Remote Neuropscyhological Assessment: Teleneuropsychology.

Introduction: Teleneuropsychology, which includes the remote application of neuropsychological tests to patients via telephone or videoconferencing, can expand access to health services for patients who reside in distant areas or have mobility restrictions. With the emergence of the COVID-19 pandemic, there has been a significant increase in the use of teleneuropsychology in cognitive assessment. In this review, the aim was to critically review the results of studies conducted in the field of teleneuropsychology and the fundamental principles related to tele-neuropsychological assessment. Additionally, the "guideline for home-based teleneuropsychology" developed for Türkiye's practices is outlined in this review. Method: A literature search was conducted using the Web of Science and PubMed databases to include all types of articles related to the subject. Results: The results of studies on in-clinic and home-based teleneuropsychological assessment indicate that tests that assess cognitive functions such as attention, memory, executive functions, and language, particularly those based on verbal administration, can be reliably applied through teleneuropsychological assessment. However, there are factors to consider when referring patients for teleneuropsychological assessment, selecting tests for assessment, and making ethical considerations. Additionally, it is important to follow recommended steps for both the clinician and the patient and/or their caregiver before and during the interview in order for the assessment to be carried out effectively. Conclusion: Although direct contact with the patient is an essential element in clinical neuropsychology practice, when necessary, teleneuropsychological assessment performed by trained experts following appropriate application procedures can be a good alternative to face-to-face evaluations.

Eating Difficulties and Relationship With Nutritional Status Among Patients With Dementia.

BACKGROUND: One of the most common behavioral problems in patients with dementia is eating problems, which are known to increase the risk of malnutrition. However, few studies have been conducted in this patient group regarding the relationship between eating difficulties and nutritional status. PURPOSE: This study was designed to determine the eating difficulties faced by patients with dementia and to evaluate the relationship in this population between eating difficulties and malnutrition. METHODS: This study was carried out in a dementia outpatient clinic of a university hospital in Istanbul, Turkey. This cross-sectional, case-control study included 50 patients and 50 healthy controls as participants. Participants were assessed for eating difficulties and for nutritional, cognitive, and functional statuses. RESULTS: The patients with dementia had more difficulties in terms of self-feeding skills. Although problems related to manipulating food on the plate and the use of utensils were not seen in the control group, these problems were found in 30% of the participants in the dementia group ( p < .001). Moreover, 30% of the patients in the dementia group were unable to eat without assistance ( p < .001). Associations were found between eating difficulties and age, duration of illness, and cognitive and functional (basic and instrumental activities of daily living) statuses. In addition, self-feeding skills were found to be associated with nutritional status. Rate of malnutrition or risk of malnutrition was higher in patients with dementia than in those in the control group. CONCLUSIONS: In this study, compared with the control group, patients with dementia had more problems in self-feeding skills such as manipulation of food on a plate, use of utensils, need for assistive tools, ability to eat without assistance, and negative eating behaviors (refusal to eat). An association was found between eating difficulties and nutritional status. Evaluating eating difficulties is recommended in patients with dementia to prevent nutritional deterioration.

Alterations in Large-Scale Intrinsic Connectivity Networks in the Parkinson's Disease-Associated Cognitive Impairment Continuum: A Systematic Review.

Introduction: Cognitive impairment is common in the course of Parkinson's disease (PD) and displays a continuum from subjective cognitive impairment to dementia. Illuminating the pathophysiological processes associated with the continuum may help create follow-up and new treatment approaches. In this context, large-scale intrinsic connectivity networks are widely investigated to elucidate the neural processes underlying PD and are promising as non-invasive biomarkers. This systematic review aims to examine the alterations in large-scale intrinsic connectivity networks in the continuum of PD-associated cognitive impairment. Method: ScienceDirect, Web of Science, and PubMed databases were searched with the specified keywords. The studies obtained as a result of this review were investigated by the PRISMA criteria, which were taken as a basis for the systematic review and writing of meta-analyses. Results: A total of 974 studies were obtained from three databases. Twenty studies were included in the systematic review based on predetermined eligibility criteria. Among the large-scale connectivity networks examined in these studies, it was found that sensory-motor networks decreased their connectivity in the continuum of PD-associated cognitive impairment, and there were conflicting results in terms of cognitive networks. Conclusion: Well-designed longitudinal studies are needed to clarify the alterations in the intrinsic connectivity networks in the PD cognitive impairment continuum. In these studies, it is necessary to define the cognitive disorder groups well, to control the connectivity changes that may occur due to dopaminergic treatment, and to evaluate Parkinson's patients with subjective cognitive impairment and dementia within the continuum.

Normative data for the Turkish version of the pyramids and palm trees test.

AIM: In this study, we aimed to establish Turkish normative data for two versions of The Pyramids and Palm Trees Test (PPTT), pictorial (PPTT-P), and verbal (PPTT-V) using Turkish culture-specific items. METHODS: The study sample involves 181 participants stratified into three age groups and further stratified into three education levels and gender. The participants were given the PPTT versions along with a neuropsychological battery. Participants in the aged group were further screened for cognition and depression. The internal consistency, the convergent and discriminant validity of the PPTT versions, and predictors of the performance in the PPTT versions are statistically analyzed. RESULTS: The Cronbach's alpha coefficients for PPTT-P and PPTT-V were found as 0.48. and 0.42, respectively. Among the demographic variables, only education had an effect on the performances of both versions. Education level explained 21.2% of the variance in PPTT-P performance and 13.7% of the variance in PPTT-V performance. A cutoff score of 45 is proposed for the individuals with primary school education and 47 for those with higher education. Results suggested that both versions had moderate convergent but no discriminant validity. CONCLUSIONS: Present findings suggest that PPTT is a useful neuropsychological instrument for assessing semantic memory in the Turkish population.

Clinical and molecular genetic findings of hereditary Parkinson's patients from Turkey.

INTRODUCTION: The majority of Parkinson's disease (PD) ensue late-onset with a complex spectrum of environmental and genetic risk factors. Awareness of genetic causes in patients with PD is essential for genetic counseling and future genotype-oriented therapeutic developments. METHODS: Large pathogenic changes in eight PD-related genes and small pathogenic sequence variants in 22 PD-related genes were investigated simultaneously in 82 PD patients from 79 families where clinical evaluations were performed. The phenotypic characteristics of the patients with molecular changes were examined for genotype-phenotype relations. RESULTS: Pathogenic variants in SNCA, PRKN, DJ-1, FBXO7, and GBA genes were determined in 25 patients from 24 families (24/79, 30%). Associated variants were found in PRKN in 14, SNCA in three, FBXO7 in two, and DJ-1 in one patient. A novel homozygous deletion (c.491delT, p.(V164Dfs*13) (SCV001733595)) leading to protein truncation in the PRKN gene was identified in two patients from the same family. Furthermore, heterozygous GBA gene variants were detected in five patients from different families. CONCLUSION: It has been shown that the most common cause of genetically transmitted PD is the PRKN gene, while LRRK2 does not play an essential role in this selected population. It has been suggested that even if the autosomal recessive inheritance is expected, genes with autosomal dominant effects such as SNCA should not be overlooked and suggested for investigation. Our study is also the first for evaluating the pathogenic GBA variants' frequency in PD patients from Turkey.

Resting-state fMRI analysis in apathetic Alzheimer's disease.

PURPOSE: Diagnosis of comorbid psychiatric conditions are a significant determinant for the prognosis of neurodegenerative diseases. Apathy, which is a behavioral executive dysfunction, frequently accompanies Alzheimer's disease (AD) and leads to higher daily functional loss. We assume that frontal lobe hypofunction in apathetic AD patients are more apparent than the AD patients without apathy. This study aims to address the neuroanatomical correlates of apathy in the early stage of AD using task-free functional magnetic resonance imaging (MRI). METHODS: Patients (n=20) were recruited from the Neurology and Psychiatry Departments of Istanbul University, Istanbul School of Medicine whose first referrals were 6- to 12-month history of progressive cognitive decline. Patients with clinical dementia rating 0.5 and 1 were included in the study. The patient group was divided into two subgroups as apathetic and non-apathetic AD according to their psychiatric examination and assessment scores. A healthy control group was also included (n=10). All subjects underwent structural and functional MRI. The resting-state condition was recorded eyes open for 5 minutes. RESULTS: The difference between the three groups came up in the pregenual anterior cingulate cortex (pgACC) at the trend level (P = 0.056). Apathetic AD group showed the most constricted activation area at pgACC. CONCLUSION: The region in and around anterior default mode network (pgACC) seems to mediate motivation to initiate behavior, and this function appears to weaken as the apathy becomes more severe in AD.

Caregiver Burden, Quality of Life and Related Factors in Family Caregivers of Dementia Patients in Turkey.

This study aimed to evaluate caregiver burden and quality of life (QoL) and their predictors in family caregivers of dementia patients. A descriptive cross-sectional survey was carried out with a sample of 102 patients and their family caregivers. The Caregiver Burden Inventory (CBI) and Short Form-12 (SF-12) were used to collect data. CBI mean score was 37.97 ± 21.30. Mean scores of SF-12 sub-domains varied between 36.02 and 77.94 and were significantly lower as compared to normative means of the general population, excluding only the physical health subdomain. Among several patient and caregiver-related correlations, the number of medications and worse cognitive function of the patient, caregiver's age and having limited space at home were found as predictors of burden, whereas caregiver's chronic disease and having a limited space were predictors of QoL. Also, the burden and QoL were correlated. This study demonstrated a high burden and low QoL in dementia caregivers. In societies where caregivers are mostly informal such as that in Turkey, supportive systems should be established.

The attitude of elderly lay people towards the symptoms of dementia.

OBJECTIVES: To assess the attitude of elderly lay people towards the concept and symptoms of dementia. METHODS: A population-based, cross-sectional study of 859 residents without dementia, aged 70 years or older, living in an urban area in Istanbul. Nine questions with yes/no responses were designed to investigate the attitudes of the responders to the concept of dementia and symptoms related to particular aspects of dementia. The chi(2)-test was used to test for differences between proportions of respondents in different age, sex and education groups. RESULTS: Dementia was considered as normal by the majority of respondents and age and education did not influence this attitude. Women were significantly less inclined to consider dementia and its associated problems as normal. CONCLUSION: The concept of dementia is generally not considered as a medical problem by the elderly Turkish population, independent of age and education. These results are important in guiding policy makers and shaping awareness raising campaigns of local Alzheimer's Associations.

Cognitive impairment in amyotrophic lateral sclerosis: evidence from neuropsychological investigation and event-related potentials.

The presence of subclinical cognitive impairment in patients with amyotrophic lateral sclerosis (ALS) is investigated using neuropsychological assessment and event-related potential recordings (ERP). An extensive battery of neuropsychological tests assessing the domains of attention, memory, language, visuo-spatial and executive functions were administered to 20 non-demented patients with sporadic ALS and 13 age- and education-matched healthy control subjects. Mismatch negativity (MMN), P3b, P3a (novelty P300) and contingent negative variation (CNV) were recorded. ALS patients were significantly impaired in tests of working memory, sustained attention, response inhibition, naming, verbal fluency and complex visuo-spatial processing. The memory impairment seemed to be secondary to deficits in forming learning strategies and retrieval. In ERP recordings, P3a and P3b amplitudes of ALS patients were lower compared with the controls, P3a latencies were significantly longer and mean CNV amplitudes were higher. These results indicate subclinical impairment of cognitive functions in patients with ALS. The pattern of cognitive impairment suggests the dysfunction of the frontal network.

Therapeutic effects of an acetylcholinesterase inhibitor (donepezil) on memory in Wernicke-Korsakoff's disease.

Wernicke-Korsakoff's disease (WKD) is cognitively an amnestic state resulting from strategic lesions in the limbic system subserving the episodic memory network and resulting from thiamine deficiency. Neurochemical deficits have been implicated in the pathophysiology of amnesia based on the pathologic observations that various brainstem and basal forebrain nuclei are also affected. Previous treatment attempts with serotoninergic, noradrenergic, and cholinergic drugs have given controversial results. The objective of this study was to assess the effects of a cholinesterase inhibitor, donepezil, on memory, attention, and executive functions in patients with nonalcoholic WKD. Seven patients who developed WKD after a hunger strike were included in this single, blind, placebo-controlled, one-way, crossover study. The patients were administered donepezil during the first 30 days, and were administered placebo during the following 30 days. Neuropsychological tests to evaluate verbal and visual memory, and attention and executive function were performed on days 0, 31, and 61. All patients completed both phases of the study. There were no statistically significant differences between the three evaluations, except for a difference between active treatment and the placebo phase during recall of the Rey-Osterrieth complex figure, which was in favor of the placebo phase. There were no significant changes in favor of the active treatment. Cholinergic treatment with the cholinesterase inhibitor donepezil does not seem to provide marked beneficial effects in patients with WKD in this small, descriptive study. This may be because pathways mediating channel and state-dependent functions are impaired in this disease, and enhancement of state-dependent cholinergic transmission may not be sufficient. Subtle benefits, however, cannot be excluded because of the small sample size and the relatively short duration of the treatment.