RESUMEN
BACKGROUND: Carbon monoxide (CO) poisoning may result in white matter hyperintensities (WMH) and neurocognitive impairments. OBJECTIVE: To assess in a prospective study WMH in CO-poisoned patients and their relationship to cognitive functioning. METHODS: Seventy-three consecutive CO-poisoned patients were studied. MR scans and neurocognitive tests were administered on day 1 (within 36 hours after CO poisoning), 2 weeks, and 6 months. Age- and sex-matched control subjects for white matter analyses only were obtained from the authors' normative imaging database. MR scans were rated for WMH in the periventricular and centrum semiovale regions, using a 4-point rating scale. Two independent raters rated the scans, and a consensus was reached. RESULTS: Thirty percent of CO-poisoned patients had cognitive sequelae. Twelve percent of the CO-poisoned patients had WMH, with significantly more periventricular, but not centrum semiovale, WMH than control subjects. The WMH in CO-poisoned patients did not change from day 1 to 6 months. Centrum semiovale hyperintensities were related to worse cognitive performance. Duration of loss of consciousness correlated with cognitive impairment at all three times. Initial carboxyhemoglobin levels correlated with loss of consciousness but not with WMH or cognitive sequelae. CONCLUSIONS: CO poisoning can result in brain injury manifested by WMH and cognitive sequelae. The WMH were not related to CO poisoning severity. The WMH occurred in both the periventricular and the centrum semiovale regions; however, only those in the centrum semiovale were significantly associated with cognitive impairments.
Asunto(s)
Encéfalo/patología , Intoxicación por Monóxido de Carbono/patología , Trastornos del Conocimiento/patología , Pruebas Neuropsicológicas/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Encéfalo/efectos de los fármacos , Intoxicación por Monóxido de Carbono/complicaciones , Intoxicación por Monóxido de Carbono/psicología , Trastornos del Conocimiento/inducido químicamente , Trastornos del Conocimiento/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Vaina de Mielina/patología , Estudios ProspectivosRESUMEN
This study was designed to determine the relationship between psychiatric features of dementia and their impact on caregivers. 35 patient-caregiver pairs were evaluated at two university-affiliated dementia clinics, using standard instruments to rate patient psychiatric features and caregiver burden and depression. There were highly significant correlations between patient agitation and both caregiver burden (r = 0.59, p = 0.0002) and depression (r = 61, p = 0.0001). These associations remained significant after adjusting for multiple demographic and dementia variables. There was no significant association between patient delusions, hallucinations, or depression and caregiver burden or depression. Agitation, particularly physical aggression, may impact caregivers even more than does the cognitive status of the demented patient.
Asunto(s)
Cuidadores/psicología , Demencia/psicología , Anciano , Depresión/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Estrés Psicológico/psicologíaRESUMEN
The distribution of apolipoprotein E (ApoE) mRNA was characterized in the hippocampus of humans with Alzheimer disease (AD) and in rats with experimental lesions (unilateral ablation of the entorhinal cortex) that model selected features of AD. In both AD and the lesion model, we observed a shift in the location of astrocytes containing prevalent ApoE mRNA from the neuropil to regions with densely packed neurons. The increased abundance of ApoE mRNA in astrocytes close to neuron cell bodies could be indicative of lipid uptake in regions where neurons are degenerating or where synaptic remodeling is taking place.
Asunto(s)
Enfermedad de Alzheimer/metabolismo , Apolipoproteínas E/genética , Corteza Entorrinal/fisiología , Hipocampo/metabolismo , ARN Mensajero/metabolismo , Enfermedad de Alzheimer/patología , Animales , Astrocitos/metabolismo , Astrocitos/patología , Desnervación , Hipocampo/patología , Humanos , Hibridación in Situ , Masculino , Neuronas/patología , Neurópilo/metabolismo , Neurópilo/patología , Ratas , Ratas Endogámicas F344RESUMEN
As part of a multicenter project to study noncognitive behavioral disturbances in dementia, the authors developed a comprehensive caregiver-rated questionnaire for these behaviors. The authors determined the reliability of caregiver ratings and compared caregiver ratings with clinician ratings using standard instruments. Caregivers showed good test/retest reliability for ratings of all types of patient behavioral disturbance. Caregiver interrater reliability was highest for depression and lowest for psychosis. The correlation between caregiver reports and professional assessments was highest for agitation, intermediate for psychosis, and lowest for depression. The match between caregiver and clinician assessments of patient behaviors appears to vary significantly by the type of behavior assessed.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Demencia/diagnóstico , Pruebas Neuropsicológicas/estadística & datos numéricos , Trastorno de la Conducta Social/diagnóstico , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/psicología , Cuidadores/psicología , Demencia/clasificación , Demencia/psicología , Trastorno Depresivo/clasificación , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Neurocognitivos/clasificación , Trastornos Neurocognitivos/diagnóstico , Trastornos Neurocognitivos/psicología , Variaciones Dependientes del Observador , Proyectos Piloto , Psicometría , Agitación Psicomotora/clasificación , Agitación Psicomotora/diagnóstico , Agitación Psicomotora/psicología , Reproducibilidad de los Resultados , Trastorno de la Conducta Social/clasificación , Trastorno de la Conducta Social/psicologíaRESUMEN
OBJECTIVE: To investigate specific neuropathologic correlates of agitation and physical aggression in Alzheimer disease (AD). DESIGN: Neuronal counts in the nucleus basalis, locus ceruleus, and substantia nigra were compared in the brains of patients with pathologically definite AD with or without histories of agitation or interpersonal violence. SETTING: Alzheimer disease center of a university department of neurology. MAIN OUTCOME MEASURES: Neuron densities in the nucleus basalis and absolute neuron counts in the locus ceruleus and substantia nigra pars compacta. RESULTS: The patients with AD who had histories of unequivocal interpersonal violence had significantly greater neuron counts in the substantia nigra pars compacta than did the nonviolent patients with AD. This finding remained significant after multiple clinical and neuropathologic variables were adjusted for. Neuropathologic findings in the nucleus basalis and locus ceruleus were not different between violent and nonviolent patients. CONCLUSION: Preservation of pigmented substantia nigra neurons may be a risk factor for physical aggression in AD.
Asunto(s)
Agresión , Enfermedad de Alzheimer/patología , Enfermedad de Alzheimer/psicología , Neuronas/patología , Sustancia Negra/patología , Anciano , Autopsia , Femenino , Humanos , Locus Coeruleus/patología , Masculino , Núcleo Olivar/patología , Especificidad de Órganos , ViolenciaRESUMEN
OBJECTIVE: The aim of the present study was to determine the accuracy of clinical diagnoses of dementia in a large group of patients evaluated in a multicenter, university-based, Alzheimer's disease diagnostic and treatment program. METHOD: Clinical diagnoses and neuropathological results from seven collaborating Alzheimer's disease research centers were compared for 196 cases of dementia. RESULTS: When diagnoses of probable Alzheimer's disease, possible Alzheimer's disease, and Alzheimer's disease plus another condition were combined, 163 (83%) of the patients were clinically regarded as likely to have had Alzheimer's disease. Of those patients, 134 (82%) were found to have neuropathological changes diagnostic of Alzheimer's disease or Alzheimer's disease plus another condition. A total of 116 patients were diagnosed as having probable Alzheimer's disease; 100 (86%) of those were found to have pathological diagnoses of Alzheimer's disease or Alzheimer's disease plus another condition. Cerebral infarcts were found in 17% of the patients clinically diagnosed with probable Alzheimer's disease. Lewy bodies with variable Alzheimer's disease-type pathological changes were found in 7% of the patients with clinical diagnoses of probable Alzheimer's disease. Conversely, significant Alzheimer's disease-type pathological changes were found in 55% of the patients clinically diagnosed as having vascular dementia. CONCLUSIONS: Clinicians accurately predict Alzheimer's disease-type neuropathological findings in a high proportion of cases of dementia but may not predict cerebrovascular pathology and Lewy bodies in some patients with apparent clinical Alzheimer's disease and may often fail to predict Alzheimer's disease-type pathological findings in patients with apparent vascular dementia. With the emergence of effective treatments for Alzheimer's disease, there is an increasing need to optimize methods for ante-mortem diagnosis of dementia.
Asunto(s)
Enfermedad de Alzheimer/patología , Anciano , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/epidemiología , Infarto Cerebral/diagnóstico , Infarto Cerebral/epidemiología , Comorbilidad , Demencia/diagnóstico , Demencia/epidemiología , Demencia/patología , Demencia Vascular/diagnóstico , Demencia Vascular/epidemiología , Demencia Vascular/patología , Diagnóstico Diferencial , Femenino , Humanos , Cuerpos de Lewy/patología , Masculino , Ovillos Neurofibrilares/patología , Probabilidad , Escalas de Valoración PsiquiátricaRESUMEN
MR scanning is used in the clinical evaluation of patients with dementia but lacks a reliable method of visual inspection. Two neurologists conducted multiple pilot trials of alternate methods for visual inspection of MRIs, including methods that produced at least 75% interrater agreement in repeat trials, and selected a final method for rating ventricular:brain ratio (VBR), cortical atrophy, and white matter changes. Two other neurologists, new to the method, tested interrater reliability for each component of the method after a brief training session. The correlation of VBR measurement was 0.884 (p = 0.0001). The weighted kappa scores were 0.68 for overall frontal lobe atrophy, 0.38 for right temporal lobe atrophy, 0.20 for left temporal lobe atrophy, and 0.54 for parietal lobe atrophy. The weighted kappa scores were 0.77 for overall periventricular white matter hyperintensities and 0.72 for centrum semiovale hyperintensities. The proposed method may provide a rapid and reliable way to assess VBR, frontal lobe atrophy, parietal lobe atrophy, and white matter changes on brain MRIs in the evaluation of dementia, but it was less reliable for the assessment of temporal lobe atrophy.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Encéfalo/patología , Imagen por Resonancia Magnética , Atrofia , Corteza Cerebral/patología , Ventrículos Cerebrales/patología , Lóbulo Frontal/patología , Humanos , Variaciones Dependientes del Observador , Lóbulo Parietal/patología , Proyectos Piloto , Reproducibilidad de los Resultados , Lóbulo Temporal/patologíaRESUMEN
OBJECTIVE: A subgroup of patients with progressive dementia has been reported with a marked predominance of symptoms attributed to the dysfunction of the posterior parieto-occipital cortex. These cases have been referred to as posterior cortical atrophy. The objective of this study was to determine whether posterior cortical atrophy is associated with distinct, uniform neuropathologic findings. DESIGN: Three individuals with progressive dementia that began with higher visual dysfunction (posterior cortical atrophy) were followed up to definitive neuropathologic diagnosis. RESULTS: Three separate neuropathologic entities were discovered: subcortical gliosis, Alzheimer's disease, and Creutzfeldt-Jakob disease. CONCLUSION: Posterior cortical atrophy is a clinically homogeneous but pathologically heterogeneous syndrome.
Asunto(s)
Demencia/patología , Lóbulo Occipital/patología , Lóbulo Parietal/patología , Anciano , Enfermedad de Alzheimer/patología , Atrofia , Síndrome de Creutzfeldt-Jakob/patología , Demencia/metabolismo , Gliosis/patología , Humanos , Masculino , Persona de Mediana Edad , Lóbulo Occipital/metabolismo , Lóbulo Parietal/metabolismoRESUMEN
OBJECTIVE: We sought to determine whether the frequency of depressive disorders among patients with complex partial seizures is associated with the laterality of ictal onset or the laterality of interictal cerebral hypometabolism. DESIGN: Fifty-three patients with medically intractable complex partial seizures were assessed for history of interictal depressive disorders meeting strict Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R), criteria with use of a modification of the Structured Clinical Interview for DSM-III-R. All subjects underwent video-electroencephalographic telemetry and fludeoxyglucose F18 positron emission tomographic scanning. The main outcome measure was the frequency of a history of major depressive episodes (MDEs) in subjects with left-sided vs right-sided ictal onset and in subjects with left-sided vs right-sided temporal lobe hypometabolism. RESULTS: Thirty-three subjects (62%) had a history of interictal depressive disorders, 16 (30%) of whom met criteria for one or more MDEs. More of those with left-sided ictal onset had a history of depression. Thirty-six subjects had definite unilateral temporal lobe hypometabolism demonstrated by positron emission tomographic scanning. More of those with left temporal lobe hypometabolism had a history of MDEs, and the combination of left temporal lobe hypometabolism and high-degree hypometabolism was strongly associated with a history of MDEs. Furthermore, among those with right temporal lobe hypometabolism, more of those with high-degree hypometabolism had a history of MDEs. CONCLUSION: Laterality of ictal onset and degree of interictal temporal lobe hypometabolism may be interdependent factors that contribute to the risk of depressive disorder in patients with complex partial seizures.
Asunto(s)
Trastorno Depresivo/etiología , Epilepsia del Lóbulo Temporal/complicaciones , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/metabolismo , Encéfalo/fisiopatología , Trastorno Depresivo/metabolismo , Trastorno Depresivo/fisiopatología , Electroencefalografía , Epilepsia del Lóbulo Temporal/metabolismo , Epilepsia del Lóbulo Temporal/fisiopatología , Femenino , Glucosa/metabolismo , Humanos , Masculino , CintigrafíaRESUMEN
Accurate diagnosis of vascular dementia is important for the recognition of underlying pathophysiology and the institution of appropriate therapy. It is also important for the determination of the incidence and prevalence of not only vascular dementia but also Alzheimer's disease (AD), since differentiating between these two entities is often problematic. The State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) herein propose criteria for the diagnosis of ischemic vascular dementia (IVD). These criteria broaden the conceptualization of vascular dementia, include the results of neuroimaging studies, emphasize the importance of neuropathologic confirmation, refine nosology, and identify areas that require further research. Parallel use of the proposed definitions of "possible" and "mixed" categories in the diagnosis of both AD and IVD would ensure compatibility between the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) criteria for AD and the ADDTC criteria for IVD. Uniform classification of subtypes of IVD will improve the generalizability of individual studies and aid in multicenter collaborations.