Publications by authors named "Majid Barekatain"

35 Publications

National Guidelines for Cognitive Assessment and Rehabilitation of Iranian Traumatic Brain Injury Patients.

Arch Iran Med 2020 12 1;23(12):813-820. Epub 2020 Dec 1.

Department of Neurosurgery, Urmia University of Medical Sciences, Urmia, Iran.

Background: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran.

Methods: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients' conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2).

Results: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation.

Conclusion: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system.
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http://dx.doi.org/10.34172/aim.2020.108DOI Listing
December 2020

Comparison of Cognitive Rehabilitation versus Donepezil Therapy on Memory Performance, Attention, Quality of Life, and Depression among Multiple Sclerosis Patients.

Neurol Res Int 2020 22;2020:8874424. Epub 2020 Nov 22.

Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that affects cognitive performance and leads to depression and decreased quality of life (QOL). The current study aims to assess the effects of cognitive rehabilitation versus donepezil therapy on memory, attention, depression, and QOL in MS patients compared to placebo and control groups.

Methods: Eighty MS patients were randomly selected from parallel randomized trials and divided into four groups: A: cognitive rehabilitation (10 sessions of 120 minutes), B: control (no intervention), C: donepezil (10 mg daily), and D: placebo. Patients received the intervention for three months. They were assessed for cognitive status, depression, and QOL prior to the intervention and immediately after that using abbreviated mental test (AMT), prospective and retrospective memory questionnaire (PRMQ), everyday memory questionnaire (EMQ), digit span, MSQOL-54, and second edition Beck depression inventory (BDI). We compared scores between groups after the intervention, as well as the progression of scores in every single group.

Result: s. The cognitive rehabilitation group showed improvement in EMQ, RPMQ, digit span, physical and mental health subscales of MSQOL54, and depression ( < 0.05). We observed the same effect for donepezil except for the digit span test ( = 0.15). Intergroup comparison of scores showed the superiority of cognitive rehabilitation over donepezil in digit span, depression, and mental health scores.

Conclusion: Both donepezil and cognitive rehabilitation effectively improve memory performance, attention, depression, and QOL in MS patients. Cognitive rehabilitation is superior altogether. This study is registered with the Iranian registry of clinical trials http://clinicaltrials.gov/ct2/show/IRCT2016042227522N1.
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http://dx.doi.org/10.1155/2020/8874424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704202PMC
November 2020

A systematized review of cognitive load theory in health sciences education and a perspective from cognitive neuroscience.

J Educ Health Promot 2020 28;9:176. Epub 2020 Jul 28.

Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Introduction: To design instructions in health sciences education, it is highly relevant to heed the working memory and the approaches for managing cognitive load. In this article, we tried to mention the implications of cognitive load theory (CLT) for optimizing teaching-learning in health sciences education and discussing cognitive load from the perspective of cognitive neurosciences as brain-aware medical education.

Materials And Methods: We searched databases of Pubmed, Proquest, SCOPUS, and ISI Web of Science for relevant literature in September 1, 2018.

Results: The 27 articles out of a total of 46 records, along with 23 papers from snowballing and hand searching were included in this study. Main items encompassed; "Various types of cognitive loads," "Aim of cognitive load theory," "Strategies to managing Cognitive Load," "Cognitive Load Theory in novice and experienced learners and "expertise reversal effect," Medical and Health Sciences Curriculums and Cognitive Load Theory," "Challenges of Cognitive Load Theory."

Conclusions: We discussed six important themes for CLT in health sciences education according to the literature. Mental imagery (visualization) as one of the useful techniques to optimize germane load was suggested, as it processes further gain access to neural circuits that are engaged in sensory, motor, executive, and decision-making pathways in the brain.
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http://dx.doi.org/10.4103/jehp.jehp_643_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482702PMC
July 2020

Language representation and presurgical language mapping in pediatric epilepsy: A narrative review.

Iran J Child Neurol 2020 ;14(3):7-18

Professor of Neurology and Pediatrics, George Washington University, Center for Neuroscience and Behavioral Health, Children's National Medical Center, Washington DC. USA.

As one of the most common neurological diseases in children, epilepsy affects 0.9-2% of children. Complex interactions among the etiologies of epilepsy, interictal discharges, seizures, and antiepileptic drugs lead to cognitive impairments in children with epilepsy. Since epilepsy is considered as a network disorder, in which seizures have a widespread impact on many parts of the brain, childhood epilepsy can even affect the normal development of language. About 25% of children with epilepsy do not respond to medications; therefore, brain surgery is considered as a treatment option for some of them. Presurgical neuropsychological evaluations including language mapping are recommended to preserve cognitive and language abilities of patients after surgery. Functional magnetic resonance imaging as a non-invasive technique for presurgical language mapping has been widely recommended in many epileptic centers. The present study reviewed language representation and presurgical language mapping in children with epilepsy. Mapping language in children with epilepsy helps to localize the epileptogenic zone, and also, to predict the cognitive outcome of epilepsy surgery and possible cognitive rehabilitation. This review collected information about language representation and language mapping in pediatric epilepsy settings.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468084PMC
January 2020

The Epigenetic Overlap between Obesity and Mood Disorders: A Systematic Review.

Int J Mol Sci 2020 Sep 15;21(18). Epub 2020 Sep 15.

MPH Program, School of Public Health, Central Michigan University, Mount Pleasant, MI 48859, USA.

(1) Background: Obesity and mood disorders are considered as the most prevalent morbidities in many countries. We suppose that epigenetic mechanisms may induce higher rates of obesity in subjects who suffer from mood disorders. In this systematic review, we focused on the potential roles of DNA methylation on mood disorders and obesity development. (2) Methods: This systematic review was conducted in accordance with the PRISMA statement and registered in Prospero. A systematic search was conducted in MEDLINE, Scopus, Web of Science, Cochrane Central database, EMBASE, and CINHAL. We also conducted a Grey literature search, such as Google Scholar. (3) Results: After deduplication, we identified 198 potentially related citations. Finally, ten unique studies met our inclusion criteria. We have found three overlap genes that show significant DNA methylation changes, both in obesity and depression. Pathway analysis interaction for , and confirmed the relation of these genes in both obesity and mood disorders. (4) Conclusions: While mechanisms linking both obesity and mood disorders to epigenetic response are still unknown, we have already known chronic inflammation induces a novel epigenetic program. As the results of gene enrichment, pathways analysis showed that and linked together by inflammatory pathways. Hypermethylation in these genes might play a crucial rule in the co-occurrence of obesity and mood disorders.
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http://dx.doi.org/10.3390/ijms21186758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555814PMC
September 2020

Effect of Donepezil on Cognitive Impairment, Quality of Life, and Depression in Multiple Sclerosis Patients: A Randomized Clinical Trial.

Int J Prev Med 2020 19;11:69. Epub 2020 Jun 19.

Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Cognitive impairment is one of the debilitating consequences of multiple sclerosis (MS) with negative effects on daily life, individual and social activities, quality of life (QOL), and depression. No approved medication is introduced so far for affected individuals. We aimed to evaluate the efficacy of donepezil on cognitive performance, QOL, and depression in MS.

Methods: This is a double-blinded randomized clinical trial conducted on 100 patients with MS during 2018. Patients were assessed prior to intervention abbreviated mental test (AMT), prospective and retrospective mental questionnaire (PRMQ), everyday memory questionnaire (EMQ), digit span test, Beck depression inventory (BDI), and MSQOL questionnaire. Then patients were randomly divided into two groups of treatment (daily regimen of 10 mg donepezil) and placebo for 3 months. Subjects were reassessed using the same instruments at the end of intervention.

Results: Fifty patients remained in each group at the end of study. The mean age in donepezil and placebo groups was 31.9 ± 5.89 and 30.65 ± 5.43 years, respectively. EMQ, PRMQ, digit span test, MSQOL, and depression scores improved following donepezil therapy ( < 0.001) while no statistically significant difference was found in the placebo group ( > 0.05). Comparison of two groups also showed more favorable scores in donepezil group with respect to all assessment tools ( < 0.001).

Conclusions: Donepezil could effectively improve cognitive impairment in MS patients. Also, its positive effect on QOL and depression could result in a smaller number of interventions in this group of patients.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_154_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373083PMC
June 2020

Lavender and dodder combined herbal syrup versus citalopram in major depressive disorder with anxious distress: A double-blind randomized trial.

J Integr Med 2020 Sep 15;18(5):409-415. Epub 2020 Jun 15.

Department of Persian Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran 1668753961, Iran. Electronic address:

Background: Major depressive disorder (MDD) accompanied by anxious distress is a chronic and disabling disorder. Its conventional drug therapies often have low patient compliance due to drug-related side effects. In Persian medicine, lavender-dodder syrup is one formula often recommended for such disorders.

Objective: This study compares the effects of lavender-dodder syrup to the standard drug, citalopram, for treating MDD with anxious distress.

Design, Setting, Participants And Intervention: This six-week, double-blind, randomized, clinical trial was carried out in a psychiatric outpatient clinic. During the six-week intervention period, patients in citalopram group received citalopram tablets 20 mg/d plus 5 mL placebo syrup every 12 h; patients in group B received placebo tablets once daily plus 5 mL of lavender-dodder herbal syrup every 12 h.

Main Outcome Measures: Primary outcome measures, depression and anxiety, were evaluated using the Hamilton Depression/Anxiety Rating Scales, and were scored at the beginning of the study and at weeks three and six. Secondary outcome measures including response to treatment and remission rates were also compared between the two groups.

Results: Fifty-six participants with MDD and anxious distress were randomly assigned to two groups. Mean depression scores significantly decreased in citalopram and herbal groups at weeks three and six (time effect: P < 0.001), although the observed changes were not significantly different between the groups (intervention effect: P = 0.61). Mean anxiety scores were not significantly different between the two groups at week three (P = 0.75). However, at the end of week six, the observed decrease was significantly higher in the herbal syrup group than the citalopram group (intervention effect: P = 0.007).

Conclusion: The herbal syrup is an effective and tolerable supplement for treating MDD with anxious distress.

Trial Registration Number: IRCT2016102430459N1 on Iranian Registry of Clinical Trials.
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http://dx.doi.org/10.1016/j.joim.2020.06.002DOI Listing
September 2020

Stress as a challenge in promoting mental health among dementia caregivers.

J Educ Health Promot 2020 31;9:65. Epub 2020 Mar 31.

Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Caregiver stress is harmful to the health of both caregivers and people living with Alzheimer's disease or other dementias. The present study was conducted to assess stress and its predictors of people living with Alzheimer's disease or other dementias' caregivers.

Methods: The present descriptive, analytical, cross-sectional study was conducted in December 2017-June 2018 in Isfahan, Iran. Data were collected by interviewing 99 caregivers had at least 6 months of experience caring for a patient diagnosed with Alzheimer's disease, through questionnaires developed by the researcher. A convenience sample (easy access) of caregivers was recruited from calling the home of formally diagnosed with Alzheimer's patient, that have registered in educational hospitals affiliated to Isfahan University of Medical Sciences and psychiatrists' office both paid caregivers (formal) and unpaid caregivers (family). All caregivers provided informed consent. The type and severity of the relationship between the dependent (stress) and independent variable were assessed using Pearson's and Spearman's correlation coefficients, the independent -test, and the multivariate regression analysis.

Results: The caregivers' mean stress score was 25.4 ± 10.9 (range: 4-54). About 80% of the caregivers were female. Age and stress score was correlated ( = 0.004), the mean stress score was significantly higher in female caregivers ( = 0.04), informal caregivers ( < 0.001), and significantly lower in the caregivers with previous experience of caring for Alzheimer's patients ( = 0.02) or those introduced by service companies ( = 0.005). Variables including the family relationship with the patient ( = 0.01), kind of caregiving ( = 0.03), and previous experience of caring for Alzheimer's patients ( = 0.04) were stronger predictors of the stress score.

Conclusion: Stress is a challenge in promoting mental health among dementia caregivers. Providing social support with an emphasis on physical, mental, and social health is mandatory, especially for female and family caregivers, to promote stress management, mental health in this group, and enable optimal and purposeful care.
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http://dx.doi.org/10.4103/jehp.jehp_445_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255562PMC
March 2020

The Relationship between Aura and Postoperative Outcomes of Epilepsy Surgery in Patients with Mesial Temporal Sclerosis.

Adv Biomed Res 2020 21;9. Epub 2020 Jan 21.

Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: We conducted a study to evaluate the relationship between aura types and postoperative outcomes in patients with mesial temporal sclerosis (MTS) to predict the prognosis of patients, accordingly.

Materials And Methods: In this cross-sectional study, 99 patients with MTS-temporal lobe epilepsy were enrolled based on inclusion and exclusion criteria. The types of aura were evaluated, and the outcomes were categorized according to the Engel scale. Preoperative and postoperative results of patients were compared and analyzed with the Kruskal-Wallis test.

Results: About 73.7% of patients had seizure-free after their surgeries. The most of patients ( = 81) were in Class I of Evaluating Engel criteria. About 36.3% had not experienced any aura before their seizures, and among those with aura, the most prevalent aura was abdominal aura in 29 patients (29.3%) followed by other types of aura and affective aura. Most of the patients in Class I, II, III, and IV of Engel scale had an abdominal aura, without aura, effective aura, and abdominal aura, respectively, but this difference was not statistically significant ( = 0.691).

Conclusion: According to this study, the type of aura cannot predict postoperative outcomes in MTS patients. More studies are needed to evaluate this relation in better-planned studies with greater sample size.
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http://dx.doi.org/10.4103/abr.abr_25_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003553PMC
January 2020

Evaluation of cognitive rehabilitation on the cognitive performance in multiple sclerosis: A randomized controlled trial.

J Res Med Sci 2019 23;24:110. Epub 2019 Dec 23.

Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Multiple sclerosis (MS) can involve cognitive entities, including memory, attention, performance, and information processing. Furthermore, MS causes depression and negatively affects the quality of life (QOL). This study was aimed to assess the efficacy of cognitive rehabilitation on cognitive entities of MS patients.

Materials And Methods: This is a clinical trial study conducted on 56 MS patients in 2016-2017. Patients were randomly divided into two Groups of A (cognitive rehabilitation) and B (control group). Patients were evaluated in terms of memory, attention, QOL, and depression. Questionnaires included Abbreviated Mental Test, Prospective and Retrospective Memory Questionnaire, Everyday Memory Questionnaire, Digit Spam test for attention assessment, QOL-54 questionnaire, and Second version of Beck questionnaire assessing depression. They were filled through an interview before the study initiation, and then, the intervention group underwent ten sessions of cognitive rehabilitation and questionnaires refilled within 3 months after study initiation. Outcomes of the two groups were compared.

Results: Memory, attention, QOL, and depression improved significantly following the intervention in cases ( < 0.05), while no significant change was observed among controls ( > 0.05). Comparison of cases and controls in the second evaluation showed a significant difference between cases and controls ( < 0.05).

Conclusion: Ten sessions of cognitive rehabilitation could significantly improve MS patients' cognitive performance. Moreover, this approach affected their QOL and sense of depression in a decisive trend. It can be concluded that cognitive rehabilitation can successfully affect numerous aspects of MS patients, while numerous medical therapies may be required for treatment of each mere aspect. Further evaluations are strongly recommended.
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http://dx.doi.org/10.4103/jrms.JRMS_124_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950338PMC
December 2019

What motivates informal caregivers of people with dementia (PWD): a qualitative study.

BMC Palliat Care 2019 Nov 28;18(1):105. Epub 2019 Nov 28.

Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The burden of caring for People with Dementia (PWD) is heavy; identifying incentives that motivate them in providing care is essential in facilitating and optimizing care. This study aims to explore and describe these motivating factors.

Methods: We conducted this qualitative study between January 2016 and January 2017 in Isfahan, Iran. Data were extracted through in-depth, semi-structured interviews with 19 caregivers of PWD. These data were then examined through thematic content analysis.

Results: We identified four categories of psychological motives based on the caregivers' feedback and experience. These include 1) Moral-based motives, 2) Religious, and spiritual motives; 3) Financial motives, and 4) Wicked motives.

Conclusions: Our results revealed several aspects of caregivers' motives. They include moral, religious, and spiritual aspects; sharing housing accommodations, and the likelihood of inheriting a portion of the patient's assets based on unspoken rules and informal arrangements in the family, and wicked and immoral aspects. These findings can inform future efforts in enhancing the experiences of caregivers of PWD, and subsequently, the quality of care these patients receive. It further suggests that family members, members of a religious and spiritual organization, as well as social media, could play important roles in setting the stage.
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http://dx.doi.org/10.1186/s12904-019-0491-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883577PMC
November 2019

Outcome of lesional epilepsy surgery: Report of the first comprehensive epilepsy program in Iran.

Neurol Clin Pract 2019 Aug;9(4):286-295

Kashani Comprehensive Epilepsy Center (JMH, MZ), Kashani Hospital, School of Medicine, Isfahan University of Medical Sciences; Departments of Neurology (JMH, SB, BZ, NM, MZ), Isfahan Neurosciences Research Center and Neurosurgery (HM), Department of Radiology (RB), Students' Research Center (SB, NM), and Department of Psychiatry (MB), Psychosomatic Research Center, School of Medicine, Isfahan University of Medical Sciences; Shefa Neuroscience Research Center (ER), Tehran, Iran; Students' Research Center (AMH), School of Medicine, Shahrekord University of Medical Sciences, Iran; Department of Neurology (PM), University of Tennessee Health Science Center, Memphis, TN; Department of Clinical Neurosciences (YA), University of Calgary, Calgary, Alberta, Canada; and Epilepsy Center (SA, SL), Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH.

Background: We investigated the utility of epilepsy surgery and postoperative outcome in patients with lesional epilepsy in Iran, a relatively resource-poor setting.

Methods: This prospective longitudinal study was conducted during 2007-2017 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with a diagnosis of intractable focal epilepsy, with MRI lesions, who underwent epilepsy surgery and were followed up ≥ 24 months, were included and evaluated for postoperative outcome.

Results: A total of 214 patients, with a mean age of 26.90 ± 9.82 years (59.8% men) were studied. Complex partial seizure was the most common type of seizure (85.9%), and 54.2% of the cases had auras. Temporal lobe lesions (75.2%) and mesial temporal sclerosis (48.1%) were the most frequent etiologies. With a mean follow-up of 62.17 ± 19.33 months, 81.8% of patients became seizure-free postoperatively. Anticonvulsants were reduced in 86% of the cases and discontinued in 40.7%. In keeping with previous studies, we found that seizure freedom rates were lower among patients with longer follow-up periods.

Conclusions: We found high rates of seizure freedom after surgery in lesional epilepsy patients despite limited facilities and infrastructure; antiepileptic medications were successfully tapered in almost half of the patients. Considering the favorable outcome of epilepsy surgery in our series, we believe that it is a major treatment option, even in less resource-intensive settings, and should be encouraged. Strategies to allow larger scale utility of epilepsy surgery in such settings in the developing world and dissemination of such knowledge may be considered an urgent clinical need, given the established mortality and morbidity in refractory epilepsy.
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http://dx.doi.org/10.1212/CPJ.0000000000000627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745744PMC
August 2019

Evaluation of dual pathology among drug-resistant epileptic patients with hippocampal sclerosis.

Neurol Sci 2019 Mar 11;40(3):495-502. Epub 2018 Dec 11.

Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose: Dual pathology (DP) is defined as simultaneous presence of hippocampal sclerosis (HS) and any other pathology in the brain. Since this is a less probed concept, we aimed to evaluate the frequency and characteristics of DP among drug-resistant epileptic patients with HS.

Methods: This is a cross-sectional study conducted during 2007-2016 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with diagnosis of drug-resistant epilepsy and HS were enrolled in the study, and demographic data, seizure semiology, EEG findings, and MRI findings were collected. We compared these variables between three groups of DP, unilateral HS, and bilateral HS.

Results: Of the 200 enrolled cases, 29 patients (14.5%) had DP and 21 patients (10.5%) had bilateral HS; the remaining patients had unilateral HS. The average age of patients with DP was 30.03, and 65.5% of them were male. Patients with DP had more EEG discharges from regional and multi-focal sites compared to unilateral HS (P value < 0.001). Also, complex partial seizure (CPS) was more commonly presented in patients with unilateral HS (96.8%). Comparison of disease characteristics between DP and bilateral HS showed no difference in most categories (P > 0.05).

Conclusions: We found DP among 14.5% of our drug-resistant epileptic patients with HS. DP patients mostly presented with CPS and had high proportion of ictal and interictal EEG discharges from regional and multi-focal areas. Gliosis and focal cortical dysplasia were the most common pathologies among DP patients. Patients with DP showed a similar behavior to bilateral HS in many features.
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http://dx.doi.org/10.1007/s10072-018-3677-7DOI Listing
March 2019

Association between cognitive function and parameters of echocardiography and coronary artery angiography.

Arq Neuropsiquiatr 2018 Apr;76(4):225-230

Psychiatry Department, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

We aimed to determine whether there is an association between cognition and the results of echocardiography and angiography, based on neuropsychological assessments.

Methods: We assessed the cognition of 85 patients who had recently undergone coronary artery angiography. We calculated the Gensini score for the coronary artery disease index. We also performed echocardiography to find indices of cardiac functioning.

Results: The lower left ventricular ejection fraction correlated with lower scores on visuospatial, executive function, processing speed/attention and verbal memory capacities (p ≤ 0.05). A higher Gensini score and left atrial size correlated with lower executive function and processing speed/attention (p ≤ 0.05). In the group of patients with an impaired cognitive state, higher Gensini scores correlated with decreased processing speed/attention (p = 0.01) and the e' index was associated with lower capacity of executive function (p = 0.05).

Conclusion: Decreased processing speed/attention and executive function may correlate with cardiac dysfunction and coronary artery disease. The Color Trail Test may be considered for simple screening for cognitive problems in elderly patients with coronary artery disease or diastolic dysfunction.
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http://dx.doi.org/10.1590/0004-282x20180026DOI Listing
April 2018

Memory specificity training can improve working and prospective memory in amnestic mild cognitive impairment.

Dement Neuropsychol 2017 Jul-Sep;11(3):255-261

Professor of Neuropsychiatry, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Iran.

Amnestic Mild Cognitive Impairment (MCI) is one of the cognitive profiles of aging.

Objective: In this study, Memory Specificity Training (MEST) was used as cognitive training in patients with amnestic MCI to understand the effectiveness of the intervention on memory dimensions.

Methods: Twenty patients that met the criteria for amnestic MCI were selected and randomly assigned to experimental (n=10) or control (n=10) groups. The experimental group received five sessions of training on memory specificity while the participants in the control group took part in two general placebo sessions. Participants were assessed before, immediately after, and three months after, the treatment using the Autobiographical Memory Test, the Prospective and Retrospective Memory Questionnaire, the Wechsler Memory Scale, and the Hospital Anxiety and Depression Scale. Analysis of variance was used to analyze the data.

Results: Results from both post-test and follow-up treatment indicated that MEST improves working and prospective memory (p<0.05).

Conclusion: These findings support the effectiveness of MEST for MCI patients as a viable cognitive intervention. Also, the findings have implications for the role of brain plasticity in the effectiveness of this intervention.
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http://dx.doi.org/10.1590/1980-57642016dn11-030007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674669PMC
December 2017

Cognitive rehabilitation in patients with nonamnestic mild cognitive impairment.

J Res Med Sci 2016 2;21:101. Epub 2016 Nov 2.

Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The nonamnesic type of mild cognitive impairment (na-MCI) is predementia state with subtle decline incognitive domains except memory. Although cognitive rehabilitation (CR) has been investigated in amnesic type of MCI, we could not find any trial that rehabilitated na-MCI exclusively. We studied the effectiveness of CR on na-MCI.

Materials And Methods: This study was a blinded, randomized clinical trial. Individuals with age of 60 years or more, complete self-directedness and diagnosis of na-MCI, based on Neuropsychiatry Unit Cognitive assessment tool, were selected. The 51 patients were randomly assigned into three groups: CR, lifestyle (LS) modification, and the control group (CG). Neuropsychological tests for executive functioning were assessed at the baseline, after the interventions, and 6 months later.

Results: The mean score of the "design fluency" test increased significantly in CR, compared to LS and CG ( = 0.007). In "five-point" test, mean score increased significantly in CR ( = 0.03). There was higher mean score of Behavioral Rating Inventory of Executive Function for adults in CR ( = 0.01).

Conclusion: Consideration of the MCI subtypes allows us to target specific cognitive domains, such as information processing, for better CR outcome. CR may result in better performance of executive functioning of daily living.
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http://dx.doi.org/10.4103/1735-1995.193173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322687PMC
November 2016

An Undiagnosed Case of Hypothalamic Hamartoma with a Rare Presentation.

Case Rep Med 2017 26;2017:2432315. Epub 2017 Jan 26.

Isfahan Neurosciences Research Center, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Kashani Comprehensive Epilepsy Center, Kashani Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

. Hypothalamic hamartomas (HHs) are rare tumor-like malformations that may present with complex partial seizures refractory to anticonvulsants in adulthood. The condition may be misdiagnosed because of rarity. . We report a 25-year-old man with complaint of seizures presented by falling, tonic spasm of limbs, oral automatism, vocalization, and hypermotor activities. His seizures started at the age of one month and presented as eye deviation and upper limbs myoclonic jerk, followed by frequent seizures with variable frequency. The patient had delayed developmental milestones and was mentally retarded. He was hospitalized and underwent video-EEG monitoring and neuroimaging, and the diagnosis of HH was made. The patient became candidate for surgery after that. . In this case, the underlying etiology of seizures was diagnosed after 25 years. HH is a rare condition and neurologists may encounter very small number of these cases during their practice. Therefore, they should consider it in patients who present with suspected signs and symptoms.
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http://dx.doi.org/10.1155/2017/2432315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299200PMC
January 2017

Automatic Diagnosis of Mild Cognitive Impairment Using Electroencephalogram Spectral Features.

J Med Signals Sens 2016 Jan-Mar;6(1):25-32

Psychosomatic Research Center, Department of Psychiatry, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.

Alzheimer's disease (AD) is one of the most expensive and fatal diseases in the elderly population. Up to now, no cure have been found for AD, so early stage diagnosis is the only way to control it. Mild cognitive impairment (MCI) usually is the early stage of AD which is defined as decreasing in mental abilities such a cognition, memory, and speech not too severe to interfere daily activities. MCI diagnosis is rather hard and usually assumed as normal consequences of aging. This study proposes an accurate, mobile, and nonexpensive diagnostic approach based on electroencephalogram (EEG) signal. EEG signals were recorded using 19 electrodes positioned according to the 10-20 International system at resting eyes closed state from 16 normal and 11 MCI participants. Nineteen Spectral features are computed for each channel and examined using a correlation based algorithm to select the best discriminative features. Selected features are classified using a combination of neurofuzzy system and k-nearest neighbor classifier. Final results reach 88.89%, 100%, and 83.33% for accuracy, sensitivity, and specificity, respectively, which shows the potential of proposed method to be used as an MCI diagnostic tool, especially for screening a large population.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786960PMC
March 2016

Hippocampal volume and hippocampal angle (a more practical marker) in mild cognitive impairment: A case-control magnetic resonance imaging study.

Adv Biomed Res 2015 28;4:192. Epub 2015 Sep 28.

Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Mild cognitive impairment (MCI) accompanies brain atrophy in neuroimaging investigations. The aim of this study was to compare MCI patients with the normal population for hippocampal volume (HV) and hippocampal angle (HA), and to assess the correlation between HV and HA.

Materials And Methods: In a case-control study on 2014, in Kashani Hospital (Isfahan, Iran), 20 MCI patients were compared with 20 normal controls for HV and HA. Subjects were diagnosed with MCI or normal control, based on neuropsychiatry interview, which was confirmed by neuropsychiatry unit cognitive assessment tool (NUCOG). All magnetic resonance imaging scans were processed using the Free-Surfer software package for HV assessment. The HA was measured on the most rostral slice in which the uncal sulcus could be identified on a coronal plane. The data were analyzed using multiple analysis of co-variance and Pearson correlation.

Results: The mean (standard deviation [SD]) score of NUCOG in control and case group were 91.05 (3.01) and 82.42 (3.57), respectively. Comparison of HV and HA scores in two groups, showed that mean (SD) HV and HA were not different between control and case groups, significantly, (P = 0.094 and P = 0.394, respectively). There was a negative correlation between the adjusted HV and the HA in case (r = -0.642, P = 0.004), and control groups (r = -0.654, P = 0.003).

Conclusion: HV and HA were not different between MCI patients and normal controls; however, HA is correlated with HV negatively and may be used as an alternative factor because of more feasibility and availability in clinical settings in compared to HV.
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http://dx.doi.org/10.4103/2277-9175.166153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617004PMC
November 2015

Coronary artery disease and plasma apolipoprotein E4 in mild cognitive impairment.

ARYA Atheroscler 2014 Sep;10(5):244-51

Isfahan Center of Health Research, Isfahan, Iran.

Background: Atherosclerosis and apolipoprotein E4 (APOE4) are known risks for Dementia. We sought to evaluate the relationship between coronary atherosclerosis and APOE4 with mild cognitive impairment (MCI).

Methods: In a case-control study, subjects with age more than 60 years and recent coronary angiography were evaluated by mini-mental state examination and neuropsychiatry unit cognitive assessment tool (NUCOG) to find the patients with MCI (n = 40) and the controls with normal cognition (n = 40). Coronary angiography records were re-assessed to find the severity of coronary artery disease by the Gensini scores. Plasma levels of APOE4 were measured.

Results: There were no-significant difference between the 2 groups regarding the plasma APOE4 levels (P = 0.706) and the Gensini scores (P = 0.236). Associations between the Gensini scores and the NUCOG scores in the MCI group (r = -0.196, P = 0.225) and the control group (r = 0.189, P = 0.243) were not significant. However, the interaction effect between the Gensini and the NUCOG scores based on allocation to the control or the patient groups showed statistically significant difference (F(1,67) = 4.84, P = 0.031).

Conclusion: Although atherosclerosis has been considered as known risk factor for dementia and MCI, this study could not reveal that coronary atherosclerosis-related to declining in cognitive functioning. There was no significant association between plasma APOE4 levels and MCI.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251478PMC
September 2014

The effect of chronic periodontitis on serum levels of tumor necrosis factor-alpha in Alzheimer disease.

Dent Res J (Isfahan) 2014 Sep;11(5):549-52

Department of Periodontics, Khorasgan Islamic Azad Dental School, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Despite the outbreak in dental science, oral and dental complications in Alzheimer are of the unsolved problems. It is assumed that tumor necrosis factor-α, which is a key factor in Alzheimer, has a relation with periodontal complications in patients with Alzheimer disease. The present study evaluated the effect of chronic periodontitis on serum levels of tumor necrosis factor-α in Alzheimer disease.

Materials And Methods: This case-control study was performed on 80 patients with Alzheimer disease seeking medical care at Nour Hospital, Isfahan, Iran. Eighty patients with Alzheimer disease between 40 and 70 years old attended this study. Forty had chronic periodontitis (case group), and 40 patients had healthy periodontium (control group). Blood sample was taken, and serum levels of tumor necrosis factor-α were measured by means of an ELISA Reader device. Independent T-Test was used to analyze data, and P < 0.05 was considered significant.

Results: The mean of tumor necrosis factor-α was 749.1 ng/μL in case group and 286.8 ng/μL in control group. Independent t-test showed that the mean of tumor necrosis factor-α in patients with Alzheimer and periodontitis was approximately three folds higher than the patients only with Alzheimer, and this difference was statistically significant (P < 0.001).

Conclusion: According to the results of this study, it seems that there is a difference between serum levels of tumor necrosis factor-α in patient with Alzheimer and chronic periodontitis and patients with Alzheimer disease and healthy periodontium. Tumor necrosis factor-α level in serum may act as a diagnostic marker of periodontal disease in patients with Alzheimer disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241606PMC
September 2014

The relationship between regional brain volumes and the extent of coronary artery disease in mild cognitive impairment.

J Res Med Sci 2014 Aug;19(8):739-45

Department of Cardiology, Cardiac Rehabilitation Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: There are conflicting reports regarding the association between coronary artery disease (CAD) and mild cognitive impairment (MCI). Volumetric Magnetic resonance imaging (MRI) investigations have been considered as an objective biomarker for MCI. In this study, we determined the relationship between the regional brain volumes and the extent of CAD in MCI patients and cognitively normal controls.

Materials And Methods: In a case-control study a subset of MCI patients (n = 20) and cognitively normal controls (n = 20), aged 66.4 ± 4.6 and 65.3 ± 3.9 respectively, from subjects who were recently admitted to cardiac catheterization facilities in two general hospitals were selected. All subjects underwent a clinical interview, biochemical measures, neuropsychological testing and Neuropsychiatry Unit COGnitive assessment tool. Video records of coronary angiography were scored with the Gensini method. For volumetric evaluation of regions of interest, brain MRI scans was processed using the FreeSurfer software package the relationship between the regional brain volumes and the extent of CAD in MCI patients and cognitively normal controls were compared.

Results: We have found that, there were significant differences between the two groups in volumes of left fusiform (P = 0.039), left pars triangularis (P = 0.003) and left superior temporal gyrus (P = 0.009), after controlling for intracranial volumes. Higher Gensini scores were associated with reduced volumes of total cortical volume (P = 0.047, R = -0.4), left precuneus (P = 0.022, R = -0.5), right inferior parietal lobule (P = 0.011, R = -0.5) and left supra marginal gyrus (P = 0.035, R = -0.04) in MCI.

Conclusion: In MCI, a greater degree of coronary stenosis correlates with greater loss of gray matter in specific brain regions relevant to cognitive function. This, however, was not the case for cognitively normal subjects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235094PMC
August 2014

Aftercare services for patients with severe mental disorder: A randomized controlled trial.

J Res Med Sci 2014 Mar;19(3):240-5

Department of Psychology, Khorasgan Branch, Islamic Azad University, Isfahan, Iran.

Background: Although evidences emphasize on the importance of aftercare programs to achieve continuity of care, different studies have revealed controversial results about the outcome. The objective of this study was to investigate the effect of aftercare program on outcome measures of patients with severe mental disorders.

Materials And Methods: Of a total 123 eligible patients with severe mental disorders, 61 patients were randomly assigned to the intervention group and 62 patients to the control group. The interventions included follow-up phone calls, home visits, and psychoeducation for families. Assessments were performed on hospital admission, discharge and the following 3(rd), 6(th) and 12(th) month. Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the World Health Organization Quality of Life Questionnaire (WHO-QOL) were used. Data were analyzed through Chi square, t-test, Mann-Whitney-U, and Repeated Measures Analysis of Co-Variance.

Results: Mean of the HDRS scores revealed significant difference between the two groups when HDRS scores on the admission day were controlled (P = 0.028). The level of functioning was significantly different between the two groups based on the sequential assessments of GAF (P = 0.040). One year after the onset of trial, the number of psychiatric readmissions were significantly different between the two groups (P = 0.036).

Conclusion: Readmission rates could be reduced by aftercare services, through the first year, after discharge of patients with severe mental disorders. On the other hand, higher levels of functioning would be expected after one year.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061646PMC
March 2014

Psychometric properties and validation of Persian version of quality of life in epilepsy inventory (QOLIE-89).

J Res Med Sci 2013 Nov;18(11):990-4

Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Several epilepsy-specific quality of life questionnaires have been developed. One of them is quality of life in epilepsy-89 version. The objective of this study was to develop a Persian version of QOLE-89 and confirm its psychometric properties.

Materials And Methods: Participants were 75 patients with epilepsy. The quality of life questionnaire was adapted to Persian language through a translation and translation-back procedure. Internal consistency by Cronbach's α, was determined and construct validity was assessed by correlation with GHQ-12 and BDI-PC and discriminant validity was confirmed by comparing scores for known groups.

Results: Reliability based on internal consistency (Cronbach's α) for QOIE-89 was 0/96 and for 17 subscales was varied form 0/70 to 0/89 and Test-retest reliability (Pearson's correlation coefficient) for the Farsi version of the QOLIE-89 ranged from 0.75 to 0.88. Total score of QOLIE-89 discriminated well between the patients according to depression severity and drug resistance and seizure controllability. Correlation between the total scores, BDI-PC and GHQ-R to confirm construct validity was 0/55 and 0/63, respectively.

Conclusion: In this cross-sectional survey, Persian version of the QOLIE-89 was reliable and showed properties supporting the construct and discriminant validity at a level comparable with the original and some other versions. Thus, this questionnaire has suitable properties in Iranian population and can be used in clinical trials with epileptic patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906792PMC
November 2013

Psychometric properties and validation of Persian version of quality of life in epilepsy inventory (QOLIE-89).

J Res Med Sci 2013 Nov;18(11):990-4

Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Several epilepsy-specific quality of life questionnaires have been developed. One of them is quality of life in epilepsy-89 version. The objective of this study was to develop a Persian version of QOLE-89 and confirm its psychometric properties.

Materials And Methods: Participants were 75 patients with epilepsy. The quality of life questionnaire was adapted to Persian language through a translation and translation-back procedure. Internal consistency by Cronbach's α, was determined and construct validity was assessed by correlation with GHQ-12 and BDI-PC and discriminant validity was confirmed by comparing scores for known groups.

Results: Reliability based on internal consistency (Cronbach's α) for QOIE-89 was 0/96 and for 17 subscales was varied form 0/70 to 0/89 and Test-retest reliability (Pearson's correlation coefficient) for the Farsi version of the QOLIE-89 ranged from 0.75 to 0.88. Total score of QOLIE-89 discriminated well between the patients according to depression severity and drug resistance and seizure controllability. Correlation between the total scores, BDI-PC and GHQ-R to confirm construct validity was 0/55 and 0/63, respectively.

Conclusion: In this cross-sectional survey, Persian version of the QOLIE-89 was reliable and showed properties supporting the construct and discriminant validity at a level comparable with the original and some other versions. Thus, this questionnaire has suitable properties in Iranian population and can be used in clinical trials with epileptic patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906792PMC
November 2013

Factors associated with readmission of patients at a university hospital psychiatric ward in iran.

Psychiatry J 2013 17;2013:685625. Epub 2013 Mar 17.

Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan 8169658514, Iran.

Objectives. Readmission has a major role in the reduction of the quality of life and the increase in the years of lost life. The main objectives of this study were to answer to the following research questions. (a) What was the readmission rate? (b) What were the social, demographic, and clinical characteristics of patients admitted to the Psychiatric Emergency Service at Nour University Hospital, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran? (c) What were the effective factors on readmission? Method. This cross-sectional study was conducted on a total number of 3935 patients who were admitted to Isfahan University Hospital Psychiatric Ward in Isfahan, Iran, from 2004 to 2010. Gender, age, marital status, education, self-report history of previous admission, type of psychiatric disorder, substance misuse, suicide, and the length of the current psychiatric disorder were collected from the registered medical files of patients. The data were analysed using the negative binomial regression model. Results. We found that factors such as psychiatric anxiety disorder, bipolar I, bipolar II, psychotic disorder, depression, and self report history of previous admission were statistically significant in the number of readmissions using the negative binomial model. Conclusion. Readmission to the psychiatric ward is mainly predictable by the type of diagnosis and psychosocial supports.
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http://dx.doi.org/10.1155/2013/685625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820075PMC
November 2013

The effect of Boswellia Serrata on neurorecovery following diffuse axonal injury.

Brain Inj 2013 2;27(12):1454-60. Epub 2013 Oct 2.

Behavioral Sciences Research Center, Noor Hospital, Isfahan University of Medical Sciences , Isfahan , Iran .

Objectives: This pilot trial was conducted to establish whether Boswellia Serrata (BS), a traditional herbal medicine, could improve the outcome of patients who have diffuse axonal injury (DAI).

Methods: In total, 38 patients with pure DAI were enrolled in this 12-week, double-blind, randomized, cross-over study. The patients were randomly assigned to receive either placebo (group A, n = 20) or BS capsules (group B, n = 18) for 6 weeks and then switched to the other intervention for another 6 weeks. The disability rating scale (DRS) was used to assess the outcome at 2-, 6- and 12-weeks post-trauma.

Results: A non-significant trend for improvement of DRS total scores was observed after the use of BS. Regarding the DRS sub-scores, however, there was significant improvement in 'cognitive ability to self-care' during the second 6 weeks in group A on BS compared to an insignificant spontaneous recovery in group B during the same period on placebo. Moreover, both groups experienced a close-to-significant increase in the cognitive function-related items of the DRS during the periods they were on BS. The reported adverse events were all of mild quality and had similar frequency between the groups.

Conclusion: These results suggest that BS resin does not significantly affect general outcome, but may enhance the cognitive outcome of patients with DAI.
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http://dx.doi.org/10.3109/02699052.2013.825009DOI Listing
June 2014

Cognitive impairments in patients with intractable temporal lobe epilepsy.

J Res Med Sci 2011 Nov;16(11):1466-72

Assistant Professor, Department of Psychology, School of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran.

Background: Cognitive impairment associated with temporal lobe epilepsy (TLE) has been recognized in multiple studies. We designed this study to find a specific cognitive profile in patients with TLE who were candidates for epilepsy surgery. We also sought to find if neuropsychological assessment could differentiate left TLE, right TLE and normal subjects.

Methods: The sample of this study consisted of 29 patients with right TLE, 31 with left TLE, and 32 subjects without history of seizure as the control group. For all recruited patients and controls, demographic questionnaire, Wechsler Memory Scale-III (WMS-III) and Wechsler Adult Intelligence Scale-R (WAIS-R) were administered. Multivariate analysis of variance was carried out to reveal differences in memory and intelligence performance between the three groups.

Results: All of the mean scores of the WMS-III indexes were significantly higher in the control group in comparison with the right or the left TLE groups (p < 0.001). There were not any significant differences between mean scores of WMS-III indexes of the right and the left. The WAIS-R also showed significantly better mean scores of full scale intelligence quotient (FSIQ) and performance intelligence quotient (PIQ) in the control groups than both of the right and left TLE patients (p < 0.001). Although the verbal intelligence quotient (VIQ) mean scores were significantly different between the left TLE and the control group (p = 0.037), there were not any significant differences between the right TLE patients and the control group.

Conclusions: These findings indicated that WMS-III and WAIS-R can differentiate patients with refractory temporal lobe epilepsy from normal subjects. However, the obtained cognitive profile could not differentiate between the right and the left TLE.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430065PMC
November 2011

Efficacy of memoral herbal on prevention of electroconvulsive therapy-induced memory impairment in mood disorder patients (isfahan - iran 2011).

Int J Prev Med 2012 Jul;3(7):499-503

Behavioral Sciences Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran.

Background: Electroconvulsive therapy (ECT) is one of the most efficacious treatment for major depressive disorder (MDD), it is also used as a rapid and efficacious treatment for other psychiatric disorders, especially treatment resistant ones. The cognitive impairment is one of the most important side effects of ECT. This study examined the Memoral herbal efficacy in prevention of ECT-induced memory impairment.

Methods: In a randomized clinical trial, 70 patients with mood disorders who were candidates for ECT enrolled in either Memoral or Control group, and received either Memoral or placebo. The memory was assessed by Addenbrook Cognitive Examination (ACE), and the findings were analyzed by ANOVA under SPSS18.

Results: The Memoral group patients showed significantly higher total ACE scores than placebo group (P < 0.001). The scores of attention and orientation, verbal fluency and memory subscales not only never decreased during the study in Memoral group, but also increased. There was no significant difference between these scores of Memoral and placebo groups for the subscales of language and visuospacial ability.

Conclusion: The Memoral herbal is an efficacious and safe choice in prevention of ECT- induced cognitive impairment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415191PMC
July 2012

Converting three general-cognitive function scales into persian and assessment of their validity and reliability.

Int J Prev Med 2011 Apr;2(2):82-7

General Practitioner, School of Medicine, Isfahan University of Medical sciences, Hezarjerib Street, Isfahan, Iran.

Objectives: Glasgow Outcome Scale Extended (GOSE), Galveston Amnesia and orientation Test (GOAT) and Disability Rating Scale (DRS) are three popular outcome measure tools used principally in traumatic brain injury (TBI) patients. We conducted this study to provide a Farsi version of these outcome scales for use in Iran.

Methods: Following a comprehensive literature review, Farsi transcripts were prepared by "forward-backward" translation and reviewed by subject experts. After a pretest on a few patients, the final versions were obtained. 38 patients with closed head injury were interviewed simultaneously by two interviewers. Main statistics used to assess validity and reliability included "Factor analysis" for construct validity, Cronbach's alpha for internal consistency, and Pearson Correlation and Kappa Coefficient for inter-rater agreement.

Results: Factor analysis for Farsi-GOAT (FGOAT) revealed 5 independent factors with a total distribution variance of 80.2%. For Farsi-DRS (FDRS), 3 independent factors were found with a 92.3% variance. The Cronbach's alpha (95% confidence interval) was 0.84 (0.763- 0.919) and 0.91 (0.901-0.919) for FGOAT and FDRS, respectively. Pearson Correlation between total scores of two raters was 0.98 and 0.97 for FGOAT and FDRS, in order. Kappa coefficient (95% CI) between outcome rankings of raters was 0.73 (0.618-0.852) and 0.68 (0.594-0.770) for FGOAT and FDRS, respectively. As for Farsi-GOSE scale, Kappa value was 0.4 (0.285-0.507) for 8-level outcome ranking and improved to 0.7 (0.585-0.817) for 5-level scale. We found a good correlation between FDRS and FGOSE predicted prognoses (Spearman's rho= 0.74, 95% CI: 0.676-0.802).

Conclusions: FDRS and FGOAT had appropriate validity and reliability. The 8-level outcome FGOSE scale disclosed a low inter-rater agreement, but a suitable observer agreement was achieved when the 5-level outcome was applied.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093777PMC
April 2011