Progressive Neurological Condition Research Articles

Exploring access to community neurorehabilitation for people with progressive neurological conditions: a qualitative study

Purpose Community neurorehabilitation enables people with progressive neurological conditions (PNCs) to manage their symptoms to live an active, fulfilling life; however, it is not accessible to all. This study explored the factors influencing access to community neurorehabilitation in Northern Ireland from the perspective of people with PNCs and their carers. Methods Eleven people living with a PNC and three carers took part in virtual focus groups. Data was thematically analysed using the framework method. Results Access to neurorehabilitation was described as a staged journey, driven by people with PNCs, and impacted by interactions with others. Four themes were identified: the person in the driving seat, describing the value of person-centred care and the need for proactivity; the traffic lights, depicting the role and influence of health care professionals (HCPs); the need for direction; and roadworks and roadblocks, identifying additional barriers to access. In addition, six fundamentals of good access were identified. Conclusions This study adds depth to our understanding of the complexity, and the roles and needs of people with PNCs and HCPs, in accessing community neurorehabilitation. Further research is needed to determine how best to empower people to access rehabilitation.

Dysphagia therapy in adults with a tracheostomy: A scoping review protocol.

Swallowing impairment (dysphagia) and tracheostomy coexist. Research in this area has often provided an overview of dysphagia management as a whole, but there is limited information pertaining to specific dysphagia therapy in the tracheostomy population. The aim of this scoping review is to provide a detailed exploration of the literature with regard to dysphagia therapeutic interventions in adults with a tracheostomy. The scoping review will describe current evidence and thus facilitate future discussions to guide clinical practice. A scoping review using the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews guideline will be used. Ten electronic databases from inception to December 2023 and grey literature will be searched. From identified texts forward and backward citation chasing will be completed. Data extraction will compose of population demographics, aetiology and dysphagia therapy (type, design, dose and intensity). A number of citations and papers included in the scoping review will be presented visually. The scoping review aims to expand upon the existing literature in this field. A detailed description of the evidence is required to facilitate clinical discussions and develop therapeutic protocols in a tracheostomised population. The results of this scoping review will support future research in dysphagia therapy and provide the basis for the development of best practice guidelines. What is already known on this subject There is an abundance of evidence available regarding dysphagia therapy targeting impairments of the swallowing sequence in a variety of populations including stroke, head and neck cancer, progressive neurological conditions and critical illness. However, there is a paucity in the literature with regard to identifying dysphagia therapy for adults with a tracheostomy. What this study adds The study protocol aims to describe the methodological features that need to be extracted from existing studies to outline dysphagia therapy for adults with a tracheostomy. To the researchers' knowledge, this is the first study protocol to describe the methodological features of dysphagia therapy for people with a tracheostomy from the literature using a standardised approach (Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guideline). This will ensure that the protocol is replicable for other researchers to use and demonstrates transparency in research methods. What are the clinical implications of this work? The development of a robust protocol is necessary in order to facilitate the scoping review to describe the current evidence and thus facilitate future discussions to guide clinical practice for speech and language therapists working with adults who have a tracheostomy and dysphagia. The publication of the scoping review protocol allows future clinical researchers in the area of tracheostomy and dysphagia management a blueprint with which to narrow their own research questions and it also enables replicability as the principles of good research practice dictate.

Gait Data-Driven Analysis of Parkinson’s Disease Using Machine Learning

INTRODUCTION: Parkinson's disease is a progressive and complex neurological condition that mostly affects coordination and motor control. Parkinson's disease is most commonly associated with its motor symptoms, which include tremors, bradykinesia (slowness of movement), rigidity, and postural instability.
 OBJECTIVES: Determine any minor alterations in walking patterns that could be early signs of Parkinson's disease. Track the course of Parkinson's disease over time by using gait data.
 METHODS: In this study, we applied three types of VGRF datasets ("Dual Tasking, RAS, and Treadmill Walking") and developed an ML-based model using six different classifier methods. The datasets were analysed using 16 sensors, of which 8 were applied to each foot and the total pressure of the left and right foot. The aforementioned three distinct gait patterns movement disorders were the sources of the dataset. The gait signals dataset benefited by the participant demographic data. 
 RESULTS: Then, we passed the outcome of applying the model and measuring performance through a cross-validation operator to check the accuracy and decision-making of the five algorithms i) Deep Learning, ii) Neural Networks, iii) Support Vector Machine (SVM), iv) Gradient Boost Tree (GBT), v) Random Forest”. The following findings compare the effectiveness of the various algorithms utilized and the observed PD very well.
 CONCLUSION: The different ML classifier algorithms demonstrated good detection capability with different accuracy. Our proposed ensemble model is superior to compare with the existing models. Because we can observe the proposed ensemble model result and accuracy better than the other classifier model. The other classifier model’s highest accuracy is 92.08% whereas our ensemble model got 92.31%. So, it has proved that our proposed ensemble model is excellent and robust.

Physiotherapy for Alzheimer’s Disease: A Case Report

Alzheimer's disease is a progressive neurological condition characterized by brain changes resulting in the accumulation of specific proteins, leading to brain shrinkage and eventual cell death. It is the primary cause of dementia, resulting in a gradual decline in memory, cognition, behaviour, and social skills, impairing overall functionality. The case study involves an 84-year-old woman displaying symptoms of Alzheimer's disease requiring physiotherapy rehabilitation. Assessment reveals joint pain, abnormal gait, respiratory issues due to pneumonia, reduced balance and cognitive function, concentration difficulties, impaired decision-making, fluctuating moods, and behavioural issues such as depression and aggression. Physical examination shows shoulder shrugging and slight tension in the upper trapezius muscle. The rehabilitation program involves various interventions like stretching, strengthening, aerobic exercises, breathing exercises, lung clearance techniques, active range of motion exercises, postural control, and gait training. The role of the physiotherapist is to address the both physical and cognitive decline and improve mood and behaviour.

The Effects of Home Automation on Personal and Social Autonomies in Spinal Cord Injury Patients: A Pilot Study.

Background: Spinal cord injury (SCI) is a severe and progressive neurological condition caused by trauma to the nervous system, resulting in lifelong disability and severe comorbidities. This condition imposes serious limitations on everyday life, interfering with patients' social lives and compromising their quality of life, psychological well-being, and daily living activities. Rehabilitation is essential to helping SCI patients gain more independence in their daily routines. Home automation (HA) systems provide personalized support to users, allowing them to manage various aspects of their living environment, promoting independence and well-being. This study aims to demonstrate the efficacy of an HA system in enhancing personal and social autonomies in SCI patients, resulting in improved cognitive function and reduced anxiety-depressive symptoms compared to traditional training. Methods: We enrolled 50 SCI patients undergoing neurorehabilitation at IRCCS Centro Neurolesi (Messina, Italy). These patients were randomly assigned to one of two groups: a control group (CG) and an experimental group (EG). The CG received traditional training, while the EG underwent HA training. We evaluated the patients before (T0) and after (T1) rehabilitation using various scales, including the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Anxiety (HRS-A), the 12-Item Short-Form Survey (SF-12), the Functional Independence Measure (FIM), Activities of Daily Living (ADL), Instrumental Activities of Daily Living Scale (IADL), and the EQ-5D-5L. Results: The effect of the experimental treatment showed an improvement in all patients test scores in the EG, especially regarding cognitive functions, mood disorders, activities of daily living, and quality of life. Conclusion: Our findings suggest that HA may be effective in improving daily autonomy and, in turn, alleviating mood disorders and enhancing psychological well-being.

Behavioural change for Parkinson's Disease: A randomised controlled feasibility study to promote physical activity and exercise adherence among people with Parkinson's: study protocol.

Parkinson's is a common progressive neurological condition characterized by motor and non-motor deficits. Physical activity and exercise can improve health, but many people with Parkinson's (PwP) have trouble reaching the recommended dosage. Our recent literature review found improvements in exercise adherence with behavioural change interventions, but it remains unclear which are most effective. Further qualitative research and patient and public involvement has informed a novel behavioural change intervention to be tested alongside an existing exercise program. To examine the feasibility of behavioural change techniques delivered alongside an exercise programme to improve physical activity, function, and self-efficacy in PwP (and study procedures) to inform a future pilot RCT trial. A parallel-arm single blinded randomised feasibility study. Twenty participants with Parkinson's (Hoehn and Yahr stage 1-3) will be recruited from a physiotherapy primary-care waiting list. Following written consent, and baseline assessment, the participants will be randomly allocated to the intervention (n=10) or the control group (n=10). Both groups will receive usual care, which includes a weekly program of a multidisciplinary education, a supervised exercise class and a prescribed home exercise program. The intervention group will receive additional behavioural change techniques, targeting behaviour regulation, belief about capabilities and social influences. Class and home exercise adherence, behavioural component uptake and adherence, and negative events will be recorded. Outcomes will include enrolment and maintenance rates, physical function, falls, physical activity, and exercise self-efficacy measured pre- and post- the 12-week program (in-person). Surveys will be used to compare experiences and satisfaction between groups. Exit interviews will be completed with the intervention group only, exploring their experience of the behavioural change techniques. The results will help inform a future pilot RCT, based on the intervention acceptability, consent rate, maintenance, and protocol integrity. ClincialTrials.gov NCT06192628.

Protective Effect of Ferulic Acid on Acetylcholinesterase and Amyloid Beta Peptide Plaque Formation in Alzheimer's Disease: An In Vitro Study.

Aim This study aims to comprehensively evaluate the effects of ferulic acid (FA) on acetylcholinesterase (AChE) enzyme activity and amyloid beta (Aβ) peptide plaque formation in an in vitro model of Alzheimer's disease (AD). Background ADis a progressive neurological condition marked by disrupted cholinergic signaling, accumulation of Aβ peptide, and tau protein hyperphosphorylation. Currently, no direct anti-Alzheimer drug that effectively prevents the cognitive decline from AD has been reported. To combat this, a multi-target drug addressing several molecular aspects would be ideal for AD. Natural compounds are preferred over synthetic drugs due to their accessibility, cost-efficiency, and lower toxicity The proven association between polyphenolconsumption and the prevention of AD has led to the investigation of the effect of FA, a polyphenolic compound, on acetylcholinesterase enzyme activity and Aβ peptide formation, the key targets of AD. Materials and method The free radical scavenging ability of FA was assessed by xanthine oxidase inhibitory activity. Furthermore, FA was also evaluated for its inhibitory activity against AChE enzyme and amyloid beta peptide formation to evaluate the neuroprotective potential of FA. Results The results showed that FA has the potential to be an AChE inhibitor, thus helping in blocking the activity of AChE and also reducing the incidence of amyloid beta plaque formation. Furthermore, the compound also exhibited a significant antioxidant property which was demonstrated by the xanthine oxidase enzyme inhibitory effect. Conclusion From the observed results, FA has significant antioxidant and neuroprotective effects which are compared with those of their respective standards. More research is required to determine the efficacy and safety of this compound as a treatment for neurodegenerative diseases like AD because the precise mechanism and degree of its AChE inhibitory effects in the brain are still elusive. A potent, selective, and effective drug is desperately needed to treat patients with AD and those at risk of developing the disease.

Impaired communication at the neuromotor axis during Degenerative Cervical Myelopathy.

Degenerative Cervical Myelopathy (DCM) is a progressive neurological condition characterized by structural alterations in the cervical spine, resulting in compression of the spinal cord. While clinical manifestations of DCM are well-documented, numerous unanswered questions persist at the molecular and cellular levels. In this study, we sought to investigate the neuromotor axis during DCM. We use a clinically relevant mouse model, where after 3 months of DCM induction, the sensorimotor tests revealed a significant reduction in both locomotor activity and muscle strength compared to the control group. Immunohistochemical analyses showed alterations in the gross anatomy of the cervical spinal cord segment after DCM. These changes were concomitant with the loss of motoneurons and a decrease in the number of excitatory synaptic inputs within the spinal cord. Additionally, the DCM group exhibited a reduction in the endplate surface, which correlated with diminished presynaptic axon endings in the supraspinous muscles. Furthermore, the biceps brachii (BB) muscle exhibited signs of atrophy and impaired regenerative capacity, which inversely correlated with the transversal area of remnants of muscle fibers. Additionally, metabolic assessments in BB muscle indicated an increased proportion of oxidative skeletal muscle fibers. In line with the link between neuromotor disorders and gut alterations, DCM mice displayed smaller mucin granules in the mucosa layer without damage to the epithelial barrier in the colon. Notably, a shift in the abundance of microbiota phylum profiles reveals an elevated Firmicutes-to-Bacteroidetes ratio-a consistent hallmark of dysbiosis that correlates with alterations in gut microbiota-derived metabolites. Additionally, treatment with short-chain fatty acids stimulated the differentiation of the motoneuron-like NSC34 cell line. These findings shed light on the multifaceted nature of DCM, resembling a synaptopathy that disrupts cellular communication within the neuromotor axis while concurrently exerting influence on other systems. Notably, the colon emerges as a focal point, experiencing substantial perturbations in both mucosal barrier integrity and the delicate balance of intestinal microbiota.

Insights of structure-based virtual screening and MPO-based SAR analysis of berberine-benzimidazole derivatives against Parkinson disease

Parkinson's disease (PD) is a progressive neurological condition that causes tremors, rigidity and postural instability. In addition, it can lead to complications such as constipation, orthostatic hypotension, and psychiatric disorders like depression and anxiety. Berberine is a natural alkaloid used in Chinese medicine, extracted from various plants such as Berberis vulgaris and Tinospora cordifolia. The compounds have been reported to possess therapeutic activities, including anti-Alzheimer's, anti-diabetic, anti-inflammatory, antiviral, antibacterial and, in the context of this study, anti-Parkinson's action. This study conducts a structure-based virtual screening of aryl-substituted berberine-benzimidazole derivatives (D1–7). Molecular docking and dynamics simulations are used to predict pharmacodynamics against monoamine oxidase B (MAOB), while multiparametric optimization (MPO) is used to predict pharmacokinetics to the Central Nervous System (CNS). The aim is to propose new alkaloids derived from berberine that can modulate the activity of MAOB receptors in treating PD. The simulations revealed that the D7 compound, which contains a dichlorophenyl group, exhibited a high affinity with MAOB, with an affinity energy of −10 kcal/mol. In contrast, the fluoro- and nitro- substituted compounds showed lower affinity. Structure-activity/property relationship (SAR/SPR) analysis suggest that the chloro‑substituted derivatives are more lipophilic and form essentially hydrophobic interactions with the MAOB. This is corroborated by the dynamics simulations, which show that the MAOB-D7 complex is highly stable and allows for a synergistic effect associated with other anti-Parkinson drugs, further enhancing the inhibition of MAOB. Furthermore, pharmacokinetic predictions indicate that optimal levels of lipophilicity and polarity enhance high passive permeability (Papp = 1.7 × 10−5 cm/s) and metabolic stability of the D7 derivative, leading to increased distribution in the CNS.

Review of best practices of integrated care for people living with Motor Neurone Disease

Introduction: Motor neurone disease is a life limiting progressive neurological condition that requires a team-based approach to care. Person-centred care (PCC), integrated care and access to specialised motor neurone disease (MND) multidisciplinary clinics (MDC) are optimal approaches to the delivery of quality service for people living with MND (plwMND) for improved quality of life, health outcomes and care experiences. These MND MDCs models of care vary in design, implementation, and are predominantly specialist hospital based. Therefore, not all MND services are delivered consistently highlighting a need to explore the evidence on current practices that contribute to more effective, efficient person-centred integrated care practices across the continuum.
 Aim: This rapid review explores best practices of integrated care for people living with motor neurone disease, and their families and carers.
 Methods: A search was undertaken of six databases, Medline (Ovid), Embase (Ovid), CINAHL, Cochrane, Joanna Briggs Institute and Google Scholar. The 1469 retrieved abstracts were screened for eligibility against the inclusion criteria, and full text review was conducted on 149 studies. Data were extracted from 58 studies and a quality assessment conducted on final 45 included studies. The following information was gathered from the included studies to inform the review.
 1.What is ‘best practice’ in the management/care of plwMND
 2.What models of (integrated) care have been developed to support plwMND
 3.What are the common elements of integrated care approaches that have been implemented in MND?
 4.What impacts, outcomes, or effects of integrated care approaches have been reported for plwMND?
 
 Results: The initial review analysis indicated specialised MND multidisciplinary clinics (MDC) as ‘best practice’ in the optimal management of MND, but revealed no standardised approaches in design and implementation, the multidisciplinary workforce, and degree of integration and partnerships between hospitals and the community. MND MDC are predominantly hospital based, but the inclusion of either outreach community teams, hub and spoke approaches, and/or a hybrid design, (care delivered in person and /or by telehealth), improved integration, knowledge sharing and coordination across services. The timing of introduction and delivery of palliative care services differs but there is greater focus on integration into MND MDC, or earlier referrals to dedicated palliative care service and/or specific palliative care training of neurologist/multidisciplinary team, to optimise symptom management, decision-making and end of life care. Additional features that enable integration, improve care satisfaction and equity are one or a mix of 1) telehealth, 2) care coordination, 3) case management, 4) partnerships with MND associations, and/or 5) MND helpline.
 Conclusion: This review highlights a range of practices of integrated care that are not universal and predominantly practiced in high income countries. Adapting delivery of model of care to stage and duration of MND, and differing expectations, needs and priorities of plwMND and caregivers, is a common theme throughout. There has been greater uptake in telehealth and technology to support the equitable delivery of integrated approaches to care, with rapid development in this area during COVID 19 pandemic.
 

NEUROPROTECTIVE EFFECT OF PALIPERIDONE IN LPS INDUCED ANIMAL MODEL OF AD

AbstractBackgroundAlzheimer’s disease is a progressive neurological condition, that impairs cognition and memory. Extracellular beta‐amyloid plaques and intracellular neurofibrillary tangle formation are the two hallmarks while cognitive decline, neurotransmitter deficit, neuroinflammation, mitochondrial dysfunction, decreased cerebral glucose uptake, and oxidative stress has been known to contribute to the pathogenesis of AD. The present study was designed to investigate the neuroprotective potential of Paliperidone on intracerebroventricular (i.c.v.) Lipopolysaccharide‐induced experimental dementia of Alzheimer’s type.MethodLPS was administered by the i.c.v route on 1st day of the study in rats. Paliperidone was administered (1mg/Kg and 2mg/kg/day i.p) from the 1st to 21st day in LPS‐infused rats. Morris water maze, open‐field test, and object recognition parameters were used to assess learning, memory, behavioral changes and locomotor activity in rats. LPS infusion rapidly causes neuroinflammation and oxidative‐nitrosative stress.ResultThese markers were determined in the cortical and hippocampal brain regions of rats. While paliperidone treatment attenuates the LPS‐induced behavioral and biochemical abnormalities in rats by reducing levels of Malondialdehyde (MDA), reduced glutathione (GSH), and increasing levels of catalase. The neurodegeneration in Hippocampus and cortex regions was observed through histopathological examination. The observed cognitive improvement following paliperidone in LPStreated rats may be due to its antioxidant and anti‐inflammatory activity and restoration of cholinergic functions.ConclusionOur results suggest the therapeutic potential of paliperidone in cognitive disorders such as AD. However, more investigations are required to evaluate the potential of paliperidone in boosting memory and cognition and preventing neuronal damage.

Optimized MobileNetV3: a deep learning-based Parkinson’s disease classification using fused images

Background and Objective Parkinson’s disease (PD) is a progressive neurological condition that manifests motor and non-motor symptoms. Early in the course of the disease, PD patients frequently experience vocal difficulties. In the beginning, preprocessing procedures were used with multi-focus image fusion to enhance the quality of input images. It is essential to diagnose and treat PD early to ensure that patients live healthy and productive lives. Methods Tremors, rigidity in the muscles, slow movement, difficulty balance, and other psychological symptoms are some of the disease’s symptoms. One of the critical mechanisms supporting PD identification and assessment is the dynamics of handwritten records. Several machine-learning techniques have been researched for the early detection of this disease. Yet the main problem with most of these manual feature extraction methods is their poor performance and accuracy. Results This cannot be acceptable when discovering such a chronic condition. For this purpose, a powerful deep learning model is suggested to help with the early diagnosis of Parkinson’s disease. Therefore, we proposed MobileNetV3-based classification. To enhance the classification performances even more, the MobileNetV3-based approach was optimized by the Improved Dwarf Mongoose Optimization algorithm (IDMO). Conclusion The Pyramid channel-based feature attention network (PCFAN) chooses the critical features. The efficiency of the approaches is tested using the PPMI and NTUA datasets. Our proposed approach obtains 99.34% accuracy, 98.53% sensitivity, 97.78% specificity, and 99.12% F-score compared to previous methods.

Health-Related Quality of Life in Patients with Inherited Ataxia in Ireland.

Inherited cerebellar ataxias (CA) are heterogeneous progressive neurological conditions associated with significant functional limitations. This study aimed to assess the implications of inherited CA on patients' self-reported quality of life (QoL) and impairments in work and activities. 129 individuals with ataxia responded to a survey focused on QoL. Health-related QoL was measured using the RAND 36-Item Short Form Survey. An adaptation of the validated Work Productivity and Activity Impairment questionnaire was used to assess the effect of health on work productivity and ability to perform activities over the past week. Nine percent of respondents were currently employed. Individuals with inherited ataxia experienced significant activity impairment, and 75% required professional or informal care. Health-related quality of life (HRQoL) was significantly worse in all areas for the individuals with inherited ataxia compared with Irish population normative values. Participants with Friedreich's ataxia (n = 56) demonstrated worse physical functioning then those with undetermined ataxia (n = 55). Female gender, younger age at symptom onset, current employment, retirement due to age or ataxia, and living in a long-term care facility were associated with higher sub-scores in different domains of HRQoL, while disease duration correlated with worse physical functioning sub-scores. This study is the first cross-sectional study on HRQoL in patients with inherited ataxia in Ireland. It highlights high rates of unemployment, difficulty with daily activities and physical functioning limitations, which is worse than comparative international studies. Given the limited therapeutic options currently available, optimising HRQoL is an important aspect of managing ataxia.

Impossible Chess, Close Reading, and Inattention as Disability in Percival Everett’s Telephone

Percival Everett’s Telephone (2021) is a novel published, by deliberate design, in three very different versions. Ostensibly, the author has claimed in interview, this choice was to test the boundaries of authorial authority and to delegate interpretative control to the reader. In this article, I argue that such a stance is disingenuous. Telephone is, instead, a novel that continually withholds information from the reader and that ultimately frustrates close reading techniques. In doing so, the text casts the reader into the mental viewpoint of the terminally ill child in the novel, Sarah, who suffers from the progressive neurological condition Batten disease. The outcome is that Telephone should be read as a novel that pathologizes readerly inattention but that, as a result, passes innovative comment on disability narratives in fiction more broadly.

Targeting GM2 Ganglioside Accumulation in Dementia: Current Therapeutic Approaches and Future Directions.

Dementia in neurodegenerative diseases, such as Alzheimer's disease (AD), Parkinson's disease (PD), and dementia with Lewy bodies (DLB) is a progressive neurological condition affecting millions worldwide. The amphiphilic molecule GM2 gangliosides are abundant in the human brain and play important roles in neuronal development, intercellular recognition, myelin stabilization, and signal transduction. GM2 ganglioside's degradation requires hexosaminidase A (HexA), a heterodimer composed of an α subunit encoded by HEXA and a β subunit encoded by HEXB. The hydrolysis of GM2 also requires a non-enzymatic protein, the GM2 activator protein (GM2-AP), encoded by GM2A. Pathogenic mutations of HEXA, HEXB, and GM2A are responsible for autosomal recessive diseases known as GM2 gangliosidosis, caused by the excessive intralysosomal accumulation of GM2 gangliosides. In AD, PD and DLB, GM2 ganglioside accumulation is reported to facilitate Aβ and α-synuclein aggregation into toxic oligomers and plaques through activation of downstream signaling pathways, such as protein kinase C (PKC) and oxidative stress factors. This review explored the potential role of GM2 ganglioside alteration in toxic protein aggregations and its related signaling pathways leading to neurodegenerative diseases. Further review explored potential therapeutic approaches, which include synthetic and phytomolecules targeting GM2 ganglioside accumulation in the brain, holding a promise for providing new and effective management for dementia.

A Concatenated Deep Feature Extraction Architecture For Multi-Class Alzheimer Disease Prediction

Alzheimer's disease (AD), particularly affects adults, is among the most common brain disorders, causing memory loss and losing information to varied degrees. is a progressive neurological condition that gradually impairs cognitive performance and can lead to death. With today's technological advancements, Magnetic Resonance Imaging (MRI) scanning can diagnose AD. As a result, MRI is the most often utilized tool for diagnosing and monitoring the progression of AD. Image identification in the early detection of AD can be accomplished automatically utilizing machine learning (ML) with this technique. Although ML has several advantages, deep learning (DL) is currently more extensively used because it has superior learning ability and is more suited to tackling image identification difficulties. However, there are significant hurdles to implementing DL, such as the requirement for huge datasets, large computational resources, and careful parameter tuning to avoid overfitting or underfitting. In order to solve the problem of classifying AD using DL, this research provides randomised concatenated feature representations obtained by two pre-trained network models that learn feature information in deep from brain functional schemes of MRI scans simultaneously. To execute the task of AD multiclass classification, we experimented using concatenated CNN of DenseNet and MobileNet. To highlight the discriminating regions from scans for the suggested model prediction, a gradient class activation map has been used. In multiclass classification, the suggested model achieved 98.87 percent accuracy, 98.95 percent precision, and 98.99 percent recall, according to the experimental results. The findings suggest that advanced DL techniques combined with MRI data can be utilised to classify and forecast neurodegenerative brain illnesses such as Alzheimer's.

Quality by design for sumatriptan loaded nano-ethosomal mucoadhesive gel for the therapeutic management of nitroglycerin induced migraine

Migraine is a progressive neurological condition often accompanied by nausea and vomiting. Various drugs have recently been used in the treatment of migraine, including sumatriptan (SUT). However, SUT has poor pharmacological effects mainly due to its reduced permeability, blood brain barrier (BBB) effect, half-life and bioavailability. Herein, we developed SUT loaded nano-ethosomes (SUT-NEs) for intranasal (IN) delivery, after their incorporation into chitosan based mucoadhesive gel (SUT-NEsG). The observed mean particle size of SUT-NEs was 109.45 ± 4.03 nm with spherical morphology, mono dispersion (0.191 ± 0.001), negatively charged (-20.90 ± 1.98 mV) and with excellent entrapment efficiency (96.90 ± 1.85 %). Fourier-transform infrared (FTIR) spectra have depicted the compatibility of the components. Moreover, SUT-NEsG was homogeneous having suitable viscosity and mucoadhesive strength. In vitro release and ex vivo permeation analysis showed sustained release and improved permeation of the SUT-NEsG, respectively. Additionally, histopathological studies of nasal membrane affirmed the safety of SUT-NEsG after IN application. In vivo pharmacokinetic study demonstrated improved brain bioavailability of SUT-NEsG as compared to orally administered sumatriptan solution (SUT-SL). Furthermore, significantly enhanced pharmacological effect of SUT-NEsG was observed in behavioral and biochemical analysis, immunohistochemistry for NF-κB, and enzyme linked immuno assay (ELISA) for IL-1β and TNF-α in Nitroglycerin (NTG) induced migraine model. It can be concluded that migraine may be successfully managed through IN application of SUT-NEsG owing to the direct targeted delivery to the brain.

The Role of Rehabilitation for Early-Stage Alzheimer's Disease and Related Dementias: Practice and Priorities

The World Health Organization describes rehabilitation as interventions that focus on addressing disability through optimizing functional ability for individuals living with various health challenges in their unique daily life contexts. Rehabilitation services are typically seeking to enhance functional capacity and health, either in concert with, or in place of pharmacologic interventions. These services typically fall into 2 categories, restorative, where the client endeavors to return to a prior level of independent function, and compensatory, where s/he may not. In the latter case, clients might receive, and be trained to use, technology aids or other external supports to enable them to engage in a safe, healthy, and meaningful day-to-day life. For some populations, however, even enhanced functional capacity can present in the form of an insidious, albeit slower decline. So, what is, or should, rehabilitation's role be in progressive neurologic conditions? Specifically, what are the policy and practice implications of rehabilitation for (not in the presence of, but for) the care of persons living with neurodegenerative conditions such as Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD)?

Diagnosis of Parkinson’s disease based on voice signals using SHAP and hard voting ensemble method

Parkinson’s disease (PD) is the second most common progressive neurological condition after Alzheimer’s. The significant number of individuals afflicted with this illness makes it essential to develop a method to diagnose the conditions in their early phases. PD is typically identified from motor symptoms or via other Neuroimaging techniques. Expensive, time-consuming, and unavailable to the general public, these methods are not very accurate. Another issue to be addressed is the black-box nature of machine learning methods that needs interpretation. These issues encourage us to develop a novel technique using Shapley additive explanations (SHAP) and Hard Voting Ensemble Method based on voice signals to diagnose PD more accurately. Another purpose of this study is to interpret the output of the model and determine the most important features in diagnosing PD. The present article uses Pearson Correlation Coefficients to understand the relationship between input features and the output. Input features with high correlation are selected and then classified by the Extreme Gradient Boosting, Light Gradient Boosting Machine, Gradient Boosting, and Bagging. Moreover, the weights in Hard Voting Ensemble Method are determined based on the performance of the mentioned classifiers. At the final stage, it uses SHAP to determine the most important features in PD diagnosis. The effectiveness of the proposed method is validated using ‘Parkinson Dataset with Replicated Acoustic Features’ from the UCI machine learning repository. It has achieved an accuracy of 85.42%. The findings demonstrate that the proposed method outperformed state-of-the-art approaches and can assist physicians in diagnosing Parkinson’s cases.

255 Preliminary findings from a prospective cohort study of Ireland’s first community Fibreoptic Endoscopic Evaluation of Swallowing (cFEES) service

Abstract Background Dysphagia is a common and resource-demanding symptom of many conditions. Dysphagia prevalence increases with age and can affect quality of life, nutritional status, hydration and increase healthcare utilisation/cost. Instrumental swallowing assessment is essential for accurate diagnosis and treatment. FEES is a gold standard diagnostic tool carried out by speech and language therapists (SLTs), typically in the acute setting. The aim of this study is to profile participants who accessed Ireland’s first cFEES service by describing clinical and process outcomes. Methods Adult patients referred for cFEES were invited to participate. Demographic, clinical and process data were recorded at index visit. A structured phone interview was completed at six months. Descriptive analysis was completed. Results In total, 53 participants were included: 70% were aged >65 years, median age was 72. Diagnoses included progressive neurological conditions such as motor neuron disease, multiple sclerosis and others (23%), Parkinson’s Disease, including Parkinson’s Plus Syndromes (15%), stroke (13%), head and neck cancer (11%), dysphagia unknown aetiology (9%), other (9%), chronic obstructive pulmonary disease (8%), other cancers (6%), and gastro-oesophageal reflux disease (4%). Nutritional status was screened using the Malnutrition Universal Screening Tool (MUST) at index visit for 44 participants. Of those, 23% (N = 10) had a MUST score ≥ 1. Dysphagia Outcome Severity Scale was used to rate swallowing: 43% had some degree of dysphagia (mild to severe). FEES referrals originated mainly from primary care SLTs: 75%, the remaining 25% from older person’s services (community nursing facilities, inpatient rehabilitation and integrated care for older persons). One participant was unable to tolerate the procedure, which was abandoned. Three participants experienced non-limiting gagging or hypersensitivity. Conclusion cFEES is a novel service model which was accessed mainly by older people. cFEES was tolerated well by most, leading to evidence-based outcomes including ruling out significant dysphagia in 57% of cases.