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Yayın Neuropsychiatric outcomes and caregiver distress in primary progressive aphasia(Wiley, 2023-01) Seçkin, Mustafa; Yıldırım, Elif; Demir, İlayda; Orhun, Ömer; Bülbül, Ezgi; Velioğlu, H. Aziz; Öget, Öktem; Yeşilot, Nilüfer; Çoban, Oğuzhan; Gürvit, HakanBackground: In this study, we aimed to outline the neuropsychiatric consequences of primary progressive aphasia (PPA) and to understand how neuropsychiatric symptomatology affects distress in caregivers. Methods: The Neuropsychiatric Inventory (NPI) including the distress index (NPI-Distress) was used. Additional information about the caregiver burden was obtained using Zarit Burden Interview (ZBI). NPI, NPI-Distress, and ZBI data from 17 patients with a clinical diagnosis of PPA were compared with 10 stroke aphasia patients. Neuropsychiatric symptomatology was investigated based on three clusters; Mood, Frontal/Comportmental, and Psychotic/Disruptive. Additionally, the Activities of Daily Living Questionnaire (ADLQ) was used to outline the functional impairment. Twelve healthy controls were included to compare the neurocognitive test scores with PPA and stroke aphasia groups. Results: A greater number of neuropsychiatric symptoms were observed in the PPA group compared to the stroke aphasia group. The number of symptoms in Mood, and Frontal/Comportmental clusters were greater than the number of symptoms in Psychotic/Disruptive clusters in the PPA group, whereas no significant relationship between the number of symptoms and symptom clusters was found in the stroke aphasia group. In the PPA group, a strong correlation was found between the NPI-Frequency × Severity scores and the NPI-Distress scores. Moreover, the NPI-Distress scores in the PPA group strongly correlated with the ZBI scores. Scores for anxiety, irritability/lability, and apathy had a stronger correlation with the NPI-Distress scores compared to the other NPI symptoms. The Communication subscale was the most impaired domain in the PPA group. Travel, and Employment and Recreation subscales showed greater functional impairment in the stroke aphasia group compared to the PPA group. Conclusions: Neuropsychiatric symptoms in PPA in our study were more frequent than previously reported. Furthermore, the distress index of the NPI was not only correlated with the severity of the neuropsychiatric symptoms but also reflected the overall burden on the caregivers in the PPA group.Yayın Influence of ABCB1 polymorphisms and serum concentrations on venlafaxine response in patients with major depressive disorder(Taylor and Francis Ltd, 2017-04) Özbey, Gül; Çam Çelikel, Feryal; Cumurcu, Birgül Elbozan; Kan, Derya; Yücel, Berna; Hasbek, Ekrem; Perçin, Ferda Emriye; Güzey, İsmail Cüneyt; Uluoǧlu, CananBackground: The pharmacokinetics and the pharmacodynamics of antidepressants show large inter-individual variations which result in unpredictable clinical responses. Aim: The aim of the study was to examine the effect of ABCB1 polymorphisms and the serum concentrations on the efficacy and tolerability of venlafaxine in patients with major depressive disorder (MDD). Methods: Fifty-two outpatients who met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria for MDD were recruited for the study. The severity of depression was assessed using the 17-item Hamilton Rating Scale for Depression scale (HDRS17) and tolerability was assessed based on a query regarding side-effects for 6 weeks. The ABCB1 C3435T/A and G2677T/A polymorphisms were genotyped by PCR/RFLP and steady-state serum venlafaxine concentrations were measured by high-performance liquid chromatography. Results: Patients with the TT genotype for the C3435T and the TT/TA genotype for the G2677T/A polymorphism showed significantly higher frequencies in venlafaxine-induced akathisia. This relationship was not observed for efficacy. As regards serum venlafaxine concentrations, patient groups showed no significant differences in efficacy and tolerability. Conclusion: The results suggest that individuals with the TT-TT/TA genotypes for the C3435T-G2677T/A polymorphisms of ABCB1 may be pre-disposed to a risk of akathisia.Yayın Attentional bias and training in social anxiety disorder(Turkish Neuropsychiatric Society, 2015-03) Fıstıkçı, Nurhan; Saatçioğlu, İbrahim Ömer; Keyvan, Ali; Topçuoǧlu, VolkanCognitive behavioral therapy (CBT) is one of the most effective treatment modalities for social anxiety disorder (SAD), showing a high level of clinical evidence supporting its effectiveness. On the other hand, lack of the desired benefit from this treatment in some patients causes continuation of the search for new techniques. Recent research studies have focused on attentional bias and attention training in SAD. Attention processes in SAD have been a major target of interest and investigation since the introduction of the first cognitive models explaining SAD. In the first model, it was highlighted that attention was self-focused. The relationship between threatening stimuli and attention was considered in the subsequent models. Attentional bias towards threat may take place in several ways, such as facilitated processing of threat, difficulty in disengaging attention from the threat and avoidance of attention from the threat. After these descriptions regarding the phenomenology of the disorder, treatments to modify attention, processes were developed. In spite of conflicting results, investigations on attentional training are promising. Attention processes, attentional bias and attentional training in SAD are discussed in this review.Yayın Diffusion tensor imaging findings in children with sluggish cognitive tempo comorbid Attention Deficit Hyperactivity Disorder(Taylor and Francis Ltd, 2020-06-16) Ünsel Bolat, Gül; Baytunca, Muharrem Burak; Kardaş, Burcu; İpçi, Melis; İnci İzmir, Sevim Berrin; Özyurt, Onur; Çallı, Mehmet Cem; Ercan, Eyüp SabriObjective: The construct of Sluggish Cognitive Tempo (SCT) is characterized by daydreaming, mental confusion, staring blankly and hypoactivity. Our main goal was to explore neuropsychological differences in Attention Deficit Hyperactivity Disorder-Inattentive presentation (ADHD-IA) groups with and without SCT symptoms compared to healthy controls. After detecting specific neuropsychological differences, we examined white matter microstructure using Diffusion Tensor Imaging (DTI) data obtained from 3.0 Tesla MRI scans of the cases with SCT symptoms comparing to Typically Developing (TD) controls. Method: In this study, we included 24 cases in the ADHD-IA group with SCT symptoms, 57 cases in the ADHD-IA group without SCT symptoms and, 24 children in the TD group. We applied tract-based spatial statistics to the DTI measures for obtaining fractional anisotropy (FA), axial, radial and mean diffusivity (AD, RD, MD) to explore white matter differences for the whole brain. Results: Omission error scores and longer reaction time scores were specifically associated with inattention symptoms. Commission error scores were significantly and specifically related to SCT symptoms. Cases with SCT symptoms presented increased FA in the bilateral anterior and posterior limb of the internal capsule, bilateral cerebral peduncle, and the fornix than TD group. Conclusions: Neurobiological differences in ADHD cases are still relatively unexplored. We suggest that including an assessment for SCT in the neuropsychological and neuroimaging studies of ADHD may provide more consistent results.Yayın Olanzapin kullanımına bağlı çekilme diskinezisi ve süpersensitivite psikozu(Turkish Neuropsychiatric Society, 2016-06) Karaş, Hakan; Güdük, Mehmet; Saatçioğlu, İbrahim ÖmerTardive dyskinesia (TD) usually appears after years of antipsychotic drug use and appears to be related to the total lifetime medication dose. In withdrawal-emergent dyskinesia (WE-D), which is considered to be a subtype of TD, dyskinetic symptoms often appear shortly after a rapid reduction in antipsychotic drug dose or sudden discontinuation of the drug. Supersensitivity psychosis, which is frequently observed along with TD and is considered to have a similar etiology as TD, is a psychotic relapse phenomenon that occurs after the withdrawal of an antipsychotic drug or a rapid reduction in the drug dosage. In general, atypical antipsychotics tend to be associated with less propensity to cause TD when compared with typical antipsychotics. Furthermore, olanzapine and clozapine may have a therapeutic potential in improving or totally curing TD. In this study, a case of WE-D because of discontinuing olanzapine use and supersensitivity psychosis is discussed.Yayın One size does not fit all in psychotherapy: Understanding depression among patients of Turkish origin in Europe(Turkish Neuropsychiatric Society, 2016-03) Balkır Neftçi, Nazlı; Barnow, SvenOver the last decades, Europe has become an immigration country hosting an estimated 56 million international immigrants. Yet, a large amount of literature suggests that migration is associated with a higher risk of common mental disorders, such as depression and anxiety. As representatives of one of the largest immigrant groups in Europe, various studies have shown that Turkish immigrants exhibit a higher prevalence of depression and anxiety disorders than do the background population. Nevertheless, it is also well demonstrated that this particular patient group is more likely to terminate treatment prematurely and displays lower rates of treatment compliance than their native counterparts. This reluctance for service utilization might be partially because of the fact that people from non-Western ethnocultural backgrounds (e.g., Turkey) often have a different notion and comprehension of mental health and illness as compared with those of the people from Western societies. Such mismatch often results in discrepancies between the needs and expectations of immigrant patients and clinicians, which attenuate the communication and effectiveness of treatment and lead to unexplained high dropout rates. To provide continued provision of culture-sensitive, high quality, evidence-based mental health care, the advancement of researches exploring such sociocultural differences between the patients’ and the clinicians’ notions of mental health must occur. In response to these problems, the current review aims to explore the interplay between culture and mental processes that associate with the etiology, maintenance, and management of depression among Turkish immigrant patients. This is to inform clinicians regarding culturespecific correlates of depression among Turkish patients to enable them to present interventions that fit the needs and expectations of this particular patient group.Yayın Increased cerebral blood flow in the right anterior cingulate cortex and fronto-orbital cortex during go/no-go task in children with ADHD(Taylor & Francis Ltd, 2021-04-01) Baytunca, Muharrem Burak; de Frederick, Blaise; Bolat, Gül Ünsel; Kardaş, Burcu; İnci İzmir, Sevim Berrin; İpçi, Melis; Calli, Cem; Özyurt, Onur; Öngür, Dost; Süren, Serkan; Ercan, Eyüp SabriObjective: Arterial spin labeling (ASL) is a relatively new imaging modality in the field of the cognitive neuroscience. In the present study, we aimed to compare the dynamic regional cerebral blood flow alterations of children with ADHD and healthy controls during a neurocognitive task by using event-related ASL scanning. Methods: The study comprised of 17 healthy controls and 20 children with ADHD. The study subjects were scanned on 3 Tesla MRI scanner to obtain ASL imaging data. Subjects performed go/no-go task during the ASL image acquisition. The image analyses were performed by FEAT (fMRI Expert Analysis Tool) Version 6. Results: The mean age was 10.88 +/- 1.45 and 11 +/- 1.91 for the control and ADHD group, respectively (p = .112). The go/no-go task was utilized during the ASL scanning. The right anterior cingulate cortex (BA32) extending into the frontopolar and orbitofrontal cortices (BA10 and 11) displayed greater activation in ADHD children relative to the control counterparts (p < .001). With a lenient significance threshold, greater activation was revealed in the right-sided frontoparietal regions during the go session, and in the left precuneus during the no-go session. Conclusion: These results indicate that children with ADHD needed to over-activate frontopolar cortex, anterior cingulate as well as the dorsal and ventral attention networks to compensate for the attention demanded in a given cognitive task.Yayın Alzheimer hastalığında olağan durum ağı bağlantısallığı(Türkiye Sinir Ve Ruh Sağlığı Derneği, 2019-12) Yıldırım, Elif; Soncu Büyükişcan, EzgiAmaç: Alzheimer hastalığı (AH) beyinde yapısal ve işlevsel değişimler meydana getiren nörodejeneratif bir hastalıktır. Gelişen beyin görüntüleme yöntemleri sayesinde AH patolojisine eşlik eden yapısal ve işlevsel bağlantılardaki bozulmalar gitgide daha görünür hale gelmiştir. AH’de dinlenim durumu bağlantısallığında, özellikle de olağan durum ağı (default mode network - DMN) olarak adlandırılan içsel bağlantısallık ağında farklılaşmalar görülmektedir. Bu çalışmada DMN bağlantısallık bulgularının incelenmesi ve tartışılması amaçlanmıştır. Yöntem: İşlevsel manyetik rezonans görüntüleme (fMRI) çalışmalarında en yaygın kullanılan 2 temel metodoloji (tohum temelli ve bağımsız bileşen analizi) temel alınarak alanda yapılan çalışmalar incelenmiştir. Bulgular: Çalışmalar genel olarak, DMN bağlantısallığının AH süreci boyunca ilerleyici bir şekilde bozulduğunu göstermektedir. DMN alt sistemlerinin AH’nin preklinik ve prodromal evrelerinde farklı bağlantısallık örüntüleri gösterdiği de belirtilmektedir. DMN’deki bozulmanın diğer bağlantısallık ağlarındaki farklılaşma ile ilişkili olabileceğini öne süren kanıtlar da mevcuttur. Buna ek olarak, bulgular DMN’nin AH ile ilişkili nöropatoloji ve genetik risk faktörleri ile olan ilişkisine de işaret etmektedir. Sonuç: AH’nin beyinde başta DMN olmak üzere diğer dinlenim durumu ağlarında işlevsel bozulmalara yol açan yaygın bir diskonneksiyon sendromu olduğu öne sürülebilir. Buna ek olarak, preklinik vakalarda ve risk taşıyan kişilerde de saptanabilen AH ile ilişkili işlevsel bağlantısallık değişimleri AH için muhtemel bir biyo-belirteç olabilir.Yayın White-matter changes in early and late stages of mild cognitive impairment(Churchill Livingstone, 2020-08) Femir Gürtuna, Banu; Kurt, Elif; Ulaşoğlu Yıldız, Çiğdem; Bayram, Ali; Yıldırım, Elif; Soncu Büyükişcan, Ezgi; Bilgiç, BaşarMild Cognitive Impairment (MCI) is characterized by cognitive deficits that exceed age-related decline, but not interfering with daily living activities. Amnestic type of the disorder (aMCI) is known to have a high risk to progress to Alzheimer's Disease (AD), the most common type of dementia. Identification of very early structural changes in the brain related to the cognitive decline in MCI patients would further contribute to the understanding of the dementias. In the current study, we target to investigate whether the white-matter changes are related to structural changes, as well as the cognitive performance of MCI patients. Forty-nine MCI patients were classified as Early MCI (E-MCI, n = 24) and Late MCI (L-MCI, n = 25) due to their performance on The Free and Cued Selective Reminding Test (FCSRT). Age-Related White-Matter Changes (ARWMC) scale was used to evaluate the white-matter changes in the brain. Volumes of specific brain regions were calculated with the FreeSurfer program. Both group and correlation analyses were conducted to show if there was any association between white-matter hyperintensities (WMHs) and structural changes and cognitive performance. Our results indicate that, L-MCI patients had significantly more WMHs not in all but only in the frontal regions compared to E-MCI patients. Besides, ARWMC scores were not correlated with total hippocampal and white-matter volumes. It can be concluded that WMHs play an important role in MCI and cognitive functions are affected by white-matter changes of MCI patients, especially in the frontal regions.Yayın Elevated sTREM2 and NFL levels in patients with sepsis associated encephalopathy(Taylor & Francis, 2023-03-04) Orhun, Günseli; Esen, Figen; Yılmaz, Vuslat; Ulusoy, Canan; Şanlı, Elif; Yıldırım, Elif; Gürvit, İbrahim Hakan; Ergin Özcan, Perihan; Sencer, Serra; Bebek, Nerses; Tüzün, ErdemPurpose: Sepsis-associated encephalopathy (SAE) is a common manifestation of sepsis that may lead to cognitive decline. Our aim was to investigate whether the neurofilament light chain (NFL) and soluble triggering receptor expressed on myeloid cells 2 (sTREM2) could be utilized as prognostic biomarkers in SAE. Materials and methods: In this prospective observational study, baseline serum levels of sTREM2 and cerebrospinal fluid (CSF) levels of sTREM2 and NFL were measured by ELISA in 11 SAE patients and controls. Patients underwent daily neurological examination. Brain magnetic resonance imaging (MRI) and standard electroencephalography (EEG) were performed. Cognitive dysfunction was longitudinally assessed after discharge in 4 SAE patients using the Mini-Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination-Revised (ACE-R) tests. Results: SAE patients showed higher CSF sTREM2 and NFL levels than controls. sTREM2 and NFL levels were not correlated with the severity measures of sepsis. Three months after discharge, 2 SAE patients displayed ACE-R scores congruent with mild cognitive impairment (MCI), persisting in one patient 12 months after discharge. SAE patients with MCI showed higher CSF NFL levels, bacteremia, and abnormal brain MRI. Patients with increased serum/CSF sTREM2 levels showed trends towards displaying poorer attention/orientation and visuo-spatial skills. Conclusions: sTREM2 and NFL levels may serve as a prognostic biomarker for cognitive decline in SAE. These results lend further support for the involvement of glial activation and neuroaxonal degeneration in the physiopathology of SAE.
