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PubMed1999

Validity of current clinical criteria for Alzheimer's disease, vascular dementia and dementia with Lewy bodies.

BACKGROUND: Following the success of the NINCDS-ADRDA criteria for Alzheimer's disease, groups interested in vascular dementia and dementia with Lewy bodies have now adopted similar criteria. AIMS: To assess whether the validity of these criteria are influenced by the prevalence of mixed pathologies or by the prevalence rate. METHOD: A community based post-mortem study. RESULTS: Mixed pathologies were common (33.8%). The high specificities obtained for the CDLB and NINDS-AIREN criteria (1.00 and 0.95, respectively) were associated with low sensitivities (0.22 and 0.43, respectively). Low prevalence and the presence of mixed pathologies had a deleterious effect on positive predictive values. CONCLUSIONS: Current clinical diagnostic criteria are good at detecting pathology per se but not at detecting pure pathology. A large proportion of subjects from the general population fulfilling probable CDLB, probable NINCDS-ADRDA or probable NINDS-AIREN will have mixed pathologies.

Adult↗
PubMed1986

Decreased cerebral blood flow precedes multi-infarct dementia, but follows senile dementia of Alzheimer type.

A 7-year prospective study among 181 neurologically normal elderly volunteers (mean age, 70.6 years) revealed an incidence of 3.3%, or 0.47% new cases per year, for Alzheimer's disease (SDAT) and 5.5%, or 0.78% new cases per year, for multi-infarct dementia (MID). The unusually high incidence of MID is considered to reflect preselection of a large percentage of volunteers (48.6%) with risk factors for (but without symptoms of) atherothrombotic stroke. Of 88 volunteers at risk of stroke, 11.4% developed MID within 7 years. In MID patients, cerebral blood flow (CBF) values began to decline around 2 years before onset of symptoms, while in SDAT patients, CBF levels remained normal until symptoms of dementia appeared; thereafter, CBF declined rapidly.

Aged↗
PubMed1999

Report of the second dementia with Lewy body international workshop: diagnosis and treatment. Consortium on Dementia with Lewy Bodies.

BACKGROUND/OBJECTIVE: The second International Workshop of the Consortium on Dementia with Lewy Bodies (DLB) met to review developments since publication of consensus guidelines for the clinical and pathologic diagnosis of DLB in 1996. The specificity of a clinical diagnosis of probable DLB, made using consensus criteria, is generally high (>85%), but sensitivity of case detection is lower and more variable. Inter-rater reliability for the core clinical features-recurrent visual hallucinations and spontaneous motor features of parkinsonism-is acceptable, but reliable identification of fluctuating cognition remains problematic. Depression and REM sleep behavior disorder may be additional features supportive of a diagnosis of DLB that were not included in the original guideline. RESULTS: It is recommended that the clinical consensus criteria continue to be used in their current format with research efforts focused on increasing sensitivity of case detection. Antiubiquitin immunocytochemistry is the method of choice for routine detection of Lewy bodies for diagnostic purposes in research and clinical practice. The use of alpha-synuclein antibodies to label Lewy bodies and Lewy neurites represents a major methodologic advance since the first DLB workshop. alpha-Synuclein-based methods are likely to be most useful in research laboratories, particularly for clinicopathologic correlative studies. CONCLUSION: Clinical management of DLB patients usually centers on the treatment of noncognitive features. There is now a pressing need to establish appropriately designed randomized controlled trials in DLB. Collaboration between dementia and movement disorder specialists is essential for rapid progress in research and clinical management protocols.

Dementia↗
PubMed2002

Patterns of brain atrophy in frontotemporal dementia and semantic dementia.

OBJECTIVE: To identify and compare the patterns of cerebral atrophy associated with two clinical variants of frontotemporal lobar degeneration (FTLD): frontotemporal dementia (FTD) and semantic dementia (SemD). METHODS: Twenty patients with FTLD were classified as having FTD (N = 8) or SemD (N = 12) based on current clinical criteria. Both groups showed a similar spectrum of behavioral abnormalities, as indicated by the neuropsychiatric inventory. T1-weighted MRI was obtained for each patient and 20 control subjects. The regions of focal gray matter tissue loss associated with both FTD and SemD, as well as those differing between the two groups were examined using voxel-based morphometry. RESULTS: Regions of significant atrophy seen in both groups were located in the ventromedial frontal cortex, the posterior orbital frontal regions bilaterally, the insula bilaterally, and the left anterior cingulate cortex. The FTD, but not the SemD, group showed atrophy in the right dorsolateral frontal cortex and the left premotor cortex. The SemD, but not the FTD, group showed tissue loss in the anterior temporal cortex and the amygdala/anterior hippocampal region bilaterally. CONCLUSIONS: Although FTD and SemD are associated with different overall patterns of brain atrophy, regions of gray matter tissue loss in the orbital frontal, insular, and anterior cingulate regions are present in both groups. The authors suggest that pathology in the areas of atrophy associated with both FTD and SemD may underlie some the behavioral symptoms seen in the two disorders.

Adult↗
PubMed2003

Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease.

OBJECTIVES: To verify the diagnostic accuracy of the Brazilian version of the Mattis Dementia Rating Scale (DRS) in the diagnosis of patients with mild dementia in Alzheimer's disease (AD); to verify the interference of the variables age and schooling on the performance of the DRS. METHOD: The DRS was administered to 41 patients with mild AD and to 60 controls. In order to analyze the effects of age and schooling on the performance of the tests, patients and controls were separated into three age groups and three levels of schooling. RESULTS: The cutoff score of 122 showed a sensitivity of 91.7 % and specificity of 87.8 %. Age and schooling interfered in the DRS total score and in the scores of its subscales. CONCLUSION: The DRS showed good diagnostic accuracy in the discrimination of patients with mild AD from the control individuals. In the sample examined, the effects of schooling were more marked than age.

Age Factors↗
PubMed1989

Brainstem auditory evoked potentials in patients with multi-infarct dementia and dementia of the Alzheimer type.

Brainstem auditory evoked potentials (BAEPs) were recorded in 25 patients with multi-infarct dementia (MID) (mean age 71.2 years), 16 patients with dementia of the Alzheimer type (DAT) (mean age 70.6 years), and 34 normal subjects (mean age 69.1 years). Both MID and DAT patients showed significant prolonged interpeak latencies between waves I and V (I-V IPLs) compared to normal subjects (p less than .001 and p less than .01, respectively). In patients with MID, both I-III IPLs and III-V IPLs were significantly longer than those of normal subjects (p less than .01 and p less than .01 respectively). On the other hand, only III-V IPLs were significantly prolonged in patients with DAT (p less than .01). There were no significant differences between MID and DAT with regard to any of the IPLs. Present results suggest that the brainstem lesions are located in the auditory pathways in patients with MID and DAT. However, with BAEP measurements, we were not able to discriminate between patients with MID and DAT.

Aged↗
PubMed1998

Randomized, dim light controlled, crossover test of morning bright light therapy for rest-activity rhythm disorders in patients with vascular dementia and dementia of Alzheimer's type.

The authors compared the therapeutic effect of morning bright and dim light exposure on rest-activity (R-A) rhythm disorders in patients with vascular dementia (VD) and patients with dementia of Alzheimer's type (DAT). Participants in this study were 12 patients with VD (M/F = 5/7; average age = 81 years) and 10 patients with DAT (M/F = 4/6; average age = 78 years). They were exposed to 2 weeks of bright light (BL; 5000-8000 lux) and 2 weeks of dim light (DL; 300 lux) in the morning (09:00-11:00) in a randomized crossover design in which the 2-week treatment period took place between pretreatment (1 week) and posttreatment (1 week) periods. Continuous R-A monitoring was performed at 1-minute intervals throughout the study using an actigraph around the nondominant wrist. The BL exposure for 2 weeks induced a significant reduction in both nighttime activity and percentages of nighttime activity to total activity compared with the pretreatment period, as well as compared with the DL condition in the VD group, but not in the DAT group. These findings support the assumption that the therapeutic efficacies of morning BL exposure are prominent in VD patients and are mainly due to its photic effect rather than nonphotic effects such as the intensification of social interaction accompanying light therapy.

Activity Cycles↗
PubMed1975

Second thoughts on dementia. Evaluation and management of patients with mild dementia.

The early recognition of dementia along with consideration of differential diagnosis and elucidation of its underlying causes is of paramount importance because many of these conditions are remediable, given proper diagnosis and adequate treatment. The purpose of this article is to emphasize possible alternatives to the grim sentence of slowly progressive irreversible deterioration of personality and intellect when the verdict of dementia is pronounced.

Aged↗
PubMedDate not supplied

[Differential diagnosis among depressive pseudodementia, frontal dementia and subcortical dementia: a case report].

Among the clinical entities that show cognitive impairments it may sometimes be difficult to reach a diagnosis. That is the case with the differential diagnosis among depressive pseudodementia, subcortical dementia without motor symptoms and predominantly frontal-mesial frontotemporal dementia. This current paper presents one clinical case that illustrates such difficulties. In the first place, clinical, neuropsychological and neuroimaging features as well as common features of these three disorders are described, after which the case, and evolution of the diagnostic process are described.

Adult↗
PubMed2003

[What is dementia? 5. "Anti-dementia" drug: myth or reality?].

The frame of neurodegenerative diseases contains multiple pathologies for which very few active drugs have been found. Currently, drugs whose benefit is well established, are only available for Alzheimer's disease. May we term these drugs anti-dementia drugs? Pharmacological research was first oriented to find the mythic Fontaine of Youth. Nowadays, it is directed in a more concrete way, to protect the neurone from aggression before the occurrence of dementia. This pledge could appear very hazardous because we do not know the nature of the aggressors, and time is associated with wearing out and decline. Neurosciences have shown that there is a biology of cognition and that neurogenesis and apoptosis are permanently in confrontation in the brain. The present targets of pharmacology are directed against the decline of the neurone and of cognitive performance. Clinicians will check the accuracy of this very ambitious project.

Aging↗
PubMedDate not supplied

[EEG studies in Alzheimer dementia and multi-infarct dementia at various times of the day].

From three men and seven women (mean age 70 years) with dementia of the Alzheimer-type (DAT), and from four men and six women (mean age 77 years) with multi-infarct dementia (MID) closed-eye EEGs were registered at 0800, 1200, 1600, and 2000 hours and recorded on tape for computer processing. The data of both groups were compared statistically and also compared with data of former investigations conducted with 10 healthy elderly volunteers and 10 patients who suffered from cerebral arteriosclerosis with serious disorder of sleep-walking rhythm (HA). Most pathological EEG deviations are found in the MID-patients, but there is no significant distinction compared to the DAT-patients, although three of the latter showed normal EEGs. Compared to the HA the EEGs of the MID-patients differed more from those of the healthy volunteers; however, the physiological circadian variations were not leveled as in the HA. Even in consideration of daytime dependent fluctuations of frequency-parameters, a clear-cut discrimination between DAT and MID by means of the EEG seems impossible.

Aged↗
PubMed1990

[Standardization of a modular and hierarchic cognitive evaluation scale applicable to dementia. A French version of the Hierarchic Dementia Scale].

We tested a revised version of the Hierarchic Dementia Scale (HDS), proposed by Cole and Dastoor (1980), in order to improve its clinical usefulness and to enrich our knowledge about ageing. The scale was built with 20 subtests which covered the entire range of cognitive and motor functions. Each subtest was hierarchically organized so that success in a item implied success in inferior items. This hierarchical principle was time-saving and was validated by Cole and Dastoor. 149 control subjects performed this test. They were equally divided in 4 age-groups (55-64, 65-74, 75-84, 85-97) and 2 educational levels. None of these subjects had previous history of somatic or neuropsychiatric disease. They were completely self-sufficient in daily life. A large part of the controls failed in the most difficult items of some subtests: Learning, Calculation, Mental Control, Drawing, Recall, Similarities, Constructional Praxis. For these subtests, significantly different mean-scores were observed between age-groups and educational levels. However, the influence of each factor was variable from one subtest to another. Moreover, subgroups seem to exist in our population according to specific difficulties in some of these subtests. This study calls for caution in the interpretation of results in demented patients. Comparisons with other psychometric tools remain to be performed. This scale seems to be more useful for the quantification and follow-up of cognitive deficits than for the early diagnosis of dementia. In addition, this scale, which briefly explores many aspects of cognitive functions, seems especially useful to approach the heterogeneity of DAT.

Aged↗
PubMed1990

[Cerebral white matter bundle alterations in patients with dementia of Alzheimer type and patients with multi-infarct dementia--magnetic resonance imaging study].

The widths of the anterior white matter bundle (AWM) and the interhemispheric (AWM-TER) and intrahemispheric (AWM-TRA) bundles at the level of the foramen of Monro on horizontal inversion recovery MRI scans were measured in 17 patients with dementia of Alzheimer type (DAT), 16 patients with multi-infarct dementia (MID) and 47 age-matched normal subjects (NOR). The area of the corpus callosum (CC) on midsagittal spin-echo MRI scans was also measured in 12 DAT, 11 MID and 36 NOR. The Mini-mental score in patients with DAT was 20.8 +/- 5.9, which was not significantly different from that of 22.9 +/- 5.4 in patients with MID. The width of AWM was not significantly decreased in either DAT or MID compared with NOR. However, the width of AWM-TER in DAT and MID showed a significant decrease from that in NOR. The width of AWM-TRA was decreased significantly only in DAT. Compared with NOR, the area of the CC in DAT and MID was decreased by 7.0% (p less than 0.05) and 6.5%, respectively. The white matter bundle has an important role in the connectivity of the brain. Although loss of white matter occurs in both DAT and MID, the change appears more diffuse in DAT than MID.

Aged↗
PubMed1980

Hollymoor Hospital Dementia Service. Analysis of outcome of 230 consecutive referrals to a psychiatric-hospital Dementia Service.

Among patients aged under 75 referred to a psychiatric-hospital dementia service the sex ratio was 1:1. In older age groups women greatly outnumbered men. More men than women were in need of institutional care, and mortality was significantly higher in men. Significantly more men than women were referred for aggressive behaviour, and significantly more women than men for paraphrenia-like symptoms. Prompt domiciliary assessment, neuroleptic treatment, and community help arranged by the dementia service enabled more than a third of patients referred to be managed at home.

Aged↗
PubMed1984

[Relation between the degree of severity of the dementia and the extent of the manifestation of the pathomorphological changes in the cerebral cortex in senile dementia and Alzheimer's disease].

A study of 169 patients with senile dementia and Alzheimer's disease included history collection and the examination of the temporal pole. In the preparations impregnated according to Bilshovsky (in strictly the same volume of the cortex), senile plaques, neurofibrillar nodes and neurofibrillar skeletons were counted. Subsequently, the degree of the pathomorphological changes in each case was scored. The collation of the anamnestic and pathomorphological findings demonstrated a marked correlation (r = 0.99 +/- 0.0015) between the severity of dementia and the degree of pathomorphological changes in the cortex of the temporal pole.

Alzheimer Disease↗
PubMed1995

[Differential diagnosis of Alzheimer-type dementia and vascular dementia based on neuroimaging study].

A new method for differential diagnosis of Alzheimer-type dementia (AD) and vascular dementia (VD) based on neuroimaging studies was developed by Hayashi's quantification theory II. Fifty-five patients with AD and 36 patients with VD underwent both SPECT and MRI studies. Both images in each subject were scored according to the extent of hypoperfusion in areas including frontal and temporoparietal regions and the severity of deep white matter lesions and medial temporal lobe atrophy. The scores of AD and VD patients were significantly different, and this difference was considered to contribute most to the differential diagnosis of AD and VD. The weight of each score of SPECT and MRI items was computed, and the sum of the weights was calculated as a score for each subject to best distinguish AD from VD patients. This method was designed to simplify the calculation of the sample scores, and the sum of the weights was established so that a positive score (0 < or =) indicated the probability of AD, while a negative score (< 0) indicated the probability of VD. The correct diagnosis rate was 91% (50/55) for AD and 89% (32/36) for VD, for an overall discrimination of 90%. The present method seemed to be practically useful in the differential diagnosis of AD and VD.

Aged↗
PubMedDate not supplied

[Cognitive evaluation of patients with Alzheimer-type dementia by French revised version of the Hierarchic Dementia Scale].

The revised French version of the Hierarchic Dementia Scale (HDS) was assessed in 88 DAT patients (30 men, 58 women, mean age: 70, MMS from 0 to 26). The HDS consisted of 20 subtests which covered the entire range of cognitive functions; each subtest was hierarchically organized. This scale has been validated by the authors in 149 control subjects (Démonet et al., 1990). The goals of the present study were to validate this scale in DAT patients in comparison with the MMS scores and to specify the cognitive impairments of our pathologic population. Results showed that the scores on the HDS were highly correlated with the MMS scores (p < .0001). Some subtests of the HDS (memory subtests and mental control) allow good discrimination between mild demented patients and controls (sensibility = 80.8 p. 100, specificity = 96 p. 100). Conversely some subtests allowed a cognitive follow-up of patients for whom the MMS was no longer useful (MMS scores from 0 to 10). In conclusion, it appears that this scale is useful for drawing cognitive profile of DAT patients and to approach the heterogeneity of dementia.

Aged↗
PubMed1994

[Clinical differences in senile dementia of the Alzheimer's type and in multi-infarct dementia].

Impoverished grasp of the abstract and the essential notions (IG) and delusion of stealing (DS) were investigated in Alzheimer's senile dementia (ASD) and multi-infarction dementia (MID). IG severity was evaluated in impairment of memory and disorientation in 67 ASD and 70 MID patients. DS was studied in 24 ASD and 56 MID patients. It was found that in similar impairment of memory and disorientation, IG was more distinct in ASD, especially at early stages of the disease. DS occurred more frequently in ASD than in MID. In MID the IG and DS symptoms were more common and severe in patients over 80. No age-specific relations were recorded in ASD. The findings suggest involvement of cerebral senile-atrophic processes in IG and DS genesis in MID patients.

Aged↗