Cognitive impairment can occur at all stages of Parkinson's disease. Rasagiline is a selective monoamine oxidase type-B inhibitor that enhances central dopaminergic transmission. Dopamine is thought to be involved in certain cognitive processes such as working memory. We assessed the effects of rasagiline on cognitive deficits in cognitively impaired, nondemented patients with Parkinson's disease. This was a randomized, double-blind, placebo-controlled prospective study. Patients with Parkinson's disease receiving stable dopaminergic treatment were assigned to receive rasagiline 1 mg/day or placebo for 3 months. Patients were eligible if they had impairment in 2 of 4 cognitive domains (attention, executive functions, memory, visuospatial functions) in the screening neuropsychological tests, yet did not fulfill criteria for Parkinson's disease dementia. Fifty-five patients were randomized; 48 patients completed the study. Patients in the rasagiline group showed significant improvement in digit span-backward compared with the placebo group (P = .04), with trends favoring rasagiline in digit span total and digit-ordering tests. Verbal fluency total score showed a significant difference in favor of rasagiline (P = .038), with trends favoring rasagiline in semantic fluency test and Stroop spontaneous corrections. The composite cognitive domain Z scores revealed a significant difference in favor of rasagiline compared with placebo in the attentional Z score (P < .005). There were no significant differences between the 2 groups in the other cognitive tests or cognitive domain Z scores. The monoamine oxidase type-B inhibitor rasagiline may exert beneficial effects on certain aspects of attention and executive functions in nondemented patients with Parkinson's disease with cognitive impairment.
ÖzetBeyin ven trombozu çocuklarda enflamatuar bağırsak hastalığının; özellikle ülseratif kolitin seyri sırasında gelişebilen nadir ancak önemli bir komplikasyondur. Dokuz yaşında kanlı, mukuslu dışkılama ve beraberinde gelişen şiddetli başağrısı yakınması ile gelen ülseratif kolit ile aynı anda beyin ven trombozu tanısı alan bir olgu sunuldu. Dokuz yaşında erkek hasta üç haftadır süren kanlı ve mukuslu dışkılama nedeni ile başvurdu. Tetkiklerinde anemi, lökositoz, trombositoz ve yüksek eritrosit çökme hızı saptanan hastanın kolonoskopik incelemesinde yaygın ülserler ile seyreden pankolit görüldü ve tanı histopatolojik inceleme ile ülseratif kolit olarak kesinleştirildi. Kolonoskopiden bir gün sonra sürekli, zonklar tarzda, frontal ve sol oksipital bölgeye yerleşik başağrısı yakınması gelişen hastanın nörolojik değerlendirilmesinde sol göz kapağında pupil seviyesinde pitoz, her iki göz dibinde birinci derece papil ödem saptandı. Kraniyal manyetik rezonans görüntüleme ve manyetik rezonans venografi incelemesinde sol transvers ve sigmoid sinüsde tromboz saptanan hastaya antikoagülan tedavi ile ülseratif kolit için mesalamin ve steroid başlandı. Trombofili açısından da değerlendirilen hastanın protein C, protein S, antitrombin III, faktör VIII, homosistein, protrombin II and fibrinojen düzeyleri normal sınırlarda; metilen tetrahidrofolat redüktaz gen mutasyonu ise heterozigot pozitif saptandı. Tedavinin ikinci haftasında kanlı dışkılaması kontrol altına alınan hastanın başağrısı azaldı, papilödem ve pitozu kayboldu. Mesalamin, prednisolon, azatiyopürin ve düşük molekül ağırlıklı heparin ile tedavisi devam ettirilen olgumuzda tedavinin birinci yılında manyetik rezonans venografi incelemesinde trombozda radyolojik açıdan artma yada düzelme izlenmedi. (Türk Ped Arfl 2013; 48: 160-4) Anahtar sözcükler: Beyin ven trombozu, komplikasyon, ülseratif kolit Summary Ulcerative colitis (UC) can be complicated by various extra-intestinal manifestations such as thromboembolic disease. Most thrombotic events occure in lower extremities, whereas the incidence of cerebral venous involvement is very rare and serious in children. We present a case of a nine years old boy with UC and cerebral venous thrombosis diagnosed at the same time. A nine years old boy with a 3week history of bloody diarrhea and abdominal pain was admitted to our hospital. On admission his laboratory data showed anemia, leukocytosis , thrombocytosis and elevated erythrocyte sedimentation rate. Colonoscopic evaluation revealed severe active pancolitis with diffuse ulceration. The day after colonoscopy he had complained of severe headache. Neurolological examination revealed pitosis of the left palpebra and bilateral papilledema. Magnetic resonance (MR) imaging and MR venography revealed thrombosis in the left transvers sinus and sigmoid sinus. The patient was treated immediatly with heparin. At the same time he was diagnosed with severe active UC based upon histopathological findings and managed initially with mesalamin and prednisolon. He also had been screened...
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