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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The article presents diagnostic criteria for dementia associated with diffuse Lewy body disease (DLBD) elaborated by the group of investigators from Nottingham (Byrne et al. 1991). These criteria allow to make the diagnosis of "probable" or "possible" dementia associated with DLBD. With certainty this form of dementia can only be diagnosed by neuropathological examination which reveals diffuse cortical Lewy bodies. At present there is no agreement whether DLBD is a variant of Alzheimer's disease or a separate nosological entity--the second commonest cause of dementia. The main clinical feature of DLBD is coexistence of dementia and symptoms of parkinsonian syndrome. The other important feature which differentiates between DLBD and other forms of dementia is a very considerable early fluctuation of cognitive state. Psychotic symptoms in the course of DLBD--visual and auditory hallucinations, delusions and depression--are common. At present treatment of DLBD is unknown. Treatment of psychotic symptoms is difficult because of the presence of parkinsonism.
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PMID:[Dementia in diffuse Lewy body disease]. 765 84

Diffuse Lewy body disease, a severely disabling neuropsychiatric disease, presents with progressive dementia, psychotic symptoms, depression, and parkinsonian symptoms. The authors report a case illustrating that clozapine, a novel neuroleptic drug, has special efficacy in treating psychotic symptoms in these patients.
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PMID:Clozapine use in diffuse Lewy body disease. 850 40

We conducted a retrospective study to determine the frequency of depression, hallucinations, and delusions in patients with diffuse Lewy body disease (DLBD) and to compare these findings with those in Alzheimer's disease (AD) and Parkinson's disease (PD). One hundred twelve subjects were included in the study. Of these, 28 subjects were diagnosed with DLBD, 58 with AD, and 26 with PD at autopsy. Main outcome measures included the percentages of subjects in each of the three categories in whom depression, hallucinations, or delusions were reported at any time during the course of the illness. Hallucinations and delusions were further classified by type. We found that depression was more common in DLBD (50.0%) than in AD (13.8%) (chi 2 = 13.00, p = 0.0003). There was no difference in the frequency of depression in DLBD and PD (57.7%) (chi 2 = 0.32, p = 0.57). Hallucinations were reported more frequently in DLBD (60.7%) than in AD (34.5%) (chi 2 = 5.30, p = 0.021). There was no difference in the frequency of hallucinations in DLBD and PD (53.8%) (chi 2 = 0.26, p = 0.61). Delusions were more common in DLBD (57.1%) than in PD (15.4%) (chi 2 = 10.08, p = 0.0015). There was no difference in the frequency of delusions in DLBD and AD (53.4%) (chi 2 = 0.10, p = 0.75). There was a male predominance of DLBD cases and PD cases; AD cases were predominantly women. We conclude that psychiatric features are very common in DLBD and should be a central diagnostic criterion for the disease.
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PMID:Psychiatric features in diffuse Lewy body disease: a clinicopathologic study using Alzheimer's disease and Parkinson's disease comparison groups. 948 9

Recent years have seen the introduction of several new antidepressants, many of which have selective effects on serotonin (5-HT) pathways. In most patients these drugs are as effective as traditional tricyclic antidepressants and are somewhat better tolerated. In the most severe depressive disorders, however, drugs such as clomipramine, that produce potent inhibition of both 5-HT and noradrenaline reuptake may be more effective. Lithium is increasingly used in the treatment of resistant depression but its role in the short-term management of mania is less certain because of the increased risk of relapse on sudden discontinuation. In the treatment of mania and prophylaxis of bipolar disorder, carbamazepine and valproate are alternatives to lithium. In dementia, the cholinesterase inhibitor, tacrine, produces worthwhile improvement in about 40% of patients able to tolerate adequate doses. There is concern about adverse effects of antipsychotic drugs in patients with dementia, particularly those with Lewy body disease.
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PMID:Advances in psychopharmacology: mood disorders and dementia. 894 56

Parkinsonism occurs frequently in the patients with Alzheimer type dementia (ATD). The frequency ranges from 9% to 100% of ATD patients, depending on samples, clinical instruments and stages of illness. Several studies have described that rigidity and hypokinesia are the most prevalently observed signs of parkinsonism, and that resting tremor is less. The clinical progress of patients with parkinsonism is more rapid than those of patients without parkinsonism. Patients with parkinsonism are frequently associated with psychiatric symptoms such as depression and delusion. The pathogenesis of parkinsonism in ATD remains to be elucidated, but it should be noted that some cases with parkinsonism correlates with Parkinson's disease pathologic condition, and some have diffuse Lewy body disease.
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PMID:[Parkinsonism in Alzheimer's disease]. 901 40

Dementia of the Alzheimer-type (DAT) is characterized by progressive cognitive decline, variably combined with frontal lobe release signs, parkinsonian symptoms and myoclonus. The features of diffuse Lewy body disease (DLBD), the second most common cause of degenerative dementia, include progressive cognitive deterioration, often associated with levodopa-responsive parkinsonism, fluctuations of cognitive and motor functions, psychotic symptoms (visual and auditory hallucinations, depression), hypersensitivity to neuroleptics and orthostatic hypotension. A recent report suggests that positron emission tomography studies in patients with degenerative dementia may be useful in the differential diagnosis of DAT and DLBD. However, the diagnostic role of single-photon emission tomography (SPET) studies remains to be established. The aim of this study was therefore to evaluate regional cerebral perfusion [with either technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) or 99mTc-ethyl cysteinate dimer (99mTc-ECD) SPET] and striatal dopamine transporter density [using iodine-123 2 beta-carboxymethoxy-3 beta-[4-iodophenyl]tropane (123I-beta-CIT) SPET] in patients with DAT and DLBD. Six patients with probable DAT and seven patients with probable DLBD were studied. Blinded qualitative assessment by four independent raters of 99mTc-HMPAO or 99mTc-ECD SPET studies revealed bilateral temporal and/or parietal hypoperfusion in all DAT patients. There was additional frontal hypoperfusion in two patients and occipital hypoperfusion in one patient. In the DLBD group, regional cerebral perfusion had a different pattern. In addition to temporoparietal hypoperfusion there was occipital hypoperfusion resembling a horseshoe defect in six of seven patients. In the DAT group, the mean 3-h striatal/cerebellar ratio of 123I-beta-CIT binding was 2.5 +/- 0.4, with an increase to 5.5 +/- 1.1 18 h after tracer injection. In comparison, in the DLBD patients the mean 3-h striatal/cerebellar ratio of 123I-beta-CIT binding was significantly reduced to 1.7 +/- 0.3, with a modest increase to 2.1 +/- 0.4 18 h after tracer injection (P < 0.05, Scheffe test, ANOVA). These results suggest that 99mTc-HMPAO or 99mTc-ECD and 123I-beta-CIT SPET may contribute to the differential diagnosis between DAT and DLBD, showing different perfusion patterns and more severe impairment of dopamine transporter function in DLBD than in DAT.
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PMID:Brain perfusion scintigraphy with 99mTc-HMPAO or 99mTc-ECD and 123I-beta-CIT single-photon emission tomography in dementia of the Alzheimer-type and diffuse Lewy body disease. 914 72

The diagnosis of Alzheimer's disease (AD) is done by a careful history, requiring reliable informants and serial observations. The main differential diagnosis is depression, delirium, and inappropriate use of psychotropic drugs. Other common causes of dementia such as vascular, Lewy body disease, frontal lobe degeneration, can be distinguished by the pattern of symptoms and findings on the physical examination. A minimal amount of laboratory investigation is usually required. The natural history of AD, with progressive involvement of cognition, activities of daily living and behaviour, justifies the need of outcome variables addressing these specific symptomatic domains. These are complemented by global clinical assessment tools for disease staging and disease progression. A new challenge is to select from outcome variables used in clinical investigations the most appropriate tools for regular clinical practice.
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PMID:Current diagnostic methods and outcome variables for clinical investigation of Alzheimer's disease. 970 Jun 62

The authors assessed the accuracy of published clinical criteria and their own modifications of those criteria in diagnosing Lewy body disease (LBD). Clinical diagnoses were made by two clinicians, blinded to neuropathologic diagnoses, using the Rochester Alzheimer's Disease Center database and traditional medical records. Neuropathologic diagnoses were made according to published guidelines. Results from 21 Alzheimer's disease and 18 LBD patients indicated that no set of clinical criteria was accurate in diagnosing LBD. The only significant predictor of LBD in this population was depression, which was more common in LBD than in Alzheimer's disease. The authors conclude that clinical identification of LBD is an important but unresolved neurological problem.
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PMID:Lewy body disease: can we diagnose it? 981 85

There is a preponderance of research on the neuropsychology of the various dementias. There are also direct comparisons between two or more dementias available in the literature. This paper sought to summarize the most recent literature, primarily from 1990 through mid-1996, including recent reviews of the literature from previous decades. The purpose was to provide, in one location, a summary of neuropsychological (i.e., cognitive, motor, and psychiatric) characteristics of major noninfectious, progressive dementias and depression of middle and late adulthood. It is hoped that this review, particularly a summary table provided, will serve as a guide in the differential diagnosis of the dementias by clinicians. In addition to Alzheimer's disease, vascular dementias, Parkinson's disease, Lewy body dementia, Huntington's disease, and frontal lobe dementia, the impact of depression on cognitive functioning is covered given the frequency with which neuropsychologists are asked to differentiate depression from primary dementia.
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PMID:Differential diagnosis of the major progressive dementias and depression in middle and late adulthood: a summary of the literature of the early 1990s. 983 89

Brain tissue obtained at autopsy continues to provide unique opportunities in current dementia research. Not only is tissue analysis still essential for diagnosis, but investigation of neurochemical pathology, at a level of resolution beyond current in vivo imaging, continues to provide new insights into the involvement of neurotransmitter signalling systems. These are relevant to therapy which, with respect to symptoms such as cognitive impairment, psychosis and depression, is currently targeted to specific transmitter (cholinergic, dopaminergic and serotonergic) systems. This paper focuses on dopaminergic, cholinergic and histaminergic parameters in Alzheimer's disease (AD), Dementia with Lewy bodies (DLB) and Parkinson's disease (PD). In the normal striatum the dopamine transporter and D2 receptor exhibit distinct rostral-caudal distributions and D2 binding is affected by genetic polymorphism at the Taq 1A locus. The transporter is reduced in both DLB and PD but not AD, correlating with severity of extrapyramidal dysfunction, and receptor abnormalities are apparent in DLB patients responding adversely to neuroleptics. Striatal nicotine receptors are lost in all 3 disorders, further reduced as a result of neuroleptic medication, and elevated as a result of tobacco use. In the thalamus there are selective reductions in presynaptic cholinergic activity in DLB in the reticular nucleus which relate to symptoms of hallucinations and fluctuating consciousness prevalent in this disorder. In the hippocampus coupling of muscarinic M1 receptors, relevant to response to cholinergic therapy, is impaired in areas most affected by beta-amyloid plaques and intact in less affected areas. Analysis of histamine H2 receptors indicates that, despite presynaptic histamine abnormalities in AD, receptor numbers are normal. Such clinically and therapeutically relevant observations on human brain neurochemistry provide a basis for improving therapeutic strategies and prospects of diagnostic in vivo chemical imaging.
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PMID:Clinical neurochemistry: developments in dementia research based on brain bank material. 986 26


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