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Biomedical subjects

R Gil

Publications and source records attributed to R Gil.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Hallucinations, delusions, and nocturnal events in 152 Parkinson's patients: a regional survey].

Parkinson's disease cannot be reduced to its motor symptoms. Psychological and behavioral disorders often accompany its development. Our study was conducted in June 1999 among 36 neurologists practicing in hospital or private clinic settings in the Poitou-Charentes area. Neurologists were requested to record hallucinations, delusions and nocturnal events observed in Parkinson's patients. A total of 152 reports were collected from 17 physicians. Fifty-three percent of the patients attended hospital clinics and 47p.100; were seen at the physician's office. Hallucinations were recorded in 23.1p.100; of the patients. The risk of hallucination symptoms was higher among patients seen at hospital clinics and who had more advanced disease. Only 7.2p.100; of the patients reported delusions, most often of a persecution type. Nocturnal events affected 49.3p.100; of the patients. The appearance of such symptoms was highly related to Hoehn and Yahr stage and was more frequent in hospital patients. Hallucinations, delusions, and nocturnal events affect patients with advanced Parkinson's disease, associated with long-term L-dopa treatment. Eighty-three percent of the patients had such symptoms and most of them used L-dopa. This long-term treatment is linked to these three symptoms. Hallucinations were increasingly reported for patients with increasing long-term medication with dopaminergic agonists. Nocturnal events, for patients on L-dopa, were associated with advanced disease, long-term treatment with L-dopa, and hospitalization. Psychic and behavioral disorders appear frequently in Parkinson's disease patients and are inter-related. Physicians should be aware of the relationship with treatment to avoid aggravation.

Aged↗
PubMed2002

[Metamemory and Parkinson's disease].

Metamemory is a multifaceted concept, which deals with the individual's knowledge and control of his or her own memory system. One metacognitive ability that has considerable importance in everyday life is the ability to control his or her own memory. In this study, we have examined whether Parkinson's disease affects the degree to which a person allocate study time. 17 Parkinson subjects and 18 older controls participated in this study. Parkinson subjects and control subjects made a readiness recall task in which subjects monitor themselves the learning procedure, allowing to measure metamemory control (study time by item). Control subjects were found to take more time in study than parkinson subjects. The lists were learned under two condition: a self-paced condition in which subjects could study each word as long as they would and an experimenter-paced condition. The analysis revealed that control subjects recalled more items than parkinson subjects only in the self-paced condition. These results suggested that Parkinson-related differences in the allocation of study time mediate a part of Parkinson-related differences in memory performance.

Aged↗
PubMed2002

[Depression and Parkinson's Disease: study of a series of 135 Parkinson's patients].

OBJECTIVE: The prevalence of depression in Parkinson's disease (PD) raises the issues of the difficulties of diagnosing the condition and of the relationships between depression and the natural history of the disease. METHODS: A cohort of 135 consecutive patients with idiopathic PD underwent psychiatric (DSM-III-R, Goldberg depression scale), neurological (distinguishing "axial" signs from other signs of parkinsonism), and neuropsychological (particularly frontal tests) evaluations. RESULTS: Depression is present in more than half of the patients and it seems to be more frequent in patients with the akinetic and fluctuating forms of the disease. The subjects who are depressed do not have a greater degree of cognitive impairment, but their scores on frontal tests are higher. Moreover, the axial signs of the disease (postural instability, axial rigidity) are more severe in depressed parkinsonians suggesting a link between depression and the non-dopaminergic lesions of the disease. Even though slowness, appetite and sleep disturbances, and fatigue may be encountered in non-depressed parkinsonian patients, separation of the parkinsonian population into subgroups shows that certain symptoms are never seen in parkinsonians who are not depressed: it is thus evident that "the impression that life is not worth living", "the hopelessness", "the impression of being worthless and incompetent", "the low level of energy", "the morning sadness" are characteristic of parkinsonian depression. Parkinsonian depression has two major clinical forms. The first one is associated with a greater number of somatic manifestations: sleep disturbances, morning fatigue. corresponding to more severe depression with hopelessness and loss of self confidence. The second exhibits few somatic manifestations with apathy and slowness as frequent complaints. CONCLUSIONS: This study defines the symptoms of parkinsonian depression which should be better recognised in order to be treated. The link between depression and axial signs of the disease may explain why L-dopa and dopaminergic agonists improve the motor signs of depression without influencing depressive manifestations in most cases.

Aged↗
PubMed2002

[The effects of normal aging on face naming and recognition of famous people: battery 75].

The difficulty to recall proper nouns is often something elderly people complain about. Thus, we tried to build and standardize a tool that could allow a quantified estimation of the naming and recognition abilities about famous people faces, specifying the part of gender, age and cultural level for each kind of test. The performances of 542 subjects divided in 3 age brackets and 3 academic knowledge levels were analysed. To carry out the test material, the artistic team of the Grevin Museum (Paris) was called upon. Their work offers a homogeneous way to shape famous people faces. One same person thus photographed 75 characters from different social categories with the same conditions of light, during only one day. The results of the study show that men perform better than women as concerns naming task, but that there's no difference between genders as concerns recognition task. Recognition performances are significantly better whatever the age, the gender and the cultural level may be. Generally, performances are all the more better since subjects are younger and have a higher cultural level. Our study then confirms the fact that normal aging goes hand in hand with rising difficulties to name faces. Moreover, results tend to show that recognition of faces remains better preserved and that the greater disability to recall a name is linked to difficulties in lexical accessing.

Adolescent↗
PubMed2002

[Aphasic hypergraphy in the course of a bilateral hemispheric glioblastoma].

A 68-year old patient, suffering from a left temporal and right frontal multifocal glioblastoma, initially presented Wernicke's aphasia with abnormal behavior. After a stereotaxic biopsy of his right frontal lesion, the patient developed an activity of ceaseless writing associated with mutism. This hypergraphic behavior was accompanied with a production of numerous aphasic paragraphics contrasting with the mutism. Such association could evoke the rise of a suppressive activity of the right hemisphere on graphic functions linguistically organized by the left hemisphere.

Aged↗
PubMed2001

[Dissection of cervical arteries].

INDICENCE: Cervical artery dissection (CAD) is one of the major cause of cerebral infarction before 45 years of age. The average annual incidencerate is between 2.5 and 3 per 100,000, but the reported incidence of CAD is probably underestimated because of frequent asymptomatic forms, or producing only minor and local symptoms. Dissection of the internal carotid artery (ICA) is more frequent than dissection of the vertebral artery (VA) and intracranial dissection is less frequent than extracranial dissection. PATHOGENESIS: Traumas and primary diseases of the arterial wall are the main predisposing factors, but the pathogenesis of spontaneous DAC remains unknown in most cases, although the possibility of an underlying arteriopathy is suspected. CLINICAL AND RADIOLOGICAL MANIFESTATIONS: The clinical presentation of ICA dissections includes isolated local signs (Homer's sign, headaches) followed by a few hours or days later by signs of cerebral or retinal ischemia. Brainstem infarcts and occipital or cervical pain are the most strinking clinical feature of VA dissection. Recent progress in neuroradiology (i.e. CT-scan, MRI, magnetic resonance ongiography) and neurosonology (i.e. transcranial Doppler) allows a non invasive approach in the diagnosis and follow-up of CAD. MANAGEMENT: The prognosis is highly variable, but remains usually good. Heparin in the acute stage, followed by an oral anticoagulant or aspirin treatment for 3 to 6 months is most commonly used, although it has never been proved by a randomized trial.

Adolescent↗
PubMed2001

[The recording of cognitive evoked potentials during and after transient global amnesia: report of three cases].

It is of interest to record event-related potentials in the course of transient global amnesia (TGA) because the hippocampus and diencephalon, generally considered to be the sites of the dysfunction responsible for the amnesic episodes are also considered as two possible generators of the P300 wave. However, the only four cases reported so far in the literature showed an intact auditive P300 in three cases and an intact auditive P300 with reduction of visual P300 in one case. Here are reported four new cases. The P300 wave was readily identifiable in all four cases, without any amplitude reduction, thus suggesting that the condition did not entail inactivation or functional depression of P300 generators. Concerning P300 latency, in one case it was delayed but became normal after the ictus. In the second case, the latency, although within normal limits, shortened after the ictus. In the third and the fourth cases, the latency, initially within normal limits, remained unchanged. These apparently disparate results should be analysed in the light of the results of isotope measurement of cerebral blood flow during the amnesia, which are also inconsistent but most frequently indicate bilateral temporal or thalamic flow reduction. It remains to be determined in the future whether the stability or change in the P300 will make it possible to predict the brain region involved in transient global amnesia, which could perhaps vary from one patient to another.

Acoustic Stimulation↗
PubMed2001

Self-consciousness and Alzheimer's disease.

OBJECTIVES: To propose a neuropsychological study of the various aspects of self-consciousness (SC) in Alzheimer's disease. METHODS: Forty-five patients with probable mild or moderate AD were included in the study. Severity of their dementia was assessed by the Mini Mental State (MMS). Fourteen questions were prepared to evaluate SC. RESULTS: No significant correlations were found between SC score and educational level, age, and duration of disease. A significant correlation was found between SC score and the severity of dementia, whereas frontal disturbances were just short of the significance threshold. The various aspects of SC were not impaired to the same degree. The most disturbed ones were awareness of cognitive deficiencies, moral judgements and prospective memory. The least disturbed aspects were awareness of identity and of mental representation of the body. Items relating to anosognosia and moral judgements were significantly correlated with the MMS score, whereas affective state, body representation disorders, prospective memory, and capacities for introspection were not related to the severity of the dementia. Consciousness of identity was sound, regardless of MMS score. CONCLUSIONS: AD clearly induces an heterogeneous impairment of SC. SC requires a convergence of many neural networks. In AD, neuronal alterations involve many cortical areas and information sent to the associative frontal cortex from memory, language and visuospatial areas is lacking or disturbed. Thus, the sequential order of successive stimuli cannot be maintained by the heteromodal associative cortex (dorsal convexity of the prefrontal cortex), and the supramodal associative cortex (located rostrally in the frontal lobes) is unable to provide reliable monitoring and assessment of simultaneous neural cognitive networks carrying insufficient and inadequate input. The core deficiency in AD patients might be impaired SC equated with the disability to maintain sequential and simultaneous "attention to life". The Self-Consciousness Questionnaire, a clinical scale providing multidimensional measurement, indicates that different aspects of consciousness are not correlated with overall cognitive deficiency as determined by the MMSE.

Aged↗
PubMed2001

Intracranial hemorrhage and oral anticoagulant treatment.

OBJECTIVE: To detect risk factors for intracranial hemorrhage (ICH) in patients with long-term oral anticoagulant and to identify clinical or radiological data specific of anticoagulant-related ICH. METHODS AND PATIENTS: Three groups of patients were included. Group 1 represents patients who were admitted because of anticoagulant-related ICH between January 1984 and February 1996. All patients underwent CT scan. Clinical data, anticoagulation parameters, location and volume of the ICH, treatment and the 30-days in-hospital mortality were analyzed. Group 2 consisted of patients selected at random among all patients with spontaneous ICH admitted to our department during the same period of time. Patients without ICH, but regularly taking oral anticoagulants constituted group 3. RESULTS: Seventy-nine patients with anticoagulant-related ICH were compared to 127 patients with spontaneous ICH. The volume of supratentorial ICH was greater in group 1 of patients and was correlated with a worse prognosis. Comparison of group 1 with group 3 (212 controls) demonstrated that length of anticoagulation, prothrombin time or excessive anticoagulation, prior cerebral infarct and use of acénocoumarol, but not age or indication of anticoagulant, were significant risk factors for ICH in multivariate analysis. CONCLUSIONS: The results emphasize that anticoagulant-related ICH are not clinically different from spontaneous ICH except for volume of bleeding, and that frequent and careful coagulation monitoring is needed, especially during the first year in order to decrease the risk of ICH.

Administration, Oral↗
PubMed2001

[Taste impairment in Alzheimer's disease].

We conducted a study of Alzheimer's disease focusing on taste impairment to determine at which step of gustatory information processing (discriminative or perceptive, gnosic or associative, gustatory-verbal) possible perturbations might be located. We used various foods found in a normal diet. Twenty patients and a matched control group participated in this study. The patients were divided into two subgroups according to disease severity (mild, moderate or severe). The study showed that patients with Alzheimer's disease exhibited an impairment at all three levels of gustatory information processing. Impairment of discriminative and gustatory-verbal stages was more obvious in the group of patients with severe Alzheimer's disease. Our study also showed that the gustatory deficiency can be described as an associative agnosia in the mild stage of Alzheimer's disease. This concept is in line with the notion of a dissociation between preservation of olfactory and gustatory thresholds and an alteration in odor identification in patients with mild stage Alzheimer's disease, suggesting that the alteration is central rather than peripheral. Our findings suggest that an alteration of the associative level of gustatory information processing can be found in Alzheimer's disease early stage.

Aged↗
PubMed2000

Increased baseline occupancy of D2 receptors by dopamine in schizophrenia.

The classical dopamine hypothesis of schizophrenia postulates a hyperactivity of dopaminergic transmission at the D(2) receptor. We measured in vivo occupancy of striatal D(2) receptors by dopamine in 18 untreated patients with schizophrenia and 18 matched controls, by comparing D(2) receptor availability before and during pharmacologically induced acute dopamine depletion. Acute depletion of intrasynaptic dopamine resulted in a larger increase in D(2) receptor availability in patients with schizophrenia (19% +/- 11%) compared with control subjects (9% +/- 7%, P = 0.003). The increased occupancy of D(2) receptors by dopamine occurred both in first-episode neuroleptic-naive patients and in previously treated chronic patients experiencing an episode of illness exacerbation. In addition, elevated synaptic dopamine was predictive of good treatment response of positive symptoms to antipsychotic drugs. This finding provides direct evidence of increased stimulation of D(2) receptors by dopamine in schizophrenia, consistent with increased phasic activity of dopaminergic neurons.

Adult↗
PubMed2000

IV glycine and oral D-cycloserine effects on plasma and CSF amino acids in healthy humans.

BACKGROUND: The amino acid glycine, modulates neurotransmission via actions at GLY-A receptor and GLY-B receptor. The latter are coagonist sites associated with N-Methyl-D-Aspartate (NMDA) glutamate receptors. The central bioavailability of peripherally administered glycine has not been adequately characterized in humans. METHODS: Healthy human subjects were administered either oral D-cycloserine (50 mg or placebo) and intravenous glycine (saline, 100 mg/kg or 200 mg/kg) in random order over 4 test days under double-blind conditions. Cerebrospinal fluid was collected by lumbar puncture performed on the first test day was analyzed to determine amino acid levels. The acoustic startle response was measured on the second test day. RESULTS: Intravenous glycine dose-dependently increased both serum and CSF glycine and serine levels. Neither glycine nor DCS produced any significant effects on behavior, cognition or the acoustic startle response. Neither IV glycine nor DCS were associated with any toxicity. CONCLUSIONS: Thus, peripheral glycine administration raised CSF glycine levels without producing any clear central nervous system effects. Glycine and D-cycloserine did not worsen cognitive test performance and did not induce behavioral symptoms on their own. The possibility that glycine and D-cycloserine enhanced cognitive test performance cannot be excluded given the psychometric limitations of the test battery.

Acoustic Stimulation↗
PubMed2000

Dopamine and serotonin transporters in patients with schizophrenia: an imaging study with [(123)I]beta-CIT.

BACKGROUND: Several lines of evidence derived from imaging and postmortem studies suggest that schizophrenia is associated with hyperactivity of dopamine function and deficiency in serotonin (5-HT) function. The aim of this study was to investigate potential alterations of striatal dopamine transporters (DAT) and brainstem serotonin transporters (SERT) density in schizophrenia. METHODS: Striatal DAT and brainstem SERT were measured in 24 patients with schizophrenia and 22 matched healthy control subjects using single photon emission computed tomography and [(123)I]beta-CIT. In this cohort of subjects, we previously reported an increase in striatal amphetamine-induced dopamine release, measured as the displacement of the D(2) receptor radiotracer [(123)I]IBZM. RESULTS: No differences were observed between patients and control subjects in the equilibrium uptake ratio (V(3)") of [(123)I]beta-CIT in the striatum, indicating that schizophrenia is not generally associated with an alteration of striatal DAT density; however, a trend level association (p =.07) was observed in patients with schizophrenia between low striatal [(123)I]beta-CIT V(3)" and severity of negative symptoms. After controlling for age, striatal [(123)I]beta-CIT V(3)" in patients was not associated with duration of illness, suggesting that this relative deficit was not secondary to a neurodegenerative process. No correlation was observed between DAT density and amphetamine-induced dopamine release, either in the patients or in the controls. Brainstem [(123)I]beta-CIT V(3)" was unaffected in patients with schizophrenia, and was unrelated to symptomatology. CONCLUSIONS: Schizophrenia is generally not associated with alterations of DAT in the striatum or SERT in the brainstem. In some patients, a relative deficit in dopamine nerve terminals might play a role in the pathophysiology of negative symptoms.

Adult↗
PubMed2000

Balloon positioning difficulties during nonsurgical septal reduction therapy in a patient with hypertrophic obstructive cardiomyopathy.

Dual chamber (DDD) pacing and catheter-based nonsurgical septal reduction therapy (NSRT) with ethanol are evaluated for treatment of patients with hypertrophic cardiomyopathy. This report describes a patient with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction who had failed to respond to DDD pacing but showed benefit from subsequent NSRT. Procedural difficulties during NSRT due to massive septal hypertrophy are presented.

Adult↗
PubMed2000

Prevalence and clinical significance of anti-phospholipid antibodies in multiple sclerosis: a study of 89 patients.

The prevalence of serum anti-phospholipid antibodies (aPL) was evaluated in multiple sclerosis (MS) patients to search for a possible association with a distinct form of the disease. Anti-cardiolipin antibodies (Ab) (aCL) and anti-beta 2 glycoprotein I Ab (abeta2GPI) were measured together with antinuclear Ab (ANA), anti-double-stranded DNA Ab (anti-ds DNA) and anti-myelin Ab in 89 patients. Twenty-nine (32.6%) patients had serum aPL, 19xaCL (15 of the IgG and four of the IgM isotype), 14 abeta2GPI (two IgG and 12 IgM) (four of these patients had both Ab). Prevalence of aCL correlated with that of ANA, which were positive in 52 patients (P=0. 005) and with anti-myelin Ab detected in two patients (P=0.046) but not with that of anti-ds DNA (mostly of the IgM class) detected in 28% of case by ELISA. No correlation could be found between aPL and age, sex, duration of the disease from diagnosis, category of MS, clinical course, clinical symptoms, serum IgM levels nor atypical lesions by magnetic resonance imaging. Hence, aCL and abeta2GPI are neither rare in MS nor associated with a specific clinical form of the disease and they cannot be a diagnosis exclusion criteria.

Adult↗
PubMed2000

Neuropsychological disturbances in cerebellar infarcts.

BACKGROUND: Recent clinical and research reports suggest that the cerebellum may contribute to the modulation of higher cognitive functions. MATERIAL AND METHODS: We included 15 consecutive patients with isolated cerebellar infarcts (4 superior cerebellar artery territory infarcts, 1 anterior inferior cerebellar artery territory infarct and 10 posterior inferior cerebellar artery territory infarcts), all confirmed by magnetic resonance imaging. These subjects plus 15 controls matched for age, sex, and educational level underwent a neuropsychological test battery including vocabulary, similarities and block design subtests of the Wechsler Adult Intelligence Scale Revised (WAIS-R); verbal fluency tests (categorial, phonemic, and alternate categorial fluency tests); Rey's 15 auditory word learning list; the paced auditory serial addition task; the Stroop test and the Zerssen Rating Scale. One year after the cerebellar infarct, each subject with cerebellar infarct was asked to undergo a second neuropsychological examination with the same test battery. RESULTS: Patients with cerebellar infarcts exhibited significantly lower neuropsychological performances compared to those of the control group without any obvious difference between the different vascular cerebellar territories. After 1 year of follow-up, this neuropsychological impairment tended to improve. CONCLUSIONS: The pattern of deficits observed in isolated cerebellar infarcts highlights the nonmotor functions of the cerebellum and functional relationship between the cerebral cortex and the cerebellum.

Adult↗