摘要:

SummaryWe applied the recently reported consensus criteria for frontotemporal dementia (FTD) to 12 patients presenting with a frontal-type dementia. All 12 patients fulfilled the Manchester/Lund consensus criteria and had at least five of the behavioural abnormalities listed as core diagnostic clinical features. Speech abnormalities were, by contrast, an inconsistent and late feature. We also reviewed the psychiatric symptomatology in the same group of patients; although six (50%) were diagnosed as FTD at presentation, 33% received an initial psychiatric diagnosis. These were schizophreniform psychosis, depression with obsessive-compulsive features, alcohol dependency, and psychogenic memory impairment. Major depression (DSM-IV) appears to be unusual, but depressive symptoms are common. The Mini-Mental State Examination (MMSE) was found to be an insensitive measure; it was within the normal range (>23) in 72% of patients. However, verbal fluency (production of words beginning withF, A, andS) was markedly reduced in all but one case. The prognosis appears to be poor; most patients declined rapidly and required part- or full-time support within 24 months of diagnosis.

ISSN:0894-878X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThis study examines the relationship between frontal-subcortical and temporoparietal system dysfunction and depressive and psychotic (e.g., delusions and hallucinations) symptomatology in frontotemporal dementia (FTD) and Alzheimer's disease (AD). We evaluated the frequency and characteristics of neurological signs and specifically defined psychiatric symptoms in 20 patients with FTD and 40 patients with AD matched by education level and severity of the dementia as measured by the Mini-Mental State Examination (MMSE). FTD patients were younger and had higher Hamilton Depression Rating Scale (HDRS) scores than AD patients. FTD patients exhibited more syndromal major depression, anxiety, agitation, irritability, lability of mood, disinhibition, anergia, and social withdrawal than AD patients. By contrast, AD patients exhibited more psychotic symptoms than FTD. Although patients with AD exhibited more motor tone abnormalities (e.g., gegenhalten) and those with FTD had more glabellar reflex and grasping, it was difficult to differentiate AD from FTD based on the neurological symptomatology. These results support the hypothesis that a frontalsubcortical abnormality is necessary to produce symptoms of depression in dementia, whereas the emergence of psychotic symptoms is not necessarily related to frontal lobe abnormality.

ISSN:0894-878X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PurposeTo investigate the factors that predict the development or predispose to the occurrence of behavioral disturbances that occur frequently in Alzheimer's disease (AD).Materials and MethodsThe factors examined at entry into the study included individual distinguishing features (e.g., premorbid personality), disease characteristics (e.g., functional competence in activities of daily living), and care and living situation (e.g., type of caregiver). The subsequent occurrence of seven aberrant behaviors was assessed over a mean of 17.83 months. Life table statistical methods were used to determine the relative importance of the factors in predicting behavioral disturbances. The study took place at the Alzheimer's Disease Research Center at the University of Massachusetts Medical Center in Worcester, Massachusetts, with 30 mildly to moderately affected community-dwelling AD patients and their caregivers. Aggressive behaviors (physical and verbal attacks), disordered ideation (hallucinations, paranoia, delusions), and mechanical/motor abnormalities (wandering, hyperkinesia) were assessed using the Caretaker Obstreperous Behavior Rating Assessment (COBRA) Scale (1).ResultsUnivariate Kaplan-Meier life table analyses suggested that greater disease severity and younger age of disease onset predicted the development of disordered ideation. Greater disease severity remained the best predictor of disordered ideation in the multivariate Cox proportional hazards model. Neither premorbid personality or caregiver characteristics predicted the development of aberrant behaviors. Post hoc analyses suggested that patients who exhibited aggressive behaviors on initial evaluation were remembered as having been more hostile premorbidly than those patients who developed aggressive behaviors later in follow-up.ConclusionThe results from this study suggest that greater disease severity is a significant risk factor for the development of troublesome and disruptive behaviors. Premorbid personality traits do not predispose to subsequent behavioral disturbances in AD. Rather, the memories of caregivers appear to be biased by the patients' current behavioral repertoire. Replication of these results is needed in a larger sample of patients to strengthen the conclusions from this study.

ISSN:0894-878X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryMemory disturbance is the most prominent residual deficit after closed-head injury (CHI). Recent studies have demonstrated that CHI patients, just like global amnesic patients, show impaired memory when measured explicitly, but not when measured implicitly. Many theorists have concluded that the saving paradigm introduced by Ebbinghaus in 1885 can be viewed as a measure of implicit memory. Thus, it was hypothesized that saving will be preserved in CHI patients. Thirteen CHI patients and 13 control subjects were tested individually on three word lists. Each list was tested in two phases: learning and relearning. There was a different time delay between the two phases for each list: 1 h, 1 day, and 3 days. The groups were compared on explicit-recall and implicit-saving measures of memory. Time delay from learning to relearning did not affect the performance of either group. As expected, the results show that overall, the control group recalled more words than the CHI group, but the groups did not differ on the overall amount of saving measure. However, when saving was measured just on the initial learning and relearning trials, the groups did differ. The results are discussed in terms of the relationship between saving and implicit memory.

ISSN:0894-878X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummarySeveral investigators have suggested that amnesics fail to encode contextual information. Support for this approach was derived from studies that tested the recall or recognition of different aspects of contextual information. In the present study, we tested the possibility that contextual information is encoded by patients with memory impairment but cannot be retrieved by direct methods. The distinction between direct and indirect recall of context is an important one that has not been sufficiently addressed with regard to brain-injured patients. Fifteen brain-injured (BI) patients and 19 non-brain-injured (NBI) subjects participated in this study. The results show that when contextual information was tested directly the NBI group outperformed the BI group. However, both groups benefited from the contextual cues (i.e., indirect measure). Results are interpreted in terms of the theoretical distinction between implicit and explicit memory regarding contextual information; implicit memory is shown to be preserved in patients with memory impairment.

ISSN:0894-878X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThis study examined neuropsychiatric impairment in social phobia by comparing neurological soft signs in 12 social phobia patients and 24 normal controls. Patients with social phobia had increased neurological soft signs as compared with healthy controls.

ISSN:0894-878X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryTo determine the neuropsychological correlates of attention-deficit hyperactivity disorder (ADHD) in adults, we examined 21 subjects (16 males, 5 females) with childhood-onset and familial ADHD (i.e., biological parents of children with ADHD) with the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the Wide Range Achievement Test-Revised (WRAT-R). Gray Oral Reading Test, and the Wisconsin Card Sorting Test. Consistent with findings in children with ADHD, Freedom from Distractibility (Arithmetic and Digit Span subtests) was decreased relative to the Verbal Comprehension and Perceptual Organization factors on the WAIS-R for the group as a whole, with seven subjects (33%) demonstrating significant attentional deficits when either factor or individual subtest profiles were considered. Although six men (29% of sample) met regression-based criteria for reading/spelling disabilities, only two of these subjects showed absolute deficits in reading and spelling. None showed a comorbid arithmetic disorder. Wisconsin Card Sort performance fell within normal limits for all but three subjects. The lack of significant deficits on our test battery suggest that future studies should address test sensitivity issues and include a broader assessment of the impact of ADHD symptoms on daily social functioning in adults.

ISSN:0894-878X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryPrevious studies have suggested a relation between Gilles de la Tourette syndrome (GTS) and attention deficit hyperactivity Disorder (ADHD). However, the findings are inconsistent as to the exact nature of the relation. Whether the disparate findings are due to ascertainment and referral bias, the use of high-density multiply affected kindreds, and family history data is a matter of debate. We studied 40 consecutive GTS probands and their 168 first-degree relatives (FDRs) to test whether the two disorders share a common genetic mechanism. All subjects included in the study were directly interviewed. Although the rate of ADHD in the GTS probands was 40%, the rate of ADHD in the FDRs was 6%. Furthermore, the data were analyzed in two groups: relatives of probands with both GTS and ADHD and relatives of probands with GTS only. The rate of ADHD among relatives of GTS+ADHD probands was 10.3%, and the rate in the GTS-ADHD group was 4.5%. In these families of GTS+ADHD probands, no evidence suggested cosegregation of the two disorders. Our data do not support the view that ADHD may be an alternative expression of the putative GTS gene.

ISSN:0894-878X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryWe distributed a hypothetical response set for a slightly modified version of the Folstein Mini-Mental State Examination (MMS) to resident and attending psychiatrists and neurologists (“raters”). Some of the hypothetical responses were designed to be ambiguous. Raters returned their scores for each item with comments explaining why they scored as they did. Total scores awarded by the raters ranged from 13 to 24. Raters varied in how much flexibility they thought examiners should have when administering and scoring the MMS. We conclude that ambiguous responses and raters' differing assumptions about the administration and scoring of the MMS may produce interrater variability in scoring on the MMS. MMS scores that are obtained from modified versions of the original MMS may not be comparable to scores obtained from the original version of the MMS.

ISSN:0894-878X    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryTest-retest stability of digit span forward (DF), backward (DB), and DF-DB was investigated in 61 elderly normal subjects. Means for age, education, and Full Scale I.Q. (FSIQ) were 78.93 years (SD = 3.46), 9.74 years (SD = 1.91), and 103.90 (SD = 11.53). The retest interval ranged from 1 to 5.2 months. Stability coefficients were .61, .46, and .04 for DF, DB, and DF-DB. Average retest gains were < 1 for each digit span component; range of gain or loss was 3 to −2 for both DF and DB. A retest decrease >2 on forward repetition and a decrease >3 on backward span should be considered unusual. Interpretation of DF-DB scores should be avoided.

ISSN:0894-878X    

出版商:OVID    

年代:1996

数据来源: OVID