Neuropsychiatric and neuropsychological correlates of delusions in Alzheimer's disease.

We examined the prevalence, phenomenology, and clinical correlates of delusions in a consecutive series of 103 patients with probable Alzheimer's disease (AD). Patients were examined with the Present State Exam and the Dementia-Psychosis Scale. Twenty-one patients (20%) met DSM-III-R criteria for a delusional disorder.

A single-photon emission computed tomographic study of anosognosia in Alzheimer's disease.

Objective: To examine the presence of specific regional cerebral blood flow correlates of anosognosia in patients with probable Alzheimer's disease.

Design: Case series, group comparisons.

Setting: Ambulatory care referral center.

SPECT findings before and after ECT in a patient with major depression and Cotard's syndrome.

A patient's major depression and Cotard's syndrome (the delusion of being dead) both resolved completely after 12 ECT treatments. A SPECT study 1 week before ECT showed reduced blood flow in the frontoparietal medial and dorsolateral frontal cortex, basal ganglia, and thalamus; SPECT 1 month after ECT showed perfusion increments in those regions. This case study demonstrates that Cotard's syndrome in the context of major depression may be successfully treated with ECT and suggests that the psychiatric improvement was accompanied by increased blood flow in specific brain areas.

Prevalence and correlates of dysthymia and major depression among patients with Alzheimer's disease.

Objective: The purpose of this study was to examine the prevalence, risk factors, and correlates of depression among patients with Alzheimer's disease.

Method: A consecutive series of 103 patients with probable Alzheimer's disease were examined with a structured psychiatric interview and were assessed for the presence of cognitive impairments, deficits in activities of daily living, social functioning, and anosognosia.

Results: Fifty-one percent of the patients had depression (28% had dysthymia and 23% major depression).

Quantified electroencephalographic correlates of neuropsychological deficits in Alzheimer's disease.

The authors examined relationships between quantified EEG (qEEG) variables and neuropsychological performance in 54 consecutive patients with probable Alzheimer's disease (AD). Patients were studied with qEEG and a neuropsychological battery that assessed memory, attention, verbal functions, set-shifting abilities, and procedural learning. More severe memory, attention, and verbal deficits were significantly correlated with lower alpha relative power, and increased theta relative power was significantly correlated with poor set-shifting abilities.

Anosognosia in Alzheimer's disease: a study of associated factors.

The authors examined the prevalence and correlates of anosognosia in a consecutive series of patients with probable Alzheimer's disease (AD). Patients were examined with the Anosognosia Questionnaire-Dementia (AQ-D), which showed good reliability and validity. On the basis of the AQ-D scores, patients were divided into those with anosognosia (n = 21) and those without anosognosia (n = 52).

A SPECT study of parkinsonism in Alzheimer's disease.

The authors examined the presence of significant regional cerebral blood flow (rCBF) differences between Alzheimer's disease (AD) patients with and without extrapyramidal signs (EPS). Nine patients with probable AD and EPS (resting tremor or rigidity and bradykinesia) and 9 AD patients without EPS, comparable in age, duration of illness, and global cognitive decline, were studied with [99mTc]HMPAO SPECT. Patients with AD and EPS showed significantly lower rCBF in the superior frontal, superior temporal, and parietal regions of the left hemisphere than AD patients without EPS.

Extrapyramidalism in Alzheimer's disease: prevalence, psychiatric, and neuropsychological correlates.

The prevalence and clinical correlates of extrapyramidal signs in a consecutive series of 78 patients with Alzheimer's disease attending a neurology clinic, and 20 age comparable normal controls, were examined. Based on the unified Parkinson's disease rating scale (UPDRS) findings, 18 patients (23%) met criteria for parkinsonism, 44 (56%) had isolated extrapyramidal signs, and 16 (21%) had no extrapyramidal signs. Whereas the control group showed a similar prevalence of isolated extrapyramidal signs (57%), none of them showed parkinsonism.

Quantified electroencephalographic changes in Parkinson's disease with and without dementia.

We examined the presence of quantified electroencephalographic (qEEG) differences between Parkinson's disease (PD) patients with and without dementia, and a group of age-comparable normal controls. While there were no significant differences in relative power in any of the qEEG bands between PD patients without dementia and normal controls, PD patients showed a significantly greater reactivity in the alpha band. On the other hand, PD patients with dementia showed significantly less alpha and more theta relative power than both the normal control and the PD without dementia groups.

A SPECT study of delusions in Alzheimer's disease.

Although delusions are a frequent finding in patients with Alzheimer's disease (AD), their mechanism is not well known. We carried out Tc 99m HMPAO single-photon emission computed tomography studies in 16 AD patients with delusions and 29 AD patients without delusions comparable in age, years of education, duration of illness, and severity of dementia. Although we found no significant between-group differences in performance on neuropsychological tasks, AD patients with delusions had significantly lower mean cerebral blood flow in both the left and right temporal lobes.

Specificity of changes in cerebral blood flow in patients with frontal lobe dementia.

Eight patients with a clinical diagnosis of probable Alzheimer's disease, eight patients with the clinical diagnosis of frontal lobe dementia, and eight controls were examined with single photon emission tomography (SPECT) using 99Tc-HMPAO. Patients with Alzheimer's disease and those with frontal lobe dementia met DSM-III-R criteria for mild dementia and were in the early stages of the illness. Compared with patients with Alzheimer's disease, the group with frontal lobe dementia had significantly lower blood flow in the frontal lobes (dorsolateral and orbital), the anterior temporal cortex, and the basal ganglia.

The nature of apraxia in corticobasal degeneration.

Although apraxia is one of the most frequent signs in corticobasal degeneration, the phenomenology of this disorder has not been formally examined. Hence 10 patients with corticobasal degeneration were studied with a standardised evaluation for different types of apraxia. To minimise the confounding effects of the primary motor disorder, apraxia was assessed in the least affected limb.

Neuropsychological and neuroradiologic correlates of emotional prosody comprehension.

We examined a series of 59 patients with acute stroke lesions for the presence of comprehension emotional aprosody. Based on a standardized assessment of comprehension of emotional intonation, 29 patients (49%) showed emotional aprosody (17% "mild" aprosody [n = 10] and 32% "severe" aprosody [n = 19]). Patients with comprehension emotional aprosody showed a higher frequency of extinction on double-simultaneous stimulation, anosognosia, and deficits in facial emotion comprehension.

PET and functional testing in temporal lobe epilepsy.

Thirty-seven patients with severe temporal lobe epilepsy were studied interictally with [18F]fluorodeoxyglucose-PET in each of three conditions: resting, during emotional speech, and while performing a visual recognition task. In the resting state, each patient exhibited regional hypometabolism in agreement with his epileptic EEG focus, but that area was typically very large. The zone of maximum dysfunction was significantly better demarcated on activated scans showing an increase in whole-brain metabolism averaging 18%.

Bromocriptine-induced dystonia in patients with aphasia and hemiparesis.

Five of seven patients with chronic nonfluent aphasia and hemiparesis due to a focal ischemic infarction developed painful hemidystonia during treatment with a high dose of bromocriptine. All seven patients had cortical damage, but four also had basal ganglia and one thalamic involvement. While lesion location did not differ between dystonic and nondystonic patients, the dystonic patients had more weakness than those without dystonia.

Quantified electroencephalographic correlates of depression in Alzheimer's disease.

While depression is one of the most frequent psychiatric problems among patients with probable Alzheimer's disease (AD), its mechanism is not well known. We performed quantified EEGs in a consecutive series of seven patients with mild dementia and depression, six patients with mild dementia and no depression, eight patients with moderate dementia and depression, and eight patients with moderate dementia and no depression. Regardless of the severity of dementia, depressed patients had a significantly higher percent theta in posterior brain areas.

Paroxysmal alien hand syndrome.

Four patients are described who presented with a paroxysmal form of the alien hand syndrome. Two patients with damage to one frontomedial cortex had brief episodes of abnormal motor behaviour of the contralateral arm that featured groping, grasping, and apparently purposeful but perseverative movements, which both patients interpreted as alien or foreign. The other two patients, with posterior parietal damage, reported a paroxysmal feeling of unawareness of the location of the contralateral arm, lack of recognition of the arm as their own, purposeless movements, and personification of the arm.

Sensitivity and specificity of the Mini-Mental State Exam in the diagnosis of dementia.

The Mini-Mental State Exam (MMSE) is a brief cognitive test that assesses several cognitive domains, such as orientation, attention, concentration, memory, language, and constructional abilities. While the MMSE was found to be valid and reliable in the diagnosis of moderate dementia, its sensitivity and specificity for the diagnosis of mild dementia has been rarely examined. We assessed the specificity and sensitivity of the MMSE in a consecutive series of 44 patients with mild dementia, and a group of age-comparable normal controls.

Anxiety and depression in Parkinson's disease.

We examined a consecutive series of 40 patients with Parkinson's disease (PD) for the presence of anxiety. We found that 40 % met DSM-III criteria for generalized anxiety disorders, and half of them also met criteria for either major depression or minor depression. While depression was associated with long duration of illness and more severe cognitive and physical impairments, anxiety was not associated with greater impairment.

Neuropsychological correlates of brain atrophy in Parkinson's disease: a CT-scan study.

We examined the presence of cortical or subcortical brain atrophy (as shown by CT scans) in patients with Parkinson's disease (PD) and assessed whether there were significant correlations between CT measurements and the presence of cognitive deficits. There were three main findings. First, patients with bilateral symptoms of PD showed more severe cortical and subcortical atrophy than age-matched normal controls.

ECT in a patient with a frontal craniotomy and residual meningioma.

Electroconvulsive therapy (ECT) was used to treat a patient with a large left frontal craniotomy and remaining frontal meningioma. Treatment was successful and uneventful. ECT should be considered in the treatment of drug-resistant depressed patients with craniotomies and remaining tumor.

SPECT findings in patients with primary mania.

Five patients with a manic episode and 7 age-comparable control subjects were studied with single-photon emission computed tomography and [99mTc]d,l-hexamethylpropyleneamine oxime. Manic patients showed significantly lower blood flow in the basal portion of the right temporal lobe compared with normal control subjects. Moreover, manic patients showed a left-right asymmetry (a significantly lower perfusion in the right versus left temporal basal cortex), as well as a dorsal-ventral asymmetry (a significantly lower perfusion in the right temporal basal versus dorsal cortex).

Dementia of depression in Parkinson's disease and stroke.

Depression is a frequent finding in patients with neurological disorders. These depressions, however, have similar phenomenology, duration, biological markers, and response to treatment as depressions in patients with no known brain injuries (i.e.

Cardiovascular reflexes and pudendal evoked responses in chronic haemodialysis patients.

The bulbocavernous reflex (BCR), cortical pudendal evoked responses (CPERs), non-invasive cardiovascular tests and nerve conduction studies were performed in 16 patients on chronic haemodialysis and in a group of normal subjects. BCR and CPERs were more severely affected in patients with impotence. There was a significant correlation between the Valsalva ratio and P1 latency of the CPERs.