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Practical Neurology Nov 2023A 68-year-old Brazilian woman had 3 months of progressive fatigue, difficulty walking and 18 kg weight loss. On examination, there was gait apraxia and executive...
A 68-year-old Brazilian woman had 3 months of progressive fatigue, difficulty walking and 18 kg weight loss. On examination, there was gait apraxia and executive dysfunction. MR scan of brain showed communicating hydrocephalus and a cerebrospinal fluid showed 105 white cells/µL (≤5), predominantly lymphocytes, protein of 1.35 g/L (0.15-0.45) and the glucose content of 0.06 mmol/L (3.3-4.4). We suspected an infective cause and used of metagenomic next-generation sequencing to diagnose neurocysticercosis. This case highlights the challenge of diagnosing chronic meningitis and the relevance of genetic approaches in diagnosing neurological infections.
Topics: Female; Humans; Aged; Neurocysticercosis; Meningitis; Brain; Hydrocephalus; High-Throughput Nucleotide Sequencing
PubMed: 37468299
DOI: 10.1136/pn-2023-003795 -
Journal of the American Geriatrics... Aug 2023Mobility assessments are commonly used among older adults as risk stratification for falls, preoperative function, frailty, and mortality. We determined if gait speed...
BACKGROUND
Mobility assessments are commonly used among older adults as risk stratification for falls, preoperative function, frailty, and mortality. We determined if gait speed and self-reported difficulty walking are similarly associated with social isolation and loneliness, which are key markers of social well-being and linked to health outcomes.
METHODS
We used 2015-2016 data from the National Social life Health and Aging Project (NSHAP), an in-person nationally-representative survey of 2640 community-dwelling adults ≥65 years old. We measured gait speed (timed 3-m walk: unable to walk, ≥5.7 s, and <5.7 s), and self-reported difficulty walking one block or across the room (unable, "much," "some," or "no" difficulty). Social measures included loneliness (3-item UCLA scale), social isolation (12-item scale), and individual social activities (frequency socializing, religious participation, community participation, and volunteering). We used logistic regression to determine the adjusted probability of each social measure by gait speed and difficulty walking, adjusting for sociodemographic and health characteristics, and tested for interaction terms with age.
RESULTS
Participants were on average 75 years old (SD = 7.1), 54% female, 9% Black/African American, and 6% Hispanic. Difficulty walking one block was associated with (p < 0.05): social isolation (much difficulty: 26% vs no difficulty: 18%), low socializing (33% vs 19%), low volunteering (67% vs 53%), low community participation (54% vs 43%), low religious participation (51% vs 46%), and loneliness (25% vs 14%). Difficulty walking across the room was similarly strongly associated with social isolation and individual activities. The association between self-reported difficulty walking and social isolation was stronger at older ages (p-value of interaction <0.001).
CONCLUSIONS
Self-reported mobility difficulty is a widely used clinical assessment that is strongly associated with loneliness and social isolation, particularly at older ages. Among persons with limited mobility, clinicians should consider a careful social history to identify social needs and interventions addressing mobility to enhance social connections.
Topics: Humans; Female; Aged; Male; Walking Speed; Self Report; Mobility Limitation; Walking; Social Isolation; Gait
PubMed: 37000466
DOI: 10.1111/jgs.18348 -
The Lancet. Neurology Dec 2023
Topics: Humans; Parkinson Disease; Mobility Limitation; Quality of Life
PubMed: 37865117
DOI: 10.1016/S1474-4422(23)00376-9 -
Connective Tissue Research Jul 2023Tendinopathy describes a complex pathology of the tendon characterized by abnormalities in the microstructure, composition, and cellularity of the tendon, leading to... (Review)
Review
Tendinopathy describes a complex pathology of the tendon characterized by abnormalities in the microstructure, composition, and cellularity of the tendon, leading to pain, limitation of activity and reduced function. Nevertheless, the mechanism of tendinopathy has not been fully elucidated, and the treatment of tendinopathy remains a challenge. High mobility group box 1 (HMGB1), a highly conserved and multifaceted nuclear protein, exerts multiple roles and high functional variability and is involved in many biological and pathological processes. In recent years, several studies have suggested that HMGB1 is associated with tendinopathy and may play a key role in the pathogenesis of tendinopathy. Therefore, this review summarizes the expression and distribution of HMGB1 in tendinopathy, focuses on the roles of HMGB1 and HMGB1-based potential mechanisms involved in tendinopathy, and finally summarizes the findings on HMGB1-based therapeutic approaches in tendinopathy, probably providing new insight into the mechanism and further potential therapeutic targets of tendinopathy.
Topics: Humans; HMGB1 Protein; Tendons; Tendinopathy
PubMed: 37032550
DOI: 10.1080/03008207.2023.2199089 -
Experimental Brain Research Jul 2023Older adults adapt the execution of complex motor tasks to use compensatory strategies in the reaching-to-grasping (i.e., prehension) movement. The presence of postural...
Older adults adapt the execution of complex motor tasks to use compensatory strategies in the reaching-to-grasping (i.e., prehension) movement. The presence of postural constraints may exacerbate these compensatory strategies. Therefore, we investigated the reach-to-grasp action with different postural constraints (sitting, standing, and walking) in younger and older people and evaluated the postural stability during the reach-to-grasp action. Thirty individuals (15 younger and 15 older adults) performed the prehension under three postural tasks: sitting, standing, and walking. The reaching movement was slower in the walking task than in the other two postural tasks; however, there was no difference between the age groups. For the grasping action, the older adults presented a larger grip aperture, and the peak grip aperture occurred earlier during hand transportation in sitting and standing tasks. In the standing task, the margin of stability was smaller for older adults. In the walking task, there was no difference between the groups for the margin of stability. Also, prehension during sitting and standing tasks were similar, and both differed from walking across age groups. Finally, older adults reduced their margin of stability compared to younger adults, but only in the standing task. The margin of stability was similar between age groups during the walking task. We concluded that age affected grasping (distal component) but not reaching (proximal component), suggesting that healthy older adults have more difficulty controlling distal than proximal body segments.
Topics: Humans; Aged; Walking; Hand; Movement; Standing Position; Sitting Position; Postural Balance
PubMed: 37256337
DOI: 10.1007/s00221-023-06647-0 -
Brain Communications 2023has been recently reported causing a rare axonal Charcot-Marie-Tooth disease in three independent Caucasian families carrying a recurrent change. We describe the first...
has been recently reported causing a rare axonal Charcot-Marie-Tooth disease in three independent Caucasian families carrying a recurrent change. We describe the first alternative causative mutation in in a family from black African and also observed in a patient of Caucasian ancestry. The disease inheritance was consistent with autosomal dominant and sporadic patterns, respectively. Eight patients and their relatives were enroled from both families. The mean age at diagnosis was 33.9 years, and walking difficulty was commonly the first symptom. Neurological examination showed distal muscle weakness and atrophy, sensory loss and foot and hand deformities. A high clinical variability was noted, but as seen in -associated neuropathy, symptoms were more pronounced in the arms in some patients. Nerve conduction studies showed no response in most of the examined nerves, and an axonal type of neuropathy, where recorded. Whole exome sequencing revealed a novel missense variant (c.1102G>T; Gly368Cys) in , segregating with the disease. Functional analyses showed a significant decrease in CADM3-Gly368Cys protein levels in the membrane and major structural changes in its predicted secondary structure. Therefore, we extend the genotype spectrum of C, underlining the need for genetic studies in underrepresented populations like in Africa.
PubMed: 38074074
DOI: 10.1093/braincomms/fcad227 -
The Journal of Rheumatology Jun 2024Difficulty walking is a primary reason that individuals with knee osteoarthritis (OA) seek care. We examined the change in self-reported difficulty walking after...
OBJECTIVE
Difficulty walking is a primary reason that individuals with knee osteoarthritis (OA) seek care. We examined the change in self-reported difficulty walking after participating in the Good Life with osteoArthritis in Denmark (GLA:D®) 8-week education and exercise program and assessed patient factors associated with improvement in difficulty walking.
METHODS
This was a registry-based cohort study of individuals with knee OA who enrolled in GLA:D® in Denmark. Assessments were administered at baseline, at program completion (~3 months), and 12 months. Our pre-specified primary outcome was change in self-reported difficulty walking assessed using the EuroQol 5-dimension 5-level walking item. Exposures included sociodemographic factors, measures of OA illness severity, comorbidities, and psychological factors. In those with baseline moderate/severe difficulty walking, using multivariable regression analysis we assessed the relationship between exposures of interest and improvement to no/slight difficulty walking.
RESULTS
We included 5,262 participants. Of 2,178 (41.4%) individuals with baseline moderate/severe difficulty walking, 51.4% and 58.3% reported no/slight difficulty walking at 3 and 12 months, respectively. Greater self-efficacy, younger age, female sex, lower BMI, less intense knee pain and better function at baseline were associated with greater likelihood of improvement in difficulty walking; severe difficulty walking at baseline and back pain intensity were associated with decreased likelihood of improvement.
CONCLUSION
More than half of those with baseline difficulty walking experienced substantial improvement after completing GLA:D® and this improvement was maintained at 12 months. Several patient factors were associated with the outcome suggesting that some individuals may require additional support and extended treatment.
PubMed: 38879187
DOI: 10.3899/jrheum.2023-1213 -
The Journals of Gerontology. Series A,... Oct 2023The Health, Aging, and Body Composition Study is a longitudinal cohort study that started just over 25 years ago. This ground-breaking study tested specific hypotheses... (Review)
Review
BACKGROUND
The Health, Aging, and Body Composition Study is a longitudinal cohort study that started just over 25 years ago. This ground-breaking study tested specific hypotheses about the importance of weight, body composition, and weight-related health conditions for incident functional limitation in older adults.
METHODS
Narrative review with analysis of ancillary studies, career awards, publications, and citations.
RESULTS
Key findings of the study demonstrated the importance of body composition as a whole, both fat and lean mass, in the disablement pathway. The quality of the muscle in terms of its strength and its composition was found to be a critical feature in defining sarcopenia. Dietary patterns and especially protein intake, social factors, and cognition were found to be critical elements for functional limitation and disability. The study is highly cited and its assessments have been widely adopted in both observational studies and clinical trials. Its impact continues as a platform for collaboration and career development.
CONCLUSIONS
The Health ABC provides a knowledge base for the prevention of disability and promotion of mobility in older adults.
Topics: Humans; Aged; Longitudinal Studies; Aging; Sarcopenia; Body Composition; Cohort Studies
PubMed: 37431156
DOI: 10.1093/gerona/glad167 -
Journal of Neuro-ophthalmology : the... May 2024
PubMed: 38755743
DOI: 10.1097/WNO.0000000000002182 -
Life (Basel, Switzerland) Dec 2023Sarcoidosis is a chronic granulomatous disease of unknown cause characterized by the presence of non-caseating granulomas. The disease can affect any organ including the... (Review)
Review
Sarcoidosis is a chronic granulomatous disease of unknown cause characterized by the presence of non-caseating granulomas. The disease can affect any organ including the nervous system. Neurosarcoidosis occurs in about 5% patients with sarcoidosis. The clinical presentation of neurosarcoidosis is varied, and it can involve the brain, spinal cord and peripheral nervous system, separately or in different combinations. The diagnosis of neurosarcoidosis is challenging, as biopsies from the nervous system are not readily available. Anti-TNFα agents are becoming one of the cornerstone treatments for neurosarcoidosis. In this case-based review, we discuss two cases of neurosarcoidosis with different clinical presentations. The first patient presented with confusion, while the second presented with walking difficulty and neurogenic bladder. Both patients were treated with methylprednisolone pulse therapy with rapid, but non-complete, improvement. Therefore, infliximab was initiated in both cases with subsequent improvement in the clinical manifestations and imaging findings, emphasizing the effectiveness and safety of infliximab in cases of severe neurosarcoidosis. In conclusion, the goal of neurosarcoidosis management is to prevent organ system damage and minimize the toxic cumulative adverse effects of glucocorticoid use. In this case-based review we discuss the various presentations, the diagnosis and the treatment of neurosarcoidosis.
PubMed: 38255684
DOI: 10.3390/life14010069