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[Functional investigation of the sense of smell and its role in the diagnosis of sense of smell disorders].

The authors deal in turn with: -- the anatomical classification of disorders of the sense of smell, -- the various clinical and instrumental methods used to investigate the sense of smell, -- a practical method of investigation enabling the topography and the nature of the lesion to be found when a patient presents with a disorders involving the sense of smell. Finally, a classification of the various disorders which may be observed is suggested based on the topography of the lesion in the olfactory system.

Humans↗

[Consciousness disorders in focal lesions of the right and left cerebral hemispheres].

In the light of modern concepts of functional asymmetry in the human brain, the authors analyse paroxysmal conditions of changed consciousness which occurred in 160 patients with lesions of the hemispheres due to brain tumors (75 patients) and in epilepsy (85 patients). It is shown that certain forms of changed consciousness are characteristic of disorders of the right and left hemispheres in right-handedness. This clinical fact is taken as a basis for the assumption that in the formation of consciousness both hemispheres in different ways play a certain role and they provide different "formating" kinds of consciousness: the right hemisphere--a direct perception or a sensory perception of the environment and itself, the left--process of abstract perception based on speech, symbols, semantics.

Brain Neoplasms↗

[The relationship between the side of the lesion and the psychopathology of focal lesions of the frontal lobes].

The author studied 36 patients with benign tumors, located in one of the frontal lobes: in 20 cases in the left and in 16 cases in the right lobe. In tumors of the left lobe there were disorders in the motor and initiative side of speech, general inhibition, a decline in the level of generalizing, a prevalence of memory disorders, rather than attention, inertia of mental processes with a preservation of a sense of being ill. Tumors of the right frontal lobe were characterized by an insufficient insight to the illness, euphoria, an absence of a critical understanding of the environment, a prevalence of attention disorders over memory disturbances, a narrowing of the volume of simultaneously perceived information and a tendency towards a confabulatory addition to fragmentarily perceived images.

Brain Neoplasms↗

[The structure of the intellectual defect in children with cerebral palsy born prematurely].

The paper is concerned with a study of the structure of an intellectual defect in 2 groups of children with intrauteral birth trauma is characterized by a certain dissociation (in a satisfactory speech development and verbal thinking there was an insufficiency of spacial perception). The structure of an intellectual defect in children of the 2nd group (characterized by a bilirubin encephalopathy due to a physiological icterus of the prematurely born) the main feature was a defect of hearing and an underdevelopment of verbal thinking, while as the subject-visual thinking was preserved.

Birth Injuries↗

Working memory for visual features and conjunctions in schizophrenia.

The visual working memory (WM) storage capacity of patients with schizophrenia was investigated using a change detection paradigm. Participants were presented with 2, 3, 4, or 6 colored bars with testing of both single feature (color, orientation) and feature conjunction conditions. Patients performed significantly worse than controls at all set sizes but demonstrated normal feature binding. Unlike controls, patient WM capacity declined at set size 6 relative to set size 4. Impairments with subcapacity arrays suggest a deficit in task set maintenance: Greater impairment for supercapacity set sizes suggests a deficit in the ability to selectively encode information for WM storage. Thus, the WM impairment in schizophrenia appears to be a consequence of attentional deficits rather than a reduction in storage capacity.

Adult↗

Cyclorotation of the eyes and the subjective visual vertical.

Pathological CR of the eyes and deviations of the SVV are among the most sensitive clinical brain stem signs. In acute unilateral brain stem infarctions, deviations of the SVV occur in 94% of cases and CR of one or both eyes is found in 88%. Deviations of CR and the SVV are typically ipsiversive with pontomedullary lesions and contraversive with pontomesencephalic lesions. They may involve a complete OTR, the triad of lateral head tilt, skew deviation and CR. There is a directional linkage between CR and the SVV (i.e. either right or left tilt), but the net tilt angles do not always match quantitatively. Pathological CR and deviations of the SVV obviously represent dysfunction of the VOR in the roll plane, which is subserved by both otolith and vertical canal inputs.

Animals↗

[Clinical heterogeneity of Alzheimer's disease. Different clinical profiles can predict the progression rate].

INTRODUCTION: Alzheimer's disease (AD) is a degenerative dementia that may disclose different cognitive, behavioral, psychiatric and functional symptoms since onset. These distinct cognitive profiles support the conception of clinical heterogeneity and account for AD's highly variable rate of progression. In spite of strict diagnostic criteria NINCS ADRDA's and DSM IV the clinical certainty is only about 85%. Mayeux define 4 subtypes: a). Benign: mild cognitive and functional impairment without focal signs and late onset behavioral signs, slow progression; b). Myoclonic: usually of presenile onset with severe cognitive deterioration, mutism and early onset myoclonus; c). Extrapyramidal: early onset akineto rigid signs with severe cognitive, behavioral and psychiatric involvement; d). Typical: gradual and progressive cognitive, behavioral and functional impairment. The differentiation of these subtypes will allow us to define discrete patterns of progression, to define prognostic subgroups, and to homogenize them for clinical research and drug trials. DEVELOPMENT: We examined 1000 charts of probable AD patients from the Santojanni Center. We found 42% extrapyramidal, 35% typical, 15% benign and 8% myoclonic. The early onset of parkinsonism and myoclonus predict a rapidly evolving cognitive impairment and a more severe rate of progression with psychiatric disorders and dependency in activities of daily living. (DADL) Patients with low level of education, low cognitive performance at entry as well as those with rapid rate of cognitive deterioration had a faster rate of progression to DADL. CONCLUSION: Delusions, low level of education, extrapyramidal signs and motor hyperactivity but not hallucinations, and anosognosia were the best non cognitive predictors of DADL.

Activities of Daily Living↗

Effect of mycelial extract of Clavicorona pyxidata on acetylcholinesterase and beta-secretase activity in vitro.

In a previous study, an extract of Clavicorona pyxidata DGUM 29005 mycelia demonstrated an inhibitory effect against enzyme-associated perceptual disorders. We have attempted to determine whether this mycelial extract is also capable of inhibiting the activities of acetylcholinesterase (AChE) and beta-secretase (BACE) activity. Butanol, ethanol, and water extracts of C. pyxidata DGUM 29005 mycelia were shown to inhibit AChE activity by 99.3%, 93.7%, and 91.7%, respectively. The inhibitory value of the butanol extract was more profound than that of tacrine (95.4%). The ethanol extract also exerted an inhibitory effect against BACE activity; this fraction may harbor the potential for development into a pharmocotherapeutic modality for the treatment of Alzheimer's disease (AD) patients. Rat pheochromocytoma PC12 cells in culture were not determined to be susceptible to the cytotoxic activity evidenced by the mycelial extract. The ethanol extract inhibited endogenous AChE activity in PC12 cellular homogenates, with an IC50 of 67.5 microg/ml, after incubation with intact cells, and also inhibited BACE activity in a dose-dependent fashion. These results suggest that the C. pyxidata mycelial extract has the potential to enhance cholinergic function and, therefore, may perform a function in the amelioration of the cholinergic deficit observed in cases of AD, as well as other types of age-associated memory impairment.

Acetylcholinesterase↗

Postural disorders and spatial neglect in stroke patients: a strong association.

PURPOSE: In this paper we analyse the arguments for a strong association between spatial neglect and postural disorders and attempt to better understand the mechanisms which underlie that. METHODS: We first provide a general overview of the available tools for a rational assessment of postural control in a clinical context. We then analyse the arguments in favour of a close relationship, although not necessarily causal, between spatial neglect and: 1) body orientation with respect to gravity (including verticality perception i.e. the visual vertical, the haptic vertical, and the postural vertical); 2) body stabilisation with respect to the base of support; 3) posturographic features of stroke patients; 4) and finally their postural disability in daily life. This second part of the paper is based both on the literature review and on results of our current research. RESULTS: Neglect patients show a dramatic postural disability, due both to problems in body orientation with respect to gravity and to problems in body stabilisation. It might be that these problems are partly caused by a neglect phenomenon bearing on graviceptive (somaesthetic > vestibular) and visual information serving postural control. This could correspond to a kind of postural neglect involving both the bodily and nonbodily domains of spatial neglect. The existence of distorsion(s) in the body scheme are also probably involved, especially to explain the weight-bearing asymmetry in standing, and probably an impaired multisegmental postural coordination leading to an impaired body stabilisation. CONCLUSION: The present paper explains why neglect patients show longer/worse recovery of postural-walking autonomy than other stroke patients.

Animals↗

[Sleep and psychological disorders in intensive care units].

The evaluation of sleeping and psychical disorders for 24 patients hospitalized during at least 5 days in an intensive care unit was realized through a semi-guiding talk with a psychiatrist. All patients were faced to a very disordered sleep and a high number of psychopathological phenomenons: amnesia, disorientation, hallucinations, anxiety, depression. Different factors are concerned in the genesis of those troubles. Some means could prevent it.

Critical Care↗

[Too much or not enough in dementia].

Inside the silence with demented subjects, they suddenly name or design a present reality; they are attesting the quality of an object or its place inside space. Variable forces are always stated in an impersonal way. Nothing is announcing this testimony, nothing seems to justify it. It does not concern personal life at it's present time, does not state any promise for future, does not refer to any former times. The subject is creating the object: he says and it was. This disclosure is strictly related to prophecy which is choosing its material in the profane and ordinary language. We might be talking about inspiration, due to the fact that these revelations are appealing to an existential answer. We sometimes still have to do with such ways of thinking when they are remembering something and their sentences are relating to established facts: we are in present and past, punctual instant resuming, containing, anticipating all the others and cancelling them at the same time. It's not a question of souvenirs any more. The particular aspect of that language is more relating to onirism.

Cognition Disorders↗

[Thalamic neglect].

Thalamic lesions can provoke negligence behavior with various, sometimes dissociated manifestations: motor negligence or reduction in use of one half of the body whatever the direction of the gesture or the half-space in which it occurs; extinction phenomena demonstrated without difficulty for visual, somatesthetic and auditory modalities; spatial negligence involving attentional and intentional components, often difficult to distinguish. Negligence of this type is mainly the result of right sided lesions, with several non-exclusive explanations: natural predominance of the left hemisphere, activating role of language with respect to the left hemisphere, capacity of the right hemisphere to be "attentive" to bath half-spaces in contrast to the left hemisphere, attentive to the right half-space only.

Aged↗

[Mental disorders in patients with unilateral frontal tumors].

Using clinical procedures and psychological tests, the authors examined 72 patients with tumours of the left, and 68 with those of the right frontal lobe of the brain. Tumours of the left frontal lobe were shown to be associated with such manifestations as an impoverishment of motor activity and facial mobility, speech disturbances in the form of efferent motor or dynamic aphasia, slower rate of mental processes, impaired verbal memory, diminished capacity for generalization, difficulty in switching attention to another subject, and inclination toward stereotypy. These disturbances were attended by depressive emotions at the initial, and by the apathoabulic syndrome at the later stages. Tumours located in the right frontal lobe resulted in excessive elation and euphoria, underestimation of the gravity of one's condition and anosognosia, noncritical perception of reality, lack of concentration, diminution in the volume of perception, and a tendency toward confabular additions, which was particularly manifest in the sphere of visual perceptions. The local factor appears to play the principal part in the development of psychic disorders related to the left frontal tumours, whereas in cases of the right frontal tumours, it is the size and the degree of malignancy that matter.

Adult↗