An analysis of communication in conversation in patients with dementia

Patients with degenerative dementia often show language disorders, but little is known about their verbal (VC) and non-verbal communication (NVC). Our aim was to analyse VC and NVC in patients with standard criteria of mild-moderately severe dementia (MMSE ≥14/30) resulting from Alzheimer's disease (AD; 29 cases), behavioural variant of frontotemporal dementia (FTD; 16), or dementia with Lewy bodies (DLB; 13). We used the Lille Communication Test, which addresses three domains: participation in communication (PC: greeting, attention, participation), VC (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback), and NVC (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). Patients were compared with 47 matching control subjects. AD patients were partially impaired (p≤0.01) in PC (greeting), and more definitely in VC, especially by verbal comprehension and word finding difficulties and to a much lesser degree in verbal pragmatics (responding to open questions, presenting new information), while NVC was mostly preserved. FTD patients were severely impaired in PC. VC difficulties were related to lexical-semantic, syntactic and more specifically pragmatic problems. NVC was impaired by difficulties in affective expressivity, pragmatics and feedback management. DLB patients showed modest difficulties with VC. PC, VC and NVC strongly correlated with performance in the dementia rating scale. In conclusion, the profile of communication difficulties was quite different between groups. FTD patients showed most severe difficulties in PC and verbal and non-verbal pragmatics, in relation to their frontal lesions. AD patients had prominent impairment of lexical-semantic operations.

[VZV-related myelitis: a pathophysiological hypothesis]

INTRODUCTION

Complications of VZV infection in the central nervous system are multiple. VZV-related myelitis is an uncommon complication of herpes zoster.

OBSERVATION

We report the case of a 55-year old man with intercostal herpes zoster who presented a subacute medullar syndrome. MRI demonstrated an extended cervico-thoracic medullar hyperintensity on the T2-weighted images. Cerebrospinal fluid (CSF) analysis showed 100 leukocytes/mm3, 0.94 g/L protein, negative VZV PCR, elevated rate of anti-VZV IgG and no oligoclonal bands. Clinical, biological and radiological presentations were compatible with the diagnosis of VZV-related myelitis with three potential pathophysiological mechanisms: infectious, immune post-infectious, vascular. The course was partially favorable after a 3-day regimen of corticosteroid and 3 weeks of acyclovir infusions.

DISCUSSION

Parainfectious myelitis is often the consequence of a viral infection with a post-infectious pathogenesis. Most often, the clinical outcome is good. In this case report, we highlight the VZV vascular tropism and its more severe outcome.

CONCLUSION

VZV-related myelitis should be diagnosed early. The combination of aciclovir and corticoids infusions seems to be beneficial.

Angioplasty and stenting for high-grade internal carotid artery stenosis: safety study in 39 selected patients

BACKGROUND

Carotid angioplasty and stenting (CAS) is sometimes used as an alternative to surgery, despite the lack of evidence for its safety and efficacy.

METHOD

Over a 33-month period, 39 consecutive patients with a stenosis >/=70% underwent CAS (4 in a randomized trial and 35 because of contra-indications for surgery).

RESULTS

In 5 patients (13%; 95% CI: 3-23), a major complication occurred (3 disabling ischaemic strokes, 1 myocardial infarction, 1 acute interstitial nephropathy). In 7 patients (18%; 95% CI: 6-30), a minor complication occurred (5 transient ischaemic attacks, 1 transient confusional state, 1 non-disabling ischaemic stroke).

CONCLUSION

CAS cannot be considered as a routine procedure and should be restricted to high-risk patients unfit for surgery.

[Sarcoidosis and progressive multifocal leukoencephalopathy]

A 70-year-old woman treated for sarcoidosis complained of progressive cognitive impairment and gait disability. Magnetic resonance imaging of the brain revealed a nonenhancing lesion in T1-weighted imaging in the left parieto-occipital region and sarcoidosis of the central nervous system was evoked. However, she rapidly deteriorated with posterior and cerebellar extension of the lesions, suggesting of progressive multifocal leukoencephalopathy (PML). DNA of the JC virus (JCV) was detected in the cerebrospinal fluid (CSF) by a polymerase chain reaction. Despite antiviral therapy, she died nine months after the first neurological signs. This case illustrates the possible association between sarcoidosis and PML, and underlines the interest to detect the presence of JCV in the CSF when the diagnosis of neurosarcoidosis appeared uncertain.