Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Jul 2015
Apraxia profile differentiates behavioural variant frontotemporal from Alzheimer's dementia in mild disease stages.
Despite refined criteria for behavioural variant frontotemporal dementia (bvFTD), its differentiation from Alzheimer's dementia (AD) remains difficult at early clinical presentation. Apraxia is not considered as a supportive feature for the diagnosis of bvFTD, but for AD. However, only few studies have quantified praxis disturbances in mild disease stages and their specificity for AD compared with bvFTD remains indistinct. We explore apraxia in bvFTD and investigate the differential validity of apraxia screening tests to distinguish between AD, bvFTD and healthy controls (HC). ⋯ Praxis disturbances are important but under-represented diagnostic features in mild stages of AD and bvFTD. Apraxia screening tests are easily applicable diagnostic tools, which may support clinical diagnoses of both neurodegenerative diseases. The analysis of individual apraxia profiles can effectively facilitate differential diagnosis of AD and bvFTD.
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J. Neurol. Neurosurg. Psychiatr. · Jul 2015
Obesity-stroke paradox and initial neurological severity.
An obesity paradox in patients with stroke has been documented. However, although the initial neurological severity (INS) is generally the most important prognostic factor, the impact of this paradox has not been considered in most previous studies. We sought to investigate the impact of obesity on INS in patients with ischaemic stroke and to investigate whether it is a significant risk factor for short-term outcomes. ⋯ In our study, although obesity was associated with better short-term functional outcomes, INS might be a more important prognostic factor. Therefore, initial status should also be considered when considering an 'obesity paradox' in chronic diseases.
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J. Neurol. Neurosurg. Psychiatr. · Jul 2015
Clinical relevance of serum antibodies to extracellular N-methyl-D-aspartate receptor epitopes.
There are now a large number of requests for N-methyl-D-aspartate receptor autoantibody (NMDAR-Ab) tests, and it is important to assess the clinical relevance of all results, particularly when they are reported as 'Low Positive'. ⋯ Using live cell-based assays, Positive and Low Positive antibodies can be of clinical significance. The number of core clinical features should help to select those patients in whom an immunotherapy intervention might be considered, irrespective of the antibody level.
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J. Neurol. Neurosurg. Psychiatr. · Jul 2015
Destruction of paranodal architecture in inflammatory neuropathy with anti-contactin-1 autoantibodies.
Autoantibodies against paranodal proteins have been described in patients with inflammatory neuropathies, but their association with pathology of nodes of Ranvier is unclear. We describe the clinical phenotype and histopathological changes of paranodal architecture of patients with autoantibodies against contactin-1, identified from a cohort with chronic inflammatory demyelinating polyradiculoneuropathy (n=53) and Guillain-Barré syndrome (n=21). ⋯ We conclude that anti-contactin-1-related neuropathy constitutes a presumably autoantibody-mediated form of inflammatory neuropathy with distinct clinical symptoms and disruption of paranodal architecture as a pathological correlate. Anti-contactin-1-associated neuropathy does not meet morphological criteria of demyelinating neuropathy and therefore, might rather be termed a 'paranodopathy' rather than a subtype of demyelinating inflammatory neuropathy.