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INS; a systematic review and meta-analysis
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Abstracts / Journal of the Neurological Sciences 333 (2013) e292–e357
Conclusion: In prospective observational studies, gender does not seem to influence the attended alone sign. The head turning sign may possibly be of greater diagnostic utility in female patients. doi:10.1016/j.jns.2013.07.1113
Abstract — WCN 2013 No: 120 Topic: 5 — Dementia Analysis of polymorphism in Brain-derived neurotrophic factor gene in sporadic Alzheimer's disease in Han Chinese X. Shu-Wen, G. Guangsheng, L. Dongfeng, Y. Ruifan, H. Fangfang, X. Hao. Department of Neurology of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangdong Neuroscience Institute Guangzhou, Guangzhou, China Objective: To investigate the association between the C270T polymorphism of the Brain-derived neurotrophic factor (BDNF) gene and sporadic Alzheimer's disease (SAD) in Han Chinese. Methods: The polymerase chain reaction-restriction fragment length polymorphism (PCR-RELP) was used to detect BDNF genotypes of 55 SAD patients and 80 controls. Results: Gender or age had no significant difference in SAD and control group (x2 = 0.072, p = 0.789; t = 1.494, p = 0.137, respectively). The genotype distribution for the control group was not significantly deviated from the Hardy–Weinberg equilibrium (x2 = 0.167, p = 0.682), and the frequency distributions of the two groups' genotype and allele were not significantly different (x2 = 0.219, p = 0.640; x2 = 0.211, p = 0.646, respectively). Conclusion: There is no association between the C270T polymorphism of BDNF gene and SAD in Han Chinese. doi:10.1016/j.jns.2013.07.1114
Abstract — WCN 2013 No: 111 Topic: 5 — Dementia Behavioural Assessment of the Dysexecutive Syndrome (BADS) on the context of normal and pathological aging M. Paixãoa, B. Peixotob. aPsychology and Health Research Unit (UnIPSa-CESPU), Gandra, Portugal; bSciences, Instituto Superior de Ciências da Saúde-Norte (CESPU), Gandra, Portugal Several authors advocate the need to assess executive functioning (EF) as a robust determinant of the functional status of the subject and as a potential marker of dementia. However there are few available instruments that allow the assessment of different components of the EF in the context of aging, both normal and pathological. The present work aimed to determine the psychometric properties of the Behavioural Assessment of the Dysexecutive Syndrome (BADS) in the context of aging in a Portuguese sample. Our sample comprised 33 subjects with more than 65 years divided in two groups: Control Group (n = 22), made of cognitively intact subjects; Dementia Group (n = 11), composed of patients with probable diagnosis of Alzheimer's disease (NINCDS-ARDA Criteria). We have applied the BADS, the Dementia Rating Scale and the Geriatric Depression Scale to both groups. The BADS revealed good levels of acceptance, internal consistency, discriminative and criterion validity. These results favor the use of this instrument in the context of aging and dementia. It may be very useful in monitoring EF and in the detection of dementia. doi:10.1016/j.jns.2013.07.1115
Abstract — WCN 2013 No: 93 Topic: 5 — Dementia Posterior Cortical Atrophy — a possible cause for visual complaints J. Moreira Martinsa, J. Serinob, I. Ribeirob. aNeurology, Hospital Pedro Hispano, ULSM, Oporto, Portugal; bOphthalmology, Hospital Pedro Hispano, ULSM, Oporto, Portugal Background: Posterior Cortical Atrophy (PCA) is a rare subtype of Alzheimer's dementia accounting for 5% of its cases. It refers to a clinical syndrome in which complex visual processing is progressively disrupted due to a cognitive neurodegenerative disorder, clinically distinct from typical Alzheimer's, but sharing similar neuropathological features. It involves the posterior parts of brain used in visual and gestural activities, with variable signs and symptoms observed in Gerstmann and Balint syndromes. Language, memory and insight remain relatively preserved until late in the course. Clinical case: A 71-year-old woman was referred to our outpatient clinic after 4 years of unspecific visual complaints affecting predominantly the left visual field. She was followed and investigated during 2 years and no primary relevant ophthalmological pathology was found. A neurological consultation was required and several cognitive defects were detected: left hemineglect, prosopagnosia, simultanagnosia, finger agnosia, and mild left–right disorientation. She also had agraphia and alexia, without verbal language dysfunction. Her episodic memory was mildly impaired. The brain MRI revealed bilateral parieto-temporal–occipital cortical atrophy predominantly affecting the right hemisphere. Conclusion: It is relevant to recognize the PCA as a type of dementia that usually presents first to the ophthalmologist due to its visual impairments. Since visual complaints can occur following any lesion affecting the visual pathways from the retina to the occipital lobe or adjacent processing visual cortex, a full neuropsychological examination should be performed whenever there is doubt about the significance of the visual impairment, especially when no obvious ophthalmological pathology is found. doi:10.1016/j.jns.2013.07.1116
Abstract — WCN 2013 No: 73 Topic: 5 — Dementia The diagnostic utility of cerebrospinal fluid alpha-synuclein analysis in dementia with Lewy bodies — a systematic review and meta-analysis X. Lima, J.M. Yeoa, A. Greenb, S. Palc,d,e. aCollege of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; bCJD Research & Surveillance Unit, Western General Hospital, Edinburgh, Edinburgh, UK; cDepartment of Neurology, Forth Valley Royal Hospital, NHS Forth Valley, Larbert, Edinburgh, UK; dDivision of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; eAnne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK Objectives: Dementia with Lewy Bodies (DLB) is difficult to distinguish from other dementias due to heterogeneity in clinical presentation and phenotypic overlap. Our aim was to investigate the diagnostic utility of cerebrospinal fluid (CSF) alpha-synuclein analysis in differentiating between DLB and other dementias. Methods: We systematically searched MEDLINE, EMBASE, PsychINFO and Web of Knowledge up to May 2012. Studies were included if they utilized reproducible quantification methods of CSF alpha-synuclein levels and included patients from a representative spectrum, classified using international consensus criteria. Random effects model was used
Abstracts / Journal of the Neurological Sciences 333 (2013) e292–e357
to calculate weighted mean difference (WMD) and 95% confidence intervals between DLB and other groups. Results: A total of 11 studies, comprising 2019 patients were included. 7 studies were evaluated in a meta-analysis. Mean CSF alpha-synuclein concentration was lower in DLB patients compared to those with Alzheimer's disease (AD) [WMD −0.24; 95% CI, −0.44, −0.03; p = 0.02]. No significant difference was identified between DLB patients compared to those with Parkinson's disease [WMD 0.05; 95% CI, −0.17, 0.28; p = 0.65] or other neurodegenerative conditions. Mean CSF alpha-synuclein levels were significantly lower in DLB patients compared to the non-synucleinopathies [WMD −0.25; 95% CI, −0.44, −0.06; p = 0.01]. No significant difference was found between DLB and synucleinopathies [WMD 0.05; 95% CI, −0.17, 0.27, p = 0.65]. Conclusion: CSF alpha-synuclein may be of diagnostic use in differentiating between DLB and AD. However, no definite conclusion can be made due to assay heterogeneity, poor reporting standards and study design. We emphasize the need for adherence to reporting protocols in future studies.
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Objective: We aim to investigate the effects of ginkgolide B (GKB) and velvet antler polypeptide (VAP) on the generation and differentiation of cholinergic progenitors. Methods: Telencephalon cells were cultured. GKB, VAP and the combination of them were added into the culture medium. Cell culture was terminated on day 4, and then the SP kit (Boster, China) was used to mark the ChAT and BrdU positive cells. The data of these positive cells were analyzed among groups. Results: Compared to the control group, the neurospheres of experimental group were bigger and the neurites were longer and stronger. More cells migrated from neurospheres. Most cells of ChaT positive distributed on the edge of neurospheres; only a small amount scattered among the neurospheres. The number of ChaT positive neurons in experimental group was higher than that in the control group, especially the GKB and VAP combined group. The VAP group had the most BrdU positive cells. Conclusion: GKB and VAP, especially when used together, could facilitate the generation and differentiation of cholinergic progenitors efficiently.
doi:10.1016/j.jns.2013.07.1117 doi:10.1016/j.jns.2013.07.1119 Abstract — WCN 2013 No: 74 Topic: 5 — Dementia Novel prion protein gene mutation at codon 196 (E196A) in a septuagenarian with Creutzfeldt–Jakob disease H. Zhanga, M. Wangb, L. Suna. aDepartment of Neurology, The First Bethune Hospital of Jilin University, Changchun, China; bDepartment of Neurology, Tengzhou Central People's Hospital, Tengzhou, China Creutzfeldt–Jakob disease (CJD) is a rare and rapidly progressive neurodegenerative disease in the central nervous system, which may occur in inherited, acquired (variant and iatrogenic), or spontaneous (sporadic) forms. Genetic CJD is caused by a point mutation of the prion protein (PrP) gene (PRNP) on human chromosome 20. Here we report a 76-year-old CJD patient found unexpectedly to harbor a novel mutation in PRNP. Routine clinical investigations were undertaken to elucidate the cause of the rapidly progressive dementia and neurological decline manifested by the patient. Both neuron-specific enolase (NSE) and 14-3-3 protein in the cerebrospinal fluid (CSF) were positive. Magnetic resonance imaging (MRI) diffusion-weighted image (DWI) revealed ribbon-like high signals in the bilateral frontal, insular, occipital and parietal cortices, suggestive of CJD. Electroencephalography showed typical periodic synchronous discharge (PSD). Continuous deterioration of clinical symptoms was observed, and typical manifestations including myoclonus and akinetic mutism gradually appeared. CJD was clinically diagnosed based on the above characteristic findings. Interestingly, a point mutation of PRNP at codon 196 (E196A) was detected. To our knowledge, we are the first to report the point mutation of PRNP at codon 196 (E196A) in patients with CJD. doi:10.1016/j.jns.2013.07.1118
Abstract — WCN 2013 No: 9 Topic: 5 — Dementia Antidepressant treatment improves estrogen levels and cognitive function in postmenopausal anxiety/depression patients B.R. Zhou. GuangZhou Medical College, GuangZhou, China Rationale and objectives: The current study investigated the role of antidepressant treatment on the level of sex hormones and cognitive function in post-menopausal anxiety/depression patients. Methods: A total of 82 post-menopausal patients who were diagnosed with anxiety/depression disorder and were not receiving hormonal replacement therapy participated in a prospective, 6-month, open-label naturalistic study. Patients were divided into an antidepressant treatment group (44 cases) and a non-antidepressant treatment (control) group (38 cases). We collected demographic data and tested sex hormone levels and assessed the extent of psychological disorder and examined cognitive function. Results: 1) The E2 level at six-months post-treatment was significantly increased, conversely, FSH and LH levels were significantly decreased, in the antidepressant treatment group compared with pre-therapy or the control group (P b 0.01). 2) HARS-14 and CHDS scores decreased significantly more, MoCA scores significantly improved in the antidepressant treatment group than in the pre-therapy or the control group (P b 0.01). 3) E2 levels were strongly correlated with MoCA and CHDS or HARDS-14 scores at pre- and post-therapy in the antidepressant treatment group. E2 levels maintained a significant association with improvement in CHDS at post-therapy, even we controlled for age, severity of depression, and MoCA scores, (R 0.35, P 0.038).
Abstract — WCN 2013 No: 75 Topic: 5 — Dementia Facilitative effects of ginkgolide B and velvet antler polypeptide on cholinergic progenitor differentiation
Conclusions: The antidepressant Paroxetine improved cognitive function in postmenopausal anxiety–depression patients, possibly by increasing endogenous estrogen discharge or delaying degeneration of the gonads.
H. Zhanga, X. Sunb, L. Suna. aDepartment of Neurology, The First Bethune Hospital of Jilin University, Changchun, China; bDepartment of Neurology, People's Hospital of Zhengzhou, Zhengzhou, China
doi:10.1016/j.jns.2013.07.1120
Abstracts / Journal of the Neurological Sciences 333 (2013) e292–e357
Conclusion: In prospective observational studies, gender does not seem to influence the attended alone sign. The head turning sign may possibly be of greater diagnostic utility in female patients. doi:10.1016/j.jns.2013.07.1113
Abstract — WCN 2013 No: 120 Topic: 5 — Dementia Analysis of polymorphism in Brain-derived neurotrophic factor gene in sporadic Alzheimer's disease in Han Chinese X. Shu-Wen, G. Guangsheng, L. Dongfeng, Y. Ruifan, H. Fangfang, X. Hao. Department of Neurology of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Geriatrics Institute, Guangdong Neuroscience Institute Guangzhou, Guangzhou, China Objective: To investigate the association between the C270T polymorphism of the Brain-derived neurotrophic factor (BDNF) gene and sporadic Alzheimer's disease (SAD) in Han Chinese. Methods: The polymerase chain reaction-restriction fragment length polymorphism (PCR-RELP) was used to detect BDNF genotypes of 55 SAD patients and 80 controls. Results: Gender or age had no significant difference in SAD and control group (x2 = 0.072, p = 0.789; t = 1.494, p = 0.137, respectively). The genotype distribution for the control group was not significantly deviated from the Hardy–Weinberg equilibrium (x2 = 0.167, p = 0.682), and the frequency distributions of the two groups' genotype and allele were not significantly different (x2 = 0.219, p = 0.640; x2 = 0.211, p = 0.646, respectively). Conclusion: There is no association between the C270T polymorphism of BDNF gene and SAD in Han Chinese. doi:10.1016/j.jns.2013.07.1114
Abstract — WCN 2013 No: 111 Topic: 5 — Dementia Behavioural Assessment of the Dysexecutive Syndrome (BADS) on the context of normal and pathological aging M. Paixãoa, B. Peixotob. aPsychology and Health Research Unit (UnIPSa-CESPU), Gandra, Portugal; bSciences, Instituto Superior de Ciências da Saúde-Norte (CESPU), Gandra, Portugal Several authors advocate the need to assess executive functioning (EF) as a robust determinant of the functional status of the subject and as a potential marker of dementia. However there are few available instruments that allow the assessment of different components of the EF in the context of aging, both normal and pathological. The present work aimed to determine the psychometric properties of the Behavioural Assessment of the Dysexecutive Syndrome (BADS) in the context of aging in a Portuguese sample. Our sample comprised 33 subjects with more than 65 years divided in two groups: Control Group (n = 22), made of cognitively intact subjects; Dementia Group (n = 11), composed of patients with probable diagnosis of Alzheimer's disease (NINCDS-ARDA Criteria). We have applied the BADS, the Dementia Rating Scale and the Geriatric Depression Scale to both groups. The BADS revealed good levels of acceptance, internal consistency, discriminative and criterion validity. These results favor the use of this instrument in the context of aging and dementia. It may be very useful in monitoring EF and in the detection of dementia. doi:10.1016/j.jns.2013.07.1115
Abstract — WCN 2013 No: 93 Topic: 5 — Dementia Posterior Cortical Atrophy — a possible cause for visual complaints J. Moreira Martinsa, J. Serinob, I. Ribeirob. aNeurology, Hospital Pedro Hispano, ULSM, Oporto, Portugal; bOphthalmology, Hospital Pedro Hispano, ULSM, Oporto, Portugal Background: Posterior Cortical Atrophy (PCA) is a rare subtype of Alzheimer's dementia accounting for 5% of its cases. It refers to a clinical syndrome in which complex visual processing is progressively disrupted due to a cognitive neurodegenerative disorder, clinically distinct from typical Alzheimer's, but sharing similar neuropathological features. It involves the posterior parts of brain used in visual and gestural activities, with variable signs and symptoms observed in Gerstmann and Balint syndromes. Language, memory and insight remain relatively preserved until late in the course. Clinical case: A 71-year-old woman was referred to our outpatient clinic after 4 years of unspecific visual complaints affecting predominantly the left visual field. She was followed and investigated during 2 years and no primary relevant ophthalmological pathology was found. A neurological consultation was required and several cognitive defects were detected: left hemineglect, prosopagnosia, simultanagnosia, finger agnosia, and mild left–right disorientation. She also had agraphia and alexia, without verbal language dysfunction. Her episodic memory was mildly impaired. The brain MRI revealed bilateral parieto-temporal–occipital cortical atrophy predominantly affecting the right hemisphere. Conclusion: It is relevant to recognize the PCA as a type of dementia that usually presents first to the ophthalmologist due to its visual impairments. Since visual complaints can occur following any lesion affecting the visual pathways from the retina to the occipital lobe or adjacent processing visual cortex, a full neuropsychological examination should be performed whenever there is doubt about the significance of the visual impairment, especially when no obvious ophthalmological pathology is found. doi:10.1016/j.jns.2013.07.1116
Abstract — WCN 2013 No: 73 Topic: 5 — Dementia The diagnostic utility of cerebrospinal fluid alpha-synuclein analysis in dementia with Lewy bodies — a systematic review and meta-analysis X. Lima, J.M. Yeoa, A. Greenb, S. Palc,d,e. aCollege of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; bCJD Research & Surveillance Unit, Western General Hospital, Edinburgh, Edinburgh, UK; cDepartment of Neurology, Forth Valley Royal Hospital, NHS Forth Valley, Larbert, Edinburgh, UK; dDivision of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; eAnne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK Objectives: Dementia with Lewy Bodies (DLB) is difficult to distinguish from other dementias due to heterogeneity in clinical presentation and phenotypic overlap. Our aim was to investigate the diagnostic utility of cerebrospinal fluid (CSF) alpha-synuclein analysis in differentiating between DLB and other dementias. Methods: We systematically searched MEDLINE, EMBASE, PsychINFO and Web of Knowledge up to May 2012. Studies were included if they utilized reproducible quantification methods of CSF alpha-synuclein levels and included patients from a representative spectrum, classified using international consensus criteria. Random effects model was used
Abstracts / Journal of the Neurological Sciences 333 (2013) e292–e357
to calculate weighted mean difference (WMD) and 95% confidence intervals between DLB and other groups. Results: A total of 11 studies, comprising 2019 patients were included. 7 studies were evaluated in a meta-analysis. Mean CSF alpha-synuclein concentration was lower in DLB patients compared to those with Alzheimer's disease (AD) [WMD −0.24; 95% CI, −0.44, −0.03; p = 0.02]. No significant difference was identified between DLB patients compared to those with Parkinson's disease [WMD 0.05; 95% CI, −0.17, 0.28; p = 0.65] or other neurodegenerative conditions. Mean CSF alpha-synuclein levels were significantly lower in DLB patients compared to the non-synucleinopathies [WMD −0.25; 95% CI, −0.44, −0.06; p = 0.01]. No significant difference was found between DLB and synucleinopathies [WMD 0.05; 95% CI, −0.17, 0.27, p = 0.65]. Conclusion: CSF alpha-synuclein may be of diagnostic use in differentiating between DLB and AD. However, no definite conclusion can be made due to assay heterogeneity, poor reporting standards and study design. We emphasize the need for adherence to reporting protocols in future studies.
e297
Objective: We aim to investigate the effects of ginkgolide B (GKB) and velvet antler polypeptide (VAP) on the generation and differentiation of cholinergic progenitors. Methods: Telencephalon cells were cultured. GKB, VAP and the combination of them were added into the culture medium. Cell culture was terminated on day 4, and then the SP kit (Boster, China) was used to mark the ChAT and BrdU positive cells. The data of these positive cells were analyzed among groups. Results: Compared to the control group, the neurospheres of experimental group were bigger and the neurites were longer and stronger. More cells migrated from neurospheres. Most cells of ChaT positive distributed on the edge of neurospheres; only a small amount scattered among the neurospheres. The number of ChaT positive neurons in experimental group was higher than that in the control group, especially the GKB and VAP combined group. The VAP group had the most BrdU positive cells. Conclusion: GKB and VAP, especially when used together, could facilitate the generation and differentiation of cholinergic progenitors efficiently.
doi:10.1016/j.jns.2013.07.1117 doi:10.1016/j.jns.2013.07.1119 Abstract — WCN 2013 No: 74 Topic: 5 — Dementia Novel prion protein gene mutation at codon 196 (E196A) in a septuagenarian with Creutzfeldt–Jakob disease H. Zhanga, M. Wangb, L. Suna. aDepartment of Neurology, The First Bethune Hospital of Jilin University, Changchun, China; bDepartment of Neurology, Tengzhou Central People's Hospital, Tengzhou, China Creutzfeldt–Jakob disease (CJD) is a rare and rapidly progressive neurodegenerative disease in the central nervous system, which may occur in inherited, acquired (variant and iatrogenic), or spontaneous (sporadic) forms. Genetic CJD is caused by a point mutation of the prion protein (PrP) gene (PRNP) on human chromosome 20. Here we report a 76-year-old CJD patient found unexpectedly to harbor a novel mutation in PRNP. Routine clinical investigations were undertaken to elucidate the cause of the rapidly progressive dementia and neurological decline manifested by the patient. Both neuron-specific enolase (NSE) and 14-3-3 protein in the cerebrospinal fluid (CSF) were positive. Magnetic resonance imaging (MRI) diffusion-weighted image (DWI) revealed ribbon-like high signals in the bilateral frontal, insular, occipital and parietal cortices, suggestive of CJD. Electroencephalography showed typical periodic synchronous discharge (PSD). Continuous deterioration of clinical symptoms was observed, and typical manifestations including myoclonus and akinetic mutism gradually appeared. CJD was clinically diagnosed based on the above characteristic findings. Interestingly, a point mutation of PRNP at codon 196 (E196A) was detected. To our knowledge, we are the first to report the point mutation of PRNP at codon 196 (E196A) in patients with CJD. doi:10.1016/j.jns.2013.07.1118
Abstract — WCN 2013 No: 9 Topic: 5 — Dementia Antidepressant treatment improves estrogen levels and cognitive function in postmenopausal anxiety/depression patients B.R. Zhou. GuangZhou Medical College, GuangZhou, China Rationale and objectives: The current study investigated the role of antidepressant treatment on the level of sex hormones and cognitive function in post-menopausal anxiety/depression patients. Methods: A total of 82 post-menopausal patients who were diagnosed with anxiety/depression disorder and were not receiving hormonal replacement therapy participated in a prospective, 6-month, open-label naturalistic study. Patients were divided into an antidepressant treatment group (44 cases) and a non-antidepressant treatment (control) group (38 cases). We collected demographic data and tested sex hormone levels and assessed the extent of psychological disorder and examined cognitive function. Results: 1) The E2 level at six-months post-treatment was significantly increased, conversely, FSH and LH levels were significantly decreased, in the antidepressant treatment group compared with pre-therapy or the control group (P b 0.01). 2) HARS-14 and CHDS scores decreased significantly more, MoCA scores significantly improved in the antidepressant treatment group than in the pre-therapy or the control group (P b 0.01). 3) E2 levels were strongly correlated with MoCA and CHDS or HARDS-14 scores at pre- and post-therapy in the antidepressant treatment group. E2 levels maintained a significant association with improvement in CHDS at post-therapy, even we controlled for age, severity of depression, and MoCA scores, (R 0.35, P 0.038).
Abstract — WCN 2013 No: 75 Topic: 5 — Dementia Facilitative effects of ginkgolide B and velvet antler polypeptide on cholinergic progenitor differentiation
Conclusions: The antidepressant Paroxetine improved cognitive function in postmenopausal anxiety–depression patients, possibly by increasing endogenous estrogen discharge or delaying degeneration of the gonads.
H. Zhanga, X. Sunb, L. Suna. aDepartment of Neurology, The First Bethune Hospital of Jilin University, Changchun, China; bDepartment of Neurology, People's Hospital of Zhengzhou, Zhengzhou, China
doi:10.1016/j.jns.2013.07.1120