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Ricardo Jorge

Publications and source records attributed to Ricardo Jorge.

10 recordsLinked to original sources
PubMed2007

The construct of generalized anxiety disorder in Alzheimer disease.

OBJECTIVES: The objectives of this study were to examine the criterion validity in Alzheimer disease (AD) of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the International Classification of Diseases, 10th Revision (ICD-10) criteria for generalized anxiety disorder (GAD), to clarify the symptoms associated with excessive anxiety and worry in AD, to examine the co-occurrence of GAD and depression in these patients, and to determine the neuropsychologic and functional impact of GAD in AD. RESULTS: One hundred forty-four of a consecutive series of 552 patients with probable AD (26%) reported excessive anxiety and worry difficult to control for most of the 6 months before the psychiatric evaluation. Excessive anxiety and worry were significantly associated with restlessness, irritability, muscle tension, fears, and respiratory symptoms of anxiety. Using these symptoms as diagnostic criteria, 56 of the 552 patients (10%) met revised diagnostic criteria for GAD as compared with 15% when using DSM-IV criteria and 9% when using the ICD-10 criteria. GAD was present in 38 of the 144 patients (26%) with major depression and in 12 of the 261 patients (5%) without depression. Patients with both GAD and depression showed more severe cognitive deficits than patients with either GAD or depression only. CONCLUSION: The authors validated a set of diagnostic criteria for anxiety in dementia. These criteria include restlessness, irritability, muscle tension, fears, and respiratory symptoms in the context of excessive anxiety and worry. Anxiety in AD is a frequent comorbid condition of major depression.

Aged↗
PubMed2006

Evaluation of the GTRACT diffusion tensor tractography algorithm: a validation and reliability study.

Fiber tracking, based on diffusion tensor imaging (DTI), is the only approach available to non-invasively study the three-dimensional structure of white matter tracts. Two major obstacles to this technique are partial volume artifacts and tracking errors caused by image noise. In this paper, a novel fiber tracking algorithm called Guided Tensor Restore Anatomical Connectivity Tractography (GTRACT) is presented. This algorithm utilizes a multi-pass approach to fiber tracking. In the first pass, a 3D graph search algorithm is utilized. The second pass incorporates anatomical connectivity information generated in the first pass to guide the tracking in this stage. This approach improves the ability to reconstruct complex fiber paths as well as the tracking accuracy. Validation and reliability studies using this algorithm were performed on both synthetic phantom data and clinical human brain data. A method is also proposed for the evaluating reliability of fiber tract generation based both on the position of the fiber tracts, as well the anisotropy values along the path. The results demonstrate that the GTRACT algorithm is less sensitive to image noise and more capable of handling areas of complex fiber crossing, compared to conventional streamline methods.

Algorithms↗
PubMed2006

Phenomenology and clinical correlates of delusions in Alzheimer disease.

OBJECTIVES: The objectives of this study were to determine whether anosognosia, depression, and elevated mood are associated with delusions in Alzheimer disease (AD), and to examine the validity of standardized diagnostic criteria for psychosis of dementia. METHOD: The authors assessed a consecutive series of 771 patients with AD attending a dementia clinic with a comprehensive neuropsychologic and psychiatric evaluation that included specific measures of delusions, hallucinations, anosognosia, depression, and elevated mood. RESULTS: Delusions were found in one-third of the patients and hallucinations in 7%. Most patients with hallucinations also had delusions. A principal component analysis of the Psychosis Dementia Scale, which rates the presence and severity of delusions, produced the factors of paranoid misidentification and expansive delusions. Paranoid, but not expansive, delusions increased across the stages of the illness. Anosognosia and depression were significantly and independently associated with the presence of delusions, whereas elevated mood was significantly associated with expansive, but not paranoid, delusions. A multiple logistic regression analysis demonstrated that delusions in AD were significantly associated with depression, anosognosia, overt aggression, and agitation. CONCLUSIONS: Anosognosia, depression, global cognitive deficits, and elevated mood are the main psychiatric correlates of paranoid misidentification and expansive delusions in AD, whereas overt aggression and agitation are the most frequent behavioral concomitants of psychosis in AD.

Aged↗
PubMed2005

Uncommon causes of cerebrovascular dementia.

BACKGROUND: The concept of Binswanger's disease (BD) remains unclear and may not constitute a useful diagnostic category. However, cognitive decline may be present in a proportion of patients with subarachnoid hemorrhages (SAH) or subdural hematomas (SH). METHOD: We provide a critical review of the concept of BD and summarize the main findings on the association between SAH, SH and cognitive decline. RESULTS AND CONCLUSIONS: BD was originally identified as a type of dementia different from neurosyphilis and with characteristic white matter atrophy. The phenomenology of BD is currently construed around the concept of frontosubcortical dementia, but the validity of this construct is unclear. Patients with SAH frequently develop a variety of cognitive and behavioral problems that usually result in poor psychosocial adjustment and poor quality of life. SH is a rare cause of progressive cognitive impairment. A proportion of patients (particularly functionally impaired old individuals) are at a high risk for cognitive deficits after surgical drainage of the hematoma.

Brain↗
PubMed2005

Dementia after traumatic brain injury.

Early retrospective studies suggested that individuals with a history of a traumatic brain injury (TBI) had a higher risk for dementia than those without a history of TBI. Two meta-analyses demonstrated that the risk for dementia is higher among men, but not women, with a history of TBI. More recent prospective studies, however, are providing discrepant findings, probably due to important methodological differences. TBI is usually associated with significant neuropsychological deficits, primarily in the domains of attention, executive functioning and memory. These deficits may not improve with time. TBI may also lower the threshold for the clinical expression of dementia among predisposed individuals, and the onset of Alzheimer's disease (AD)-like neuropathological and biochemical changes immediately after severe TBI may play an important role in this mechanism.

Brain Injuries↗
PubMed2005

The construct of minor and major depression in Alzheimer's disease.

OBJECTIVE: This study examined the frequency of major and minor depression in Alzheimer's disease and determined whether these types of depression have a different functional and psychopathological impact and whether there is a change in the prevalence of major and minor depression throughout the stages of Alzheimer's disease. METHOD: A consecutive series of 670 patients with probable Alzheimer's disease were assessed with the Structured Clinical Interview for DSM-IV; specific instruments to rate the presence and severity of depression, anxiety, apathy, irritability, delusions, pathological affective crying, performance of activities of daily living, and social functioning; and a standardized neuropsychological evaluation. Diagnoses of major and minor depression were generated from DSM-IV criteria. RESULTS: Twenty-six percent of the patients had major depression, 26% had minor depression, and 48% were not depressed. Major depression was significantly associated with sad mood in all three stages of the illness, although this association dropped significantly for minor depression in severe Alzheimer's disease. Both major and minor depression were significantly associated with more severe psychopathology, functional impairments, and social dysfunction. Depressive symptoms that most strongly discriminated between Alzheimer's disease patients with and without sad mood were guilty ideation, suicidal ideation, loss of energy, insomnia, weight loss, psychomotor retardation/agitation, poor concentration, and loss of interest. CONCLUSIONS: Our study demonstrates that DSM-IV criteria for major and minor depression identify clinically relevant syndromes of depression in Alzheimer's disease, mild levels of depression can produce significant functional impairment, and the severity of psychopathological and neurological impairments increases with increasing severity of depression.

Activities of Daily Living↗
PubMed2003

Mood disorders following traumatic brain injury.

Mood disorders are a frequent complication of traumatic brain injury that exerts a deleterious effect on the recovery process and psychosocial outcome of brain injured patients. Prior psychiatric history and impaired social support have been consistently reported as risk factors for developing mood disorders after traumatic brain injury (TBI). In addition, biological factors such as the involvement of the prefrontal cortex and probably other limbic and paralimbic structures may play a significant role in the complex pathophysiology of these disorders. Preliminary studies have suggested that selective serotonin reuptake inhibitors such as sertraline, mood stabilizers such as sodium valproate, as well as stimulants and ECT may be useful in treating these disorders. Mood disorders occurring after TBI are clearly an area of neuropsychiatry in which further research in etiology as well as treatment is needed.

Adult↗
PubMedDate not supplied

[Sclerotherapy of female varicocele].

The female varicocile is associated to the pelvic congestion syndrome that is described. Five patients 31 to 52 years old are presented. Four of them have continuous pelvic pain and the fifth had huge vaginal and vulvar varices. Flebography of the left ovarian vein showed retrograde flux of the dilated vein. Sclerotherapy with Aethoxysklerol 3% was performed. There was an immediate relief of symptoms. During the follow up period between 9 and 12 months the five patients were asymptomatic. There are publications of embolization of the ovarian vein, however the present cases are the first ones in which the selective Sclerotherapy was the only treatment used with good results.

Adult↗