia was 8.4%, although it ranged from 2.2% among those aged 55-59 years to 5.3% among those aged 60-64 years, and to 30.4% among those aged 75 or above. Vascular dementia was the most common type (51.1%), followed by Alzheimer's dementia (48.8%). In a very small proportion of individuals (0.1%), dementia was due to other causes such as B12 deficiency, a tumour or hydrocephalus. Significant risk factors for dementia were female sex, low education, age, living in a rural area and a family history of dementia.

We assessed the effect of intravenous high-dose methylprednisolone (IVMP) on cerebral reactivity in multiple sclerosis (MS) patients during exacerbations by means of functional transcranial Doppler imaging. Forty-eight clinically defined MS patients were evaluated with visual evoked potentials (VEP) and functional transcranial Doppler sonography (TCD) of both posterior cerebral arteries before and after 5 days of 1000 mg IVMP. After treatment, mean Expanded Disability Status Scale score, mean blood flow velocities and mean blood flow velocities at rest and at stimulation, significantly decreased (p < 0.0001, for each). The change in cerebral blood flow velocity ratio (CBFv) with visual stimulation after treatment increased slightly (p = 0.20). All TCD parameters were not significantly correlated with VEP changes. In conclusion, we observed significant changes in CBFv with a non-significant increase in vascular reactivity after treatment with IVMP in exacerbations of MS. Case-control studies are necessary to draw conclusions regarding the beneficial effects of IVMP treatment.

Hyperhomocysteinemia is as a risk factor for increased vascular disease in l-dopa-treated Parkinson disease (PD) patients. This effect of l-dopa is associated with the metabolism of l-dopa by methylation. This study aimed to assess the effect of pergolide on plasma homocysteine levels. Plasma homocysteine levels were compared between PD patients treated with pergolide as monotherapy, with l-dopa as monotherapy, or with an l-dopa and pergolide combination and compared with controls. Plasma homocysteine levels were significantly higher in the l-dopa monotherapy group, and there were no significant differences for the pergolide treatment groups. Pergolide can be beneficial for increased plasma homocysteine levels.