Are hallucinations and extrapyramidal signs associated with a steeper cognitive decline in degenerative dementia patients?

The aim of this study was to verify if visual hallucinations and extrapyramidal signs are associated with a high speed of cognitive decline in degenerative dementia patients with amnesic onset. The analysis of 1082 consecutive patients showed that hallucinations, but not extrapyramidal signs, were associated with a faster cognitive decline. However, patients with hallucinations were also more severe at the time of examination with the Milan Overall Dementia Assessment (MODA). One interpretation is that hallucinations are the marker of a distinct process of nervous degeneration that specifically causes a steeper cognitive decline from onset. Another interpretation is that the speed of cognitive decline is set along a continuum, and the incidence of hallucinations is simply proportional to the level of cognitive decline. The statistical analysis of our data was consistent with the latter interpretation, in that we were able to quantify the probability of presenting visual hallucinations on the basis of the overall severity of cognitive decline.

Cognitive deterioration in Alzheimer's disease: is the early course predictive of the later stages?

This study investigated the predictive value of the early progression rate of Alzheimer's disease on that of the later stages. We retrospectively evaluated 91 patients affected by possible Alzheimer's disease; the patients had been examined twice with the Milan overall dementia assessment (MODA) scale at an interval of 12 months (53 patients) or 24 months (38 patients). At the first assessment, speed of progression was calculated for each patient dividing the MODA difference from the normality threshold by the time elapsed from the cognitive decline onset. The second assessment of speed of progression was calculated dividing the difference between the two MODA scores by the time elapsed from the first examination. Patients with a slow progression rate in the early stage were unlikely to show a subsequent fast progression rate, and vice versa for patients with a fast early progression. A tool is provided for predicting the speed of cognitive decline of patients from a single MODA assessment. We suggest that, in future clinical trials on Alzheimer's disease, a stratification of participants based on the early rate of cognitive deterioration may be considered.

How to calculate an MMSE score from a MODA score (and vice versa) in patients with Alzheimer's disease.

The aim of the present study was to provide a statistically sound way of reciprocally converting scores of the mini-mental state examination (MMSE) and the Milan overall dementia assessment (MODA). A consecutive series of 182 patients with "probable" Alzheimer's disease patients was examined with both tests. MODA and MMSE scores proved to be highly correlated. A formula for converting MODA and MMSE scores was generated.

Gait apraxia after bilateral supplementary motor area lesion.

OBJECTIVES: The study aimed at addressing the issue of the precise nature of gait apraxia and the cerebral dysfunction responsible for it. METHODS: The case of a patient, affected by a bilateral infarction limited to a portion of the anterior cerebral artery territory is reported. The patient's ability to walk was formally assessed by means of a new standardised test. RESULTS: Due to an anomaly within the anterior cerebral artery system, the patient's lesion was centred on the supplementary motor regions of both hemispheres. He presented with clear signs of gait apraxia that could not be accounted for by paresis or other neurological deficits. No signs of any other form of apraxia were detected. CONCLUSIONS: The clinical profile of the patient and the analysis of 49 cases from previous literature suggest that gait apraxia should be considered a clinical entity in its own right and lesions to the supplementary motor areas are responsible for it.

Variables linked to psychotic symptoms in Alzheimer's disease.

This study is aimed at assessing the prevalence and features of psychotic symptoms in a sample of 180 patients with Alzheimer's disease (AD). Sixty-four patients (35.5% of the sample) showed one or more psychotic symptoms. The presence of these symptoms correlated with the severity of the patients' cognitive impairment, as well as the patients' age at first assessement. Sex, duration of illness, education and familiar history for dementia were not significantly correlated with the psychotic symptoms. Hallucination was the most common symptom (24.4%, of the whole sample), followed by delusion (18.3%) and misperception (11.1%). Visual hallucinations were more frequent than auditory, and, among delusions, persecutory and theft themes were largely prevailing. Misperceptions included television related phenomena and phantom boarder illusions. A follow-up study of 37 patients demonstrated the association between the presence of psychotic symptoms and a steeper slope of cognitive deterioration. Copyright 1998 Lippincott Williams & Wilkins