Neurological Tests Research Articles

Effect of remote ischemic preconditioning on perioperative neurocognitive disorder in elderly patients undergoing major surgery and associated genetic variant analysis: a randomized clinical trial

ObjectiveTo investigate whether remote ischemic preconditioning (RIPC) could reduce the incidence of perioperative neurocognitive disorder (PND) in elderly patients undergoing major surgery (> 2 h), to assess the potential of myeloid differentiation factor 2 (MD2) and cystatin C as biomarkers and to identify key genetic variants associated with PND.MethodsFrom August 2020, 250 patients scheduled for major surgeries under general anesthesia were screened and 120 patients were randomly assigned to the control group or the RIPC group. After anesthesia induction, patients in the RIPC group received a blood pressure cuff around their right upper limb, which was pressurized to 200 mmHg to induce ischemia, whereas the cuff in the control group was pressurized to only 60 mmHg. A total of five cycles were repeated with ischemia for five minutes and reperfusion for five minutes. Six neurological tests were performed before and after the surgery to assess the incidence of PND. Serum levels of myeloid differentiation factor 2 (MD2) and Cystatin C and PND-associated single nucleotide polymorphisms were analyzed by ELISA and whole genome sequencing, respectively. This study adhered to CONSORT research guidelines.ResultsIn the RIPC group, the incidence of PND (44%) was comparable to that in the control group (44%, P = 0.982). There was no significant difference in the concentrations of MD2 or cystatin C between the NPND and PND groups. A total of 3877 mutated genes were exclusively identified in PND patients. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that these mutated genes are enriched in synapse function. Notably, a Shank3 variant (SNP rs4824145) was included.ConclusionsRIPC had little effect on the incidence of PND in elderly patients who underwent major surgery (> 2 h). MD2 and cystatin C were unable to predict the occurrence of PND. Patients harboring rs4824145 in the Shank3 gene may be more susceptible to PND.Trial registration.Chinese Clinical Trial Registry (ChiCTR2000035020(07/28/2020)).

Psychological and Neurological Tests are Required to Reduce the Risk of Injuries in Paragliding

<p dir="ltr"><span>The study’s objective is to analyse and comprehend the types, frequency, and causes of paragliding pilot accidents to identify preventative and reducing measures in the future, such as a suitable physical training program designed explicitly for paragliding pilots. This study hypothesized that several factors, including the pilot’s experience level, weather conditions, terrain, equipment quality, attitude toward the sport, and adherence to safety regulations, may be related to the frequency of paragliding accidents. The study’s findings indicated a high accident rate since 66% of respondents had injuries while paragliding, and 67% had an occurrence that may have resulted in a pilot suffering severe injury. The analysis shows the frequent causes of accidents are primary piloting mistakes and poor decision-making as technological faults played a minor role. Equipment used for paragliding seldom malfunctions if it is routinely inspected and tested; the only exception is when it is subjected to abnormally high stresses while in flight. Oversteering of the wing or, on the other hand, inadequate reaction—specifically, inadequate pilot training in flap control and active piloting—were the leading causes of these mistakes. Poor judgments about weather and flying conditions or inadequate familiarity with the area landscape and characteristics caused some of these mistakes. In conclusion, we address the necessity to establish a standard for the ideal paraglider, conceiving psychological and neurological tests without reducing the access to this adrenaline rush sport, but increasing its safety.</span></p><div><span><br /></span></div>

Exploring unintended consequences of paraneoplastic neurological testing in the Australian setting

Exploring unintended consequences of paraneoplastic neurological testing in the Australian setting

Pre-clinical acute oral toxicity and subacute neurotoxicity risk assessments on sprague dawley rats treated with single dose or repeated doses of flavonoid-enriched fraction extracted from Oroxylum indicum leaves

Oroxylum indicum possesses promising flavonoid secondary metabolites. However, translation of these compounds into clinical practice for neurological disease treatment is halted as the toxicity and safety profile of the plant extracts are yet to be determined. This study was conducted to assess the acute oral toxicity and subacute neurotoxicity that could be imposed by the flavonoid-enriched fraction (FEF) extracted from O. indicum leaves, by strictly following the procedures set in Organization for Economic Co-operation and Development (OECD) Guidelines No.420 and 424. It was found that at the highest dosage (2000 mg/kg b.wt), no death or toxicity-related behavioral changes were observed. No significant alteration in hematological and serum biochemical parameters beyond the standard laboratory range was observed. Detailed histopathological examination, as verified by clinical pathologist, revealed absence of detectable inflammation, changes in any macroscopic and microscopic tissue abnormalities in all vital organ of the treated rats. Moreover, neurological functional test of rats treated with repeated doses of FEF for 28 d also showed absence of neurological abnormality, suggesting negative long term side effects of this fraction on the animal. In conclusion, this study presented valuable pre-clinical safety validation of a high-quality herbal medicinal product, setting the foundation for its future application in clinical setting.

Urgent modern trends in disability assessment after a stroke, life activity criteria according to the ICF and principles of neurorehabilitation (literature review and own research)

Background. The purpose of our work was to study the functional outcomes in stroke patients, the justification of a clinical diagnosis according to the International Classification of Functioning, Disability and Health (ICF), including criteria, principles of disability prevention and rehabilitation. Materials and methods. We conducted a prospective, case-control cohort study of 5,818 patients who suffered a cerebral stroke over the past 10 years, 4,520 (78 %) were survivors, with an average age of 73.0 ± 10.2 years. All participants underwent a standard neurological examination and ICF testing. Results. It is obvious that in every case after a stroke, there are functional disorders, and in most patients (from 76 to 85 %) this results in disability. Such trend is consistent worldwide and was also observed in our study. However, the overall 37% decrease in the disability rate over the specified period, in our opinion, can be attributed to population aging and the lack of workplace opportunities for the able-bodied population, which previously served as a form of social protection for patients. Therefore, the further optimization of preventive and rehabilitation measures, starting with addressing stroke risk factors and preventing recurrences, could significantly improve the quality of life of stroke patients without imposing a substantial burden on their families and society as a whole. Factors have been determined, criteria for limiting life activities in the main areas of life have been developed. The adaptation of the ICF makes it possible to use it in expert diagnosis, the formation of a correct clinical and functional diagnosis, and allows assessing the potential and effectiveness of rehabilitation measures in the post-stroke period. Conclusions. 1. The use of the ICF makes it possible to objectively assess the state of patients, the rehabilitation potential and the effectiveness of rehabilitation measures in people with the consequences of a stroke. 2. The use of the criteria for limiting life activities developed by the authors will improve the quality of medical and social examination of patients who have suffered a stroke, and further research will optimize new approaches to the rehabilitation of these patients and their adaptation in society. 3. Further optimization of preventive and rehabilitation measures, starting with addressing stroke risk factors and preventing recurrences, could significantly improve the quality of life of patients, their relatives and society as a whole.

Effect of anemoside B4 on ameliorating cerebral ischemic/reperfusion injury.

Anemoside B4 (AB4) is a multifunctional compound with anti-inflammatory, anti-apoptotic, antioxidant, antiviral, and autophagy-enhancing effects. However, the role of AB4 in cerebral ischemia/reperfusion injury (CIRI) remains obscure. This experiment aims to investigate the pharmacological effects of AB4 in CIRI. In vivo, eighty male SD rats were randomly divided into five groups: sham, MCAO/R, LD group (2.5 mg/kg), MD group (5 mg/kg), and HD group (10 mg/kg). The rats in sham and MCAO/R groups were given equal volumes of normal saline. In vitro, PC12 cells were divided into five groups: normal, OGD/R, OGD/R+AB4 (50 μM), OGD/R+AB4 (100 μM), and OGD/R+AB4 (200 μM). The cells were treated with hypoxia and hypoglycemia for 1.5 hr and reoxygenation for 24 hr. In vivo, TTC and neurological scoring tests indicated that AB4 favors promoting the recovery of the brain. The histopathologic study of the brain tissues revealed that AB4 inhibited the damage of neuron cells. The TUNEL assay found that AB4 could improve cell apoptosis and prevent the brain from injury. In vitro, the data showed that AB4 inhibited cell damage and prevented PC12 cells from OGD/R injury, reduced IL-1β content, and increased the IL-10 level. AB4 could inhibit apoptosis of PC12 cells, down-regulate Caspase 12 and BAX expression, and up-regulate Bcl-2 expression. AB4 played a protective role in CIRI and could be a promising active ingredient against ischemia stroke.

Major Depressive Disorder and Driving Behavior Among Older Adults

Depression and antidepressant use are independently associated with crash risk among older drivers. However, it is unclear what factors impact daily driving that increase safety risk for drivers with depression. To examine differences in naturalistic driving behavior and safety between older adults with and without major depressive disorder (MDD). A prospective longitudinal cohort study was conducted among older adults (≥65 years) from the Driving Real-World In-Vehicle Evaluation System Project collected from July 1, 2021, to December 30, 2023. The sample included 85 participants with MDD and 310 participants without. Neurological, clinical, mood, and neuropsychological tests were collected annually. Daily driving behavior was recorded using a commercial data logger. Statistical analysis was performed from January 31 to June 24, 2024. MDD and antidepressant usage. Linear mixed models with propensity score weighting compared slopes of driving behaviors over time (trips taken at night, speeding, hard braking, entropy, and radius of gyration) between groups. In a sample of 395 participants, 85 were classified as individuals with MDD (mean [SD] age, 69.6 [6.1] years; 60 [70.6%] female; 8 [9.4%] non-Hispanic Black and 77 [90.6%] non-Hispanic White) and 310 as individuals in the control group without depression (mean [SD] age, 70.1 [5.1] years; 153 [49.4%] female; 40 [12.9%] non-Hispanic Black and 270 [87.1%] non-Hispanic White). Adults with MDD had greater depressive symptoms (mean [SD], 8.35 [5.35] vs 2.33 [2.72]; difference, 6.02; 95% CI for difference, 5.17 to 6.85; P < .001), comorbidities (mean [SD], 4.08 [2.07] vs 2.79 [1.67]; difference, 1.29; 95% CI for difference, 0.87 to 1.70; P < .001), used more antidepressants (mean [SD], 0.94 [0.81] vs 0.27 [0.54]; χ21 = 65.8; P < .001), and had a higher number of medications (mean [SD], 3.80 [3.27] vs 1.98 [2.21]; χ21 = 21.0; P < .001) compared with controls at baseline. Longitudinal analysis demonstrated an association between adults with MDD and hard braking (mean [SE], 3.17 × 10-4 [7.30 × 10-5] vs 6.70 × 10-5 [4.00 × 10-5]; difference, 2.50 × 10-4; 95% CI for difference, 1.74 × 10-4 to 4.61 × 10-4; P < .001) and hard cornering events per trip (mean [SE], 0.80 [0.64] vs 0.57 [0.25]; difference, 0.23; 95% CI for difference, 0.08 to 1.06; P = .04), greater distances driven from home (mean [SE], 31.19 [7.35] vs 7.76 [3.80] km; difference, 23.43; 95% CI for difference, 0.28 to 15.2; P < .001), more unique destinations visited (mean [SE], 0.34 [0.10] vs -0.27 [0.03]; difference, 0.61; 95% CI for difference, 0.14 to 0.54; P < .001), and higher random entropy (mean [SE], 0.01 [0.01] vs -0.02 [0.00]; difference, 0.03; 95% CI for difference, -0.03 to -0.01; P < .001) over time. In this longitudinal cohort study of older drivers, adults with MDD demonstrated distinct and riskier driving behaviors than those in the control group without depression, with higher rates of hard braking, cornering, and unpredictability in driving patterns over time. Routine depression screening and tailored interventions are essential for enhancing driving safety and maintaining independence among older adults with MDD. Comprehensive care approaches addressing both mental and physical health are crucial for this vulnerable population.

Visual quality of life in NMOSD and MOGAD: profiles, dynamics and associations with ageing and vision.

In this multicentric study, we were interested in the vision-related quality of life and its association with visual impairment in neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in comparison to multiple sclerosis (MS) and healthy controls. We analysed extracted data from the German NEMOS registry including National Eye Institute Visual Function Questionnaire (NEI-VFQ) scores, high and low contrast visual acuity (HCVA, LCVA), visually evoked potentials (VEP) and the scores for the expanded disability status scale (EDSS) and other neurological tests which assessed their disease-related impairment. The mean follow-up time of our patients was 1.2years. We used adjusted linear mixed effect models to analyse NEI-VFQ differences and interactions with visual acuity among NMOSD, MOGAD, a matched MS cohort and healthy controls. Despite a younger age in the MOGAD cohort (39 y.o.), vision and socioemotional-related quality of life reduction was similar over all patient subgroups in comparison to healthy controls. The most impacted life quality dimension was general health, followed by general vision, driving and role difficulties. Decline in some of the NEI-VFQ subscales scores is mostly predicted by age. The HCVA was the best predictor for most of the subscales of the NEI-VFQ. Despite important age differences, NMOSD, MOGAD and MS seem to share a rather similar perception on their vision and quality of life impairment, which is overall poorer than that of healthy controls.

Risk factors of long-term brain health outcomes after hospitalization for critical illness.

Brain health may be impaired years after hospitalization for critical illness, and similar impairments occur after hospitalization for COVID-19. However, it remains unclear which patients are most likely to experience long-term brain health consequences and whether these adverse events differ between non-COVID critical illness and COVID-19. In a prospective observational study, we enrolled patients hospitalized for (1) non-COVID critical illness (pneumonia, myocardial infarction, or ICU-requiring conditions) or for (2) COVID-19, from March 2020 to June 2021. Brain health was assessed at 18-month follow-up with cognitive, psychiatric, and neurological tests. We used both logistic regression and prediction models to test for associations between different variables and brain health. We included 245 patients: 125 hospitalized for non-COVID critical illness and 120 for COVID-19 [mean age 61.2 (± 13.6) years, 42% women]. Brain health was impaired in 76% of patients (72% critical illness, 81% COVID-19; p = 0.14) at 18-month follow-up. The strongest predictive factors associated with impaired brain health were education < 13 years, age ≥ 70 years, and neuroticism traits in the best performing model (AUC = 0.63). When analyzing non-COVID critical illness and COVID-19 patients separately, low education was one of the few factors associated with impaired brain health in both groups (AUCs for best models: 0.66 and 0.69). Brain health is comparably impaired after hospitalization for critical illness and COVID-19. Factors like higher age, lower education and neuroticism may help identifying vulnerable individuals, who could benefit from close monitoring to improve brain health after critical illness, regardless of the underlying disease etiology.

A Cross-Sectional Study of Dorso-Lumbar Discs Laminectomy Complications

Background: Epidural Fibrosis (EF) is a risk factor for Failed-Back Syndrome (FBS) and inadequate symptom alleviation following lumbar disc surgery. There is an increase in arachnoiditis and dural tears after reoperation due to the unfavourable consequences, which compromise the result and make the nerve roots vulnerable to electrical field harm. It is possible that Suction Drains (SD) used to remove collections from the surgical site significantly contribute to the prevention of EF. Aim: This research looked at the results and risks of dorso-lumbar disc laminectomy for herniated discs. Methods: One hundred patients with symptomatic unilateral or bilateral single-level (L4-5 or L5-S1) lumbar disc herniation were recruited at the Department of Neurosurgery for disc surgeries. Of these patients, 65 were males and 35 were women. Researchers used a cross-sectional design. When the SD and barrier were not implanted, the results were compared to those without. Using single-level midline surgery, which was limited to the L4, L5 or L5-S1 levels, all surgeries were performed in a prone posture. In order to expose the nerve root and dural sac, techniques such as discectomy, decompression inter-laminar laminectomy, micro-, hemi- or formal laminectomy were used. A further 24-36 hours after the procedure, the SD persisted. During the appointment, the patient had a neurological evaluation and clinical evaluation with an emphasis on the patient’s strength, reflexes, sensibility and pain levels in relation to the operated level. It also covered range of motion, discomfort in the low back and radicles, pain associated with physical activity and the results of Straight Leg Raise (SLR) tests, which included flexion (normal 60°), extension (normal 25°) and lateral flexion (normal 25°). We also measured the length of pain alleviation and the degree of the pain. As part of the follow-up after one year, an MRI was performed. Results: When comparing the groups according to neurological tests, the frequency and severity of adverse events and wound healing features, no statistically significant differences were found. Fifty patients underwent surgery at the L4-5 level and fifty more were operated on at the L5-S1 level. No new neurological impairments or problems were noted. The average amount of time spent in the hospital was five days. In comparison to the results in the beginning, more patients reported feeling better (Table 1,2). A decrease in pain alleviation of more than 50% was seen in both groups. A total of 97% of patients in the therapy group reported substantial improvement in their pain levels at the 3-month, 6-month and 1- to 3-year post-operative follow-up evaluations. All members of the study group had their values compared to their baseline levels before surgery and again after the procedure. At the one-year point, there was a tendency towards better results in the therapy group. Lots of people in the therapy group had long-term relief, along with better pain and functional status, according to the criteria that says short-term relief is less than six months and long-term relief is more than six months. Conclusion: Patients benefited greatly from suction drainage in terms of both immediate and delayed pain relief, functional improvements and SLR performance, regardless of whether it was administered alone or in combination with other therapies. Using MRI, we found that the ejection percentage was significantly lower when we used combination techniques. There was a robust clinical association between results and the degree of EF as measured by the MRI grading system. Keywords: Dorso-Lumbar Discs Laminectomy; Disc Herniation; Epidural Fibrosis; Failed-Back Syndrome; Suction Drains

Sex dependent intergenerational effects of lead in mouse model

Lead (Pb) exposure negatively impacts fertility in both males and females, pregnancy outcomes, and child brain development. We investigated the reproductive and neurological effects of Pb exposure on male and female mice via Pb-contaminated soil for 4 weeks. Breeding was conducted after completion of exposure, in four groups; group 1 consisted of exposed dams and unexposed sires, group 2 consisted of exposed sires and unexposed dams, group 3 consisted of exposed sires and exposed dams and group 4 was the control. Generally, Pb exposure reduced observed conception rates, with a cumulative decrement observed when both males and females are exposed. Gene expression of the testes revealed oxidative stress as the cause of reduced conception rates. Neurological tests: Morris water maze and rotarod were conducted on F1 generation offspring. Maternally and paternally exposed F1 mice performed poorly in the Morris water maze when compared to the control. The severity of the neurological effects was also parent-dependent and sex-dependent. Paternal Pb exposure effects were more pronounced in female offspring. A comparison of gene expression changes of the hippocampus and prefrontal cortex showed paternal Pb-exposure resulted in more prefrontal cortex changes than in the hippocampus, a trend also recorded in the exposed sires. The pronounced effects in female offspring of paternal Pb exposure may suggest that Pb neurological effects may be X-chromosome-linked.

DETECT‐AD ‐ Digital Evaluations and Technologies Enabling Clinical Translation for Alzheimer’s Disease: Results of amyloid screening methodologies in a simulated anti‐amyloid clinical trial using digital biomarkers as primary outcome measures

AbstractBackgroundWith the advent of anti‐amyloid therapies, identifying those with underlying amyloid burdens and detecting subsequent clinical effects of this AD pathology is critical. The DETECT‐AD study (ClinicalTrials.gov, NCT05385913) is a simulated secondary prevention anti‐amyloid clinical trial testing digital biomarkers as more sensitive and meaningful primary outcome measures. Clinically prodromal AD patients with estimable rates of AD progression based on Aβ PET status are enrolled as Aβ “positive” (higher amyloid burden) patients who predictably progress (as if receiving placebo) and Aβ “negative” patients progressing more slowly (representing the treatment group). Typical of current trials, participants are screened at entry to determine those with critical CNS amyloid burdens. Given the effort and cost of establishing AD phenotypes, efficient means for this screening are needed. Here we report to date the results of examining the screening process using blood‐based amyloid determinations for identifying florbetapir PET imaging‐based, amyloid status leading to enrollment of prodromal AD trial participants.MethodParticipants were initially screened by telephone using inclusion/exclusion criteria questionnaires. If passing this phase, participants underwent in‐person cognitive and neurological examinations and clinical blood tests; if passing this phase, an MRI/amyloid PET scan was performed; if passing this last step, the digital technologies were deployed in‐homes. The first 47 participants used this protocol. The subsequent 140 participants underwent a blood amyloid test (plasma Aβ42:40) first, and then the remaining procedures if intermediate or high risk for CNS amyloid (Aβ42:40 &lt; 0.170).ResultA Consort Diagram shows the study results (Figure). As of 1/3/2024, 85/100 have been enrolled with mean(SD): follow‐up=59.4(21.3) weeks; age=78.2(6.5); 65% women; MoCA=25.0(2.5); PET SUVR=1.14(0.23), range: 0.806‐2.18. Without blood amyloid pre‐screening, 26% of participants were PET amyloid positive (SUVR≧1.11). With the blood amyloid screening, 52% were PET amyloid positive.ConclusionA simple telephone screen and blood amyloid test significantly improved the yield of amyloid PET positive participants in a simulated clinical trial, which can reduce costs, personnel effort, and participant burden and risk. Follow‐up will suggest how additional simple clinical, digital, and blood‐based biomarkers may further aid in identifying well‐defined target populations for clinical trials.

Isolated expressive aphasia caused by acute subdural hematoma: case report and literature review

The occurrence of aphasia as an isolated and dominant clinical feature of acute subdural hematoma (aSDH) has been rarely mentioned in the available literature. Being the most common focal intracranial lesion, subdural hematomas (SDH) pose a clinical challenge, especially when presented with unorthodox clinical features. We report a case of a patient with a traumatic aSDH, presenting with intense frontal headaches and normal neurological examination. On the 3rd postadmission day, he developed expressive dysphasia which progressed to aphasia, with neurological examination findings of an upper motor neuron lesion (UMNL), without hematoma expansion, verified via head CT (computed tomography). The patient underwent decompressive craniotomy and hematoma evacuation. Early speech improvements were noted immediately postoperatively, and at hospital discharge the patient had no evident clinical features of speech disorder and neurological deficits or tests suggesting UMNL. Speech disorders in the setting of an aSDH need to be further investigated and potentially considered as an indication for surgical management, especially in rare instances where they present as an isolated clinical feature and conservative treatment is initially considered.

Predictive Factors Driving Positive Awake Test in Carotid Endarterectomy Using Machine Learning

Positive neurologic awake testing during the carotid cross-clamping may be present in around 8% of patients undergoing carotid endarterectomy (CEA). The present work aimed to assess the accuracy of an artificial intelligence (AI)-powered risk calculator in predicting intraoperative neurologic deficits (INDs). Data was collected from carotid interventions performed between January 2012 and January 2023 under regional anesthesia. Patients with IND were selected along with consecutive controls without IND in a case-control study design. A predictive model for IND was developed using machine learning, specifically Extreme Gradient Boosting (XGBoost) model, and its performance was assessed and compared to an existing predictive model. Shapley Additive exPlanations (SHAP) analysis was employed for the model interpretation. Among 216 patients, 108 experienced IND during CEA. The AI-based predictive model achieved a robust area under the curve of 0.82, with an accuracy of 0.75, precision of 0.88, sensitivity of 0.59, and F1Score of 0.71. High body mass index (BMI) increased contralateral carotid stenosis, and a history of limb paresis or plegia were significant IND risk factors. Elevated preoperative platelet and hemoglobin levels were associated with reduced IND risk. This AI model provides precise IND prediction in CEA, enabling tailored interventions for high-risk patients and ultimately improving surgical outcomes. BMI, contralateral stenosis, and selected blood parameters emerged as pivotal predictors, bringing significant advancements to decision-making in CEA procedures. Further validation in larger cohorts is essential for broader clinical implementation.

Using a Webcam to Assess Upper Extremity Proprioception: Experimental Validation and Application to Persons Post Stroke.

Many medical conditions impair proprioception but there are few easy-to-deploy technologies for assessing proprioceptive deficits. Here, we developed a method-called "OpenPoint"-to quantify upper extremity (UE) proprioception using only a webcam as the sensor. OpenPoint automates a classic neurological test: the ability of a person to use one hand to point to a finger on their other hand with vision obscured. Proprioception ability is quantified with pointing error in the frontal plane measured by a deep-learning-based, computer vision library (MediaPipe). In a first experiment with 40 unimpaired adults, pointing error significantly increased when we replaced the target hand with a fake hand, verifying that this task depends on the availability of proprioceptive information from the target hand, and that we can reliably detect this dependence with computer vision. In a second experiment, we quantified UE proprioceptive ability in 16 post-stroke participants. Individuals post stroke exhibited increased pointing error (p < 0.001) that was correlated with finger proprioceptive error measured with an independent, robotic assessment (r = 0.62, p = 0.02). These results validate a novel method to assess UE proprioception ability using affordable computer technology, which provides a potential means to democratize quantitative proprioception testing in clinical and telemedicine environments.

Smartphone tests quantify lower extremities dysfunction in multiple sclerosis.

Increasing shortage of neurologists compounded by the global aging of the population have translated into suboptimal care of patients with chronic neurological diseases. While some patients might benefit from expanding telemedicine, monitoring neurological disability via telemedicine is challenging. Smartphone technologies represent an attractive tool for remote, self-administered neurological assessment. To address this need, we have developed a suite of smartphone tests, called neurological functional test suite (NeuFun-TS), designed to replicate traditional neurological examination. The aim of this study was to assess the ability of two NeuFun-TS tests-short walk and foot tapping-to quantify motor functions of lower extremities as assessed by a neurologist. A cohort of 108 multiple sclerosis (MS) patients received a full neurological examination, imaging of the brain, and completed the NeuFun-TS smartphone tests. The neurological exam was digitalized using the NeurEx™ platform, providing calculation of traditional disability scales, as well as quantification of lower extremities-specific disability. We assessed unilateral correlations of 28 digital biomarkers generated from the NeuFun-TS tests with disability and MRI outcomes and developed machine learning models that predict physical disability. Model performance was tested in an independent validation cohort. NeuFun-TS-derived digital biomarkers correlated strongly with traditional outcomes related to gait and lower extremities functions (e.g., Spearman ρ > 0.8). As expected, the correlation with global disability outcomes was weaker, but still highly significant (e.g., ρ 0.46-0.65; p < 0.001 for EDSS). Digital biomarkers also correlated with semi-quantitative imaging outcomes capturing locations that can affect lower extremity functions (e.g., ρ ~ 0.4 for atrophy of medulla). Reliable digital outcomes with high test-retest values showed stronger correlation with disability outcomes. Combining strong, reliable digital features using machine learning resulted in models that outperformed predictive power of best individual digital biomarkers in an independent validation cohort. NeuFun-TS tests provide reliable digital biomarkers of lower extremity motor functions.

Quando l'anemia blocca le gambe

A 17-month-old girl was hospitalized for dehydration due to gastroenteritis. She presented with a severe microcytic anaemia (Hb 6.2 g/dl) linked to an exclusive breastfeeding diet. Attempts at introducing solid foods had failed. Despite improvement in anaemia and diet after discharge, she showed motor regression and ceased to walk. Neurological tests excluded traumatic, metabolic and genetic conditions, but anaemia persisted. Following a blood transfusion, the patient regained motor abilities. The paper highlights the link between iron deficiency and developmental delays, particularly in walking. This case underscores the vital role of iron in neurodevelopment and emphasises awareness of chronic anaemia in children worldwide.

Anti-saccade can be used as a screening tool for early cognitive impairment: a correlation study based on anti-saccade parameters and cognitive function.

Eye movement tasks, especially anti-saccade tasks, have been used to assess cognitive function in patients with neuropsychiatric disorders. Although it has been shown that individuals with cognitive impairment perform worse on anti-saccades tasks, there is a lack of systematic evaluation of the sensitivity of parameters of anti-saccades to assess different subtypes of cognitive impairment. A total of 158 participants were enrolled in this study, consisting of 66 men and 92 women, with an average age of 50.2 ± 10 years. The comparison of pro-saccade reaction time, anti-saccade reaction time, and error rates in the saccade task between individuals with cognitive impairments and a normal group was conducted. Furthermore, we systematically analyzed the correlations between the performance in neurological function tests (Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Stroop) and these anti-saccade parameters. Especially, the correlation between these parameters and cognitive function in different domains of the MoCA task were also evaluated. The pro-saccade reaction time, anti-saccade reaction time and error rate were negatively correlated with the MMSE and MoCA scores (P < 0.001), and positively correlated with the time used in Stroop tasks. Among them, the error rate had the strongest correlation with the performance of MMSE, MoCA and Stroop tasks (MoCA: P < 0.0001, r2 = -0.608; MMSE: P < 0.0001, r2 = -0.344; Stroop: P < 0.0001, r2 = 0.455). Among the seven cognitive domains examined by the MoCA task, error rates had relatively high correlations with visuospatial/executive (P < 0.0001, r2 = -0.4660) and delayed recall (P < 0.0001, r2 = -0.4228) compared to naming, language (P = 0.0004, r2 = -0.0788), attention (P = 0.0004, r2 = -0.0780), abstraction (P < 0.0001, r2 = -0.1515), orientation (P < 0.0001, r2 = -0.1075). Moreover, pro-saccade reaction time, anti-saccade reaction time and error rate of people with high MoCA scores were significantly higher than those of people with low MoCA scores, which can be used to identify people with mild cognitive impairment. Our study's results provide valuable clinical evidence supporting the effectiveness of anti-saccades in assessing cognitive impairment, which is beneficial for screening and timely clinical intervention in individuals with specific cognitive impairment.

BAK ameliorated cerebral infarction/ischemia–reperfusion injury by activating AMPK/Nrf2 to inhibit TXNIP/NLRP3/caspase-1 axis

BackgroundCerebral ischemia/reperfusion (I/R) injury is a serious vascular disease with extremely high mortality and disability rate. Bakuchiol (BAK) was found in leaves and seeds of Psoralea corylifolia Linn and has been shown to decrease inflammation and reduce oxidative stress, while the mechanism of BAK in ameliorating cerebral I/R injury remains unclear. MethodsMiddle cerebral artery occlusion reperfusion (MACO/R) was used to establish mouse model. The protective effect of BAK in MCAO/R mices was detected by performing neurological deficit testing, TTC staining, and H&E staining. Oxygen/glucose deprivation and reperfusion (OGD/R) was used to stimulate SH-SY5Y cells in vitro. Protein expression was detected by western blotting, gene expression was detected by quantitative real-time polymerase chain reaction and apoptosis was detected by immunofluorescence. ResultsOur study indicated that BAK protected ischemia–reperfusion injury in MACO/R mice, and upregulated superoxide dismutase (SOD) and the catalase (CAT) enzyme activity. BAK also inhibited the expression of TNF-α, IL-1β, IL-6, and IL-18 and suppressed apoptosis and pyroptosis both in MACO/R mice and in OGD/R SH-SY5Y cells. Further results showed that BAK could suppress TXNIP, ASC, NLRP3, and caspase-1 mRNA levels to reverse assembly of inflammasome. And BAK could also upregulate the expression of phosphorylated AMP-activated protein kinase (AMPK) and nuclear factor erythroid 2-related factor (Nrf2). In addition, Nrf2 inhibitor ML385 reversed the BAK induced reduction of TXNIP, ASC, NLRP3, and the AMPK inhibitor also abolished BAK’ the effect on the regulation of Nrf2, TXNIP, ASC, NLRP3, caspase-1, and pro-inflammatory cytokines. In conclusion, BAK, found in leaves and seeds of Psoralea corylifolia Linn, could ameliorated cerebral I/R injury through activating AMPK/Nrf2 to inhibit NLRP3 inflammasome, which might present new therapeutic strategy for cerebral I/R injury.

Monoclonal Gammopathy in Patients with Neuropathy.

The incidence of monoclonal gammopathy of undetermined significance (MGUS) in the population of over 50-year-olds is approximately 3% and increases with age. The association between MG and neuropathy has been of interest for several years, but the causal relationship has not yet been clarified. For 682 patients who visited the Department of Neurology and requested tests for MG work-up, we retrospectively collected demographic and clinical information, such as age, gender, diagnosis, and neurologic and laboratory test results, from their medical records. Out of a total of 682 patients who were suspected of neuropathy and tested for monoclonal gammopathy (MG), twelve (1.76%) showed MG on their serum protein electrophoresis. The most common form was IgM-κ with five patients, followed by IgG-κ, IgG-λ, and biclonal IgG-λ and IgA-κ. The results of the immunoglobulin quantitation test and free light chain assay showed that involved M-protein values in these patients were increased. Some patients were positive for anti-myelin-associated glycoprotein (MAG) antibody, anti-GD1b IgM antibody, anti-GM1 IgG & IgM antibody, and anti-cardiolipin IgM antibody. Also, some had antinuclear antibody (ANA) or antineutrophil cytoplasmic antibody (ANCA). In the future, it is necessary to investigate the pathogenic relationship between M-protein and autoantibodies in patients with neuropathies.