The MOG antibody associated encephalitis preceded by COVID-19 infection; a case study and systematic review of the literature

Background

New neurological complications of COVID-19 infection have been reported in recent research. Among them, the spectrum of anti-MOG positive diseases, defined as anti-MOG antibody associated disease (MOGAD), is distinguished, which can manifest as optic neuritis, myelitis, or various forms of encephalitis (MOGAE).

Materials and methods

This study reports a new case of MOGAE following SARS-CoV-2 infection. A literature review of other MOGAE cases associated with COVID-19 infection was conducted and summarized.

Results

A 60-year-old male patient, who had previously been infected with COVID-19, was admitted to the Neurology Department with a rapidly progressive deterioration of his cognitive functions that lasted for about 3 months. On neurological examination, the Mini-Mental State Examination (MMSE) score was 17, which further deteriorated to 13. In addition, central paresis of the right VIIth nerve and pyramidal hemiparesis on the right side were noted. The MRI of the brain showed multiple hyperintense lesions. The CSF examination revealed an elevated total protein level with a normal cell count, and serum showed a positive finding of anti-MOG antibodies. Taking into account all the information, the diagnosis of MOGAE, following COVID-19 infection, was made. A total of 9 similar cases of MOGAE associated with SARS-CoV-2 infection were identified in the available literature. Among them 2 cases presented progressive cognitive dysfunction and another 5 altered mental status. The most frequently described MRI changes were hyperintense lesions located cortically and/or subcortically. Anti-MOG antibodies were positive in all patients. In 5 cases they were detected only in serum, in 2 cases in serum and CSF, and in 2 cases the origin was not reported.

Conclusion

The reported cases of MOGAE following COVID-19 infection suggest an increasing new clinical problem, and show an association between COVID-19 and MOGADs.

Risk factors for dementia in Parkinson's Disease - the overuse of anticholinergic drugs

AIM OF THE STUDY

To determine the risk factors for dementia in a group of patients with Parkinson's Disease (PD), especially the effect of the anticholinergic burden assessed according to the Anticholinergic Cognitive Burden scale (ACB) and the CRIDECO Anticholinergic Load Scale (CALS).

CLINICAL RATIONALE FOR THE STUDY

To provide information about factors associated with Parkinson's Disease dementia (PDD), especially the anticholinergic burden and testing the effect of both scales in an assessment of the anticholinergic burden in this group of patients.

MATERIAL AND METHODS

A retrospective and cross-sectional analysis of medical records of patients with Parkinson's Disease admitted to the Neurology Department of the Medical University of Silesia, Katowice, Poland between 2019 and 2021 was performed. We found 418 patients with a diagnosis of PD, but 80 were excluded due to lack of a cognitive function assessment. Based on MMSE score, the remaining 338 patients were divided into two groups of patients with, and without, PDD. Next, demographic and clinical data was collected. The anticholinergic burden was assessed using the ACB and the CALS scales. According to the authors of these scales, : if a scale score is of three or more points, this should be considered as a significant anticholinergic burden. Multiple logistic regression with backward elimination was used to assess factors significantly related to the presence of dementia, and two different models were used for both scales assessing the anticholinergic burden.

RESULTS

62 (18.3%) patients were diagnosed with PDD. Overall significant anticholinergic burden (≥ 3 points) was found in 31.95% of patients using CALS and in 18.93% using ACB. Anticholinergic burden was higher in patients with dementia (CALS 50 vs. 27.90%, p < 0.001, ACB 43.5 vs. 13.41%, p < 0.001). According to both models, the factors significantly related to dementia were: age (ACB OR 1,114 (1.062-1.170), p < 0.001, CALS OR 1.123 (1.070-1.178), p < 0.001), significant anticholinergic burden (ACB OR 3.433 (1.746-6.750), p < 0.001, CALS OR 2.166 (1.157-4.055), p = 0.016) disease severity in the Hoehn-Yahr scale (ACB OR 1.752 (1.197-2.565), p = 0.004, CALS OR 1.831 (1.256-2.670), p = 0.002) and atrial fibrillation (ACB OR 5.593 (1.417-22.083), p = 0.014, CALS OR 5.159 (1.314-20.254), p = 0.016).

CONCLUSIONS AND CLINICAL IMPLICATIONS

The anticholinergic burden is larger in PDD patients compared to PD patients without dementia. CALS or ACB scales are helpful in this risk assessment and might be crucial to avoid the development of PDD, especially in older PD patients with multimorbidities.

If Not Insulin Resistance so What? - Comparison of Fasting Glycemia in Idiopathic Parkinson's Disease and Atypical Parkinsonism

BACKGROUND

Parkinson's disease (PD) is a synucleinopathy, which presents dysautonomia, as its common non-motor symptom. Some research suggests the existing interplay between the autonomic nervous system dysfunction and glucose metabolism dysregulation in PD.

OBJECTIVE

To determine the prevalence of metabolic disorders with particular emphasis on glucose metabolism in patients with PD and atypical parkinsonism (AP).

PATIENTS AND METHODS

A retrospective study was performed by analyzing 461 clinical data of consecutive patients diagnosed with PD, multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) hospitalized from 2019 to 2021 in the authors' institution. The study group included 350 patients (303 PD, 14 MSA, 33 PSP), aged 65.8 ± 9.7 years (42% were female). Laboratory results (fasting glycemia, lipid parameters, TSH, homocysteine and vitamin D3 levels) were collected. The patient's clinical condition was assessed in III part of Unified Parkinson's Disease Rating Scale (UPDRS p. III), Hoehn-Yahr scale, Mini Mental State Examination (MMSE) and Beck Depression Inventory (BDI).

RESULTS

Impaired fasting glycemia (IGF) was more prevalent in PD than in the PSP (43.43% vs 18.18%; p = 0.043). Similarly, PD presented a higher level of fasting glycemia (102.4 ± 16.7 mg/dl vs 92.2 ± 16.1mg/dl; p = 0.042). According to lipid parameters, patients with PD showed lower LDL cholesterol (92.3 ± 44.3mg/dl vs 119 ± 61.0mg/dl; p = 0.016) and lower BMI compared to patients with PSP (26.1 ± 4.0kg/m² vs 29.3 ± 4.4 kg/m²; p = 0.024), but there were no statistically significant differences in triglycerides (TG) and HDL cholesterol levels. Males with PD presented greater frequency of IFG (35.05% vs 50.6%; p = 0.042), higher fasting glycemia (99.1 ± 14.3mg/dl vs 103.7 ± 14.7mg/dl; p = 0.006), lower total cholesterol, HDL cholesterol, and BMI compared to women with PD.

CONCLUSION

Our investigation supports an association between synucleinopathies and glucose metabolism dysregulation.