ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Neuropathological examination confirmed the clinical diagnosis of possible or probable Alzheimer disease (AD) in 90 of the first 100 patients who came to autopsy at the Johns Hopkins Alzheimer's Disease Research Center. In 10 cases, postmortem brain examination did not confirm AD but revealed variable patterns of neuronal loss in neocortex and limbic structures without amyloid deposits. The most common pattern of degeneration was relatively isolated hippocampal sclerosis (HS). Despite the finding that the 10 patients with non-AD neuropathology were ill for less time and were less cognitively impaired at study entry than those patients with definite AD, they had shorter survival times and showed equal behavioral disturbance at study entry (on a standardized measure). The clinical case reports included here suggest early and progressive prominent behavioral disturbance and other indexes of rapid illness progression in three of the four HS patients and two other non-AD patients. We conclude that the criteria of the National Institute of Neurological Disorders and Stroke/Alzheimer Disease and Related Disorders Association for possible or probable AD are highly accurate and that misdiagnosis is most likely to occur early in the course of illness and in patients with prominent behavioral disturbance or other atypical features

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The apolipoprotein E (APOE) ε4 allele has been consistently found to be frequent in patients with progressive degenerative dementia of the Alzheimer type (DAT). Vascular dementia (VD) may occur as strokes superimposed on presymptomatic DAT, in which case APOE-ε4 frequency should also be increased in VD. We have examined the distribution of APOE-ε4 in patients with DAT (n = 176) or VD (n =74) and controls (n = 133), and evaluated the risk of dementia associated with APOE-ε4. APOE-ε4 allele frequency was 27% in DAT patients, 21% in VD patients, and 11% in controls. The difference in the distribution of the ε4 allele between DAT or VD patients and controls was statistically significant (χ2test, p < 0.05), with a 3.6- and 2.1-fold risk of dementia in DAT and VD patients carrying an ε 4 allele. The result that the APOE-ε4 allele is more frequent in DAT patients than in controls, with VD patients falling in between, is consistent with the assumption that VD is a heterogeneous condition, with some patients having an underlying preclinical brain degeneration, in whom the dementia was precipitated by strokes

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Serum levels of α1-antichymotrypsin (α1-ACT), macroglobulin, α1-antitrypsin, ceruloplasmin, acid glycoprotein, transferrin, and C-reactive protein were measured in patients with probable late onset dementia of Alzheimer type (1-AD), patients with vascular dementia (VD), healthy elderly (HC), and patients with chronic or acute inflammation. Three blood samples were taken at 10-15-day intervals. Serum α1-ACT levels from first and second serum samples were elevated in one out of 11 1-AD patients. Serpin serum levels from the third sample were increased in four out of 11 1-AD patients. None of these patients showed increased levels of other acute phase proteins measured in the three serum samples. VD patients did not show abnormal serum levels of α1-ACT. Serum levels of α1-ACT along with those of other acute phase proteins were altered in patients with inflammation. This investigation showed that in 1-AD patients with increased α1-ACT and no concomitant elevation of other acute phase proteins, serum levels of α1-ACT varied with time. Based on our results, serum α1-ACT does not appear to be a useful biomarker for clinical diagnosis of probable 1-AD, but it might be associated with the clinical history of the disease

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Neuropeptide Y (NPY) has been shown to be involved in the control of several neuroendocrine functions. Moreover, in animal models, NPY produces behavioral effects that are similar to those induced by anxiolytics. We studied NPY-like immunoreactivity (NPY-LI) in cerebrospinal fluid (CSF) in two primary degenerative dementias, Alzheimer disease (AD, n = 34) and frontotemporal dementia (FTD, n = 22) and correlated the CSF NPY-LI levels with clinical characteristics, as rated with the Organic Brain Syndrome scale. There were significant correlations between NPY-LI and such clinical items as suspiciousness, anxiousness, restlessness-agitation, and irritability in both AD and FTD. AD patients, but not FTD patients, showed a significant negative correlation between NPY-LI and duration of the disease. Thus, the study found significant correlations between CSF NPY-LI and emotional symptoms and behavior in organic dementia

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:To examine the relation of dementia severity to the quality and quantity of oral discourse of individuals with Alzheimer disease (AD), a picture description task was administered to elicit oral discourse samples from 63 AD subjects, five individuals with very mild cognitive impairment, and 52 normal controls. Eight measures of discourse were used: total words, information units, conciseness, circumlocutions, frustrations, aborted phrases, revisions, and ideational repetitions. Information units, which decreased with increased dementia severity, proved to be the best measure for evaluating the effects of AD on oral descriptive discourse. The conciseness index also decreased with increased dementia severity, and a significantly greater proportion of AD discourse samples contained ideational repetitions. Circumlocutions and frustrations rarely occurred, and although the discourse of AD subjects was more likely to contain an aborted phrase, the frequency of aborted phrases did not vary by stage of dementia. Revisions were commonly observed in the discourse of both normal controls and AD subjects and did not differentiate the two groups

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The rates of change for five widely used psychometric tests were analyzed to compare how much more variance reduction can be achieved using full-information methods relative to the single-equation methods previously used in dementia research. Nondemented controls and subjects with Alzheimer disease (AD), probable/possible vascular dementia (VD), or mixed dementia (MD) were evaluated. A cohort design was followed, with follow-up of three demented groups and one normal control group; data were analyzed in a multiple-equation regression model estimated with full-information methods. The study was conducted at Alzheimer's Disease Research Center sites at the University of California, Irvine, and at the University of Southern California. In all, 226 patients and controls who had completed initial assessment and at least one annual reassessment were included in the study. Dependent variables were annualized rates of change in the Mini-Mental State Examination (MMSE), the Short-Blessed Dementia Rating Scale (DRS), the Consortium to Establish a Registry for Alzheimer's Disease drawings test (CD), the WAIS-R Block Design test (WRB), and the Boston Naming Test (BNT). Independent variables were dementia severity, diagnosis (AD, VD, MD, or control), sex, age, marital status, education, and age at onset. Full-information methods reduced the variance in the change scores by ≥25% compared with previous studies. The model's prediction of a test's rate of change was almost entirely due to dementia stage and diagnosis. The effects of other explanatory variables (sex, marital status, age, and education) were weak and statistically insignificant. When the effects of other independent variables were controlled, AD and MD patients were found to decline at significantly faster rates than VD patients. Full-information methods, relative to single-equation methods, substantially reduce the variance of rates of change for multiple psychometric tests. They do so by simultaneously considering the correlated error terms in the regressions for each dependent psychometric change score variable. The robustness of these results to minor variations in follow-up time suggests that annualization is a reasonably valid procedure for making change scores comparable. This study's results suggest that change scores in psychometric tests provide information that can be used to aid differential diagnosis. However, the large variances of change scores preclude many other uses. Finally, sincestandardizationof psychometric change scores translates all tests to the same scale (0-100%), standardized change scores are easier to interpret. The analysis of standardized change scores deserves further investigation

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The relationship between cognitive deterioration and abnormalities detected by magnetic resonance imaging (MRI) was investigated to determine the radiological correlates of cognitive deterioration in hereditary cerebral hemorrhage with amyloidosis- Dutch type (HCHWA-D). Twenty HCHWA-D subjects (12 patients who had suffered one or more strokes and eight who had not suffered a stroke) were studied with MRI and underwent extensive neuropsychological examination. On MRI the number of focal lesions was counted, and white matter hyperintensities (WMHs) were scored semiquantitatively. A significant correlation between cognitive deterioration and WMH score and number of focal lesions was found. However, cognitive deterioration, WMH score, and the number of focal lesions all increase with age, and therefore their mutual correlation can be explained as an age effect. This study shows that cognitive deterioration in HCHWA-D is not correlated with abnormalities detected by MRI (number of focal lesions and subcortical WMHs) independently of age. Although a contribution of white matter changes and/or focal lesions, possibly in combination with age, to cognitive deterioration cannot be excluded. Cognitive deterioration in these HCHWA-D patients is probably primarily the result of chronic damage of amyloid angiopathy to the brain, to which may be superimposed cognitive impairment from focal cerebral hemorrhage or infarction

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID