Zoltán Janka

Epidemiological and biological evidence indicate a close connection between Alzheimer’s disease (AD) and type-2 diabetes mellitus. Glucose transporter 1 (GLUT1), encoded by the SLC2A1 gene, has a major role in glucose metabolism, the dysregulation of which has been implicated in both diseases. We conducted a case-control association study in a sample of 439 non-diabetic patients with late-onset AD and 304 cognitively healthy, non-diabetic elderly controls to determine the potential risk for developing AD associated with SLC2A1 rs841847 polymorphism. The rs841847 C/C genotype occurrence was higher in the AD group (AD: 60.4%, controls: 50.7%), while the minor T allele-containing genotypes were more frequent among controls (AD: 39.6%, controls: 49.3%). A multivariate logistic regression model adjusted for age, sex, and apolipoprotein E (APOE) ε4 status (ε4 allele carriers versus non-carriers) demonstrated that carriers of the T allele had a significantly reduced risk for AD compared to C/C homozygotes (OR = 0.672; 95% CI: 0.493–0.916; p = 0.012). Although the rs841847 polymorphism has been linked to type-2 diabetes mellitus, the present study investigated this gene variant in AD for the first time. Our findings indicate a moderate protective effect for the rs841847 T allele on the susceptibility to AD. We demonstrated the rs841847 polymorphism as a candidate single nucleotide polymorphism for further examination as a predisposing genetic factor for AD.

Depending on affinity, attitude, preference, understanding, and mental state, music can influence emotions, mood, motivation, psychomotor, cognitive, and spiritual functions in the receptive person. It is presumed that a given music may reflect the actual psychic condition of the composer and, if applicable, the nature of the chosen topic to be characterized. However, extreme situations may emerge from these components i.e. the music might overshoot the frontiers of normal psychological phenomena and 'heavy mental' psychopathological symptoms or syndromes may appear in it. Present search restricts the wide range of music categories to the classical one (instrumental and vocal, opera included) and attempts to screen for such 'heavy mental' psychopathological signs beside mentioning the slighter symptoms. Phenomena of amnesia, dementia/delirium, mental retardation, biased perception, chemical/behavioural addiction, delusion, misidentification, mania, depression, suicide, anxiety, obsession-compulsion, conversion, disso - ciation, para/hyper/insomnia, sexual and personality disorders are listed as examples from the wide repertoire. The figure of the 'fool' and the topic of 'madness' (in general, and folia, tarantella) are mentioned as well as the appearance of some behavioural traits ('seven deadly sins'), feigning psychic/somatic states, pathological lying, mutism, stutterism, famous oracles, mesmerism, and employing magic or various potions. Mad scenes as psychotic conditions (often tran - sient if due to psychotrauma from romantic love) occur in many operas. However, quite a few of them have been written by Donizetti. Considering his life, behaviour and composing features, the question arises about Donizetti's ailment: was it mood disorder, Barbaja, or luetic derailment?

Depending on the personal attitude toward a given style and performance, music can influence mental activities such as emotion, mood, motivation, psychomotor tempo and possibly cognition. Experimental data indicate that music can alter physiological parameters of somatic functions (blood pressure, heart rhythm, peripheral blood flow, respiration). However, efforts are taken in medicine and neuroscience to decipher brain physiological and morphological correlates in processing or performing music. Modern imaging techniques brought a significant advance in this respect. It appears that there is no single music center in the brain, but depending on the components (melody, rhythm) of the music, more cerebral areas with strong network connections participate in that. Important regions are the upper temporal area (primary, secondary, tertiary auditory cortex), and parts of the frontal and parietal lobes, limbic system, and cerebellum. Beyond the above aspects, medicine joins to music in the field of music therapy. Meta-analyses of controlled studies show that music can be suitable to decrease stress, anxiety, and depression in various disease groups (cardiovascular, oncological, mental) and in medical examinations (surgical, urological, cardiac catheterization). Improvements were observed in motor, cognitive and psychosocial functions after music interventions in stroke rehabilitation. The links between mood disorders and creativity in music belong to medicine as well, where eminent composers can be mentioned, and also the examples of scholar and practitioner physicians playing or composing music superbly. Orv Hetil. 2019; 160(11): 403–418.

Current writing is a tribute of respect, on the occasion of his 80th birthday, to professor László Tringer. In a somewhat unusual way, instead of a bouquet of 80 flowers, a bunch of 80 limericks is presented for him with compliments. The origin of the idea is that professor Tringer himself also writes poems and rhymes in his leasure time. The celebrated professor is an eminently recognized person in the profession, and he is one of the founding fathers of modern psychiatry in Hungary. After receiving the diploma in medical sciences, he has obtained one in psychology and in theology as well. Beside other qualifications he has specializations in psychiatry, neurology, clinical pharmacology, clinical psychology, psychotherapy, addictology and geriatry. Thanks to the providence, the author of the current writing has many common and unforgettable experiences with him. The 80 limericks on the one hand refer to these mutual memories and on the other hand reflect the author's subjective observations on some areas of the society, life situations, character depictions, psychiatry, other medical professions, mental functions, the brain's structural and neurochemical features, and several hints for life conduct. It is assumed that professor Tringer may not necessarily agree with all of these opinions. Nevertheless, these might serve as a basis for further mutual (and for him now over 80 years) inspiring consultations and intellectual adventures.

Trace elements are found in the living organism in small (trace) amounts and are mainly essential for living functions. Essential trace elements are in humans the chromium (Cr), cobalt (Co), copper (Cu), fluorine (F), iodine (I), iron (Fe), manganese (Mn), molybdenum (Mo), selenium (Se), zinc (Zn), and questionably the boron (B) and vanadium (V). According to the biopsychosocial concept, mental functions have biological underpinnings, therefore the impairment of certain neurochemical processes due to shortage of trace elements may have mental consequences. Scientific investigations indicate the putative role of trace element deficiency in psychiatric disorders such in depression (Zn, Cr, Se, Fe, Co, I), premenstrual dysphoria (Cr), schizophrenia (Zn, Se), cognitive deterioration/de-mentia (B, Zn, Fe, Mn, Co, V), mental retardation (I, Mo, Cu), binge-eating (Cr), autism (Zn, Mn, Cu, Co) and attention deficit hyperactivity disorder (Fe). At the same time, the excess quantity (chronic exposure, genetic error) of certain trace elements (Cu, Mn, Co, Cr, Fe, V) can also lead to mental disturbances (depression, anxiety, psychosis, cognitive dysfunction, insomnia). Lithium (Li), being efficacious in the treatment of bipolar mood disorder, is not declared officially as a trace element. Due to nutrition (drinking water, food) the serum Li level is about a thousand times less than that used in therapy. However, Li level in the red cells is lower as the membrane sodium-Li countertransport results in a Li efflux. Nevertheless, the possibility that Li is a trace element has emerged as studies indicate its potential efficacy in such a low concentration, since certain geographic regions show an inverse correlation between the Li level of drinking water and the suicide rate in that area.

Mental flexibility enabling shifts from the usual prepotent behaviour to new strategies and solutions is a significant factor in the successful adaptation to the changing environment. Components of mental flexibility comprise attention, salience detection, inhibition, working memory and switch processes which can be measured by neurocognitive tests. Data derived from examinations by the methods of cognitive neuroscience can be compared to the features, observed under resting state and during task performance, of brain structures and functions. Studying central nervous system correlates of mental flexibility by imaging, neurobiological, and pharmacological techniques revealed that certain cerebral regions (prefrontal cortex, anterior cingulate and insula, striatum, inferior parietal lobule) with their network connectivities, and some neurotransmitters (e.g. dopamine) have profound roles in this respect. Flexibility shares some similarities with artistic/scientific/everyday creativity and openness as a personality trait and this is also reflected in neurobiological parameters. According to precedents in art history, the public reception and acceptance of nonconform avant-garde artistic products are also dependent on flexibility and openness. Alterations of mental flexibility have been found in diseases (psychiatric and others), and in stress situations. Although flexible switch is generally considered as positive and beneficial, under certain conditions advantages might arise from keeping stability maintaining customs, conventions, and traditions. Orv Hetil. 2017; 158(45): 1771–1786.

Suspicious thinking in given situations can be useful and helps the adaptation as events occurring in the world also corroborate this. Factors participating in the development of paranoia can be listed as psychodynamic (projection), salience attributional, neurobiological (dopamine), impaired perceptual (hearing loss), sociocultural (minority, pseudocommunity), self-esteem (worrying, depression, mania), and cognitive (jump-to-conclusion) mechanisms. Along the spectrum of thinking, from the mild to the severe, enhanced worrying, salience attribution, overvalued concepts, suspicion/mistrust, paranoid ideations, and crystallized delusions may occur with different contents. In recent years intensive research has been started to reveal the presence of subclinical paranoid thoughts in the general population. Applying various screening methods developed for this purpose (delusions inventories, psychometric tests, virtual reality laboratory) it has been found that suspicious/mistrustful ideations are fairly common in nonclinical samples and some of these are comparable to that seen in patient population. From the larger occurrence of milder forms to the smaller frequency of more severe delusional thoughts the whole hierarchical phenomenon can be described as a ‘paranoia pyramid’. Based on this everyday paranoid thinking style lurking in people, it may well be that ‘our life is delusional’. Orv. Hetil., 2016, 157(50), 1979–1988.