Parkinson's disease cluster: the wind of change
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By: Ana Monteiro and João Massano
This paper aims at demonstrating that “Parkinson’s disease” (PD) is an umbrella designation for a number of heterogeneous
disorders sharing an important number of clinical features, but separated by significant differences.
In fact, PD should probably be regarded as a “Parkinson’s disease cluster”, and the core clinical features termed Parkinson
syndrome. Disease manifestations, genetic underpinnings, and pathological findings argue against a unique disease
process and, hence, a unique management approach, especially one that aims solely at the improvement of later (i.e.
motor) disease manifestations.
We propose that true therapeutic innovation in PD calls for a leap in concepts and shift in research efforts. Disease-specific
neuroprotective agents targeting early molecular and pathological events should ideally be developed.
Keywords: Parkinson's disease, Parkinson's disease cluster, Genetics, Pathophysiology, Neuropathology, Therapeutics,
Clinical trials, Neuroprotection.
International Journal of Clinical Neurosciences and Mental Health 2014; 1:7
Usefulness of Doppler ultrasound in ischemic “vertigo plus”
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By: J.M. de Bray, J.O. Fortrat, L. Laccoureye, and C. Verny
Vertigo is an illusion of a moving environment. Ischemic “vertigo plus” has additional focal neurological symptoms which are sometimes discrete.
Before an initial Doppler examination it is possible to analyze voice, audition, gait, and wave of the hands during history taking.
A patient presenting vertigo plus has to be considered as an emergency case (Stroke Unit).
The following pathologies may present with symptoms of “vertigo plus": (1) Latero-medullar infarction: vertigo and a nasal voice; (2) Infarction in the
posterior inferior cerebellar artery (PICA) territory—vertigo and severe ataxia and/or clumsiness of one hand; (3) Progressive infarction of the brainstem
with fluctuating symptoms as vertigo, diplopia, and transient hemiparesis; (4) Infarction in the distribution of the anterior inferior cerebellar artery
(AICA)—vertigo with unilateral hearing problems in 50% of the cases.
With condition (1) and (2) Doppler Ultrasound (DUS) is likely to find a distal obstruction of the ipsilateral vertebral artery, with (3) and (4) a basilar
artery stenosis or occlusion can be suspected and detected by DUS.
In conclusion, DUS is useful in vertigo plus, especially when the hospital does not have immediate access to magnetic resonance with angio. Anyway, DUS can
yield additional intracranial and cervical hemodynamic information, even after this technique.
Keywords: Vertigo, Vertebrobasilar stroke, Emergency, Doppler ultrasound, Transcranial Doppler sonography.
International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S09
Perinatal depression screening, prevention and early intervention: recent advances in Portugal
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By: Ana Telma Pereira, Mariana Marques, Cristiana Marques, Elisabete Bento, Julieta Azevedo, Sandra Xavier, Maria João Soares, and António Macedo
Perinatal depression (PD) is a significant public health concern, needing a more efficient detection, prevention and treatment. Experts in the area recently recommended universal psychosocial assessment programs that combine the evaluation of PD symptoms and psychosocial risk factors. Within a new research project, our team has been exploring this avenue to try to reduce the high negative impact of PD. Our aims are: (1) to analyze the predictive ability of a new instrument (Perinatal Depression Screening and Prevention Tool/PDSPTool) to assess both PD symptoms and risk factors previously validated/identified by our team; (2) to test the efficacy of prevention and/or early intervention program —Mother in Me (MIM), focused on psychoeducational and psychotherapy sessions focusing on Cognitive-Behavioral Therapy (CBT) and on exercises from the third generation CBT. The new instrument (PDSPT), includes the short version of the Postpartum Depression Screening Scale (adapted and validated for pregnancy) and other valid self-report questionnaires to assess the PD risk factors in Portuguese women: lifetime history of depression, prenatal insomnia and prenatal negative affect. The PDSPTool and the Diagnostic interview for Psychological Distress have been administered to pregnant women (third trimester), recruited in the primary health care centers and maternity hospitals, where the vast majority of Portuguese women have their pregnancy and puerperium followed. The effectiveness of the program will be tested at 5 weeks, 3 and 6 months postpartum, based on the PDSS cutoff points and on the administration of the interview.
Keywords: Perinatal depression, Risk Factors, Screening, Prevention, Intervention.
International Journal of Clinical Neurosciences and Mental Health 2016; 3:2
Endovascular therapy in acute stroke: directly to the catheter lab!
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By: Ana Inês Martins and João Sargento-Freitas
The recent compelling evidence of intra-arterial therapies in acute ischemic stroke have urged the revision of local algorithms in stroke units across the globe. In fact, in the presence of a proximal intracranial occlusion endovascular treatments reached unprecedented hemodynamic and functional efficacy in an otherwise problematic clinical scenario. Up until recently, the attempt to reperfuse the symptomatic area was limited to the “old” intravenous infusion of alteplase (IVtPA). Albeit its merits, the clinical impact caused is significantly impaired due to its narrow therapeutic window, extensive list of contra-indications and limited efficacy in large vessel occlusions.
In acute ischemic stroke with salvageable cerebral tissue a simplistic and pragmatic approach could define three main clinical scenarios: patients with contra-indication to IVtPA, patients with and those without large-vessel occlusions. For the first clinical scenario the answer is straightforward: to the catheter lab in all those with proximal occlusions. The answer is more troublesome in the advent of a large vessel occlusion without contra-indication to IVtPA. In this setting IVtPA has a reported recanalization rate of 10-20% with very limited clinical impact. On the other hand, it is not without side effects in the ischemic area, in remote cerebral areas as well as other organs susceptible to bleeding, not rarely in uncompressible locations. Ultimately, it may represent exposing the patient to potentially severe risks for minimal impact in the ischemic brain. For patients without proximal intracranial occlusions IVtPA is highly efficacious, rendering intra-arterial therapies as unnecessary.
In conclusion, IVtPA will remain the mainstay of acute stroke treatment for all those with clear clinical indications. However, the advent of intra-arterial therapies has had a dramatic impact on stroke algorithms worldwide. Particularly, in the subset of patients with large vessel occlusions the option of going straight to the catheter laboratory is appealing as it would prevent the use of a marginally effective therapy with rare but potentially severe complications, promoting the need for urgent intra-arterial recanalization.
Acute stroke, Fibrinolysis, Neurosonology
Special Issue on Controversies in Neurology. From the 10th World Congress on Controversies in Neurology (CONy), Lisbon, Portugal. 17–20 March 2016.
International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 1):S11
Life training for aging and migration
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By: Marta Gonçalves and Benjamin Cook
Immigrants tend to have better mental health than their host country-born counterparts, despite disadvantaged socioeconomic status—the so-called immigrant paradox. The acculturation hypothesis suggests a decline in their mental health over time in the host country. Increased perceived discrimination and family cultural conflict are pathways by which acculturation might relate to deterioration of mental health for immigrants. In this paper we will present an intervention approach, which proposes that a strategy for ensuring maintenance of mental health for immigrants is changing lifestyle. This approach called “Life Training: My 7 Core Areas of Health” is based on the theoretical model of Ralf Schwarzer—The Health Action Process Approach and works on psychological processes that are under behavioral change in seven areas of health: physical, psychological, social, spiritual, financial, family and leisure. This is a discussion paper in which two claims are made. First, that some migrants’ health can worsen as they age which is associated with their migrant status. Second, that there may be, as yet untested in this respect, models of health behavioral change, which can mitigate these risks.
Keywords: Immigrants, Mental health, Aging, Life training, Health behavior change, Health action process approach.
International Journal of Clinical Neurosciences and Mental Health 2016; 3:7