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Biomedical subjects

R Leiguarda

Publications and source records attributed to R Leiguarda.

At least 55 records · Page 3Linked to original sources
PubMed1995

A single-photon emission computed tomographic study of anosognosia in Alzheimer's disease.

OBJECTIVE: To examine the presence of specific regional cerebral blood flow correlates of anosognosia in patients with probable Alzheimer's disease. DESIGN: Case series, group comparisons. SETTING: Ambulatory care referral center. PATIENTS: Twelve patients with probable Alzheimer's disease and anosognosia and 12 patients with probable Alzheimer's disease without anosognosia who were matched for age, duration of illness, and cognitive impairments. MAIN OUTCOME MEASURES: Single-photon emission computed tomographic scan studies with technetium Tc 99m hexamethylpropylene-amine oxime and regional cerebral blood flow measurements. RESULTS: Patients with Alzheimer's disease and anosognosia showed significant blood flow deficits in the frontal inferior and superior (dorsal) areas of the right hemisphere. On the other hand, no significant between-group differences were found in depression scores and neuropsychological tasks that assessed verbal and visual memory, verbal comprehension, naming, verbal fluency, auditory attention, abstract reasoning, and set-shifting abilities. CONCLUSIONS: Our study demonstrates that anosognosia may not be related to deficits in specific cognitive domains, but it may result from dysfunction of the right frontal lobe.

Aged↗
PubMed1995

Neuropsychiatric and neuropsychological correlates of delusions in Alzheimer's disease.

We examined the prevalence, phenomenology, and clinical correlates of delusions in a consecutive series of 103 patients with probable Alzheimer's disease (AD). Patients were examined with the Present State Exam and the Dementia-Psychosis Scale. Twenty-one patients (20%) met DSM-III-R criteria for a delusional disorder. The most frequent delusion type was paranoid (71%), followed by hypochondriacal (67%), the Capgras syndrome (29%), house misidentification (29%), and grandiose delusions (29%). Out of the 21 AD patients with delusions, 76% had three or more different types of delusions simultaneously. The frequency of delusions was not significantly associated with age, education, or age at dementia onset, and the type and severity of cognitive impairments was similar for AD patients with and without delusions. However, AD patients with delusions had significantly higher mania and anosognosia scores.

Activities of Daily Living↗
PubMed1995

Dissociation between declarative and procedural learning in dementia and depression.

Declarative and procedural learning were assessed in patients with probable Alzheimer's Disease (AD) and major depression, patients with AD and no depression, patients with major depression but no dementia, and a group of age-comparable nondemented and nondepressed normal controls. AD patients showed significant deficits in declarative but not in procedural learning, while depressed nondemented patients showed the opposite pattern (i.e., a significantly worse procedural than declarative learning). Patients with both AD and major depression showed a similar learning pattern to the AD nondepressed group (relatively preserved procedural learning but severe deficits in declarative memory). These findings provide further evidence for the independence between declarative and procedural learning, and demonstrate their different vulnerability in dementia and depressive-like states.

Aged↗
PubMed1995

Prevalence and clinical correlates of pathological affective display in Alzheimer's disease.

This study examined the prevalence and correlates of pathological affect in Alzheimer's disease. A consecutive series of 103 patients with Alzheimer's disease were examined with a comprehensive psychiatric assessment that included the pathological laughing and crying scale (PLACS). Forty patients (39%) showed pathological affect: 25% showed crying episodes, and 14% showed laughing or mixed (laughing and crying) episodes. Patients with pathological affect crying showed significantly higher depression scores and a significantly higher frequency of major depression and dysthymia than patients with no pathological affect. Patients with mixed pathological affect showed significantly more subcortical atrophy on CT than patients with pathological affect crying. Forty seven per cent of the patients with pathological affect had no congruent mood disorder, and they showed a significantly longer duration of illness and more severe anosognosia than patients with pathological affect that was congruent with an underlying mood disorder. The study validates the PLACS, and shows the high prevalence of pathological affect in Alzheimer's disease.

Affect↗
PubMed1995

Prevalence and correlates of dysthymia and major depression among patients with Alzheimer's disease.

OBJECTIVE: The purpose of this study was to examine the prevalence, risk factors, and correlates of depression among patients with Alzheimer's disease. METHOD: A consecutive series of 103 patients with probable Alzheimer's disease were examined with a structured psychiatric interview and were assessed for the presence of cognitive impairments, deficits in activities of daily living, social functioning, and anosognosia. RESULTS: Fifty-one percent of the patients had depression (28% had dysthymia and 23% major depression). Women had a significantly higher prevalence of both major depression and dysthymia than men. Depressed and nondepressed patients had a similar frequency of family and personal histories of depression, a similar frequency of personality disorders before the onset of depression, and no significant differences in cognitive deficits and impairment in activities of daily living. Dysthymia usually started after the onset of dementia and was significantly more prevalent in the early stages of dementia; patients with dysthymia had a significantly better awareness of intellectual deficits than patients with major or no depression. On the other hand, patients with major depression had an earlier onset of depression (half of them before the onset of dementia), and the prevalence of major depression was similar across the different stages of the illness. CONCLUSIONS: This study demonstrates a high prevalence of dysthymia and major depression among patients with probable Alzheimer's disease. While dysthymia may be an emotional reaction to the progressive cognitive decline, major depression may be related to biological factors.

Activities of Daily Living↗
PubMed1995

A SPECT study of parkinsonism in Alzheimer's disease.

The authors examined the presence of significant regional cerebral blood flow (rCBF) differences between Alzheimer's disease (AD) patients with and without extrapyramidal signs (EPS). Nine patients with probable AD and EPS (resting tremor or rigidity and bradykinesia) and 9 AD patients without EPS, comparable in age, duration of illness, and global cognitive decline, were studied with [99mTc]HMPAO SPECT. Patients with AD and EPS showed significantly lower rCBF in the superior frontal, superior temporal, and parietal regions of the left hemisphere than AD patients without EPS. Rigidity and bradykinesia independently accounted for the decreased rCBF in these areas. These findings suggest that the presence of EPS in AD may result from dysfunction in specific brain regions.

Aged↗
PubMed1995

Anosognosia in Alzheimer's disease: a study of associated factors.

The authors examined the prevalence and correlates of anosognosia in a consecutive series of patients with probable Alzheimer's disease (AD). Patients were examined with the Anosognosia Questionnaire-Dementia (AQ-D), which showed good reliability and validity. On the basis of the AQ-D scores, patients were divided into those with anosognosia (n = 21) and those without anosognosia (n = 52). Patients with anosognosia showed a significantly longer duration of illness, more severe cognitive impairments and deficits in activities of daily living, and higher mania and pathological laughing scores than AD patients without anosognosia. These findings suggest that anosognosia in AD may be part of a specific neuropsychiatric syndrome.

Aged↗
PubMed1995

A randomized, double-blind, placebo-controlled study of bromocriptine in nonfluent aphasia.

We carried out a double-blind and placebo-controlled study of the efficacy of bromocriptine in the treatment of nonfluent aphasia. Seven patients received bromocriptine (up to 60 mg/d) and an identical placebo in a randomized order. End points were the number of content words, content units, and pauses > 3 seconds during the description of a figure; verbal naming; and verbal fluency. There were no significant benefits of bromocriptine over placebo in any of the variables examined.

Adult↗
PubMed1995

[Treatment of motor fluctuations in Parkinson's disease with subcutaneous injections of apomorphine].

Sixteen patients with Parkinson's disease and severe motor fluctuations were treated with subcutaneous injections of apomorphine and followed up prospectively for a year. The use of the drug improved the number of daily "off" hours by 52%, while treatment efficacy remained constant for a year without the appearance of tolerance (ANOVA with repeated measurements:p = 0.0002). No severe adverse effect or any justifying treatment discontinuance were recorded. Apomorphine proved a safe and reliable drug for the treatment of motor fluctuations.

Aged↗
PubMed1994

Extrapyramidalism in Alzheimer's disease: prevalence, psychiatric, and neuropsychological correlates.

The prevalence and clinical correlates of extrapyramidal signs in a consecutive series of 78 patients with Alzheimer's disease attending a neurology clinic, and 20 age comparable normal controls, were examined. Based on the unified Parkinson's disease rating scale (UPDRS) findings, 18 patients (23%) met criteria for parkinsonism, 44 (56%) had isolated extrapyramidal signs, and 16 (21%) had no extrapyramidal signs. Whereas the control group showed a similar prevalence of isolated extrapyramidal signs (57%), none of them showed parkinsonism. No significant differences were found for age, sex, duration of illness, and severity of dementia among the three Alzheimer's disease groups. Patients with Alzheimer's disease-parkinsonism, however, showed a significantly higher frequency of major depression and dysthymia and significantly higher Hamilton depression scores than patients with isolated or no extrapyramidal signs. Patients with Alzheimer's disease-parkinsonism also showed significantly more deficits on frontal lobe related tasks such as the Wisconsin card sorting test, trail making test, and verbal fluency, as well as on tests of constructional praxis and abstract reasoning than patients with Alzheimer's disease but no extrapyramidal signs. In conclusion, the study showed a specific association between Alzheimer's disease and parkinsonism, as well as significant relations between parkinsonism, deficits in executive functions, and depression among patients with Alzheimer's disease.

Aged↗
PubMed1994

The nature of apraxia in corticobasal degeneration.

Although apraxia is one of the most frequent signs in corticobasal degeneration, the phenomenology of this disorder has not been formally examined. Hence 10 patients with corticobasal degeneration were studied with a standardised evaluation for different types of apraxia. To minimise the confounding effects of the primary motor disorder, apraxia was assessed in the least affected limb. Whereas none of the patients showed buccofacial apraxia, seven showed deficits on tests of ideomotor apraxia and movement imitation, four on tests of sequential arm movements (all of whom had ideomotor apraxia), and three on tests of ideational apraxia (all of whom had ideomotor apraxia). Ideomotor apraxia significantly correlated with deficit in both the mini mental state examination and in a task sensitive to frontal lobe dysfunction (picture arrangement). Two of the three patients with ideomotor apraxia and ideational apraxia showed severe cognitive impairments. The alien limb behaviour was present only in patients with ideomotor apraxia. In conclusion, ideomotor apraxia is the most frequent type of apraxia in corticobasal degeneration, and may be due to dysfunction of the supplementary motor area. There is a subgroup of patients with corticobasal degeneration who have a severe apraxia (ideomotor and ideational apraxia), which correlates with global cognitive impairment, and may result from additional parietal or diffuse cortical damage.

Aged↗
PubMed1994

Specificity of changes in cerebral blood flow in patients with frontal lobe dementia.

Eight patients with a clinical diagnosis of probable Alzheimer's disease, eight patients with the clinical diagnosis of frontal lobe dementia, and eight controls were examined with single photon emission tomography (SPECT) using 99Tc-HMPAO. Patients with Alzheimer's disease and those with frontal lobe dementia met DSM-III-R criteria for mild dementia and were in the early stages of the illness. Compared with patients with Alzheimer's disease, the group with frontal lobe dementia had significantly lower blood flow in the frontal lobes (dorsolateral and orbital), the anterior temporal cortex, and the basal ganglia. Within the frontal lobe dementia group, blood flow was significantly lower in the orbital than in the dorsal frontal cortex, and in the anterior temporal than in the dorsal temporal cortex. The present study shows the specificity of changes in regional cerebral blood flow in the diagnosis of different types of dementia, and supports the importance of orbitofrontal, anterior temporal, and basal ganglia dysfunction in the production of the psychiatric syndrome of frontal lobe dementia.

Aged↗
PubMed1994

A SPECT study of delusions in Alzheimer's disease.

Although delusions are a frequent finding in patients with Alzheimer's disease (AD), their mechanism is not well known. We carried out Tc 99m HMPAO single-photon emission computed tomography studies in 16 AD patients with delusions and 29 AD patients without delusions comparable in age, years of education, duration of illness, and severity of dementia. Although we found no significant between-group differences in performance on neuropsychological tasks, AD patients with delusions had significantly lower mean cerebral blood flow in both the left and right temporal lobes.

Aged↗
PubMed1993

Neuropsychological correlates of brain atrophy in Parkinson's disease: a CT-scan study.

We examined the presence of cortical or subcortical brain atrophy (as shown by CT scans) in patients with Parkinson's disease (PD) and assessed whether there were significant correlations between CT measurements and the presence of cognitive deficits. There were three main findings. First, patients with bilateral symptoms of PD showed more severe cortical and subcortical atrophy than age-matched normal controls. Second, the presence of unilateral symptoms of PD was significantly associated with contralateral brain atrophy only in patients with right hemi-PD. Third, there was a significant correlation between neuropsychological deficits and atrophy in specific brain areas.

Atrophy↗
PubMed1993

Inverse masticatory muscle activity due to syringobulbia.

The clinical, radiological, and electrophysiological data of a 25-year-old woman with "inverse masticatory muscle activity" due to syringobulbia is presented. This uncommon brain stem syndrome may be due to a disturbance in central programming of mastication.

Adult↗
PubMed1993

Abnormal sympathetic skin response in patients with autoimmune vitiligo and primary autoimmune hypothyroidism.

The sympathetic skin response was studied in 21 patients with autoimmune vitiligo or hypothyroidism or both. No response to stimulation was found in 6 patients, but 4 with both diseases showed abnormal results. Sympathetic skin response is useful in evaluating sudomotor activity of the autonomic nervous system, and it is concluded that patients with autoimmune vitiligo, autoimmune hypothyroidism and especially those with both diseases show evidence of sudomotor dysfunction.

Autoimmune Diseases↗
PubMed1993

Paroxysmal alien hand syndrome.

Four patients are described who presented with a paroxysmal form of the alien hand syndrome. Two patients with damage to one frontomedial cortex had brief episodes of abnormal motor behaviour of the contralateral arm that featured groping, grasping, and apparently purposeful but perseverative movements, which both patients interpreted as alien or foreign. The other two patients, with posterior parietal damage, reported a paroxysmal feeling of unawareness of the location of the contralateral arm, lack of recognition of the arm as their own, purposeless movements, and personification of the arm. These cases represent a new form of the alien hand syndrome manifested by brief, paroxysmal episodes, which may be due to ictal mechanisms.

Adult↗