Neuropsychological correlates of apathy and depression in patients with dementia.

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.

Prevalence and correlates of aggressive behavior in Alzheimer's disease.

The authors assessed a consecutive series of 196 patients with probable Alzheimer's disease (AD) for the presence of aggressive behavior, using a standardized neurological, neuropsychiatric, and neuropsychological battery that included both the Overt Aggression Scale and the Irritability Scale. Twelve percent of patients showed aggressive episodes (5% with verbal aggression, 7% with physical aggression) during the 4 weeks preceding the psychiatric evaluation. Physical aggression was significantly associated with more frequent delusions and more severe irritability.

Prevalence and correlates of anxiety in Alzheimer's disease.

We assessed a consecutive series of 398 patients with probable Alzheimer's disease (AD) for the presence of Generalized Anxiety Disorder (GAD) using a standardized neuropsychiatric evaluation. Five percent of patients showed GAD during the 4 weeks preceding the psychiatric evaluation. AD patients with GAD showed significantly higher scores of depression, irritability, overt aggression, mania, and pathological crying than AD patients without GAD.

[Neuropsychological and psychopathologic changes following cardiac surgical procedures].

Neuropsychological and neuropsychiatric disorders following open heart surgery are estimated to occur in as many as 80 per cent of all patients. They have been recognised from the very beginning of modern heart surgery. Despite a huge amount of scientific literature, data concerning incidence, the phenomenology and duration of symptoms diverge.

Prevalence and correlates of the catastrophic reaction in Alzheimer's disease.

We examined the prevalence of the catastrophic reaction (CR) in 146 patients with Alzheimer's disease. Sixteen percent showed a CR during the neuropsychological evaluation. A factor analysis of the CR scale demonstrated an anxious/angry factor that was significantly associated with higher irritability scores and a longer duration of illness, as well as a depressive factor that was significantly associated with more severe cognitive impairments and older age.

Depression in classic versus akinetic-rigid Parkinson's disease.

We examined the prevalence of major depression and dysthymia in 78 patients with the classic variant of Parkinson's disease (PD) (that is, tremor plus rigidity and/or bradykinesia), and in 34 patients with the akinetic-rigid variant. Although the prevalence of dysthymia was similar in both groups (classic PD, 31%; and akinetic-rigid PD, 32%), patients with akinetic-rigid PD had a significantly higher prevalence of major depression (38% versus 15%, respectively; p < 0.01).

Cognitive functions in major depression and Parkinson disease.

Objective: To investigate the importance of major depression in the production of cognitive deficits in patients with Parkinson disease (PD).

Design: A comprehensive neuropsychological and psychiatric assessment was conducted in 19 patients with PD and major depression, 31 patients with PD without depression, 27 patients with major depression but without PD, and 12 age-comparable healthy controls.

Setting: Outpatient clinic.

Prospective longitudinal study of depression and anosognosia in Alzheimer's disease.

Background: The aim was to examine the longitudinal evolution of depression and anosognosia in patients with probable Alzheimer's disease (AD).

Method: Sixty-two of a consecutive series of 116 AD patients that were examined with a structured psychiatric interview had a follow-up evaluation between one and two years after the initial evaluation.

Results: At the initial evaluation 19% of the 62 patients had major depression, 34% had dysthymia, and 47% were not depressed.

Neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease.

Objective: To examine neurological, neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease.

Methods: A consecutive series of patients with probable Alzheimer's disease was assessed with a comprehensive neuropsychological battery, a structured psychiatric evaluation, the unified Parkinson's disease rating scale, MRI, and single photon emission computed tomography with technetium 99m hexamethylpropyleneamine oxime (HMPAO) and regional cerebral perfusion measurements.

Results: Patients with Alzheimer's disease and leukoaraiosis were significantly more apathetic and had significantly more extrapyramidal signs than patients with Alzheimer's disease without leukoaraiosis.

Anosognosia and procedural learning in Alzheimer's disease.

Awareness of cognitive deficits may rely on the implicit learning of intellectual limitations, and anosognosia in Alzheimer's disease (AD) may result from deficits in implicit learning. To examine this hypothesis, a consecutive series of 55 patients with probable AD were divided into groups with mild (n = 13), severe (n = 12), or no anosognosia (n = 30) and were assessed with a neuropsychological battery that included tests of declarative and procedural learning. Whereas there were no significant between-group differences in tests of declarative learning (the Buschke Selective Reminding Test and the Benton Visual Retention Test), patients with severe anosognosia showed a significantly worse performance on procedural learning (as measured with the Maze Learning Test) and a test assessing set shifting abilities (the Wisconsin Card Sorting Test) than AD patients without anosognosia.

Mechanism of disinhibition after brain lesions.

Disinhibition syndromes, ranging from mildly inappropriate social behavior to full blown mania, may result from lesions to specific brain areas. Several studies in patients with closed head injuries, brain tumors, stroke lesions, and focal epilepsy have demonstrated a significant association between disinhibition syndromes and dysfunction of orbitofrontal and basotemporal cortices of the right hemisphere. Based on the phylogenetic origin of these cortical areas and their main connections with dorsal regions related to visuospatial functions, somatosensation, and spatial memory, the orbitofrontal and basotemporal cortices may selectively inhibit or release motor, instinctive, affective, and intellectual behaviors elaborated in the dorsal cortex.

SPECT findings in Alzheimer's disease and Parkinson's disease with dementia.

We examined, with single photon emission tomography (SPECT) and (99mTc)-HMPAO, 18 patients with idiopathic Parkinson's disease and no dementia (PD), 12 patients with PD and dementia, 24 patients with probable Alzheimer's disease (AD), and 14 controls. While the three patient groups showed significantly lower perfusion in frontal inferior and temporal inferior areas as compared to controls, both demented groups showed significantly more severe bilateral hypoperfusion in superior frontal, superior temporal and parietal areas as compared to non-demented PD patients and controls. On the other hand, no significant differences in cerebral perfusion were found between patients with AD and patients with PD and dementia.

Apraxia in Parkinson's disease, progressive supranuclear palsy, multiple system atrophy and neuroleptic-induced parkinsonism.

We studied 45 non-demented patients with Parkinson's disease (PD), 12 with progressive supranuclear palsy (PSP), 10 with multiple system atrophy (MSA) and 12 with neuroleptic-induced parkinsonism (NIP) for the presence of apraxia. Our aim was to determine whether a standard comprehensive assessment of different praxic functions would demonstrate specific types of errors not attributable to bradykinesia, rigidity, tremor or any other abnormal elementary motor deficit. PD patients on chronic levodopa treatment were examined in the 'on' and 'off' (treatment) states.

Two domains of anosognosia in Alzheimer's disease.

Objective: To examine the presence of different dimensions of unawareness in patients with probable Alzheimer's disease.

Methods: A consecutive series of 170 patients with probable Alzheimer's disease were assessed with the anosognosia questionnaire-dementia (AQ-D) which includes items related to cognitive deficits and behavioural problems.

Results: A factor analysis of the AQ-D produced two factors: a "cognitive unawareness" factor, which loaded on items of memory, spatial and temporal orientation, calculation, abstract reasoning, and praxis, and a "behavioural unawareness" factor which loaded on items of irritability, selfishness, inappropriate emotional display, and instinctive disinhibition.

Neuropsychological and psychiatric differences between Alzheimer's disease and Parkinson's disease with dementia.

Objective: To examine neuropsychological and neuropsychiatric differences between patients with probable Alzheimer's disease and patients with Parkinson's disease and dementia.

Methods: Thirty three patients with probable Alzheimer's disease and 33 patients with Parkinson's disease and dementia were matched for age, sex, and mini mental state examination scores and given a battery of neuropsychological and neuropsychiatric tests.

Results: Patients with Parkinson's disease with dementia had a significantly higher prevalence of major depression than patients with Alzheimer's disease; patients with Alzheimer's disease showed more severe anosognosia and disinhibition than patients with Parkinson's disease.

Neuropsychological, psychiatric, and cerebral blood flow findings in vascular dementia and Alzheimer's disease.

Background And Purpose: Psychiatric, neuropsychological, and cerebral blood flow differences between patients with ischemic vascular dementia (IVD) or Alzheimer's disease (AD) were examined.

Methods: A consecutive series of patients who met either the criteria of the National Institute of Neurological Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association for probable AD or the State of California AD Diagnostic and Treatment Centers criteria for probable IVD were included in the study. Twenty consecutive patients with IVD were matched for age, sex, and Mini-Mental State Examination scores with 40 consecutive patients with probable AD.

A double-blind placebo-controlled study of clomipramine in depressed patients with Alzheimer's disease.

Twenty-one depressed patients with probable Alzheimer's disease (AD) were randomized to receive a 6-week treatment with clomipramine or placebo in a study with a double-blind crossover design. Main outcome measures were Hamilton Depression, Mini-Mental State (MMSE), and Functional Independence Measure (FIM) scores. Mood improved significantly on both clomipramine and placebo, but clomipramine was significantly more effective than placebo during the first 6-week treatment period.

Quantified electroencephalographic correlates of relative frontal or parietal hypoperfusion in dementia.

The authors examined the presence of specific quantified electroencephalographic (qEEG) changes in dementia patients with relatively lower frontal or parietal blood perfusion as demonstrated by SPECT. Over all brain regions, patients with relatively lower parietal perfusion showed significantly higher theta relative power than demented patients with relatively lower frontal perfusion or normal control subjects. Dementia patients with relatively lower frontal perfusion showed no differences from age-comparable normal control subjects in qEEG variables.

The prevalence and clinical correlates of apathy and irritability in Alzheimer's disease.

We examined the prevalence and correlates of apathy and irritability in a consecutive series of 101 patients with probable Alzheimer's disease (AD). Based on clinical criteria, 46 (46%) patients had apathy, and 13 (13%) patients had irritability. Apathy was significantly associated with more severe impairments in activities of daily living, significantly more severe extrapyramidal signs, and a significantly higher frequency of both major depression and dysthymia.

A randomized, double-blind, placebo-controlled study of bromocriptine in nonfluent aphasia.

We carried out a double-blind and placebo-controlled study of the efficacy of bromocriptine in the treatment of nonfluent aphasia. Seven patients received bromocriptine (up to 60 mg/d) and an identical placebo in a randomized order. End points were the number of content words, content units, and pauses > 3 seconds during the description of a figure; verbal naming; and verbal fluency.

Dissociation between declarative and procedural learning in dementia and depression.

Declarative and procedural learning were assessed in patients with probable Alzheimer's Disease (AD) and major depression, patients with AD and no depression, patients with major depression but no dementia, and a group of age-comparable nondemented and nondepressed normal controls. AD patients showed significant deficits in declarative but not in procedural learning, while depressed nondemented patients showed the opposite pattern (i.e.

Quantified electroencephalographic changes in depressed patients with and without dementia.

We carried out quantified electroencephalograms (qEEG) in 17 patients with probable Alzheimer's disease (AD), who also met the DSM-III-R criteria for either dysthymia or major depression, and 18 AD patients with comparable intellectual impairment but no depression, 13 patients with depression but no AD, and 10 age-matched normal controls. There was a significant effect for depression in alpha relative power: depressed patients (with or without AD) showed a significantly lower alpha relative power in the right posterior region as compared to nondepressed patients; however, this change was observed over the right hemisphere in depressed non-AD patients, and in left, medial, and right posterior regions in depressed-AD patients. Depressed patients without AD showed a significant global decrease in delta power, whereas depressed patients with AD showed significant increments in delta power in posterior brain areas.

Single fiber electromyography of extraocular muscles: a sensitive method for the diagnosis of ocular myasthenia gravis.

We performed single fiber electromyography (SFEMG) in the superior rectus and levator palpebralis (SR-LP) muscles of 17 patients with pure ocular myasthenia gravis (MG) and 9 controls. Thirteen patients were also assessed with SFEMG in the orbicularis oculi (OO) muscle. All the MG patients but none of the control subjects showed abnormal SFEMG jitter in the SR-LP muscles.

Prevalence and clinical correlates of pathological affective display in Alzheimer's disease.

This study examined the prevalence and correlates of pathological affect in Alzheimer's disease. A consecutive series of 103 patients with Alzheimer's disease were examined with a comprehensive psychiatric assessment that included the pathological laughing and crying scale (PLACS). Forty patients (39%) showed pathological affect: 25% showed crying episodes, and 14% showed laughing or mixed (laughing and crying) episodes.

Karl Ludwig Kahlbaum's concept of catatonia.

Catatonia is a neuropsychiatric syndrome described by Karl Ludwig Kahlbaum in 1874. Based on Kahlbaum's own description and Carl Wernicke's hypothesis about the mechanism of catatonia, we describe two types of catatonic domain: the akinetic motality psychosis, which is characterized by rigid immobility, fixed gaze, lack of blink, and cogwheel rigidity, and catatonia sensu strictu, which is characterized by spasms, iterations and verbigerations. The loss of motility allows the 'hypobulic levels' described by Kretschmer in 1920, which consist of aggressive acts, furious shouting, hyperactivity and orality, to break through.