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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of 79 patients with multi-infarct dementia (MID) were divided into 2 groups designated cortical MID and subcortical MID, according to whether the computed tomography (CT) scan showed the presence or absence of cortical infarcts, and an absent to mild or moderate to severe degree of white matter low attenuation (WMLA). Cortical MID was characterized by repeated atherothrombotic and cardiogenic strokes, moto-sensory hemiparesis, a severer degree of aphasia, and abrupt onset of cognitive failure. Subcortical MID typically showed the following features: lacunar strokes, bulbar signs including dysarthria, pure motor hemiparesis, depression and emotional lability. WMLA was found in all patients with subcortical MID but also in over 60% of those with cortical MID. In the 2 groups CT scans showed equal frequencies of deep infarcts. When divided according to severity of WMLA, 92% of patients in the cortical MID group and 44% of those in the subcortical MID group were found to have at least one cortical infarct on the CT scan. Although cortical and subcortical MID differed in several clinical features, they did not show major differences in the risk factors for stroke, and clearly overlapped each other as regards ischaemic scores and the findings in neurological examinations and CT. Thus, it is still an open question whether cortical MID and subcortical MID, including the lacunar state and Binswanger's disease, are 2 distinct entities or merely represent the expression of biological variation while having the same etiopathogenesis.
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PMID:Types of multi-infarct dementia. 363 Jun 35

Eighty-one patients (mean age: 66 +/- 9 years) who had been in gerontopsychiatric in-patient care were included in the study. As well as physical, psychiatric and neurological examinations, EEG, brain CT scanning and the determination of the Ischemic Scale were performed, in order to confirm the clinical diagnosis of dementia of Alzheimer type (DAT), dementia of vascular type (DVT) or multi-infarct dementia (MID), and depression in old age, as based on the DSM III criteria. A comprehensive psychological test battery was administered, to one section of the subjects. Our results indicate that EEG and Ischemic Score can differentiate patients with DAT and DVT to a satisfactory degree, whereas CT findings and psychometric assessment were apt to confirm the overall diagnosis of dementia (DAT/DVT) and depression. Patients with dementia showed memory impairment to a greater extent than depressive patients, as could be proved by a memory test (Syndrom-Kurztest). However, a dementia screening test (Information-Memory-Concentration Test) could more accurately differentiate dementia and depression. The application of a comprehensive psychometric testing procedure did not prove to be an effective diagnostic tool in the assessment of various stages of dementia. Short dementia tests and rating scales seem to be appropriate to distinguish depression from dementia, especially in cases of mild to moderate dementia. In patients with very mild and insignificant organic brain disturbances these screening methods fall short of diagnostic validity. Beyond this, there is a current need for assessment instruments in the evaluation of alterations in personality and affectivity, such as are seen in depression.
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PMID:[Interdisciplinary research strategies in geriatric psychiatry--studies and results in dementia and depressed patients]. 366 Sep 17

A Multivariate Analysis of Covariance and Discriminant Analysis were carried out on complete WAIS profiles obtained from three groups of demented patients: Multi-Infarct Dementia patients, Senile Dementia of Alzheimer Type patients, and Alcoholic Dementia patients. A group of middle-aged Depressed patients was also included. WAIS did not differentiate among dementias, but Picture Completion and Block Design subtests proved to be effective in differentiating dementia from depression.
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PMID:Discriminant analysis of WAIS results in different types of dementia and depressed patients. 366 44

In a retrospective study of 84 outpatients with multiinfarct dementia, urinary and gait disturbances were found in 50% and 27%, respectively, and often preceded dementia and discrete stroke-like episodes by more than 5 years. Compared to patients without urinary disturbance, those with urinary dysfunction were predominantly male and more behaviorally impaired, but were similar in age, cognitive score, depression score, computerized tomography findings, and relative survival. Compared to patients without gait disturbance, those with gait abnormality had a higher Hachinski ischemic score and depression score and were more behaviorally impaired. Urinary and gait abnormalities may be markers for cerebrovascular disease and vascular dementia even in the absence of frank stroke. Damage to bifrontal outflow tracts may be the common pathophysiological mechanism underlying the behavioral and motor symptoms characteristic of vascular dementias.
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PMID:Urinary and gait disturbances as markers for early multi-infarct dementia. 381 Jul 46

Delusions, depression, and hallucinations were assessed in 30 patients with dementia of the Alzheimer type (DAT) and 15 with multi-infarct dementia (MID). The nature and prevalence of delusions did not distinguish DAT from MID: delusions were present at the time of examination in 30% of patients with DAT and in 40% of patients with MID, and had occurred at some time in the course of the illness in half the patients of each diagnostic group. Delusions were primarily paranoid in type and involved elementary misbeliefs concerning theft or infidelity. Depression was significantly more common in MID than DAT. Seventeen percent of patients with DAT had depressive symptoms; none with severe depression were identified. Four of 15 patients with MID exhibited major depressive episodes and 60% manifested depressive symptoms. Depression and delusions were not deducted in patients with severe dementia. Hallucinations occurred in both diagnostic groups but were not common: one patient with DAT and one with MID had auditory hallucinations, and three patients with MID had visual hallucinations.
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PMID:Neuropsychiatric aspects of multi-infarct dementia and dementia of the Alzheimer type. 382 94

In the apathetic, withdrawn patient, tricyclic secondary amines such as desipramine and nortriptyline are as efficacious as tricyclic tertiary amines, and they offer the advantage of fewer anticholinergic and sedating side effects. Depressions usually have a sudden onset, whereas degenerative dementias such as Alzheimer's disease and multi-infarct dementia are manifested gradually. However, many elderly demented patients have concomitant depression, making assessment difficult.
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PMID:Geriatric depression: a guide to successful therapy. 399 18

The prevalence and significance of clinical heart disease and hypertension were compared in three groups of elderly patients. One group was diagnosed as dementia of an Alzheimer's type (AD), another as multiinfarct dementia (MID), and the third as major depression. Clinical heart disease and hypertension were uncommon in the AD group with the prevalence being lower than that reported in most epidemiologic studies. Four percent of the AD patients had a history of myocardial infarction, 5% angina, 1% arrhythmias, and 3% heart failure. Electrocardiographic changes of an old myocardial infarction were present in 9%, atrial fibrillation in 1%, and left ventricular hypertrophy in 3%. A history of hypertension was present in 24% of the AD patients. In comparison, a history of myocardial infarction, angina, and heart failure was five times greater, and electrocardiographic abnormalities were twice as prevalent in the MID group. A history of hypertension was three times more common and actual blood pressure readings were higher. In the depression group heart disease was not uncommon and the prevalence, in general, was comparable with the MID group. However, a history of increased blood pressure and actual increased blood pressure readings were statistically less than in the MID group.
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PMID:Prevalence and significance of cardiovascular disease and hypertension in elderly patients with dementia and depression. 401 97

Dementia affects an estimated 5 percent of the population 65 years of age and older, with 20 percent being affected at 75 years or older. Although the most common forms, primary degenerative and multi-infarct dementia, currently lack specific treatments, it is estimated that a thorough diagnostic evaluation will uncover a treatable cause in 10 percent to 20 percent. The differential diagnosis includes benign senescent forgetfulness, depression, adjustment disorder, paranoid states, amnestic syndrome, delirium, drug effects, systemic illnesses and intracranial conditions. The approach to each patient involves a history, physical examination, mental status evaluation and laboratory tests that focus on identifying treatable conditions. When no specific treatments are available, however, symptomatic treatments, including pharmacotherapy, environmental management, family supports and psychotherapy, can offer relief for both patients and their families and improve the daily functioning of the elderly patient with dementia.
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PMID:Diagnosis and treatment of dementia in the aged. 612 26

The prevalence of severe dementia in the United States is about 1.3 million cases, of which at least 50 to 60% are of the Alzheimer type. Severe dementia of the Alzheimer type is found rarely in a clearly dominant pattern, although often one or more relatives are affected. Down's syndrome in adults is often associated with Alzheimer changes. The diagnosis is a clinicopathological one; there is a considerable error rate in the clinical diagnosis early in the course of the disease, especially in regard to dementia in depression. The differential diagnosis involves a great many disorders, including multi-infarct dementia, tumors, subdural hematomas, and others. Physiological aspects of Alzheimer's disease include a diffusely slow electroencephalogram, reduced cerebral blood flow, and particular patterns noted on positron emission tomographic scanning. The latter technique has also demonstrated that oxygen extraction is normal in Alzheimer's disease, thus excluding ischemia from possible pathogenetic factors. Morphological changes, that is, the presence of plaques and tangles, are widely distributed in neocortex, paleocortex, and many deep gray areas down through the pontine tegmentum, but largely exclude the basal ganglia, thalamus, and substantia nigra. Numerous plaques without neocortical tangles are found in many demented persons older than 75 years. A severe loss of large neocortical neurons is characteristic of the disease. The chemical nature of the paired helical filaments that make up the neurofibrillary tangle has not yet been ascertained. Neurons are markedly deficient in the basal forebrain nuclei, and this deficiency may account for the severe diminution of choline acetyltransferase and acetylcholine in the neocortex and paleocortex. Muscarinic cholinergic receptors are present in normal amounts. Norepinephrine is reduced in some cases, and somatostatin in most. Substance P is low in severe cases. The etiology of the disorder is unknown and the role of aluminum is disputed. Management of patients with Alzheimer's disease is difficult, and neuroleptics are to be used with great caution because of their side effects. Substrate therapy has not been effective; physostigmine improves memory but is not suitable for general use. Trophic factors, gangliosides, and aluminum chelation are being investigated for use in pharmacological intervention.
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PMID:Senile dementia of the Alzheimer type. 613 75

Patients who had Alzheimer's disease-senile dementia of the Alzheimer type (AD/SDAT) or multi-infarct dementia (MID) were compared with a group of controls. Demented patients had approximately the same degree of dementia and the same duration of illness. The MID group had a significantly higher mean age than the AD/SDAT group. Sixty-three per cent of the AD/SDAT patients were free of other diseases, while 65 per cent of the MID patients had cardiovascular disease. Thirty per cent of the MID patients had a history of previous depression, while only 5 per cent of the AD/SDAT patients had had depression. At the time of the investigation, however, AD/SDAT patients showed significantly more signs of depression than the MID patients. Focal neurologic signs were found in 70 per cent of the MID patients and only 6 per cent of the AD/SDAT patients. The electrocardiogram was normal for every AD/SDAT patient, while 75 per cent of the MID patients had abnormal ECGs. Electroencephalography showed generalized slow frequencies in 79 per cent of the AD/SDAT patients and localized slow frequencies and abnormalities in 65 per cent of the MID patients. Computed tomography of the brain showed that MID patients had significantly greater dilation of the ventricular system, while cortical atrophy did not differ significantly among the three groups. Homovanillic acid in the cerebrospinal fluid was significantly lower in the AD/SDAT group as compared with controls.
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PMID:Dementia of the Alzheimer type and multi-infarct dementia: a clinical description and diagnostic problems. 620 54


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