Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Feb 2010
The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's disease.
The Timed Up and Go (TUG) test has been used to assess balance and mobility in Parkinson's Disease (PD). However, it is not known if this test is sensitive to subtle abnormalities present in early stages of the disease, when balance and gait problems are not clinically evident but may be detected with instrumented analysis of movement. We hypothesise that postural transitions and arm swing during gait will be the most sensitive characteristics of the TUG for early PD. ⋯ Our findings show that although the stopwatch measure of TUG duration did not detect any abnormalities in early-to-mid-stage PD, the peak arm swing velocity on the more affected side, average turning velocity, cadence and peak trunk rotation velocity were significantly slower. These iTUG parameters were also correlated with the Unified Parkinson's Disease Rating Motor Scale. Thus, the iTUG test is sensitive to untreated PD and could potentially detect progression of PD and response to symptomatic and disease-modifying treatments.
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J. Neurol. Neurosurg. Psychiatr. · Feb 2010
Blood-brain barrier permeability is increased in normal-appearing white matter in patients with lacunar stroke and leucoaraiosis.
The pathogenesis of cerebral small-vessel disease (SVD) is incompletely understood. Endothelial dysfunction has been implicated and may result in increased blood-brain barrier (BBB) permeability with leakage of blood constituents into the vessel wall and white matter. We used contrast-enhanced MRI to determine whether there was any evidence for BBB permeability in the white matter of patients with SVD, and whether this was present not only in areas of leucoaraiosis (white-matter lesions) but also in normal-appearing white matter (NAWM). ⋯ This study provides evidence for increased BBB permeability in SVD, and this is particularly seen in SVD with leucoaraiosis. Its presence in NAWM would be consistent with it playing a causal role in disease pathophysiology.
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J. Neurol. Neurosurg. Psychiatr. · Feb 2010
Standardised measurement of self-awareness deficits in FTD and AD.
Diminished ability to perceive one's own impairments, whether cognitive or social, is common in dementia, in particular frontotemporal dementia (FTD), where 'lack of insight' is listed as a core diagnostic feature. Yet, there is no currently accepted method for measuring insight in dementia. The most commonly used methods, which involve comparing patients' opinions of their level of impairment with the opinions of care givers or close family members, are subjective and require the participation of a knowledgeable informant. Here, the authors introduce a new method that allows objective quantification of an individual's awareness of their cognitive abilities and relies upon objective bedside testing. ⋯ Failures of insight and self-awareness of cognitive dysfunction can be objectively measured in dementia without the assistance of an informant, which will facilitate further study of this key component of higher cognitive functioning.
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J. Neurol. Neurosurg. Psychiatr. · Jan 2010
Clinical TrialSingle versus bilateral external ventricular drainage for intraventricular fibrinolysis in severe ventricular haemorrhage.
Intraventricular fibrinolysis (IVF) through bilateral external ventricular drains (EVD) may provide better access of the thrombolytic agent to the intraventricular clot, potentially influencing clot clearance and outcome. ⋯ Our results do not support the use of bilateral EVDs for IVF in patients with severe IVH.
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J. Neurol. Neurosurg. Psychiatr. · Jan 2010
Effect of immigration on multiple sclerosis sex ratio in Canada: the Canadian Collaborative Study.
The ratio of female to male (F:M) multiple sclerosis (MS) cases varies geographically, generally being greater in areas of high prevalence. In many regions, including Canada, rising MS incidence in women has been implied by the marked increase in F:M ratio. ⋯ MS sex ratio in immigrants to Canada is increasing but variable by region of origin and influenced by age at migration. The findings highlight the importance of environmental effect(s) in MS risk, which are likely gender-specific.