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Barker A, Jones R, Prior J, Wesnes K. Scopolamine-induced cognitive impairment as a predictor of cognitive decline in healthy elderly volunteers: a 6-year follow-up. Int J Geriatr Psychiatry 1998; 13:244-7. [PMID: 9646152 DOI: 10.1002/(sici)1099-1166(199804)13:4<244::aid-gps764>3.0.co;2-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if scopolamine-induced cognitive impairment in healthy elderly people predicts cognitive decline 6 years later. DESIGN Prospective cohort study. SETTING Elderly care research unit. PARTICIPANTS Healthy elderly people who were part of a volunteer panel of research subjects. INTERVENTIONS Scopolamine 0.2 mg administered subcutaneously at baseline. MAIN OUTCOME MEASURES Cognitive drug research computerized cognitive testing battery pre- and post-scopolamine, with repeat testing over 6 years later. MAIN RESULTS 16/24 subjects were retested. Although marked decrements in cognitive functioning were seen with scopolamine, there was little change in performance over 6 years, and no significant association was seen between scopolamine-induced decrement and change over time. CONCLUSIONS The scopolamine challenge test is not likely to play a role in the preclinical diagnosis of Alzheimer's disease.
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Affiliation(s)
- A Barker
- Thornhill Research Unit, Moorgreen Hospital, Southampton, UK
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102
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Lavenu I, Pasquier F, Lebert F, Pruvo JP, Petit H. Explicit memory in frontotemporal dementia: the role of medial temporal atrophy. Dement Geriatr Cogn Disord 1998; 9:99-102. [PMID: 9524801 DOI: 10.1159/000017030] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In our memory clinic experience, memory impairment differs widely in patients with frontotemporal dementia (FTD). We searched for a correlation between explicit memory disturbance assessed with the Grober and Buschke test and medial temporal atrophy on CT scan in 22 consecutive patients with FTD. Five of the 22 patients had a medial temporal lobe (MTL) atrophy. There was no significant difference between the two groups for the demographic characteristics. Free recall, cued recall and the learning curve were significantly better in patients without MTL atrophy. The patients with MTL atrophy made more intrusions. We found a positive correlation between total recall and cued recall and the mean of medial temporal lobe measurement. These results are in agreement with the role of the hippocampal formation in the memory process. In our group, the ratio of patients with MTL atrophy is similar to the ratio of Pick's disease in frontotemporal dementia. In histological series more severe hippocampal atrophy are reported in Pick's disease. Therefore MTL atrophy on CT scan could be a marker of Pick's disease in FTD.
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Affiliation(s)
- I Lavenu
- Department of Neurology, University Hospital of Lille, France
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103
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104
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Lehmann DJ, Johnston C, Smith AD. Synergy between the genes for butyrylcholinesterase K variant and apolipoprotein E4 in late-onset confirmed Alzheimer's disease. Hum Mol Genet 1997; 6:1933-6. [PMID: 9302273 DOI: 10.1093/hmg/6.11.1933] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The allelic frequency of the gene for the K variant of butyrylcholinesterase (BCHE-K) was 0.17 in 74 subjects with late-onset (age > 65 years) histopathologically diagnosed Alzheimer's disease (AD), which was higher than the frequencies in 104 elderly control subjects (0.09), in 14 early-onset cases of confirmed AD (0.07) and in 29 confirmed cases of other dementia (0.10). The association of BCHE-K with late-onset AD was limited to carriers of the epsilon 4 allele of the apolipoprotein E gene (APOE), among whom the presence of BCHE-K gave an odds ratio of confirmed late-onset AD of 6.9 (95% C.I. 1.65-29) in subjects > 65 years and of 12.8 (1.9-86) in subjects > 75 years. In APOE epsilon 4 carriers over 75 years, only 1/22 controls, compared with 10/24 confirmed late-onset AD cases, had BCHE-K. We suggest that BCHE-K, or a nearby gene on chromosome 3, acts in synergy with APOE epsilon 4 as a susceptibility gene for late-onset AD.
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Affiliation(s)
- D J Lehmann
- Oxford Project to Investigate Memory and Ageing (OPTIMA), University Department of Pharmacology, UK
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105
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Lavenu I, Pasquier F, Lebert F, Jacob B, Petit H. Association between medial temporal lobe atrophy on CT and parietotemporal uptake decrease on SPECT in Alzheimer's disease. J Neurol Neurosurg Psychiatry 1997; 63:441-5. [PMID: 9343120 PMCID: PMC2169791 DOI: 10.1136/jnnp.63.4.441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Alzheimer's disease is the most frequent cause of degenerative dementia. Despite the available diagnostic criteria, improvement of diagnosic accuracy is still required. The aim of this prospective study was to assess in a large population of patients referred to a memory clinic the diagnostic value of the combination of medial temporal lobe atrophy on temporal oriented CT and decreased temporoparietal uptake on HMPAO single photon emission tomography (SPECT). METHODS The study was conducted in 125 patients aged 51-93: 64 with probable Alzheimer's disease (Mean (SD) mini mental state examination (MMSE)=18.34 (6.93)), duration of disease=6.48 (2.93) years, 13 possible Alzheimer's disease (MMSE=21.58 (5.48), duration of disease=6.08 (2.56)), 48 patients with miscellaneous memory disorders (MMSE=21.98 (6.10), duration the disease = 6.85 (3.91)). RESULTS For the diagnosis of probable Alzheimer's disease, the sensitivity of this association was 0.56, the specificity 0.93, the positive predictive value 0.95, and the negative predictive value 0.45. The diagnosic accuracy was 0.68. Both medial temporal atrophy and parietotemporal decrease in uptake were present in four of 13 patients with possible Alzheimer's disease and 11 of 48 with miscellaneous memory disorders. The association was absent in 27 of 29 patients with frontotemporal dementia. In mild stages (MMSE>18; n = 32), the sensitivity of the association was 0.34, the specificity 0.93, the positive predictive value 0.85, and the negative predictive value 0.57. The diagnosic accuracy was 0.53. CONCLUSION This association, although not sensitive, helps to select patients with high probability of Alzheimer's disease at an early stage which can be of interest for clinical and research purposes.
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Affiliation(s)
- I Lavenu
- Memory Clinic, Department of Neurology, University Hospital of Lille, France
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106
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Detoledo-Morrell L, Sullivan MP, Morrell F, Wilson RS, Bennett DA, Spencer S. Alzheimer's disease: in vivo detection of differential vulnerability of brain regions. Neurobiol Aging 1997; 18:463-8. [PMID: 9390771 DOI: 10.1016/s0197-4580(97)00114-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The severe cognitive impairment during the later stages of Alzheimer's disease is usually preceded by a selective disturbance in the ability to remember new experiences. With quantitative, high-resolution magnetic resonance imaging techniques, it is now possible to determine, in vivo, differences in the pattern of anatomical changes that might reflect behavioral symptomatology during different stages of the disease. In the present investigation, magnetic resonance imaging examinations were carried out in aged controls and in clinically diagnosed Alzheimer's disease patients who were divided into three groups based upon dementia severity. Atrophy of the hippocampal formation, a region important for memory function, was observed even in Alzheimer's disease patients with the mildest dementia. With more prominent dementia, atrophy extended to the parahippocampal gyrus and the temporal neocortex.
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Affiliation(s)
- L Detoledo-Morrell
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Rush-Presbyterian-St.Luke's Medical Center, Chicago, Ill. 60612, USA
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107
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Frederick BB, Satlin A, Yurgelun-Todd DA, Renshaw PF. In vivo proton magnetic resonance spectroscopy of Alzheimer's disease in the parietal and temporal lobes. Biol Psychiatry 1997; 42:147-50. [PMID: 9209733 DOI: 10.1016/s0006-3223(97)00242-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- B B Frederick
- Brain Imaging Center, McLean Hospital, Belmont, Massachusetts 02178, USA
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108
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Herholz K. Diagnostic imaging of dementia in the elderly. Arch Gerontol Geriatr 1997; 25:5-12. [PMID: 15374097 DOI: 10.1016/s0167-4943(96)00767-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/1996] [Revised: 09/09/1996] [Accepted: 10/24/1996] [Indexed: 11/28/2022]
Abstract
Dementia is a frequent problem in elderly patients. More than age per se, it may influence the indication for invasive diagnostic and therapeutic procedures to treat other diseases. Here, the role of tomographic imaging methods for differential diagnosis of dementia will be reviewed briefly, with the new possibilities that became available recently. Computed tomography (CT) of the brain is used primarily to detect potentially treatable conditions, such as multiple ischemic infarcts, hematomas, hydrocephalus and brain tumors. It should be performed even at higher age if the general condition of the patient is good enough not to exclude all specific therapeutic measures. Magnetic resonance imaging (MRI) is more sensitive for ischemic white matter lesions and hippocampal atrophy and should therefore used preferentially in mildly affected patients. Functional imaging methods, such as single photon emission computed tomography (SPECT) and positron emission tomography (PET), are necessary only in clinically unclear cases to demonstrate functional impairment of association cortex.
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Affiliation(s)
- K Herholz
- Neurologische Universitätsklinik and Max-Planck-Institut für Neurologische Forschung, Joseph-Stelzmann-Strasse 9, 50924 Köln, Germany
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109
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Yamaguchi S, Meguro K, Itoh M, Hayasaka C, Shimada M, Yamazaki H, Yamadori A. Decreased cortical glucose metabolism correlates with hippocampal atrophy in Alzheimer's disease as shown by MRI and PET. J Neurol Neurosurg Psychiatry 1997; 62:596-600. [PMID: 9219745 PMCID: PMC1074143 DOI: 10.1136/jnnp.62.6.596] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the relation between atrophy of the hippocampus and parahippocampal gyrus (the % hippocampal area) and cerebral metabolic rate for glucose (CMRGlc) in Alzheimer's disease. METHODS 13 patients with probable Alzheimer's disease by NINCDS-ADRDA criteria (six men; seven women, mean age 71 years, mini mental state 13.8 (SD 4.6)) and age matched controls were studied. T1 weighted MRI (0.5T) images were used for evaluation of the hippocampal area. With a digitiser system, a percentage of the hippocampal area to the brain (the % hippocampal area) was calculated. Eight patients received another T1 weighted MRI (1.5T) for further evaluation of the minimum thickness of the hippocampus. Regional CMRGlc (rCMRGlc) was measured using PET and the FDG technique. RESULTS The hippocampal area in patients with Alzheimer's disease was significantly lower than that of controls (P < 0.01). All the cortical rCMRGlc values in patients with Alzheimer's disease were lower than those of controls (P < 0.01). A significant correlation (P < 0.05) was found between the % hippocampal area and rCMRGlc in the temporal lobe, temporoparieto-occipital (TPO) region, and frontal lobe in Alzheimer's disease. There was a significant correlation between minimal hippocampal thickness and ipsilateral TPO metabolism on both sides. CONCLUSION The ipsilateral correlation between hippocampal atrophy and decreased TPO metabolism in Alzheimer's disease suggests a functional relation and the asymmetries show that Alzheimer's disease is an asymmetric disease in its early stages.
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Affiliation(s)
- S Yamaguchi
- Division of Disability Science, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
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110
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Convit A, De Leon MJ, Tarshish C, De Santi S, Tsui W, Rusinek H, George A. Specific hippocampal volume reductions in individuals at risk for Alzheimer's disease. Neurobiol Aging 1997; 18:131-8. [PMID: 9258889 DOI: 10.1016/s0197-4580(97)00001-8] [Citation(s) in RCA: 276] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our goal was to ascertain the involvement of the temporal lobe in the preclinical (not yet diagnosable) stages of dementia of the Alzheimer's type (DAT) by using MRI-derived volumes. We assessed anatomical subdivisions of the temporal lobe on three groups of carefully screened age- and education-matched elderly individuals: 27 normal elderly (NL), 22 individuals with minimal cognitive impairment (MCI), who did not fulfill DAT criteria but were regarded at high risk for future DAT, and 27 DAT individuals. We found hippocampal volume reductions of 14% for the MCI and 22% for the DAT group compared to the NL group. Utilizing regression analyses and after accounting for gender head size-age, generalized atrophy (CSF), and other temporal lobe subvolumes, the hippocampal volume separated NL from MCI individuals, correctly classifying 74%. For NL and MCI groups combined the hippocampal volume was the only temporal lobe subvolume related to delayed recall memory performance. When contrasting MCI and DAT individuals, the fusiform gyrus volume uniquely improved the ability of the hippocampal volume to separate MCI from DAT individuals from 74 to 80%. Our cross-sectional data suggest that, within the temporal lobe, specific hippocampal volume reductions separated the group at risk for DAT from the normal group. By the time impairments are sufficient to allow a diagnosis of DAT to be made, in addition to the medial temporal lobe volume reductions, the lateral temporal lobe is also showing volume reductions, most saliently involving the fusiform gyrus.
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Affiliation(s)
- A Convit
- Department of Psychiatry, New York University Medical Center, New York 10016, USA
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111
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Mattman A, Feldman H, Forster B, Li D, Szasz I, Beattie BL, Schulzer M. Regional HmPAO SPECT and CT measurements in the diagnosis of Alzheimer's disease. Neurol Sci 1997; 24:22-8. [PMID: 9043743 DOI: 10.1017/s0317167100021041] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study investigated the hypothesis that the combination of regional CT brain atrophy measurements and semiquantitative SPECT regional blood flow ratios could produce a diagnostic test for Alzheimer's disease (AD) with an accuracy comparable to that achieved with the present clinical gold standard of the NINCDS-ADRDA criteria. METHODS Single proton emission computed tomography (SPECT) and CT head scans were performed on 122 subjects referred an UBC Alzheimer clinic and diagnosed as either 'not demented' (ND-37) or 'possible/probable AD' (AD-85) by the NINCDS-ADRDA criteria. Stepwise discriminant analysis (SDA) was performed on the bilateral SPECT regions of interest and compared to bilateral CT qualitative/quantitative assessment in the frontal, parietal and temporal lobes to determine which were most accurate at ND/AD distinction. Receiver operating curves (ROC) were then constructed for these variables individually and for their combined discriminant function. RESULTS The left temporal qualitative cortical atrophy score (CT) and left temporal perfusion ratio (SPECT) were selected in the SDA. The combined discriminant function was more specific at AD/ND distinction than either of CT or SPECT alone. The accuracy of AD/ND distinction with the combined discriminant function was below that achieved by clinical diagnosis according to the NINCDS-ADRDA criteria and was not significantly different from that achieved with SPECT or CT alone as defined by ROC curve analysis. CONCLUSION The measurements of left temporal cortical atrophy and regional cerebral blood flow were most indicative of AD; however they lacked the sensitivity and specificity to recommend their use as a diagnostic test for AD.
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Affiliation(s)
- A Mattman
- Clinic for Alzheimer's Disease and Related Disorders, Vancouver Hospital and Health Sciences Center-UBC Site, Canada
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112
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De Leon MJ, George AE, Golomb J, Tarshish C, Convit A, Kluger A, De Santi S, McRae T, Ferris SH, Reisberg B, Ince C, Rusinek H, Bobinski M, Quinn B, Miller DC, Wisniewski HM. Frequency of hippocampal formation atrophy in normal aging and Alzheimer's disease. Neurobiol Aging 1997; 18:1-11. [PMID: 8983027 DOI: 10.1016/s0197-4580(96)00213-8] [Citation(s) in RCA: 237] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We used CT and MR to examine the frequency of occurrence of hippocampal formation atrophy (HA) in a research clinic population of 130 normal elderly, 72 nondemented patients with very mild memory and cognitive impairments (MCI), 73 mild Alzheimer's disease (AD) patients, and 130 patients with moderate to severe AD. HA was found in 29% of the normal elderly group and its frequency of occurrence was strongly related to increasing age. For normal elderly 60-75 years of age, 15% had HA: the proportion rose to 48% in subjects 76-90 years of age. Among the three groups of impaired patients, the frequencies of HA ranged from 78% in the MCI patients to 96% in the advanced AD group. Unlike the normal elderly group, the percentages were not related to age. In both the normal elderly group and MCI group disproportionately more males than females had HA. After controlling for learning and the effects of generalized brain changes as reflected in ventricular size, only in the normal group was HA associated with reduced delayed verbal recall performance. Follow-up examinations for 15 individuals with baseline HA. 4 who at entry were MCI and 11 probable AD, yielded clinical and neuropathologic diagnoses of AD in all cases. The results of the present study indicate that hippocampal formation atrophy is associated with memory and cognitive impairments. Further longitudinal and neuropathologic work is required to validate the relationship between hippocampal formation atrophy and AD.
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Affiliation(s)
- M J De Leon
- Department of Psychiatry, New York University School of Medicine, NY 10016, USA
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113
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Small GW, Komo S, La Rue A, Saxena S, Phelps ME, Mazziotta JC, Saunders AM, Haines JL, Pericak-Vance MA, Roses AD. Early detection of Alzheimer's disease by combining apolipoprotein E and neuroimaging. Ann N Y Acad Sci 1996; 802:70-8. [PMID: 8993486 DOI: 10.1111/j.1749-6632.1996.tb32600.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
New treatments for Alzheimer's disease (AD) are more likely to slow or halt disease progression rather than to reverse existing neuronal damage. Identifying persons with mild cognitive complaints who are at risk for AD will allow investigators to apply anti-dementia treatments before extensive brain damage develops. The discovery of the apolipoprotein E epsilon 4 allele (APOE epsilon 4) as a major risk factor for AD offers promise of assisting in early detection and prediction of Alzheimer's disease, particularly when genetic assessments are combined with other biomarkers such as neuroimaging. Studies of relatives at risk for familial AD using neuroimaging (positron emission tomography [PET]) and genetic assessments of APOE suggest that at-risk relatives with APOE epsilon 4 have lower parietal metabolism than those without APOE epsilon 4. Additional techniques that might increase sensitivity and specificity include longitudinal assessment of clinical and brain functional change, pharmacological challenges of short-acting anticholinergic agents, and memory activation paradigms during functional scanning. Such strategies should eventually assist in early detection of AD and in vivo therapeutic monitoring of brain function during experimental anti-dementia treatment trials.
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Affiliation(s)
- G W Small
- Department of Psychiatry, University of California at Los Angeles 90024, USA
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114
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Abstract
The pathological diagnosis of Alzheimer-type dementia (ATD) is reviewed. The problems with the quantitative diagnosis are three-fold: the number of the senile plaques (SP) is not always related to the presence or the absence of dementia; recent research indicates that the SP and the neurofibrillary tangles (NFT) could represent a different level in the pathogenesis of ATD, and finally it has not been seriously discussed whether ATD is the final stage of physiological aging or if ATD is a definitive disease. For these reasons, new diagnostic criteria are proposed in order to differentiate ATD from physiological aging. The new criteria are suitable even in the old-old and oldest-old patients. It is stressed that ATD is heterogeneous in the pathogenetic aspect, consisting of Alzheimer's disease with onset before the age of 70 years (the neocortical type of ATD) and senile dementia of the Alzheimer type (the limbic type of ATD) with the onset after the age of 70. Even in cases with the latter type, there are several atypical ATD and non-ATD forms. "Primary senile dementia' is proposed as a comprehensive term to include various types of senile dementia of unknown etiology.
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Affiliation(s)
- T Mizutani
- Department of Neuropathology, Tokyo Metropolitan Institute of Gerontology, Japan
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115
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Abstract
This study examined caudate nuclei areas in 10 schizophrenic subjects with and 25 schizophrenic subjects without parkinsonian symptoms. The subjects with parkinsonian symptoms were found to have statistically significantly smaller right caudate nuclei and a trend towards smaller left caudates. Cortical measurements did not differ between the groups. These results are consistent with the suggestion that antipsychotic drugs exert some neurotoxic effects, but should be viewed as preliminary and require replication.
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Affiliation(s)
- K W Brown
- Central Scotland Healthcare NHS Trust, Bellsdyke Hospital, Larbert, Scotland, UK
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116
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Abstract
This article reviews the significance of changes in the level of cerebrospinal fluid acetylcholinesterase or cholinesterase in patients with Alzheimer's disease or other dementias. Evidence has shown that the methodology of assaying cerebrospinal fluid acetylcholinesterase or cholinesterase is reliable and the activity of the enzyme is stable. Low acetylcholinesterase or cholinesterase levels presenting in cerebrospinal fluid of a demented individual may confirm the clinical diagnosis of Alzheimer's disease or other organic dementia. A low activity of acetylcholinesterase or cholinesterase existing in cerebrospinal fluid of a non-demented individual may indicate a brain at risk, or that the person is in the preclinical stage of dementia. Recognition of the presence of the preclinical stage may be very beneficial for explaining the real meaning of the 'overlap' in the biochemistry and pathology between dementia and non-dementia, and also very important for prevention and treatment. Therefore, the strategy of prevention and of treatment should no longer be designed to inhibit acetylcholinesterase activity. In contrast, it should be designed to enhance the neuronal acetylcholinesterase activity or to delay the degeneration of brain acetylcholinesterase system.
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Affiliation(s)
- Z X Shen
- Department of Neurology, Xuan-Wu Hospital, Beijing, China
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117
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Frisoni GB, Beltramello A, Geroldi C, Weiss C, Bianchetti A, Trabucchi M. Brain atrophy in frontotemporal dementia. J Neurol Neurosurg Psychiatry 1996; 61:157-65. [PMID: 8708683 PMCID: PMC1073989 DOI: 10.1136/jnnp.61.2.157] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate the pattern of regional brain atrophy in patients with frontotemporal dementia by comparing it with that in patients with Alzheimer's disease and normal controls. METHODS Fourteen patients with frontotemporal dementia, 13 with moderate, and 33 with mild Alzheimer's disease, and 31 controls were studied. Atrophy was evaluated with linear measures in the anterior brain, medial temporal lobe, and hippocampal formation regions using MRI. RESULTS Patients with frontotemporal dementia had greater atrophy in the anterior brain regions than patients with Alzheimer's disease or controls. Atrophy of the hippocampal formation, which best discriminates Alzheimer's disease from controls, was present also in patients with frontotemporal dementia. By contrast, atrophy of the medial temporal lobe, which is also present in Alzheimer's disease, was absent in frontotemporal dementia. CONCLUSION A pattern of atrophy in the frontal lobes and hippocampal formation with sparing of the medial temporal lobe might be distinctive of frontotemporal dementia. Hippocampal involvement might not be specific for Alzheimer's disease and specific patterns of atrophy might be distinctive of some forms of degenerative dementia.
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Affiliation(s)
- G B Frisoni
- Alzheimer's Unit, S Cuore-FBF Hospital, Brescia, Italy
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118
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Abstract
BACKGROUND Definitive diagnosis of Alzheimer's disease requires histological examination of brain tissue. In life, brain atrophy can be visualised by computed tomography or magnetic resonance (MR) imaging, but the atrophy due to the disease is difficult to distinguish from that caused by normal ageing. We have investigated use of accurate positional matching (registration) and digital subtraction of serially acquired MR brain scans to allow determination of rates of global and regional atrophy. METHODS This technique was applied to eleven patients with clinically diagnosed Alzheimer's disease and eleven age-matched controls. Each individual had two scans approximately 1 year apart; scan intervals were matched between the groups. FINDINGS The median rate of atrophy was significantly greater in the Alzheimer's disease group than in the control group (12.3 [range 5.8 to 23.6] vs 0.3 (-1.2 to 1.7) mL per year; p < 0.0001). There was no overlap between the groups. Furthermore, three non-demented individuals at risk of familial Alzheimer's disease had scans 6-14 months apart and showed greater rates of volume loss than the controls; these three individuals have subsequently developed symptoms. INTERPRETATION This technique may be useful for the diagnosis of Alzheimer's disease, the assessment of disease progression, and the evaluation of potential treatments.
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Affiliation(s)
- N C Fox
- Dementia Research Group, National Hospital for Neurology and Neurosurgery, London, UK
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119
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Rigby M, Le Bourdellès B, Heavens RP, Kelly S, Smith D, Butler A, Hammans R, Hills R, Xuereb JH, Hill RG, Whiting PJ, Sirinathsinghji DJ. The messenger RNAs for the N-methyl-D-aspartate receptor subunits show region-specific expression of different subunit composition in the human brain. Neuroscience 1996; 73:429-47. [PMID: 8783260 DOI: 10.1016/0306-4522(96)00089-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The expression of the messenger RNAs encoding N-methyl-D-aspartate receptor subunits in neurologically normal post-mortem human brain was studied by in situ hybridization. In the caudate, putamen and nucleus accumbens strong hybridization signals were observed for N-methyl-D-aspartate R1-1 messenger RNA but much weaker signals for N-methyl-D-aspartate R1-3 and N-methyl-D-aspartate R1-4, N-Methyl-D-aspartate R1-2 was not detectable. N-methyl-D-aspartate R2B was the only N-methyl-D-aspartate R2 subunit detected in these nuclei. In the hippocampus the messenger RNAs for both N-methyl-D-aspartate R1-1 and N-methyl-D-aspartate R1-4 were strongly expressed in the dentate gyrus, CA3-CA1 pyramidal cells, subiculum, entorhinal cortex and perirhinal cortex. Much lower expression was seen for N-methyl-D-aspartate R1-2 and N-methyl-D-aspartate R1-3. The messenger RNAs for both N-methyl-D-aspartate R2A and N-methyl-D-aspartate R2B, but not N-methyl-D-aspartate R2C, subunits were expressed in the hippocampus. In the temporal cortex all N-methyl-D-aspartate RI isoforms were expressed (N-methyl-D-aspartate R1-1 and N-methyl-D-aspartate R1-4 being the most abundant) and N-methyl-D-aspartate R2A and N-methyl-D-aspartate R2B but not N-methyl-D-aspartate R2C were also moderately expressed. In the brain stem N-methyl-D-aspartate R1-4 was strongly expressed in various nuclei including the locus coeruleus, nucleus centralis superior and deep pontine nuclei. Only weak expression was seen for N-methyl-D-aspartate RI-1 and N-methyl-D-aspartate R1-3 but not N-methyl-D-aspartate RI-2; of the N-methyl-D-aspartate R2 subunits only N-methyl-D-aspartate R2C was found to be expressed in these nuclei. In the cerebellum all the N-methyl-D-aspartate I isoforms were expressed (mostly N-methyl-D-aspartate R1-4) in the Purkinje layer which also expressed N-methyl-D-aspartate R2A and N-methyl-D-aspartate R2C. In the molecular layer cells were found expressing N-methyl-D-aspartate R1-4 and N-methyl-D-aspartate R2B and cells in the granule layer were found to express N-methyl-D-aspartate R1-1, N-methyl-D-aspartate R1-3 and N-methyl-D-aspartate R1-4 and N-methyl-D-aspartate R2C only. Preliminary studies indicated that the messenger RNA for the N-methyl-D-aspartate R2D subunit was not expressed in the above areas of brain. These results give the first demonstration of the distribution of N-methyl-D-aspartate receptor subunit messenger RNAs in the human brain. The region-specific expression of subunit combinations suggests a heterogeneity of N-methyl-D-aspartate receptors with diverse physiological/pathophysiological roles and provides a rationale for the development of discriminatory N-methyl-D-aspartate receptor antagonists to target selective neuronal populations.
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Affiliation(s)
- M Rigby
- Merck, Sharp and Dohme Research Laboratories, Neuroscience Research Centre, Harlow, Essex, U.K
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120
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Postiglione A, Soricelli A, Covelli EM, Iazzetta N, Ruocco A, Milan G, Santoro L, Alfano B, Brunetti A. Premature aging in Werner's syndrome spares the central nervous system. Neurobiol Aging 1996; 17:325-30. [PMID: 8725892 DOI: 10.1016/0197-4580(96)00033-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Werner's Syndrome is a rare genetic disease, characterized by premature aging of many tissues and organs. We studied the brain morphology and function in two patients with Werner's syndrome to assess the possible involvement of the central nervous system in this premature aging process. The two patients (brother and sister, respectively) were studied by magnetic resonance imaging (MRI) and angiography (MRA), single photon emission computed tomography (SPECT) with (99mTc)-d,l-hexamethyl propilene amine oxime (HMPAO), positron emission tomography (PET) with 2(18F)-Fluoro-2-deoxyglucose (FDG), electroencephalography (EEG), and electromyography (EMG). Some of these investigations were also repeated after 1 year. The results of all these studies were normal. The premature aging process in patients with Werner's syndrome, while affecting most tissues, seems to spare the central nervous system.
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Affiliation(s)
- A Postiglione
- Department of Clinical and Experimental Medicine, University of Naples Federico II, Italy
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121
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Xanthakos S, Krishnan KR, Kim DM, Charles HC. Magnetic resonance imaging of Alzheimer's disease. Prog Neuropsychopharmacol Biol Psychiatry 1996; 20:597-626. [PMID: 8843486 DOI: 10.1016/0278-5846(96)00035-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
1. Although dementia is caused by a heterogeneous group of diseases and pathologic states, Alzheimer's disease is the largest cause, estimated to account for 50 to 75% of all dementias. 2. Unfortunately, confirmation of Alzheimer's disease (AD) requires postmortem histologic confirmation; clinical diagnosis prior to death remains one of exclusion. 3. A large number of structural and volumetric MRI studies have noted anatomic and structural changes accompanying AD, including variable degrees of general cortical atrophy. 4. A classic feature reported by many MRI studies is hippocampal and temporal lobe atrophy. 5. White matter hyperintensities on MRI are common, especially in late onset AD although their significance is still controversial. 6. This article reviews the contribution of magnetic resonance to imaging the neuropathologic changes of AD, discussing both advantages and limitations, and summarizing the major findings.
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Affiliation(s)
- S Xanthakos
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
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122
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Geroldi C, Frisoni GB, Beltramello A, Weiss C, Bianchetti A, Pizzolato G, Ferlin G, Trabucchi M. Magnetic resonance and single-photon emission tomography findings in a pair of twins discordant for Alzheimer's disease. J Neuroimaging 1996; 6:76-80. [PMID: 8634491 DOI: 10.1111/jon19966276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The value of functional and morphological neuroimaging in the early diagnosis of Alzheimer's disease (AD) is still debated. Described here are cerebral perfusion and linear measures of medial temporal lobe atrophy in 2 monozygotic twins discordant for AD who were investigated with technetium 99m-hexamethylpropy-leneamineoxime single-photon emission tomography (SPET) and magnetic resonance (MR) imaging. Both showed pathological cortical perfusion findings on SPET, while medical temporal lobe atrophy was present only in the affected twin. MR measures of medial temporal lobe atrophy have greater agreement with clinical data than do SPET measures of cerebral perfusion. Evaluation of atrophy may be useful in the early diagnosis of AD.
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Affiliation(s)
- C Geroldi
- Alzheimer's Disease Unit, Istituto Sacro Cuore-FBF, Geriatric Research Group, Brescia, Italy
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123
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Wahlund LO. Biological markers and diagnostic investigations in Alzheimer's disease. ACTA NEUROLOGICA SCANDINAVICA. SUPPLEMENTUM 1996; 165:85-91. [PMID: 8740993 DOI: 10.1111/j.1600-0404.1996.tb05876.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The diagnosis of Alzheimer's disease (AD) is based on numerous clinical, neuroradiological, neurophysiological, and neuropsychological evaluations, but a definitive diagnosis can only be established at autopsy or by brain biopsy. Because the need for a simple and accurate diagnostic marker is increasing as new drug treatments emerge, intensive research to identify diagnostic markers is now in progress. Computer tomography and magnetic resonance imaging are being used to compare linear and volumetric measurements of brains for patients with AD and normal controls. Functional imaging techniques, such as single photon emission computer tomography and positron emission tomography, are being used to identify possible disease-related changes in regional blood flow, glucose metabolism, and receptor activities. Elevated tau-protein concentrations or reduced levels of beta-amyloid precursor protein in the cerebrospinal fluid; mutations on chromosomes 14, 19, and 21; the presence of the Apo-epsilon-4 allele; and impaired odor identification are also being evaluated as possible markers.
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Affiliation(s)
- L O Wahlund
- Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Huddinge, Sweden
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124
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Abstract
The prevalence of dementia is expected to increase markedly as our population ages. Although only a minority of cases currently are found to have treatable causes, the personal and financial costs of misdiagnosis are great. Furthermore, progress in developing effective therapy hinges on accurate diagnosis. This article reviews the current state of diagnostic testing in the diagnosis of dementia.
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Affiliation(s)
- T A Sandson
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
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125
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Abstract
Alzheimer's disease (AD) is unique in medicine in that millions of people suffer from what appears to be the same form of disease, and unlike most other late-onset diseases, the genetic etiologies have been well identified. Three early onset forms of AD inherited as autosomal dominant traits account for less than 2% of prevalent AD. A major susceptibility locus, apolipoprotein E (APOE, gene; apoE, protein) is associated with risk and age of onset distributions for the common familial and sporadic late-onset AD. The identification of additional genetic susceptibility genes in the etiology of AD and the metabolic mechanisms leading to differences in age of onset and disease pathogenesis are active areas of current research.
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Affiliation(s)
- A D Roses
- Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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126
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Prentice N, Van Beck M, Dougall NJ, Moffoot AP, O'Carroll RE, Goodwin GM, Ebmeier KP. A double-blind, placebo-controlled study of tacrine in patients with Alzheimer's disease using SPET. J Psychopharmacol 1996; 10:175-81. [PMID: 22302942 DOI: 10.1177/026988119601000301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND the effect of single-dose and long-term cholinergic enhancement with tacrine on regional cerebral perfusion was examined in patients with Alzheimer's disease using single-photon emission tomography (SPET). METHOD 23 patients with probable Alzheimer's disease (DSM-III-R and NINCDS-ADRDA criteria) were scanned before and after a single oral dose of tacrine at the start of the study and again after 12 weeks of randomized, double-blind treatment with tacrine or placebo, using high resolution (99m)Tc-Exametazime SPET. Patients also underwent neuropsychological testing with the CAMCOG, the Mini-Mental State Examination and the Rivermead Behavioural Memory Test before and after 12 weeks of treatment. RESULTS occipital count ratios in all regions of interest declined by 3% over 12 weeks, indicating a progression of the disease. Acute tacrine challenge resulted in a 16% increase in the superior frontal and a 11% decrease in the anterior temporal cortex. The acute effects of tacrine were modified by 12 weeks of treatment, particularly in the medial frontal (cingulate) cortex where active treatment was associated with a reduced acute tacrine response. There were no changes in cognitive function associated with active treatment. CONCLUSION the study demonstrates the sensitivity of cerebral perfusion measures to changes during acute and medium-term tacrine treatment.
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Affiliation(s)
- N Prentice
- MRC Brain Metabolism Unit, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF, UK
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127
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Lebert F, Pasquier F, Petit H. Sundowning syndrome in demented patients without neuroleptic therapy. Arch Gerontol Geriatr 1996; 22:49-54. [PMID: 15374192 DOI: 10.1016/0167-4943(95)00676-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/1995] [Revised: 09/11/1995] [Accepted: 09/12/1995] [Indexed: 11/18/2022]
Abstract
Characterisation of sundowning syndrome, defined as 'an exacerbation of symptoms indicating increased arousal or impairment in late afternoon, evening or at night, among elderly demented individuals', is complicated by neuroleptic therapy and frequent failure to specify the nature of the associated dementia. Screening by a memory disorders unit of an institutionalized population of 30 neuroleptic-free demented patients revealed 8 sundowners, with diagnoses of probable Alzheimer's disease (n = 5), frontal lobe dementia (n = 1), Lewy body disease (n = 1), and sequelae of herpes encephalitis (n = 1). Sundowners did not differ from non-sundowners in age, Mini Mental State score, degree of temporal and spatial disorientation or perceptual delusion. Sundowning was related to restlessness (P < 0.0001), sleep disorder (P < 0.003) and a history of hypotension lipothymia (P < 0.08). These results provide further evidence for a chronobiological explanation of sundowning syndrome.
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Affiliation(s)
- F Lebert
- Memory Disorders Unit, Clinique Neurologique, Centre Hospitalier Régional et Universitaire, 59037 Lille, France
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128
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Smith CD. Quantitative computed tomography and magnetic resonance imaging in aging and Alzheimer's disease. A review. J Neuroimaging 1996; 6:44-53. [PMID: 8555663 DOI: 10.1111/jon19966144] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
In recent aging research, quantitative techniques have been used to overcome limitations of qualitative interpretation of magnetic resonance and computed tomographic imaging. The purpose of this review is to summarize imaging results emphasizing quantitative studies using these two modalities in human aging. Magnetic resonance spectroscopy is viewed as an extension of imaging, and results of in vivo spectroscopic studies are included. Because Alzheimer's disease (AD) is closely related to aging, a discussion of quantitative imaging techniques that may distinguish normal elderly from patients with AD is included.
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Affiliation(s)
- C D Smith
- Department of Neurology, University of Kentucky College of Medicine, Lexington 40536, USA
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129
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Villa G, Cappa A, Tavolozza M, Gainotti G, Giordano A, Calcagni ML, De Rossi G. Neuropsychological tests and [99mTc]-HM PAO SPECT in the diagnosis of Alzheimer's dementia. J Neurol 1995; 242:359-66. [PMID: 7561963 DOI: 10.1007/bf00868390] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty-three patients with Alzheimer's dementia (AD) in relatively early stages and 40 patients with other cognitive disorders of vascular or degenerative aetiology underwent neuropsychological examination and [99mTc]-HM PAO single photon emission computed tomography (SPECT). In contrast to the commonly accepted notion of a posterior temporoparietal reduction of tracer uptake as the typical SPECT pattern of AD, the most consistent feature found in the SPECT images of our AD patients was a hippocampal uptake deficit, associated with a variable degree of temporal, parietal and frontal deficit (extending from the posterior to the anterior regions), according to the severity of the disease. These results support the theory of AD as a "hippocampal dementia", at least in the early stages. Neuropsychological tests were found to be somewhat more specific and more accurate than SPECT in distinguishing AD from non-AD cases.
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Affiliation(s)
- G Villa
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Roma, Italy
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130
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Hindley NJ, Jobst KA, King E, Barnetson L, Smith A, Haigh AM. High acceptability and low morbidity of diagnostic lumbar puncture in elderly subjects of mixed cognitive status. Acta Neurol Scand 1995; 91:405-11. [PMID: 7639073 DOI: 10.1111/j.1600-0404.1995.tb07029.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A total of 273 participants (186 with clinical dementia; 87 "normal" controls; mean age 72 years) in a prospective, longitudinal, dementia research study, underwent lumbar puncture (LP), where possible, on an annual basis. Reporting of symptoms after all LP's (n = 541) was 21.6%, the predominant complaints being mild localised back-pain (12.8%) and headache (10.7%). All symptoms were self-limiting. Analysis of headaches after all first LP's (n = 273) revealed an incidence of 14.2% with marked differences between subjects under 60 years of age (33%) and those over 60 years (10.1%), between subjects with "minimal" cerebral atrophy (19.5%) and those with "significant" atrophy (5.6%) and, to a lesser extent, between subjects with no or mild cognitive impairment (20.6%) and those with significant impairment (9.5%). Age under 60 years and lack of significant cerebral atrophy were shown to be independent predictors of headache. Acceptability of LP was high as demonstrated by agreement to a second procedure by 92.2% of eligible subjects. Our results show that LP can be successfully incorporated into research with the elderly.
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Affiliation(s)
- N J Hindley
- Oxford Project to Investigate Memory & Ageing, Radcliffe Infirmary, England
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131
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132
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Affiliation(s)
- P Kist
- Division of Geriatric Medicine, St George's Hospital Medical School, London, UK
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133
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Abstract
The potential clinical utility of SPECT (Single Photon Emission Computed Tomography) brain imaging to clarifying certain diagnostic dilemmas faced by clinical psychiatrists is considered generally and is illustrated by several case vignettes. Three case histories consider dementia vs depressive pseudodementia, two the possibility of a cerebral vasculitis in patients with auto-immune conditions, and two whether the patient had a "type" of depression likely to benefit from a course of ECT. Published studies reviewing the utility of SPECT in dementia, depression, depressive "pseudodementia" and cerebral lupus are considered. It is suggested that SPECT is an important investigatory technique providing additional information that may assist some diagnostic decisions, while its utility in assisting other clinical decisions awaits clarification.
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Affiliation(s)
- G Parker
- School of Psychiatry, University of New South Wales
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134
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Kennedy AM, Frackowiak RS, Newman SK, Bloomfield PM, Seaward J, Roques P, Lewington G, Cunningham VJ, Rossor MN. Deficits in cerebral glucose metabolism demonstrated by positron emission tomography in individuals at risk of familial Alzheimer's disease. Neurosci Lett 1995; 186:17-20. [PMID: 7783942 DOI: 10.1016/0304-3940(95)11270-7] [Citation(s) in RCA: 185] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In order to establish whether positron emission tomography (PET) can identify metabolic changes in Alzheimer's disease at a presymptomatic stage, we have examined 24 asymptomatic at risk individuals from families with Alzheimer's disease. A significant reduction in global cerebral metabolic rate for glucose was found when compared with 16 age-matched controls. There was also a focal, parieto-temporal deficit similar to, although less extensive than, that found in 18 symptomatic individuals from familial Alzheimer's disease (FAD) pedigrees. Follow up of this cohort will establish whether these metabolic changes relate to a presymptomatic stage of the disease.
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Affiliation(s)
- A M Kennedy
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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135
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Becker T, Retz W, Hofmann E, Becker G, Teichmann E, Gsell W. Some methodological issues in neuroradiological research in psychiatry. J Neural Transm (Vienna) 1995; 99:7-54. [PMID: 8579809 DOI: 10.1007/bf01271468] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
An outline is given of some of the methodological issues discussed in neuroradiological research on psychiatric illness. Strengths and shortcomings of magnetic resonance imaging (MRI) in depicting and quantifying brain structures are described. Temporal lobe anatomy and pathology are easily accessible to MRI, whereas limits on anatomical delineation hamper approaches to frontal lobe study. White matter hyperintense lesions are sensitively depicted by MRI, but specificity is limited. Distinction of vascular and primary degenerative dementia is considerably improved by CT and MRI analysis. Computed tomography (CT) and MRI have enhanced the understanding of treatable organic psychiatric disorders, e.g., normal pressure hydrocephalus. Subcortical and white matter pathology has been replicated in CT and MRI studies of late-onset psychiatric disorders, clinical overlap with cerebrovascular disease or neurodegeneration may be of import. Transcranial sonography findings of brainstem structural change specific to unipolar depression may contribute to the understanding of affective psychoses. Magnetic resonance spectroscopy and functional MRI are likely to stimulate psychiatric research in the future.
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Affiliation(s)
- T Becker
- Department of Psychiatry, University of Würzburg, Federal Republic of Germany
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136
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Convit A, de Leon MJ, Hoptman MJ, Tarshish C, De Santi S, Rusinek H. Age-related changes in brain: I. Magnetic resonance imaging measures of temporal lobe volumes in normal subjects. Psychiatr Q 1995; 66:343-55. [PMID: 8584590 DOI: 10.1007/bf02238754] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The volume of temporal lobe structures was examined in twenty-seven older (mean age of 69.2 +/- 8.3 years) and ten younger subjects (mean age of 26.1 +/- 4.1 years) using quantitative magnetic resonance imaging (MRI) methods. Multiple regression analysis, using gender, overall atrophy, and head size as covariates, showed unique contributions of age to variance in both medial and lateral temporal lobe volumes. Temporal lobe subregions that showed the strongest unique age-related reductions were the hippocampus, fusiform gyrus, and parahippocampus. These results suggest age-related reductions in temporal lobe subvolumes.
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Affiliation(s)
- A Convit
- Neuroimaging Laboratory, New York University Medical Center, NY 10016, USA
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137
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Affiliation(s)
- I Moseley
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
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138
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Affiliation(s)
- M N Rossor
- Department of Neurology, St Mary's Hospital, London, UK
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139
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Klockgether T, Bürk K, Schulz JB, Dichgans J, Wessel K, Auburger G. Absence of SCA1 mutation in idiopathic cerebellar ataxia. J Neurol Neurosurg Psychiatry 1994; 57:1439-40. [PMID: 7964835 PMCID: PMC1073211 DOI: 10.1136/jnnp.57.11.1439-a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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140
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Frisoni GB, Bianchetti A, Geroldi C, Trabucchi M, Beltramello A, Weiss C. Measures of medial temporal lobe atrophy in Alzheimer's disease. J Neurol Neurosurg Psychiatry 1994; 57:1438-9. [PMID: 7964833 PMCID: PMC1073209 DOI: 10.1136/jnnp.57.11.1438] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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141
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Desmond PM, O'Brien JT, Tress BM, Ames DJ, Clement JG, Clement P, Schweitzer I, Tuckwell V, Robinson GS. Volumetric and visual assessment of the mesial temporal structures in Alzheimer's disease. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1994; 24:547-53. [PMID: 7848158 DOI: 10.1111/j.1445-5994.1994.tb01756.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Alzheimer's disease is the commonest cause of dementia. Clinical diagnosis of Alzheimer's disease may be difficult. Magnetic resonance imaging has a role to play in diagnosis. AIM To assess whether volumetric and/or visual assessment of the mesial temporal structures is useful in separating patients with Alzheimer's disease from age matched controls. METHODS Twenty-four patients with Alzheimer's disease diagnosed by NINCDS/ADRDA criteria and 15 age matched controls were studied with magnetic resonance imaging (MRI) and volumetric techniques. Segmented volumes of the mesial temporal structures were assessed visually and volumetrically. RESULTS Volumetric analysis demonstrated significant (p < .001) differences between the two groups, but showed overlap in individual cases. Discriminant function analysis predicted correct group membership (patient or control) in 85% of cases. Visual assessment alone demonstrated a sensitivity of 92% and a specificity of 93% in distinguishing the Alzheimer patients from controls. CONCLUSION Volumetric and visual assessment of the mesial temporal structures is useful in separating Alzheimer patients from controls. Overlap is present in individual cases. Visual assessment was as useful in separating the two groups as the volumetric analysis.
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Affiliation(s)
- P M Desmond
- University of Melbourne, Department of Radiology, Royal Melbourne Hospital, Vic
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142
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143
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Jobst KA, Smith AD, Szatmari M, Esiri MM, Jaskowski A, Hindley N, McDonald B, Molyneux AJ. Rapidly progressing atrophy of medial temporal lobe in Alzheimer's disease. Lancet 1994; 343:829-30. [PMID: 7908080 DOI: 10.1016/s0140-6736(94)92028-1] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The symptoms of Alzheimer's disease are associated with pathological change and loss of neurons in the medial temporal lobe. By yearly temporal-lobe-oriented computed tomograms the average rate of atrophy of the medial temporal lobe was 15.1% per year (95% CI 10.0, 20.2) in 20 patients with histopathologically, confirmed Alzheimer's disease and 1.5% (0.2, 2.8) in 47 healthy ageing controls. Such excessive atrophy presumably reflects the vulnerability of the medial temporal lobe to a catastrophic event, probably a pathological cascade process. Thus, Alzheimer's disease may not be due simply to an acceleration of normal ageing but, rather, is the consequence of a true disease process.
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Affiliation(s)
- K A Jobst
- University Department of Pharmacology, Radcliffe Infirmary, Oxford, UK
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144
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Pasquier F, Bail L, Lebert F, Pruvo JP, Petit H. Determination of medial temporal lobe atrophy in early Alzheimer's disease with computed tomography. Lancet 1994; 343:861-2. [PMID: 7908112 DOI: 10.1016/s0140-6736(94)92068-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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145
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Hankey GJ. What's New? Med J Aust 1994. [DOI: 10.5694/j.1326-5377.1994.tb125837.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Graeme J Hankey
- Department of NeurologyRoyal Perth Hospital Wellington Street Perth WA 6001
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Philpot M, Burns A. Jobst et al's "Detection in life of confirmed Alzheimer's disease using a simple measurement of medial temporal lobe atrophy by computed tomography". Br J Psychiatry 1993; 163:809-12. [PMID: 8306125 DOI: 10.1192/bjp.163.6.809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
"The medial temporal lobe of the brain is important for normal cognitive function, notably for memory, and is the region with the most extensive pathological change in Alzheimer's disease (AD). We wanted to find out if atrophy of the medial temporal lobe could be detected in life in patients in whom a diagnosis of AD was subsequently established histopathologically. The minimum width of the medial temporal lobe, measured by temporal-lobe-oriented computed tomography (CT) about one year before death, in 44 patients with a histopathological diagnosis of AD (cases) was nearly half (0.56 of the median) that in 75 controls of the same age with no clinical evidence of dementia (95% confidence interval 0.51-0.61). There was little overlap between the distributions of measurements in cases and controls. A cut-off (< 0.79 MoM) selected to yield a 5% false-positive rate gave an expected detection rate of 92%. A cut-off selected to yield a false-positive rate of 1% (< 0.70 MoM) yielded a 79% detection rate. 20 of the 44 patients with histopathologically diagnosed AD had been scanned more than once before death, and the test (cut-off < 0.79 MoM) was positive in all 20 more than a year before and in 9/10 more than 2 years before death. In 10 subjects with dementia but with histopathology excluding AD, the mean minimum width of the medial temporal lobe was significantly greater than that in the cases with AD, but was not significantly different from that in controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Philpot
- Guy's and Lewisham NHS Trust, Hither Green Hospital, London
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Affiliation(s)
- A Burns
- School of Psychiatry and Behavioural Sciences, University of Manchester, UK
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Convit A, de Leon MJ, Golomb J, George AE, Tarshish CY, Bobinski M, Tsui W, De Santi S, Wegiel J, Wisniewski H. Hippocampal atrophy in early Alzheimer's disease: anatomic specificity and validation. Psychiatr Q 1993; 64:371-87. [PMID: 8234547 DOI: 10.1007/bf01064929] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We evaluated three groups of elderly individuals who were carefully screened to rule out clinically significant diseases that could affect cognition. They were matched for age and education. The groups included normals (N = 18), Alzheimer's Disease (AD) patients (N = 15), and minimally impaired individuals with memory complaints and impairments but who did not fulfill criteria for AD (N = 17). Volumetric measurements of different regions of the temporal lobe on the coronal scan as well as ratings of the perihippocampal cerebrospinal fluid (CSF) accumulation (HCSF) on the negative angle axial MR were carried out. Volume reductions were found in AD relative to the normals for both medial and lateral temporal lobe volumes. Only hippocampal volume reductions were found in the minimal group. The minimally impaired individuals had equivalent hippocampal volume reductions and significantly larger parahippocampal and lateral temporal lobe gyri than the AD group. The axial HCSF was validated using the coronal volumes. The combination of coronal hippocampal and perihippocampal CSF was the best predictor of the axial HCSF rating. The parahippocampal volume did not add to the predictive ability of the hippocampal-perihippocampal CSF combination. Future work should validate these findings with longitudinal designs as well as assess the issue of normal aging of these structures and their relationship to cognitive function.
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Affiliation(s)
- A Convit
- Aging and Dementia Research Center, Millhauser Labs, New York, NY 10016
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