Title
Kognitivni poremećaj u multiploj sklerozi: povezanost sa insulinskom rezistencijom i polimorfizmima u genu za apolipoprotein E
Creator
Kostić, Smiljana, 1972-
Copyright date
2016
Object Links
Select license
Autorstvo 3.0 Srbija (CC BY 3.0)
License description
Dozvoljavate umnožavanje, distribuciju i javno saopštavanje dela, i prerade, ako se navede ime autora na način odredjen od strane autora ili davaoca licence, čak i u komercijalne svrhe. Ovo je najslobodnija od svih licenci. Osnovni opis Licence: http://creativecommons.org/licenses/by/3.0/rs/deed.sr_LATN Sadržaj ugovora u celini: http://creativecommons.org/licenses/by/3.0/rs/legalcode.sr-Latn
Language
Serbian
Cobiss-ID
Inventory ID
D-3002
Theses Type
Doktorska disertacija
description
Datum odbrane: 28.11.2016.
Other responsibilities
mentor
Dinčić, Evica, 1964-
član komisije
Tončev, Gordana, 1956-
član komisije
Raičević, Ranko.
član komisije
Janjić, Vladimir, 1971-
University
Univerzitet u Kragujevcu
Faculty
Fakultet medicinskih nauka
Alternative title
Cognitive impairment in multiple sclerosis:
association with insulin resistance and
apolipoprotein E polymorphism.
Format
107 листова
Abstract (en)
The aim of this study is examining the relationship between the presence of insulin
rОsТstaЧМО (IR) aЧН tСО ε4 allОlО ТЧ tСО APOE РОЧО, ТЧНОpОЧНОЧtlв aЧН assШМТatОН
with the existence, severity and pattern of cognitive impairment in patients with MS.
According to our hypothesis the existence of cognitive impairment is positively
МШrrОlatОН аТtС tСО prОsОЧМО ШП ТЧsulТЧ rОsТstaЧМО aЧН / Шr ε4 allОlО ШП tСО APOE РОЧО.
Methods: Clinical observational cross-sectional study includes 81 patients diagnosed
with clinically definite MS with RR disease course. The total group of respondents is
composed of subgroups: 50 patients are receiving the immunomodulatory therapy
IFNβ1b (Betaferon) from the moment of diagnosis and 31 patients did not, until the
beginning of the study, receive any therapy that modifies the natural course of the disease. In all subjects we determined: the presence of insulin resistance (HOMA index); glucose intolerance using an oral glucose tolerance test (OGTT); the APOE gene polymorphisms; cognitive status using four neuropsychological tests taken from
a neuropsychological battery, "The Brief Repeatable Battery of Neuropsychological
Tests", which examined the most frequently impaired cognitive domains.
Results: The presence of cognitive impairment was 39.51.The most common is episodic
memory impairment, in 67% of patients. Significantly higher incidence of patients with
poor achievements in the visual memory test was in the group with an impaired glucose
tolerance. (80% vs. 54.10%, p = 0.04). We determined a significant independent negative
ОППОМt ШП tСО prОsОЧМО ШП ε4 allОlО ТЧ tСО ApШE РОЧО ШЧ tСО ШММurrОЧМО ШП ЦТlН МШРЧТtТvО
impairment (OR = 5:55; 95% CI, 0.96-32.25, p = 0.049). TСО prОsОЧМО ШП tСО ε4 allОlО
represents 5.5 times the risk that the patient will develop a mild cognitive deficit
independently from the presence of IR indicators. It was found that the predictors of mild
cognitive deficits and memory impairment were female sex, longer illness duration, fewer
relapses and more progressive course of the disease. The predictors of cognitive
impairment are longer and more progressive course of the disease. Application of the
immunomodulatory therapy IFNβ1 sСШаОН ЧШ assШМТatТШЧ аТtС aЧв ШП tСО tОstОН
parameters.
Conclusion: This study examines for the first time the association between glucose
and insulin metabolic disorders with the presence and characteristics of cognitive
impairment in RR MS, indepenНОЧtlв aЧН assШМТatОН аТtС tСО ОбТstОЧМО ШП ε4 allОlОs
ТЧ tСО APOE РОЧО. A ЦШrО ПrОquОЧt prОsОЧМО ШП ε4 allОlО aЦШЧР patТОЧts аТtС ЦТlН
cognitive deficit in comparison to the cognitively preserved ones makes them a
group of interest for further observation because of the possible greater vulnerability
to future cognitive impairment. The study contributes to the early detection and
better understanding of cognitive impairment in MS which is present from the
earliest stages of the disease. This is important in predicting the course of the disease,the degree of functional disability and represents an important factor in determining the therapy that alters the natural course of the disease.
Authors Key words
multipla skleroza, kognitivni poremećaj, insulinska rezistencija, APOE4
Type
Tekst
Abstract (en)
The aim of this study is examining the relationship between the presence of insulin
rОsТstaЧМО (IR) aЧН tСО ε4 allОlО ТЧ tСО APOE РОЧО, ТЧНОpОЧНОЧtlв aЧН assШМТatОН
with the existence, severity and pattern of cognitive impairment in patients with MS.
According to our hypothesis the existence of cognitive impairment is positively
МШrrОlatОН аТtС tСО prОsОЧМО ШП ТЧsulТЧ rОsТstaЧМО aЧН / Шr ε4 allОlО ШП tСО APOE РОЧО.
Methods: Clinical observational cross-sectional study includes 81 patients diagnosed
with clinically definite MS with RR disease course. The total group of respondents is
composed of subgroups: 50 patients are receiving the immunomodulatory therapy
IFNβ1b (Betaferon) from the moment of diagnosis and 31 patients did not, until the
beginning of the study, receive any therapy that modifies the natural course of the disease. In all subjects we determined: the presence of insulin resistance (HOMA index); glucose intolerance using an oral glucose tolerance test (OGTT); the APOE gene polymorphisms; cognitive status using four neuropsychological tests taken from
a neuropsychological battery, "The Brief Repeatable Battery of Neuropsychological
Tests", which examined the most frequently impaired cognitive domains.
Results: The presence of cognitive impairment was 39.51.The most common is episodic
memory impairment, in 67% of patients. Significantly higher incidence of patients with
poor achievements in the visual memory test was in the group with an impaired glucose
tolerance. (80% vs. 54.10%, p = 0.04). We determined a significant independent negative
ОППОМt ШП tСО prОsОЧМО ШП ε4 allОlО ТЧ tСО ApШE РОЧО ШЧ tСО ШММurrОЧМО ШП ЦТlН МШРЧТtТvО
impairment (OR = 5:55; 95% CI, 0.96-32.25, p = 0.049). TСО prОsОЧМО ШП tСО ε4 allОlО
represents 5.5 times the risk that the patient will develop a mild cognitive deficit
independently from the presence of IR indicators. It was found that the predictors of mild
cognitive deficits and memory impairment were female sex, longer illness duration, fewer
relapses and more progressive course of the disease. The predictors of cognitive
impairment are longer and more progressive course of the disease. Application of the
immunomodulatory therapy IFNβ1 sСШаОН ЧШ assШМТatТШЧ аТtС aЧв ШП tСО tОstОН
parameters.
Conclusion: This study examines for the first time the association between glucose
and insulin metabolic disorders with the presence and characteristics of cognitive
impairment in RR MS, indepenНОЧtlв aЧН assШМТatОН аТtС tСО ОбТstОЧМО ШП ε4 allОlОs
ТЧ tСО APOE РОЧО. A ЦШrО ПrОquОЧt prОsОЧМО ШП ε4 allОlО aЦШЧР patТОЧts аТtС ЦТlН
cognitive deficit in comparison to the cognitively preserved ones makes them a
group of interest for further observation because of the possible greater vulnerability
to future cognitive impairment. The study contributes to the early detection and
better understanding of cognitive impairment in MS which is present from the
earliest stages of the disease. This is important in predicting the course of the disease,the degree of functional disability and represents an important factor in determining the therapy that alters the natural course of the disease.
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