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Changes in brain magnetic resonance imaging in Alzheimer's disease
Šilhán, David ; Bartoš, Aleš (advisor) ; Dušek, Petr (referee) ; Krajčovičová, Lenka (referee)
Changes in brain magnetic resonance imaging in Alzheimer's disease Introduction Brain MRI is important auxiliary examination method in the diagnosis of Alzheimer's disease (AD). Mediotemporal atrophy is typical for late-onset AD. Brain atrophy can be different in patients with early-onset AD. Current visual scales for assessing brain atrophy in AD may be too complicated for routine clinical practice. Aims The main goal was to develop new, simple and reliable visual scales for the evaluation of mediotemporal and parietal atrophy on brain MRI, which will be suitable for the diagnosis of AD in routine clinical practice. Methods and patients We have developed a Parietal Atrophy Score (PAS) for the assessment of parietal atrophy, which is based on the evaluation of atrophy of 3 structures (sulcus cingularis posterior, precuneus, parietal gyri) on a sequence of coronal slices of the parietal lobe. We first used this scale to assess parietal cortex atrophy in 74 cognitively normal individuals from the Czech cohort (age range 48-87 years, MMSE 29 ± 1). The brain MRI of 25 people from this cohort were assessed by 4 evaluators with different professional experience to determine the reliability of the PAS. Parietal atrophy was compared between 24 patients with late-onset AD (MMSE 21 ± 3) and 26 cognitively normal...
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Predictive value of clinical, imaging and cerebrospinal fluid dynamics examinations in the diagnostic algorithm of the normal pressure hydrocephalus.
Radovnický, Tomáš ; Sameš, Martin (advisor) ; Haninec, Pavel (referee) ; Bartoš, Aleš (referee)
8.SUMMARY By evaluating the effect of treatment of patients with idiopathic normal pressure hydrocephalus (iNPH) indicated for surgery based on positive supplementary tests, we determined their positive predictive value. Both the lumbar infusion test and the tap test have a high positive predictive value for the clinical response to shunt surgery. A patient with a typical symptomatology, a radiological examination finding, and a positive supplementary test will most likely benefit from surgery. Supplementary tests are a valid part of the diagnostic algorithm regardless their invasiveness. Using diffusion tensor imaging on the MRI performed in patients with iNPH prior to surgery, one year after surgery and in healthy controls, we found changes in diffusion parameters in the periventricular white matter. Patients had a higher MD in ALIC, PLIC and CC compared to healthy controls, reflecting a higher degree of axonal degeneration in patients with iNPH. Patients in comparison with healthy controls had higher FA only in a PLIC. This area is affected by compression in patients with iNPH more severe. After the shunt surgery, we recorded a significant decrease in PLIC, which corresponds to the decompression after derivation of the CSF. However, the drop in value was not to the value of healthy controls. In patients...
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Multiple sclerosis: Clinical and paraclinical markers of disease activity.
Srpová, Barbora ; Horáková, Dana (advisor) ; Taláb, Radomír (referee) ; Bartoš, Aleš (referee)
Multiple sclerosis is chronic, autoimmune and neurodegenerative disorder of central nervous system. Currently, we have only limited markers of disease activity. From clinical markers, speech markers were analysed. Data from 141 patients and 70 healthy controls were evaluated. The most important results were detection of speech abnormalities in patients with minimal neurological disability (EDSS<2) and their correlations with global and regional brain atrophy. This work is predominantly concetrated on neurofilament light chain (NfL) as one of the most promising paraclinical biomarkers. NfL, especially level of serum NfL (sNfL), is considered to be a biomarker of future disease course, disease activity and effect of DMD (disease modifying drugs) therapy. The main aim was to clarify the position of NfL among others biomarkes and their potential benefit for routine clinical praxis. MRI data, clinical data and results of NfL measurements from 172 newly diagnosed patients with relaps-remiting MS (revised McDonald criteria 2017) from original SET cohort were analysed. Additionally, we compared levels of serum and CSF NfL with other biochemical parameters, such as lipidogram and markers of blood-brain permeability. We found sNfL as a marker of ongoing neuroinflammation and predictor of future brain atrophy...
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Biochemical parameters of energy metabolism in cerebrospinal fluid in inflammatory and non-inflammatory CNS diseases.
Bořecká, Klára ; Fialová, Lenka (advisor) ; Bartoš, Aleš (referee) ; Matouš-Malbohan, Ivan (referee)
The basic examination of the cerebrospinal fluid provides a quick orientation in the diagnostic algorithm of CNS diseases about the nature of the pathological process. The current evaluation of cytology and biochemical parameters of glucose metabolism reports about the cells present and at the same time about the level of their activation. The aim of the work was to investigate the relationship between biochemical and cytological findings in cerebrospinal fluid in a large data set (n = 8 178), or confirm the hypothesis of a significant alteration in the Coefficient of Energy Balance (CEB) in cytological classes typically accompanying oxidative burst of phagocytes. CEB was subjected to analysis and comparison with other energy parameters (lacto-glucose ratio, gluco-lactate ratio, concentration of lactate and glucose in cerebrospinal fluid). The relationships between blood and cerebrospinal fluid glucose and lactate concentrations were investigated. CEB values were statistically significantly different in cytological groups, which reflected purulent inflammation, tumor involvement or infection by potential intracellular pathogens, the hypothesis was confirmed. Other energy parameters excluding glycorrhachia distinguish these cytological groups as well as CEB. There are inaccuracies in the derivation...
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Predictive value of clinical, imaging and cerebrospinal fluid dynamics examinations in the diagnostic algorithm of the normal pressure hydrocephalus.
Radovnický, Tomáš ; Sameš, Martin (advisor) ; Haninec, Pavel (referee) ; Bartoš, Aleš (referee)
8.SUMMARY By evaluating the effect of treatment of patients with idiopathic normal pressure hydrocephalus (iNPH) indicated for surgery based on positive supplementary tests, we determined their positive predictive value. Both the lumbar infusion test and the tap test have a high positive predictive value for the clinical response to shunt surgery. A patient with a typical symptomatology, a radiological examination finding, and a positive supplementary test will most likely benefit from surgery. Supplementary tests are a valid part of the diagnostic algorithm regardless their invasiveness. Using diffusion tensor imaging on the MRI performed in patients with iNPH prior to surgery, one year after surgery and in healthy controls, we found changes in diffusion parameters in the periventricular white matter. Patients had a higher MD in ALIC, PLIC and CC compared to healthy controls, reflecting a higher degree of axonal degeneration in patients with iNPH. Patients in comparison with healthy controls had higher FA only in a PLIC. This area is affected by compression in patients with iNPH more severe. After the shunt surgery, we recorded a significant decrease in PLIC, which corresponds to the decompression after derivation of the CSF. However, the drop in value was not to the value of healthy controls. In patients...
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Assessment of activities of daily living in patients with Alzheimer disease in clinical practice
Martínek, Pavel ; Bartoš, Aleš (advisor)
Alzheimer's disease (AD) is a very frequent disorder. There are about 150 thousand people living with AD in the Czech Republic. The diagnostic criteria require not only the evaluation of cognitive abilities (e.g. memory), but also the activities of daily living (ADL). The aim of this thesis is to describe the concept of ADL and to provide the information about its assessment in the patients with AD. It also describes the scales for ADL assessment available in the Czech Republic and abroad. The assessment of ADL is useful for the diagnosis of AD and its prodromal stages, for the evaluation of treatment effects or disease progression, for its staging, to estimate the caregiver burden, and for other purposes. The best way to assess ADL in the clinical setting is the administration of structured questionnaires to the caregiver of the patient. The thesis provides a list of 14 ADL questionnaires and a brief information about each of them. Together with my tutor, we have translated three ADL scales (FAQ-CZ, DAD-CZ and BADLS-CZ) into Czech language during my student scientific activity. These scales were given to 47 caregivers of the patients with clinical probable AD according to NINCDS-ADRDA criteria. The cognitive abilities of the patients were measured with the Mini-Mental State Examination. It proved to be...
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