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Biomedical subjects

F Boller

Publications and source records attributed to F Boller.

At least 73 records · Page 4Linked to original sources
PubMed1994

Non-Alzheimer degenerative dementias.

The explosion of research aimed at exploring degenerative dementias in the past 20 years has produced a great deal of knowledge concerning not only Alzheimer's disease but also other conditions referred to as non-Alzheimer degenerative diseases. The conditions reviewed here fall broadly into two main categories: diseases with focal (lobar) atrophy and diffuse Lewy body disease. These conditions, which are described more and more often in centers around the world, represent entities different from Alzheimer's disease not only from a clinical and pathological viewpoint, but also in terms of genetics and perhaps even in terms of therapeutic responses. In view of the numerous therapeutic trials currently underway, the distinction between Alzheimer's disease and non-Alzheimer degenerative diseases has acquired new importance.

Alzheimer Disease↗
PubMed1994

Sex differences in the left and right hemifields of normal subjects with computerised static perimetry.

Results of routine perimetric testing of the left and right hemifields in normal subjects have been assumed to be symmetric although asymmetry due to hemispheric dominance has been established for other psychophysical tests. These asymmetries have sometimes been related to sex. With the advent of computerised static perimetry, subtle differences between the left and the right hemifields might be found that were not obvious before. This study investigated differences in retinal sensitivity between the hemifields and the role of sex and eye dominance. Forty three unequivocally right handed and right eye dominant normal adult volunteers, 24 females and 19 males, underwent Humphrey 24-2 testing, half beginning with the left eye, the other half with the right eye. The Peridata program was used to calculate decibel totals per hemifield. Four subjects were excluded because of poor cooperation or test artefacts. In females, the total of the left hemifield was significantly less than the right (p < 0.01) by a mean 18.2 (SD 24) dB equivalent to a difference of 0.34 dB per tested point. No significant difference in hemifields was found for males, between the sexes for both eyes combined, or between the two eyes for either sex. It was concluded that asymmetries in retinal sensitivity with respect to the vertical axis may be physiological and found in females, but not in males.

Adult↗
PubMed1993

Amygdala atrophy in Alzheimer's disease. An in vivo magnetic resonance imaging study.

OBJECTIVES: To study the ability of magnetic resonance imaging to measure the volume of the amygdala and detect amygdala atrophy in patients with early Alzheimer's disease. DESIGN: Prospective case-control study and "blind" measurements. SETTING: Subjects were ambulatory outpatients selected from an institutional practice in Paris, France. PATIENTS: We studied 11 patients with probable Alzheimer's disease according to National Institute of Neurologic and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and Consortium to Establish a Registry for Alzheimer's Disease (CERAD) inclusion and exclusion criteria, as well as six age-matched control subjects. INTERVENTION: None. MAIN OUTCOME MEASURE: A 1.5-T magnetic resonance imager was used to acquire the images. Two neuroradiologists independently and blindly measured the volume of the right and left amygdalas on high-resolution contiguous slices. In addition, other cerebral structures, ie, the sylvian fissures, temporal lobes, lateral and third ventricles, corpus callosum, and hippocampal formation, were measured on a single slice. RESULTS: The values obtained by the two observers correlated highly (r = .90), and interrater variability was 13%. The Alzheimer's disease group showed significant (33%, P < .0001) atrophy of the amygdala when compared with the control group. The other structures showed less variation. CONCLUSION: Significant amygdala atrophy can be detected in vivo in patients with early Alzheimer's disease by means of standard magnetic resonance imaging. This technique may be useful in the early diagnosis of Alzheimer's disease.

Aged↗
PubMed1993

Principal component analysis of language performances in Alzheimer's disease.

This report analyzes the performances of a group of 104 mildly to moderately impaired probable Alzheimer's disease patients (Mini Mental Examination 10 to 23) on linguistic tasks exploring written and oral language. A principal component analysis showed a two-factor solution including 14 out of the 15 linguistic tasks. Each factor is characterized by a type of operation required to process language material: "operativeness factor," where verbal material receives a transformation; "transcoding factor," where verbal material is processed without any structural modification. Oral verbal repetition remained isolated from the solution.

Aged↗
PubMed1992

Neuropsychiatric correlates of cerebral white-matter radiolucencies in probable Alzheimer's disease.

We evaluated the neuropsychological functions, rate of disease progression, and psychiatric characteristics of 22 patients with probable Alzheimer's disease in whom periventricular white-matter radiolucencies (PWMRs) were seen on the computed tomographic scan of the brain and compared them with 22 matched patients with Alzheimer's disease without PWMRs. Executive/attention, lexical/semantic, memory/learning, and visuospatial functions did not differ between the two groups at baseline or at the 1-year follow-up examination. The frequency of major depression, delusions, and hallucinations did not differ between the groups. However, patients with PWMRs had significantly higher Hachinski Rating scores at both visits and were more likely to develop cerebrovascular disease during follow-up than were controls with Alzheimer's disease. These preliminary results suggest that the presence of PWMRs is not associated with specific cognitive and psychiatric features or with an altered rate of progression of Alzheimer's disease but does predict the development of clinically significant cerebrovascular disease.

Aged↗
PubMed1992

Clinical trials in cognitive impairment in the elderly.

The pharmacological treatment of dementia is particularly difficult because of the uncertainty of the diagnosis and of the underlying pathogenetic processes, and because of the variable severity of the syndrome. This paper suggests several lines for future therapeutic trials in dementia. These include the need to work with homogenous populations and to take into account the natural history of the disease, the pharmacologic characteristics of the drugs, and the particular ethical considerations pertaining to demented patients. We review the diagnostic criteria for dementia, Alzheimer's disease (AD) and vascular dementia. We discuss the different types of therapeutic trial design, the problem of the duration of the protocol, the tools to evaluate the cognitive effects and the activities of daily living, and the use of a Clinical Global Impression of Change (CGIC). The results of some therapeutic trials in AD and vascular dementia are given as examples.

Activities of Daily Living↗
PubMed1992

Quantitative computer tomography in Alzheimer's disease: a re-evaluation.

This investigation addresses the question of usefulness of computer-tomographic (CT) scanning in discriminating patients with Alzheimer's disease (AD) from healthy, aged controls. Quantitative measures of brain volume loss found to be significant by other investigators as well as additional unique variables are used to discriminate 58 longitudinally studied patients meeting NINCDS-ADRDA criteria for the clinical diagnosis of probable AD from 59 controls. The sensitivity and specificity of both single CT scan parameters and multivariate models comprised of such CT parameters are explored. Reasons for diagnostic misclassification are also illuminated.

Aged↗
PubMed1991

Alzheimer's disease, cerebral amyloid angiopathy, and dementia of acute onset.

The coexistence of cerebral amyloid angiopathy (CAA) and Alzheimer's disease (AD) should be considered in the differential diagnosis of cases with acute onset of dementia when other causes have been excluded. We report clinical and neuropathological findings in a 78-year-old man who developed dementia of acute onset with an apparent rapid course three months before his death. Postmortem microscopic examination of the brain revealed senile (neuritic) plaques and neurofibrillary tangles in the hippocampus and cerebral cortex. CAA affected vessels of the neocortex and leptomeninges, most severely in the frontal and parietal areas.

Aged↗
PubMed1991

Hypertension and the risk of dementia in the elderly.

Vascular dementia is the second most common type of dementia in the elderly after the dementia of Alzheimer's disease. Six forms of vascular dementia have been described: multi-infarct dementia, lacunar dementia, Binswanger's subcortical encephalopathy, cerebral amyloid angiopathy, white-matter lesions associated with dementias, and single-infarct dementia. Each is described. Severe dementia is found in 5% of persons over age 65 and in 15% to 20% of persons over age 80 years. Alzheimer's disease accounts for 50% to 60% of cases of severe dementia and vascular dementia for 10% to 20%; 20% of the patients have both disorders. The incidence of vascular dementia, which seems to be declining, is about 7/1,000 persons/year. Hypertension is the most powerful risk factor for all vascular dementias. Vascular dementias can be accurately diagnosed by using clinical and mental state examinations, Diagnostic and Statistical Manual of Mental Disorders criteria, ischemic scores, and computed tomography or magnetic resonance imaging. The most successful treatment of vascular dementia is the prevention of cerebral infarcts. Study of the incidence of vascular dementias and their treatment will be included in the European Trial on Systolic Hypertension in the Elderly (SYST-EUR) of 3,000 elderly hypertensive patients.

Aged↗
PubMed1991

Predictors of decline in Alzheimer's disease.

Age of onset and aphasia are frequently proposed as predictors of decline in Alzheimer's disease (AD). We compared longitudinally the neuropsychological test performance of AD patients classified as Fast Decliners (FD, N = 18) based on the rate of change of their scores on the Mini-Mental State Examination (MMS) and a group classified as Slow Decliners (SD, N = 15). There was no statistical difference in the age of onset of AD or in severity of dementia at first visit. Performance on verbal tests was the best predictor of rapid cognitive decline, even after the influence of the overall degree of dementia had been accounted for. Among the language tasks, performance on a naming test was the best predictor. The results of this study do not support age of onset as a predictor of the course of AD. On the other hand, poor performance on language tests does predict a more rapid rate of decline in AD.

Aged↗
PubMed1991

Motor impersistence in Alzheimer's disease.

We studied motor impersistence syndrome (MIS) in patients with a clinical diagnosis of probable Alzheimer's Disease (AD). MIS was found in 16 (10%) of the 166 patients examined; all 16 were moderately to severely demented (Mini-Mental State scores ranging from 17 to 2). We compared the neuropsychological features between these AD patients with MIS and AD patients without MIS matched by the severity of dementia. We found no significant difference between the two groups in terms of orientation, memory, language, attention, and visuoconstructional and visuoperceptual abilities. Buccolingual and limb praxis also failed to reveal differences between the groups. Although MIS has been related to visuoconstructional disorders and apraxia, the phenomenon as it occurs in AD seems not to be related to any specific cognitive domain.

Aged↗
PubMed1990

Alzheimer's disease and depression: neuropsychological impairment and progression of the illness.

The authors longitudinally evaluated the cognitive functions of patients with probable Alzheimer's disease who also met criteria for major depression and compared them with matched patients with Alzheimer's disease who were not depressed. They found no significant difference in the pattern of neuropsychological deficits between the two groups; composite scores on attention, language, memory, learning, and visuospatial functions did not differentiate the two groups at baseline or at 1-year follow-up. The results of this preliminary report suggest that depression does not modify the neuropsychological features and the rate of progression of Alzheimer's disease.

Aged↗
PubMed1989

The alien hand syndrome. Clinical and postmortem findings.

Two patients had automatonlike movements of their left hands and arms (alien hand syndrome) following damage to the brain. Autopsy findings in one patient demonstrated gunshot wound damage to the medial frontal white matter bilaterally, as well as the corpus callosum, right basal ganglia, internal capsule, and thalamus. The other patient had a ruptured anterior communicating aneurysm, with subsequent resection of the right frontal gyrus rectus. We postulate that this syndrome is due to the combination of a partial callosectomy and mesial frontal lesions.

Adult↗
PubMed1989

Alzheimer's disease and THA: a review of the cholinergic theory and of preliminary results.

The cholinergic theory is based on the assumption that acetylcholine (ACh) metabolism plays an important role in memory processes and that the deterioration of memory and other cognitive functions in Alzheimer's disease (AD) is directly related to degeneration of cerebral presynaptic cholinergic neurons. This article reviews various therapeutic strategies based on this theory and particularly that of using cholinesterase inhibitors such as tetrahydroaminoacridine (THA). The few available studies--all preliminary--on THA are reviewed. They show that THA is neither a cure nor a definitive treatment for AD. However, the preliminary reports suggest for the most part a certain degree of efficacy, greater at any rate than the efficacy of other pharmaceutical agents tried so far. Despite the apparent multiplicity of pharmacological actions of THA, it appears that the cholinergic hypothesis remains valid and should be pursued further.

Aging↗
PubMed1989

The progressive breakdown of number processing and calculation ability: a case study.

We examined a retired Army General with Progressive Dementia whose initial major presenting complaint was dyscalculia. Our examinations revealed an orderly dissolution of calculation ability with differing dissociations in calculation ability apparent at progressive stages of cognitive decline. For example, we found that number reading and writing errors were qualitatively different from calculation errors. Numerosity knowledge and magnitude comparisons can remain intact even when other arithmetic knowledge and calculation abilities were grossly impaired. His decline in calculation abilities was first demonstrated on more complex problems (e.g., multiplication) and only in later stages on simpler (e.g., addition) problems. The patient was aware that aspects of his performance were impaired, but he was unable to state why--a dissociation between declarative and procedural knowledge.

Aged↗
PubMed1989

Descriptive writing abilities in Alzheimer's disease.

The descriptive writing abilities of 15 subjects with Alzheimer's disease (AD) of mild to moderate severity were compared with 15 age- and sex-matched normal controls. Sixteen features of written linguistic ability were analyzed. AD subjects wrote shorter descriptive paragraphs than normal elderly subjects. Features related to letter or spelling errors and content words were found to be significantly different between the two groups, whereas functor word errors and number of attempted corrections did not significantly differ between the two groups.

Aged↗
PubMed1989

Diagnosis of dementia: clinicopathologic correlations.

Based on 54 demented patients consecutively autopsied at the University of Pittsburgh, we studied the accuracy of clinicians in predicting the pathologic diagnosis. Thirty-nine patients (72.2%) had Alzheimer's disease, while 15 (27.7%) had other CNS diseases (four multi-infarct dementia; three Creutzfeldt-Jakob disease; two thalamic and subcortical gliosis; three Parkinson's disease; one progressive supranuclear palsy; one Huntington's disease; and one unclassified). Two neurologists independently reviewed the clinical records of each patient without knowledge of the patient's identity or clinical or pathologic diagnoses; each clinician reached a clinical diagnosis based on criteria derived from those of the NINCDS/ADRDA. In 34 (63%) cases both clinicians were correct, in nine (17%) one was correct, and in 11 (20%) neither was correct. These results show that in patients with a clinical diagnosis of dementia, the etiology cannot be accurately predicted during life.

Adult↗