Diffusion tension imaging is a good tool for assessing patients with dementia and behavioral problems and discriminating them from other dementia patients

Background Dementia is one of the leading public health concerns as the world’s population ages. Although Alzheimer’s disease (AD) is the most common dementia diagnosis among older patients, some patients have additional behavioral symptoms. It is therefore important to provide an exact diagnosis, both to provide the best possible treatment for patients and to facilitate better understanding. Purpose To investigate whether magnetic resonance imaging (MRI) with fractional anisotropy (FA) can accurately find patients with behavioral symptoms within a group of AD patients. Material and Methods Forty-five patients from the geriatric outpatient clinic were recruited consecutively to form a group of patients with AD and behavioral symptoms (AD + BS) and a control group of 50 patients with established AD. All patients had a full assessment for dementia to establish the diagnosis according to ICD-10. MRI included 3D anatomical recordings for morphometric measurements, DTI for fiber tracking, and quantitative assessment of regional white matter integrity. The DTI analyses included computing of the diffusion tensor and its derived FA index. Results We found a significant difference in FA values between the patient groups’ frontal lobes. The FA was greater in the study group in both left (0.39 vs 0.09, p < 0.05) and right (0.40 vs 0.16, p < 0.05) frontal lobes. Conclusion MRI with FA will find damage in frontal tracts and may be used as a diagnostic tool and be considered a robust tool for the recognizing different types of dementia in the future.

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Multiple sclerosis and depressive manifestations: can diffusion tensor MR imaging help in the detection of microstructural white matter changes?

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0033-8 ◽

2019 ◽

Vol 50 (1) ◽

Cited By ~ 2

Author(s):

Talaat A. Hassan ◽

Shaima Fattouh Elkholy ◽

Bahaa Eldin Mahmoud ◽

Mona ElSherbiny

Keyword(s):

Multiple Sclerosis ◽

Depressive Symptoms ◽

White Matter ◽

Limbic System ◽

Diffusion Tensor ◽

Control Group ◽

Uncinate Fasciculus ◽

White Matter Tracts ◽

Significant Difference ◽

The Right

Abstract Background Multiple sclerosis is one of the commonest causes of neurological disability in middle-aged and young adults. Depression in MS patients can compromise cognitive functions, lead to suicide attempts, impair relationships and reduce compliance with disease-modifying treatments. The aim of this study was to investigate and compare the microstructural changes in the white matter tracts of the limbic system in MS patients with and those without depressive manifestations using a diffusion tensor imaging (DTI) technique. Methods This study included 40 patients who were divided into three groups. Group 1 comprised of 20 patients with relapsing-remitting MS with depressive symptoms and group 2 comprised 10 MS patients without symptoms of depression. The third group is a control group that included 10 age-matched healthy individuals. All patients underwent conventional MRI examinations and DTI to compare the fractional anisotropy (FA) values in the white matter tracts of the limbic system. Results We compared the DTI findings in MS patients with and those without depressive symptoms. It was found that patients with depression and MS exhibited a significant reduction in the FA values of the cingulum (P < 0.0111 on the right and P < 0.0142 on the left), uncinate fasciculus (P < 0.0001 on the right and P < 0.0076 on the left) and the fornix (P < 0.0001 on both sides). No significant difference was found between the FA values of the anterior thalamic radiations in both groups. Conclusion Patients with depression and MS showed more pronounced microstructural damage in the major white matter connections of the limbic pathway, namely, the uncinate fasciculus, cingulum and fornix. These changes can be detected by DTI as decreased FA values in depressed MS patients compared to those in non-depressed patients.

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The Positive Association Between Metatarsal Length and Meary’s Angle and Hammertoe Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00302 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0030

Author(s):

Jesse King ◽

Chris M. Stauch ◽

Ryan M. Ridenour ◽

Umur Aydogan

Keyword(s):

Average Length ◽

Articular Surface ◽

Positive Association ◽

Lower Extremity Injury ◽

Control Group ◽

First Metatarsal ◽

Diagnosis Codes ◽

Radiographic Measurements ◽

Significant Difference ◽

Icd 10

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Hammertoe deformities are the most common pathology of the forefoot, accounting for up to 48% of all forefoot operations. There is currently limited evidence documenting differences in foot radiographs and radiographic measurements that may represent a predisposition to developing hammertoe deformity. The purpose of this study was to investigate whether patients with hammertoe deformity demonstrate increased radiographic measurements of first, second, or third metatarsal (MT) lengths as well as Meary’s angle compared to a healthy control group. Methods: Following IRB approval, an institutional radiology database was queried from January 2009-2018 for patients with ICD- 9 and ICD-10 diagnosis codes for hammertoe deformity of the 2nd or 3rd phalange. Control cases were selected using diagnosis codes for acute plantar fascial pain in the same timeframe with medical record review to exclude patients with prior lower extremity injury, surgery or pathology. 234 hammertoe and 110 control patients met inclusion and exclusion criteria. Automated 1:1 case-control matching was performed to control for age, sex and laterality. Following matching, the sample size consisted of 80 patients in each cohort. Proximal to distal end-to-end articular surface radiographic lengths were documented for metatarsals and phalanges of the 1st, 2nd and 3rd rays on anteroposterior radiographs. Lateral talar-first metatarsal (Meary’s) angle was measured using weightbearing sagittal radiographs by calculating the angle formed by lines that bisect the talar neck and anatomic neck of the first metatarsal. Results: A total of 160 patients (80 cases and 80 controls) were included in the study. Mean age was 47.7 years among hammertoe cases and 47.5 years among controls (p=0.92). 54 of 80 cases in each group were female. There was a statistically significant increase in the average Meary’s angle among hammertoe patients (5.23 +- 8.60°) compared to controls (2.15 +- 5.96°) (p<0.01). The average length for the 1st, 2nd and 3rd metatarsals were 65.6, 80.0, and 76.7 mm, respectively for the hammertoe patients and 62.8 mm, 76.0 mm, and 73.5 mm among control cases, respectively. For all three metatarsals, this difference was statistically significant (p<0.01; Table 1). There was no statistically significant difference between lengths of the proximal or distal phalanges. Conclusion: Patients with hammertoe deformity were associated with an increased length on the 1st, 2nd and 3rd metatarsals. Also, these patients demonstrated an increased Meary’s angle creating pes planus deformity. These results illustrate the importance of both medial column instability and long metatarsal length in the development of hammertoe deformity. [Table: see text]

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Evaluation of white matter in patients with multiple sclerosis through diffusion tensor magnetic resonance imaging

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2007000400002 ◽

2007 ◽

Vol 65 (3a) ◽

pp. 561-564 ◽

Cited By ~ 10

Author(s):

Rachel E. Maia de Andrade ◽

Emerson L. Gasparetto ◽

Luiz Celso Hygino Cruz Jr. ◽

Fabiana Brito Ferreira ◽

Roberto Cortês Domingues ◽

...

Keyword(s):

Multiple Sclerosis ◽

White Matter ◽

Magnetic Resonance ◽

Mr Imaging ◽

Diffusion Tensor ◽

Statistical Treatment ◽

Control Group ◽

Normal Appearing White Matter ◽

Significant Difference ◽

Normal White Matter

OBJECTIVE: To study the white matter of patients with multiple sclerosis (MS) with diffusion tensor magnetic resonance (MR) imaging (DTI). METHOD: Forty patients with clinical-laboratorial diagnosis of relapsing-remitting MS and 40 age- and sex-matched controls, who underwent conventional and functional (DTI) MR imaging, were included in the study. The DTI sequences resulted in maps of fractional anisotropy (FA) and regions of interest were placed on the plaques, peri-plaque regions, normal-appearing white matter (NAWM) around the plaques, contralateral normal white matter (CNWM) and normal white matter of the controls (WMC). The FA values were compared and the statistical treatment was performed with the Mann-Whitney U test. RESULTS: The mean FA in plaques was 0.268, in peri-plaque regions 0.365, in NAWM 0.509, in CNWM 0.552 and in WMC 0.573. Statistical significant differences in FA values were observed in plaques, peri-plaque regions and in NAWM around the plaques when compared to the white matter in the control group. There was no significant difference between the FA values of the CNWM of patients with MS and normal white matter of controls. CONCLUSION: Patients with MS show difference in the FA values of the plaques, peri-plaques and NAWM around the plaques when compared to the normal white matter of controls. As a result, DTI may be considered more efficient than conventional MR imaging for the study of patients with MS.

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Neurocognitive Outcome of Childhood ALL Survivors Using Three Different Protocols Over a Decade

Blood ◽

10.1182/blood.v118.21.4226.4226 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4226-4226

Author(s):

Mohsen Saleh Elalfy ◽

Iman Ahmed Ragab ◽

Enas Ahmed Azab ◽

Shaimaa Nasr ◽

Marwa Abdel Maguid

Keyword(s):

Frontal Cortex ◽

Diffusion Tensor ◽

Treated Group ◽

Control Group ◽

High Dose ◽

Cognitive Tests ◽

Neurocognitive Dysfunction ◽

Childhood All ◽

Significant Difference ◽

And Control

Abstract Abstract 4226 Patients with childhood ALL achieve long-term disease-free survival, making reducing complications of therapy of major concerns. The aim of this study was to assess the prevalence and degree of neurocognitive dysfunction in survivors of childhood ALL treated with different protocols and the effect of time since end of chemotherapy. Patients and methods: A cross-sectional study including 60 ALL survivors aged 5–16 years at enrollment; 2–9 years at diagnosis, CNS1, treated through 1998–2008 and regularly followed up in childhood cancer survivors clinic;. They were compared to 20 healthy age and sex matched controls. Grade of school, scholastic achievement in the previous year were reported followed by revision of hospital records including type and risk of ALL, protocol of treatment, number, type and dose of intrathecal chemotherapy, number and doses of high dose I.V methotrexate, data of cranial radiotherapy. Three different protocols were applied to these patients according to the time of diagnosis, patients diagnosed between January 1998 to December 2000 were treated with Modified BFM 83. Those diagnosed between January 2001 to June2004 were treated with BFM 90 protocol, and those diagnosed From July 2004 to June 2008 were treated with CCG 1991 for standard risk and CCG 1961 for high risk patients.Neurocognitive functions were tested using Wechsler Intelligence Scale for Children,Benton visual retention (BVR) test and Trail making test (part A and B were done. MRI Brain was performed to the patients and control group using diffusion weighed images and diffusion tensor magnetic resonance imaging (DTI). Results: Survivors treated with CCG protocol showed a significant decrease in all cognitive tests results compared to control (p<0.05). Survivors treated with BFM 90 protocol had a significant lower total IQ, verbal IQ, TMT-partA, compared to both control and survivors treated with Modified BFM 83, and a significant decrease in performance IQ, BVRT and TMT-partB compared to control only. No significant difference between results of cognitive tests in survivors treated with Modified BFM 83 and control group. Both left and right frontal cortex apparent diffusion coefficient (ADC) was significantly higher in CCG(.88±.060.91±.028) treated group compared to control(.695±.0018.684±.0018), BFM 90(.79±.071.76±.048) and modified BFM 83(.76±.030.83±.023×10−3mm2/s) groups (p<0.05) yet a significant decrease in FA of right frontal cortex only in CCG (.250±.039)treated group compared to control(.684±.0018), BFM 90(.450±.042) and Modified BFM 83(.41±.028) groups(p<0.05). FA of right frontal, was significantly lower in BFM 90 and Modified BFM 83 treated group compared to control group. No significant correlation was found between cognitive tests results with age at diagnosis, time since the end of therapy, total number of intrathecal injections, age at radiotherapy treatment, dose and time of radiotherapy. Cognitive tests didn’t differ between survivors treated with triple intrathecal therapy(ITTT) compared to those treated with intrathecal methotrexate, yet significant decrease in FA of right hippocampus in survivors who received ITTT compared to survivors treated with intrathecal monotherapy, Conclusion: Neurocognitive dysfunction was a common sequelae of childhood ALL treatment. It was more related to protocol of therapy rather than the duration of follow-up since end of chemotherapy. Frontal lobe FA may be a clinically useful biomarker for the assessment of neurotoxicity in post-treatment childhood ALL survivors. Disclosures: No relevant conflicts of interest to declare.

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Adventure Camp Programs, Self-Concept, and Their Effects on Behavioral Problem Adolescents

Journal of Experiential Education ◽

10.1177/105382590702900304 ◽

2007 ◽

Vol 29 (3) ◽

pp. 313-330 ◽

Cited By ~ 7

Author(s):

Bruce A. Larson

Keyword(s):

Behavioral Problems ◽

Behavioral Problem ◽

Self Concept ◽

Female Adolescents ◽

Group Differences ◽

Control Group ◽

Control Groups ◽

Significant Difference ◽

And Control ◽

Level Analysis

The purpose of this study was to examine the effects of an adventure camp program on the self-concept of adolescents with behavioral problems. Subjects in the study included 61 randomly selected male and female adolescents ranging in age from 9 to 17 years with behavioral problems. The treatment group of 31 adolescents was randomly selected from a population (N = 85) of behavioral problem adolescents who voluntarily attended an adventure camp. The control group of 30 adolescents was randomly selected from a population (N = 80) that underwent treatment for behavioral problems. Analysis of variance was utilized to determine if significant differences existed between the treatment and control groups. The paired t test was utilized to determine within group differences between pretest and posttest scores on both groups. Alpha for both tests was set at the .05 level. Analysis demonstrated a significant difference between the experimental and control 9- to 11-year-old age group's self-concept.

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Relationship between montelukast and behavioral problems in preschool children with asthma

Allergologia et Immunopathologia ◽

10.15586/aei.v50i1.312 ◽

2022 ◽

Vol 50 (1) ◽

pp. 85-91

Author(s):

Eda Özata ◽

Zülfikar Akelma ◽

Sacit Günbey

Keyword(s):

Preschool Children ◽

Behavioral Problems ◽

Inhaled Corticosteroids ◽

Controlled Study ◽

Control Group ◽

Healthy Children ◽

Significant Difference ◽

Children With Asthma ◽

Healthy Control ◽

Asthma Group

Background: There is insufficient clarity regarding whether or not drugs used in asthma cause behavioral problems in children.Methods: A total of 155 individuals, categorized into an asthma group (n = 95) and a control group (n = 60), were enrolled in the current prospective controlled study. The asthma group consisted of patients receiving treatment (inhaled corticosteroids [ICS] or montelukast) for at least 1 month. Check Behavior Checklist (CBCL) for ages 1.5–5 scores for the asthma and controls were compared. The asthma group was divided into two subgroups based on prophylactic therapy received, ICS and montelukast, and these groups’ CBCL scores were also compared. Results: The asthma group consisted of 95 children (ICS subgroup 45, montelukast subgroup 50) and the healthy control group of 60 cases. The mean total CBCL score was higher in the asthma group than in the control group (42 vs 32, respectively, P = 0.001). Internalization and externalization scores were also higher in the asthma group compared to the control group (P = 0.004 and P = 0.005, respectively). No significant difference was determined in terms of CBCL scores between the ICS and montelukast groups (P = 0.3). Montelukast was discontinued in one asthmatic child due to hallucination.Conclusion: This study determined a higher rate of behavioral problems in preschool children with asthma compared to healthy children. In contrast to other studies in the literature, we determined no difference in terms of total CBCL, and internalization and externalization scores of children with asthma who received ICS and montelukast. Nevertheless, it should be kept in mind that montelukast may cause serious neuropsychiatric events such as hallucination.

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Improved Cartilage Quality on Delayed Gadolinium-Enhanced MRI of Hip Cartilage after Subchondral Drilling of Acetabular Cartilage Flaps in Femoroacetabular Impingement Surgery at Minimum 5-Year Follow-Up

Cartilage ◽

10.1177/1947603520941241 ◽

2020 ◽

pp. 194760352094124

Author(s):

Florian Schmaranzer ◽

Pascal C. Haefeli ◽

Emanuel F. Liechti ◽

Markus S. Hanke ◽

Moritz Tannast ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Mr Arthrography ◽

Additional Treatment ◽

Analysis Of Covariance ◽

Control Group ◽

Study Group ◽

Acetabular Cartilage ◽

Significant Difference ◽

Magnetic Resonance Imaging Mri

Objective To assess whether subchondral drilling of acetabular cartilage flaps during femoroacetabular impingement (FAI) surgery improves (1) acetabular dGEMRIC indices and (2) morphologic magnetic resonance imaging (MRI) scores, compared with hips in which no additional treatment of cartilage lesions had been performed; and (3) whether global dGEMRIC indices and MRI scores correlate. Design Prospective cohort study of consecutive patients with symptomatic FAI treated with open surgery between 2000 and 2007. Patients with subchondral drilling of acetabular cartilage flaps were allocated to the study group, those without drilling to the control group. All patients underwent indirect 3-T MR arthrography to assess cartilage quality by dGEMRIC indices and a semiquantitative morphologic MRI score at minimum 5 years after surgery. dGEMRIC indices and morphologic MRI scores were compared between and among groups using analysis of covariance/paired t tests. Results No significant difference was found between the global dGEMRIC indices of the study group (449 ± 147 ms, 95% CI 432-466 ms) and the control group (428 ± 143 ms, 95% CI 416-442 ms; P = 0.235). In regions with cartilage flaps, the study group showed higher dGEMRIC indices (472 ± 160 ms, 95% CI 433-510 ms) compared with the control group (390 ± 122 ms, 95% CI 367-413 ms; P < 0.001). No significant differences were found for the morphologic MRI scores. A strong inversely linear correlation between the dGEMRIC indices and the morphologic MRI scores ( r = −0.727, P < 0.001) was observed. Conclusions Treatment of acetabular cartilage flaps with subchondral drilling leads to better cartilage quality in regions with cartilage flaps at minimum 5 years of follow-up.

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Diffusion Tensor Magnetic Resonance Imaging in Patients with Multiple Sclerosis and its Relationship with Disability

The Neuroradiology Journal ◽

10.1177/197140091302600101 ◽

2013 ◽

Vol 26 (1) ◽

pp. 3-17 ◽

Cited By ~ 7

Author(s):

Ş. Temel ◽

H.D. Kekliğkoğlu ◽

G. Vural ◽

O. Deniz ◽

K. Ercan

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

White Matter ◽

Magnetic Resonance ◽

Diffusion Tensor ◽

Water Diffusion ◽

Control Group ◽

Healthy Individuals ◽

Resonance Imaging ◽

Significant Difference

Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system. Diffusion tensor magnetic resonance imaging (DTI) can yield important information on the in vivo pathological processes affecting water diffusion. The aim of this study was to quantitatively define water diffusion in normal-appearing white matter (NAWM) distant from the plaque, in the plaque, and around the plaque, and to investigate the correlation of these changes with clinical disability. Conventional MRI and DTI scans were conducted in 30 patients with MS and 15 healthy individuals. Fractional anisotropy maps and visible diffusion coefficients were created and integrated with T2-weighted images. Regions of interest (ROIs) were placed on the plaques on the same side, white matter around the plaques and NAWM on the opposite side. Only the white matter of healthy individuals in the control group, and FA and ADC values were obtained for comparison. The highest FA and lowest ADC were detected in the control group at the periventricular region, cerebellar peduncle and at all ROIs irrespective of location. There was a significant difference in comparison to the control group at all ROIs in patients with MS (p < 0.001 for all comparisons). No significant correlation between diffusion parameters and expanded disability state scale (EDSS) scores was found in patients with MS. DTI may provide more accurate information on the damage due to the illness, compared to T2A sequences, but this damage may not be correlated with the clinical disability measured by EDSS score.

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P401 Sarcopenia in children and young adults with primary sclerosing cholangitis and IBD

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.530 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S371-S372

Author(s):

E Shteyer ◽

R Cytter-Kuint ◽

L Winberg

Keyword(s):

Young Adults ◽

Nutritional Status ◽

Sclerosing Cholangitis ◽

Psoas Muscle ◽

Control Group ◽

Significant Difference ◽

Apri Score ◽

Inflammatory Bowel ◽

Children And Young Adults ◽

Magnetic Resonance Imaging Mri

Abstract Background Malnutrition is common in children with inflammatory bowel disease (IBD) and in liver diseases. The nutritional status can be assessed by evaluating for sarcopenia, which is described as the loss of muscle mass and/or strength that are reflected by decreased psoas muscle surface area (PMSA). Accumulating data shows association of PSMA with chronic diseases, however, literature regarding sarcopenia in children is still limited. The aim of this study is to assess sarcopenia in children and young adults with sclerosing cholangitis (PSC) with or without IBD. Methods Retrospective analysis of patients below 25 years of age diagnosed with PSC between the years 2010–2018 was done. Patients who performed magnetic resonance imaging (MRI) were included in the study. Detailed clinical, anthropometric, laboratory and imaging findings were recorded. The control group was comprised of children who underwent MRI due to suspected scoliosis or kidney structural anomalies and had normal study. PMSA was determined at intervertebral disc L3. Results Sixty-five patients were included in the study. Twenty with PSC with a mean age of 15.2 ± 5 years, 12 were female and 9 had IBD. The control group comprised of 45 healthy subjects with no significant difference in age, gender and BMI from the study group. There was no significant difference in PMSA between groups. However, PMSA significantly correlated with aspartate transaminase (AST) and Platelet Ratio Index (APRI) score (marker for hepatic fibrosis, r = −0.49, p = 0.02). Additionally, PMSA was significantly higher in patients who had both PSC and IBD (475.61 ± 136 vs. 789 ± 328, p = 0.01). Conclusion Children and young adults with concomitant PSC and IBD were in a better nutritional status in comparison to patients with PSC alone, as evidenced by a lesser degree of sarcopenia. Additionally, sarcopenia correlates to the degree of liver fibrosis assessed by APRI score. Further larger studies are warranted in order to corroborate the importance of sarcopenia in patients with PSC.

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Efficacy of hyperbaric oxygen combined with escitalopram in depression and its effect on cognitive function

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.4.3993 ◽

2021 ◽

Vol 37 (4) ◽

Author(s):

Kun Mi ◽

Qiang Guo ◽

Bao-yan Xu ◽

Man Wang ◽

Hao Bi

Keyword(s):

Cognitive Function ◽

Hyperbaric Oxygen ◽

Depression Scale ◽

Control Group ◽

Hamilton Depression Scale ◽

Observation Group ◽

Creative Commons ◽

Significant Difference ◽

Hamd Score ◽

Icd 10

Objective: To investigate the efficacy of hyperbaric oxygen (HBO) combined with escitalopram in patients with depression and its effect on cognitive function. Methods: From 2016 to 2018, seventy patients with depression aged 18-65 years treated in Affiliated Hospital of Hebei University were selected. Seventy patients with depression meeting the diagnostic criteria of ICD-10 were selected and randomly divided into control group and observation group using a random number table, with 35 patients in each group. The control group was treated with escitalopram, while the observation group was additionally treated with HBO on this basis. The patients were assessed using the Hamilton Depression Scale (HAMD) and Montreal Cognitive Assessment Scale (MoCA) before treatment and two, four and six weeks after treatment. Results: Two weeks after treatment, HAMD score showed a statistically significant difference between the two groups (P < 0.05). No statistically significant differences were found in HAMD score between the two groups four and six weeks after treatment (P > 0.05). Four and six weeks after treatment, MoCA score presented statistically significant differences between the two groups (P < 0.05). Conclusion: Escitalopram combined with HBO in the treatment of depression presents rapid efficacy and a certain effect in improving cognitive function. doi: https://doi.org/10.12669/pjms.37.4.3993 How to cite this:Mi K, Guo Q, Xu BY, Wang M, Bi H. Efficacy of hyperbaric oxygen combined with escitalopram in depression and its effect on cognitive function. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.3993 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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