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All Journal Medicina E-Jurnal Medika Udayana Jurnal Kesehatan Andalas Damianus Journal of Medicine MNJ (Malang Neurology Journal) Callosum Neurology Journal : Jurnal Berkala Neurologi Bali ISM (Intisari Sains Medis) : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research Majalah Kedokteran Neurosains Diponegoro International Medical Journal (DIMJ) Bioscientia Medicina : Journal of Biomedicine and Translational Research Cermin Dunia Kedokteran Magna Neurologica Cermin Dunia Kedokteran
Anak Agung Ayu Putri Laksmidewi
Departemen Neurologi, Fakultas Kedokteran Universitas Udayana
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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The Synergistic Impact of Astrocyte Reactivity and Vitamin D Deficiency on Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis Patricia; Anak Agung Ayu Putri Laksmidewi; Kumara Tini
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1449

Abstract

Background: Post-stroke cognitive impairment (PSCI) is a common, debilitating outcome of ischemic stroke. Glial Fibrillary Acidic Protein (GFAP), marking astrocyte reactivity, and Vitamin D, a neuro-immunomodulatory steroid, are independently linked to PSCI. This study aimed to quantify the synergistic impact of elevated serum GFAP and concurrent Vitamin D deficiency on PSCI risk. Methods: Following PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted for prospective cohort studies (2015-2025) assessing acute serum GFAP, 25-hydroxyvitamin D (25(OH)D), and subsequent cognitive outcomes in ischemic stroke patients. Quality was assessed using the Newcastle-Ottawa Scale. A meta-analysis of seven studies (n=3,850) was performed using a random-effects model to calculate pooled odds ratios (ORs) for PSCI across four biomarker-defined groups. A formal test for synergistic interaction was conducted by assessing the departure from additivity of effects on the log-odds scale. Results: Seven high-quality studies were included. Compared to the reference group (Normal GFAP/Sufficient Vitamin D), the pooled OR for PSCI was 2.18 (95% CI: 1.85-2.57) for high GFAP alone and 1.95 (95% CI: 1.65-2.30) for Vitamin D deficiency alone. For the dual-biomarker group (High GFAP/Deficient Vitamin D), the pooled OR was 4.75 (95% CI: 3.98-5.67). This observed risk was significantly greater than the 3.13 OR expected from a purely additive model (p for interaction < 0.001), confirming a significant synergistic effect. Sensitivity analysis showed the effect was most pronounced in patients with moderate-to-severe strokes (NIHSS > 5). Conclusion: Elevated serum GFAP and Vitamin D deficiency synergistically increase the risk of PSCI, particularly in patients with more severe strokes. The interplay between acute astroglial injury and compromised systemic neuroprotection appears to be a critical determinant of cognitive outcomes. While confounding by patient frailty requires further study, this dual-biomarker profile identifies a high-risk subgroup and highlights a key pathophysiological interaction.
Role of Balinese Flute Playing in Enhancing Cognitive Function and Serum Brain-derived Neurotrophic Factor (BDNF) Levels in the Elderly Laksmidewi, Anak Agung Ayu Putri; Mahadewi, Ni Putu Ayu Putri; Arshinta, Lasta; Hardika, Made Sebastian Dwi Putra; Sari, Christine Kathy Putri
Diponegoro International Medical Journal Vol 6, No 2 (2025): December 2025
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dimj.v6i2.29300

Abstract

Background: Aging is associated with cognitive decline, yet the brain retains adaptive capacity with proper stimulation. Musical activities, including traditional Balinese flute playing, have shown potential in enhancing memory, concentration, and cognitive performance.Objective: This study examined the effect of playing the Balinese flute piece “Morning Happiness” on cognitive improvement in the elderly, as indicated by changes in serum Brain-derived Neurotrophic Factor (BDNF) levels.Methods: This experimental study was conducted from June to September 2024 among elderly participants (>60 years) with controlled risk factors. Subjects were randomized into an intervention group (n=28) and control group (n=14), with a male-to-female ratio of 3:4. The intervention group played the Balinese flute for 20 minutes daily, while the control group listened to the same music for 10 minutes, three times weekly. Cognitive function was assessed using the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina), and serum BDNF levels were measured before and after the intervention.Results: The intervention group showed a significant improvement in total MoCA-Ina scores (Z = -2.82, p = 0.005), particularly in abstraction (Z = -2.296, p = 0.022) and delayed recall (Z = -3.436, p = 0.026). Serum BDNF levels also increased significantly after the intervention (from 5.46 ± 6.16 to 7.63 ± 10.16; p = 0.033), while no significant changes were observed in the control group.Conclusion: Balinese flute playing enhances cognitive function, especially abstraction and memory recall, and increases serum BDNF, supporting its role as a non-pharmacological strategy to promote cognitive health in the elderly.
PARKINSON’S DISEASE DEMENTIA: A COMPREHENSIVE CASE REPORT Fitriasari, Elsye; Laksmidewi, Anak Agung Ayu Putri; Widyastuti, Ketut; Mahadewi, Ni Putu Ayu Putri
MNJ (Malang Neurology Journal) Vol. 12 No. 1 (2026): January
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.2025.012.01.18

Abstract

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder affecting 1–2% of individuals over 60 years old. Beyond motor symptoms, PD is often associated with dementia, especially with advancing age and disease duration. The risk of Parkinson’s Disease Dementia (PDD) increases markedly in older patients, reaching up to 80–90% by age 90. Key risk factors include age, severity of parkinsonism, male gender, psychiatric symptoms, and mild cognitive impairment. PDD differs from Alzheimer’s disease, with more prominent deficits in attention, executive function, and visuospatial skills. Its pathogenesis involves dopaminergic neuronal loss, α-synuclein deposition, inflammation, and oxidative stress. Case Report: A 70-year-old man with a five-year history of worsening hand tremors, gait disturbance, and bradykinesia presented with additional cognitive decline, including forgetfulness and difficulty managing daily tasks. He had a known diagnosis of PD, hypertension, and hearing impairment. Physical exam showed classic PD features, and brain MRI revealed cortical atrophy and an absent swallow tail sign. He was diagnosed with PDD, Hoehn and Yahr stage 3, and treated with pharmacologic therapy and rehabilitation. Discussion: The diagnosis of PDD in this patient was based on the Movement Disorder Society (MDS) criteria, which require pre-existing PD, gradual onset of dementia, and significant cognitive decline affecting daily function, without other identifiable causes. Cognitive testing and MRI findings supported the diagnosis. PDD is associated with neurodegeneration involving dopaminergic and other neurotransmitter systems, particularly affecting executive function and memory. Management aims to address both motor and cognitive symptoms, with cholinesterase inhibitors like rivastigmine shown to improve cognitive outcomes. Conclusion: Patients with PD may experience progression to dementia, marked by both motor and non-motor symptoms. Compared to age-matched individuals without PD, those with PD are at a substantially higher risk of developing dementia.
Co-Authors Adriana Marsha Yolanda Anna Marita Gelgel Arimbawa, I Komang Arshinta, Lasta Bagus Ngurah Mahasena Putera Awatara Dewa Putu Gede Purwa Samatra Dian Kusumastuti Anggraeni Putri Fitriasari, Elsye Gde Putra Dhyatmika Gede Suputra Hardika, Made Sebastian Dwi Putra I Gede Supriadhiana I Ketut Sumada I Made Oka Adnyana I Putu Eka Widyadharma I WAYAN WIDYANTARA Indah, Carolin Tiara Lestari Kelvin Yuwanda Ketut Widyastuti Kumara Tini Lasta Arshinta Mahadewi, Ni Putu Ayu Putri Mahendrakrisna, Daniel Ni Putu Witari Ni Wayan Nurlina Ekasari NKA, Sudiarini P. Gde Daniswara Raditya Rahman Patricia Putra, Ida Bagus Kusuma Putri Eka Pradnyaning Risky Ilona Saputra Sari, Christine Kathy Putri Suherlim, Richard Tertia, Clarissa Tirtha, Putu Bagus Bramanthana Trisnawati, Sri Yenni Valentina Tjandra Dewi Vania, Aurelia Widyastuti, Ketut Yusari, I Gusti Agung Ayu Andra