V S Kostić

University Children's Hospital, Belgrade, Serbia, Beograd, Central Serbia, Serbia

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Publications (161)449.37 Total impact

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    ABSTRACT: Amyotrophic lateral sclerosis (ALS) is characterized by weakness, fatigue, loss of balance and coordination. The purpose of the study was to examine gait in ALS patients. Gait was compared in ALS with spinal and bulbar onset, while performing dual mental and motor tasks. Dual-task walking was performed by 27 ALS patients, 13 with spinal- and 14 with bulbar-onset disease. Twenty-nine healthy subjects were used as a control group. The subjects performed a basic, simple walking task, dual-motor task, dual-mental task, and combined motor and mental tasks. Results showed that dual-task paradigm has an effect on gait in ALS patients. Gait was differently affected in spinal and bulbar onset of ALS by some of the given tasks. Mental tasks had a larger effect than motor tasks in all gait parameters. In conclusion, both ALS forms have impaired gait in dual tasks. Simple walk in patients with spinal onset shows higher variability of certain gait parameters compared to bulbar-onset patients and controls. Differences in gait could also indicate postural instability and possible falls in complex walking situations.
    Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration 06/2014; · 2.37 Impact Factor
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    ABSTRACT: Cortico-striatal-thalamic network functional connectivity (FC) and its relationship with levodopa (L-dopa) were investigated in 69 patients with hemiparkinsonism (25 drug-naïve [n-PD] and 44 under stable/optimized dopaminergic treatment [t-PD]) and 27 controls. Relative to controls, n-PD patients showed an increased FC between the left and the right basal ganglia, and a decreased connectivity of the affected caudate nucleus and thalamus with the ipsilateral frontal and insular cortices. Compared with both controls and n-PD patients, t-PD patients showed a decreased FC among the striatal and thalamic regions, and an increased FC between the striatum and temporal cortex, and between the thalamus and several sensorimotor, parietal, temporal, and occipital regions. In both n-PD and t-PD, patients with more severe motor disability had an increased striatal and/or thalamic FC with temporal, parietal, occipital, and cerebellar regions. Cortico-striatal-thalamic functional abnormalities occur in patients with hemiparkinsonism, antecede the onset of the motor symptoms on the opposite body side and are modulated by L-dopa. In patients with hemiparkinsonism, L-dopa is likely to facilitate a compensation of functional abnormalities possibly through an increased thalamic FC.
    Neurobiology of aging 05/2014; · 5.94 Impact Factor
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    ABSTRACT: AimThe aim of the present study was to estimate fall frequency as well as demographic and clinical factors related to falling in a cohort of Serbian patients with Parkinson's disease (PD).Method The cross-sectional study comprised 300 consecutive patients recruited at the Neurology Clinic in Belgrade, Serbia, from August 2011 to December 2012. Data were acquired though detailed interviews, while a history of falling referred to the period of 6 months before testing. After a interview related to the circumstances of the last fall sustained by PD patients, the participants were evaluated with the Mini-Mental State Examination, the Unified Parkinson's Disease Rating Scale, the Hoehn and Yahr scale, the Falls Efficacy Scale and the Self-Assessment Disability Scale, New Freezing of Gait questionnaire for frequency and impact of freezing, and the Hamilton Depression and the Hamilton Anxiety Rating Scale.ResultsA total of 60% of individuals reported a fall in the 6-month period before testing. Multivariate regression showed that patients with PD who had a Self-Assessment Disability Scale score of ≥56 and Unified Parkinson's Disease Rating Scale total score of ≥69 were 2.04 and 3.32 times more likely to fall, respectively (95% CI 1.10–3.79, P = 0.023 for Self-Assessment Disability Scale and 95% CI 1.83–6.00, P = 0.001 for Unified Parkinson's Disease Rating Scale). In contrast, a decrease of risk for falling by 57% was observed among those who practiced regular physical activity before the onset of PD (95% CI 0.23–0.80, P = 0.008).Conclusion There is a strong relationship between falling and self-perceived disability, whereas previous physical exercise had a protective effect. Geriatr Gerontol Int 2014; ●●: ●●–●●.
    Geriatrics & Gerontology International 05/2014;
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    ABSTRACT: Dysautonomia appears in almost all patients with Parkinson's disease (PD) in a certain stage of their condition. The aim of our study was to detect the development and type of autonomic disorders, find out the factors affecting their manifestation by analyzing the potential association with demographic variables related to clinical presentation, as well as the symptoms of the disease in a PD patient cohort. The patients with PD treated at the Clinic of Neurology in Belgrade during a 2-year period, divided into 3 groups were studied: 25 de novo patients, 25 patients already treated and had no long-term levodopa therapy-related complications and 22 patients treated with levodopa who manifested levodopa-induced motor complications. Simultaneously, 35 healthy control subjects, matched by age and sex, were also analyzed. Autonomic nervous system malfunction was defined by Ewing diagnostic criteria. The tests, indicators of sympathetic and parasympathetic nervous systems, were significantly different in the PD patients as compared with the controls, suggesting the failure of both systems. However, it was shown, in the selected groups of patients, that the malfunction of both systems was present in two treated groups of PD patients, while de novo group manifested only sympathetic dysfunction. For this reason, the complete autonomic neuropathy was diagnosed only in the treated PD patients, while de novo patients were defined as those with the isolated sympathetic dysfunction. The patients with the complete autonomic neuropathy differed from the subjects without such neuropathy in higher cumulative and motor unified Parkinson's disease rating score (UPDRS) (p < 0.01), activities of daily living scores (p < 0.05), Schwab-England scale (p < 0.001) and Hoehn-Yahr scale. There was no difference between the patients in other clinical-demographic characteristics (sex, age at the time of diagnosis, actual age, duration of disease, involved side of the body, pain and freezing), but mini mental status (MMS) score and Hamilton depression and anxiety rating scale were significantly lower (p < 0.05). Our results confirm a high prevalence of autonomic nervous system disturbances among PD patients from the near onset of disease, with a predominant sympathetic nervous system involvement. The patients who developed complete autonomic neuropathy (both sympathetic and parasympathetic) were individuals with considerable level of functional failure, more severe clinical presentation and the existing anxiety and depression.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 04/2014; 71(4):346-51. · 0.21 Impact Factor
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    ABSTRACT: Consensus diagnostic criteria for multiple system atrophy consider dementia as a nonsupporting feature, despite emerging evidence demonstrating that cognitive impairments are an integral part of the disease. Cognitive disturbances in multiple system atrophy occur across a wide spectrum from mild single domain deficits to impairments in multiple domains and even to frank dementia in some cases. Frontal-executive dysfunction is the most common presentation, while memory and visuospatial functions also may be impaired. Imaging and neuropathological findings support the concept that cognitive impairments in MSA originate from striatofrontal deafferentation, with additional contributions from intrinsic cortical degeneration and cerebellar pathology. Based on a comprehensive evidence-based review, the authors propose future avenues of research that ultimately may lead to diagnostic criteria for cognitive impairment and dementia associated with multiple system atrophy. © 2014 International Parkinson and Movement Disorder Society
    Movement Disorders 04/2014; · 4.56 Impact Factor
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    ABSTRACT: Background Mutations in GNAL (DYT25) have recently been established as the first confirmed cause of focal or segmental adult-onset dystonia. Mutation carriers show craniocervical involvement; however, the GNAL mutational and phenotypic spectrum remain to be further characterized, and guidelines for diagnostic testing need to be established.Methods The authors used Sanger sequencing to test for changes in the GNAL coding or splice-site regions in 236 Serbian patients suffering from isolated dystonia with craniocervical involvement.ResultsOne novel likely pathogenic substitution (c.1061T>C; p.Val354Ala) in GNAL was detected in a sporadic cervical dystonia patient (mutation frequency: 0.4%). This mutation was not present in the DNA of either parent, despite confirmed parentage.Conclusions This is the first report of a de novo GNAL mutation causing genetically proven, seemingly sporadic DYT25 dystonia. Our finding highlights the importance of genetic testing for GNAL mutations in establishing the molecular diagnosis even for patients with a negative family history. © 2014 International Parkinson and Movement Disorder Society © 2014 International Parkinson and Movement Disorder Society
    Movement Disorders 04/2014; · 4.56 Impact Factor
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    ABSTRACT: White matter (WM) tract alterations were assessed in patients with progressive supranuclear palsy (PSP) relative to healthy controls and patients with idiopathic Parkinson's disease (PD) to explore the relationship of WM tract damage with clinical disease severity, performance on cognitive tests, and apathy. 37 PSP patients, 41 PD patients, and 34 healthy controls underwent an MRI scan and clinical testing to evaluate physical disability, cognitive impairment, and apathy. In PSP, the contribution of WM tract damage to global disease severity and cognitive and behavioural disturbances was assessed using Random Forest analysis. Relative to controls, PSP patients showed diffusion tensor (DT) MRI abnormalities of the corpus callosum, superior cerebellar peduncle (SCP), cingulum and uncinate fasciculus bilaterally, and right inferior longitudinal fasciculus. Corpus callosum and SCP DT MRI measures distinguished PSP from PD patients with high accuracy (area under the curve ranging from 0.89 to 0.72). In PSP, DT MRI metrics of the corpus callosum and superior cerebellar peduncles were the best predictors of global disease severity scale scores. DT MRI metrics of the corpus callosum, right superior longitudinal and inferior longitudinal fasciculus, and left uncinate were the best predictors of executive dysfunction. In PSP, apathy severity was related to the damage to the corpus callosum, right superior longitudinal, and uncinate fasciculi. In conclusion, WM tract damage contributes to the motor, cognitive, and behavioural deficits in PSP. DT MRI offers markers for PSP diagnosis, assessment, and monitoring.
    Journal of Neurology 03/2014; · 3.58 Impact Factor
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    ABSTRACT: IMPORTANCE Mutations in the GNAL gene have recently been shown to cause primary torsion dystonia. The GNAL-encoded protein (Gαolf) is important for dopamine D1 receptor function and odorant signal transduction. We sequenced all 12 exons of GNAL in 461 patients from Germany, Serbia, and Japan, including 318 patients with dystonia (190 with cervical dystonia), 51 with hyposmia and Parkinson disease, and 92 with tardive dyskinesia or acute dystonic reactions. OBSERVATIONS We identified the following two novel heterozygous putative mutations in GNAL: p.Gly213Ser in a German patient and p.Ala353Thr in a Japanese patient. These variants were predicted to be pathogenic in silico, were absent in ethnically matched control individuals, and impaired Gαolf coupling to D1 receptors in a bioluminescence energy transfer (BRET) assay. Two additional variants appeared to be benign because they behaved like wild-type samples in the BRET assay (p.Ala311Thr) or were detected in ethnically matched controls (p.Thr92Ala). Both patients with likely pathogenic mutations had craniocervical dystonia with onset in the fifth decade of life. No pathogenic mutations were detected in the patients with hyposmia and Parkinson disease, tardive dyskinesias, or acute dystonic reactions. CONCLUSIONS AND RELEVANCE Mutations in GNAL can cause craniocervical dystonia in different ethnicities. The BRET assay may be a useful tool to support the pathogenicity of identified variants in the GNAL gene.
    JAMA neurology. 02/2014;
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    ABSTRACT: Background Leber hereditary optic neuropathy (LHON) is the most common mitochondrial disorder. However, few countries have published their population-based findings related to this multisystemic disease. The aim In order to get a better insight into the epidemiological and clinical picture of this maternally inherited disorder, we performed the first population-based clinical and molecular-genetic study of LHON in the Serbian population. Methods Prospective study included patients who were diagnosed with LHON after detailed medical examination and molecular-genetic confirmation. Results We identified 41 individuals from 12 genealogically unrelated families, carrying one of the three “primary” mitochondrial (mt) DNA point mutations associated with LHON. Fourteen of them were clinically affected, giving a minimum point prevalence of 1.9 per 1 000 000. The minimum point prevalence for mtDNA LHON mutations was 5.2 per 1 000 000. Male to female ratio was 6:1. Only one affected patient harboured mutant mtDNA in heteroplasmic condition. All patients were presented with common clinical findings. Conclusion We observed significantly lower prevalence and higher gender ratio than expected. However, frequencies of primary mutations, incidence of heteroplasmy and clinical findings are in accordance with other studies in Caucasoid populations. Our results might be a consequence of poor recognition and misdiagnosis due to lack of diagnostic possibilities of the entity in different region of our country or less likely be in part due to specific haplotype background of Serbian population which should be further investigated.
    European journal of paediatric neurology: EJPN: official journal of the European Paediatric Neurology Society 01/2014; · 2.01 Impact Factor
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    ABSTRACT: Depressed patients demonstrate alterations in motor and cognitive functioning that can affect their adjustments to the variations in everyday life environment. The objective was to explore gait parameters and variability of patients with major depressive disorder in dual task walking situations. Eight patients and 20 healthy controls performed motor, mental and combined motor+mental task while walking. Calculated parameters were cycle time, stride length, swing time, double support time and their coefficients of variation (CV). Patients demonstrated greater gait variability (swing time CV) than controls during baseline walk (t(26)=2.64, p<0.05) and motor dual task (t(26)=3.68, p<0.05). Moreover, the transition from mental to combined task decreased stride length (M=126.48±15.35 and M=121.19±13.55, p<0.001) and increased double support time (M=0.266±0.072 and M=0.287±0.076, p<0.01) only in controls. Also, gait variability increased in controls during the combined task, while remaining the same or decreasing in patients. Tasks that required greater cognitive involvement affected gait variability in patients more than controls, but only up to a certain level, after which patients’ stability appeared unaffected by the increase of cognitive demand. This could be explained by a tendency of patients to neglect complex cognitive tasks while walking in order to preserve stability and prevent possible falls.
    Psychiatry Research. 01/2014;
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    ABSTRACT: Musician's dystonia (MD) affects 1% to 2% of professional musicians and frequently terminates performance careers. It is characterized by loss of voluntary motor control when playing the instrument. Little is known about genetic risk factors, although MD or writer's dystonia (WD) occurs in relatives of 20% of MD patients. We conducted a 2-stage genome-wide association study in whites. Genotypes at 557,620 single-nucleotide polymorphisms (SNPs) passed stringent quality control for 127 patients and 984 controls. Ten SNPs revealed P < 10(-5) and entered the replication phase including 116 MD patients and 125 healthy musicians. A genome-wide significant SNP (P < 5 × 10(-8) ) was also genotyped in 208 German or Dutch WD patients, 1,969 Caucasian, Spanish, and Japanese patients with other forms of focal or segmental dystonia as well as in 2,233 ethnically matched controls. Genome-wide significance with MD was observed for an intronic variant in the arylsulfatase G (ARSG) gene (rs11655081; P = 3.95 × 10(-9) ; odds ratio [OR], 4.33; 95% confidence interval [CI], 2.66-7.05). rs11655081 was also associated with WD (P = 2.78 × 10(-2) ) but not with any other focal or segmental dystonia. The allele frequency of rs11655081 varies substantially between different populations. The population stratification in our sample was modest (λ = 1.07), but the effect size may be overestimated. Using a small but homogenous patient sample, we provide data for a possible association of ARSG with MD. The variant may also contribute to the risk of WD, a form of dystonia that is often found in relatives of MD patients. © 2013 International Parkinson and Movement Disorder Society.
    Movement Disorders 12/2013; · 4.56 Impact Factor
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    ABSTRACT: In the present study, we investigated the role of the main intracellular energy sensor, AMP-activated protein kinase (AMPK), in the in vitro neurotoxicity of α-synuclein (ASYN), one of the key culprits in the pathogenesis of Parkinson's disease. The loss of viability in retinoic acid-differentiated SH-SY5Y human neuroblastoma cells inducibly overexpressing wild-type ASYN was associated with the reduced activation of AMPK and its activator LKB1, as well as AMPK target Raptor. ASYN-overexpressing rat primary neurons also displayed lower activity of LKB1/AMPK/Raptor pathway. Restoration of AMPK activity by metformin or AICAR reduced the in vitro neurotoxicity of ASYN overexpression, acting independently of the prosurvival kinase Akt or the induction of autophagic response. The conditioned medium from ASYN-overexpressing cells, containing secreted ASYN, as well as dopamine-modified or nitrated recombinant ASYN oligomers, all inhibited AMPK activation in differentiated SH-SY5Y cells and reduced their viability, but not in the presence of metformin or AICAR. The RNA interference-mediated knockdown of AMPK increased the sensitivity of SH-SY5Y cells to the harmful effects of secreted ASYN. AMPK-dependent protection from extracellular ASYN was also observed in rat neuron-like pheochromocytoma cell line PC12. These data demonstrate the protective role of AMPK against the toxicity of both intracellular and extracellular ASYN, suggesting that modulation of AMPK activity may be a promising therapeutic strategy in Parkinson's disease.
    Neurobiology of Disease 11/2013; · 5.62 Impact Factor
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    ABSTRACT: Alternation of walking pattern decreases quality of life and may result in falls and injuries. Freezing of gait (FOG) in Parkinson's disease (PD) patients occurs occasionally and intermittently, appearing in a random, inexplicable manner. In order to detect typical disturbances during walking, we designed an expert system for automatic classification of various gait patterns. The proposed method is based on processing of data obtained from an inertial sensor mounted on shank. The algorithm separates normal from abnormal gait using Pearson's correlation and describes each stride by duration, shank displacement, and spectral components. A rule-based data processing classifies strides as normal, short (short+) or very short (short-) strides, FOG with tremor (FOG+) or FOG with complete motor block (FOG-). The algorithm also distinguishes between straight and turning strides. In twelve PD patients, FOG+ and FOG- were identified correctly in 100% of strides, while normal strides were recognized in 95% of cases. Short+ and short- strides were identified in about 84% and 78%. Turning strides were correctly identified in 88% of cases. The proposed method may be used as an expert system for detailed stride classification, providing warning for severe FOG episodes and near-fall situations.
    IEEE transactions on neural systems and rehabilitation engineering: a publication of the IEEE Engineering in Medicine and Biology Society 10/2013; · 2.42 Impact Factor
  • European Journal of Epidemiology 10/2013; · 5.12 Impact Factor
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    ABSTRACT: Abstract Objectives - To compare characteristics of migraine and some lifestyle habits in migraineurs with and without a positive family history for migraine. Method - The prevalence study was combined with a case-control study and comprised 245 female students with migraine. Results - Of 245 female students with migraine, 132 (53.9%) had a positive family history for migraine. In comparison with migraineurs who had not, those with a positive family history were younger at the onset of migraine and significantly more frequently reported menstrual migraine (p < 0.001), unilateral pain (p < 0.05) and pulsate pain (p < 0.05) as well as severe headache (p < 0.01). In comparison to migraineurs with a positive family history for migraine, those who did not report a significantly higher frequency of average number of meals per day of < 3 (p < 0.001), missed meals (p < 0.05) and an average sleep duration of ≤ 6 hours (p < 0.05). Conclusions -The results of the present study are in line with literature showing a high frequency of positive family history for migraine among migraineurs. They also suggest that subjects with a positive family history have a lower "migrainous threshold" for the development of migraine and that environmental factors are more important for the occurrence of migraine in subjects without a positive family history. Accordingly, the conclusions of this study are limited to reproductive aged women.
    The International journal of neuroscience 07/2013; · 0.86 Impact Factor
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    ABSTRACT: Idiopathic intracranial hypertension (IIH) is a pathological state defined as an increase of intracranial pressure in the absence of a causative pathological process. The aim of this study was to evaluate the clinical features of the patients with IIH diagnosed in our Headache Center according to the current knowledge of this disorder. In the retrospective and cross-sectional analysis of 3395 patients we present 12 newly diagnosed IIH patients, ten women and two men, aged from 19 to 51, with obtained values of cerebrospinal fluid pressure between 250 and 680 mm of water. The symptoms of IIH clinical presentation have been headache, reported by 92 % of patients; papilledema, noted in 67 %; and cranial nerve impairment (25 %). The results obtained from presented patients confirmed the presence of headache features that are included in criteria for headache attributed with IIH in majority of them: progressive, daily, diffuse, non-pulsatile headache with aggravation by coughing or straining. Decrease of pain intensity after lumbar puncture was noted in all patients. We notice the relatively small proportion of patients with headache attributed to IIH among the patients treated in our Headache Center. The prevalence of IIH is not low and headache is the most frequent presenting symptom; therefore, we could only conclude that some chronic headache patients refractory for treatment are patients with IIH.
    Acta neurologica Belgica. 07/2013;
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    ABSTRACT: The symptoms of Parkinson's disease (PD) worsen over time affecting performance and causing disability. The purpose of this study was to translate the Self-Assessment Disability Scale in patients with Parkinson's disease (SADS-PD) into the Serbian language and assess its validity and reliability. From January to July 2012, 114 consecutive PD patients were recruited at the Neurology Clinic in Belgrade. The inclusion criteria were: ability to walk independently for at least 10 m, ability to stand for at least 90 s. The exclusion criteria were: cognitive impairment, the presence of other major neurologic, psychiatric, visual, audio-vestibular, and orthopedic disturbances. The 25-item SADS-PD was translated according to internationally-accepted methodology. The internal consistency of the scale was evaluated using Cronbach's alpha coefficient. Test-retest reliability was evaluated using Kendall's concordance coefficient for total scores. To evaluate construct validity, an exploratory factor analysis (principal component analysis, varimax rotation) was performed. Cronbach's alpha coefficient was 0.984. Kendall's concordance coefficient was 0.994. Duration of the disease, Hoehn & Yahr (H&Y) stage, Unified Parkinson's Disease Rating Scale (UPDRS) motor score, history of falls, Hamilton's Depression and Anxiety Rating Scales (HDRS and HARS) scores were significantly correlated with the total SADS-PD score. On factor analysis 25 items in the SADS-PD questionnaire were separated in two clusters with total matrix variance of 79.7 %. The psychometric properties of the cross-culturally adapted SADS-PD questionnaire (Serbian version) have outstanding validity and reliability as an instrument for evaluation of the extent of disability in patients with PD.
    Journal of Neurology 04/2013; · 3.58 Impact Factor
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    ABSTRACT: Transcranial magnetic stimulation (TMS) is a standard technique for noninvasive assessment of changes in central nervous system excitability. The aim of this study was to examine changes in responses to TMS in patients suffering from Parkinson's disease (PD) during sustained submaximal isometric voluntary contraction [60% of maximal voluntary contraction (MVC)] of the adductor pollicis muscle, as well as during a subsequent recovery period. Cortical excitability was tested by single TMS pulses of twice of the motor threshold intensity applied over the vertex. Testing was carried out during the sustained contraction phase every 10 s before and every 5 s after the endurance point, as well as at rest and during brief 60% MVC contractions before (control), immediately after the sustained contraction, and at 5 min intervals during the recovery period. Although the PD patients could sustain the contraction at the required level for as long period of time as the healthy subjects (though contraction level subsided more rapidly after the endurance point), effects of muscle fatigue on the responses to TMS were different. In contrast to the findings observed in the healthy people where motor evoked potentials (MEP) and EMG silent period (SP) in fatigued muscle gradually diminished during contraction up to the endurance point, and increased thereafter, in the majority of patients no changes occurred in MEP size (peak and area) of the adductor pollicis muscle, either before or after the endurance point. On the other hand, changes in the SP of this muscle differed among the subjects, showing a gradual increase, a decrease or no changes in duration. The trends of changes in both MEP size and SP duration in the musculus brachioradialis varied among the tested PD patients, without any consistent pattern, which was in contrast with the findings in the healthy people where both measures showed a gradual increase from the beginning of the sustained contraction. A complete dissociation between changes in MEP and SP during fatigue was also of note, which differed sharply from the findings in the healthy people in who fatigue induced changes in these measures followed identical patterns. These results in the PD patients suggest the presence of impairment and/or compensatory changes in mechanisms responsible for adaptation of voluntary drive as well as for matching between cortical excitation and inhibition which become manifest in demanding motor tasks such as those imposed by muscle fatigue.
    Vojnosanitetski pregled. Military-medical and pharmaceutical review 03/2013; 70(3):298-303. · 0.21 Impact Factor
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    ABSTRACT: AIM: The aim of the present study was to assess the validity and reliability of the Falls Efficacy Scale (FES) in Parkinson's disease (PD) patients in Serbia. METHODS: A cross-sectional study was carried out at the Clinic for Neurology, between June 2011 and June 2012. A total of 201 consecutive PD outpatients were recruited. The inclusion criteria were: ability to walk independently for at least 10 m, ability to stand for at least 90 s and a Mini-Mental State Examination score >24. The exclusion criteria were: the presence of other major neurological, psychiatric, visual, audio-vestibular and orthopedic disturbances. The 10-item FES was translated according to internationally-accepted methodology. The internal reliability of the Serbian version of the FES was evaluated using Cronbach's alpha coefficient. Reproducibility of the FES was evaluated using the Spearman-Brown coefficient. To evaluate construct validity, an exploratory factor analysis (principal component analysis, varimax rotation) was carried out. RESULTS: The internal consistency of the Serbian version of the FES was 0.98. Age, duration of disease, Hoehn and Yahr stage, Unified Parkinson's Disease Rating Scale motor score, history of falls, and the Hamilton depression and anxiety scores were significantly correlated with the total FES score. On factor analysis, all 10 items were compact in a one-factor cluster, with an explained variance of 85%. Spearman-Brown's correlation coefficient between the total scores was 0.99. CONCLUSIONS: The psychometric characteristics of the Serbian version of the FES have excellent reliability and validity as an instrument for measuring the fear of falling in PD patients. Geriatr Gerontol Int 2013; ●●: ●●-●●.
    Geriatrics & Gerontology International 02/2013;
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    ABSTRACT: Background: A limited number of studies examined anxiety in Parkinson disease (PD). Questionable validity of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) defined anxiety disorders in PD population as well as a lack of validated rating scales hampered the investigation in this field. Objective: To screen for prevalence of anxiety symptoms and their associated demographic and clinical features in an outpatient-based cohort with PD. Patients and methods: A consecutive series of 360 patients with PD underwent investigation with the Hamilton Anxiety Rating Scale (HARS), the 17-item Hamilton Depression Rating Scale, Neuropsychiatric Inventory, section E (anxiety), motor scoring with Hoehn and Yahr staging, the Unified Parkinson's Disease Rating Scale, and cognitive screening with the Mini-Mental State Examination. Results: In all, 136 (37.8%) patients with PD of our cohort had anxiety symptoms, whereas both depression and anxiety were recorded in 5.6% of the patients, while in 56.7% neither anxiety nor depression was present. Female gender, motor disability, and core depression symptoms were the main markers of anxiety in patients with PD. The severity of anxiety symptoms was not associated with asymmetry of motor symptoms. Education, disease duration, and levodopa dose were poor predictors in the model. The HARS had a satisfactory inter-item correlation, convergent validity, and factorial structure. Conclusions: Anxiety may be present as an isolated symptom, with specific demographic and clinical markers, and not only as a feature of depression in PD population. This highlighted the importance of identifying anxiety symptoms when treating patients with PD.
    Journal of Geriatric Psychiatry and Neurology 02/2013; · 3.53 Impact Factor

Publication Stats

2k Citations
449.37 Total Impact Points


  • 2012–2014
    • University Children's Hospital, Belgrade, Serbia
      Beograd, Central Serbia, Serbia
    • St. Sava Hospital, Belgrade
      Beograd, Central Serbia, Serbia
  • 1990–2014
    • University of Belgrade
      • • School of Medicine
      • • Faculty of Philology
      • • Institute of Endocrinology
      • • Faculty of Biology
      Beograd, Central Serbia, Serbia
  • 2013
    • Università Vita-Salute San Raffaele
      Milano, Lombardy, Italy
    • Klinički Centar Niš
      Nisch, Central Serbia, Serbia
  • 2009–2012
    • Institute for Educational Research, Belgrade, Serbia
      Beograd, Central Serbia, Serbia
    • Oncology Institute of Vojvodina
      Varadinum Petri, Autonomna Pokrajina Vojvodina, Serbia
  • 2003–2012
    • Universität zu Lübeck
      Lübeck Hansestadt, Schleswig-Holstein, Germany
  • 2011
    • San Raffaele Scientific Institute
      Milano, Lombardy, Italy
  • 1997–2010
    • Klinički centar Srbije
      • Institute of Neurology
      Beograd, Central Serbia, Serbia
  • 2006
    • Institut za onkologiju i radiologiju Srbije
      Beograd, Central Serbia, Serbia
  • 1991–1997
    • Columbia University
      • Department of Neurology
      New York City, NY, United States