Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). The aim of the study was to determine the distribution of cognitive disorders in MS in relation to demographic parameters, degree of clinical disability and depression. The prospective study included 135 subjects with MS in the Clinic of Neurology of the University Clinical Center in Tuzla. The first group consisted of women (101 respondents) and the second of men (34 respondents). Clinical assessment instruments were: Expanded Disability Status Scale Score, Mini Mental Status, Beck Depression Scale, Battery of Cognitive Function Assessment Tests: Wechsler Intelligence Scale, Revised Beta Test, Raven Coloured Progressive Matrix, Wechsler Memory Verification Scale, Audio Memory Test learning, Rey-Osterriecht complex character test, verbal fluency test. There were no significant differences between the mentioned groups in age, level of education, duration of the disease, severity of disease symptoms or in the prevalence of certain forms of MS. Cognitive disorders are present in 40-60 % of subjects with MS. Visuospatial, visuoconstructive, visuoperceptive functions, mnestic functions were most affected in both groups of respondents. There was no difference in the level of depression in relation to sex. Poor results of cognitive parameters in 32.7 % can be considered the cause of high scores of EDSS in female patients and in 29.2 % in patients, which is not statistically significant. The correlation between depression and EDSS is positive but not statistically significant in both sexes. Cognitive disorders are heterogeneous regardless of sex. Cognitive impairment in MS patients is related to impairment of working ability and memory, executive functions and attention. Subjects with a more severe degree of clinical disability had poorer cognitive functions.

Background: More than 50% of stroke patients have sleep-disordered breathing.Aim: To determine whether the location and type of stroke affect the occurrence of sleep apnea.Patients and methods: We analyzed 110 patients with acute stroke and verified sleep apnea. Acute stroke has been verified either by computerized tomography or magnetic resonance imaging of the brain. Average age was 65.13±9.27 years and it was 59% men. Number of patients without apnea in control group was the same as well as gender distribution, with average age 64±8.69 years.Results: Apnea was verified in 22% patients. The largest number of patients with and without apnea had ischemic stroke 83.6%, while 16.4% of patients had hemorrhagic stroke. Of these, there were 86.2% men and 80% women with ischemic and 13.8% men and 20% women with hemorrhagic stroke. With apnea, the largest number had a lesion in two or more places 51.8%,as well as without apnea 45.45%, but the difference was not statistically significant. According to the acute stroke, the largest number of patients with and without apnea had lesions in the left and right hemispheres 45.4%. There was no statistically significant association between apnea and localization of stroke in the left or in both hemispheres. There is a statistically significant association of AS localization in the right hemisphere with the occurrence of apnea.Conclusion: There is a statistically significant association between the localization of stroke in the right hemisphere and the occurrence of apnea.

Background: More than 50% of stroke patients have sleep-disordered breathing (SDB), mostly in the form of obstructive sleep apnea (OSA). SDB represents both a risk factor and a consequence of stroke. The presence of SDB has been linked with the poorer long-term outcome and increased long-term stroke mortality. About 20 to 40% of stroke patients have sleep-wake disorders (SWD), mostly in form of insomnia, excessive daytime sleepiness/fatigue, or hypersomnia (increased sleep needs). Objective: The aim of this study was to analyze the frequency of risk factors in patients with acute stroke and sleep apnea. Methods: The study included patients without cognitive impairment or with mild cognitive impairment. The diagnosis of apnea syndrome was made on the basis of the Snoring and Apnea Syndrome Questionnaire, the Epworth Sleep Scale, the Berlin Questionnaire, the Stanford Sleepiness Scale, and the General Sleep Questionnaire. The severity of stroke was assessed by the National Institutes of Health Stroke Scale and the Rankin Disability Scale. Patients with a Glasgow score <8 on the day of neuropsychiatric examination were excluded from the study, as well as patients with epileptic seizures at the onset of stroke, with aphasia, with Mini - mental test <23, with verified previous dementia / cognitive impairment. Results: There is no statistically significant difference in the age of men and women, both with apnea and without apnea. In patients with apnea, heart disease was in the first place 91.8%, followed by hypertension 86.4%, Body mass index 79.1%, hyperlipidemia 50%, smoking 38.2 % and diabetes mellitus 20.9%. Hypertension was the most common risk factor in patients without apnea 83.6%, followed by heart disease 81.0%, Body mass index 60.9%, hyperlipidemia 48.21%, smoking 28.2 % and diabetes mellitus 20%. Conclusion: Heart diseases, hypertension and body mass index are significantly more frequent in patients with than in patients without sleep apnea.

Opacity of data on stroke for Bosnia and Herzegovina (B&H) is mainly due to the lack of a unified national stroke registry. This article aims to present updated epidemiological data on the etiology and risk factors for first‐ever ischemic stroke in Tuzla Canton, B&H.

Background: Sleep is a complex process involving the interactions of several brain regions, which play a key role in regulating the sleep process, particularly the brainstem, thalamus, and anterior basal brain regions. The process of sleep is accompanied by a change in body functions, as well as a change in cerebral electrical activity, which is under the control of the autonomic nervous system. Objective: The aim of the study was to analyze the frequency of stroke recurrence and disability of patients with stroke and apnea. Methods: It was analyzed 110 acute stroke patients with sleep apnea. All patients were evaluated with: Glasgow scale, The American National Institutes of Health Scale Assessment, Mini Mental Test, The Sleep and snoring Questionnaire Test, The Berlin Questionnaire Test, The Epworth Sleepiness Scale, The Stanford Sleepiness Scale, and The general sleep questionnaire. Results: The largest number of patients with apnea on admission had a degree of disability of 4, and on discharge of 1. There was a statistically significant difference between the mean values of incapacity for admission and discharge. The student’s t - test did not determine a statistically significant difference in disability according to the Rankin scale between patients with and without apnea at admission (t = 0.059, p = 0.95) and discharge (t = 0.71, p = 0.48). According to the NIHS scale, patients of both sexes with apnea had a neurological deficit of 7.55 ± 5.22 on admission and 7.1 ± 4.3 without apnea. Statistically significant difference was not found on the neurological deficit of both sexes, with and without apnea, at admission and discharge. With apnea, there were 13 relapses of stroke during one year, and without apnea in only 3 patients. Conclusion: Patients with acute stroke have a significantly higher correlation rate according to sleep apnea. There is no significant correlation in the degree of disability between patients with and without apnea.

BACKGROUND Sleep apnea is described as an isolated risk factor for stroke or recurrent stroke which could be cause of death. In our study, the aim was to determine whether sleep apnea affects the outcome of stroke patients. SUBJECTS AND METHODS This is a prospective study in which a group of 110 patients in the acute phase of a stroke was evaluated sleep apnea. Acute stroke has been diagnosed either by computed tomography and magnetic resonance imaging of the brain. There was no significant difference in patient's age with or without sleep apnea neither in men nor women. Neurological, neuropsychiatric, pulmonary test were performed in all patients at five different time periods. In these time periods, all patients were evaluated: Glasgow scale, The American National Institutes of Health Scale Assessment, Mini Mental Test, The Sleep and snoring Questionnaire Test, The Berlin Questionnaire Test, The Epworth Sleepiness Scale, The Stanford Sleepiness Scale and The general sleep questionnaire. RESULTS One year after the onset of stroke, 91 (82.7%) of 110 patients with apnea survived. The survival rate of patients with sleep apnea is significantly lower than without sleep apnea (p=0.01). In men with apnea, the survival rate was significantly lower in patients without apnea (p=0.004). The largest number of survivors of apnea had diabetes mellitus, followed by survival of patients with heart disease, body mass index >29 kg/m2 and hypertension, with hyperlipoproteinemia and smoking. The highest number of survivors without apnea was body mass index >29 kg/m2, followed by survival of patients with hyperlipoproteinemia, heart disease, hypertension, smoking, and diabetes mellitus. CONCLUSION Patients with sleep apnea have a significant correlation in survival rates compared with sexually and age-matched subjects, associated with concomitant risk factors such as hypertension, body mass index, and smoking.

BACKGROUND Delirium is a syndrome that occurs in all age groups and in many clinical departments, and is most common in intensive care units. It is an emergency, in the overlapping fields of somatic medicine, neurology and psychiatry. Delirium occurs suddenly, dramatically, and requires a quick reaction, recognition and treatment. There are only a small number of studies that have reported delirium after a stroke. In our study, the goal was to determine the cognitive functionality of patients with delirium after a stroke. SUBJECTS AND METHODS This is a prospective study in which a group of 100 delirium patients in the acute phase of a stroke were evaluated for cognitive function. The control group consisted of the same number of patients with acute stroke who were not diagnosed with delirium. Neurological, neuropsychiatric and neuropsychological tests were performed in all patients at five different time periods. In these time periods, all patients were evaluated: Glasgow Coma Scale; Delirium Assessment Scale; The American National Institutes of Health Scale Assessment; Information-Memory-Concentration test; Dementia Score; Mini-Mental Test. The findings of computed tomography of the brain and magnetic resonance imaging of the brain were interpreted by a radiologist who was not familiar with the goals of this study. RESULTS Cognitive functioning of delirious patients is statistically significantly worse after three and six months, and one year from stroke compared to those without delirium. There is no statistically significant difference in cognitive functioning between delirious patients in relation to gender, age, location and type of stroke and patients without delirium throughout one year from stroke. There is no significant difference in cognitive functioning between delirious patients during one year from stroke in relation to severity and type of delirium, and statistically significantly higher degree of cognitive dysfunction has those older than ≥65 years. CONCLUSIONS Delirium significantly reduces the cognitive functioning of patients after a stroke.