Delirium is associated with lower quality of life, increased healthcare costs, longer hospitalizations, and worse prognosis when detected in patients who are already confronted with a severe and invalidating disease, like the major neurocognitive disorder (MND). In order to identify the most evidence-based interventions that could be included in case management for patients with both delirium and MND, this narrative review explored three electronic databases (Pubmed, Cochrane, and Web of Science/Clarivate) for primary and secondary sources dedicated to this topic. All papers published in English between the inception of each database and September 2024 were screened for relevant data on pharmacological and non-pharmacological therapies targeting delirium. The results supported the use of a multicomponent approach as the first line of treatment, mitigating the precipitating factors, and only as a second line, the use of pharmacological instruments. There is a lack of validated therapies targeting specifically the delirium superimposed on MND, most of the recommendations being extrapolated from studies with delirium in the general population or in elderly patients with different organic diseases. Further studies are required to investigate the specifics of delirium in patients with MND and potential strategies focused on neurobiological mechanisms instead of just clinical manifestations.
There is a potential lateralization of vegetative influences at the cerebral level. We sought to understand the impact of these influences in the setting of ischemic stroke. We conducted a prospective study on 110 who presented with acute ischemic stroke (symptom onset maximum 24 hours before admission). We investigated correlations between stroke subtype, insular location or lateralization, stroke severity, hospital mortality, and the dynamic of enzymes (Tn, TnT, CK, CK-MB). We demonstrated that a higher cardiac enzyme value is associated either with stroke severity or with a higher risk of death in the short term, this growth being a marker for a more severe prognosis of a large stroke rather than an independent cause of mortality. Cardiac monitoring in the acute phase of ischemic stroke can prevent cardiac morbidity and mortality, which is why it is important to identify patients at high risk of heart complications after stroke.
More and more research in recent years has focused on neurogenesis and neuroplasticity. The hippocampus is a key location of adult neurogenesis. Because this part of the brain is regulated by environmental variables, it must be mentioned the therapeutic potential for neurodegenerative illnesses and brain injuries. Furthermore, this information challenges the historical concept of a static brain and tries to demonstrate its flexibility, adaptability, and possibility for regeneration. Those mechanisms which are found in a variety of mammalian species, including humans, are important when it comes to adaptive learning and memory, thus providing insights into cognitive well-being and mental health. The discovery of the brain's dynamic nature represented by new neurons, marks a shift in the field of neurology with far-reaching potentials. This paper highlights the significant potential of adult neurogenesis when it comes to clinical applications such as Alz-heimer’s disease.
The primary objective of this narrative review is to evaluate the most frequently recommended structural and functional imaging methods in managing epilepsy cases as effectively as possible from a neurologist’s perspective. This review examines the background of current practice, from the beginnings of neuroimaging by computer tomography to the newly introduced methods and their combination, which helps diagnose and monitor these patients. The neuroimaging investigations required for the presurgical evaluation of patients with epilepsy are presented, and recommendations for specific MRI protocols are provided. The clinical use of functional imaging methods is also considered, and correlations between clinical aspects and specific imaging methods are explored, based on the retrieved data in the literature. In conclusion, this review emphasizes using functional and structural imaging methods, guided by clinical evidence, for better therapeutic management in patients with epilepsy.
