MOLNÁR Márk1, BOHA Roland1, BENYOVSZKY Máté1,2, GAÁL Zsófia Anna1, TÓTH Brigitta1,3
JANUARY 30, 2011
Clinical Neuroscience - 2011;64(01-02)
[During the course of ageing the decline of cognitive performance, including attention and working memory processes - essential for arithmetic procedures - is well known. For the investigation of the neuronal mechanisms of these processes the application of methods capable of taking into account the high complexity of the nervous system, the role of nonlinear processes and network-properties of its constituents are necessary. As for the latter the recently realized small world network characteristics representing optimal conditions for information processing may be of particular importance. In the present study the spectral, complexity-, and network characteristics of the EEG recorded during performing an arithmetic task in a group of young (n=32, mean age 22.0 yrs) and elderly (n=19, mean age: 66.7 yrs) was analyzed. Heart rate and behavioral measures (number of mistakes, reaction time) were also investigated. The alpha2 band decreased in the young, while the delta band increased in the elderly in the task condition. The increased Omega-complexity observed in the elderly is probably caused by reduced interneuronal connectivity. “Small-world” network characteristics were found in the beta and delta bands although in the elderly the topology was closer to a random pattern. In the task condition the network features of the elderly subjects shifted more towards the small world pattern than those seen in the young indicating that for the elderly the mobilized effort for task completion was higher. In spite of this, the level of performance and the heart rate change observed in the elderly was lower than that seen in the young. The application of complexity-, and graph theoretical analysis appears to be a promising tool for the investigation of diseases of the nervous system characterized by diffuse pathology as in the case of as various types of dementias.]
Clinical Neuroscience
[In my opinion Hungarian medicine, and not just neurology, is in a critical state. This is the consequence of various factors, such as the overemphasizing of medicine’s economic aspects, the malfunctions of patient care caused by inadequate source allocation, and the misinterpretation of the doctors’ role by the society. The vastly increased knowledge base and the huge amount of information we can gather about our patients are an unparalleled chance, rather than a deathly wound, for neurology as a discipline. The challenge the future’s neurology has to face is high-quality patient care, which necessitates dedicating the necessary time for patients, rationally using our ever-increasing diagnostic arsenal, and continuously updating our knowledge about the therapeutic possibilities.]
Clinical Neuroscience
[The blood vessels which are running nearby the cranial nerves and the brainstem can be elongated; curves and loops of the vessels may develop mostly due to the degenerative alterations of ageing and these vessels can compress the surrounding neural elements. The authors report a review of vascular compression syndromes based on the literature and their own experience. The typical clinical symptoms of the syndromes subserving the proper diagnosis, the pathomechanism, the significance of imaging especially the magnetic resonance angiography, the experience with the surgical technique of microvascular decompression which is the only causal treatment of the syndromes are discussed. In cases of non-responsible medical treatment the microvascular decompression should be the eligible treatment in certain syndromes (trigeminal and glossopharyngeal neuralgia, hemifacial spasm) for it is a highly effective and low risk method.]
Clinical Neuroscience
[Background - Fabry-disease (FD) is a rare X-linked lysosomal storage disease. Deficiency of alpha-galactosidase A activity leads to the accumulation of neutral glycosphingolipids, primarily globotriaosylceramide (GL-3) in various tissues, particularly blood vessels, kidneys, myocardium and in ganglions of the peripheral and autonomic nervous system and causes diverse symptoms. The classical phenotype is seen in most males and rarely in females. In women, symptomes start later and the severity is milder. Both peripheral and central nervous system can be both affected. Objectives - Fabry-patiens and gene-carriers in the central region of Hungary are treated in the 2nd Pediatric Department, Semmelweis University. These patients are consulted by an interdisciplinary team. At present, four hemizygous male, four heterozygous female Fabry-patients and three asymptomatic heterozygous gene carriers are followed. Results - After reviewing the neurological complications of FD, we present clinical and neuroimaging data of our patients. Conclusion - We emphasize that neurologists should suspect the rare monogenic FD in the case of acroparaesthesia and heat-cold intolerance in childhood or adolescence; clinical signs of TIA/stroke or unexplained MRI alterations suggesting small vessel disease in young adults. Early diagnosis and introduction of enzyme replacement therapy (ERT) can halt or reverse progression.]
Clinical Neuroscience
[The carpal tunnel syndrome is the most frequent compression-induced neuropathy. A severe but rare clinical manifestation of this disorder associates with ulceration, acral osteo-lysis and mutilation of the terminal phalanges of the second and third fingers. Recognition of this disorder is difficult, because various dermatological and internal diseases might lead to acral ulcerative lesions, and these patients are seldom referred to neurological and/or electrodiagnostic examination. In this article, we present three cases of this rare clinical form of carpal tunnel syndrome and discuss the electrodiagnostic findings. The early diagnosis is important since decompression of the median nerve in due time might prevent mutilation and could significantly improve the patients’ quality of life.]
Lege Artis Medicinae
[Stressing the continuous increase of elderly population, the author demonstrates the negative impact of technical development on everyday routines of old population. It can explain that members of younger generations often create false ideations on mental and cognitive abilities of older ones, and consequently some stubborn misbeliefs are existing here. He deals with the following four of them in details: (1) Young age means worth, while old age is equal to deficit, (2) Every old person becomes demented, (3) Elderly people loose their interest and social sensitivity, (4) Old people means ballast for younger ones. The author emphasizes, that even the elderly persons are able to fall into these traps of misbeliefs. In addition to complex refutations, he states that the “spacecraft-model” described by L. Hayflick offers efficient solutions to preserve an adequate quality of life both for old people and their society. ]
Clinical Neuroscience
[Goals - In the present study basic arithmetic induced rearrangements in functional connections of the brain were investigated by using graph theoretical analysis what becomes increasingly important both in theoretical neuroscience and also in clinical investigations. Research questions - During mental arithmetic operations (working) memory plays an important role, but there are only a few studies in which an attempt was made to separate this effect from the process of arithmetic operations themselves. The goal of our study was to separate the neural networks involved in cognitive functions. Methods - As an attempt to clarify this issue the graph-theoretical “minimal spanning tree” method was used for the analysis of EEG recorded during task performance. The effects of passive viewing, number recognition and mental arithmetic on PLI based minimal spanning trees (MST) were investigated on the EEG in young adults (adding task: 17 subjects; passive viewing and number recognition: 16 subjects) in the θ (4-8 Hz) frequency band. Results - Occipital task relevant synchronization was found by using the different methods, probably related to the effect of visual stimulation. With respect to diameter, eccentricity and fraction of leafs different task-related changes were found. Discussion - It was shown that the task related changes of various graph indices are capable to identify networks behind the various relevant dominant functions. Thus the “minimal spanning tree” method is suitable for the analysis of the reorganization of the brain with respect to cognitive functions.]
Lege Artis Medicinae
[INTRODUCTION - In Hungary, the ageing of the population is a major challenge for the healthcare system (and for the social care). Due to the complexity of treatment of the elderly, geriatric care needs to have a special integrative approach, in order to function effectively. METHODS - We analysed the data that was made publicly available by the Hungarian Payer, together with domestic and international publications, to provide suggestions regarding geriatric care. RESULTS - Based on public data, the utilization of geriatric healthcare services is low, and major differences could be observed within different areas of the country. Within outpatient care, geriatric care shows a decreasing trend. DISCUSSION - It is complicated to navigate through the services provided by the Hungarian healthcare system, while international examples show that additional health gain can be realized with geriatric care. The role of geriatric care needs to be increased within the Hungarian healthcare system, together with addressing the shortage of experts, and clarification of the relations and coordination amongst macro-level systems, and different healthcare professions.]
Clinical Neuroscience
[During mental arithmetic operations working memory playsan important role, but there are only few studies in which anattempt was made to separate this effect from the process ofarithmetics per se. In this study the effects of arithmetic onthe EEG of young adults (14 participants, six of themwomen, mean age 21.57 years, SD: 2.62) was investigatedduring a subtraction task in the θ(4-8 Hz) frequency band.Besides the power density spectrum analysis phasesynchrony based on recently developed graph theoreticalmethods were used and strength of local connections (clustercoefficient; C) and global interconnectedness of network(characteristic path length; L) were determined. Before thearithmetic task passive viewing (control situation) and anumber recognition paradigms were used. During the arith-metic task compared to the control situation significantlyincreasing phase synchrony and C values were found. L wassignificantly shorter (F(2, 26)=818.77, p<0.0001) only dur-ing the arithmetic task: this fact and the former two resultsimply that the network topology shifted towards the “smallworld” direction. Our findings concerning regionaldifferences confirm those reported earlier in the literature:compared to the control condition significant task-relatedincrease was found in C values in the parietal areas [moreexplicitly in the left side, (F(1, 13)=7.2020, p=0.0188)],which probably corresponds to stronger local connectionsand more synchronized (sub)networks. During the task con-dition significantly increased θband power; (F(1,13)=7.9708, p=0.0144) and decreased L values werefound in the left frontal region compared to the right side(F(1, 13)=6.0734, p=0.0284), which can also be interpret-ed as an indicator of optimized network topology ofinformation processing.]
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Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease2.
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Hypertension and nephrology
[Treatment and care of hypertensive patients during and after the Covid-19 pandemic. Possibilities and effectiveness of telemedicine]4.
Hypertension and nephrology
[Post-career development of cardiometabolic changes and hypertension in competitive athletes]5.
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