Background: Behavioral and psychological symptoms of dementia (BPSD) are common in individuals with Alzheimer disease (AD). Donepezil and memantine are both widely used for the treatment of moderate AD. Objective: To evaluate the effects of donepezil and memantine in relieving BPSD in individuals with moderate AD. Method: We conducted a prospective, randomized, 6-month clinical trial involving 85 individuals with moderate AD divided into two groups: group 1 (n = 42) was treated with donepezil; group 2 (n = 43) was treated with memantine. We used the Neuropsychiatric Inventory (NPI) to assess the prevalence and severity of BPSD at baseline and after 6 months of treatment with donepezil or memantine. Results: The two groups’ baseline characteristics, including age, sex, mean length of education, and disease duration, were comparable, as were their baseline Mini-Mental State Examination scores. The NPI Total score improved from baseline to month 6 in both groups (P < 0.0001). Analyses of the NPI subdomains revealed that both donepezil treatment and memantine treatment produced statistically significant improvement in all of the NPI domains except euphoria and apathy, for which no improvement was observed after memantine treatment. Both treatments were well tolerated, with mostly mild and transient adverse effects. Conclusion: Specific drugs for AD, including donepezil and memantine, may be effective in treating BPSD in individuals with moderate AD, with a favorable safety profile.

Spectacular Shrinking Deficit (SSD) is a term attributed by J.P. Mohr to a rare cerebrovascular event defined by a rapid and dramatic improvement of major hemispheric stroke syndrome. It is presumed to be caused by the migration of initially embolic occlusion of an internal carotid artery or middle cerebral artery to its distal branches. It is only reported in several case reports, and case series with differing criteria of what defies an SSD meaning that its presumed prevalence rate of 7-14% of major hemispheric stroke syndromes could be an overestimation. It is usually associated with the cardioembolic cause of stroke, and it has a higher prevalence rate in younger patients, males, and nondiabetics. Our case is a 58 -year old male who presented to our ER with a major hemispheric stroke syndrome (deviation of head and eyes on the right side, central facioparesis on the left, left hemiplegia, and left hemineglect, NIHSS 16) 30 minutes after symptom onset. He was aggressive, insisting nothing was wrong with him. His initial brain CT showed acute ischemic changes in the right temporooccipital region with an inadequate filling of distal branches of the right MCA shown on CT brain angiography. His symptoms spectacularly improved in our ICU (NIHSS 0) 51 minutes from symptom onset negating the need for thrombolysis. Except for one positive Beta -2 GPI test his detailed laboratory tests, 24h Holter ECG, TTE, carotid, and vertebral artery ultrasound were noneventful. He had no cognitive or neurological deficit. He denied the possibility of performing TEE and prolonged cardiac monitoring. Control brain MRI 4 days and 4 months later confirmed moderate ischemic changes of the right insular, temporal, and occipital cortex. Studies report that spontaneous recanalization usually happens in 17% of patients but does not correlate with TIA. This is the first report of an SSD with moderate ischemic stroke and no leftover neurological deficit. Other case series report moderate ischemic stroke SSD with a small residual neurological deficit (NIHSS 2-4). Perhaps mood changes can be associated with selective neuronal loss found in animals and patients suffering transient occlusion of the brain artery. The cardioembolic cause can in certainty be excluded with TEE and prolonged cardiac monitoring.

After headache, vertigo is the most common symptom, not only in neurology or otorhinolaryngology but also one of the most common symptoms in medicine in general. Due to the different aetiology, acute and chronic manifestations, combination with other diseases, drugs, or other substances such as narcotics, alcohol or synthetic drugs, and unclear description of vertiginous symptoms on admission, vertigo as a disease or only a symptom can easily mislead. Due to the illusiveness of the symptoms as perceived and reported by patients and doctors alike, vertiginous symptoms warrant cooperation between patients and doctors, and amongst doctors of different specialities as well. In the Republic of Croatia, as well as in the rest of Europe 1 , the waiting lists for an appointment in the hospital are getting longer and longer. Moreover, it can take several months to a year to get an appointment with a specialist. Waiting listsThe waiting list for hospitals for vertigo can vary depending on several factors, such as the healthcare system in a particular country or region, the availability of specialized healthcare providers, and the severity of the condition. In general, the waiting times for treatment of vertigo can range from a few weeks to several months. This is because there may be a limited number of healthcare professionals who specialize in treating vertigo, such as otolaryngologists or neurologists. Additionally, diagnostic tests, such as vestibular function tests or imaging studies, may also contribute to the waiting time. There can be several issues associated with waiting lists for vertigo treatment. Some common challenges include: a) Limited resources: Hospitals and healthcare facilities may have a limited number of specialists, equipment, and resources dedicated to diagnosing and treating vertigo. This can result in longer waiting times for patients seeking treatment. b) High demand: Vertigo is a common symptom, and many individuals may seek medical attention for its treatment. The high demand for services can contribute to longer waiting lists. c) Prioritization of cases: Hospitals often prioritize patients based on the severity of their condition.Patients with more severe or urgent cases may be given priority over those with less urgent cases. This can lead to longer waiting times for individuals with milder or less urgent symptoms. d) Geographic location: The availability of specialized healthcare providers can vary depending on the geographic location. Individuals residing in rural or remote areas may have limited access to healthcare services, resulting in longer waiting times.

In this letter, we present our opinion, subserved to sociological data, on an underwhelming state of affairs concerning the public, and medical community opinion of functional neurological disorders in Croatia.Functional neurological disorders abbreviated "FND" (ICD -10 F44, F45) are defined as various neurological symptoms such as limb weakness, unexplained sensory symptoms, cognitive disorders, gait difficulty, movement disorders, or paroxysmal episodes which are inconsistent and incompatible with current knowledge of known organic neurological diseases (1). The prevalence of FND is estimated to be 50 per 100 000 population per year with an incidence of 4 to 12 per 100 000 population per year (2). Total costs of ED visits and inpatient care of adult FND in the USA are above $1.2 billion annually (1) comparable to hardest-to-treat neurological diseases. Current understanding of FND has advanced with neurobiological data of altered neuronal networks, and the exclusion of necessary stressor agents advancing its understanding from previous definitions such as psychogenic, conversive, or medically unexplained neurological disorders. Combining detailed medical history, and clearly defined positive signs in neurological examination demonstrating inconsistency allows this to be a safe diagnosis with the frequency of misdiagnosis being 4%, and with a rate of reversal of diagnosis being only 0.4% (2). Neurologists› role is paramount in treating FND starting with an adequate explanation of diagnosis, arranging a multidisciplinary treatment plan (physiotherapy, cognitive behavioral therapy by psychologists, and non-pharmacological methods), and follow-up of patients. Early diagnosis, honest follow-up, and discourse show promising results in treating this disorder (3). FND as a diagnosis in Croatia is still underrecognized by primary physicians, neurologists, patients, and the general public. No adequate scientific research on it is represented in the Croatian scientific bibliography search engine (CROSBY) with keywords such as "dissociative disorder" entered in search engine resulting in 28 papers, "conversive disorder" presenting 10 papers, "psychogenic" presenting 8 papers, and "functional neurological disorder" presenting 0 papers (4). FND is often mentioned to be second to headaches with regards to outpatient neurological visits, and the CROSBY keyword "headache" produces 276 results showing the disparity in coverage of these diagnoses in Croatia. According to the Croatian Public Health Department Mental disease Bilten (5) morbidity percentage