BACKGROUND

Magnetic resonance imaging (MRI) has gained increased diagnostic utility for patients with transient global amnesia (TGA), particularly for unwitnessed events or those with diagnostic uncertainty based on clinical grounds.

The objectives are first, to determine the demographic and comorbid conditions of TGA patients; second, to determine the percentage of MRI diffusion weighted imaging (MRI DWI) hippocampal lesions, their time relationship from symptom onset, and their morphological characteristics; and lastly, to determine the dementia visual rating scale scores on neuroimaging for these patients.

A total of 20 TGA patients in a tertiary hospital from 2018 to 2022 were included in this retrospective study, and their medical records and neuroimaging were reviewed.

TGA patients had a mean age of 61.4 years and a female predominance. Prevalent comorbid conditions include hypertension, dyslipidemia, and diabetes, and the majority were discharged with antithrombotic medications. An emotionally triggering event was identified in 15% (n = 3). Mean symptom onset-to-scan time was 8.33 h, and one patient (detection rate of 5%) who underwent neuroimaging after 21.7 h demonstrated typical punctate hippocampal DWI hyperintensity. None exhibited significant cortical atrophy.

TGA patients showed female predominance, occurring mostly within the 5th–6th decade, with a moderate prevalence of vascular risk factors and absence of significant cerebral atrophy based on the Dementia Visual Rating Scales. A conventional MRI protocol yielded a 5% detection rate with a delay of 21 h from symptom onset. Hence, in a resource-limited setting such as the Philippines, it may be suggested, with limited evidence, that performing the procedure in TGA patients when the event is unwitnessed or uncertain could be reasonable, as correctly diagnosing TGA has therapeutic implications. Further studies may investigate prospectively the diagnostic utility of MRI, neuropsychological profile, and estimate cardiovascular and cognitive deterioration risk.

Previous studies have proposed two cognitive mechanisms responsible for the Ebbinghaus illusion effect, i.e., contour interaction and size contrast. However, the neural underpinnings of these two mechanisms are largely unexplored. The present study introduced binocular depth to the Ebbinghaus illusion configuration and made the central target appear either in front of or behind the surrounding inducers in order to disturb size contrast instead of contour interaction. The results showed that the illusion effect, though persisted, was significantly reduced under the binocular depth conditions. Notably, the target with a larger perceived size reduced early alpha-band power (8-13 Hz, 0-100 ms after stimulus onset) at centroparietal sites irrespective of the relative depth of the target and the inducers, with the parietal alpha power negatively correlated with the illusion effect. Moreover, the target with a larger perceived size increased the occipito-parietal beta-band power (14-25 Hz, 200-300 ms after stimulus onset) under the no-depth condition, and the beta power was positively correlated with the illusion effect when the depth conditions were subtracted from the no-depth condition. The findings provided neurophysiological evidence in favor of the two cognitive mechanisms of the Ebbinghaus illusion by revealing that early alpha power is associated with low-level contour interaction and late beta power is linked to high-level size contrast, supporting the claim that neural oscillations at distinct frequency bands dynamically support different aspects of visual processing.
Humans ; Alpha Rhythm/physiology* ; Female ; Male ; Size Perception/physiology* ; Young Adult ; Adult ; Beta Rhythm/physiology* ; Photic Stimulation/methods* ; Illusions/physiology* ; Optical Illusions/physiology* ; Depth Perception/physiology*

Humans ; Cerebral Cortex ; Hallucinations/pathology* ; Neurodegenerative Diseases/pathology* ; Atrophy/pathology* ; Magnetic Resonance Imaging

Wernekink commissure syndrome is a rare midbrain syndrome with bilateral cerebellar dysfunction,eye movement disorder,and palatal myoclonus.Few cases of this syndrome have been reported in China,let alone those combined with hallucinations and involuntary groping.This paper reports the diagnosis and treatment of a case of Wernekink commissure syndrome with hallucinations and involuntary groping,aiming to enrich the knowledge about this disease for clinicians.
Humans ; Mesencephalon ; Ocular Motility Disorders/diagnosis* ; Spinal Cord ; Syndrome ; Hallucinations

Objective: As part of the thrust towards Universal Health Care, the Philippines has enhanced health insurance coverage for rehabilitation with recent introductions of benefits for disabilities in children, prostheses, and orthoses. The project aimed to develop a functionality-based framework to guide comprehensive benefits for rehabilitation services for adult Filipinos. Methods: Scoping review was conducted to identify common rehabilitation conditions, frameworks for clinical assessment, and essential services for rehabilitation. Key informant interviews and focus group discussions were conducted with targeted rehabilitation service providers and experts to validate the information collected. A unified pathway of care and essential services for the provision of rehabilitation medicine services was developed through triangulation. The study was conducted from October 2018 to September 2019, with activities done in Metro Manila. Results: The results summarized treatment pathways for four major disease categories: neurologic, musculoskeletal, chronic pain, and activities of daily living/ cardiopulmonary. Impairments were identified reflecting the principles from the International Classification of Function. Disabilities were categorized based on function: mobility, self-care, cognitive-behavioral, and communication. A unified care pathway was developed to harmonize rehabilitation assessment, management, and care. A framework to simplify financial coverage was likewise provided. The extent of management (e.g., duration of therapy) depends on the severity of the disability classified as mild, moderate, or severe. Based on this classification, essential management modalities included physiatry interventions, medications, and rehabilitation sessions, supported by outcomes evaluation. Conclusion A framework is proposed to guide the design and implementation of benefits and health insurance coverage. Awareness and application of this approach among rehabilitation practitioners and health facilities are essential steps for successful uptake and implementation of the upcoming expansion in PhilHealth coverage.
Rehabilitation ; Rehabilitation of Speech and Language Disorders ; Neurobehavioral Manifestations ; Cognitive Behavioral Therapy ; Behavioral Symptoms ; Communication Disorders ; Insurance, Major Medical

OBJECTIVES: Major depressive disorder (MDD) patients with anhedonia tend to have a poor prognosis. The underlying imaging basis for anhedonia in MDD remains largely unknown. The relationship between nodal properties and anhedonia in MDD patients need to be further investigated. Herein, this study aims to explore differences of cerebral functional node characteristics in MDD patients with severe anhedonia (MDD-SA) and MDD patients with mild anhedonia (MDD-MA) before and after the antidepressant treatment. METHODS: Ninety participants with current MDD were recruited in this study. 24-Item Hamilton Depression Scale (HAMD-24) and Snaith-Hamilton Pleasure Scale (SHAPS) were used to assess the severity of depression and anhedonia at baseline and the end of 6-months treatment. The MDD patients who scored above the 25th percentile on the SHAPS were assigned to an MDD-SA group (n=19), while those who scored below the 25th percentile were assigned to an MDD-MA group (n=18). All patients in the 2 groups received antidepressant treatment. Functional magnetic resonance imaging (fMRI) images of all the patients were collected at baseline and the end of 6-months treatment. Graph theory was applied to analyze the patients' cerebral functional nodal characteristics, which were measured by efficiency (e_i) and degree (k_i). RESULTS: Repeated measures 2-factor ANCOVA showed significant main effects on group on the e_i and k_i values of left superior frontal gyrus (LSFG) (P=0.003 and P=0.008, respectively), and on the e_i and k_i values of left medial orbital-frontal gyrus (LMOFG) (P=0.004 and P=0.008, respectively). Compared with the MDD-MA group, the significantly higher e_i and k_i values of the LSFG (P=0.015 and P=0.021, respectively), and the significantly higher e_i and k_i values of the LMOFG (P=0.015 and P=0.037, respectively) were observed in the MDD-SA group at baseline. Meanwhile, higher SHAPS scores could result in higher e_i and k_i values of LSFG (P=0.019 and P=0.026, respectively), and higher e_i value of LMOFG (P=0.040) at baseline; higher SHAPS scores could result in higher e_i values of LSFG (P=0.049) at the end of 6-months treatment. The multiple linear regression analysis revealed that sex were negatively correlated with the e_i and k_i values of LSFG (r= -0.014, P=0.004; r=-1.153, P=0.001, respectively). The onset age of MDD was negatively correlated with the k_i value of LSFG (r=-0.420, P=0.034) at the end of 6-months treatment. We also found that SHAPS scores at baseline were positively correlated with the HAMD-24 scores (r=0.387, P=0.022) at the end of 6-months treatment. CONCLUSIONS There are obvious differences in nodal properties between the MDD-SA and the MDD-MA patients, such as the high e_i of LSFG in the MDD-SA patients, which may be associated with the severity of anhedonia. These nodal properties could be potential biomarkers for the prognosis of MDD. The increased e_i and k_i values in the LSFG of MDD-SA patients may underlie a compensatory mechanism or protective mechanism. The mechanism may be an important component of the pathological mechanism of MDD-SA. The poor prognosis in the MDD-SA patients suggests that anhedonia may predict a worse prognosis in MDD patients. Sex and onset age of MDD may affect the nodal properties of LSFG at baseline and the end of 6-months treatment.
Anhedonia ; Antidepressive Agents/therapeutic use* ; Depressive Disorder, Major/drug therapy* ; Humans ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Prefrontal Cortex

PURPOSE: This study aimed to examine the effects of subjective memory complaints, depression and cognitive function on performance of activities of daily living (ADL) in individuals with mild cognitive impairment (MCI). METHODS: A total sample consisted of 250 MCI patients diagnosed within one year. All participants were assessed with a battery of standardized neuropsychological tests, self-report measures of subjective memory complaints and depression, and performance of basic and instrumental ADL. Correlational and multiple linear regression analyses were conducted to identify the factors associated with performance of basic and instrumental ADL, respectively. RESULTS: Executive function and depression explained 9.4% of the variance in basic ADL. Reduced executive function and greater depressed mood were associated with worse performance on basic ADL. Executive function, subjective memory complaints, and time since onset of cognitive symptoms accounted for 22.2% of the variance in instrumental ADL in individuals with MCI. Lower executive function (t=−2.02, p=.044), greater memory complaints (t=5.36, p<.001), and longer periods of experiencing cognitive symptoms (t=2.24, p=.026) were associated with worse instrumental ADL performance. CONCLUSION: These results may help healthcare professionals develop interventions to improve cognitive outcomes with better understanding of the relationship among cognition, mood, and behavioral performance in individuals with MCI.
Activities of Daily Living ; Cognition ; Delivery of Health Care ; Depression ; Executive Function ; Humans ; Linear Models ; Memory Disorders ; Memory ; Mild Cognitive Impairment ; Neurobehavioral Manifestations ; Neuropsychological Tests

BACKGROUND: While various screening tools are available for depression, they are not feasible in clinical practice because of their excessive number of questions. The Patient Health Questionnaire-2 (PHQ-2) consists of two questions gauging the frequency of depressed mood and anhedonia over the past two weeks. This study aimed to assess the usefulness of the PHQ-2 as a brief screening tool for depression.METHODS: This study used Korean National Health and Nutrition Examination Survey data from 2014, and the study population consisted of 4,946 individuals. We analyzed the validity of the PHQ-2 compared with ‘depression by PHQ-9,’ and obtained the optimal cut point for screening depression. The agreement between PHQ-2 and depression by PHQ-9 and the agreement between PHQ-2 and ‘currently diagnosed as depression’ were analyzed using Cohen's kappa. The correlation between EuroQol-5D (EQ-5D) index scores and PHQ-2 scores was analyzed using Student's t-test.RESULTS: Using ‘depression by PHQ-9’ as the criterion standard, PHQ-2 scores ≥2 had a sensitivity of 89% and a specificity of 87%, and a receiver operating characteristic analysis identified PHQ-2≥2 as the optimal cut point for screening. The agreement between PHQ-2 and depression by PHQ-9 was 0.430 when PHQ-2 ≥2 was used as a cut point. The agreement between PHQ-2 and ‘depression by questionnaire’ was poor. The EQ-5D index score of the depressive group was significantly lower than that of the normal group.CONCLUSION: The PHQ-2 is an effective measure for screening depression and is expected to be useful in busy clinical settings.
Anhedonia ; Depression ; Humans ; Mass Screening ; Nutrition Surveys ; ROC Curve ; Sensitivity and Specificity ; Surveys and Questionnaires

Adult ; Brain ; diagnostic imaging ; physiopathology ; Diffusion Tensor Imaging ; Female ; Hallucinations ; diagnostic imaging ; physiopathology ; Humans ; Magnetic Resonance Imaging ; Male ; White Matter ; diagnostic imaging ; physiopathology ; Young Adult

Dementia ; pathology ; Hallucinations ; pathology ; Humans ; Lewy Body Disease ; pathology ; Nerve Net ; pathology