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Tertia, Clarissa
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Neuroscience

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VASCULAR PARKINSONISM WITH EARLY COGNITIVE IMPAIRMENT: A CASE REPORT AND LITERATURE REVIEW Tertia, Clarissa; Trisnawati, Sri Yenni; Widyadharma, I Putu Eka; Samatra, Purwa
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.16

Abstract

Introduction: Vascular parkinsonism has a prevalence 4.4% to 12% of parkinsonism. Until now there are no specific diagnostic criteria to establish diagnosis of vascular parkinsonism, so it is often misdiagnosed with idiopathic parkinsonism. Case Report: Male, 82 years old, with gait disorder 3 years ago, appeared stiff with small steps. The patient appears to be slower, drooling frequently, and has difficulty swallowing food. The patient was diagnosed with Parkinson's disease and given levodopa/benserazide. However, the progress of the disease was getting worse, so the dose was increased. Since 2 years, patient became forgetful and more irritable. History of ischemic stroke 3 years ago with no sequelae. History of hypertension and gout arthritis (GA). Patient was compos mentis without signs of focal deficit or lateralization, however, there was a cogwheel-type rigidity in all extremities without any tremor. MoCA-Ina (Montreal Cognitive Assesment Indonesian Version) test was 21. The head CT (Computer Tomography) scan revealed chronic lacunar infarct with brain atrophy and small vessel ischemic changes. Then patient was diagnosed with vascular parkinsonism and treated with levodopa, acetosal, candesartan and consulted to medical rehabilitation department. Discussion: Based on criteria of Zijlmans et al., and Winikates and Jankovic, patient is included in vascular parkinsonism, namely the presence of bradykinesia, rigidity and postural instability which indicates a parkinsonism accompanied by 3 vascular scores. Conclusion: Diagnosis of vascular parkinsonism is very complex and challenging. Multidisciplinary management from neurologists and medical rehabilitation specialists must be applied to improve the quality of life, reduce morbidity and mortality.
EVALUATION OF VITAMIN B12 LEVELS WITH NEUROPATHIC PAIN IN HEMODIALYSIS PATIENTS: A SINGLE CENTER OBSERVATIONAL STUDY Sri Wijayanti, Ida Ayu; Tresna Erawan, I Gusti Ngurah Agung; Mulyantari, Ni Kadek; Tertia, Clarissa; Widyadharma, I Putu Eka
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.03

Abstract

Background: Uremic syndrome in chronic kidney disease (CKD), particularly in hemodialysis (HD) patients, is a growing global health problem. The majority of patients with this condition experience one or more neurological disorders, such as neuropathic pain. One of the adjuvant therapies in the treatment of neuropathic pain is vitamin B12, which is important for the regeneration and myelination of peripheral nerves and also plays an important role in the restoration of functional nerves. Objective: The aim of this research is to evaluate the role of vitamin B12 in the relief of pain symptoms Method: This research was conducted at General Hospital in Bali use a case-control design and consecutive sampling. This was carried use 21 patients with CKD on regular hemodialysis with neuropathic pain, while 22 patients without neuropathic pain were used as the control group. All patients were tested for serum vitamin B12 levels. Neuropathic pain was assessed using the DN4. Results: The data values of total vitamin B12 levels in blood serum were obtained within a range of 81.72 pmol/L to 2337.5 pmol/L, and a median value of 1306.25 pmol/L. A cut-off value of 1509.375 pmol/L was obtained with 76.2% sensitivity and 59.1% specificity. Furthermore, an odd ratio between low serum vitamin B12 and the incidence of neuropathic pain was also obtained, namely OR= 3.611 (95% CI= 1.012-12.9; p=0.044). Conclusion: It was found that low serum vitamin B12 in CKD patients on hemodialysis increased the risk of experiencing neuropathic pain by 3.611 times compared to those with normal serum vitamin B12.
EFFECT OF BALINESE FLUTE INSTRUMENT FOR IMPROVING COGNITIVE FUNCTION IN ELDERLY Laksmidewi, Anak Agung Ayu Putri; Tertia, Clarissa; Indah, Carolin Tiara Lestari; Suherlim, Richard; Arshinta, Lasta; Mahadewi, Ni Putu Ayu Putri
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.05

Abstract

Background: Cognitive impairment is mostly affected the elderly population which reduces the quality of life for sufferers and their families. The last research showed that listening to Balinese flute instrument music increased cognitive function, especially in the memory domain. However, the study is still limited to small populations. Objective: to determine whether playing the Balinese flute with or without listening to the "Morning Happiness" song affects the cognitive function of elderly. Methods: This experimental study was conducted on healthy geriatric patients above 55 years old with controlled risk factors or no history of any chronic conditions which were divided into 2 groups. The "Morning Happiness" song will be played with Balinese flute instrument in both groups whereas the intervention will add to listen to similar songs. Results: 28 subjects in the intervention group and 20 subjects in the control group. Both groups were comprised of typical gender distribution with an average of 65.08±6.41 years old. Both the intervention and control groups had improved in MoCA-Ina (The Indonesian Version of Montreal Cognitive Assessment) scores, but the intervention group gained a better Z-score (-3.193, p-value 0.001) than the control group (-1.466, p-value 0.143) after procedural. The delayed recall domain also showed significant improvement in both groups with a Z-score of -3.241 (p-value 0.001) in control and -2.30 (p-value 0.026) in intervention group respectively. Interestingly, the attention domain is improved in the control group with a Z-score of -2.142 (p-value 0.032) rather than in intervention group. Conclusion: The overall MoCa-Ina score was significantly higher in interventional subjects than control, specifically in the delayed recall domain.
Co-Authors Anak Agung Ayu Putri Laksmidewi Arshinta, Lasta Dewa Putu Gede Purwa Samatra I Putu Eka Widyadharma Indah, Carolin Tiara Lestari Mahadewi, Ni Putu Ayu Putri Ni Kadek Mulyantari Sri Wijayanti, Ida Ayu Suherlim, Richard Tresna Erawan, I Gusti Ngurah Agung Trisnawati, Sri Yenni