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PubMed1993

Relationships between extrapyramidal signs and cognitive function in a community-dwelling cohort of patients with Parkinson's disease and normal elderly individuals.

The relationship between extrapyramidal sign (EPS) severity and cognitive function was investigated in 184 patients with idiopathic Parkinson's disease (PD) and 301 normal elderly individuals from a community-dwelling cohort in northern Manhattan, New York City. Fifty-six of the patients with PD met criteria for dementia of the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised, and of the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association. EPS were rated according to the Unified Parkinson's Disease Rating Scale. Cognitive function was assessed by neuropsychological tests of memory, orientation, abstract reasoning, language, construction, and psychomotor speed. Significant associations were found between EPS and neuropsychological performance in PD patients without dementia. Yet EPS severity was unable to account for the pronounced cognitive impairment in PD dementia. Individuals in the normal group with subtle EPS, but without overt idiopathic PD, showed widespread cognitive changes, including impairment in most of the tests that differentiated PD patients from normal subjects. Prospective follow-up of these individuals will determine whether this represents a preclinical stage of PD or constitutes an early manifestation of dementia.

Aged↗
PubMed2002

Incidence of dementia, Alzheimer's disease, and vascular dementia in Italy. The ILSA Study.

OBJECTIVES: To estimate the incidence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in older Italians and evaluate the relationship of age, gender, and education to developing dementia. DESIGN: Cohort incidence study in the context of the Italian Longitudinal Study on Aging. SETTING: Population sample from eight Italian municipalities. PARTICIPANTS: A dementia-free cohort of 3,208 individuals (aged 65-84), individuated after a baseline evaluation performed in 1992 / 93, aimed at detecting prevalent cases. MEASUREMENTS: The dementia-free cohort was reexamined in 1995 to identify incident cases. The Mini-Mental State Examination (cutoff 23 / 24) was employed to screen for dementia. Trained neurologists evaluated the individuals who screened positive. Final diagnoses had to meet Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria for dementia, National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD, and International Classification of Diseases, Tenth Revision criteria for VaD. RESULTS: Before the follow-up examination, 382 individuals had died (232 had reliable information). Of the 2,826 survivors, 2,266 completed the study. Overall, 127 new dementia cases were identified. Average incidence rates per 1,000 person-years were 12.47 (95% confidence interval (CI)=10.23-14.72) for dementia, 6.55 (95% CI=4.92-8.17) for AD, and 3.30 (95% CI=2.14-4.45) for VaD. Both AD and VaD showed age-dependent patterns. Education was protective against dementia and AD. Women carried a significantly higher risk of developing AD (hazard ratio=1.67, 95% CI=1.02-2.75), and men of developing VaD (hazard ratio=2.23, 95% CI=1.06-4.71). CONCLUSIONS: Incidence of dementia in Italy paralleled that in most industrialized countries. About 150,000 new cases per year are expected. A significant gender effect was evidenced for major dementia subtypes. The burden of VaD, especially in men, offers opportunities for prevention.

Age Distribution↗
PubMed2005

The longitudinal course of thought disorder in geriatric patients with chronic schizophrenia.

OBJECTIVE: This study longitudinally assessed previously validated dimensions of thought disorder--verbal underproductivity and disconnection--in geriatric schizophrenia and replicated previous cross-sectional differences in communication disorders. METHOD: Two hundred twenty patients with chronic schizophrenia were assessed with the Thought, Language, and Communication Scale over a mean follow-up period of 2.3 years. RESULTS: Patients had increases in verbal underproductivity but stable scores on disconnection over the follow-up period. Worsening in verbal underproductivity was associated with concurrent worsening in Mini-Mental State Examination scores and older age at baseline. CONCLUSIONS: Verbal underproductivity worsens with aging and is associated with cognitive worsening, although disconnected speech is relatively stable. Some geriatric patients with schizophrenia may lose the skills necessary to report symptoms, leading to the impression that their clinical status is improving.

Aged↗
PubMed1990

On prognostic research in adult neurologic disorders.

This note suggests some changes in variable selection and operationalization for research on prognosis in adult neurologic communicative disorders. The issues raised are relevant to both broad prognostic questions concerning extent of recovery, and focused questions regarding candidacy and treatment efficacy.

Adult↗
PubMed1987

Ten-year study of a Wilson's disease dysarthric.

This case study presents a ten-year speech treatment history of a young adult Wilson's disease patient in whom a severe dysarthria persisted despite drug and dietry controls. The patient was initially classified as "100% disabled" and was compensated because of his severe communication disorder. As he progressed, he ultimately secured full-time employment (involving verbal communication) which affords him economic independence. One aspect of therapy that played a critical role in the transfer of intelligible speech to situations outside the clinical setting was the use of a protocol for systematic client self-evaluation and for systematic elicitation and use of listener feedback. Methods that may prove helpful in the study of intelligibility maintenance in other dysarthric clients are presented. This report suggests that in some instances long-term therapy for dysarthria is both beneficial and economically justifiable.

Adult↗
PubMed1999

Efficacy and safety of rivastigmine in patients with Alzheimer's disease: international randomised controlled trial.

OBJECTIVES: To assess the effects of rivastigmine on the core domains of Alzheimer's disease. DESIGN: Prospective, randomised, multicentre, double blind, placebo controlled, parallel group trial. Patients received either placebo, 1-4 mg/day (lower dose) rivastigmine, or 6-12 mg/day (higher dose) rivastigmine. Doses were increased in one of two fixed dose ranges (1-4 mg/day or 6-12 mg/day) over the first 12 weeks with a subsequent assessment period of 14 weeks. SETTING: 45 centres in Europe and North America. PARTICIPANTS: 725 patients with mild to moderately severe probable Alzheimer's disease diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, and the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. OUTCOME MEASURES: Cognitive subscale of the Alzheimer's disease assessment scale, rating on the clinician interview based impression of change incorporating caregiver information scale, and the progressive deterioration scale. RESULTS: At the end of the study cognitive function had deteriorated among those in the placebo group. Scores on the Alzheimer's disease assessment scale improved in patients in the higher dose group when compared with patients taking placebo (P<0.05). Significantly more patients in the higher dose group had improved by 4 points or more than had improved in the placebo group (24% (57/242) v 16% (39/238)). Global function as rated by the clinician interview scale had significantly improved among those in the higher dose group compared with those taking placebo (P<0.001), and significantly more patients in the higher dose group showed improvement than did in the placebo group (37% (80/219) v 20% (46/230)). Mean scores on the progressive deterioration scale improved from baseline in patients in the higher dose group but fell in the placebo group. Adverse events were predominantly gastrointestinal, of mild to moderate severity, transient, and occurred mainly during escalation of the dose. 23% (55/242) of those in the higher dose group, 7% (18/242) of those in the lower dose group, and 7% (16/239) of those in the placebo group discontinued treatment because of adverse events. CONCLUSIONS: Rivastigmine is well tolerated and effective. It improves cognition, participation in activities of daily living, and global evaluation ratings in patients with mild to moderately severe Alzheimer's disease. This is the first treatment to show compelling evidence of efficacy in a predominantly European population.

Activities of Daily Living↗
PubMed1991

Relationships between personality development, interpersonal perception and communication in parents of schizophrenics, psychiatric controls and normal subjects.

Employing a family interaction paradigm, the psychodynamic development of personality (Consensus Spouse-Rorschach, CSR), mutuality in interpersonal perception (Interpersonal Perception Method), and feedback mechanisms in communication (the Confirmation-Disconfirmation Coding System) were investigated. The subjects were 66 parents (33 couples) whose offspring were as follows: 12 schizophrenics (RDC, DSM-III, DSM-III-R), 12 with other mental disorders, and 9 subjects with no mental disorder. Communication was observed in 2 situations, using CSR and the Colour Conflict Method. Feedback mechanisms in parent communication, previously found to be associated with offspring mental disorder, were associated both with lack of mutuality in interpersonal perception and low personality development. Lack of mutuality was associated with low parent personality development. The results emphasize the usefulness of monitoring both parent personality development (family structure), mutuality in interpersonal perception (family phenomenology), and communication (family behaviour) when assessing interaction in families of patients with severe mental disorder. They also point to a need for theoretical integration between the different concepts of family interaction of different clinical and theoretical traditions.

Communication↗
PubMed1986

Speech disorders among college freshmen: a 13-year survey.

This report provides data collected over a 13-year period on communicative disorders among college freshmen. The students were examined for existing speech disorders and questioned about recovery from previous disorders, with and without treatment. At examination, 2.42% exhibited articulation, voice, or fluency disorders; whereas an additional 2.34%, no longer exhibiting problems, reported recovery from previous disorders. Articulation therapy was reportedly effective in recovery (46%), whereas therapy for fluency disorders was less effective (24%) than spontaneous recovery (35%). Although voice disorders were evident at examination, self-perception of previous voice problems was almost nonexistent. The data, compared with those from other reports, confirm that direct examination produces prevalence rates higher than those found via informant interview methods.

Adolescent↗
PubMed2002

Levodopa and bromocriptine in hypoxic brain injury.

BACKGROUND: Postanoxic encephalopathy is frequent in patients presenting with abrupt cardiac arrest or respiratory failure. Little is known about the effectiveness of oral medications on the cognitive and motor consequences. OBJECTIVE: To present data suggesting partial improvement after administration of levodopa/benserazide. METHODS: After observing partial benefit in one case, each patient admitted to rehabilitation following brain anoxia was systematically treated with levodopa/benserazide (200/50 to 400/100 mg/day), then bromocriptine (15 mg/day). RESULTS: In the first patient, brain anoxia was severe, with secondary agitation, quadriparesis, involuntary movements, inattention and communication disorders. Introduction of levodopa/benserazide resulted in reduction of agitation and involuntary movements and improvement of communication, thus facilitating care and rehabilitation efforts. A weaning test resulted in rapid worsening. The four following patients also presented with anoxia of variable severity. Marked improvement was observed in case 2, presenting with agitation, loss of orientation, amnesia, postural disorders, involuntary movements and dysphagia, with a withdrawal test resulting in immediate re-enhancement of symptoms. Modest improvement was observed in patient 3, who had hypokinesia, rigidity, adynamia, impaired attention, and reduced verbal fluency. Patient 4 presented with memory disorders without motor difficulties: mild improvement was observed in daily life and memory tests. In patient 5 who also presented with severe memory disorders, the benefit was absent. In each case, bromocriptine was introduced 3-4 weeks following levodopa, but without additive effect. Both treatments could be interrupted after a few months, without worsening. CONCLUSIONS: Levodopa and benserazide can be of benefit in the few months following brain anoxia, especially on some of the motor disorders and apathy, but the benefit is inconstant and modest on memory disorders. Anoxia could alter dopaminergic mesencephalic systems, which activate the striatal and mediobasal frontal cortex, and these disorders could be partially reversible by medical treatment.

Adult↗
PubMed2000

Language disorders: a 10-year research update review.

OBJECTIVE: To review the past 10 years of research in child language or communication disorders, which are highly prevalent in the general population and comorbid with childhood psychiatric disorders. METHOD: A literature search of 3 major databases was conducted. The child language literature, describing the domains of language development--phonology, grammar, semantics, and pragmatics--is reviewed. RESULTS: Disorders of grammar, semantics, and pragmatics, but not phonology, overlap significantly with childhood psychiatric disorders. Receptive language disorders have emerged as high-risk indicators, often undiagnosed. Language disorders and delays are psychiatric risk factors and have implications for evaluation, therapy, and research. However, they are often undiagnosed in child mental health and community settings. The research has focused mostly on monolingual English-speaking children. CONCLUSION: Awareness of basic child language development, delay, and deviance is crucial for the practicing child and adolescent psychiatrist, who must diagnose and refer relevant cases for treatment and remediation. Future research needs to address the growing language diversity of our clinical populations.

Adolescent↗
PubMed1980

DAF as instrumental treatment for dysarthria in progressive supranuclear palsy: a case report.

In this case study, a 59-year-old male with progressive supranuclear palsy and hypokinetic dysarthria wore a small, solid state, battery operated, delayed auditory feedback device to reduce speech rate and to aid speech intelligibility. Time series measurements were made from tape recordings taken at the beginning of treatment and again after three months of daily wearing of the device. Measures of speech rate, intensity, and overall intelligibility indicate that when the instrument is worn, the subject's speech is slowed, vocal intensity increases, and intelligibility is markedly improved. The subject and his family report satisfaction with the instrument. The application of delayed auditory feedback to the treatment of communication disorders is discussed.

Cerebral Palsy↗
PubMed2002

Dietary intake of antioxidants and risk of Alzheimer disease.

CONTEXT: Laboratory findings have suggested that oxidative stress may contribute to the pathogenesis of Alzheimer disease. Therefore, the risk of Alzheimer disease might be reduced by intake of antioxidants that counteract the detrimental effects of oxidative stress. OBJECTIVE: To determine whether dietary intake of antioxidants is related to risk of Alzheimer disease. DESIGN AND SETTING: The Rotterdam Study, a population-based, prospective cohort study conducted in the Netherlands. PARTICIPANTS: A total of 5395 participants who, at baseline (1990-1993), were aged at least 55 years, free of dementia, and noninstitutionalized and had reliable dietary assessment. Participants were reexamined in 1993-1994 and 1997-1999 and were continuously monitored for incident dementia. MAIN OUTCOME MEASURES: Incidence of Alzheimer disease, based on Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria and National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer Disease and Related Disorders Association (NINCDS-ADRDA) criteria, associated with dietary intake of beta carotene, flavonoids, vitamin C, and vitamin E. RESULTS: After a mean follow-up of 6 years, 197 participants developed dementia, of whom 146 had Alzheimer disease. When adjustments were made for age, sex, baseline Mini-Mental State Examination score, alcohol intake, education, smoking habits, pack-years of smoking, body mass index, total energy intake, presence of carotid plaques, and use of antioxidative supplements, high intake of vitamin C and vitamin E was associated with lower risk of Alzheimer disease (rate ratios [RRs] per 1-SD increase in intake were 0.82 [95% confidence interval [CI], 0.68-0.99] and 0.82 [95% CI, 0.66-1.00], respectively). Among current smokers, this relationship was most pronounced (RRs, 0.65 [95% CI, 0.37-1.14] and 0.58 [95% CI, 0.30-1.12], respectively) and also was present for intake of beta carotene (RR, 0.49 [95% CI, 0.27-0.92]) and flavonoids (RR, 0.54 [95% CI, 0.31-0.96]). The associations did not vary by education or apolipoprotein E genotype. CONCLUSION: High dietary intake of vitamin C and vitamin E may lower the risk of Alzheimer disease.

Aged↗
PubMed2002

Multiple cerebral infarcts following septic shock.

A 60-year-old female in septic shock developed neurological signs and symptoms. She had left-sided hemiparesis, left homonymous hemianopia, bimanual coordination disorder, a language dysfunction of anomic aphasic type and a non-aphasic right hemispheric communication disorder. Computer tomography demonstrated bilateral anterior and posterior watershed as well as territorial infarctions. Risk factors included chronic airways limitation, cardiac failure and heavy smoking. Carotid duplex studies were normal. The mechanisms can be explained by flow changes and thrombus formation.

Cerebral Infarction↗
PubMed1984

A discussion of apraxia, aphasia, and gestural language.

It is understood that damage to the left cerebral hemisphere in adulthood may result in syndromes of language disturbances called the aphasias. The study of these syndromes sheds light on normal language processes, the relationship between language behavior and the brain, and how best to treat aphasic individuals. Aphasia, for some, is a central communication disorder affecting all symbolic behavior in all modalities (i.e., speech, writing, and gesture). Difficulty producing symbolic gestures on command is called apraxia. Others view aphasia as a manifestation of a motor-sequencing disorder affecting all gestural systems including those required for speech movements. These divergent theories of the underlying nature of aphasia can be tested through examination of deaf individuals who use sign language before onset of aphasia. Poizner et al. [Am. J. Physiol. 246 (Regulatory Integrative Comp. Physiol. 15): R868-R883, 1984] studied three such patients with different aphasia syndromes: one patient had a nonsymbolic, motor-sequencing disorder; one had a gestural apraxia; and one had neither. These findings force the conclusion that neither the symbolic nor motor-sequencing theory of aphasia can account for the many varieties of that disorder.

Aphasia↗
PubMed1999

Rates and risk factors for dementia and Alzheimer's disease: results from EURODEM pooled analyses. EURODEM Incidence Research Group and Work Groups. European Studies of Dementia.

OBJECTIVE: To investigate the risk of AD associated with a family history of dementia, female gender, low levels of education, smoking, and head trauma. BACKGROUND: These putative factors have been identified in cross-sectional studies. However, those studies are prone to bias due to systematic differences between patients and control subjects regarding survival and how risk factors are recalled. METHODS: The authors performed a pooled analysis of four European population-based prospective studies of individuals 65 years and older, with 528 incident dementia patients and 28,768 person-years of follow-up. Patients were detected by screening the total cohort with brief cognitive tests, followed by a diagnostic assessment of those who failed the screening tests. Dementia was diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (revised), and AD was diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Incident rates and relative risk (95% CI) express the association of a risk factor for dementia. RESULTS: Incident rates for dementia and AD were similar across studies. The incidence of AD increased with age. At 90 years of age and older the incidence was 63.5 (95% CI, 49.7 to 81.0) per 1,000 person-years. Female gender, current smoking (more strongly in men), and low levels of education (more strongly in women) increased the risk of AD significantly. A history of head trauma with unconsciousness and family history of dementia did not increase risk significantly. CONCLUSION: Contrary to previous reports, head trauma was not a risk factor for AD, and smoking did not protect against AD. The association of family history with the risk of AD is weaker than previously estimated on the basis of cross-sectional studies. Female gender may modify the risk of AD, whether it be via biological or behavioral factors.

Age Distribution↗
PubMed2001

Increased prevalence of vascular dementia in Japan: a community-based epidemiological study.

BACKGROUND AND OBJECTIVE: It has been suggested that there is a major difference in the ratio of AD to vascular dementia (VaD) between Japan and Western countries. To determine the type-specific prevalence of dementia in community-dwelling elderly from the Japanese community of Nakayama, all patients with dementing illness underwent a CT scan. METHODS: A door-to-door three-phase population survey was carried out on all persons aged 65 years and older residing at home on the prevalence day (January 1, 1997). The ascertainment of cases was made between January 1997 and March 1998. The study included a psychiatric interview; physical, neurologic, and neuropsychologic examinations; comprehensive laboratory tests; and cranial CT. A public health nurse also interviewed a person close to each subject. Dementia was defined according to the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised, criteria, AD according to the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association, and VaD according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition, combined with information from the patient's neurologic history and CT scanning. RESULTS: Of 1438 inhabitants, 1162 (81.0%) completed the protocol. The prevalence of dementia was 4.8%. Of the 60 subjects with dementia, 35% had AD, 47% had VaD, and 17% had dementia resulting from other causes. CONCLUSIONS: The prevalence of dementia was similar to previous reports, but, contrary to results of virtually all studies conducted in developed countries and those recently conducted in Japan, almost half of the cases in the present study appeared to have VaD with neuroradiologic confirmation.

Aged↗
PubMed1989

Children of parents with major affective disorders. A review of the past 5 years.

This article provides a review of most reported research on the children of parents with a major affective disorder over the past 5 years. Research between 1983 and 1988 has been characterized by methodologic improvements over earlier work including the use of direct interviews of children, standardized diagnostic criteria, and the employment of normal control groups. In general, results show that children of parents with a major affective disorder are at significant risk for depression and other disorders compared with normal controls. Future research is required to clarify the specific impact of having a parent with a major affective disorder compared with a parent with a different psychiatric disorder. Studies also need to focus on the impact of nonspecific variables such as family communication disorders, dysfunction in both parents, and also the effects of protective variables within individual children and the family. Longitudinal designs combining exploration of both genetic and psychosocial factors that extend into the years of highest risk are still needed to distinguish antecedents to adult illness from reactive disorders to living with a sick parent. Finally, current research findings that can be translated into clinical practice are enumerated.

Adolescent↗