Agnes Pirker-Kees’s research while affiliated with Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel and other places

Introduction: Creutzfeldt-Jakob disease is a rare, neurodegenerative disorder that is incurable, always fatal, and transmissible. EEG is an integral part of the diagnostic workup with typical periodic sharp-wave complexes indicative of CJD, but early in the disease EEG is often unaltered. Accordingly, we aimed at evaluating disruption of brain network functional connectivity (FC) in regions belonging to the default mode network (DMN) as a potential early marker in CJD when EEG is considered visually normal. Methods: EEGs considered visually normal obtained from 7 CJD patients were compared to EEGs of 7 patients with subjective cognitive impairment (SCI) using Brainstorm application for Matlab. FC was calculated using the phase locking value separately for the delta-, theta-, alpha-, and beta-frequency-band. The global efficacy of the DMN was calculated as the inverse characteristic path length with brain-regions belonging to the DMN as nodes. Results: CJD vs. SCI had significantly lower global efficacy of the DMN in the gamma band. FC was decreased between bilateral orbitofrontal regions and the right parahippocampal gyrus and between bilateral orbitofrontal gyrus and the right anterior cingulate gyrus in CJD. Conclusion: Our findings provide evidence of disruption of the DMN in the gamma band and alterations of FC between specific brain regions in early CJD patients with visually normal EEGs. EEG brain network properties bear potential as a diagnostic tool for CJD early in the disease course in addition to established criteria. These findings call for further studies evaluating the diagnostic value of FC in early CJD.

Background Intravenous thrombolysis improves functional outcome in patients with acute stroke and frequencies of r-tPA (recombinant tissue-type plasminogen activator) treatment have been increasing over time. We aimed to assess whether functional outcome in r-tPA–treated patients improved over time and to investigate the influence of clinical variables on functional outcome. Methods We analyzed data of r-tPA–treated patients in the Austrian Stroke Unit Registry from 2006 to 2019. Favorable functional outcome was defined as modified Rankin Scale score of 0 to 2. Frequencies of modified Rankin Scale score of 0 to 2 were assessed for the overall population and in prespecified subgroups; multivariable logistic regression analysis was performed to assess associations of baseline characteristics including clinically relevant interactions, and outcome. Results Overall, 4865 out of 9409 r-tPA–treated patients (51.7%) achieved favorable functional outcome 3 months post stroke. Between 2006 and 2019, frequencies of favorable functional outcome increased from 45.9% to 56.8%. In multivariable logistic regression analysis, year of treatment (adjusted odds ratio [adjOR], 1.08 [95% CI, 1.01–1.15]) was associated with favorable functional outcome. Stroke severity (National Institutes of Health Stroke Scale, adjOR, 0.86 [95% CI, 0.85–0.87]), age (61–70 years: adjOR, 0.67 [95% CI, 0.55–0.80], 71–80 years: adjOR, 0.42 [95% CI, 0.35–0.50], >80 years: adjOR, 0.16 [95% CI, 0.13–0.20]), female sex (adjOR, 0.89 [95% CI, 0.79–0.99]), and various comorbidities (eg, atrial fibrillation, prior stroke, diabetes) were negatively associated. Inclusion of interaction terms into the multivariable logistic regression model suggests a positive effect of year of treatment and endovascular treatment by increasing stroke severity on functional outcome (interaction between year of treatment and National Institutes of Health Stroke Scale: adjOR, 1.01 [95% CI, 1.00–1.02], interaction between National Institutes of Health Stroke Scale and endovascular treatment: adjOR, 1.02 [95% CI, 1.01–1.03]). Conclusions Frequencies of favorable functional outcome in r-tPA–treated patients have been increasing over time, likely driven by improved outcome in patients with more severe strokes receiving endovascular treatment. However, some subgroups are still less likely to achieve functional independency and deserve particular attention.

Background: Hyposmia is frequently reported as an initial symptom in coronavirus disease 2019 (COVID-19). Objective: As hyposmia accompanies cognitive impairment in several neurological disorders, we aimed to study whether hyposmia represents a clinical biomarker for both neurological involvement and cognitive impairment in mild CO-VID-19. We aimed to study whether olfactory dysfunction (OD) represents a clinical biomarker for both neurological involvement and cognitive impairment in mild COVID-19. Methods: Formal olfactory testing using the Sniffin'Sticks® Screening test, neuropsychological assessment using the Montreal Cognitive Assessment (MoCA), and detailed neurological examination were performed in 7 COVID-19 patients with mild disease course and no history of olfactory or cognitive impairment, and 7 controls matched for age, sex, and education. Controls were initially admitted to a dedicated COVID-19 screening ward but tested negative by real-time PCR. Results: The number of correctly identified odors was significantly lower in COVID-19 than in controls (6 ± 3, vs. 10 ± 1 p = 0.028, r = 0.58). Total MoCA score was significantly lower in COVID-19 patients than in controls (20 ± 5 vs. 26 ± 3, p = 0.042, r = 0.54). Cognitive performance indicated by MoCA was associated with number of correctly identified odors in COVID-19 patients and controls (COVID-19: p = 0.018, 95% CI = 9-19; controls: p = 0.18, r = 0.63, 95% CI = 13-18.5 r = 0.64). Discussion/conclusion: OD is associated with cognitive impairment in controls and mild COVID-19. OD may represent a potentially useful clinical biomarker for subtle and even subclinical neurological involvement in severe acute respiratory distress syndrome coronavirus-2 infection.

Zusammenfassung Demenzerkrankungen führen durch den schleichenden Abbau kognitiver, sozialer und emotionaler Fähigkeiten, auch zu einem Verlust von Autonomie und Selbstbestimmtheit. Wearables sind am Körper getragene Sensoren: Akzelerometer und GPS-Tracker sind im Freizeit- und Fitnessbereich allgegenwärtig – sie zeichnen Bewegungs- und Positionsdaten auf. Das Potenzial, diese bei Demenzpatienten einzusetzen ist groß und wird intensiv beforscht. Wearables sind tlw. auch am Markt erhältlich (bspw. GPS-Tracker in Schuhsohlen). Informationen über Gangbild und Bewegungsdaten können auch Hinweise auf das Sturzrisiko, Verhaltensstörungen/Life-Events oder differenzialdiagnostische Aspekte geben. Trotz des großen Potenzials dürfen ethische Aspekte betreffend die Privatsphäre und den Datenschutz in der Entwicklung nicht außer Acht gelassen werden. Dieser Artikel gibt einen Überblick über die aktuelle Entwicklung von Wearables und damit verbundene ethische Aspekte.

Zusammenfassung Unter Wearables versteht man in die Kleidung oder in tragbare Geräte integrierte Sensoren, die eine kontinuierliche Langzeitmessung von physiologischen Parametern, wie Herzfrequenz, Blutdruck, Atmung, Bewegung, Hautwiderstand usw. und/oder Bewegungsmustern ermöglichen. In der Schlaganfallmedizin eröffnen Wearables neue Optionen in der Diagnostik, Prävention und Rehabilitation.