BackgroundThe sensori-motor manifestations of Guillain Barré Syndrome (GBS) are usually severe enough to mask the psychiatric and sleep problems which are in need for more attention for better functional outcome.MethodsThis study was performed on 20 GBS patients and 10 healthy controls. Patients were evaluated initially before immunotherapy using the Overall Disability Sum Score (ODSS), Neuropathy Pain Scale (NPS), Hamilton Anxiety Scale (HAS), Montgomery–Åsberg Depression Rating Scale (MADRS) and one-night polysomnography (PSG) followed by the multiple sleep latency test (MSLT) to evaluate the mean sleep latencies. Reevaluation was done using the same parameters 1 month after completing immunotherapy.ResultsThe study showed significant increase in HAS in GBS patients which were positively correlated with the degree of motor disability. The mean sleep latencies of MSLT were significantly shortened and PSG showed shortening of the total sleep time, sleep efficiency, lowest O2 saturation and pulse transit time with increased wake after sleep onset, sleep stage transition index, apnea hypopnea index, desaturation index, arousal index, snore index and periodic limb movement index. One month after immunotherapy, the anxiety symptoms and sleep abnormalities showed non-significant improvements which were not correlated with the improvements in the sensori-motor manifestations.ConclusionsGBS patients usually have sleep and psychiatric abnormalities which may take longer time to improve than the sensori-motor manifestations. So, they need more attention in the management protocol for early patients’ independence and return to usual daily activities.
Background: Mild cognitive impairment (MCI) is a heterogenous disorder in which a proportion of patients follow stationary or regressive courses while others undergo clinical progression to dementia. Methods: This study was conducted on 60 amnestic mild cognitive impairment (amMCI) and 20 healthy control subjects submitted to baseline Montreal Cognitive Assessment (MoCA) scale, one-night polysomnography (PSG), hippocampal/entorhinal cortex (HPC/ERC) MRI volumetry, and auditory mismatch negativity (MMN). Fifty-six amMCI subjects continued the study and underwent follow-up MoCA scale 1 year after their baseline evaluation, 17 showed amMCI progression (≥ 3 points decrease in MoCA scale), and 39 had stationary or regressive courses. Results: Progressive amMCI patients showed reduced sleep efficiency and shortened rapid eye movement (REM) sleep in PSG, decreased HPC/ERC-MRI volumetry and reduced amplitudes with delayed latencies of the MMN evoked potentials. Conclusions: PSG shortened REM sleep, MRI-HPC/ERC volumes reduction, and low amplitude delayed auditory MMN are valuable non-invasive screening predictors of amMCI progression.
Background The value of biomarker research in Parkinson's disease (PD) exists in the early detection and accurate diagnosis of non-motor neuropsychiatric symptoms with implications for future treatment strategies. The aim of the this work was to assess and predict risk for possible cognitive, psychiatric abnormalities in patients with early stage idiopathic PD using a combination of advanced diagnostic biomarkers for early recognition and intervention. Methods This cross-sectional case–control study was conducted on 58 eligible idiopathic PD-patients, and 45 age/sex-matched healthy controls. All participants were subjected to neuro-psychiatric-, radiological-, audiological-, and laboratory-evaluations. Cognitive assessment was performed using Montreal Cognitive Assessment, Mattis Dementia, and Parkinson’s Disease-Cognitive scales. Depression was evaluated by Hamilton Depression and Beck Depression Inventory-II rating scales. Radiologically, volumetric-MRI, diffusion tensor imaging (DTI), and susceptibility weighted imaging were done. Audiologically, P300 and cortical auditory evoked potentials were elicited. Laboratory investigations included 24 h-urinary 5-HIAA and serum levels of IL6, BDNF, 5-HT, and aberrant cimiRNA 132-3p expression profile. Results Neuropsychological scales revealed mild depression and mild cognitive impairment, with significant differences in PD group. Volumetric-MRI highlighted that PD-patients had a significant bilateral decrease in the mean cortical thickness and thickness/volume of many brain areas. DTI showed a reduction in fractional isotropy and a significant bilateral increase in mean diffusivity through many areas in PD-patients. Patients also had either absent or diminished amplitude of P300,P1, diminished amplitude of N1,P2,N2 and delayed latency of all previous waves. There was a significant reduction of 24 h-urinary 5-HIAA and serum BDNF, with significant elevation of serum IL6, as well as non-significant reduction of serum 5-HT and microRNA-132-3p(2-ΔCt) in PD-patients. Conclusions Early stage PD-patients had subtle cognitive impairment and depression as detected by psychometric scales and correlated significantly with the various biomarkers, including advanced neuro-imaging, evoked potential studies, and laboratory markers. The key message of this work include evaluating the high prevalence of cognitive and psychiatric impairment in early idiopathic PD has encouraged research and workup for precision medicine. Proper integration of advanced multimodal biomarkers in this study has led to predict the risk of early mild cognitive and psychiaric affection. This will optimize the health strategies for early proper management to improve quality of life.
Background Early assessment of cerebrovascular disease in chronic obstructive pulmonary disease (COPD) patients is an important issue for a favorable influence on the quality of life. Methodology This cross‐sectional case–control study was conducted on 38 eligible COPD patients (mean age 55.5 ± 11.5, 25 males, and 13 females) and 26 age‐/sex‐matched healthy controls. All participants were subjected to stroke risk screening instruments that included the Stroke Riskometer™, the Framingham 10‐Year Risk Score, the stroke risk screening tool (the Department of Disease Control of Thailand), the My Risk Stroke Calculator, and Q Stroke. Radiologically, diffusion tensor imaging (DTI) and echo‐gradient MRI (T2 star) T2 star imaging were done. Color‐coded duplex sonography was done. Laboratory investigations included C‐reactive protein (CRP), serum amyloid A, plasma fibrinogen level, serum IL6, 8‐Isoprostane, vWF and urinary albumin creatinine ratio. Results Stroke risk screening instruments revealed a significant increase in COPD patients. DTI showed a significant bilateral reduction in fractional isotropy and a significant bilateral increase in mean diffusivity of white matter through many areas in COPD patients. Patients also had a significant increase of intima–media thickness, presence of atherosclerotic focal thicknesses or plaques on duplex sonography. There was a significant elevation of CRP, serum amyloid A, plasma fibrinogen level, serum IL6, 8‐isoprostane, von Willebrand factor (vWF), and urinary albumin creatinine ratio in COPD patients. Conclusion COPD patients had an increased risk for stroke that could be assessed on stroke risk screening instruments, DTI, T2 star, duplex sonography, and laboratory investigation and could be correlated with the severity of the disease.
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