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PubMed2005

Involvement of neuropsychiatric pharmacists in a memory disorder clinic.

OBJECTIVE: Dementia is a progressive, degenerative brain disease characterized by an increasing loss of memory and other cognitive functions. Early diagnosis and intervention is important to enhance quality of life, as well as prevent costly nursing home admissions. Pharmacists can be used to assist in the selection and management of medications. SETTING: In the state of Florida, Memory Disorder Clinics are one approach to assist in the diagnostic process not only of Alzheimer's disease (AD), but also other causes of dementia. These clinics also provide community resources for caregivers and families. PRACTICE DESCRIPTION: The clinics provide services such as memory screenings, caregiver education, workshops for health professionals, and training for students in the allied health professions. PRACTICE INNOVATION: The clinic at Tallahassee Memorial Hospital utilizes clinical pharmacists to provide medication evaluations and education as a part of their services. MAIN OUTCOME MEASUREMENTS: The pharmacists' involvement has allowed an opportunity for interdisciplinary collaboration on the management and education of AD, other dementias, and the associated behavioral, psychiatric, and medical disorders. RESULTS: In the first six years of the clinic's existence, 408 evaluations were performed, with recommendations concerning medications. Almost 2,000 individuals have received medication evaluations through screenings. CONCLUSIONS: Pharmacists have valuable skills to assist in the management of diagnosis and management of dementia.

Journal Article↗
PubMed1990

[Memory disorders at different stages of development of temporal lobe astrocytoma].

Mnemonic disorders were investigated in 42 patients with astrocytomas of the temporal lobes. Mnemonic disorders examined at different disease stages were found to be related to the side and intralobular localization of tumors. In tumors of the mediobasal and neocortical structures of the temporal lobes, the irritative syndromes and memory loss symptoms were distinguished. Hypotheses of memory disorders seen in patients with those lesions are presented.

Adult↗
PubMedDate not supplied

[Pharmacologic models of memory disorders in pathology].

Some drugs induce memory impairments that resemble those observed in neurological and psychiatric disorders. It has therefore been suggested that these drugs might be used as models of these disorders. The concepts and methods developed by cognitive neuropsychology to investigate memory impairments are analysed. The interest and limitations of pharmacological models are discussed and illustrated by the benzodiazepine model of organic amnesia. It is concluded that the validity of a pharmacological model has to be defined in terms of face, construct and predictive validity and assessed according to the aims of modelization.

Animals↗
PubMed2002

An interdisciplinary therapeutic approach for dealing with patients attributing chronic fatigue and functional memory disorders to environmental poisoning--a pilot study.

Nonspecific symptoms and a general feeling of ill health that is difficult to objectify are the commonest health problems with which patients present to an Environmental Medicine Outpatient Department (OPD). Of this group, a great proportion meets the classification criteria for Chronic Fatigue Syndrome (CFS) or Functional Memory Disorders in association with Idiopathic Chronic Fatigue (FMD-ICF). This is a longitudinal study of the OPD of Environmental Medicine, Freiburg University Hospital, Germany, to determine the feasibility and impact of an interdisciplinary therapeutic approach (self-help program, acupuncture, psychosomatic support by group interventions) in 8 patients with CFS, FMD-ICF, or CFS in association with self-reported Multiple Chemical Sensitivities (sr-MCS). The intervention took into consideration the patients' need for treatment of physical aspects of their disease. This is an important step to motivate patients into required psychosomatic support. Although none of the patients was willing to accept psychosomatic support or psychotherapy at study outset, acceptance of psychosomatic group interventions was high during the study course. Additionally five patients started with personal counseling at the Psychosomatic Clinic, and, without feeling stigmatized, 4 patients started with specific psychotherapy. The patients' quality of life showed no increase after four months, but, as shown by the Sum-Score of SF-36, it had improved significantly at the end of the study, which covered eight months' treatment (p = 0.015). Two follow-up investigations showed that this improvement probably persisted in part (mainly in the dimensions mental health, social function, physical role function, and vitality). In conclusion our interdisciplinary therapeutic approach indicates successful treatment of patients attributing CFS, CFS/sr-MCS, and FMD-ICF to environmental poisoning. We now plan to conduct a randomized controlled trial in the future.

Acupuncture Therapy↗
PubMed1975

[Memory disorders in epileptic children with temporal psychomotor seizures].

The authors demonstrate the results of experimental psychological examination of memory in 57 patients with epilepsy in psychomotor temporal seizures. It was possible to show that in such cases there was a total decline of short-time memory. In bilateral foci and a long-term development of the disease there was a formation of an amnestic syndrome. The most distinct changes were seen in a delayed reproduction. In an electrostimulation of the structures of the temporal lobe by means of implanted electrodes the experiments displayed an intactness of direct reproduction during a stimulation of the neocortex, a moderate decrease in a stimulation of the hypocampus and a grave -- when stimulating the amygdalar complex.

Amygdala↗
PubMed1976

[Memory disorders in parkinsonism patients].

The experience of memory and retention weaknesses in Parkinsonian patients led us to question if these are only due to age-specific deteriorations, and if these weaknesses change during the L-Dopa therapy of the underlying disease. For this reason 30 Parkinsonian patients and 30 normal subjects of a matched control group took part in five different tests of retention and memory: digit span (Wechsler), visual retention test (Benton), Wechsler Memory Scale (subtests 4 and 7), delayed recall (Williams). The results (including some further samples of the test literature) gave some evidence of test-material-specific weaknesses in Parkinsonian patients: especially such memory decay as is dependent on the interval of retention. An organic deterioration of the intermediate term memory is suggested. This result could not be fully explained by known psychological or neurological characteristics of the underlying disease.

Age Factors↗
PubMed1997

[Several patients with memory disorders].

In three patients, referred to a memory clinic because of memory impairment, three different types of memory dysfunction were observed: a deficit in encoding of new episodic memories, a relatively pure loss of semantic memory and an impairment in retrieval of stored information. These patients were diagnosed as suffering from Alzheimer's disease, semantic dementia and frontotemporal dementia respectively. The diagnosis was essential in determining the individual management strategy.

Adult↗
PubMedDate not supplied

[Epidemiology of memory disorders].

To study the predictive value of memory complaints resulting in consultation with a GP as to the risk of subsequent dementia, we analysed the data from the follow-up of the Paquid cohort study carried out around Bordeaux. A sample of 1503 elderly people over 65, living at home and non-demented at the baseline screening, was considered. The risk of dementia was measured two and four years after the baseline screening: 60.8 per cent of subjects themselves perceived a memory impairment and 15.6 per cent expressed this complaint to their GP. Forty-eight developed a subsequent dementia. Taking the group without memory complaint as the reference set, three groups of elderly people could be recognized as at high risk of dementia: subjects with self-perceived memory impairment, consulting a GP with low memory performance or with normal memory performances, and subjects with memory complaints not resorting to a GP but with low memory performance. In non-demented elderly people, memory complaints expressed to the GP may be a strong predictor of dementia and should not be neglected.

Aged↗
PubMed1992

Memory complaints, memory disorders and focus localization in patients with partial epilepsy.

Our study aimed at analysing effects of epileptic foci on memory function in patients with partial epilepsy. Twenty-eight patients with spontaneous memory complaints and psychometrically established memory disorders were assessed by 21-channel electroencephalography recorded both during cognitive testing and during 99mTc-HMPAO single photon emission computed tomography (SPECT). Computed tomography (CT) was performed on the same day. None of the epilepsy-related factors (seizure type, seizure frequency, type of epilepsy, age at onset of the seizures, type of antiepileptic treatment) could be related directly to severity or type of memory impairment (classified into the categories 'global', 'verbal' and 'non-verbal'). Remarkably, this study found no significant relationship between EEG focus localization and severity of measured memory impairment. Most areas with hypoperfusion on the SPECT were found in the group with global (severe) amnesia, typically with a right frontal localization. Abnormalities on CT were predominantly found in the same group, however, with a right-sided parietal localization. An unanticipated finding was that the majority of temporal CT and SPECT lesions were found in the group with relatively better memory performance.

Adult↗
PubMed2005

Frequency of early and late-onset dementias in a Japanese memory disorders clinic.

The aim of this study was to compare the diagnostic profiles of patients with early (age<65 years) and late (age>or=65 years) onset of dementia in a memory disorders clinic in Japan. A total of 512 consecutive memory clinic patients were evaluated using clinical information and results of examinations. Diagnosis of dementia was made according to DSM-III-R, and that of subtypes according to standard diagnostic criteria. A total of 464 patients met the criteria for dementia. Amongst late-onset patients (n=430), Alzheimer's disease (AD) (48.1%) was the most frequent cause of dementia, followed by AD with cerebrovascular disease (CVD) (31.4%), vascular dementia (VaD) (9.1%), dementia with Lewy bodies (DLB) (3.7%), frontotemporal lobar degeneration (FTLD) (1.6%), and others (5.8%). On the contrary, amongst early onset patients (n=34), the most common dementia diagnosis was AD (38.2%), followed by VaD (23.5%), FTLD (14.7%), AD with CVD (5.9%), DLB (2.9%), and others (17.6%). FTLD and VaD were significantly more common in the early onset group. All patients, but one, with DLB and Parkinson's disease dementia were late-onset. The relative frequencies of AD, VaD, and DLB in our series are consistent with epidemiologic findings in several Western countries; however, the frequency of FTLD is not consistent with the previous findings presenting high frequency in late-onset patients in some Western countries.

Adenosine Triphosphatases↗
PubMed1997

[Clinical judgment and decision making in clinical practice. A music conductor with epilepsy followed by memory disorders].

A 40-year-old conductor was admitted because of increasing drowsiness and confusion. Two years before admission he had had a first seizure. One year before admission he had a generalized convulsive status epilepticus; the following months he was less able to concentrate. A second status epilepticus was followed by transient weakness of his left arm and a depressed level of consciousness for several weeks. After awakening, he had delusions, and his wife found him demented. In the following months his confusion and drowsiness gradually deteriorated. He had previously had gonorrhoea, an episode of fever and exanthema, and was found to have oligospermia as cause of his infertility. On examination he was disoriented, and he had dysarthria. His left pupil was smaller, but both pupils reacted normally. There was left hemianopia and cerebellar ataxia. CT and MR showed large ventricles and periventricular diffuse lesions in the white matter. CSF examination revealed leucocytosis and increased protein content. Further examination were focussed on serological evidence of syphilis, and finally neurosyphilis was diagnosed. After treatment with penicillin, the patient started to recover.

Adult↗
PubMed1979

Memory disorder in Korsakoff's psychosis: a neuropathological and neuropsychological investigation of two cases.

Neuropathological findings in the brains of two alcoholic patients with Korsakoff's psychosis are reported. Their memory defects had been studied in detail quantitatively over a period of nine years in one case and three years in the other, relevant details of which are presented. Both patients had had a relatively pure long-term memory impairment in the absence of other cognitive deficits and in the absence of a short-term memory impairment. Their retrograde amnesia for public events and famous faces had been measured and found to have extended backwards over at least twenty-five years. There was severe impairment in anterograde recognition memory for both verbal and non-verbal material. On a newly prepared memory quotient battery both patients had scored well below the bottom of the normal scale (less than 60, where 100 is the mean with a standard deviation of +/- 15). Both patients had also shown the characteristic differential improvement in retention when tested by cued recall and also the characteristic 'prior learning effect', i.e. normal retention of one list of words when tested by cued recall but impaired retention of a second list sharing the same cues as the first list. There had been a slight but significant deterioration in intelligence in one of the patients in the two years prior to his death, although his IQ still fell within the normal range. The other patient remained undeteriorated until his death, and his IQ also was close to an estimated measure of his premorbid IQ. In the brains of both patients there was marked gliosis, shrinkage and discolouration bilaterally in the medial nuclei of the mammillary bodies. In addition there was a thin band of gliosis bilaterally between the wall of the third ventricle and the medial dorsal nucleus, the rostral limit lying anterior to the medial dorsal nucleus. In the patient with no intellectual deterioration these were the only pathological changes that were seen. In neither patient was there evident local loss of nerve cells, gliosis or any other qualitative evidence of abnormality in the hippocampi, the white matter of the temporal lobes or the greater part of the medial dorsal nuclei, although it is difficult to be certain whether there was any overlap between the band of gliosis and the most medial region of the medial dorsal nueleus and other adjacent thalamic nuclei. In the other patient there was also a small zone of softening in the cerebellum and an increase in astrocytes in other regions of the cerebral hemispheres, including the basal ganglia, amygdala, and brain-stem, but without noticeable loss of cells. The question of the minimal lesion for the alcoholic Korsakoff amnesic state, and some aspects of the related anatomy, is discussed in the context of other reports in the literature which are, however, difficult to assess in the absence of details of the specificity, severity and character of the memory disorders.

Aged↗
PubMed1988

[The mechanisms of memory disorders at the stages in its acquisition and fixation].

The blockade of cholinergic system with scopolamine (10 mg/kg) did not impair the process of memory acquisition in rats but disrupted the process of memory fixation or consolidation, the disturbance stemming from the ketamine-blocked ion-channels of nicotinic receptors. Both scopolamine and ketamine impaired the process of memory recall, being more efficient in the case of ketamine. Piracetam (40 mg/kg) diminished the impair of fixation induced with scopolamine but did not affect the ketamine-induced impairment of memory acquisition.

Amnesia↗
PubMed2006

Accuracy of spatial normalization of the hippocampus: implications for fMRI research in memory disorders.

Functional magnetic resonance imaging (fMRI) studies in memory impairment have detected functional alterations in medial temporal lobe (MTL) structures, notably the hippocampus. Many of these studies employ spatial normalization to place subjects in a standardized template space prior to analysis; however, little is known about the effects of local atrophy on the normalization process in structures such as the hippocampus. The purpose of this study was to compare the accuracy of spatial normalization of the hippocampus between memory-impaired patients and controls. Twenty clinically-defined mild cognitive impairment (MCI) subjects and twenty elderly controls were studied at 4T with structural and functional MRI during a memory encoding-retrieval task. Bilateral hippocampal regions-of-interest (ROIs) were manually drawn for all subjects and further divided into anterior/posterior subregions. To assess normalization accuracy to the Montreal Neurological Institute template, the percentage of each template-defined hippocampal ROI originating from true hippocampal tissue was determined for all subjects. To assess the ability of spatial normalization to equalize group differences in hippocampal volume, pre- and post-normalization hippocampal volumes were compared. Finally, fMRI measures from template and non-template analyses were compared. Poorer normalization accuracy of the bilateral hippocampi, particularly the posterior portions, was found for MCI subjects. Significant group differences were found in left hippocampal and bilateral posterior hippocampal volumes, and these differences were not corrected with normalization. Hippocampal volumes were significantly correlated with normalization accuracy across MCI and control groups, but some significant differences in normalization accuracy persisted independent of these volume differences. Template and non-template fMRI analyses were significantly correlated in controls, but not MCI subjects, during memory retrieval. These findings suggest decreased normalization accuracy in memory-impaired subjects is a potentially important confounder of template-based fMRI analyses in the hippocampus and MTL.

Adult↗