Biomedical subjects

R Leiguarda

Publications and source records attributed to R Leiguarda.

At least 37 records · Page 2Linked to original sources

PubMed1998

Depression in classic versus akinetic-rigid Parkinson's disease.

We examined the prevalence of major depression and dysthymia in 78 patients with the classic variant of Parkinson's disease (PD) (that is, tremor plus rigidity and/or bradykinesia), and in 34 patients with the akinetic-rigid variant. Although the prevalence of dysthymia was similar in both groups (classic PD, 31%; and akinetic-rigid PD, 32%), patients with akinetic-rigid PD had a significantly higher prevalence of major depression (38% versus 15%, respectively; p < 0.01). A stepwise regression analysis demonstrated that bradykinesia was the extrapyramidal sign with the highest correlation with Hamilton depression scale scores. Our findings demonstrate a significant association between major depression and the akinetic-rigid type of PD.

Aged↗

PubMed1998

Confirmation of the antidyskinetic effect of posteroventral pallidotomy by means of an intraoperative apomorphine test.

We present a series of six consecutive Parkinson's disease patients undergoing posteroventral pallidotomy (PVP), who received an apomorphine injection after thermolesioning the posteroventral region of the internal globus pallidus (GPi) to evaluate the effect of the lesion on drug-induced dykinesias and therefore to proceed with further lesions or to conclude the surgery. Five of six patients failed to present dykinesias or did so to a significantly lesser degree (F [2,10] 42.6; p < 0.0001) so that surgery was concluded. One patient continued having contralateral dyskinesia despite an improvement in rigidity and bradykinesia, therefore, a new track was performed followed by a new lesion. No differences were found between intrasurgical and 1-month postoperative apomorphine test values. This report indicates that the use of an apomorphine test after thermolesioning may provide a reliable tool to check lesion efficacy on dyskinesia. The development of techniques that provide additional clinical information to the electrophysiological recording could help improve the outcome of patients undergoing pallidotomy.

Aged↗

PubMed1998

A randomized, double-blind, placebo-controlled study of methylphenidate in patients with organic amnesia.

We examined the usefulness of methylphenidate (MPH) in the treatment of organic amnesia in a randomized, double-blind, placebo-controlled design. Twenty patients with amnesia due to closed head injuries (n = 10), viral encephalitis (n = 2), stroke lesions (n = 4), or surgical brain resections (n = 4) were assessed with a neuropsychological battery after the intake of MPH (10, 20, 30 or 40 mg), or placebo. We found no significant benefit of MPH for any of the cognitive tests.Copyright Lippincott-Raven Publishers

Journal Article↗

PubMed1998

Prevalence and correlates of aggressive behavior in Alzheimer's disease.

The authors assessed a consecutive series of 196 patients with probable Alzheimer's disease (AD) for the presence of aggressive behavior, using a standardized neurological, neuropsychiatric, and neuropsychological battery that included both the Overt Aggression Scale and the Irritability Scale. Twelve percent of patients showed aggressive episodes (5% with verbal aggression, 7% with physical aggression) during the 4 weeks preceding the psychiatric evaluation. Physical aggression was significantly associated with more frequent delusions and more severe irritability.

Aged↗

PubMed1998

Prevalence and correlates of the catastrophic reaction in Alzheimer's disease.

We examined the prevalence of the catastrophic reaction (CR) in 146 patients with Alzheimer's disease. Sixteen percent showed a CR during the neuropsychological evaluation. A factor analysis of the CR scale demonstrated an anxious/angry factor that was significantly associated with higher irritability scores and a longer duration of illness, as well as a depressive factor that was significantly associated with more severe cognitive impairments and older age.

Adaptation, Psychological↗

PubMed1997

Cognitive functions in major depression and Parkinson disease.

OBJECTIVE: To investigate the importance of major depression in the production of cognitive deficits in patients with Parkinson disease (PD). DESIGN: A comprehensive neuropsychological and psychiatric assessment was conducted in 19 patients with PD and major depression, 31 patients with PD without depression, 27 patients with major depression but without PD, and 12 age-comparable healthy controls. SETTING: Outpatient clinic. RESULTS: Patients with major depression (with or without PD) had significantly more severe cognitive deficits than both healthy controls and patients with PD without depression on tests of verbal fluency and auditory attention, while patients with PD and major depression had significantly more severe deficits on tasks of abstract reasoning and set alternation compared with the other 3 groups. CONCLUSIONS: Major depression in patients with PD is associated with significant deficits on specific cognitive tasks. While some of these deficits may be explained by the presence of major depression, frontal lobe-related cognitive impairments may result from an interaction between neuropathologic factors in PD and the mechanism of major depression.

Aged↗

PubMed1997

Sleep benefit in Parkinson's disease.

Sleep benefit (SB) In Parkinson's disease (PD) is not well characterized. To determine SB frequency, as well as to characterize and correlate it with other disease variables, we evaluated prospectively a consecutive series of 312 PD patients by means of a structured questionnaire: 55% reported having SB and 35% reported that awakening was their best time of the day. Because of SB, 21% of the entire population were able to skip or delay medication. The mean duration of the phenomenon was 85.4 +/- 67 min. Patients with SB were significantly older (p < 0.0002), had disease longer (p < 0.05), and were often men (chi 2 = 3.5, df 1, p = 0.05). Patients with SB took sleep medication with similar frequency as those without SB. There were no differences in hours of sleep or sleep latency. Sleep problems such as nightmares or somnambulism, but not the number of sleep awakenings, were similar in both groups. In conclusion, SB is a frequent phenomenon, especially in men, elderly patients, and patients with longer disease duration. SB enables the morning L-dopa dose to be postponed in approximately 50% of patients.

Aged↗

PubMed1997

Comparison of subcutaneous apomorphine versus dispersible madopar latency and effect duration in Parkinson's disease patients: a double-blind single-dose study.

Twelve parkinsonian patients with severely fluctuating symptoms were given a single dose of apomorphine or Dispersible Madopar on 2 consecutive days, to confirm the latter drug's usefulness in "off" period rescue. According to our results, apomorphine proved faster in reverting "off" periods and should still be regarded as the drug of choice for this treatment modality.

Administration, Oral↗

PubMed1997

Neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease.

OBJECTIVE: To examine neurological, neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease. METHODS: A consecutive series of patients with probable Alzheimer's disease was assessed with a comprehensive neuropsychological battery, a structured psychiatric evaluation, the unified Parkinson's disease rating scale, MRI, and single photon emission computed tomography with technetium 99m hexamethylpropyleneamine oxime (HMPAO) and regional cerebral perfusion measurements. RESULTS: Patients with Alzheimer's disease and leukoaraiosis were significantly more apathetic and had significantly more extrapyramidal signs than patients with Alzheimer's disease without leukoaraiosis. Patients with Alzheimer's disease with leukoaraiosis also had significantly lower bilateral perfusion in the basal ganglia, thalamus, and frontal lobes than patients with Alzheimer's disease without leukoaraiosis. On the other hand, there were no significant differences between groups in age, duration of illness, depression scores, severity of delusions, or deficits on specific neuropsychological tasks. CONCLUSIONS: Leukoaraiosis in Alzheimer's disease may produce significant basal ganglia, and thalamic and frontal lobe dysfunction, which may be associated with more severe apathy and extrapyramidal signs.

Aged↗

PubMed1997

Involuntary movements during thermolesion predict a better outcome after microelectrode guided posteroventral pallidotomy.

Eight of the first 15 patients with advanced Parkinson's disease who underwent microelectrode guided posteroventral pallidotomy developed transient abnormal involuntary movements during thermolesion, four of whom also did so during high frequency macrostimulation. Abnormal involuntary movements found before thermolesion were choreic, ballistic, or choreoathetoid in nature, usually persisted less than 60 minutes, and were contralateral to the site of thermolesion in six and bilateral in two of them. The appearance of abnormal involuntary movements during macrostimulation or thermolesion of the internal globus pallidus correlated with better surgical outcome as measured by UPDRS motor items and CAPIT timed test, so that they seem to be of prognostic value.

Aged↗

PubMed1997

Prospective longitudinal study of depression and anosognosia in Alzheimer's disease.

BACKGROUND: The aim was to examine the longitudinal evolution of depression and anosognosia in patients with probable Alzheimer's disease (AD). METHOD: Sixty-two of a consecutive series of 116 AD patients that were examined with a structured psychiatric interview had a follow-up evaluation between one and two years after the initial evaluation. RESULTS: At the initial evaluation 19% of the 62 patients had major depression, 34% had dysthymia, and 47% were not depressed. After a mean follow-up of 16 months, 58% of patients with major depression at the initial evaluation were still depressed, whereas only 28% of patients with initial dysthymia and 21% of the non-depressed patients were depressed at follow-up. During the follow-up period, all three groups showed similar declines in cognitive status and activities of daily living. At the initial evaluation, 39% of the patients had anosognosia, and there was a significant increment of anosognosia during the follow-up period. CONCLUSIONS: While dysthymia in AD is a brief emotional disorder, major depression is a longer-lasting mood change. Anosognosia is another prevalent disorder among AD patients, and increases with the progression of the illness.

Aged↗

PubMed1997

Anosognosia and procedural learning in Alzheimer's disease.

Awareness of cognitive deficits may rely on the implicit learning of intellectual limitations, and anosognosia in Alzheimer's disease (AD) may result from deficits in implicit learning. To examine this hypothesis, a consecutive series of 55 patients with probable AD were divided into groups with mild (n = 13), severe (n = 12), or no anosognosia (n = 30) and were assessed with a neuropsychological battery that included tests of declarative and procedural learning. Whereas there were no significant between-group differences in tests of declarative learning (the Buschke Selective Reminding Test and the Benton Visual Retention Test), patients with severe anosognosia showed a significantly worse performance on procedural learning (as measured with the Maze Learning Test) and a test assessing set shifting abilities (the Wisconsin Card Sorting Test) than AD patients without anosognosia. The authors' results suggest that deficits in procedural learning and anosognosia in AD may result from dysfunction in habit-learning systems.

Aged↗

PubMed1996

Drug-induced parkinsonism in schizophrenic patients: motor response and psychiatric changes after acute challenge with L-Dopa and apomorphine.

Acute single-dose response of drug-induced parkinsonism (DIP) to L-Dopa and apomorphine challenge was evaluated in a double-blind crossover study in 12 schizophrenic patients. There were two noteworthy negative findings. First, neither L-Dopa nor apomorphine produced significant improvements in DIP and second, no changes (neither improvement nor worsening) were found in patients' psychiatric status. Findings suggest that, for a stimulation dose reaching almost 90% of the responsive dose for idiopathic Parkinson's disease, no significant changes may reasonably be expected in the parkinsonism of schizophrenic patients treated with neuroleptic drugs.

Adult↗

PubMed1996

Catatonia in depression: prevalence, clinical correlates, and validation of a scale.

OBJECTIVES: To examine the clinical correlates of catatonia in depression, to validate a scale for catatonia, and to assess the validity of the DSM-IV criteria of the catatonic features specifier for mood disorders. METHODS: A series of 79 consecutive patients with depression and 41 patients with Parkinson's disease without depression were examined using the modified Rogers scale (MRS), the unified Parkinson's disease rating scale (UPDRS), and the structured clinical interview for DSM-III-R (SCID). RESULTS: Sixteen of the 79 depressed patients (20%) had catatonia. Depressed patients with catatonia had significantly higher scores on the MRS than non-catatonic depressed patients matched for severity of depression, or non-depressed patients with Parkinson's disease matched for severity of motor impairment. Depressed patients with catatonia were older, had a significantly higher frequency of major depression, more severe cognitive impairments, and more severe deficits in activities of daily living than depressed non-catatonic patients. The DSM-IV criteria of catatonia separated depressed catatonic patients from patients with Parkinson's disease matched for motor impairment, with a specificity of 100%. Catatonic signs did not improve after apomorphine. CONCLUSIONS: catatonia is most prevalent among elderly patients with severe depression. The study showed the validity of the MRS for the diagnosis of catatonia in depressed patients, as well as the specificity of the DSM-IV criteria of the catatonic features specifier.

Aged↗

PubMed1996

Neuropsychological and psychiatric differences between Alzheimer's disease and Parkinson's disease with dementia.

OBJECTIVE: To examine neuropsychological and neuropsychiatric differences between patients with probable Alzheimer's disease and patients with Parkinson's disease and dementia. METHODS: Thirty three patients with probable Alzheimer's disease and 33 patients with Parkinson's disease and dementia were matched for age, sex, and mini mental state examination scores and given a battery of neuropsychological and neuropsychiatric tests. RESULTS: Patients with Parkinson's disease with dementia had a significantly higher prevalence of major depression than patients with Alzheimer's disease; patients with Alzheimer's disease showed more severe anosognosia and disinhibition than patients with Parkinson's disease. Whereas no significant between group differences were found on tests of memory and language, demented patients with Parkinson's disease had a significantly greater impairment on a test of visual reasoning than patients with Alzheimer's disease. CONCLUSION: There were significant psychiatric differences between patients with Alzheimer's disease and demented patients with Parkinson's disease, but neuropsychological differences were restricted to a single cognitive domain.

Aged↗

PubMed1996

Two domains of anosognosia in Alzheimer's disease.

OBJECTIVE: To examine the presence of different dimensions of unawareness in patients with probable Alzheimer's disease. METHODS: A consecutive series of 170 patients with probable Alzheimer's disease were assessed with the anosognosia questionnaire-dementia (AQ-D) which includes items related to cognitive deficits and behavioural problems. RESULTS: A factor analysis of the AQ-D produced two factors: a "cognitive unawareness" factor, which loaded on items of memory, spatial and temporal orientation, calculation, abstract reasoning, and praxis, and a "behavioural unawareness" factor which loaded on items of irritability, selfishness, inappropriate emotional display, and instinctive disinhibition. A stepwise forward regression analysis showed significant correlations between the cognitive unawareness factor and more severe cognitive deficits, delusions, and apathy, but less depression. On the other hand, the behavioural unawareness factor correlated significantly with higher mania and pathological laughing scores. Whereas the cognitive unawareness factor showed a significant correlation with cognitive tests assessing verbal comprehension and long term memory, and was significantly associated with a longer duration of illness, no significant correlations were found between the behavioural unawareness factor and the neuropsychological tasks. CONCLUSION: Unawareness of cognitive deficits and unawareness of behavioural problems may constitute independent phenomena in Alzheimer's disease. Whereas unawareness of cognitive deficits is related to the severity of intellectual impairment and the presence of delusional apathetic mood, unawareness of behavioural problems may be part of a disinhibition syndrome.

Alzheimer Disease↗

PubMed1996

Neuropsychological, psychiatric, and cerebral blood flow findings in vascular dementia and Alzheimer's disease.

BACKGROUND AND PURPOSE: Psychiatric, neuropsychological, and cerebral blood flow differences between patients with ischemic vascular dementia (IVD) or Alzheimer's disease (AD) were examined. METHODS: A consecutive series of patients who met either the criteria of the National Institute of Neurological Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association for probable AD or the State of California AD Diagnostic and Treatment Centers criteria for probable IVD were included in the study. Twenty consecutive patients with IVD were matched for age, sex, and Mini-Mental State Examination scores with 40 consecutive patients with probable AD. Patients underwent a psychiatric interview, a neuropsychological assessment, and single-photon emission CT imaging with 99mTc-hexamethylpropyleneamine oxime. RESULTS: Patients with IVD showed significantly more severe anosognosia (P<.05) and emotional lability (P<.01) than AD patients, but no significant between-group differences were found in the frequency and severity of depression. IVD patients showed significantly more severe deficits in tests of planning, sequencing (P<.05), and verbal fluency (P<.05) as well as significantly more severe cerebral blood flow deficits in the basal ganglia (P<.01) and the frontal lobes (P<.001) than AD patients. CONCLUSIONS: Patients with IVD showed a relatively more severe dysfunction of the frontal lobes as demonstrated by single-photon emission CT and expressed in specific psychiatric and neuropsychological changes than AD patients matched for age, sex, and severity of dementia.

Aged↗

PubMed1996

A double-blind placebo-controlled study of clomipramine in depressed patients with Alzheimer's disease.

Twenty-one depressed patients with probable Alzheimer's disease (AD) were randomized to receive a 6-week treatment with clomipramine or placebo in a study with a double-blind crossover design. Main outcome measures were Hamilton Depression, Mini-Mental State (MMSE), and Functional Independence Measure (FIM) scores. Mood improved significantly on both clomipramine and placebo, but clomipramine was significantly more effective than placebo during the first 6-week treatment period. Patients started on clomipramine maintained improvement during the washout and placebo periods, whereas patients started on placebo worsened during the washout period. However, patients on clomipramine showed significantly lower MMSE scores overall than patients on placebo. No significant drug effects were found on FIM scores. Clomipramine proved to be a useful treatment of depression in patients with probable AD.

Activities of Daily Living↗