System of natural killer lymphocytes in Alzheimer's type dementias

Cytotoxic activity and quantity of natural killer (NK) lymphocytes were measured in 25 patients with Alzheimer's disease (AD), in 13 patients with senile dementia of Alzheimer's type (SDAT) and in 31 normals of different age (controls). In mentally healthy elderly individuals of the same age as the patients, functional activity of a subpopulation of NK lymphocytes was significantly decreased in comparison with healthy young people, meanwhile a number of these cells wasn't changed. In patients with AD and SDAT the tendency was found to increasing of functional activity of NK lymphocytes in comparison with elderly normals, which achieved the degree of significant differences only in SDAT patients with moderate dementia. Direct dependence of cytotoxic activity of NK lymphocytes on AD duration was determined. Such correlation was not observed in SDAT. This permitted to suppose a destructive influence of lymphocytes with increased cytotoxic activity on either CNS cells or their components in AD.     

Cerebral mapping in patients with dementia of Alzheimer's type

INTRODUCTION: The electric cerebral activity maps complement the conventional electroencefalography quantifying electric cerebral activity. One of the applications is in Alzheimer's dementia. OBJECT: The object of this study is to analyse the differences in the electric cerebral activity, by means a quantified EEG, in DAT and SDAT when compared with a control group of the same age. MATERIAL AND METHODS: Thirty patients meeting the criteria of probabledementia (NINCDS-ADRDA) in the senile (n = 19) and presenile (n = 11) form were studied. They were compared with a control group of the same age, 20 individuals older than and 17 younger than 65. RESULTS: The patients suffering from senile dementia as well as those suffering from the presenile form showed a significative increase of the delta and theta bands. On the other hand, a significant reduction of the alfa frequency bands and mainly those of beta was observed in the patients with ADT but not in the ADST ones. The significant increase of the slow bands in ADT and ADST and the significant decrease of the fast bands in ADT have been found in wide areas. Topographically the biggest affect has been registered in the frontal regions for the beta bands in ADT. CONCLUSIONS: The differences found in the electrical activity, depending on the age, would support Alzheimer's disease heterogeneity.     

Risk factors of dementia Alzheimer's type

The paper presents the study of risk factors and factors-protectors of the development of dementia of Alzheimer's type (DAT). 40 patients with Alzheimer's disease (AD), 40 patients, with senile DAT and 80 healthy individuals of the same sex, age and education level were examined. The pairs were formed: the patient-normal. The main risk factor in DAT group was family predisposition to dementia. AD risk factors may be the exposure to radioactive materials or chronic psychotraumatic situations during life. Senile DAT risk factors may be traumas of head without lack of consciousness. Acute and frequent psychotraumatic situations as well as some somatic diseases (and related drug therapy) were factors-protectors in the whole DAT group. Groups of patients with AD and senile DAT differed by both risk factors and factors-protectors, confirming DAT heterogeneity. Hypothetic biologic basis of the data obtained is described.     

Overproduction of Campylobacter ferritin in Escherichia coli and induction of paracrystalline inclusion by ferrous compound

Levels of the proteoglycans hyaluronic acid, heparan sulfate, dermatan sulfate and chondroitin sulfate in brains were measured. The samples were from 25 brains obtained at autopsy from patients who had senile dementia of Alzheimer's type (SDAT) (60 to 97 years old) and 10 brains from non-demented elderly subjects (75 to 101 years old). Proteoglycan levels in the brains of patients with SDAT were twice as high in the hippocampus and four times higher in the superior frontal gyrus than the levels in brains of non-demented elderly subjects. The content of heparan sulfate proteoglycan was greatest nine times higher in the hippocampus and seven times higher in the superior frontal gyrus. By immuno-electronmicroscopic examination, heparan sulfate proteoglycan was found in the basement membranes of capillaries, and in a portion of the cores of the senile plaques.     

Epidemiologic and clinico-pathologic study on senile dementia in a Japanese community, Hisayama

To elucidate a definite prevalence of dementia and its risk factors in the senescence, 887 subjects aged 65 years or over of Hisayama residents (94.6% of the whole population in the same age-range) were examined from May to December, 1985, as to whether he or she has suffered dementia. Karasawa's "Clinical criteria for the severity of dementia", Hasegawa's Dementia Scale and Hachinski's ischemic score were used as a procedure to identify demented persons. Out of 887 examined, 59 subjects were diagnosed to have had dementia (6.7%) with female to male ratio being 1.2. The prevalence rates of dementia increased with advanced age decades and sharply grew up over tha age of 80 years. Brain morphology in 50 of the 59 dementias was re-evaluated by autopsy and/or CT scan, during a 55-month follow-up period from January 1986 to July 1990. Coincidence rate between clinical evaluation and morphological diagnosis was 90.5% for vascular dementia (VD), 62.5% for senile dementia of Alzheimer type (SDAT), and 28.6% for other or ill-defined dementia (Others). Misdiagnosis of clinical evaluation for VD was mainly due to uncertain history of head trauma, while the subjects suffering from atypical stroke tended to be diagnosed as SDAT. Out of the 21 cases who were initially diagnosed as having other or ill-defined dementia, 8 were re-evaluated as VD, and 7 as SDAT later. Most cases who were finally diagnosed as having VD had multi-infarcts without an episode of stroke attack, while those who were classified to SDAT had less severely undergone dementia. The final type-specific prevalence of dementia was 56% for VD, 26% for SDAT and 18% for Others, respectively. The ratio of VD to SDAT was 2.2, indicating more frequent VD than SDAT. Retrospective case-control study on risk factors of VD was performed using selected parameters obtained at examinations in 1973 or 1978, comparing 27 VD cases and 789 non-demented cases. As a consequence, aging, hypertension, electro-cardiographic abnormalities (Minnesota code 3-1 and/or 4-1, 2, 3) and high hematocrit were taken as important risk factors for VD. These risk factors were very similar to those for lacunar infarcts among Hisayama residents. The difficulty of epidemiologic study on dementia in general population and the accuracy of diagnosis for type of dementia were discussed.     

The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer's disease: A comparative neuropsychological study.

The authors compared age-matched groups of patients with the frontal and temporal lobe variants of frontotemporal dementia (FTD; dementia of frontal type [DFT] and semantic dementia), early Alzheimer's disease (AD), and normal controls (n?=?9 per group) on a comprehensive neuropsychological battery. A distinct profile emerged for each group: Those with AD showed a severe deficit in episodic memory with more subtle, but significant, impairments in semantic memory and visuospatial skills; patients with semantic dementia showed the previously documented picture of isolated, but profound, semantic memory breakdown with anomia and surface dyslexia but were indistinguishable from the AD group on a test of story recall; and the DFT group were the least impaired and showed mild deficits in episodic memory and verbal fluency but normal semantic memory. The frontal and temporal presentations of FTD are clearly separable from each other and from early AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quantitative analysis of neuropathologic changes in the cerebral cortex of centenarians

1. The quantitative distribution of neurofibrillary tangles and senile plaques was studied in the brains of 65 elderly patients aged from 96 to 104 years by immunohistochemistry. 2. According to the clinical and neuropathological diagnoses, three groups of cases were considered: 19 patients with Alzheimer's disease, 22 patients with mixed dementia (vascular and degenerative) and 24 patients with no or very mild cognitive impairment. 3. Moderate to high neurofibrillary tangle densities were always present in the hippocampus and entorhinal cortex. The inferior temporal cortex was very frequently affected in demented and non-demented cases whereas the superior frontal cortex was spared in the majority of cases independently of the clinical diagnosis. Quantitatively, Alzheimer's disease cases showed significantly higher NFT densities than cases with no clinical findings of dementia only in the CA1 field of the hippocampus. 4. The hippocampus and entorhinal cortex were often devoid of senile plaques in non-demented cases while the vast majority of Alzheimer's disease cases had few SP in these regions. The frontal and temporal cortex were more frequently involved than the limbic structures in both non-demented and Alzheimer's disease cases. The SP densities in layers II and III of the inferior temporal and superior frontal cortex were significantly higher in Alzheimer's disease than in non-demented cases. 5. These observations suggest that the dementing process in nonagenarians and centenarians may differ to that described in younger demented individuals in that neurofibrillary tangles involve principally the hippocampal formation with relative sparing of the neocortex. Furthermore, they indicate that both the neurofibrillary tangle densities in the CA1 field and senile plaque densities in the superficial layers of the neocortex must be considered for the neuropathological diagnosis of Alzheimer's disease in this age group.     

Psychiatric correlates of MR deep white matter lesions in probable Alzheimer's disease

The authors examined the relationship between psychiatric symptoms and the presence of of MR deep white matter lesions (DWMLs) in 28 probable Alzheimer's disease (AD) patients with mild to moderate dementia. The difference in frequency of psychiatric symptoms between patients with and without DWMLs was not statistically significant. However, MR global scores of severity correlated with the presence of ideational disturbances (such as low self-esteem and suicidal ideation). Analysis of specific cerebral regions indicated that the highest correlation occurred in the frontal white matter. Thus, DWMLs are correlated with specific symptoms of depression in AD. Whether DWMLs are etiologically related to these symptoms remains to be determined.     

The long-term effect of day care rehabilitation on individuals with dementia

In the treatment of senile dementia, rehabilitation rather than drugs, could result in more positive long-term effects. A Day Care program designed for individuals with Senile Dementia of the Alzheimer type (SDAT) and Vascular Dementia (VD:MID and BD), activates the brain through memory training, creative arts therapy, physical activity, and social interaction. The objective of this study is to determine if Day Care can modify the patients intellectual decline or even alter the natural course of the dementing illness. 135 SDAT and 213 VD patients were studied over three years. ADL (Activities of Daily Living) measurements were evaluated by the Barthel Index and cognitive measurements by the NM-scale. The Wilcoxon test and the Sign test were carried out using the BI and NM-scale scores. These results indicated a decline or arrest in the progression of SDAT and VD as determined by the multiple logistical models. The 8 variables (risk factors, medication, age at onset, self-rehabilitation, family support, sex, grade of dementia and Day Care) influence on the survival curves was calculated using the Kaplan-Meire Life table method. The Cox proportional hazard analysis was then used to examine the relationship between the 8 variables and dementia. The significantly positive results from these four analyses of the ADL and cognitive measurements indicate that Day Care programs clearly retards the progression of intellectual decline in dementia patients and improves the quality of life (QOL) in all cases. In VD patients the mortality rate was notably decreased through Day Care. These results make one consider the benefits of introducing such programs into society as a strong treatment against the onset of dementia developing into severe, dehabilitating dementia. However a healthy diet, a physically and mentally active life, as well as early diagnosis, are the best preventions against dementia.     

An analysis of confrontation naming errors in senile dementia of the Alzheimer type.

Examined confrontation naming performance as reflected by the Boston Naming Test (BNT) in 25 healthy elderly adults (aged 63–83 yrs), 25 age-matched adults with very mild senile dementia of the Alzheimer type (DAT), and 24 age-matched adults with mild DAT. Errors were classified within 17 different categories that differentially reflected perceptual, lexical, and semantic mechanisms. Early in DAT, there was a loss of lexical information and some loss in specific semantic attributes. As the disease progressed, there was increasing involvement of core semantic structures. These observations were supported by analyses of linguistically related errors, 4-alternative forced-choice recognition performance, and correlational analyses between performance on the BNT and 12 standard psychometric tests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autocrine/paracrine role of adrenomedullin in cultured endothelial and mesangial cells

Neuropsychological profiles were assessed in a large group of nondemented control subjects (n = 261) and individuals with dementia of the Alzheimer type (DAT) (n = 407) by subjecting their psychometric test results to a factor analysis. Nondemented control subjects were functionally homogeneous with only one factor accounting for the results. The results of the factor analysis on the very mild DAT and mild DAT groups, however, yielded a mental control/frontal factor, a memory-verbal/temporal factor, and a visuospatial/parietal factor. Forty-one of the original set of participants came to autopsy an average of 5.1 years after psychometric testing and had neurofibrillary tangles, total senile plaques, and cored senile plaques estimated from frontal, temporal, and parietal regions. The results of correlations indicated that the relative burden of cored senile plaques was systematically related to the three psychometric factors. These results suggest a connection between the specific functions as defined by neuropsychological measures and specific neuropathology occurring in associated areas of cortex.     

Long-term follow-up evaluation in HCV chronic hepatitis treated with alpha-2b interferon. A comparison of two protocols

OBJECTIVE: To compare prospectively the concordance between the diagnosis of dementia based on clinical criteria and using the DAT Inventory. DESIGN, SETTING, AND PARTICIPANTS: A prospective study of 81 consecutive patients referred to a Memory Clinic. Only patients for whom a definitive diagnosis of dementia was established after 8 to 20 months follow-up were retained in the study (n = 76). MEASUREMENTS: The sensitivity, specificity, positive and negative predictive values, and overall diagnostic accuracy of the DAT Inventory were calculated. Kappa values were also computed. RESULTS: Based on all patients (n = 76), sensitivity and specificity were 71% and 95%, respectively, with 98% positive prediction, 56% negative prediction, 78% overall accuracy, and kappa of 0.54. Of 21 cases not meeting NINCDS/ADRDA criteria for DAT, one patient with multi-infarct dementia was misclassified as DAT on the DAT Inventory. Of 55 DAT cases (NINCDS/ADRDA criteria), 16 patients, predominantly very mild or mixed cases, were classified as non-DAT on the DAT Inventory. When mixed, very mild, and borderline cases were excluded (remaining n = 54), DAT Inventory sensitivity increased to 94%, and specificity remained unchanged at 95%, with 97% positive and 91% negative prediction, 94% overall accuracy, and kappa of 0.88. CONCLUSIONS: In general, scores above the designated cutoff point (> 14/20) on the DAT Inventory are consistent with a clinical diagnosis of DAT (NINCDS/ADRDA criteria). Concordance is best in cases of mild to moderate dementia (Clinical Dementia Rating 1-2). The Inventory is less discriminating as a differential diagnostic instrument in cases of very mild dementia, atypical presentations of DAT, or in cases of mixed pathology.     

A neuropsychological investigation into frontal lobe involvement in dementia of the Alzheimer type.

Studied frontal lobe involvement in dementia of the Alzheimer type (DAT) using 4 neuropsychological tests (verbal fluency, delayed alternation, subject-ordered pointing, and the Wisconsin Card Sorting Test) in 25 patients suffering from DAT and 12 age-matched normal controls. The first 3 tasks demonstrated that a frontal lobe impairment is present at all stages of the disease and is related to disease severity. Results offer information regarding the frontal component in DAT by providing neuropsychological support for the findings of an anterior pathology as reflected in blood flow and metabolism studies. The need for suitable frontal tasks with minimal memory involvement in the study of dementia is emphasized, and the delayed alternation task is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cerebral glucose metabolism in patients with frontotemporal dementia

Frontotemporal dementia (FTD) is a dementia syndrome characterized by peculiar behavioral changes arising from frontotemporal involvement and distinct from Alzheimer's disease (AD). The purpose of this study was to elucidate the specific patterns in cerebral glucose metabolism in patients with FTD and to compare them with the patterns in patients with AD and normal elderly subjects using fluorodeoxyglucose (FDG) and PET. METHODS: Twenty-one patients with a clinical diagnosis of FTD [mean age 67.0 +/- 7.0 yr, Mini Mental State Examination (MMSE) score 18.7 +/- 5.7], 21 age-, sex- and dementia-severity-matched patients with probable AD (mean age 66.9 +/- 7.1 yr, MMSE score 20.2 +/- 5.5) and 21 age- and sex-matched normal control subjects (mean age 66.8 +/- 5.7 yr) were studied. The cerebral metabolic rate for glucose (CMRglc) was measured with FDG and PET. Absolute measures of regional CMRglc were compared among the three groups. One-way ANOVA and the posthoc Tukey HSD test were used for statistical analyses. RESULTS: In the FTD group, CMRglc was preserved only in the left cerebellum, right sensorimotor area and occipital lobes. The CMRglc was significantly lower in the FTD group as opposed to the AD group in the hippocampi, orbital gyri, anterior temporal lobes, anterior cingulate gyri, basal ganglia, thalami, middle and superior frontal gyri and left inferior frontal gyrus. CONCLUSION: Although metabolic abnormality in FTD is predominant in the frontal and anterior temporal lobes and the subcortical structures, it is more widespread than has been previously stressed. These findings document an FTD-specific cerebral involvement and facilitate differential diagnosis of degenerative dementias.     

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. Patients underwent a psychiatric interview, a neuropsychological assessment, and single-photon emission CT imaging with 99mTc-hexamethylpropyleneamine oxime. RESULTS: Patients with IVD showed significantly more severe anosognosia (P<.05) and emotional lability (P<.01) than AD patients, but no significant between-group differences were found in the frequency and severity of depression. IVD patients showed significantly more severe deficits in tests of planning, sequencing (P<.05), and verbal fluency (P<.05) as well as significantly more severe cerebral blood flow deficits in the basal ganglia (P<.01) and the frontal lobes (P<.001) than AD patients. CONCLUSIONS: Patients with IVD showed a relatively more severe dysfunction of the frontal lobes as demonstrated by single-photon emission CT and expressed in specific psychiatric and neuropsychological changes than AD patients matched for age, sex, and severity of dementia.     

Abnormality of bone mineral metabolism in elderly female patients with dementia

In order to clarify the relationship between dementia and osteoporosis, bone mineral metabolism was studied in elderly female patients with dementia. We measured bone mineral densities of the vertebral body and the femoral neck using DEXA, and evaluated Ca-related factors in 22 patients with dementia of the Alzheimer type (DAT), 23 patients with vascular dementia (VD), and 22 age-matched controls (C). Activity of daily living was significantly poorer in VD patients than controls, but no difference was shown between DAT and C groups. Bone mineral density values of the vertebral body and the femoral neck were significantly decreased in both DAT and VD groups when compared to C group. DAT patients showed significant decreases in serum Ca and Ca2+ ion, increase in serum parathyroid hormone, and decrease in serum 1,25-dihydroxyvitamin D, a tendency towards decrease in serum calcitonin, and a tendency towards increase in urinary Ca. However, VD patients showed only significant increase in urinary Ca and a tendency towards decrease in serum 1,2-dihydroxyvitamin D, without showing other changes of Ca-regulating hormones. These results suggest that patients with dementia are more often associated with osteoporosis, and that in DAT several abnormalities of Ca-regulating factors play an important role in the development of osteoporosis, while in VD limited physical activities contribute to bone mineral loss.     

No increased incidence of Alzheimer's disease in elderly schizophrenics

There is currently controversy as to the morphological basis of cognitive impairment in elderly schizophrenics. In contrast to previous findings, recent studies have found no increased frequency of Alzheimer's disease (AD) pathology in elderly schizophrenics. We examined 99 consecutive autopsy cases of patients over the age of 55 years from a psychiatric hospital who met the DSM-III-R and ICD.10 criteria for schizophrenia (mean age 69.5 +/- 8.25 years; mean duration of illness 35.15 +/- 10.1 years), 56% showing moderate to severe dementia. All brains were blindly reviewed for evidence of AD using CERAD criteria and Braak staging of neuritic AD lesions. "Definite" AD (CERAD C, Braak stage V) was seen in 2 cases aged 56 and 67 years, respectively [2% of total or 1/68 (1.4%) of those over age 65]. "Probable" AD (CERAD B, Braak stages IV-V) were seen in 5 cases aged 71-89 years (mean 79 years; 5% of total or 7.3% of those over age 65), and 1 case each with multiple cerebral infarcts and with Parkinson's disease pathology. In addition, 2 females aged 82 and 89 years, respectively, revealed senile dementia with tangles (NIA, CERAD negative; Braak stage IV), 1 with hippocampal sclerosis. The total incidence of definite and probable AD in this cohort was 7.1% or 8.7% for those over age 65. This is in line with other recent studies showing that the frequency of AD in elderly schizophrenics may be equal or even less than in the general population. The reasons for this negative association and the basis of cognitive deficits in elderly schizophrenics--those with dementia usually showing significantly lower brain weight--await further elucidation.     

Bender-Gestalt Test performance in senile dementia of the Alzheimer type.

Bender-Gestalt Test performances of 144 persons with very mild, mild, or moderate senile dementia of the Alzheimer type (SDAT) and 96 healthy older adults ranging in age from 63 to 95 yrs were compared. Total scores and error types according to the modified Hutt-Briskin scoring system are reported. The Bender-Gestalt Test does not appear to be useful in differentiating very mild or mild SDAT from normal aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacological and second messenger signalling selectivities of cloned P2Y receptors

An autopsy case of a 67-year-old man with typical clinical features of progressive supranuclear palsy (PSP) characterized by impairment of vertical ocular pursuit movement, pseudobulbar palsy, nuchal stiffness, parkinsonism, and dementia is described. In addition to typical pathological changes of PSP, the present case showed fronto-temporal cortical atrophy, accompanied with various Gallyas/tau-positive neuronal and glial structures such as neurofibrillary tangles, pretangle neurons, glial coiled bodies, astrocytic plaques and argyrophilic threads in the cerebral cortex and subcortical nuclei, and many senile plaques throughout the whole cerebral cortex. The present report suggests that PSP and corticobasal degeneration share a common background in neuronal and glial pathologies, that pathological changes of PSP and Alzheimer's disease are mixed in the entorhinal cortex, amygdala. Meynert nucleus, and hypothalamus, and that dementia with frontal lobe-like syndrome in PSP is related to the frontal and temporal cortical pathologies, and is cortical dementia as well as subcortical dementia.     

Component analysis of a rhythmic finger tapping task in individuals with senile dementia of the Alzheimer type and in individuals with Parkinson's disease.

The present experiment examined different components of motor control that may be impaired in normal aging, senile dementia of the Alzheimer type (SDAT), and Parkinson's disease (PD). Specifically, A. M. Wing and A. B. Kristofferson's (1973) formal quantitative model of rhythmic finger tapping was used to obtain estimates of central timekeeping and response execution components of timing control. Ss included young college students, healthy older adults, nondemented individuals with PD. and individuals with very mild and mild SDAT. Individuals with mild SDAT exhibited a breakdown in the central timekeeping mechanism but not in the execution of the response. Both very mild SDAT and PD individuals did not show any deficits in the 2 timing mechanisms relative to age-matched healthy controls. Finally, there was no effect of normal aging on timing control in this task. This study underscores the importance of examining issues of motor control in SDAT as a function of separate processing components and stages of disease progression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)