Background: The Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are the most commonly used scales to detect mild cognitive impairment in population-based epidemiologic studies. The aim of this study was to define which test is more reliable for early diagnosis of vascular dementia – MoCA or MMSE. Material and methodes: This prospective study included 274 patients with acute stroke, both sexes and all age groups. Patients were divided into groups: demented (DP) and non-demented (NDP). Each patient was underwent to a clinical examination and scoring with appropriate scales (MMSE and MoCA). Patients were tested on two times after discharge. Results: Out of the total number of patients, 171 (62.5%) of them were male, and 103 (37.5%) were female (p=0.339). First testing with the MMSE showed that 143 (52%) had mild or moderate dementia. Sixth months after stroke, the number of demented patients increased to 165 (60%). First testing with the MoCA scale showed that 183 (66%) had some degree of dementia, and after the sixth month 191 (69%). The MoCA recorded a greater number of patients with dementia in both, the first and second testing. MoCA is more sensitive than MMSE for detecting patient with vascular dementia 3 and 6 months after stroke (p=0.0004; p=0.01). Conclusion: The MoCA is more sensitive scale than the MMSE for detecting early stages of vascular dementia. It should be used in daily practice more often than the MMSE in order to make a timely diagnosis of the early stage of dementia. Keywords : vascular dementia, MMSE, MoCA

Background: The clinical manifestations of cerebrovascular diseases (CVD) depend on the localization of the damaged region in the brain. Cognitive functions are often impaired following a stroke. Initially, CVD was referred to as atherosclerotic dementia, and was distinguished from senile dementia. Objective: The aim of this study was to examine how stroke severity and localization influence the development of vascular dementia (VD) and to identify which cognitive functions are impaired in certain types of VD. Methods: This prospective study included patients with acute stroke who were hospitalized at the Department of Neurology Tuzla, Bosnia and Herzegovina, over a one-year period. Patients were divided into the following groups: dementia of strategic infarct (DSI), cortical dementia (CD), subcortical dementia (SCD), haemorrhagic dementia (HD) and non-demented patient (NDP). Stroke localization, side and number of lesions were analyzed. Results: A total of 274 stroke patients were analyzed, of whom 190 (69%) were diagnosed with some type of VD. The odds ratio (OR) for the occurrence of dementia per point increase in NIHSS on admission was 1.131 (95% CI; 1.056 – 1.210). CD was more common in patients with right hemisphere lesions (p<0.000), whereas SCD was more frequent in those with bihemispheric lesions (p<0.0001). All assessed cognitive functions were significantly associated with CD and SCD (p<0.000). Visual perceptual (p=0.007) and visual constructive (p=0.016) functions were significantly impaired in patients with DSI. Executive functions were significantly impaired in all demented patients (p<0.0001). Conclusion: Stroke localization has a significant impact on the development of vascular dementia. All analyzed cognitive functions are significantly impaired in cortical and subcortical dementia. Visual perceptual and visual constructive functions are particularly impaired in patients with dementia of strategic infarct.

Background: Stroke patients have significant disability and an increased risk of falling. Objective: To determine the incidence of falls and the degree of disability in stroke patients and to determine the correlation of falls with the degree of disability. Methods: This is a prospective study of 100 stroke patients confirmed by computed tomography and magnetic resonance imaging of the brain. We used a demographic questionnaire together with the Glasgow Coma Scale, Stroke Assessment Scale, Rankin Scale and Morse Scale to collect data and analyzed them using SPSS 17, including statistical measures, including Pearson correlation. Results: Hemorrhagic stroke patients had a higher incidence of falls (p = 0.06). There was no difference in the incidence of falls according to the gender of the patients (p = 0.07). Older people had a higher frequency of falls, and women and patients with hemorrhagic stroke had a higher risk of falling (p = 0.2). Patients with a stroke in the area of the anterior circulation were statistically significantly more disabled (p < 0.05). A weak positive correlation was calculated between the frequency of falls of patients after stroke and the degree of disability (r = 0.08, n = 94, p = 0.4). Stroke patients who also had atrial fibrillation as a comorbidity had a statistically significantly higher frequency of falls compared to patients with other comorbidities (p = 0.02). Conclusion: Patients with hemorrhagic stroke have a higher frequency of falls. Women, elderly people, patients with a stroke in the area of the anterior circulation and with atrial fibrillation as a comorbidity are statistically significantly more disabled after a stroke. There is a positive correlation between the frequency of falls in patients after a stroke and the degree of disability.

Background: Hydrocephalus is the accumulation of cerebrospinal fluid in the ventricles of the brain. Ventriculoperitoneal shunt placement is one of the most commonly performed neurosurgical procedures and is necessary for the treatment of most forms of hydrocephalus. Objective: The aim of the study was to determine demographic indicators, comorbidities, complications and outcome of patients with hydrocephalus after ventriculoperitoneal shunt implantation. Methods: This is a retrospective study. Data on the subjects' age, gender, symptoms, degree of disability, complications, comorbidities and outcome after ventriculoperitoneal shunt implantation were recorded. All patients were clinically examined by neurologists and neurosurgeons and diagnosed through unified and standardized algorithms according to established guidelines for hydrocephalus. Cognitive functionality was assessed according to the Mini Mental State Test. Urinary incontinence was assessed based on patients' subjective feelings. Data on comorbidities and complications were collected from the patients' medical records. The degree of disability was assessed using the modified Rankin scale. Results: The average age of the subjects was 58.7 years, and the highest frequency of subjects was in the age group over 61 years (62.2%). There was no statistically significant difference in age in men (X=54.69, SD=18.77), or women (X=60.88, SD=19.96); t (35)=0.8, p=0.3. A statistically significant number of patients with hydrocephalus had a lower degree of disability after ventriculoperitoneal shunt implantation (p<0.05). Hypertension was the most common comorbidity with hydrocephalus (35.1%). Pneumonia was the most common general complication in patients with hydrocephalus (8.1%). Females had a statistically significantly worse survival (p=0.01). There was no statistically significant difference in the outcome of hydrocephalus patients in relation to age groups, comorbidities, general and complications after ventriculoperitoneal shunt implantation (p>0.05). Conclusion: Patients with hydrocephalus after ventriculoperitoneal shunt implantation have a lower degree of disability, and female patients have statistically significantly worse survival. Hypertension is the most common comorbidity, and pneumonia the most common complication in patients with hydrocephalus. There is no statistically significant difference in the outcome of hydrocephalus patients in relation to age groups, comorbidities, general and complications after ventriculoperitoneal shunt implantation.

Background: Normal sleep duration is crucial for maintaining brain homeostasis. Sleep disorders in Parkinson's disease are numerous, multifactorial, and result in significant morbidity. Objective: The aim of the study was to investigate the association between gender and the duration of therapy on sleep quality in patients with Parkinson's disease. Methods: The study is prospective, and includes 40 consecutively hospitalized patients with verified Parkinson's disease. The study included subjects of both genders and all age groups. To analyze the data on the subjects, we used: medical histories, nursing documentation of patients, a questionnaire with sociodemographic data, and the Parkinson's Disease Sleep Assessment Scale. We divided all subjects into two groups: subjects who have been using therapy for up to 5 years and those who have been using therapy for more than 5 years. Results: Among subjects who have been taking medication for less than 5 years, 33.3% were female and 66.6% were male. Of the total number of respondents who have been taking therapy for more than 5 years, 36.3% are female and 63.6% are male. The duration of the therapy has a statistically significant effect on the quality of sleep in patients with Parkinson's disease (p < 0.05). The subject's gender does not have a significant independent influence on the quality of sleep in patients with Parkinson's disease (p > 0.05). The interaction of gender and length of therapy use has no significant separate effect on the quality of sleep in Parkinson's disease patients (p > 0.05). The quality of sleep is better in male and female subjects who take the therapy until the age of 5. Conclusion: The duration of therapy use has a significant impact on the quality of sleep in Parkinson's disease patients. The gender of the subject has no significant independent influence on the quality of sleep in patients with Parkinson's disease.

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.