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Biomedical subjects

F Boller

Publications and source records attributed to F Boller.

At least 55 records · Page 3Linked to original sources
PubMed1996

Classification deficits in Alzheimer's disease with special reference to living and nonliving things.

The present study was conducted to assess the hypothesis that visual similarity between exemplars within a semantic category may affect differentially the recognition process of living and nonliving things, according to task demands, in patients with semantic memory disorders. Thirty-nine Alzheimer's patients and 39 normal elderly subjects were presented with a task in which they had to classify pictures and words, depicting either living or nonliving things, at two levels of classification: subordinate (e.g., mammals versus birds or tools versus vehicles) and attribute (e.g., wild versus domestic animals or fast versus slow vehicles). Contrary to previous results (Montañes, Goldblum, & Boller, 1995) in a naming task, but as expected, living things were better classified than nonliving ones by both controls and patients. As expected, classifications at the subordinate level also gave rise to better performance than classifications at the attribute level. Although (and somewhat unexpectedly) no advantage of picture over word classification emerged, some effects consistent with the hypothesis that visual similarity affects picture classification emerged, in particular within a subgroup of patients with predominant verbal deficits and the most severe semantic memory disorders. This subgroup obtained a better score on classification of pictures than of words depicting living items (that share many visual features) when classification is at the subordinate level (for which visual similarity is a reliable clue to classification), but met with major difficulties when classifying those pictures at the attribute level (for which shared visual features are not reliable clues to classification). These results emphasize the fact that some "normal" effects specific to items in living and nonliving categories have to be considered among the factors causing selective category-specific deficits in patients, as well as their relevance in achieving tasks which require either differentiation between competing exemplars in the same semantic category (naming) or detection of resemblance between those exemplars (categorization).

Aged↗
PubMed1996

Schizophreniform catatonia on 6 cases secondary to hydrocephalus with subthalamic mesencephalic tumor associated with hypodopaminergia.

This paper presents 6 patients with catatonia and subthalamic mesencephalic tumors with hydrocephalus involving the third and the lateral ventricles. This anatomic and psychiatric anomaly is investigated on the basis of personal observations and a review of the literature. These cases allow an interesting parallel to be traced between neurological clinical signs and psychiatric signs. Various anatomic and physiological models are discussed which emphasize specialized neuronal circuits (somewhat similar to those involved in Parkinson's disease) and certain specific neurotransmitters such as dopamine, together with the reactivity of these circuits to intracranial pressure variations. Once more, clinical and laboratory data on schizophrenia concur to suggest that organic etiology is the causal factor in a known psychiatric pathology.

Adult↗
PubMed1995

Phospholipid abnormalities in early Alzheimer's disease. In vivo phosphorus 31 magnetic resonance spectroscopy.

OBJECTIVE: To determine whether changes in phosphomonoester and phosphodiester levels could be detected in vivo with phosphorus magnetic resonance spectroscopy in the early stage of Alzheimer's disease (AD). DESIGN: Survey-type of case-control study using neuropsychological testing as criterion standard with blinded data analysis. SETTING: Patients were from a neurology clinic in Paris, France. The controls were from the community. Magnetic resonance measurements were performed in the prefrontal region of the brain with a clinical 1.5-T scanner. Blinded data analysis. PARTICIPANTS: Twenty-four patients with mild AD and 15 age-matched healthy volunteers. Subjects were separated into two groups, both composed of patients with AD and healthy volunteers. Two successive acquisition protocols were used in the two groups. RESULTS: A significant increase in the phosphomonoester-total phosphorus ratio was found in patients with AD compared with controls. In this series, use of a ratio above 11% as a threshold to test our sample yielded an 83.3% sensitivity and a 73.3% specificity test for AD. Other metabolite ratios (inorganic phosphate, phosphodiesters, phosphocreatine, and nucleotide phosphates to total phosphorus) were not significantly different between patients and controls. No metabolite ratio correlated with the neuropsychological status as assessed by the Mini-Mental State Examination. CONCLUSION: Changes in phospholipid metabolism can be detected in vivo in the early stage of AD. Discrepancies in the literature may be due to differences in technical setting or in subject population types.

Aged↗
PubMed1995

Survival in institutionalized patients. Influence of dementia and loss of functional capacities.

BACKGROUND: Several studies have shown a negative correlation between dementia and survival. To our knowledge, the simultaneous effect of other factors has not been systematically studied in institutionalized patients. OBJECTIVE: To determine survival in demented inpatients compared with that in a matched population of nondemented patients institutionalized for other chronic debilitating diseases. DESIGN: The sample consisted of 213 patients with dementia and 157 patients without dementia. We studied the effect on survival of gender, age, loss of functional capacities, and cognitive functions with the method of Kaplan and Meier and with the model of Cox. RESULTS: Demented patients had significantly shorter survival when other factors were kept constant in the multivariate analysis. There was a strong correlation between survival and the degree of autonomy as measured by ability to walk, continence, and preserved activities of daily living. Survival was significantly shorter for men. No correlation was found with neuropsychological measures of severity of dementia or with age on admission. CONCLUSIONS: Survival of demented patients is shorter than that of patients institutionalized for other invalidating conditions. The lack of correlation between neuropsychological test results and survival indicates that in the population we studied, the severity of dementia did not predict length of survival. The data show that the combination of dementia and loss of functional capacities is the most important factor in predicting survival.

Activities of Daily Living↗
PubMed1995

Computed tomography--but not magnetic resonance imaging--identified periventricular white-matter lesions predict symptomatic cerebrovascular disease in probable Alzheimer's disease.

OBJECTIVE: To examine the clinical consequences of periventricular white-matter lesions on computed tomography (CT) and magnetic resonance imaging (MRI) scans in probable Alzheimer's disease. DESIGN: Case series, 12-month follow-up. SETTING: Multidisciplinary behavioral neurology research clinic. PATIENTS: We longitudinally evaluated the clinical characteristics of 27 patients with probable AD for whom both CT and MRI scans had been performed at baseline. INTERVENTIONS: None. MAIN OUTCOME MEASURE: The presence of abnormal neurological signs was examined at baseline and at a 12-month examination. RESULTS: Periventricular white-matter lesions were observed with CT in 12 patients (44%) and with MRI in 21 patients (78%). Computed tomography did not detect lesions of 1 to 3 mm, as were seen on MRI scans, and CT also did not detect lesions of 4 to 10 mm when they occurred in the deep subcortical white matter and were not part of a greater confluent lesion. There was no relationship between the severity of periventricular white-matter lesions with either neuroimaging method and the presence of abnormal neurological signs. However, there was a greater frequency of periventricular white-matter lesions shown on CT scans than on MRI scans at baseline in patients in whom abnormal neurological signs (eg, abnormal gait, asymmetric deep tendon reflexes, focal motor deficits, abnormal plantar response) developed at 12-month follow-up. CONCLUSION: Although MRI may be more sensitive in detecting periventricular white-matter lesions, CT is more specific in predicting subsequent symptomatic cerebrovascular disease.

Aged↗
PubMed1995

Anosognosia, intrusions and 'frontal' functions in Alzheimer's disease and depression.

The relationship between anosognosia of memory deficit, intrusions and 'frontal' functions was investigated in 12 Alzheimer (DAT) patients, 12 depressed patients and 24 normal controls. DAT and depressed patients could not be dissociated according to the proportion of intrusion they produced in memory tasks. However, regardless of their clinical diagnosis, patients with anosognosia produced significantly more intrusions than patients without anosognosia, and anosognosia of memory deficit was positively and strongly correlated to the tendency to produce intrusions. By contrast, there was no correlation between intrusions, anosognosia and patients' performance on frontal tasks except for Verbal Fluency. Whereas anosognosia of memory deficit seems indispensable for intrusions, frontal dysfunction must not be considered a necessary condition for intrusions or anosognosia.

Age Factors↗
PubMed1995

Understanding impaired analysis of faces by patients with probable Alzheimer's disease.

The purpose of this study was to analyze the facial recognition skills of patients diagnosed with Probable Alzheimer's Disease (AD). The performance of 181 AD patients was evaluated to address their ability to: analyze visual forms, to discriminate individual faces, and to recognize and name familiar famous faces. The results of the study demonstrate that the ability to analyze visual information is more vulnerable early in dementia than is the ability to discriminate individual faces. The inability to recognize familiar faces among the AD patients was related to impairments of their lexical/semantic system, rather than to a specific defect in facial discrimination. These data are fully consistent with existing models of face processing and recognition, and suggest that the recognition defect in AD is related to the naming component of face recognition, rather than the perceptual component.

Aged↗
PubMed1995

The naming impairment of living and nonliving items in Alzheimer's disease.

Several studies of semantic abilities in Dementia of the Alzheimer Type (DAT) suggest that their semantic disorders may affect specific categories of knowledge. In particular, the existence of a category-specific semantic impairment affecting, selectively, living things has frequently been reported in association with DAT. We report here results from two naming tasks of 25 DAT patients and two subgroups within this population. The first naming task used 48 black and white line drawings from Snodgrass and Vanderwart (1980) which controlled the visual complexity of stimuli from living and nonliving categories. The second task used 44 colored pictures (to assess the influence of word frequency in living vs. nonliving categories). Within the set of black and white pictures, both DAT patients and controls obtained significantly lower scores on high visual complexity stimuli than on stimuli of low visual complexity. A clear effect of semantic category emerged for DAT patients and controls, with a lower performance on the living category. Within the colored set, pictures corresponding to high frequency words gave rise to significantly higher scores than pictures corresponding to low frequency words. No significant difference emerged between living versus nonliving categories, either in DAT patients or in controls. In the two tasks, the two subgroups of DAT patients presented a different profile of performance and error type. As color constitutes the main difference between the two sets of pictures, our results point to the relevance of this cue in the processing of semantic information, with visual complexity and frequency also being very relevant.

Aged↗
PubMed1995

Visuo-spatial attention and psychomotor performance in elderly community residents: effects of age, gender, and education.

In cross-sectional analysis of 1,799 subjects of the Paquid Research Program, an epidemiological study on brain aging conducted in the Bordeaux area (France), we have studied the effects of age, gender, and education level on psychometric tests requiring visuo-spatial focused attention and psychomotor performance. Although previous studies suggest that normal aging produces no significant change in focused attention, we did observe lower attentional abilities and lower speed of execution with increasing age. Female gender and low education level were also related to poorer attention and psychomotor performance. As the effects of these individual factors are difficult to disentangle from each other on the small samples of subjects used in group studies, epidemiological surveys seem useful to provide a better understanding of the neuropsychology of aging.

Age Factors↗
PubMed1995

Dementia in Parkinson's disease: a population-based study in ambulatory and institutionalized individuals.

We examined the frequency of dementia and depressive symptomatology in 60 Parkinson's disease (PD) patients, identified in a large representative sample of the population, aged 65 years and older, living at home or in institutions in Gironde, France. Dementia, diagnosed according to DSM-III-R criteria, was present in 17.6%, and depressive symptomatology, assessed by the Center for Epidemiologic Studies-Depression Scale, was present in 32.7%. The frequency of dementia in PD increased strongly with age and was higher in institutionalized PD patients than in those living at home. PD was significantly associated with dementia for individuals living at home (odds ratio = 8.2, adjusted for age and symptoms of depression.

Aged↗
PubMed1995

[Difficulties in differential diagnosis of long-term Creutzfeldt- Jakob disease].

Creutzfeldt-Jakob disease (CJD) is characterized by a rapidly progressive dementia that often leads to death within a few months of onset. However, some cases evolve over a much longer period of time and have a clinical picture that is difficult to distinguish from other progressive dementias that occur in the adult, especially Alzheimer's disease (AD). We examine the clinical features of 3 patients with pathologically confirmed CJD whose course was slow (4-5 years) and who were initially diagnosed as having AD. Only two of them had shown signs of CJD in the terminal stages. In this study we examine the clinical characteristics of these patients, and discuss of differentiating CJD from other entities, especially from AD.

Aged↗
PubMed1994

Severe impairment battery. A neuropsychological test for severely demented patients.

OBJECTIVE: Patients with progressive dementia invariably evolve to a stage where they can no longer be tested by standard neuropsychological tests. We studied the use of the Severe Impairment Battery (SIB) in such patients. DESIGN: Case series. SETTING: Geriatric long-term facility. PATIENTS: Sixty-nine patients who met the criteria of the Diagnostic and Statistical Manual for Mental Disorders, Revised Third Edition, for dementia were selected. The diagnosis of probable Alzheimer's disease was established according to the guidelines suggested by the National Institute of Neurologic and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association. There were 18 men and 51 women. The mean age of the population was 82.99 +/- 5.66 years. The mean Mini-Mental State Examination (MMSE) score was 10.71 +/- 6.14. MAIN OUTCOME MEASURE: To characterize the cognitive profile and evolution of severely demented patients by means of the SIB. RESULTS: The mean score on the SIB was 92.52 +/- 31.92, with a possible maximum of 133 points. Subgroups of patients with the most severe degree of dementia (MMSE scores of 0 to 5 and 6 to 11) showed significant differences in their scores on the SIB. In contrast, no differences were found between subgroups with MMSE scores of 6 to 11, 12 to 17, and greater than 17. Fifteen patients who had MMSE scores of less than 6 had SIB scores ranging from 7 to 81. All cognitive domains showed a deterioration across the four severity groups as determined by the MMSE scores and also during a longitudinal study performed on 26 patients. CONCLUSION: Our study indicates that the SIB is useful for the neuropsychological evaluation of severely demented patients and for their follow-up.

Aged↗
PubMed1994

The natural history of Alzheimer's disease. Description of study cohort and accuracy of diagnosis.

OBJECTIVE: We describe the sampling, initial evaluation, and final diagnostic classification of subjects enrolled in a natural history study of Alzheimer's disease (AD). DESIGN: Volunteer cohort study. SETTING: Multidisciplinary behavioral neurology research clinic. PATIENTS OR OTHER PARTICIPANTS: Three-hundred nineteen individuals were enrolled in the Alzheimer Research Program between March 1983 and March 1988. Of these, 204 were originally classified with AD, 102 were normal elderly control subjects, and 13 were considered special cases. MAIN OUTCOME MEASURES: Final consensus clinical diagnosis, final neuropathologic diagnosis, and death. RESULTS: Of the 204 patients enrolled in the study, re-review after as many as 5 years of follow-up resulted in a final clinical classification of 188 with probable AD. Seven patients were believed to have a significant vascular component to the dementia, three were found to have developed depression, and six were excluded on other clinical grounds. Neuropathologic examination of 50 brains indicated definite AD in 43. After removing these seven misdiagnosed patients, the final group of probable/definite AD totaled 181 individuals. Accuracy of the baseline clinical diagnosis relative to neuropathology was 86%, and when follow-up clinical data were considered, 91.4%. Detailed neuropsychological testing yielded high sensitivity (0.988) and specificity (0.983) to dementia. Analyses of survival time from study entry until death revealed that older patients were significantly more likely to die during follow-up, but neither sex, years of education, nor pattern of cognitive impairment were related to survival. CONCLUSIONS: These data provide the descriptive basis for future studies of this cohort. They indicate that longitudinal follow-up of demented cases increases accuracy of diagnosis, and that detailed cognitive testing aids in early classification.

Aged↗
PubMed1994

Transcortical alexia with agraphia following a right temporo-occipital hematoma in a right-handed patient.

We describe the case of a 51-year-old right-handed man who was affected by a transcortical alexia with agraphia and aphasia. Transcortical alexia produces errors in both reading and writing while copying is preserved. The patient had a severe alexia and was unable to read letters, words or sentences. Language examination showed mild aphasia with reduced fluency, intermittent paraphasia but a good comprehension and a normal repetition. Spontaneously and from dictation, writing was impaired by an agraphic jargon, but copying was excellent even though the patient was unable to read his own written production. There was no visual agnosia nor hemianopia. CT scan and MRI of the brain showed that there was a single right temporo-occipital hemorrhage but no lesion in the left hemisphere. Following surgical evacuation of the hematoma, the patient improved. One month after onset, his language was quite intact and reading was possible. We hypothesize that this particular syndrome was the result of a double disconnection: alexia would result from a disconnection of the right angular gyrus and the occipital associative areas by a subangular lesion; agraphia would result from a disconnection of the right angular gyrus and the semantic store, probably located in the right hemisphere.

Agraphia↗
PubMed1994

Explicit memory, procedural learning and lexical priming in Alzheimer's disease.

Different aspects of memory functions were studied in two groups of patients with Alzheimer's disease (AD) and in normal elderly controls. The tests included: explicit memory tests with free and cued recall, and recognition measures; learning of a motor skill; learning of a perceptual skill with verbal material; a priming task with the word stem completion paradigm. The data confirmed that, besides severe impairment for all measures of explicit memory, AD patients were able to learn and retain normally a motor skill in the rotor pursuit task, even across a long retention interval. Moreover, sparing of procedural learning was not restricted to motor tasks, since patients learned normally a mirror-reading task, demonstrating (a) rapid acquisition of the procedure, and (b) acquisition of item-specific information for repeated words. This last effect is accounted for in terms of repetition priming effects rather than of explicit memory strategies, since patients had also normal repetition effect in the word stem completion paradigm.

Aged↗