Perceptions about sexuality and the population with a neurological health condition

The gut microbiome provides the host access to otherwise indigestible nutrients, which are often further metabolized by the microbiome into bioactive components. The gut microbiome can also shift the balance of host-produced compounds, which may alter host health. One precursor to bioactive metabolites is the essential aromatic amino acid tryptophan. Tryptophan is mostly shunted into the kynurenine pathway but is also the primary metabolite for serotonin production and the bacterial indole pathway. Balance between tryptophan-derived bioactive metabolites is crucial for neurological homeostasis and metabolic imbalance can trigger or exacerbate neurological diseases. Alzheimer's, depression, and schizophrenia have been linked to diverging levels of tryptophan-derived anthranilic, kynurenic, and quinolinic acid. Anthranilic acid from collective microbiome metabolism plays a complex but important role in systemic host health. Although anthranilic acid and its metabolic products are of great importance for host-microbe interaction in neurological health, literature examining the mechanistic relationships between microbial production, host regulation, and neurological diseases is scarce and at times conflicting. This narrative review provides an overview of the current understanding of anthranilic acid's role in neurological health and disease, with particular focus on the contribution of the gut microbiome, the gut-brain axis, and the involvement of the three major tryptophan pathways.

A Directed Content Analysis for Greatest Problems Among People With and Without Traumatic Brain Injury

Obstructive sleep apnea (OSA) is often overlooked by clinicians; however, undiagnosed OSA can lead to negative outcomes for patients, including patients with underlying neurologic conditions. Clinicians should be aware of what questions to ask, what diagnostic tests to use, and what treatments to consider in patients with OSA. OSA influences many neurologic conditions, including stroke, epilepsy, headache, and neuromuscular conditions. Treatment of OSA is effective, especially with patient-tailored options, the correct education, and support. OSA is a serious medical condition with impacts on patients' health, safety, and quality of life. Clinicians should identify patients at high risk for OSA and arrange for appropriate diagnosis and treatment, which, in turn, may lead to the improvement of or reduction in risk for neurologic and other health conditions.

Physical inactivity and its related health conditions have reached pandemic proportions.1 Because of its greater prevalence, inactivity in the general population now may account for more disease burden and mortality than smoking.2,3 In persons with neurologic health conditions, physical inactivity and its inherent risks are often compounded by physical and/or cognitive impairments that limit balance and mobility. Indeed, the statistics are alarming regarding the extent of inactivity and the sequelae of immobility in persons with neurologic deficits.4–7 In 2005, the US Department of Health and Human Services issued “The Surgeon General's Call to Action to Improve Health and Wellness in Persons with Disabilities.” This call to action challenges health care providers to forge partnerships to provide more effective treatment, better education of future providers, and the implementation of health promotion programs.8,9 Although barriers to implementing such programs certainly exist, the neurologic physical therapy community has been too passive on this issue. Ironically, neurologic physical therapists are on the front lines of the battle to promote physical activity and exercise. Physical therapists are trained to understand that sedentary behavior is not an inevitable consequence of most neurologic conditions.10 Physical therapists are uniquely positioned to intervene at the primary and secondary prevention levels in those living with neurologic conditions.11 Unfortunately, the majority of our care is delivered in response to the onset of disability rather than in an effort to prevent it. Many of our clients are discharged from insurance-reimbursed care and left to fend for themselves in search for health, reduction of disability, and options for physical activity and exercise. Rather than leading the charge to answer the Surgeon General's call, the physical therapy community appears willing to tacitly accept as inevitable the pervasiveness of the sedentary lifestyle due to neurologic dysfunction and its deleterious consequences. Our commitment to these individuals is incomplete unless we directly provide or advocate for access to prevention and wellness care. This special topic issue of the Journal of Neurologic Physical Therapy was designed to illustrate ongoing efforts to raise our standard of prevention and wellness care. Rimmer and Yamamato outline a plan for the prevention of postrehabilitation health decline in acquired neurologic conditions (cerebrovascular accident, traumatic brain injury, or spinal cord injury) through efforts to minimize extrinsic barriers to prevention and wellness programs. To provide an explicit example of the implementation of such a wellness program poststroke, Rose and colleagues outline their partnership with the community in delivering secondary prevention services. Ellis and Motl use Parkinson disease and Multiple Sclerosis as the context for addressing intrinsic barriers to participation, such as self-efficacy and outcomes expectations. As part of this discussion, they outline novel ways of encouraging participation through virtual coaches and online support. Mulligan and colleagues provide an explicit example of partnership with persons with Multiple Sclerosis to deliver interventions designed to minimize barriers to physical activity. The remaining two articles provide explicit examples of clinical application. Rather than focus just on mobility outcomes, in a case series of persons with Parkinson disease, Tabak and colleagues outline the potential cognitive benefits of consistent exercise. Finally, Sasso and colleagues provide an example of the successful application of efficacious interventions to a home program for an individual with a long-standing spinal cord injury. It is our hope that this special topic issue will motivate readers to consider their role in prevention and wellness in neurologic physical therapy. As stated previously, there are substantial barriers to the regular provision of prevention and wellness services to our clients. However, these barriers also represent a spectrum of opportunities for contributing to the solution. Physical therapists should be engaged in determining policy, in community advocacy with stakeholders, and in the provision of resources, infrastructure, and expertise to persons with neurologic disability in the community.11

Sphingoid bases and their involvement in neurodegenerative diseases.

Adropin, a peptide hormone has role in various various physiological processes, including metabolic regulation and cardiovascular health. This systematic review aimed to synthesize findings from observational studies on the involvement of adropin in neurological disorders and cognitive performance. An extensive literature search was conducted across PubMed, Scopus, Web of Science, Embase, CORE, and Google Scholar using terms such as "adropin," "Neurological Disorders," "cognitive function," "Alzheimer's disease," "Parkinson's disease," "cognition," and "brain function." Studies published from 2020 to 2024 were selected and reviewed. The search and selection process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Out of 127 screened articles, 5 met the inclusion criteria for this review. The combined research findings suggest a consistent link between decreased adropin levels and a range of neurological disorders and cognitive impairments. In particular, reduced adropin levels were seen in individuals with dementia, cognitive impairment, bipolar disorder, Parkinson's disease, and multiple sclerosis. These findings highlight adropin's potential role in modulating neurological health and cognitive function. This systematic review underscores the importance of adropin in neurological health and its potential as a therapeutic agent. Based on the observed connections, adropin might serve as a new focus for treating neurological disorders, prompting the need for more research and trials.

The provision of mobility exercises through a smartphone application (app) for people undertaking neurological rehabilitation may improve mobility outcomes. However, it is difficult for clinicians and consumers to select high-quality, appropriate apps. This review aimed to identify (1) which mobile health (mHealth) apps are suitable for prescribing mobility exercises for adults with neurological health conditions, (2) how well these apps incorporate telehealth strategies, and (3) how well these apps rate in terms of quality and capacity for behaviour change. The Australian Apple iTunes Store was systematically searched, by using a search code and manually, for apps suitable for training mobility in neurological rehabilitation. Additional searches were conducted in known app repositories and for web-based apps. Trained reviewers extracted data from the included apps, including population-specific characteristics; quality, by using the Mobile App Rating Scale (MARS); and behaviour change potential, by using the App Behaviour Change Scale (ABACUS). The included apps (n = 18) provided <50 to >10,000 exercises, many incurred a subscription fee (n = 13), and half included telehealth features. App quality was moderate (mean MARS score of 3.2/5 and SD of 0.5), and potential for behaviour change was poor (mean ABACUS score of 5.7/21 and SD of 2.1). A limited number of high-quality apps are available for the prescription of mobility exercises in people with neurological conditions.

Ood-e-Saleeb, derived from Paeonia emodi Wall. (Ranunculaceae), is a medicinal herb extensively used in Unani medicine, particularly for neurological disorders. Found in the western temperate Himalayas, its roots, seeds, and flowers exhibit significant therapeutic properties. Traditionally, it has been utilized as a nervine tonic, nerve stimulant, and antispasmodic agent in conditions like paralysis (Fālij), facial palsy (Laqwa), tremors (Ri‘sha), epilepsy (Ṣar‘), and hysteria (Ikhtināq al-Raḥim). Recent pharmacological studies highlight its neuroprotective potential, particularly in diabetic peripheral neuropathy, where it modulates oxidative stress, inflammation, and neuronal apoptosis. Bioactive compounds such as paeoniflorin, flavonoids, and tannins contribute to its effects by enhancing neurogenesis, regulating neurotransmitter activity, and protecting against neuronal degeneration. Its ability to improve nerve function in diabetic neuropathy is linked to mechanisms involving advanced glycation end products (AGEs) and NF-κB pathway modulation. This review consolidates its traditional and modern pharmacological relevance, emphasizing its role in neurological disorders, including diabetic peripheral neuropathy, and its potential for further research and therapeutic applications. Keywords: Ood-e-Saleeb, Neurological Disorders, Diabetic Peripheral Neuropathy, Paeonia emodi, Neuroprotection

Neurological disorders (NDs) represent a significant global health challenges, with neurodegeneration being a common pathological feature. Recent investigations indicate the involvement of gut microbiota-derived metabolites in these disorders, such as neuroinflammation, oxidative stress, and cognitive decline. The gut-brain axis, a communication network between the gut and the central nervous system (CNS), is influenced by microbial metabolites, which can cross the blood-brain barrier and impact brain function. Key metabolites such as trimethylamine N-oxide (TMAO), para-cresol sulfate (pCS), 4-ethylphenyl sulfate (4-EPS), and indoxyl sulfate (IS) have been linked with the progression of neurological disorders. TMAO disrupts blood-brain barrier integrity, promotes oxidative stress, and activates microglial cells, which lead to the apoptosis of neurons, resulting in neuroinflammation. This could also result in psychiatric changes and behavioral disorders. pCS produced from gut bacteria metabolizing dietary proteins is correlated with amplified oxidative stress, neuroinflammation, and cognitive impairments in disorders like Parkinson's disease and Alzheimer's disease. Similarly, elevated 4-EPS levels are linked to autism spectrum disorder, contributing to anxiety-like behavior and blood-brain barrier disruption. Understanding the mechanisms by which gut-derived metabolites affect neurological health could lead to novel therapeutic strategies that can target gut microbiota for the medication and treatment of neurological disorders. Dietary precursors and gut microbiota metabolites, modulated by probiotics, prebiotics, postbiotics, and synbiotics, play a critical role in maintaining microbiota homeostasis and influencing neurological health, needing sophisticated biosensors to enable real-time monitoring and early intervention in disorders linked to gut metabolite imbalances.

Pseudobulbar affect (PBA) is characterized by involuntary and uncontrollable laughing and/or crying episodes, occurring secondary to neurological disease or injury. The impact of PBA on social and occupational function, health status, quality of life (QOL), and quality of relationships (QOR) is not well studied. This US survey conducted by Harris Interactive compared health status and daily function of patients with and without PBA. Eligible respondents were Harris Panel Online registrants previously diagnosed with stroke, multiple sclerosis, Parkinson's disease, Alzheimer's disease, traumatic brain injury, or amyotrophic lateral sclerosis, or primary, nonpaid caregivers for such patients who were too debilitated to participate. PBA was identified by a Center for Neurologic Study lability scale score of 13 or greater. Measures included the 36-item short form health survey (SF-36), the work productivity and impairment (WPAI) questionnaire, visual analog scales (VAS) for impact of PBA symptoms on QOL and QOR, and customized questions related to burden and impact of involuntary laughing/crying episodes on patients' lives. Survey responses were weighted to adjust for the relative proportion of the primary neurological conditions in the overall population and between group differences in patient age and gender. PBA and non-PBA group responses were compared using two-tailed t tests adjusted for severity of the primary neurological conditions. The 1,052 respondents included 399 PBA group participants and 653 controls. The PBA group showed significantly worse scores versus non-PBA controls on component and summary SF-36 scores (P<0.05 for all), VAS scores (P<0.05 for both), and WPAI scores (P<0.05). Among PBA group respondents, PBA contributed a great deal to or was the main cause of patients becoming housebound for 24% and being moved to supervised living placement for 9% of respondents. PBA is associated with considerable burden incremental to that of the underlying neurological conditions, affecting QOL, QOR, health status, and social and occupational functioning.

This textbook introduces important neurological concepts and disease processes that could potentially affect patients in the antepartum, peripartum or postpartum period, as well as across the lifespan of a woman from puberty to post-menopause. The effect of female hormones (estrogen, progesterone), pregnant state and menopausal state on progression or onset of neurological disease is explored. Emphasis on pregnancy as a state that can improve or worsen symptoms of certain neurological diseases is explored. The importance of pregnancy related diseases such as gestational hypertension or preeclampsia on future neurological health is also explored, Diagnosis, treatments, and management of various neurological illnesses are discussed using a case-based methodology and updated literature review on current best practices. Updated guidelines and recent relevant research study results are succinctly summarized.

BiographyDerek Bolton is Emeritus Professor of Philosophy and Psychopathology at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, and Hon. Consultant Clinical Psychologist, South London & Maudsley NHS...

Introduction: Early-life neurological and inflammatory disorders significantly affect long-term cognitive, social, and emotional development. The ‘Developmental Origins of Health and Disease’ hypothesis states that an adverse intrauterine environment may predispose offspring to chronic health conditions due to altered growth and development. Factors measured in umbilical cord blood can provide information about the status of the in utero environment during development. Evidence indicates that umbilical cord blood adipokines, namely leptin and adiponectin, may influence fetal programming and could be useful in predicting offspring health outcomes. Leptin and adiponectin are crucial in energy homeostasis, immune response, and placental function, and some studies suggest that altered concentrations may increase the risk of developing inflammatory and neurological disorders in later life. Further, limited studies have demonstrated sex-specific differences in adipokine concentrations and disease risk. Conclusions: Understanding the role of umbilical cord blood adipokines in fetal programming could offer new insights into early risk prediction and intervention strategies, promoting better health outcomes for children at risk of neurological and inflammatory diseases due to an adverse maternal environment during pregnancy.

Women face a higher risk of many debilitating neurological conditions including, but not limited to Alzheimer’s disease, multiple sclerosis, migraines, myasthenia gravis, Parkinson’s disease, stroke, and vascular dementia. Not only are these conditions more prevalent in women than men, but women face noteworthy differences in the risk factors, symptoms, disease progression, and experience of many neurological diseases. Since women have traditionally been underrepresented in both randomized controlled trails and neurological research, much less is known about the unique risk factors, symptomology, treatment efficacy, and healthcare costs of neurological conditions in women. This special collection aims to gather and disseminate innovative quantitative and qualitative research, critical reviews, policy analyses, and case studies exploring the identification, prevalence, treatment, cost, and experience of neurological conditions in women. By showcasing the unique symptoms, treatments, experiences, challenges, and circumstances of women with neurological conditions, this collection will contribute to a deeper awareness and understanding of these conditions while promoting strategies to improve the diagnosis, treatment, and care of women suffering from these conditions.Neurological Conditions in WomenWomen face a higher risk of many debilitating neurological conditions, including, but not limited to, Alzheimer’s disease, multiple sclerosis, migraines, myasthenia gravis, Parkinson’s disease, stroke, and vascular dementia. Not only are these conditions more prevalent in women than men, but women face noteworthy differences in the risk factors, symptoms, disease progression, and experience of many neurological diseases. Since women have traditionally been underrepresented in both randomized controlled trials and neurological research, much less is known about the unique risk factors, symptomology, treatment efficacy, and healthcare costs of neurological conditions in women. This special collection aims to gather and disseminate innovative quantitative and qualitative research, critical reviews, policy analyses, and case studies exploring the identification, prevalence, treatment, cost, and experience of neurological conditions in women. Physical and Cognitive Decline in US WomenFunctional difficulties can result in worse quality of life. However, the factors that influence functional difficulties may vary across different life stages. This study examined associations between demographic characteristics, income, health status and walking/communication difficulties using the National Health and Nutrition Examination Survey (NHANES) 2021-2023 wave among women aged 18 and above. Binary dependent variable analysis evaluated the these associations and a sensitivity analysis estimated these associations within young, middle-aged, and older adults. High income and higher education was associated with a higher likelihood of communication and walking difficulties. Additionally, racial/ethnic and age group variations in the observed relationships was observed. This study revealed significant associations between demographic characteristics and functional difficulties in women that differed between age groups. Risk and protective factors vary throughout the lifespan and understanding the variations will be important to understanding functional difficulty in women. Post-Stroke Cognitive Decline among Women in MidlifeBackground: Stroke is a significant risk factor for cognitive impairment. Women face a heightened risk due to their longer life expectancy and the greater prevalence of stroke-related disability. Objective: To compare the trajectory of cognitive decline in women with and without a stroke diagnosis and assessed demographic differences. Methods: The Study of Women’s Health Across the Nation (SWAN) interviewed women in their 40s and 50s from seven US cities approximately yearly to collect information on their physical, biological, psychological, and social health. Cognitive assessments were conducted between 2000 (wave 4) and 2008 (wave 10) that were designed to examine information processing speed, working memory, immediate memory and delayed memory. Adjusting for baseline age, race/ethnicity, income, education, marital status, comorbidities, and insurance, generalized linear mixed models (GLMM) were used to compare cognitive decline between women who had experienced a stroke and those who had not. Results: Among the 3,302 women in the sample, age was 49.52 (SD=2.64) years old at baseline and 53.74 (SD=3.94) in the final wave. In Wave 4, only 0.67% (N=22) reported having been diagnosed with a stroke, but 8.39% (N=277) had been diagnosed by Wave 10. Compared to stroke-free women, the multivariable-adjusted acute changes in cognitive performance were -0.18 information processing, -0.09 working memory, -0.15 immediate memory and - 0.17 delayed memory. Compared to White women, Black women who suffered a stroke saw multivariable-adjusted acute annual changes in information processing, working memory, immediate memory, and delayed memory of -0.08, -0.03, -0.08, and -0.09 respectively. Conclusion: These findings underscore the acute and persistent impact of stroke on multiple cognitive domains in midlife women, with a more significant decline observed among Black women. Targeted prevention and rehabilitation efforts are needed to address both the cognitive consequences of stroke and the demographic differences in post-stroke outcomes.

BackgroundThere is increasing interest in the potential uses of mobile health (mHealth) technologies, such as wearable biosensors, as supplements for the care of people with neurological conditions. However, adherence is low, especially over long periods. If people are to benefit from these resources, we need a better long-term understanding of what influences patient engagement. Previous research suggests that engagement is moderated by several barriers and facilitators, but their relative importance is unknown.ObjectiveTo determine preferences and the relative importance of user-generated factors influencing engagement with mHealth technologies for 2 common neurological conditions with a relapsing-remitting course: multiple sclerosis (MS) and epilepsy.MethodsIn a discrete choice experiment, people with a diagnosis of MS (n=141) or epilepsy (n=175) were asked to select their preferred technology from a series of 8 vignettes with 4 characteristics: privacy, clinical support, established benefit, and device accuracy; each of these characteristics was greater or lower in each vignette. These characteristics had previously been emphasized by people with MS and or epilepsy as influencing engagement with technology. Mixed multinomial logistic regression models were used to establish which characteristics were most likely to affect engagement. Subgroup analyses explored the effects of demographic factors (such as age, gender, and education), acceptance of and familiarity with mobile technology, neurological diagnosis (MS or epilepsy), and symptoms that could influence motivation (such as depression).ResultsAnalysis of the responses to the discrete choice experiment validated previous qualitative findings that a higher level of privacy, greater clinical support, increased perceived benefit, and better device accuracy are important to people with a neurological condition. Accuracy was perceived as the most important factor, followed by privacy. Clinical support was the least valued of the attributes. People were prepared to trade a modest amount of accuracy to achieve an improvement in privacy, but less likely to make this compromise for other factors. The type of neurological condition (epilepsy or MS) did not influence these preferences, nor did the age, gender, or mental health status of the participants. Those who were less accepting of technology were the most concerned about privacy and those with a lower level of education were prepared to trade accuracy for more clinical support.ConclusionsFor people with neurological conditions such as epilepsy and MS, accuracy (ie, the ability to detect symptoms) is of the greatest interest. However, there are individual differences, and people who are less accepting of technology may need far greater reassurance about data privacy. People with lower levels of education value greater clinician involvement. These patient preferences should be considered when designing mHealth technologies.