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    A Comparative Analysis of Psychiatric Symptoms in Parkinson's Disease Between Tremor-Dominant and Non-Tremor-Dominant Phenotypes
    (Wolters Kluwer Medknow Publications, 2025) Akan, Mustafa; Ciplak, Sibel; Adiguzel, Ahmet
    Background:There is currently no study comparing psychiatric symptoms in Parkinson's patients with tremor-dominant (TD) and non-tremor-dominant (NTD) phenotypes. Our research hypothesis suggests that patients with the TD phenotype would have higher levels of anxiety compared to those with the NTD phenotype. Objective:To test this hypothesis and fill the gap in the literature. Methods:The study included 128 patients, 77 in the TD group and 51 in the NTD group. After their neurological evaluation, the same psychiatrist interviewed them, and the Brief Symptom Inventory (BSI) and sociodemographic data form were administered. Results:The TD group had statistically significantly higher scores on the BSI total and anxiety scores (P < 0.001 for both analyses). Linear regression analysis revealed that being in the TD group was an independent risk factor for BSI total and anxiety scores (P < 0.001 for both analyses). Conclusions:The results of our study are noteworthy as they show higher psychiatric symptoms in the TD group, despite previous studies reporting worse prognosis in Parkinson's patients with NTD phenotypes. In addition, the presentation of psychiatric symptoms in Parkinson's disease appears to be linked to how the disease manifests clinically.
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    The Role of the Low-Density Lipoprotein/High-Density Lipoprotein Cholesterol Ratio as an Atherogenic Risk Factor in Young Adults with Ischemic Stroke: A Case-Control Study
    (Mdpi, 2023) Ciplak, Sibel; Adiguzel, Ahmet; Deniz, Yusuf Ziya; Aba, Melike; Ozturk, Unal
    Dyslipidemia is a major atherogenic risk factor for ischemic stroke. Stroke patients tend to have high levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and low levels of high-density lipoprotein cholesterol (HDL-C). Therefore, it is noteworthy that there has been an increase in ischemic stroke cases in young and elderly individuals in recent years. This study investigated the TC/HDL-C ratio and the LDL-C/HDL-C ratio, which may be more specific and common lipid parameters in young patients with ischemic stroke. This study aimed to demonstrate the sensitivity and specificity of TC/HDL-C and LDL-C/HDL-C ratios as atherogenic markers for young adult ischemic strokes. This trial was conducted as a retrospective case-control study. A total of 123 patients (patient group) and 86 healthy individuals (control group) aged 18-50 years were randomly selected from four different hospitals. Lipid parameters and TC/HDL-C and LDL-C/HDL-C ratios were compared between these two groups. The mean age was 38.8 +/- 7.3 years in patients and 37.7 +/- 9 years in controls (p > 005). The HDL-C levels were 39.1 +/- 10.8 mg/dL in patients and 48.4 +/- 13.8 mg/dL in controls (p < 0.001). LDL-C/HDL-C ratios were 3.23 +/- 1.74 and 2.38 +/- 0.87, and TC/HDL-C ratios were 5.24 +/- 2.31 and 4.10 +/- 1.25 in the patient and control groups, respectively (p < 0.001). The LDL-C/HDL-C and TC/HDL-C cutoff values in ROC analyses were 2.61 and 4.40 respectively; the AUCs (95% CI) were determined to be 0.680 (0.608-0.753) and 0.683 (0.610-0.755) (p < 0.001), respectively. An increased risk of stroke was observed in those with a high LDL-C/HDL-C ratio (OR = 1.827; 95% CI = 1.341-2.488; p < 0.001). Our study obtained similar results when we compared the mean TC and LDL-C levels between the two groups. However, considering the TC/HDL-C and LDL-C/HDL-C ratios, it is noteworthy that there was a significant difference between the patient and control groups.
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    Virtual reality-based assessment of visuo-vestibular integration in vestibular migraine and migraine: static and dynamic visual vertical and rod-and-frame tests
    (Frontiers Media Sa, 2026) Korkmaz, Hanifi; Ciplak, Sibel; Alkahtani, Rania
    Background: Vestibular migraine (VM) is the most common cause of episodic vertigo, yet its diagnostic markers remain limited. Perception of verticality, measured via static subjective visual vertical (SVV), dynamic SVV (DSVV), and the rod-and-frame test (RFT), provides insight into visuo-vestibular integration. Traditional approaches, however, often test these paradigms in isolation with limited ecological validity. Objective: To evaluate a novel virtual reality (VR)-based protocol combining SVV, DSVV, and RFT to characterize visuo-vestibular integration in VM, migraine without vestibular symptoms (M), and healthy controls (HC). Methods: Fifty participants (VM n = 15, M n = 15, HC n = 20) completed VR-based SVV, DSVV, and RFT assessments using the BalanceVR system. Disability was assessed using the Dizziness Handicap Inventory (DHI) and Migraine Disability Assessment (MIDAS). Between-group differences were analyzed using Kruskal-Wallis tests with Mann-Whitney U post-hoc comparisons. Correlations between orientation measures and questionnaires were assessed using Spearman's rho. Results: VM patients exhibited significantly greater SVV deviations than HC (p = 0.015). DSVV errors were elevated in VM vs. HC (p = 0.040). RFT showed robust group differences (p < 0.001), with the most significant visual dependence in VM. DHI and MIDAS scores were significantly higher in both patient groups than HC (p < 0.001). DSVV (rho approximate to 0.45) and RFT (rho approximate to 0.69) showed stronger correlations with disability than static SVV (rho approximate to 0.30). Conclusion: VM is characterized by difficulties in dynamic and visually complex situations, rather than static balance problems. Combining DSVV and RFT with SVV enhances diagnostic sensitivity, explains patients' daily challenges, and supports rehabilitation approaches aimed at reducing visual dependence and improving sensory balance.