JNS.jpgThe March issue of the Journal of the Neurological Sciences Vol 410 is now available online.


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Issue highlights

Mixed dementia: Neglected clinical entity or nosographic artifice?

Clinical and pathological data show that Alzheimer's disease (AD) and vascular dementia (VaD) are the most prevalent types of dementia in the elderly. Medically speaking, mixed dementia (MxD) is a heterogenous disorder mostly referred to the coexistence of AD and VaD.

The weight of vascular contribution to AD phenotype is nowadays matter of debate. Despite great efforts in the field of neurodegeneration and cerebrovascular disease, controversy over the exact nature of their relation still remains, hampering progress in the specialty and raising doubts about the MxD concept validity. Is MxD a neglected clinical entity or a nosographic artifice?

Starting from the assumption that recent advances in dementia classification and diagnostic criteria make this a propitious time to set up preventive and therapeutic strategies, this narrative review and opinion paper summarizes the literature concerning the questioned etiopathogenic overlap between AD and VaD and challenges the traditional view of MxD as the mere co-occurrence of different pure forms of dementia.

Maintenance immunosuppression in myasthenia gravis, an update

Therapies for myasthenia gravis (MG) include symptomatic and immunosuppressive/immunomodulatory treatment. Options for immunosuppression include corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, tacrolimus, methotrexate, rituximab, cyclophosphamide, eculizumab, intravenous immunoglobulin, subcutaneous immunoglobulin, plasmapheresis, and thymectomy.

The practical aspects of long-term immunosuppressive therapy in MG are critically reviewed in this article. Application of one or more of these specific therapies is guided based on known efficacy, adverse effect profile, particular disease subtype and severity, and patient co-morbidities.

Prevalence and clinical correlates of non-convulsive status epilepticus in elderly patients with acute confusional state: A systematic literature review

Non-convulsive status epilepticus (NCSE) is a potentially treatable condition that poses considerable diagnostic challenges. NCSE is thought to be more common in the elderly than in the general population, however additional diagnostic challenges complicate its recognition in older patients, because of the wide differential diagnosis with common underlying causes of acute confusional state in this age group.

This study sets out to review the existing evidence on the clinical correlates of NCSE in the elderly population. A systematic literature review was conducted according to the methodological standards outlined in the PRISMA statement to assess the clinical correlates of NCSE in patients aged 60 or older.

The literature search identified 11 relevant studies, which confirmed that the incidence of NCSE increases with age, in particular with regard to focal forms with impairment of consciousness. Female gender, history of epilepsy (or a recently witnessed seizure with motor features), and abnormal ocular movements appeared to correlate with the diagnosis of NCSE in the elderly, prompting prioritization of electroencephalography tests for diagnostic confirmation.

Epidemiological data in the elderly vary widely because of the heterogeneity of definitions and diagnostic criteria applied across different studies. Based on the findings, the authors recommend keeping a low threshold for requesting electroencephalography tests to confirm the diagnosis of NCSE in elderly patients with acute confusional state, even in the presence of a presumed symptomatic cause.

Therapeutic effects of forced exercise cycling in individuals with Parkinson's disease

Currently, there is no cure for the progressive movement disorders associated with Parkinson's Disease (PD). Pharmacological management of movement disorders in PD are associated with significant negative side effects. Exercise improves the efficacy of anti-parkinsonian medication but does not ameliorate the side effects.

Consensus on the optimal mode of exercise training or dosing to improve motor function for individuals with PD is lacking. The new concept of forced exercise is gaining traction in the literature as a mode of exercise which has the potential to improve motor function in individuals with PD.

The purpose of this article is to review the effects of forced exercise on specific components of motor function that would help guide clinical decision making and exercise prescription for the PD patient population. Collectively, the evidence provided in this review suggests that forced exercise may be safely added as an ancillary therapy to the medical management of PD.