OBJECTIVE: To assess apathy in patients with Parkinson's disease and its relation to disability, mood, personality, and cognition. METHODS: Levels of apathy in 45 patients with Parkinson's disease were compared with a group of 17 similarly disabled patients with osteoarthritis. Additional neuropsychiatric data were collected concerning levels of depression, anxiety, and hedonic tone. Personality was assessed with the tridimensional personality questionnaire. Cognitive testing included the mini-mental state examination, the Cambridge examination of cognition in the elderly, and specific tests of executive functioning. RESULTS: Patients with Parkinson's disease had significantly higher levels of apathy than equally disabled osteoarthritic patients. Furthermore, within the Parkinson sample, levels of apathy appear to be unrelated to disease progression. The patients with Parkinson's disease with the highest levels of apathy where not more likely to be depressed or anxious than those with the lowest levels of apathy, though they did show reduced hedonic tone. No differences in personality traits were detected in comparisons between patients with Parkinson's disease and osteoarthritis, or between patients in the Parkinson group with high or low levels of apathy. As a group, the patients with Parkinson's disease tended not to differ significantly from the osteoarthritic group in terms of cognitive skills. However, within the Parkinson's disease sample, the high apathy patients performed significantly below the level of the low apathy patients. This was particularly evident on tests of executive functioning. CONCLUSIONS: Apathy in Parkinson's disease is more likely to be a direct consequence of disease related physiological changes than a psychological reaction or adaptation to disability. Apathy in Parkinson's disease can be distinguished from other psychiatric symptoms and personality features that are associated with the disease, and it is closely associated with cognitive impairment. These findings point to a possible role of cognitive mechanisms in the expression of apathy. (+info)
Detection of grey matter loss in mild Alzheimer's disease with voxel based morphometry.
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OBJECTIVES: To test the applicability of an automated method of magnetic resonance image analysis (voxel based morphometry) to detect presence and severity of regional grey matter density reduction-a proxy of atrophy-in Alzheimer's disease. METHODS: Twenty nine probable Alzheimer's patients and 26 non-demented controls (mini-mental state examinations mean (SD) 21 (4) and 29 (1)) underwent high resolution 3D brain magnetic resonance imaging. Spatial normalisation to a stereotactic template, segmentation into grey matter, white matter, and cerebrospinal fluid, and smoothing of the grey matter were carried out based on statistical parametric mapping (SPM99) algorithms. Analyses were carried out: (a) contrasting all Alzheimer's patients with all controls (p<0.05 corrected for multiple comparisons); (b) contrasting the three Alzheimer's patients with mini-mental state of 26 and higher with all controls (p<0.0001 uncorrected); and (c) correlating grey matter density with mini-mental state score within the Alzheimer's group (p<0.0001 uncorrected). RESULTS: When all Alzheimer's patients were compared with controls, the largest atrophic regions corresponded to the right and left hippocampal/amygdalar complex. All parts of the hippocampus (head, body, and tail) were affected. More localised atrophic regions were in the temporal and cingulate gyri, precuneus, insular cortex, caudate nucleus, and frontal cortex. When the mildest Alzheimer's patients were contrasted with controls, the hippocampal/amygdalar complex were again found significantly atrophic bilaterally. The mini-mental state score correlated with grey matter density reduction in the temporal and posterior cingulate gyri, and precuneus, mainly to the right. CONCLUSIONS: Voxel based morphometry with statistical parametric mapping is sensitive to regional grey matter density reduction in mild Alzheimer's disease. (+info)
Serial diffusion-weighted MR Imaging in delayed postanoxic encephalopathy. A case study.
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We report a case of delayed postanoxic encephalopathy (DPE) studied with serial diffusion weighted imaging five times in a one-year period along with apparent diffusion coefficient (ADC) map as well as ADC values of periventricular white matter. Compared to the normal value, the ADC values of the white matter were initially low on the three (0.68 +/- 0.08 x 10(-3) mm(2)/s) and seven-week images (0.67 +/- 0.08 x 10(-3) mm(2)/s) but gradually recovered to the normal range on the four, six, and twelve-month images (0.78 +/- 0.05, 0.80 +/- 0.05 and 0.87 +/- 0.11 x 10(-3) mm(2)/s, respectively). Among the several pathogenetic mechanisms associated with DPE, these serial changes may be consistent with cytotoxic edema, from apoptosis, triggered by hypoxia. (+info)
Do cognitive patterns of brain magnetic activity correlate with hippocampal atrophy in Alzheimer's disease?
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BACKGROUND: Many reports support the clinical validity of volumetric MRI measurements in Alzheimer's disease. OBJECTIVE: To integrate functional brain imaging data derived from magnetoencephalography (MEG) and volumetric data in patients with Alzheimer's disease and in age matched controls. METHODS: MEG data were obtained in the context of a probe-letter memory task. Volumetric measurements were obtained for lateral and mesial temporal lobe regions. RESULTS: As expected, Alzheimer's disease patients showed greater hippocampal atrophy than controls bilaterally. MEG derived indices of the degree of activation in left parietal and temporal lobe areas, occurring after 400 ms from stimulus onset, correlated significantly with the relative volume of lateral and mesial temporal regions. In addition, the size of the right hippocampus accounted for a significant portion of the variance in cognitive scores independently of brain activity measures. CONCLUSIONS: These data support the view that there is a relation between hippocampal atrophy and the degree of neurophysiological activity in the left temporal lobe. (+info)
Transient ischaemic attacks are associated with increased rates of global cerebral atrophy.
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OBJECTIVES: To determine whether patients presenting with a first transient ischaemic attack (TIA) subsequently show increased rates of brain atrophy compared with age matched controls; and to assess potential risk factors for brain atrophy in this group. METHODS: 60 patients with a first, isolated TIA and 26 age and sex matched controls were recruited. None had evidence of cognitive impairment. Vascular risk factors were treated appropriately. All subjects had volumetric imaging at the start of the study and one year later, when they were clinically reassessed. TIA patients also had serial dual echo brain imaging. Rates of whole brain atrophy were calculated from the registered volumetric scans, as was the incidence of new ischaemic lesions. In the TIA group, the degree of white matter disease was assessed. Atrophy rates and blood pressure were compared between patients and controls. RESULTS: 22 patients (37%) developed new "clinically silent" infarcts during follow up. The mean (SD) annualised percentage atrophy rate in the TIA group was significantly higher than in the controls, at 0.82 (0.39)% v 0.33 (0.3)% (p < 0.0001). In the TIA group, diastolic blood pressure (p = 0.004) and white matter disease severity (p < 0.001) were correlated with cerebral atrophy rate. Increased white matter disease was found in patients in whom new ischaemic lesions developed (p < 0.001). CONCLUSIONS: Patients presenting with a first TIA have excess global brain atrophy compared with age matched controls over the subsequent year. Increased atrophy rates following a TIA may be directly or indirectly related to increasing white matter disease and diastolic hypertension. Future studies should assess whether this atrophy inevitably leads to cognitive decline, and whether aggressive treatment of risk factors for cerebrovascular disease (particularly hypertension) after a TIA can influence outcome. (+info)
Quality of spirometric performance in older people.
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OBJECTIVES: chronic obstructive pulmonary disease and asthma are major causes of hospitalisation and mortality among older patients but respiratory diseases are often under- or misdiagnosed because spirometry is not extensively used at this age. DESIGN: we examined 715 elderly subjects with respiratory symptoms; all underwent a spirometric test and were administered the Mini Mental State Examination, Activities of Daily Living, Instrumental Activities of Daily Living and Geriatric Depression Scale questionnaires for cognitive, functional and effective evaluation. Their educational level and Body Mass Index were also taken into consideration. RESULTS: a total of 585 patients (81.8%) were able to perform spirometry according to ATS'94 criteria while 130 (18.2%) were unable to do it. As regards educational level, Mini Mental State Examination, Activities of Daily Living and Instrumental Activities of Daily Living scores showed a significant difference (P<0.001) between the groups of patients with high-quality spirometries and those with inadequate ones. There was no difference between the two groups in terms of age, Body Mass Index or Geriatric Depression Scale score. CONCLUSIONS: the majority of elderly subjects can perform spirometry according to international guidelines; age itself cannot be considered a risk factor for a bad spirometric performance, but it becomes influential if it is associated with cognitive and functional impairment. (+info)
Effects of physical training on the physical capacity of frail, demented patients with a history of falling: a randomised controlled trial.
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BACKGROUND: to develop a physical training programme to improve balance in dependent, demented, people with a history of falling, and so decrease falls and increase autonomy. METHODS: the study was undertaken on 20 demented elderly people with a history of falling with an average age of 81.4+/-4.7 years and an average mini mental state score of 16.3+/-6.5. They had all passed 'get up and go', 'chair sit and reach', walking speed and static balance tests. They were assigned to a control group or a training group; the latter were trained with two sessions a week for 16 weeks. RESULTS: walking, mobility, flexibility and static balance were significantly improved in the training group (P<0.05), but not in the controls. The trained subjects did not suffer a relapse, while the controls did during the training period. CONCLUSION: the balance of frail, demented, elderly patients with a history of falling can be improved by training. (+info)
Detection of Alzheimer's disease and dementia in the preclinical phase: population based cohort study.
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OBJECTIVES: To evaluate a simple three step procedure to identify people in the general population who are in the preclinical phase of Alzheimer's disease and dementia. DESIGN: Three year population based cohort study. SETTING: Kungsholmen cohort, Stockholm, Sweden. PARTICIPANTS: 1435 people aged 75-95 years without dementia. ASSESSMENTS: Single question asking about memory complaints, assessment by mini-mental state examination, and neuropsychological testing. MAIN OUTCOME MEASURE: Alzheimer's disease and dementia at three year follow up. RESULTS: None of the three instruments was sufficiently predictive of Alzheimer's disease and dementia when administered separately. After participants had been screened for memory complaints and global cognitive impairment, specific tests of word recall and verbal fluency had positive predictive values for dementia of 85-100% (95% confidence intervals range from 62% to 100%). However, only 18% of future dementia cases were identified in the preclinical phase by this three step procedure. Memory complaints were the most sensitive indicator of Alzheimer's disease and dementia in the whole population, but only half the future dementia cases reported memory problems three years before diagnosis. CONCLUSION: This three step procedure, which simulates what might occur in clinical practice, has a high positive predictive value for dementia, although only a small number of future cases can be identified. (+info)