Clinical Neuroscience

[Early mental test - developing a screening test for mild cognitive impairment]

KÁLMÁN János, PÁKÁSKI Magdolna, HOFFMANN Ildikó, DRÓTOS Gergely, DARVAS Gyöngyi, BODA Krisztina, BENCSIK Tamás, GYIMESI Alíz, GULYÁS Zsófia, BÁLINT Magdolna, SZATLÓCZKI Gréta, PAPP Edina

JANUARY 25, 2013

Clinical Neuroscience - 2013;66(01-02)

[Background and purpose - Mild cognitive impairment (MCI) is a heterogenous syndrome considered as a prodromal state of dementia with clinical importance in the early detection of Alzheimer’s Disease. We are currently developing an MCI screening instrument, the Early Mental Test (EMT) suitable to the needs of primary care physicians. The present study describes the validation process of the 6.2 version of the test. Methods - Only subjects (n=132, female 95, male 37) over the age of 55 (mean age 69.2 years (SD=6.59)) scoring at least 20 points on Mini-Mental State Examination (MMSE), mean education 11.17 years (SD=3.86) were included in the study. The psychometric evaluation consisted of Alzheimer’s Disease Assessment Scale Cognitive subscale (ADAS-Cog) and the 6.2 version of EMT. The statistical analyses were carried out using the 17.00 version of SPSS statistical package. Results - The optimalised cut-off point was found to be 3.45 points with corresponding 69% sensitivity, 69% specificity and 69% accuracy measures. The Cronbach-α, that describes the internal consistence of the test was 0.667, which is higher as compared with the same category in the case of the ADASCog (0.446). A weak negative rank correlation was found between the total score of EMT 6.2 and the age of probands (rs=-0.25, p=0.003). Similarly, only a weak correlation was found between the education levels and the total score of EMT 6.2 (rs=0.31, p<0.001). Two of the subtests, the repeated delayed short-time memory and the letter fluency test with a motorical distraction task had significantly better power to separate MCI and control groups than the other subtests of the EMT. Conclusion - The 6.2 version of EMT is a fast and simple detector of MCI with a similar sensitivity-specificity profile to the MMSE, but this version of the test definitely needs further development.]



Further articles in this publication

Clinical Neuroscience

[The presentation of a transient hyperintense lesion with legionnaires disease in a patient, is it a coincidance or an incidental finding?]

KILIC Çoban Eda, AKSOY Selma, SAHIN Riza Ahmet, UZUN Nuray, GÖKYIGIT Münevver

[Up to date the presentation of transient splenial lesions in corpus callosum were reported in diffusion weighted magnetic resonance imaging (MRI) only in epileptic patients and patients under antiepileptic therapy. A 41 year old male with no previous medical history was admitted to our clinic with symptoms of pneumonia. The neurological exam revealed stupor, but when awake his speech and orientation were normal. There were no meningeal irritation signs, cranial nerves, piramidal and cerebellar functions were normal. He had moderate respiratory distress and had bilateral rales in lower lobes while oscultating. Laboratory tests revealed high liver function levels and high acute phase reactants. Arterial blood levels showed hypoxemia. A brain MRI showed a hypointensity in the splenium of corpus callosum on T1 weighted images. There was markedly increased signal in this region on diffusion weighted imaging and hypointense on ADC. The lesion was slightly hyperintense on T2 and FLAIR weighted images. A repeat brain MRI was done 30 days after the initial study and showed a complete resolution of the splenial lesion. Transient splenial lesions can be seen due to different mechanisms in different clinical settings. It should be noted that these lesions are mostly reversible. Unnecessary therapies and procedures should be avoided in these lesions.]

Clinical Neuroscience

[Editorial message]

KINCSES Zsigmond Tamás

Clinical Neuroscience

[Meeting of the management of Hungarian Epilepsy League]


Clinical Neuroscience

[Blood lipid peroxidation, antioxidant enzyme activities and hemorheological changes in autistic children]

LÁSZLÓ Aranka, NOVÁK Zoltán, SZÕLLÕSI-VARGA Ilona, HAI Quai Du, VETRÓ Ágnes, KOVÁCS Attila

[Objectives - Early infantile autism is a severe form of childhood psychiatric disease with characteristic symptoms. Hyperserotoninaemia in 43.5%, lactic acidosis 43% and hyperpyruvataemia in 30% were biochemically demonstrated in autistic children. Our earlier results led to the postulation that a disequilibrium in the blood redox is involved in infantile autism; the oxidative loading and the antioxidant defending enzyme system were investigated together with the hemorheological parameters in infantile autism. Methods - Malonyl-dialdehyde (MDA) endproduct of lipid peroxidation and activities of the antioxidant enzymes: superoxide dismutase (SOD), catalase (C-ase), glutathione peroxidase (GP-ase) and reduced glutathione (GSH) were biochemically determined from plasma and red blood cells. Patients - The antioxidant specificities were investigated in plasma and red blood cell haemolysate from 25 infantile autistic children. Results - Significantly increased superoxide dismutase (SOD) (2.89 vs. 1.32 U/mg protein, p<0.01) and decreased glutathione peroxidase (0.620 vs. 0.910 U/mg protein, p<0.01) levels as well as catalase (0.463 vs. 4.948 BU/mg protein, p<0.001) activities were detected; while the plasma and erythrocyte lipid peroxidation and the reduced glutathione (GSH) levels did not change. The results of the investigated prooxidant and the antioxidant status provide evidence that there exists an oxidative stress in children with infantile autism. While investigating the hemorheological parameters of 25 infantile autistic patients, some characteristic pathological parameters were detected: the initial filtration rate (Fi) (0.72 vs. 0.75 p<0,01) and the clogging rate (CR) (1.926 vs. 2.912, p<0.01) values of red blood cells (RBC) decreased while the mean transit time (Tc) (8.93 vs. 7.39, p<0.001) increased suggesting reduced RBC deformability.]

Clinical Neuroscience

[Intact short-term memory and impaired executive functions in obsessive compulsive disorder]

DEMETER Gyula, RACSMÁNY Mihály, CSIGÓ Katalin, HARSÁNYI András, NÉMETH Attila, DÖME László

[Background and purpose - Previous neuropsychological studies produced inconsistent results with tasks tapping short-term verbal and visual-spatial memory and executive functions in obsessive compulsive disorder (OCD). The aim of this study was to investigate the presence of deficits in these cognitive domains. A further goal was to describe the distribution of patients in different impairment ranges for all functions, and clarify the relationship between symptom severity and cognitive impairments. Methods - Thirty patients with OCD (DSM-IV) and 30 healthy volunteers were compared using well-known neuropsychological tasks. We assessed short-term verbal memory with the Digit Span Forward and Digit Span Backward Tasks, short-term visual-spatial memory with the Corsi Block Tapping Task, while we measured the level of executive functions with the StroopTask and the Wisconsin Card Sorting Test (WCST). Results - Compared with a matched healthy control group, the performance of OCD patients was in the impaired range only in the two executive tasks. We find a significant positive correlations between the Y-BOCS (Yale-Brown Obsessive Compulsive Scale) total scores and the number of perseverative responses (r(28)=0.409, p<0.05) and perseverative errors (r(28)=0.385, p<0.05) in the WCST. Conclusion - Our results gave evidence that executive functions are impaired while short-term memory is intact in OCD. This is in line with neuropsychological model of OCD that the deficit of cognitive and behavioral inhibition are responsible for the main cognitive findings of this disorder, most prevalently the deficit in set shifting and prepotent response inhibition.]

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Lege Artis Medicinae

[Alzheimer’s disease and arrhythmia: cause, effect, complication]

PETŐ Balázs, KOVÁCS Tibor

[Alzheimer’s disease (AD) is a new endemic of the 21st century which becomes the biggest health and social problem of the ageing societies in the next few decades. Vascular factors, such as cardiac arrhythmias, especially atrial fibrillation, play an important role in the pathogenesis of AD. Arrhythmias might develop as a consequence of AD, too, and they might be caused by the cholinergic medications used in the treatment of AD. In addition, AD has a major influence on the treatment of arrhythmias, especially atrial fibrillation. Because of these, AD and arrhythmias might accompany each other in the practice of several medical specialties; these interactions are reviewed in this paper. ]

Hypertension and nephrology

[Blood pressures of adolescents at screening program in Budapest]


[The Aim of the screening program was to investigate the blood pressure and the association with obesity, hypercholesterinaemia and increased body fluid in adolescents. Methods: A screening program was conducted during the period from April 2010 to May 2011.The screenings consisted of: blood pressure, heart rate, body composition determination, cholesterol, blood glucose, weight, height and BMI. Results: 2226 children fullfied all of the outlined criteria. Their range of age was between 14–18 years. The average systolic blood pressure was 126.34±12.55 Hgmm volt. At boys were higher 131.87±13.59 then at girls 117.49±5.69 Hgmm. The average diastolic blood pressure was 71.86±8.74 Hgmm. There were also higher at boys 72.61±9.17 then at girls 66.69±5.04 Hgmm. High systolic blood pressure (95%<) were 307/1326 cases at girls, and 403/876 cases at boys. High diastolic blood pressure were together with high systolic blood pressure, but less frequency. High diastolic blood pressure occurred at 85 girls and at 90 boys. Overweight and obes were 18.994% of girls and 15.26% of boys. The percentage of pathological high blood pressure was most frequent among boys and girls who are in the overweight group. The pathologically high level of body fat percentage appeared to be 12.98% among girls and 5.9% among boys. In elevated BMI groups the frequency of high body fat was 66% among girls and 81% among boys. The mean cholesterol was significantly higher in the overweight and obese group. Conclusions: Rates of hypertension and overweight and obesity are high in school children in Budapest, and increased bodyweight is a significant risk factor for hypertension. The results of the study will help to design preventive programmers.]

Lege Artis Medicinae


MŰZES Györgyi

[The cyclooxygenase (COX) metabolic pathway and prostaglandin production appear to play a causal role in the promotion and progression of human cancers. Recently COX-2 has received a great deal of interest since it is frequently overexpressed in a wide spectrum of cancers and precancerous lesions. Furthermore, elevated production of prostanoids (particularly PGE2) via COX-2 is associated with several pro-carcinogenic effects including increased proliferation, apoptosis resistance, tumor neoangiogenesis and invasiveness, host immunosuppression, and altered xenobiotic metabolism. Inhibitors of COX-1 and COX-2 (aspirin and most other nonsteroidal anti-inflammatory drugs) and of COX-2 alone (e.g. coxibs) have shown cancer preventive efficacy in epidemiological studies, experimental studies and in human clinical trials. Due to their improved side effect profile, COX-2 selective inhibitors appear to hold substantial promise for long-term administration in the setting of cancer prevention. Emerging data suggest that these agents may have potential in cancer treatment as well. In addition recent results indicate that COX-2 enzyme is also overexpressed in inflammatory processes of the central nervous system, e.g. in Alzheimer’s disease, so its suppression could offer a possible new therapeutic strategy even in the prevention and treatment of Alzheimer’s disease.]

LAM Extra for General Practicioners



[The development of malignous tumours is a prolonged, multistage process. The onset of clinical symptoms and subjective complaints is preceded by the preclinical detectable phase, during which the tumour does not cause any symptoms but it has some signs and can be detected by screening. Information on the tumour’s natural history is of practical importance for choosing the screening strategy. When evaluating screening results, the various biases related to biological reasons need to be taken into consideration.]

Clinical Neuroscience

To treat or not to treat, cheyne-stokes respiration in a young adult with vascular encephalopathy


Cheyne-Stokes respiration (CSR) is a form of sleep-disordered breathing characterised by recurrent central sleep apnoea alternating with a crescendo-decrescendo pattern of tidal volume, relatively rare observation in sleep labs. It is mainly seen in severe heart failure and stroke. We report the case of a young man with CSR after sudden onset of seizure in the context of hypertensive exacerbation leading to the diagnosis of a leukoencephalopathy, and comment on differential diagnoses, prognostic and therapeutic outcomes. The very uniqueness of this case consists in the extremely young age for developing a vascular encephalopathy in the absence of genetic diseases and without previous diagnose of hypertension. There is no adequate explanation for the origin of vascular encephalopathy; also there is lack of evidence regarding the benefits and modality of treatment for CSR in neurologic diseases. Thus, we were forced to find the best compromise in a nocturnal oxygen therapy and follow-up.