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 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During a three-year period, 337 CT or MR scans were ordered for psychiatric patients in a teaching hospital. Scans were normal in 185 instances, equivocal in 34, and abnormal in 118 instances. When a history of neurologic disorder and/or the presence of abnormal neurologic/organic mental signs was positive, scans were abnormal in 74% of cases; when these indicators were negative, scans were normal in 72% of cases. In all, only 4 new diagnoses were made. Two patients, both with markedly abnormal neurological findings, were shown to have brain tumors, which changed their management. Two others showed abnormalities which would have been missed, both of which were of no clinical consequence. The following are suggested as sound indications for ordering CT or MR brain imaging among psychiatric patients: 1) positive history of head injury, stroke or other neurologic disease, as well as suspected Alzheimer disease or multi-infarct dementia; 2) presence of abnormal neurologic signs or organic mental signs, such as confusion or cognitive decline; and, 3) a first psychotic break or personality change after the age of 50 years.
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PMID:Clinical use of CT and MR scans in psychiatric patients. 178 61

The nature and severity of behavioral problems, and their relationship to cognitive and functional abilities, was investigated in 56 community-residing patients with Alzheimer's disease. Measures evaluated three domains of function: behavior, cognition and activities of daily living. Problems of cognitive functioning, such as memory loss, confusion, and disorientation were most prevalent, reported to occur in 84%, 82%, and 64% of the sample, respectively. Problems with activity and emotional distress were next, affecting 20 to 43% of the sample. The mean number of problems reported was 10 per patient. Twenty-two percent of caregivers reported a minimum of 15 problems occurring at least twice a week and no caregiver reported an absence of problems. Male patients were reported to have more behavioral difficulties. Level of behavioral disturbance was largely unrelated to cognitive or functional ability. Age was unrelated to cognitive or behavioral disturbance but significantly related to activities of daily living. Results indicated that behavioral problems are prevalent and pervasive in even moderately impaired community-residing Alzheimer disease patients, and that age may be more important than level of cognitive dysfunction in predicting difficulties with activities of daily living.
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PMID:Behavioral disturbance, cognitive dysfunction, and functional skill. Prevalence and relationship in Alzheimer's disease. 278 33

The aim of the article is to correlate grey and white matter changes and their topography to the results of modern methods for brain imaging such as CT, rCBF, PET, SPECT and NMR in Alzheimer's type of dementia. The findings are based on the study of a large material investigated thoroughly patho-anatomically. The findings are correlated with psychiatric and neurophysiologic follow-up studies. The degenerative grey matter process shows a regionally varying accent according to a pattern which is consistent and typical for the disease. This corresponds to metabolic changes on rCBF, PET and SPECT and thereby becomes of diagnostic value. This pattern is largely symmetric. Metabolic asymmetries have however been reported on PET scans. In this context individual variations of the topographic degenerative brain pattern and normal anatomical brain asymmetries are of interest. The white matter however also frequently shows changes, in particular loss of myelin and axons and a mild gliosis, slight in 1/3 of the cases and severe in an additional 1/3. These changes cause a decrease of density in the centrum semiovale correlating to lipid depletion. They may also influence the ventricular shape and size, of interest in CT or NMR studies. Also here variations in ventricular shape, normal and such due to pathological processes unrelated to the Alzheimer disease, may cause confusion, regarding degree of atrophy and even type of brain process. Such factors should be considered in the interpretation of non-invasive brain studies.
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PMID:Brain changes in dementia of Alzheimer's type relevant to new imaging diagnostic methods. 349 11

In a consecutive autopsy series of 580 demented elderly subjects, 256 with the clinical diagnosis of probable/possible Alzheimer's disease (AD), there were 10 cases aged between 80 and 99 years with moderate to severe dementia or confusional state in which neuropathological studies revealed abundant neurofibrillary tangles with predominant involvement of the allocortex (entorhinal region, subiculum, CA 1 sector of hippocampus, amygdala) but no or only very few senile plaques. Small numbers of diffuse deposits of beta A4 amyloid protein were present in the entorhinal cortex of 3 and in the isocortex of 5 brains, while neuritic plaques were totally absent. Only a few cases of this "senile dementia with tangles only" or, more correctly, "neurofibrillary predominant type of AD" corresponding to the limbic stage of neuritic AD pathology have been described in the literature. This rare subtype occurring in very old (over 80 years of age) subjects that does not fall within the currently used neuropathological criteria for diagnosis of AD warrants further clinico-pathological documentation.
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PMID:Neurofibrillary tangle predominant form of senile dementia of Alzheimer type: a rare subtype in very old subjects. 787 4

Seizures and epilepsy in the elderly are an important and increasingly common clinical problem. Major known causes include cerebrovascular disease, brain tumor, degenerative disorders such as Alzheimer disease and cerebral amyloid angiopathy, and toxic-metabolic syndromes such as nonketotic hyperglycemia, postcardiac arrest, and drug-induced seizures. Recognition of seizures may be complicated by relatively unique clinical presentations and differential diagnosis. Nonconvulsive status epilepticus may present as recurrent episodes of confusion. The electroencephalogram is less useful than in the pediatric age group, but has a role in the evaluation of a first seizure and may rarely show characteristic patterns, such as poststroke periodic lateralized epileptiform discharges. Convulsive status, especially that associated with drug toxicity, is associated with increased mortality in the elderly. Pharmacological treatment is complicated by age-related changes in pharmacokinetics and pharmacodynamics and drug-drug and drug-disease interactions. Some of the new antiepileptic drugs may offer advantages for use in the elderly. Oxcarbazepine has fewer drug interactions than carbamazepine, and gabapentin has one, a reduction of felbamate renal elimination. Vigabatrin causes little cognitive dysfunction, while drugs that reduce excitatory amino acid neurotransmission, such as lamotrigine and felbamate, have potentially protective effects in patients with ischemic cerebrovascular disease. The use of barbiturates, primidone, the benzodiazepine clobazam, and the calcium blockers flunarizine and cinnarizine should preferably be avoided in the elderly.
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PMID:Seizures and epilepsy in the elderly. 943 89

Fifty-six constrained acetabular components were placed, between April 1988 and February 1993, in fifty-five patients who had had recurrent dislocations (average, six dislocations; range, two to twenty dislocations) of the femoral component after a previous total hip arthroplasty. All patients had additional factors contributing to the instability of the implant, including absence or disruption of the abductor mechanism, poor health, mental retardation, confusion, and Alzheimer disease. One patient was lost to follow-up. The remaining patients were followed clinically for a minimum of three years (average, sixty-four months; range, thirty-seven to ninety-seven months) or until the time of death. During the follow-up interval, only two (4 per cent) of the fifty-five patients had a subsequent dislocation. The use of this type of component should be considered for patients who have recurrent dislocation if other treatment modalities are unlikely to be effective.
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PMID:Salvage of a recurrently dislocating total hip prosthesis with use of a constrained acetabular component. A retrospective analysis of fifty-six cases. 956 79

There has been an increasing number of patients with dementia in Japan. Although such patients were hospitalized longer than in other countries, the length of the hospital stay is becoming shorter due to changes in insurance systems. Therefore, the families of such patients are experiencing greater stress. In order to investigate the efficacy of a group structured intervention, 20 family caregivers participated in a series of five weekly sessions, each of which consisted of an educational approach, problem-solving techniques, psychological support, and relaxation. All family caregivers were women whose ages ranged from 47-66 years (mean= 54.7 +/- 4.4). The period of care at home ranged from 1-12 years (mean= 5.8 +/- 2.7). Concerning the original disease of patients, 10 had vascular dementia and 8 had senile dementia of Alzheimer type (Alzheimer disease). Two psychometries, i. e., Profile of Mood States (POMS) and General Health Questionnaire-30 (GHQ-30), were administered pre- and post-intervention. The results indicated that there was significant improvement (p<0.05) in the scores of depression, anger-hostility, fatigue, confusion in the POMS, and physical symptoms, anxiety-mood disorder, and suicidality-depression in the GHQ-30. This preliminary study suggests that this kind of intervention appears quite effective for relieving the emotional and physical discomfort suffered by family caregivers.
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PMID:A structured intervention for family caregivers of dementia patients: a pilot study. 1053 Jun 24

Down syndrome (DS) is the most common cause of mental retardation in North America, yet little information is available on the natural history of DS in adults. We report on significant medical problems of adults with DS (DS adults) residing in a British Columbia provincial residential center, Woodlands, over the 12-year period from 1981 through 1992. Prospective, yearly health care reviews on 38 DS adults are summarized according to age. Group 1 consists of 18 middle-aged DS adults less than 50 years old, and group 2 comprises 20 elderly DS adults 50 years and older. Significant health problems in all DS adults include untreated congenital heart anomalies (15. 8%), acquired cardiac disease (15.8%), pulmonary hypertension (7.8%), recurrent respiratory infections/aspiration leading to chronic pulmonary interstitial changes (30%), complications from presenile dementia/Alzheimer-type disease (42%), adult-onset epilepsy (36.8%), osteoarthritic degeneration of the spine (31.6%), osteoporosis with resultant fractures of the long bones (55%) or vertebral bodies (30%), and untreated atlantooccipital instability (7.9%). Acquired sensory deficits are significant problems including loss of vision due to early onset of adult cataracts (50%), recurrent keratitis (21%) or keratoconus (15.8%), and significant hearing loss (25%). Behavioral problems (50%), loss of cognitive abilities, and onset of symptoms of Alzheimer disease (group 1: 5.5%; group 2: 75%) pose ongoing challenges for care. In conclusion, the quality of life for adults with DS can be improved by routine, systematic health care screening to identify treatable diseases that may be missed because of poor communication or confusion due to Alzheimer disease.
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PMID:Health care concerns and guidelines for adults with Down syndrome. 1055 65

Mervyn Peake (1911-1968) was an accomplished British artist, poet, novelist, and playwright. He was a prolific and talented illustrator and wrote hundreds of poems, 4 novels, and several plays. His exceptional career was prematurely ended by a neurodegenerative illness variously ascribed to Alzheimer disease, Parkinson disease, or postencephalitic parkinsonism. However, a detailed review of biographical accounts produces substantial evidence in support of a probable diagnosis of dementia with Lewy bodies, a clinical entity remaining undiagnosed outside specialty dementia clinics. Peake developed signs of parkinsonism and insidious cognitive decline during his fifth decade. A breakdown in his writing style has frequently been cited as reflecting his encroaching dementia. Visual hallucinations are portrayed in sketches, and together with paranoid delusions are apparent in poetry composed during his illness. His deterioration was progressive and punctuated by well-described episodes of confusion and psychosis. His occasional preservation of insight is poignantly captured in drawings of figures with dunce caps or pointed heads, often with expressions of fear and apprehension etched with an economy of strokes. Peake spent his final years in various psychiatric institutions but continued to exhibit lucid intervals even late into his illness. His tragic deterioration remained undiagnosed at the time, but in retrospect, his progressive dementia with parkinsonism, visual hallucinations, and marked cognitive fluctuations likely represents one of the earliest recognized historical cases of dementia with Lewy bodies.
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PMID:Dementia with Lewy bodies and the neurobehavioral decline of Mervyn Peake. 1281 Apr 96

Chronic alcohol consumption results in considerable damage to many of the body's organs, and particularly to the brain. Beyond the confusional state occurring with acute intoxication or withdrawal, alcohol abuse is responsible of a constellation of neuropsychiatric syndromes including cognitive dysfunction, Wernicke-Korsakoff Syndrome, alcoholic cerebellar degeneration, Marchiafava-Bignami disease and alcohol-related dementia, ARD. ARD would account for nearly 20% of all admissions to state mental hospitals in the United-States. According to the DSM-IV, ARD is defined by a dementia associated with alcohol abuse. However, the concept of a dementia directly related to the neurotoxicity of alcohol for brain neurons is still a matter of debate. Several hypotheses have been proposed to explain the mechanisms of cognitive deficits related to chronic alcohol intoxication. This paper presents the epidemiological, neuropathological, neurochemical and clinical data on ARD. Alcoholism is responsible for cognitive deficits of various severity, which could be reversible or not with alcohol abstinence, but can also participate to the cognitive impairment related to other pathologies, such as Alzheimer disease. On account of this review, it is suggested that the term alcohol-related cognitive impairment should be more convenient than that of ARD, more restrictive and more confusing. Presently, there are no established treatment for alcohol-related cognitive impairment. Alcohol abstinence is a most important step. Psychosocial interventions are essential to support the patients in the daily life.
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PMID:[Alcoholism and aging. 2. Alcoholic dementia or alcoholic cognitive impairment?]. 1568 59


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