Clinical Neuroscience

[Diabetes, dementia, depression, distress]

SZATMÁRI Szabolcs1,2, ORBÁN-KIS Károly3, MIHÁLY István2, LÁZÁR Alpár Sándor4

SEPTEMBER 30, 2017

Clinical Neuroscience - 2017;70(09-10)


[The number of people living with diabetes continues to rise. Therefore neurologists or other health care practitioners may be increasingly faced with comorbid neuropsychiatric disorders commonly presented by diabetic patients. More recently there has been an increasing research interest not only in the interactions between diabetes and the nervous system, the fine structure and functional changes of the brain, but also in the cognitive aspects of antidiabetic treatments. Patients with both types of diabetes mellitus may show signs of cognitive decline, and depression. Comorbid insomnia, anxiety, and distress may also occur. The bi-directional relationships between all these phenomena as well as their connection with diabetes can lead to further health and quality of life deterioration. Therefore it is important that all practitioners involved in the care of diabetic patients recognize the presence of comorbid neuropsychiatric disturbances early on during the healthcare process. Identifying higher risk patients and early screening could improve the prognosis of diabetes and may prevent complications.]


  1. Marosvásárhelyi Orvosi és Gyógyszerészeti Egyetem, Neurológiai Tanszék, Marosvásárhely, Románia
  2. Maros Megyei Sürgôsségi Kórház, 2. Sz. Neurológiai Klinika, Marosvásárhely, Románia
  3. Marosvásárhelyi Orvosi és Gyógyszerészeti Egyetem, Élettani Tanszék, Marosvásárhely, Románia
  4. University of East Anglia, Faculty of Medicine and Health Sciences, Norwich, UK



Further articles in this publication

Clinical Neuroscience

[The Multiple Sclerosis Registry of Szeged]

BENCSIK Krisztina, SANDI Dániel, BIERNACKI Tamás, KINCSES Zsigmond Tamás, FÜVESI Judit, FRICSKA-NAGY Zsanett, VÉCSEI László

[Multiple sclerosis (MS) is a rare disease of the central nervous system considering the total population, the prevalence in Hungary is 83.9/100.000. The first MS registry was established in Denmark in the middle of the 1950’s. This was followed by the establishment of several national, then international databases with the number of enrolled patients in the hundred-thousands. At the beginning, the primary goal of the registries were the epidemiological surveys, focusing on the number of patients, the prevalence, the incidence, the mortality and the co-morbidity. As of today, however, with the rapid advancement and development of new disease modifying therapies (DMT) with different effectiveness and adverse reactions, the therapeutic use of the registries became even more essential: the modern, up-to-date, well established registries become integral part of the DMTs’ monitorization. The Multiple Sclerosis Registry of Szeged was first established as a “paper-based” database, then, in 2012, it was upgraded to an electronic, easily contactable and useable internet-based registry. As of today, it contains the socio-demographic and clinical data of more than 600 patients; we constantly add new patients as well as keep the registry up-to-date with the refreshment of old patients’ data. Aside from the “classical” clinical data, it can be used for the recording and assessment of the MRI scans and the data on psychopathological and quality of life assessments, which are becoming more and more important in everyday MS management. The establishment of the internet-based registry incredibly helped both the monitorization of the effectiveness of DMTs, and the success of the new epidemiological and psychopathological surveys. ]

Clinical Neuroscience

Health anxiety mediates the connection between somatosensory amplification and self-reported food sensitivity

ELIESON M. Linn, DÖMÖTÖR Zsuzsanna, KÖTELES Ferenc

Background - The frequency of self-reported food sensitivity (SFS) is increasing, and has a negative impact on the well-being and everyday functioning of the affected people. A considerable proportion of SFS cannot be medically explained. The lack of knowledge of its origin and treatment causes further stress in those affected. Purpose - This study aims to get a better understanding of the psychological background of the condition. Methods - A non-representative community sample (N=335; age: 35.1±13.18 yrs; 75.8% female) completed an English on-line questionnaire assessing somatosensory amplification, health anxiety, modern health worries (MHWs), beliefs concerning the scientific validity of complementary and alternative medicine (CAM), holistic beliefs on health and illness. Results - In multiple binary logistic regression analyses, SFS were associated with CAM related beliefs, somatosensory amplification, and health anxiety after controlling for age and gender. The connection between somatosensory amplification and SFS were completely mediated by health anxiety. No differences between the two groups were found with respect to MHWs, worries about the harmful effects of various artificial components in food, and holistic health beliefs. Discussion: More positive attitudes toward CAM might be based on the lack of conventional treatment, rather than on higher levels of MHWs or a more holistic worldview. Both the existence of symptoms and the presence of health anxiety might be needed for the development and maintenance of SFS. Conclusions - The findings support the notion that somatosensory amplification and health anxiety might play a role in the development and maintenance of SFS.

Clinical Neuroscience

Correlation of vitamin D levels with electrophysiological findings and pain in the patients with Carpal Tunnel Syndrome


Objective - This study aimed to assess the correlation between vitamin D deficiency and electrophysiological findings and pain level in patients with symptoms of carpal tunnel syndrome (CTS). Patients and method - A total of 131 patients with symptoms of CTS, 70 with vitamin D deficiency and 61 without vitamin D deficiency, were included in the study. Using demographic data and findings from electrophysiological examinations, the patients were divided into two groups based on their vitamin D level (Group 1: <20 ng/ml; Group 2: ≥20 ng/ml). The Boston Carpal Tunnel Syndrome Questionnaire was used to assess their CTS- related pain level. Results - Although the rate of CTS in the patients with a low vitamin D level was found to be high, no statistically significant correlation was observed between low vitamin D level and the frequency and severity of CTS. Additionally, the pain and functional loss ratio induced by CTS was found to be higher in the group with a lower vitamin D level than in the group with normal levels. Conclusion - Low vitamin D levels may increase the severity of CTS symptoms. Treatment of vitamin D deficiency in patients with CTS can play a role in reducing pain and disability.

Clinical Neuroscience

[Current diagnosis and treatment of idiopathic intracranial hypertension]

SALOMVÁRY Bernadett, PÁNCZÉL Gyula, MARKIA Balázs, NAGY Gábor

[Background - Idiopathic intracranial hypertension is cha-racterized by raised intracranial pressure of unknown origin, leading to persisting visual loss if left untreated. Purpose - We assessed timing of surgery, and the efficacy and safety of ventriculo-peritoneal shunt. Methods - Retrospective analysis of 65 patients treated at our Neuro-ophthalmology Clinic between 2009 and 2017. Patients - We treated 15 children and 50 adults, 42 patients conservatively, and 23 surgically. The median age at presentation was 27 years for adults, 88% were obese, and 86% female. The age of children was 5-17 years, 40% were obese, and 53% girl. The commonest presentation symptom was headache in both groups (64%), followed by obscuration (33%), and double vision (22-31%). Subjective visual loss was only experienced in the surgical group (50%). The time until diagnosis was 2 weeks in both groups. However, the conservative group presented to our institute significantly earlier (3 weeks), than the surgical group (8 weeks). The follow-up time was 25 months. Results - In the conservative group papilla edema was 2D, visual acuity ≥0.7, and visual field loss was only mild. Time to cure was 3 months. In the surgical group both preoperative papilla edema (3D), and visual function were significantly worse. Indications for surgery were papilla edema, deteriorating visual function or relapse resistant to conservative treatment. Papilla edema disappeared 3 months after surgery, and visual field deficit improved significantly. We detected significant improvement in all aspects of visual function even at first neuro-ophthalmic control 4 days after surgery. However, visual acuity only improved in cases of preoperative acuity ≥0.3. Shunt revision occurred in 17%, and shunt infection in 8.5%. One patient suffered from persistent visual deterioration after surgery, and asymptomatic complication (epidural hematoma) was found in another patient. There was no surgical mortality. Conclusions - This is a curable condition with early diagnosis and adequate treatment, and persistent visual loss can be prevented. Surgery is effective and safe, close neuro-ophthalmic monitoring is mandatory for its optimal timing. Visual function of all patients can be preserved when operated on in time, whereas severe visual loss appears to be irreversible despite surgery.]

Clinical Neuroscience

Does the comparison of median-to-ulnar nerve sensory conduction add an additional value in electrodiagnosis of carpal tunnel syndrome?

ÖZGÜR Selek, MURAT Alemdar

Background and purpose - Distal sensory onset latency (DSOL), conduction velocity (SCV) and nerve action potential (SNAP) amplitudes are used in electrodiagnosis of carpal tunnel syndrome (CTS) beside motor conduction data. The aim of our study is to search whether the comparison of median-to-ulnar nerve sensory conduction adds an additional diagnostic value in CTS or not. Methods - Median and ulnar nerve were stimulated on wrist, and SNAPs were recorded on second and fifth fingers, respectively. Best cut-off points for the searched parameters and their diagnostic efficiencies were determined. The cut off points were also stratified according to the age and gender, and their diagnostic efficiencies were calculated again. Results - The study includes 415 hands belong to 344 subjects. Best cut off points for median nerve DSOL and SCV were 2.7 msec and 49.0 m/sec with the diagnostic efficiencies of 87.7% and 88.7%, respectively. Best cut off points for DSOL difference and SCV difference were 0.62 msec and 4.0 m/sec, and efficiencies were 89.6% and 84.3%, respectively. Conclusion - Determining the relative elongation of median nerve DSOL to the ulnar nerve one has a little additional value in electrodiagnosis of CTS, whereas any additional value is not obtained from SCV comparison.

All articles in the issue

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Clinical Neuroscience

Evaluation of anxiety, depression and marital relationships in patients with migraine


Aim - The aim of this study was to evaluate the frequency and characteristics of attacks in patients with migraine, to determine the effects of anxiety or depressive symptoms, and to evaluate the marital relationships of patients with migraine. Method - Thirty patients who were admitted to the neurology outpatient clinic of our hospital between July 2018 and October 2018 and were diagnosed with migraine according to the 2013 International Headache Society (IHS) diagnostic criteria were included in this cross-sectional study. Age, sex, headache frequency and severity, depressive traits, marital satisfaction and anxiety status were examined. We used the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maudsley Marital Questionnaire (MMQ) and Visual Analogue Scale (VAS) for measuring relevant parameters. Results - The mean severity of migraine pain according to VAS scale was 6.93 ± 1.41 and the mean number of migraine attacks was 4.50 ± 4.24. The mean BDI score of the patients was 12.66 ± 8.98, the mean MMQ-M score was 19.80 ± 12.52, the mean MMQ-S score was 13.20 ± 9.53, the mean STAI-state score was 39.93 ± 10.87 and the mean STAI-trait score was 45.73 ± 8.96. No significant correlation was found between age, number of migraine attacks, migraine duration, migraine headache intensity, and BDI, STAI and MMQ scores (p>0.05). But there was a positive correlation between MMQ-S and scores obtained from the BDI and STAI-state scales (p<0.05). Conclusion - In this study more than half of the migraine patients had mild, moderate or severe depression. A positive correlation was found between sexual dissatisfaction and scale scores of depression and anxiety.

Clinical Neuroscience

[The application of RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) in neurocognitive testing of patients suffering from schizophrenia and dementia]

JUHÁSZ Levente Zsolt, KEMÉNY Katalin, LINKA Emese, SÁNTHA Judit, BARTKÓ György

[Introduction - The purpose of our study was to find out whether the Hungarian adaptation of the RBANS (Repeatable Battery for the Assessment of Neuropsychological Status), a brief neurocognitive screening test, is appropriate for the differentation of healthy and non-healthy subject groups, or for the detection of differences between the cognitive performance of patient groups. Patients and method - The test battery was administrated to 38 healthy subjects, 69 schizophrenic patients, and 18 patients suffering from dementia (10 probable Alzheimer-type and eight vascular dementia). Results - There was a significant decrease of performance in all patient groups compared to the healthy group. In the schizophrenic group, the test indicated a deterioration of functioning in all cognitive areas. The patient group with Alzheimer-type dementia performed only slightly better than the schizophrenic group, because the fall of performance was not significant only one of the cognitive areas (in the visuo-spatial tasks) when compared to the healthy group. There was no difference between the performance of patients with vascular dementia and that of healthy subjects in direct memory, verbal and visuo-spatial tasks. The test results indicated an even deterioration of cognitive areas in patients with Alzheimer-type dementia. As for the vascular dementia group, the most vulnerable area proved to be that of attention, while their verbal functions were relatively spared. The deterioration in other cognitive functions shown by schizophrenic subjects was more moderate, but still significant. A comparison of the RBANS scores of the schizophrenic patients in our study and the result of an American study was also carried out. The global indeces showed no difference; only the pattern of the sub-scales was a little different. Conclusion - The Hungarian version of the RBANS seems appropriate for the differentiation of healthy and deteriorated cognitive performance in a Hungarian patient population.]

Lege Artis Medicinae

[The effects of angiotensin receptor blockers on the nervous system in hypertension and dementia]


[The renin-angiotensin system (RAS) is one of the most important mechanisms regarding the pathomechanism and treatment of hyprtension. The most of the elements of the RAS are found in the nervous system too. The effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ARBs) is based on the inhibition of the RAS. ARBs might have a special role in the central nervous system because they do not decrease the production of angiotensin but inhibit its harmful effects mediated through the AT1 receptor while allowing the stimulation of AT2 receptors with resulting pleiotrophic actions. Hypertension is the most important risk factor for stroke and has a negative effect on cognitive functions. Antihypertensive treatment has an effect on the nervous system; in addition to the consequences of the reduced blood pressure, ARBs might provide additional advantages in stroke and dementia prevention.]

Hypertension and nephrology

[The significance of depressive disorders in patients with chronic kidney diseases]

ZALAI Dóra Márta, SZEIFERT Lilla, NOVÁK Márta

[In this article a practice-oriented narrative review of the depressive disorders in chronic kidney disease is provided. Depressive disorders affect approximately one fourth of the chronic kidney disease population. These mental disorders interfere with physical, cognitive and social functioning and are associated with poor prognosis of patients with chronic kidney disease. Bio-psycho-social factors, including immuno-inflammatory processes, disturbance in glucose- insulin homeostasis, sleep disorders, chronic pain, sexual difficulties, changes in social roles, losses in multiple areas of life and low social support increase the risk for the development of depression. Routine, regular screening of depression in the chronic kidney disease population seems to be warranted. Only limited published evidence is available on the therapeutic possibilities of depression in chronic kidney disease. Preliminary evidence indicates that short, structured psychotherapy may be effective for acute treatment and prevention of psychological distress. Some antidepressants can be applied without the need for dose adjustments. On the other hand, some of the psychotropic medications require dose reduction or should be avoided.]

Lege Artis Medicinae

[Psychoendocrine aspects of chronic stress, depression and eating disorders]


[The brain is not only a central organ, but also a target of stress-related events. During chronic stress, many somatic and psychiatric disorders could be initiated by the decreased allostatic or adaptive abilities of the individual. The brain is involved in the regulation of stress-related events via hormones, neuropeptides, monoamines and cytokines. A number of endocrine diseases or hormonal changes are associated with behavioural, vegetative and emotional alterations, which occasionally lead to psychological disturbances, for example depression. The endocrine background is also reflected by the medical treatment of psychiatric patients, as demonstrated by the use of selective serotonin-reuptake inhibitors, and estrogen or levothyroxine substitution therapies. The psychiatric disorders presented here, such as the various forms of depression and eating disorders (anorexia and bulimia nervosa) are highlighted because of their frequencies and lifethreatening nature. By describing these disorders, we wish to aid their early diagnosis and treatment and to help incorporate them into everyday clinical practice.]