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PubMed1989

[123I-IMP-SPECT finding of a case of presenile dementia with motor neuron disease--comparison between Alzheimer's disease, Pick's disease and presenile dementia with motor neuron disease].

Cross-sectional X-CT and 123I-IMP-SPECT studies comparing patients with presenile dementia with motor neuron disease (52-year-old, female), with Alzheimer's disease (51-year-old, male) and Pick's disease (49-year-old, male), have found a pattern of reductions in regional cerebral blood flow; the most severe reductions have been in fronto-temporal regions in cases of Pick's disease and presenile dementia with motor neuron disease. 123I-IMP-SPECT in a patient with presenile dementia with motor neuron disease differed significantly from uptake in a case with Alzheimer's disease. Although these findings should be evaluated as part of a prospective longitudinal study with X-CT and 123I-IMP-SPECT, it could be suggested that the development of these diseases has different pathophysiologies.

Alzheimer Disease↗
PubMed1989

[Acetylcholinesterase activity in CSF in senile dementia of Alzheimer type, vascular dementia, and Parkinson's disease].

Acetylcholinesterase (AChE) activity was measured in cerebrospinal fluid (CSF) from 25 patients with senile dementia of Alzheimer type (SDAT), 11 patients with vascular dementia (VD), 26 patients with Parkinson's disease (PD), and 30 normal controls. AChE activity also was measured in 46 normal subjects whose ages ranged from 15 to 85 to evaluate the effect of age on AChE activity. CSF AChE activity for the SDAT, VD and PD groups showed no significant difference compared with the value for the control group. However, there were significant decreases in CSF AChE activity in the VD and PD groups with the development of ventricular enlargement. There was no significant correlation between CSF AChE activity decrease and ventricular enlargement in the SDAT group. AChE activity increased significantly over the age range of 15 to 85. These results suggest that, although CSF AChE activity is not a useful parameter in the diagnosis of dementia, it may be a marker indicating abnormalities of the intracerebral cholinergic system during the process of cerebral atrophy.

Acetylcholinesterase↗
PubMed1989

[Multi-infarct dementia clinically simulating dementia of Alzheimer type. A comparison with angular gyrus syndrome].

A 74-year-old right-handed man with multiple cerebral infarction who presented with dementia simulating dementia of Alzheimer type (DAT) is reported. He had been well until April 20, 1987 when he developed transient right hand palsy lasting overnight. Eleven days later, he became confused, disorientated, and amnestic. He was admitted to this hospital on June 8. Physical examination revealed hypertension (170/90mmHg). On neurological examination, his consciousness was clear but he was demented. He showed disorientation, amnesia, and urinary incontinence. His most prominent symptom was disturbance of speech, including fluent aphasia and alexia with agraphia. Additionally, he showed ideomotor apraxia, construction apraxia, right-left agnosia, finger agnosia, and acalculia. On July 9, he had a transient attack of right hemiplegia with confusion. The brain CT scan performed on admission was unremarkable except for cavum septi pellucidum and a small low density area in the right basal ganglia. However, single photon emission computed tomography (SPECT) by 123I-labeled N-isopropyl-p-iodoamphetamine disclosed hypoperfusion of the cerebral blood flow in the border zones of the temporoparietal and frontal lobes on the left. A follow-up brain CT scan taken one month later demonstrated low density in the new areas corresponding to hypoperfusion shown by SPECT. Although the clinical features of the present case resembled those of DAT, dementia in this case was regarded as the result of multiple cerebral infarction since it occurred acutely with mild motor deficits, and brain CT scans and SPECT showed lesions indicating focal cerebral ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Differentiation between dementia and functional psychiatric disorders in a geriatric ward of a general psychiatric hospital using the 'Amsterdam Dementia-Screening Test'].

OBJECTIVE: Investigating the discriminative power of the Amsterdam Dementia Screening Test (ADS) in a heterogeneous elderly psychiatric population. SETTING: Observation clinic for the elderly MFC Duinoord, Psychiatric Centre Vogelenzang, Bennebroek, Holland. DESIGN: Retrospective comparison of test results and clinical diagnosis. METHOD: Patients referred for neuropsychological evaluation in 1991-1992 were selected on the basis of DSM-III-R discharge diagnosis 'dementia' or 'psychiatric syndrome'. The ADS, MMSE and SPMSQ scores of 30 male and 74 female patients were compared with diagnostic classification. RESULTS: The ADS appeared to be highly sensitive and specific. Only 10% of the psychiatric patients were incorrectly classified by the ADS, as against 55% using the MMSE, some MMSE items not differentiating at all. A significant correlation was found in the demented group between ADS and MMSE total scores on the one hand and demographic variables such as age and level of education on the other. The latter appears to be related to better performance on visuo-constructive tasks by more highly educated subjects. CONCLUSION: Normative data for the ADS come from an inpatient population. This study shows that the ADS discriminates well in a mixed in/outpatient group with dementia syndromes or psychiatric disorders. The visuo-constructive tasks appear to be related to the level of education.

Aged↗
PubMed1996

[Screening tests for dementia: agreement between CST14 and ADS3 is incomplete (Cognitive Screening Test and Amsterdam Dementia Test)].

The agreement between two screening tests for the detection of dementia was tested by comparing a 14-item orientation questionnaire (Cognitive Screening Test or CST14) and the short version of the Amsterdam Dementia Screening Test (ADS3: Visual Memory, Orientation and Fluency. All 106 consecutive patients (71% female) of a psychogeriatric day care center were tested in two sessions. Their mean age was 77,7 (range 52-89). Taking the advised cutting-scores into account, we found consistent results for 74% of the patients (95%-confidence interval: 65%-82%): 60 patients were positive for dementia on both tests, and 18 were negative. For 28 patients the results were inconsistent, in that more patients scored in the impaired range for ADS3 than for CST14.

Aged↗
PubMedDate not supplied

[Lipid metabolism parameters in patients with multi-infarct dementia and Alzheimer's type dementia].

The concentrations were determined of triglycerides (TG), total cholesterol (Ch), high density fraction of (HDL-Ch), low density fraction of cholesterol (LDL-Ch), apolipoprotein B (apo-B) in patients with dementia of Alzheimer type (DAT, 14 patients) and multi-infarct dementia (MID, 63 patients). No significant differences in the estimated lipid parameters in both groups were found, except the calculated value of atherogenic index (Ch/HDL-Ch), which was significantly higher in patients with MID. Our results suggest that this parameter is a much more sensitive atherogenic indicator in blood-vessels than other tested lipid parameters. This finding may influence the therapeutic approach to patients with dementia.

Adult↗
PubMed2005

Brain 3D-SSP SPECT analysis in dementia with Lewy bodies, Parkinson's disease with and without dementia, and Alzheimer's disease.

OBJECTIVES: Cerebral blood flow was compared among patients with dementia with Lewy bodies (DLB), Parkinson's disease with dementia (PDD), Parkinson's disease without dementia (PD), and Alzheimer's disease (AD) using three-dimensional stereotactic surface projection (3D-SSP) analysis. PURPOSE: We attempt to clarify the difference of reduction pattern on SPECT among patients having DLB, PDD, PD, AD. PATIENTS AND METHODS: Six patients with DLB, 7 patients with PDD who were matched with the DLB patients for age, unified Parkinson's disease rating scale-III (UPDRS-III) score, and degree of cognitive function disorders, 21 patients with PD who were matched with the DLB patients for age, UPDRS-III score, 12 patients with AD who were matched with the DLB patients for age and degree of cognitive function disorders, and 12 control subjects. All patients were examined by N-isopropyl-p[123I] iodoamphetamine single photon emission computed tomography (123I-IMP SPECT), and obtained images were analyzed with 3D-SSP using an image-analysis software, iSSP ver. 3.5. RESULTS: Although DLB and PDD showed similar cerebral perfusion reduction pattern at the lateral parietal association and lateral temporal association and precuneus on SPECT by the pixel-by-pixel comparison, greater perfusion reduction was observed in DLB than in PDD. Cerebral perfusion was decreased at the occipital lobe of the DLB patients compared with the AD patients. CONCLUSIONS: The regional pattern of blood flow reduction in the brain was found to be different among DLB, PD, and AD. Greater blood flow reduction was observed in DLB, although DLB and PDD showed similar reduction pattern. These regional differences were considered to suggest different and disease-specific combinations of underlying pathological and neurochemical processes.

Aged↗
PubMed2006

In vivo SPECT imaging of muscarinic acetylcholine receptors using (R,R) 123I-QNB in dementia with Lewy bodies and Parkinson's disease dementia.

INTRODUCTION: Alterations in cholinergic function have been reported to be associated with dementia. The aim of this study was to investigate differences in the distribution of muscarinic acetylcholine receptors (mAChRs) using (R,R) 123I-iodo-quinuclidinyl-benzilate (QNB) and single photon emission computed tomography (SPECT) in dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD) and age-matched controls. 123I-QNB binding was also compared to the corresponding cerebral perfusion changes in the same subjects. METHODS: 63 subjects (24 controls, 14 DLB, 25 PDD) underwent 123I-QNB and perfusion 99mTc-exametazine SPECT scanning. Image analysis, using statistical parametric mapping (SPM99), involved spatial normalisation of each image to a customised template, followed by smoothing and intensity normalisation of each image to its corresponding mean whole brain uptake. Group effects and correlations were assessed using two sample t tests and linear regression respectively. RESULTS: Relative to controls, significant elevation of 123I-QNB binding was apparent in the right occipital lobe in DLB and right and left occipital lobes in PDD (height threshold p<or=0.001 uncorrected). PDD also showed significant loss in uptake in frontal regions and temporal lobes bilaterally that was not present in DLB. These patterns appeared to be independent of any corresponding rCBF changes. CONCLUSION: Significant elevation of mAChRs in the occipital lobe was associated with DLB and PDD. This may relate to the visual disturbances that are prevalent in these disorders. Further studies are required in order to establish the role of mAChRs in visual function.

Aged↗
PubMed2005

Relationship between Parkinson disease with dementia and dementia with Lewy bodies.

Parkinson disease (PD) and dementia with Lewy bodies (DLB) are considered Lewy body diseases (LBDs). To clarify the relation between PD with dementia (PDD) and DLB, 30 patients with LBD were divided into pathological subtypes according to the consensus guidelines for DLB. Patients with PDD showed neocortical and limbic type of LBD as well as patients with DLB. Dementia had not been noted in 2 patients with neocortical type. Our results indicate that PDD and DLB share a common pathological substrate and that the pathological subtypes of LBD show considerable overlap in clinical manifestations.

Age of Onset↗
PubMed2001

Culture and dementia: accounts by family caregivers and health professionals for dementia-affected elders in South Korea.

With rapidly growing concerns about the high rates of dementing illness in Korea, this study presents findings from in-depth qualitative interviews with fifteen family caregivers and health professionals on: (1) perceptions of dementia among Korean family caregivers, (2) cultural influences on caregiving, and (3) status of the development and utilization of formal services for the older population with dementia in Korea. Practices of the traditional familism are demonstrated in the multigenerational family where both material support and respect for the aged are the social norm. Thus, providing informal care for a demented parent is expected in the context of fulfilling filial responsibilities. In assessing the current situation in Korea, there is a lack of social services established by the Korean government for the older individuals, which can be attributed to the norm of parental caregiving. This cultural influence poses significant challenges to Korean caregivers of dementia-impaired elders.

Journal Article↗
PubMed1996

Kitwood's approach to dementia and dementia care: a critical but appreciative review.

This paper critically examines the recent work of Tom Kitwood and his colleagues at the Bradford Dementia Group. After initial details relating to Kitwood's early work and the development of the research group, the paper sets out Kitwood's ideas regarding the nature of dementia and dementia care. Four areas of contribution made by Kitwood are outlined. Problems relating to Kitwood's research methods are then put forward. In conclusion, it is suggested that while Kitwood's work will undoubtedly help enhance the care given to elderly demented people, more work needs to be done to ensure the validity of his methods.

Alzheimer Disease↗
PubMed1987

Correlations of Mini-Mental State and modified Dementia Rating Scale to measures of transitional health status in dementia.

Information regarding the relationships of the Mini-Mental State (MMS) and a modified Dementia Rating Scale (mDRS) to measures of change, that is, "transitional" health status, in dementia would be potentially useful in the evaluation and care of demented patients. In a longitudinal study of demented outpatients, MMS and mDRS at entry and at 1- to 2-year follow-up were significantly correlated with five measures of physician- and advocate-rated transitional health status and change in living arrangement during this interval (p less than .01). MMS and mDRS at follow-up also predicted mortality during a subsequent year of follow-up (p less than .01). Estimated change in MMS and mDRS was significantly correlated with all transition variables, except for MMS and results suggest MMS, mDRS, and estimated change in them reflect these aspects of transitional health status in dementia.

Aged↗
PubMed2006

Characteristics of visual hallucinations in Parkinson disease dementia and dementia with lewy bodies.

OBJECTIVE: Parkinson disease dementia (PDD) and dementia with Lewy bodies (DLB) have overlapping clinical and pathologic features. Recurrent visual hallucinations (RVH) are common in both disorders. The authors have compared details of hallucination characteristics and associated neuropsychiatric features in DLB and PDD. METHODS: This is a descriptive, cross-sectional study using the Institute of Psychiatry Visual Hallucinations Interview (IP-VHI) to explore self-reported frequency, duration, and phenomenology of RVH in PDD and DLB. The caregivers' ratings of hallucinations and other neuropsychiatric features were elicited with the Neuropsychiatric Inventory (NPI). RESULTS: Fifty-six patients (35 PDD; 21 DLB) with RVH were assessed. Hallucination characteristics were similar in both disorders. Simple hallucinations were rare. Most patients experienced complex hallucinations daily, normally lasting minutes. They commonly saw people or animals and the experiences were usually perceived as unpleasant. NPI anxiety scores were higher in PDD. Neuropsychiatric symptoms coexisting with hallucinations were apathy, sleep disturbance, and anxiety. CONCLUSIONS: Patients with mild to moderate dementia can provide detailed information about their hallucinations. Characteristics of RVH were similar in PDD and DLB, and phenomenology suggests the involvement of dorsal and ventral visual pathways in their generation. The coexistence of RVH with anxiety, apathy, and sleep disturbance is likely to impair patients' quality of life and may have treatment implications.

Aged↗
PubMed2004

Responsiveness of the quality of life in late-stage dementia scale to psychotropic drug treatment in late-stage dementia.

BACKGROUND: We report on the responsiveness of a previously validated quality-of-life scale, the Quality of Life in Late-Stage Dementia scale (QUALID), as an outcome measure in a clinical trial of two psychotropic medications. METHODS: Secondary analyses were conducted comparing outcome measures used in a randomized double-blind trial of two antipsychotics (olanzapine and risperidone) for the treatment of dementia-related behavioral symptoms. The QUALID was completed for 31 of the patients in addition to several measures of behavior-related dementia symptoms including the Neuropsychiatric Inventory, the Withdrawn Behavior subscale of the Multidimensional Observation Scale for Elderly Subjects, the Mini-Mental State Examination, and the Clinical Global Impression. Measures of safety and adverse effects included the Simpson-Angus Scale and records of specific adverse events. RESULTS: A significant positive relationship was found between QUALID score and improvement in behavioral symptoms, and a negative association was found with adverse medication effects. CONCLUSIONS: The QUALID was sensitive to both the treatment effects and the adverse effects of medication in this sample of patients.

Aged↗
PubMed2004

Are Parkinson's disease with dementia and dementia with Lewy bodies the same entity?

The diagnosis of Parkinson's disease with dementia (PDD) or dementia with Lewy bodies (DLB) is based on an arbitary distinction between the time of onset of motor and cognitive symptoms. These syndromes share many neurobiological similarities, but there are also differences. Deposition of beta-amyloid protein is more marked and more closely related to cognitive impairment in DLB than PDD, possibly contributing to dementia at onset. The relatively more severe executive impairment in DLB than PDD may relate to the loss of frontohippocampal projections in DLB. Visual hallucinations and delusions associate with more abundant Lewy body pathology in temporal cortex in DLB. The differential involvement of pathology in the striatum may account for the differences in parkinsonism. Longitudinal studies with neuropathological and neurochemical evaluations will be essential to enable more robust comparisons and determine pathological substrates contributing to the differences in cognitive, motor, and psychiatric symptoms.

Amyloid beta-Peptides↗
PubMed1995

Differentiation of the dementias of Alzheimer's and Parkinson's disease with the dementia rating scale.

The Mattis Dementia Rating Scale (DRS) was used to distinguish between 50 dementia of the Alzheimer's type (DAT) and 50 Parkinson's disease (PD) subjects matched for age, education, and DRS total score. Despite a similar level of overall cognitive impairment, the DAT group earned significantly lower scores than did the PD group on the Memory subscale, while the PD group displayed lower scores than did the DAT subjects on the Construction subscale. Ajackknifed, stepwise, linear discriminant function using the five DRS subscales revealed that the Memory, Construction, and Initiation subtests significantly distinguished the groups. These results suggest qualitative differences in the dementias of DAT and PD patients and reveal that such differences can emerge on brief mental status examinations.

Aged↗
PubMed2001

[A patient with probable dementia with Lewy bodies, who showed improvement of dementia and parkinsonism by the administratim of donepezil].

We present a 73-year-old man with probable dementia with Lewy bodies(DLB). At 65 years of age, he gradually developed bradykinesia, gait disturbance and mild amnesia. At 71 years of age, he noted resting tremor in bilateral hands, and amnesia and disorientation were exacerbated. He was diagnosed as having parkinsonism and took L-dopa/carbidopa at 100 mg/day. Since he developed hallucination and abnormal behavior 2 days after the initiation of the drug, he stopped taking L-dopa and was admitted to our hospital. A neurological examination on admission revealed moderate amnesia, disorientation, finger agnosia, constitutional apraxia, mask-like face, cogwheel rigidity, resting tremor in bilateral hands, and bradykinesia. Brain MRI showed mild brain atrophy, and single photon emission computerized tomography(SPECT) showed diffuse moderate hypoperfusion in bilateral cerebral cortex. As he had fluctuating cognitive dysfunction and parkinsonism, he was diagnosed to have probable DLB. As his dementia was exacerbated by trihexyphenidyl, an anti-cholinergic agent, at 2 mg/day, we treated him with donepezil, an anti-choline esterase agent, at 3-5 mg/day. His parkinsonism, including rigidity and bradykinesia, was markedly improved his dementia, consisting of amnesia and disorientation. Electroencephalography (EEG) improved in the organization of the dominant rhythm. The SPECT improved in the blood perfusion of the bilateral frontal lobe as well as cognitive function and parkinsonism were maintained by donepezil for 6 months after discharge. A therapeutic efficacy of donepezil for DLB has recently been reported. It is notable that donepezil was beneficial not only for cognitive dysfunction but also for parkinsonism in the present case with probable DLB.

Aged↗
PubMedDate not supplied

Dementia with Lewy bodies showing advanced Lewy pathology but minimal Alzheimer pathology--Lewy pathology causes neuronal loss inducing progressive dementia.

The present study concerns an autopsied case of dementia with Lewy bodies (DLB) showing advanced Lewy pathology but minimal Alzheimer pathology. The patient was a 50-year-old Japanese male without inheritance. His initial symptoms at the age of 43 suggested the diagnosis ofjuvenile idiopathic Parkinson's disease (PD), but were followed by memory disturbance 1 year later. He showed parkinsonism, dementia, personality change, fluctuating cognition and visual hallucinations 3 years later. Neuroradiological examination revealed moderate brain atrophy, predominantly in the frontal and temporal lobes. Neuropathological examination demonstrated a widespread occurrence of Lewy bodies (LB) with LB-related neurites not only in the brainstem but also in the cerebrum. The present case showed Lewy pathology which corresponded to stage IV by our staging and was parallel to neuronal loss. There was marked neuronal loss with many LB-related neurites in the CA2 of the hippocampus. Neurofibrillary tangles (NFT) were almost restricted to the entorhinal cortex, while senile plaques were absent. Consequently, the present case was pathologically diagnosed as having DLB of the neocortical type, pure form. In the present study, we suggest that Lewy pathology in the cerebral cortex could be responsible for progressive dementia.

Alzheimer Disease↗