The clinical recognition of frontotemporal dementia (FTD) depends on its differentiation from Alzheimer's disease (AD). From 212 patients primarily diagnosed as probable AD, 24 cases with mild dementia, absence of disturbances the presence of which would have prevented a full neuropsychological assessment, and brain CT with detailed visualization of hippocampus atrophy were chosen. On the basis of neuropsychological examination the patients were divided into two groups: 11 cases with predominant deficit in frontal system tasks (FTD group) and 13 cases with changes in cognitive functions typical of AD (AD group). Age at onset, duration, behavioral changes, psychotic symptoms, depression, speech disorders, neurologic deficit and hippocampal atrophy were analyzed in both groups. Statistically significant differences for behavioral disturbances and hippocampal atrophy were found. Early behavioral changes and lack of early hippocampal atrophy on CT may be useful features for differentiating between FTD and AD, especially when SPECT is not available.

Aged↗

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[A case of neurogenic dysphagia responding to nitrates].

We described a 47-year-old man with ischemic stroke who developed a brainstem syndrome with persistent dysphagia. He was fed by the nasogastric tube placed intermittently by himself for almost 7 months after the stroke. Elective feeding via percutaneous endoscopic gastrostomy (PEG) was not accepted by the patient. All treatment attempts with benzodiazepines, antidepressants and spasmolytic agents were unsuccessful. Videofluoroscopic investigation revealed excessive and long-lasting spasm of the upper esophageal sphincter which was associated with the massive aspiration of the contrast. The patient dramatically improved after treatment with nitroglycerin and long-acting nitrates with almost complete recovery of normal swallowing. A strikingly good effect of nitrates in the treatment of oropharyngeal dysphagia is emphasized by the authors.

Brain Ischemia↗

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[Frequency and intensity of behavioral and psychological symptoms in the course of Alzheimer's disease].

The aim of the study was: 1) to estimate the occurrence and intensity of some psychopathological symptoms in the course of Alzheimer's disease, and 2) to examine whether the occurrence of behavioral and psychological symptoms increases with the deepening of dementia process among persons with Alzheimer's disease living in their homes with outpatient treatment. The study was conducted among 94 persons (38 men and 56 women ageing from 52 to 86 years (x = 72.4 +/- 6.9), with education: from 2 to 17 years (x = 11.2 +/- 3.7). Three subgroups were selected for study with regard to the intensity of dementia process, estimated according to Clinical Dementia Rating (CDR): very mild (n = 16, x = 71.4 +/- 6.7), mild (n = 43, x = 72.6 +/- 7.9), moderate (n = 35, x = 72.5 +/- 6.9). Subjects in group II and III fulfill diagnostic criteria of dementia according to ICD-10, DSM IV and criteria of probable AD according to NINCDS-ADRDA. In the estimation of occurrence of behavioral and psychological disturbances: Alzheimer's Disease Assessment Scale--non-cognitive behavior (ADAS-non-cog) and subscale "Change in Personality, Interests, Drive" of Blessed Dementia Scale were used. The results have shown that with the progress of dementia process, the occurrence of the following psychopathological symptoms such as: hallucinations, intensive motor activity, purposeless hyperactivity, pacing, rigidity increases and there is a relinquishment of hobbies. In addition, regardless of the stage of dementia, such behaviors as: apathy, depression, tearfullness, impaired emotional control and disturbances of appetite were observed relatively frequently.

Age Distribution↗

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[Vascular risk factors in demented elderly: analysis of Alzheimer Clinic materials].

UNLABELLED: In recent years evidence is increasing that vascular disease is associated with cognitive impairment and dementia. Moreover, presence of cerebrovascular disease may intensify the clinical symptoms of Alzheimer's disease (AD). The aim of the study was to determine the prevalence of vascular risk factors in age and sex matched patients with dementia. We studied 109 patients with AD and 37 patients vascular dementia (VD). DSM-III-R test for dementia, NINCDS-ADRDA guidelines for AD and NINDS-ARIEN for VD were applied. RESULTS: Mean age of dementia onset in AD and VD was 65.8 SD 7.8 and 67.4 SD 7.0 years (p > 0.05), the duration of dementia, MMS and GDS for patients with AD and VD was not significantly different. Arterial hypertension was associated in 51.3% VD and 30.3% AD (p < 0.05), hypotension in 11.1 and 23.6% respectively (p > 0.05), atrial fibrillation was similar in AD and VD, coronary artery disease was presents 64.8% AD and 46.8 VD (p > 0.05) and type 2 diabetes in 21.6% and 10.1% (p > 0.05) respectively. No significant differences in serum lipid profile were found in both groups, except two times higher incidence of normal HDL-cholesterol concentration in AD compare to VD. The relation between alcohol consumption, cigarette smoking and head trauma was similar in both types of dementia. CONCLUSION: Vascular disease and AD have to some extent a shared aetiology, and risk factors that they have in common increase the risk of both disorders independently and vascular disease is perhaps involved in the aetiology of AD.

Adult↗

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[Patterns of cognitive impairment and apolipoprotein genotype in persons with Alzheimer's disease].

The aim of this study was to test the possible relationship between patterns of cognitive deficits--especially impairment of memory processes--and ApoE genotype in patients with AD. Fifty seven right-handed subjects (31 males and 26 females) were tested in this study. The age of subjects ranged from 50 to 79, the education lasted from 11 to 16 years. All subjects were diagnosed as probable AD patients on the basis of DSM IV and NINCDS-ADRDA criteria. Each subject was examined for: 1) ApoE genotype, 2) general level of activity (GDS and MMSE), 3) neuropsychological evaluation of cognitive processes, using full test battery. 37 patients had at least one of ApoE epsilon 4 allele (e2/4, 3 and 4/4) and 20 patients had none of ApoE 4 allele (e 2/3 and 3/3). The group of tested subjects were subdivided into 2 groups. The first group was comprised by 31 patients with 3-rd stage (according to GDS) of mental activity. Twenty six patients with 4-th stage were included into the second group. Those subgroups did not significantly differ if age, education, gender or ApoE allele were considered. Experimental data were normalized and then analyzed using a statistical package SPSS/PC+. The analysis of variance showed that the type of test, stage of disease and two-way interaction ApoE x type of test were highly significant (P < 0.0001). Some results were obvious and not surprising (e.g. that results of patients with 4-th stage were much worse than the results of patients with stage 3-rd). It turned out that the best results were obtained by our patients in naming tests, the worst--in learning test with distraction. Patients with ApoE epsilon 4 performed better than patients with none ApoE epsilon 4 in the Rey's test, in the similarity test and in the test which required repeating numbers starting from the last one. The differences between the subgroups of patients with different ApoE alleles were confirmed by different distributions of correlations. All statistical analyses were repeated for more homogenous group of patients (only with stage 3-rd). The pattern of results resembled the previous one (i.e. better performance in the same tests) with one exception: additionally, in delayed recall test patients with none ApoE epsilon 4 performed much better that ApoE epsilon 4. Our results showed that some cognitive processes depended on ApoE genotype. Patients with none ApoE epsilon 4 genotype had less severe deficits in delayed recall of new information. On the other hand, working memory appeared to be less affected in patients with ApoE epsilon 4 genotype. Independent of genotype, both group showed similar impairment of learning ability without deficits in remote memory.

Aged↗