Significance of age-related white matter lesions

[Description of psychomotor disadaptation syndrome or frontal-subcortical dysfunction syndrome]

The psychomotor disadaptation syndrome (PDS) was first described 34 years ago by the geriatric research team from Dijon, France. This syndrome was initially called "psychomotor regression syndrome". It was renamed PDS in the 1990s following considerable advances in the understanding of its pathophysiology and management. Since the 2000s, a condition known as sub-cortical-frontal dysfunction (syndrome sous-cortico-frontal) has become synonymous with PDS. Effective management of PDS requires a multidisciplinary approach that includes physicians, physiotherapists, psychologists and the entire geriatrics healthcare team.

Neuromotor Assessment and Autistic Disorder

Autistic disorder presents in early childhood with marked deviations in social interactions and communication and with a restricted and peculiar range of interests and activities. Although probably a heterogeneous condition, autistic disorder includes a class of individuals who also have subtle neurological impediments manifested as disturbances of movement, balance, posture and gait. We review neuromotor and neurobehavioral assessments for persons with autistic disorder and related conditions to improve the classification of the impairments and to facilitate the utilization of therapies specific for each class.

Study of the positivity of spontaneous and directed diagnosis of leukoaraiosis in the elderly by cranial computerized tomography, and its correlation with cognitive deficit and cardiovascular risk factors

OBJECTIVE

To evaluate the prevalence of leukoaraiosis (LA) and its correlation with vascular risk factors and the cognitive performance of elderly patients.

METHOD

78 patients were randomly selected and submitted to clinic-laboratorial evaluation for vascular risk factors. Two cognitive tests were performed. All patients were submitted to cranial computerized tomography (CT), which was analyzed in two situations: the spontaneous and the directed way.

RESULTS

There was no statistically significant difference between the prevalence of spontaneous and the directed diagnoses of LA (20.5 and 18%, respectively). The presence of LA was not significantly correlated with cognitive impairment. Only age was positively associated with LA.

CONCLUSION

Cranial CT is a trustworthy method for the diagnosis of LA. Only age showed a positive association. No clinical implications were found, concerning the cognitive performance of the patients.

Syndrome de désadaptation psychomotrice

PURPOSE

We describe the psychomotor disadaptation syndrome and report the last findings on its physiopathology and therapeutic. This syndrome was first described by Pr Gaudet's team in 1986 and named "psychomotor regression syndrome". This name has been recently changed into "psychomotor disadaptation syndrome".

ACTUALITIES AND STRONG POINTS

The psychomotor disadaptation syndrome is a decompensation of postural function, gait and psychomotor automatisms due to the alteration of the posture and motor programming. That alteration is linked to subcortical-frontal lesions. Clinically, the psychomotor disadaptation syndrome is characterized by postural impairments (retro-propulsion or backward disequilibrium), non-specific gait disorders, neurological signs (akinesia, reactional hypertonia, alteration of both reactive postural responses and protective reactions) and psychological troubles. Psychological troubles include fear of standing and gait in its acute feature or slowness of cognitive processing and anhedonia in its chronic feature. The psychomotor disadaptation syndrome occurs as a failure to compensate for the effects of the following three factors which entail the reduction of motor functional reserves because of their impact on frontal subcortex: 1) aging, 2) chronic illness named predisposing factors (degenerative or vascular disorders) and both 3) functional and organic acute factors. The latter factors cause a reduction of cerebral blood perfusion. The psychomotor disadaptation syndrome requires multidisciplinary management including medical, physiotherapeutic and psychological approaches.

PROSPECTS AND PROJECTS

In the next years we have to determine the frequency of psychomotor disadaptation syndrome and its physiopathology needs to be further explored.

Reduced cerebral glucose metabolism in subjects with incidental hyperintensities on magnetic resonance imaging

OBJECTIVE

To clarify the significance of incidental and asymptomatic hyperintensities on T(2)-weighted magnetic resonance images (MRI) in adults, we examined the relationship between a variety of these lesions and cerebral metabolism evaluated by positron emission tomography (PET) with (18)F-labeled fluorodeoxyglucose ([(18)F]FDG).

SUBJECTS AND METHODS

Two hundred and thirty-one persons with hyperintensities on T(2)-weighted MRI but without overt neurological disease (mean age 60+/-9 years) were studied. MR hyperintensities were classified into deep and/or subcortical white matter hyperintensities (DSWMHs), periventricular hyperintensities (PVHs) and hyperintensities in the basal ganglia and/or thalamus (HBGTs). The relationship between these lesions and cerebral metabolic rate of glucose (CMRgl) measured by [(18)F]FDG-PET was investigated.

RESULTS

The CMRgl values in white matter and cerebral cortex in the group with severe PVHs were lower than those in the group with mild PVHs (P<0.0001 and P<0.005). Although the severity of PVHs was associated with the numbers of DSWMHs and HBGTs, the results of multivariate analysis showed a significant relationship of PVHs to glucose metabolism in cerebral cortex and white matter.

CONCLUSIONS

We conclude that increasing severity of MRI hyperintensities in adults is associated with a deterioration of cerebral metabolism. In particular, involvement of PVHs may be a marker of widespread deterioration of cortical metabolism.

Quantitative study of signal hyperintensities on T2-weighted magnetic resonance imaging in late-onset schizophrenia

OBJECTIVE

The authors investigated the extent and distribution of signal hyperintensities on T2-weighted magnetic resonance imaging (MRI) of the brains of subjects with late-onset schizophrenia.

METHOD

The study group consisted of 25 subjects with DSM-III-R schizophrenia and onset at age 50 or more years (late-onset schizophrenia) matched group-wise with 24 subjects with early-onset schizophrenia and 30 psychiatrically healthy volunteers. The subjects underwent clinical and neuropsychological assessments and MRI scans. Transaxial T2-weighted and proton-density images were analyzed manually for signal hyperintensities in cerebral and cerebellar white matter, the basal ganglia, thalamus, and brainstem, and quantitative measures were obtained.

RESULTS

Subjects with late-onset schizophrenia had greater periventricular hyperintensities measured as widths of periventricular rims and frontal and occipital caps than the two comparison groups. Hyperintense signals elsewhere in the white matter and in the basal ganglia and brainstem did not differ between groups, but the late-onset schizophrenia group had more signal hyperintensities in the thalamus than the normal comparison group. Signal hyperintensities in the frontal-subcortical circuit regions, when considered together, did not differ between groups. Periventricular hyperintensities had significant negative correlations with intelligence, memory, and frontal-executive functioning in the total group.

CONCLUSIONS

The finding of increased periventricular hyperintensities and thalamic signal hyperintensities in late-onset schizophrenia suggests the possibility that cerebrovascular disease, in an interaction with some incompletely understood vulnerability factors, may play a role in the pathogenesis of schizophrenia with onset in advanced age.