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BACKGROUND: Whereas apathy is increasingly recognised as a frequent abnormal behaviour in dementia, its overlap with depression remains poorly understood. AIMS: To assess the psychometric characteristics of a structured interview for apathy, and to examine the overlap between apathy and depression in dementia. METHODS: A total of 150 patients with Alzheimer's disease (AD) underwent a comprehensive psychiatric and cognitive assessment. RESULTS: Twelve per cent of the sample met criteria for both apathy and depression, 7% met criteria for apathy only, and 31% met criteria for depression only. Apathy (but not depression) was significantly associated with more severe cognitive deficits. Apathy and anxiety scores accounted for 65% of the variance of depression scores in dementia, and the diagnosis of apathy had a minor impact on the rating of severity of depression. CONCLUSIONS: The Structured Interview for Apathy demonstrated adequate psychometric characteristics. Using a novel structured interview for apathy in AD we demonstrated that whereas the construct of depression primarily consists of symptom clusters of apathy and anxiety, apathy is a behavioural dimension independent of depression.
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Demência/epidemiologia , Demência/psicologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/etiologia , Transtornos do Humor/epidemiologia , Idoso , Comorbidade , Demência/diagnóstico , Demografia , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Entrevista Psicológica , Masculino , Testes Neuropsicológicos , Periodicidade , Psicometria , Índice de Gravidade de DoençaRESUMO
BACKGROUND AND OBJECTIVE: Methodological variability in the assessment of white matter hyperintensities (WMH) in dementia may explain inconsistent reports of its prevalence and impact on cognition. We used a method of brain MRI segmentation for quantifying both tissue and WMH volumes in Alzheimer's disease (AD) and examined the association between WMH and structural and cognitive variables. METHODS: A consecutive series of 81 patients meeting NINCDS-ADRDA criteria for probable AD was studied. Nineteen healthy volunteers of comparable age served as the control group. Patients had a complete neurological and neuropsychological evaluation, and a three dimensional MRI was obtained. Images were segmented into grey matter, white matter, and cerebrospinal fluid. WMH were edited on segmented images, and lobar assignments were based on Talairach coordinates. RESULTS: Mild and moderate to severe AD patients had significantly more WMH than controls (p<0.05). WMH preferentially involved the frontal lobes (70%), were inversely correlated with grey matter cortical volume (R(2) = 0.23, p<0.001), and were significantly associated with vascular risk factors and with a worse performance on memory tasks. CONCLUSION: Objective measurements of tissue volumes in AD demonstrated that WMH are significantly related to cortical atrophy and neuropsychological impairment.
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Doença de Alzheimer/diagnóstico , Encéfalo/patologia , Idoso , Doença de Alzheimer/patologia , Doença de Alzheimer/psicologia , Assistência Ambulatorial , Atrofia , Córtex Cerebral/patologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/patologia , Transtornos Cognitivos/psicologia , Feminino , Humanos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Testes NeuropsicológicosRESUMO
OBJECTIVE: Posteroventral pallidotomy (PVP) has proved to be an effective method for the treatment of Parkinson's disease. However, data on bilateral procedures are still limited. To assess the effects of bilateral globus pallidus (GPi) lesion and to compare it with a combination of unilateral GPi lesion plus contralateral GPi stimulation (PVP+PVS), an open blind randomised trial was designed. METHODS: A prospective series of patients with severe Parkinson's disease refractory to medical treatment, and severe drug induced dyskinesias, were randomised either to simultaneous bilateral PVP or simultaneous PVP+PVS. All patients were assessed with the core assessment programme for intracerebral transplantation (CAPIT), and a comprehensive neuropsychological and neuropsychiatric battery both before surgery and 3 months later. RESULTS: The severe adverse effects found in the first three patients subjected to bilateral PVP led to discontinuation of the protocol. All three patients developed depression and apathy. Speech, salivation, and swallowing, as well as freezing, walking, and falling, dramatically worsened. By contrast, all three patients undergoing PVP+PVS had a significant motor improvement. CONCLUSION: Bilateral simultaneous lesions within the GPi may produce severe motor and psychiatric complications. On the other hand, a combination of PVP+ PVS significantly improves parkinsonian symptoms not associated with the side effects elicited by bilateral lesions.
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Terapia por Estimulação Elétrica/métodos , Lateralidade Funcional/fisiologia , Globo Pálido/fisiopatologia , Globo Pálido/cirurgia , Procedimentos Neurocirúrgicos/métodos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Tratos Piramidais/fisiopatologia , Idoso , Transtornos de Deglutição/etiologia , Transtorno Depressivo/etiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Procedimentos Neurocirúrgicos/efeitos adversos , Doença de Parkinson/psicologia , Doença de Parkinson/cirurgia , Estudos Prospectivos , Distúrbios da Fala/etiologia , SíndromeRESUMO
The authors examined the prevalence, clinical correlates, and longitudinal changes of parkinsonism in 94 patients with primary depression and 20 healthy control subjects. Parkinsonism was present in 20% of patients with primary depression. This syndrome was significantly associated with older age, more severe depression, and more severe cognitive impairment. In a subgroup of depressed patients, parkinsonism was reversible upon recovery from the mood disorder.
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Transtorno Depressivo/psicologia , Transtornos Parkinsonianos/psicologia , Idoso , Transtorno Depressivo/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Parkinsonianos/complicações , Prevalência , Escalas de Graduação PsiquiátricaRESUMO
OBJECTIVE: To examine the efficacy of fluoxetine in the treatment of depression in patients with probable Alzheimer's disease (AD). METHODS: This double-blind, parallel-design study included a consecutive series of 41 AD subjects meeting DSM-IV criteria for major or minor depression who were randomized to receive fluoxetine (up to 40 mg/day) or identical-appearing placebo. All patients received biweekly evaluations consisting of the Hamilton Depression Scale (HAM-D) and the Clinical Global Impression as primary efficacy measures, and the Mini-Mental State Exam, Hamilton Rating Scale for Anxiety, and the Functional Independence Measure as secondary efficacy measures. RESULTS: Complete remission of depression was found in 47% of subjects treated with fluoxetine and in 33% of subjects treated with placebo. Both the fluoxetine and the placebo groups showed a significant decline in HAM-D scores over time, but the magnitude of mood improvement was similar for both groups. Fluoxetine was well tolerated, and most side effects were mild. CONCLUSION: Fluoxetine treatment for depression in AD did not differ significantly from treatment with placebo. Our study also confirms the presence of a placebo effect in the treatment of depression in AD.
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Doença de Alzheimer/psicologia , Antidepressivos de Segunda Geração/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Fluoxetina/uso terapêutico , Idoso , Doença de Alzheimer/complicações , Análise de Variância , Transtorno Depressivo/etiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Efeito Placebo , Escalas de Graduação Psiquiátrica , Indução de Remissão , Resultado do TratamentoRESUMO
OBJECTIVE: "Theory of Mind" (ToM) is the capacity to attribute mental states to oneself and to others and to interpret behavior in terms of mental states. Deficits in both ToM and pragmatic abilities have been described in patients with neurologic disorders, such as frontal lobe lesions and right hemisphere strokes, but have not been assessed in demented patients. METHODS: This study examined ToM and pragmatic abilities in a consecutive series of 34 patients with probable Alzheimer disease (AD) using a second-order false belief story, 11 short stories assessing understanding of social situations, and a test of pragmatic abilities assessing both indirect requests and-conversational implications. RESULTS: Sixty-five percent of AD patients with mild dementia could not pass a second-order false belief task, whereas no failures were found in a group of 10 age-comparable healthy controls. AD patients who did not pass the second-order false belief task had more severe deficits on tests of verbal anterograde memory, verbal comprehension, abstract thinking, and naming, as compared with AD patients who passed the task. AD patients also showed significantly more severe pragmatic deficits than age-comparable healthy controls, and there was a significant association between ToM and pragmatic deficits. On the other hand, there were no significant associations between ToM or pragmatic deficits, and behavioral problems frequently reported in AD such as depression, delusions, apathy, and irritability. CONCLUSIONS: This initial exploratory investigation demonstrated significant deficits in both ToM and pragmatic abilities in a consecutive series of AD patients with mild dementia.
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Doença de Alzheimer/fisiopatologia , Encéfalo/fisiopatologia , Transtornos Cognitivos/diagnóstico , Teoria Psicológica , Idoso , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Comportamento SocialRESUMO
Conventional antipsychotic agents can induce extrapyramidal symptoms (EPS) that may be alleviated by switching patients to novel agents such as olanzapine. Patients with schizophrenia and related disorders (ICD-10) who were taking haloperidol (N = 94; mean dose = 12.7 mg/day) and had EPS (Simpson-Angus Scale [SAS] > 3) were directly switched to 6 weeks of open-label olanzapine treatment (mean dose = 11.4 mg/day). There were significant mean improvements (p <0.001 for all measurements) from baseline to endpoint on the SAS (-9.69+/-5.33; percentage change, 87.2%), the Barnes Akathisia Scale (-1.00+/-1.19; percentage change, 82.5%), and the Abnormal Involuntary Movement Scale (-1.48+/-2.89; percentage change, 81.1%), and anticholinergic use decreased from 47.9% to 12.8% (mean baseline to endpoint change: -1.52+/-1.91-mg equivalents of benztropine; p < 0.001). Significant mean baseline to endpoint improvements (p < 0.001 for all measurements) were observed on the Positive and Negative Syndrome Scale (PANSS; -25.28+/-18.67; percentage change, 30.3%), the PANSS-extracted Brief Psychiatric Rating Scale (0-6 scale, -13.41+/-10.16; percentage change, 54.4%), and the Clinical Global Impressions Severity scale (-1.16+/-1.19; percentage change, 26.4%). Spontaneously reported treatment- emergent adverse events with a greater than 5% incidence were somnolence (16.0%), increased appetite (14.9%), weight gain (11.7%), headache (8.5%), anxiety (7.4%), dizziness (6.4%), and insomnia (5.3%). Criteria for a successful switch were met by 90.5% of patients. Psychotic symptom exacerbation was experienced by 30.9% of patients at any time during the study and by 11.7% of patients at endpoint. Results suggest that a direct switch to olanzapine is a therapeutic option when patients with haloperidol-induced EPS are unable to tolerate a more gradual switch.
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Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Discinesia Induzida por Medicamentos/epidemiologia , Haloperidol/efeitos adversos , Haloperidol/uso terapêutico , Pirenzepina/análogos & derivados , Pirenzepina/efeitos adversos , Pirenzepina/uso terapêutico , Adolescente , Adulto , Benzodiazepinas , Feminino , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Olanzapina , Escalas de Graduação Psiquiátrica , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológico , Resultado do TratamentoRESUMO
OBJECTIVE: The study examined the usefulness and clinical correlates of specific diagnostic criteria for apathy in Alzheimer's disease. Whereas apathy is a frequent behavioral change in patients with Alzheimer's disease, the lack of standardized diagnostic criteria may explain the wide discrepancies in estimates of the frequency and demographic and clinical correlates of apathy. METHOD: A consecutive series of 319 patients who met the criteria for probable Alzheimer's disease established by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, 117 patients who met the DSM-IV criteria for depression without dementia, and 36 healthy individuals were assessed with a structured psychiatric interview. On the basis of modified Marin's criteria for apathy, they were classified into groups with or without apathy. RESULTS: Apathy was diagnosed in 37% of the 319 Alzheimer's disease patients, compared to none of the healthy comparison subjects. In 24% of the Alzheimer's disease sample, apathy coexisted with either dysthymic disorder or major depressive disorder, whereas 13% had apathy without depression. Apathy was diagnosed in 32% of the depressed nondemented patients, mostly in those with major depressive disorder. Apathy in Alzheimer's disease was significantly associated with severe impairments in activities of daily living and cognitive functions, older age, and poor awareness of behavioral and cognitive changes. CONCLUSIONS: This study provides partial validation of specific clinical criteria for apathy in Alzheimer's disease.
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Sintomas Afetivos/diagnóstico , Doença de Alzheimer/diagnóstico , Transtorno Depressivo/diagnóstico , Sintomas Afetivos/psicologia , Idoso , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/psicologia , Conscientização , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Comorbidade , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Transtorno Distímico/diagnóstico , Transtorno Distímico/psicologia , Feminino , Nível de Saúde , Humanos , Masculino , Prevalência , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Análise de Regressão , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , SíndromeRESUMO
OBJECTIVE: This study assessed the specificity of depressive symptoms in patients with Alzheimer's disease and examined the discrepancies between patient and caregiver symptom reports. METHOD: The study group was composed of a series of 233 patients with Alzheimer's disease, 47 patients with depression but without dementia, and 20 healthy comparison subjects; the latter two groups were comparable in age with the patients with Alzheimer's disease. The patients and comparison subjects received a comprehensive psychiatric evaluation, which included administration of the Hamilton Depression Rating Scale and the Structured Clinical Interview for DSM-IV. RESULTS: Patients with Alzheimer's disease with a score of 2 or higher on the "depressed mood" item of the Hamilton depression scale, as scored by their respective caregivers, comprised a group with depressed mood (N=92), whereas patients who scored 0 on this item comprised a group without depressed mood (N=62). A statistical comparison of the scores on the remaining Hamilton depression scale items (2-16) between the Alzheimer's disease patients with and without depressed mood revealed significant differences on all items, except "loss of appetite." However, there were no significant differences on any single Hamilton depression scale item between the Alzheimer's disease patients without depressed mood and the age-comparable healthy comparison subjects. CONCLUSIONS: Depressive symptoms are not widespread among patients with Alzheimer's disease but are significantly related to an underlying depressed mood. Patients with Alzheimer's disease may not be fully aware of the extent of their depressive symptoms.
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Doença de Alzheimer/diagnóstico , Transtorno Depressivo/diagnóstico , Idoso , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/psicologia , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Comorbidade , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Transtorno Distímico/diagnóstico , Transtorno Distímico/epidemiologia , Transtorno Distímico/psicologia , Feminino , Humanos , Masculino , Prevalência , Escalas de Graduação Psiquiátrica/estatística & dados numéricosRESUMO
The aging process is associated with a progressive cognitive decline, but both the extent of this decline and the profile of age-related cognitive changes remain to be clearly established. Currently, cognitive deficits associated with aging may be diagnosed under the categories of age-associated memory impairment, age-associated cognitive impairment, or the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) category of age-related cognitive decline. Age-related decline has been reported for several cognitive domains, such as language (eg, verb naming, verbal fluency), visuospatial abilities (eg, facial discrimination), executive functions (eg, set shifting, problem solving), and memory functions (eg, declarative learning, source memory). There is an age-related decline in brain cortical volume, which primarily involves association cortices and limbic regions. Studies of brain metabolic activity demonstrate an age-related decline in neocortical areas. Activation studies using cognitive tasks demonstrate that older healthy individuals have a different pattern of activation from younger subjects, suggesting thai older subjects may recruit additional brain areas in order to maintain performance.
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OBJECTIVE: To investigate the nature of deficits in social cognition and real-life decision making in a group of patients with Alzheimer's disease (AD). DESIGN: A comprehensive neuropsychological and psychiatric assessment, including the Moral Judgment Interview and the Bechara's Card Test, was carried out in 25 patients with AD and 20 age-comparable normal controls. SETTING: Outpatient clinic. RESULTS: AD patients had significantly lower scores in the Moral Judgment Interview and obtained significantly less earnings in the card test when compared to the normal control group. The Moral Judgment Interview score correlated significantly with Raven's Progressive Matrices and Block Design, whereas the card test correlated significantly with both the Benton Visual Retention Test and the Buschke Selective Reminding Test. No significant correlations were observed between the experimental tasks and the psychiatric variables. CONCLUSIONS: AD patients demonstrated significant deficits on tasks assessing social cognition and real-life decision making. These impairments correlated with deficits on specific neuropsychological tasks, but not with behavioral problems frequently found in AD patients.
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Doença de Alzheimer/complicações , Transtornos Cognitivos/complicações , Transtornos Cognitivos/diagnóstico , Tomada de Decisões , Percepção Social , Idoso , Feminino , Humanos , Julgamento , Masculino , Testes Neuropsicológicos , Índice de Gravidade de DoençaRESUMO
Patients with basal ganglia diseases may exhibit ideomotor apraxia. To define the nature of the impairment of the action production system, we studied a repetitive gesture of slicing bread by three-dimensional computergraphic analysis in eight nondemented patients with Parkinson's disease in the "on" state, five with progressive supranuclear palsy and four with multiple system atrophy. Two patients with Parkinson's disease and two with progressive supranuclear palsy showed ideomotor apraxia for transitive movements on standard testing. A Selspott II system was used for kinematic analysis of wrist trajectories and angular motions of the shoulder and elbow joints. Patients with Parkinson's disease, progressive supranuclear palsy, and even some with multiple system atrophy exhibited kinematic deficits in the spatial precision of movement and velocity-curvature relationships; in addition, they failed to maintain proper angle/angle relationships and to apportion their relative joint amplitudes normally. Spatial disruption of wrist trajectories was more severe in patients with ideomotor apraxia. We posit that the basal ganglia are part of the parallel parieto-frontal circuits devoted to sensorimotor integration for object-oriented behavior. The severity and characteristics of spatial abnormalities of a transitive movement would therefore depend on the location and distribution of the pathologic process within these circuits.
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Apraxia Ideomotora/diagnóstico , Articulações/inervação , Atrofia de Múltiplos Sistemas/diagnóstico , Orientação/fisiologia , Doença de Parkinson/diagnóstico , Desempenho Psicomotor/fisiologia , Paralisia Supranuclear Progressiva/diagnóstico , Idoso , Apraxia Ideomotora/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/fisiopatologia , Doença de Parkinson/fisiopatologia , Fotogrametria , Paralisia Supranuclear Progressiva/fisiopatologiaRESUMO
The authors examined specific deficits of cerebral blood perfusion in autistic patients as measured with [(99m)Tc]HMPAO single-photon emission computed tomography (SPECT). The study, conducted in an outpatient clinic setting, included a consecutive series of 30 patients with autism and 14 patients with mental retardation but no autism comparable in chronological age, mental age, height, weight, and head circumference. All participants were examined with a comprehensive psychiatric and neuropsychological battery and received a [(99m)Tc]HMPAO SPECT scan. Autistic patients had significantly lower perfusion than the control group in the following brain regions: right temporal lobe (basal and inferior areas), occipital lobes, thalami, and left basal ganglia. The study demonstrated significant perfusion deficits in specific brain areas of moderately to severely mentally retarded autistic patients.
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Transtorno Autístico/complicações , Encéfalo , Deficiência Intelectual/complicações , Tomografia Computadorizada de Emissão de Fóton Único , Transtorno Autístico/diagnóstico , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Encéfalo/patologia , Criança , Feminino , Humanos , Deficiência Intelectual/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Compostos Radiofarmacêuticos/farmacocinética , Índice de Gravidade de Doença , Tecnécio Tc 99m Exametazima/farmacocinéticaRESUMO
Depression and apathy are the two most frequent behavioral complications of stroke. This article reviews the prevalence of these conditions in poststroke patients, as well as their clinical correlates, longitudinal course, and possible mediators. A number of controlled clinical trials of the efficacy of various drugs in the treatment of poststroke depression are also reviewed.
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The authors present two patients with dementia who displayed recurrent transient episodes of amnestic wandering and disorientation characterized by getting lost in familiar environments. At other times these patients did not wander or become disoriented. The inability to recall any information during these episodes, and the marked difference of the episodic amnesia exacerbations from the progressive amnesia characteristic of Alzheimer disease seen in these patients led to their evaluation. These clinical episodes and the bilateral interictal epileptiform electroencephalographic changes found in both patients led to the diagnosis of transient epileptic amnesia, a syndrome that can be diagnostically elusive. These transient amnestic wandering events subsided after treatment with antiepileptic drugs in both patients. The authors suggest that transient wandering of this type may be caused by ictal events or postictal confusional states. This report emphasizes the importance of recognizing transient epileptic amnesia as an easily treatable cause of episodic behavioral abnormalities responsive to antiepileptic therapy, especially in those patients who have a markedly inconsistent pattern of wandering, disorientation in familiar settings, and amnesia exacerbation manifested by no recall of the emotional stress of getting lost or of any information during these episodes. Recognition of this type of behavioral disruption and its proper treatment can lead to improved quality of life for these patients, maintain these patients in their homes and out of chronic care institutions longer, and facilitate the community's and caretaker's interactive roles with the patient.
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Doença de Alzheimer/complicações , Amnésia/etiologia , Anticonvulsivantes/uso terapêutico , Demência por Múltiplos Infartos/complicações , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Idoso , Feminino , Humanos , Fatores de TempoRESUMO
The areas of seven subregions of the corpus callosum and three subregions of the cerebellum were examined on midsagittal magnetic resonance imaging scans of 27 low-IQ autistic individuals and 17 nonautistic individuals of comparable mental age. Autistic individuals had a significantly smaller corpus callosum (most marked in the body). No significant between-group differences were found in cerebellum areas. Results demonstrate that abnormalities of the corpus callosum reported in high-functioning autistic individuals are also present in autistic individuals with mental retardation and extend previous reports showing no evidence for a selective hypoplasia of cerebellar lobules VI-VII.
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Transtorno Autístico , Cerebelo/patologia , Corpo Caloso/patologia , Deficiência Intelectual , Adolescente , Feminino , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
The authors examined the severity and type of deficits in remote memory in patients with probable Alzheimer's disease (AD). In the first study, 40 AD patients showed significantly more severe deficits on both the free-recall and the recognition sections of the Remote Memory Scale (which measures memory for famous people and well-known events) compared with normal control subjects. In the second study, 25 AD patients showed significantly more deficits on the free-recall section of the Autobiographical Memory Scale compared with normal control subjects. Remote memory deficits in AD may be related to both retrieval deficits and damage to memory traces.
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Doença de Alzheimer , Transtornos da Memória/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Projetos Piloto , Distribuição Aleatória , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To examine the differential impairment of implicit and explicit memory systems in cortical and subcortical dementias. BACKGROUND: Whereas verbal priming was reported to be impaired in patients with Alzheimer Disease (AD), patients with Parkinson Disease (PD) may be relatively more impaired on tasks of motor skill learning. METHODS: We examined 15 patients with Alzheimer disease, 10 patients with Parkinson disease and dementia (PD-D), 15 patients with PD but no dementia, and 24 age-comparable normal control subjects with a neuropsychologic battery that included tests of explicit memory (Buschke Selective Reminding Test, Benton Visual Retention Test, Digits Span), and tests of implicit memory (Word-Stem Completion task and the Maze Test). RESULTS: AD and PD-D groups showed similar deficits on all measures of explicit memory, and performed significantly worse than PD patients without dementia and normal control subjects. On the other hand, there were no significant between-group differences in any of the measures of implicit memory. CONCLUSIONS: Our study demonstrated preserved implicit learning in the context of severe explicit learning deficits in patients with dementia, but could not demonstrate a different profile of memory deficits between so-called cortical and subcortical dementias.
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Doença de Alzheimer/psicologia , Aprendizagem , Memória , Doença de Parkinson/psicologia , Idoso , Doença de Alzheimer/complicações , Análise de Variância , Estudos de Casos e Controles , Demência/psicologia , Feminino , Humanos , Masculino , Testes NeuropsicológicosRESUMO
OBJECTIVE: To investigate the association between apathy and depression, and specific cognitive deficits in AD. BACKGROUND: Apathy and depression are frequent behavioral disorders in patients with AD. However, the neuropsychological correlates of these disorders have rarely been examined. METHODS: A comprehensive neuropsychological and psychiatric evaluation was carried out in 72 patients with AD with apathy and depression, 29 patients with AD with apathy only, 31 patients with AD with depression only, and 52 patients with AD with neither apathy nor depression (control group). RESULTS: Patients with apathy had significantly lower scores on tests of verbal memory, naming, set shifting, and verbal fluency compared with patients without apathy. The association of depression and apathy produced significantly more severe deficits compared with apathy only on a test of abstract thinking. Finally, depression in the absence of apathy was not associated with more severe cognitive impairments compared with the AD control group. CONCLUSIONS: Apathy, but not depression, is associated with significantly more severe frontal lobe related cognitive deficits in AD.
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Doença de Alzheimer/psicologia , Transtorno Depressivo/psicologia , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Escalas de Graduação PsiquiátricaRESUMO
Microelectrode-guided posteroventral pallidotomy (PVP) has shown to be an effective method in the treatment of a group of patients with advanced Parkinson's disease. A nonlesioning approach by means of deep brain electrodes connected to a programmable neuropacemaker has also been used to inhibit the internal segment of globus pallidus (posteroventral stimulation [PVS]) reporting comparable clinical efficacy to the one obtained with the ablative method. Nevertheless, no controlled studies have been performed to compare the efficacy of both procedures. A prospective series of 13 patients with a clinical indication for globus pallidus surgery was randomized either to a pallidotomy or stimulator implantation, and comparisons on motor and neuropsychologic measurements were made on a 3-month follow-up basis. Primary measurements of efficacy showed a comparable effect on Unified Parkinson's Disease Rating Scale and activities of daily living score after both procedures. Secondary measurements of efficacy showed that although both techniques improve hand tapping score and dyskinesia score, the bilateral improvement in the former was greater after PVS whereas the latter improved more significantly after PVP. No significant changes in neuropsychologic parameters were observed after either PVP or PVS. Side effects and surgery complications occurred in six of 13 patients (three after PVP and three after PVS): they were mild, transient, and unrelated to optic tract injury. In conclusion, the short-time effect and safety of both procedures is comparable.