Clinical outcomes in transient epileptic amnesia: A 10-year follow-up cohort study of 47 cases.

OBJECTIVE: Transient epileptic amnesia (TEA) is a form of adult-onset epilepsy where presenting features are well described, but little is known regarding prognosis. This study aimed to elucidate the long-term prognosis of TEA regarding seizure control, memory, medical comorbidities, and life expectancy. METHODS: Up-to-date clinical information was collected for 47 people diagnosed with TEA who had joined the The Impairment of Memory in Epilepsy (TIME) study 10 years earlier. At entry to the study, information about comorbid conditions was systematically collected. Details regarding subsequent diagnoses, seizure activity, changes to treatment, or reports of cognitive impairment were obtained through the family doctor. The variables of interest were compared with UK population data. RESULTS: Mortality in the cohort was 21 of 47 (45%), with an average age at death of 82.5 years. Seizures remained well controlled for the majority but medications required adjustments in dose and type for some (28%). A small number (three cases) remained seizure-free without medication. History of cardiovascular disorders was frequent (78.7%), typically involving hypertension (55.3%). Autoimmune disorders (25.5%), cancer (23.4%), and depression (21.3%) were also commonly reported. Although persisting memory problems were often noted, dementia was diagnosed in seven cases (14.9%). Life expectancy and comorbidities in TEA did not differ from available population norms. SIGNIFICANCE: Results suggest that life expectancy is not reduced in TEA. Although TEA does not appear to be a self-limiting form of epilepsy, seizures are typically well controlled via medication. Because adjustments to medication may be required, even after long periods of stability, ongoing medical monitoring is recommended. Comorbid vascular disorders are frequent but appear similar to general population estimates. Monitoring mood may be important, given that people with chronic conditions are often vulnerable to depression. Because of persisting memory difficulties, the development of effective memory interventions for people with TEA is warranted.

Results of a Real-world Study of Enzalutamide and Abiraterone Acetate With Prednisone Tolerability (REAAcT).

BACKGROUND: The objective of this study was to evaluate differences in tolerability in patients with metastatic castration-resistant prostate cancer treated with enzalutamide (ENZA) or abiraterone acetate plus prednisone (AA+P). PATIENTS AND METHODS: This was a phase IV, prospective, open-label, multicenter, real-world study. Patients were prescribed ENZA or AA+P at the treating physician's discretion. Computerized tests of 4 cognitive domains (Cogstate), patient-reported outcomes (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 [EORTC QLQ-30], Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue], Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog]), and patient/caregiver surveys were assessed at baseline and 2 months. Safety data were collected. RESULTS: Of 100 treated patients, 92 were evaluable (46/arm). Baseline characteristics were similar, with mild cognitive impairment observed in ∼20% of patients. The FACIT-Fatigue demonstrated a statistically significant worsening from baseline of -4.00 (95% confidence interval, -6.61 to -1.39) for ENZA compared with AA+P, -0.01 (95% confidence interval, -2.40 to 2.38). Overall, more adverse events (AEs) and more AEs of fatigue were reported with ENZA versus AA+P (52% vs. 36% and 26% vs. 8%, respectively). Grade 3/4 AEs were similar (4% vs. 6%). Unique neuropsychiatric AEs reported with ENZA included amnesia, cognitive disorders, memory impairment, and confusional state; those for AA+P included cerebrovascular accident, presyncope, and spinal cord compression. Clinically meaningful cognitive decline was seen in 4 patients on ENZA versus 1 patient on AA+P. However, the overall mean changes from baseline for the Cogstate tests, the EORTC QLQ-C30, and the FACT-Cog assessment were similar and showed no meaningful change. Caregiver survey responses noted more fatigue with ENZA and more moodiness with AA+P compared with patient responses. CONCLUSIONS: Although baseline values were similar, more fatigue and neurocognitive differences were observed with ENZA compared with AA+P.

Amnesia en el embarazo / Amnesia in Pregnancy

La memoria es la capacidad para aprender, organizar y fijar eventos de nuestro pasado y se encuentra íntimamente ligado a la función de la atención. Es capaz de guardar datos a través de mecanismos ultra complejos que se desarrollan en tres etapas: codificación, almacenamiento y evocación. La presencia de la amnesia impide que esta capacidad se desarrolle adecuadamente. La amnesia ocurre cuando se comprueba que alguien ha perdido o tiene debilitada la memoria. Hay varias causas de pérdida de la memoria, como ha sido señalado, por ejemplo, en la etapa del climaterio y la menopausia donde este aspecto es considerado para clasificar la intensidad del síndrome climatérico que se presenta con frecuencia en esta etapa. La persona que sufre este trastorno no es capaz de almacenar ni de recuperar información recibida con anticipación, ya sea por motivos orgánicos o funcionales. La amnesia (del griego ἀμνησία amnesia, olvido) es la pérdida parcial o completa de la memoria. Sus causas son orgánicas o funcionales. Muchas mujeres, cuando se encuentran embarazadas experimentan una pérdida parcial de memoria a corto plazo conocida como amnesia del embarazo, mumnecia, o lo que los anglosajones suelen llamar placenta's brain (cerebro de placenta). Durante el embarazo, las fluctuaciones hormonales que experimenta la mujer producen cambios en la actividad cerebral, provocando una pérdida parcial de memoria a corto plazo. Sobre este aspecto abordaremos el estado actual que hay sobre este tema(AU)

Memory is the capacity to learn, organize and fix events of our past and is intimately linked to the function of attention. It is capable of saving data through ultra-complex mechanisms that are developed in three stages: coding, storage and evocation. The presence of amnesia prevents this ability from developing properly. Amnesia occurs when it is proven that someone has lost or has weakened memory. There are several causes of memory loss, as has been pointed out, for example, in the climacteric stage and menopause where this aspect is considered to classify the intensity of the climacteric syndrome that frequently occurs in this stage. The person suffering from this disorder is not able to store or retrieve information received in advance, for organic or functional reasons. Amnesia (from Greek ἀμνησία amnesia, forgetfulness) is the partial or complete loss of memory. Many pregnant women experience a partial loss of short-term memory known as pregnancy amnesia, mumnecia, or placenta's brain as the Anglo-Saxons usually call it. During pregnancy, the hormonal fluctuations experienced by women produce changes in brain activity, causing partial loss of short-term memory. On this aspect, we will address the status on this topic(AU)

Dementia-related adverse events in PARADIGM-HF and other trials in heart failure with reduced ejection fraction.

AIMS: Inhibition of neprilysin, an enzyme degrading natriuretic and other vasoactive peptides, is beneficial in heart failure with reduced ejection fraction (HFrEF), as shown in PARADIGM-HF which compared the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan with enalapril. As neprilysin is also one of many enzymes clearing amyloid-ß peptides from the brain, there is a theoretical concern about the long-term effects of sacubitril/valsartan on cognition. Therefore, we have examined dementia-related adverse effects (AEs) in PARADIGM-HF and placed these findings in the context of other recently conducted HFrEF trials. METHODS AND RESULTS: In PARADIGM-HF, patients with symptomatic HFrEF were randomized to sacubitril/valsartan 97/103 mg b.i.d. or enalapril 10 mg b.i.d. in a 1:1 ratio. We systematically searched AE reports, coded using the Medical Dictionary for Regulatory Activities (MedDRA), using Standardized MedDRA Queries (SMQs) with 'broad' and 'narrow' preferred terms related to dementia. In PARADIGM-HF, 8399 patients aged 18-96 years were randomized and followed for a median of 2.25 years (up to 4.3 years). The narrow SMQ search identified 27 dementia-related AEs: 15 (0.36%) on enalapril and 12 (0.29%) on sacubitril/valsartan [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.33-1.59]. The broad search identified 97 (2.30%) and 104 (2.48%) AEs (HR 1.01, 95% CI 0.75-1.37), respectively. The rates of dementia-related AEs in both treatment groups in PARADIGM-HF were similar to those in three other recent trials in HFrEF. CONCLUSION: We found no evidence that sacubitril/valsartan, compared with enalapril, increased dementia-related AEs, although longer follow-up may be necessary to detect such a signal and more sensitive tools are needed to detect lesser degrees of cognitive impairment. Further studies to address this question are warranted.

Ankle-Brachial Index but Neither Intima Media Thickness Nor Coronary Artery Calcification is Associated With Mild Cognitive Impairment.

BACKGROUND: Several studies have reported an association of atherosclerosis with mild cognitive impairment (MCI) and dementia independent of cardiovascular risk factors. OBJECTIVE: To compare the cross-sectional association of the ankle-brachial index (ABI), intima media thickness (IMT), and coronary artery calcification (CAC) with MCI and its subtypes, amnestic MCI (aMCI) and non-amnestic MCI (naMCI) in the population-based Heinz Nixdorf Recall cohort study. METHODS: 4,086 participants performed a validated brief cognitive assessment at the first follow-up examination (2006-2008). MCI was diagnosed according to previously published criteria. Prevalence ratio (PR) regression models adjusted for age, gender, education, cardiovascular risk factors, and APOE genotype were used to compare the association of the ABI, the CAC-Agatston score and the IMT with MCI and its subtypes. RESULTS: We identified 490 participants with MCI (mean age 66.1 ± 7.8, 46.9 % male, aMCI n = 249, naMCI n = 241) and 1,242 cognitively normal participants. A decreasing ABI (per 0.1) was significantly associated with a higher MCI prevalence in fully adjusted models (PR 1.06; 95% confidence interval (CI) 1.01-1.11), whereas an increasing CAC (log(CAC+1)) or IMT (per 0.1 mm) were not associated after adjustment. A decreasing ABI was also significantly associated with naMCI in fully adjusted models (PR 1.12; CI 1.03-1.21) but not with aMCI. CONCLUSIONS: Our data show that the degree of generalized atherosclerosis as measured by the ABI is associated with MCI and with naMCI in a population-based cohort.

Self-reported memory problems in adult-onset cancer survivors: effects of cardiovascular disease and insomnia.

BACKGROUND: Cancer and its treatments can deleteriously affect memory. Cardiac function and insomnia can exacerbate memory problems. OBJECTIVE: To examine the relationships among cardiovascular disease, insomnia, and self-reported memory problems (SRMP) in adult-onset cancer survivors. METHODS: We included data from participants (41-64 year-old) of the 2007-2008 National Health and Nutrition Examination Survey, a nationally representative probability sample of the civilian, non-institutionalized population of the US. We excluded participants with brain cancer/stroke history since these conditions are expected to cause cognitive problems. Using binary logistic regression, we determined the prevalence of SRMP relative to cardiac problems and insomnia by weighting our results proportionally. We adjusted for predictors of memory problems: age, sex, race, education and general health. RESULTS: The sample included 2289 adults (49% females), 9% with a cancer history. The results pertain only to cancer survivors. Those with insomnia were 16 times as likely to have SRMP. Only insomnia symptoms (OR, 15.74; 95% CI, 1.73-143.30; p < 0.01) significantly predicted SRMP, uniquely explaining 12% of the variance. Insomnia accounted for 18.8% of the association between cardiac issues and SRMP, demonstrating mediation (Sobel p < 0.05). The large CI is a consequence of analyzing a sub-group of a subpopulation. Among participants without a cancer history, cardiovascular disease and insomnia were not associated with SRMP (p > 0.05). LIMITATIONS: We could not determine severity and time-related changes in SRMP. CONCLUSION: Likelihood of SRMP was higher in cancer survivors with a history of cardiovascular disease and insomnia symptoms. Future studies are needed to delineate the cardiac-insomnia-memory interrelationships.

Latent trajectory classes for alcohol-related blackouts from age 15 to 19 in ALSPAC.

BACKGROUND: Alcohol-related blackouts (ARBs) are reported by ~50% of drinkers. While much is known about the prevalence of ARBs in young adults and their cross-sectional correlates, there are few prospective studies regarding their trajectories over time during mid-adolescence. This paper reports latent trajectory classes of ARBs between age 15 and 19, along with predictors of those patterns. METHODS: Latent class growth analysis (LCGA) was used to evaluate the pattern of occurrence of ARBs across 4 time points for 1,402 drinking adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC). Multinomial regression analyses evaluated age-15 demography, substance-related items, externalizing characteristics, and estimated peer substance use as predictors of latent class membership. RESULTS: ARBs were reported at age 15 in 30% and at age 19 in 74% of these subjects. Four latent trajectory classes were identified: Class 1 (5.1%) reported no blackouts; for Class 2 (29.5%), ARBs rapidly increased with age; for Class 3 (44.9%), blackouts slowly increased; and for Class 4 (20.5%), ARBs were consistently reported. Using Class 2 (rapid increasers) as the reference, predictors of class membership included female sex, higher drinking quantities, smoking, externalizing characteristics, and estimated peer substance involvement (pseudo R(2)  = 0.22). CONCLUSIONS: ARBs were common and repetitive in these young subjects, and predictors of their trajectories over time involved multiple domains representing diverse characteristics.

Metabolic syndrome and amnestic mild cognitive impairment: Singapore Longitudinal Ageing Study-2 findings.

Metabolic syndrome (MetS) is reported to be associated with cognitive decline and dementia, in particular vascular dementia. However, the evidence linking MetS to Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI), a precursor of AD, is inconsistent and limited. This study examined the association of MetS and its components with aMCI and how APOE-εe4 and younger age influenced this association. Participants with aMCI (n = 98) and cognitively normal controls (n = 802) were identified from baseline data in a second wave cohort of older subjects aged 55 and over in the Singapore Longitudinal Ageing Study-2 (SLAS-2) in 2009/2010. The associations of MetS and its individual components with aMCI were analyzed using logistic regression controlling for age, gender, education, current smoking, alcohol drink, leisure time activities score, Geriatric Depression Scale score, APOE-ε4, and heart disease or stroke. The analysis was repeated for associations stratified by age and APOE-ε4 status. In multivariate analysis, MetS was associated with an elevated risk of aMCI (OR = 1.79; 95% CI 1.15-2.77). Among MetS components, central obesity showed a significant association with aMCI (OR = 1.77; 95% CI 1.11-2.82). The association between MetS and aMCI remained significant on repeated analysis among subjects free of heart disease and stroke. This association was particularly stronger among participants with APOE-ε4 allele (OR = 3.35; 95% CI, 1.03-10.85) and younger (<65 years) participants with APOE-ε4 (OR = 6.57; 95% CI, 1.03-41.74). MetS was found to be associated with aMCI, especially in individuals with APOE-ε4 at younger age in this middle-aged and older cohort.

Memory disorders in children with central nervous system germ cell tumors.

Memory disorders in children and adolescents with brain tumors are rare, but devastating to social, academic, and vocational development. Many pediatric patients with intracranial germ cell tumors (GCTs) complain of memory difficulties. This study investigated memory across a series of GCT patients. A total of 33 GCT patients were retrospectively examined for diagnosis, imaging results, intelligence quotient, treatment variables, evidence of increased intracranial pressure at diagnosis, and memory. The incidence of amnesia in GCT patients was 55%. Memory disturbance could not be predicted by intelligence quotient, treatment, location of lesion, or hydrocephalus at diagnosis. The high incidence of memory deficits in GCT patients suggests a risk to memory in patients with GCT. Formal memory assessment should be considered in all patients with central nervous system GCTs. Specific counseling and planning to assist in adjustment and to ensure safety should be considered standard care for those with memory deficits. The nurse should be instrumental in facilitating understanding of this specific injury in the brain tumor population.

Neurologically intact children with an isolated skull fracture may be safely discharged after brief observation.

PURPOSE: The management of children presenting with an isolated skull fracture (ISF) posttrauma is highly variable. We sought to estimate the risk of neurologic deterioration in children with a Glasgow coma score (GCS) 15 and ISF to reduce unnecessary hospital admissions. METHODS: A retrospective review at a level I pediatric trauma referral center was conducted for patients with ISF on head computed tomography from 2003 to 2008. Patients were excluded for injury greater than 24 hours prior, GCS less than 15, intracranial pathology, significant fracture depression, or complex fractures involving facial bones or skull base. RESULTS: A total of 235 patients were identified with an ISF. The median age was 11 months, with falls accounting for 87% of the injuries. One hundred seventy-seven patients were admitted, and 58 patients were discharged from the emergency department after a period of observation (median, 3.3 hours). Median length of stay for those admitted to the hospital was 18.2 hours. One patient developed vomiting following overnight observation and a repeat computed tomography scan demonstrated a small extra-axial hematoma that required no intervention. The mean total costs for patients discharged from the emergency department were $291 vs $1447 for those admitted for observation (P < .001). CONCLUSION: Patients with a presenting GCS of 15 and an ISF can be safely discharged from the emergency department after a short period of observation if they are asymptomatic and have a reliable social environment. This could result in significant savings by eliminating inpatient costs.

Amnesia for loss of consciousness is common in vasovagal syncope.

AIMS: The aim of this study was to determine the prevalence of amnesia for loss of consciousness (A-LOC) in those who have a history suggestive of vasovagal syncope (VVS) and who develop syncope on head-up tilt (HUT) table testing. Furthermore, we wished to determine if A-LOC is an age-dependent phenomenon in VVS and whether haemodynamic parameters on tilting can predict for A-LOC. METHODS AND RESULTS: Patients were recruited in a dedicated syncope unit and underwent neurocardiovascular evaluation as indicated under European Society of Cardiology guidelines to illicit a diagnosis of VVS. A set protocol of questioning occurred following induced syncope to determine the presence of A-LOC. The prevalence of A-LOC following syncope on tilting was 28% (44/159). Forty-two per cent of those≥60 years of age vs. 20%<60 years of age experienced amnesia post-induced syncope (P=0.003). However, regression analysis did not show age to be an independent predictor for A-LOC. Blood pressure change between those without amnesia and those with amnesia showed no significant difference (P=0.687). There was a significant difference in heart rate response; those experiencing amnesia had reduced bradycardic response on HUT compared with those without amnesia (P=0.001). CONCLUSION: Amnesia for loss of consciousness is common in VVS. Although more prevalent, it is not unique to older age-groups. Absence of syncope associated bradycardia during HUT testing predicts for A-LOC.

New developments in the diagnosis of dementia.

BACKGROUND: The terms "dementia" and "Alzheimer's disease" are often wrongly used as if they were synonyms. Dementia is a clinical syndrome whose main element is memory impairment; it is due to Alzheimer's disease in more than 75% of cases. Alzheimer's disease, on the other hand, is a neuropathological entity that is characterized by a protracted preclinical phase followed by the onset of slowly progressive dementia. METHODS: We here review relevant literature that we retrieved by a selective Medline search (2005-2009), paying special attention to the early diagnosis of Alzheimer's disease, its clinical manifestations, and its relevance in primary care. RESULTS: The early clinical manifestations of a dementing illness can be detected in primary care through the use of simple screening tests such as the mini mental state examination, clock drawing tests, and DemTect. A diminished concentration of Abeta-peptide and an increase of (phospho-)tau in the cerebrospinal fluid can suggest the presence of Alzheimer's disease even before the onset of dementia: these substances are components of amyloid plaques and neurofibrillary tangles, which are the characteristic neuropathological lesions of Alzheimer's disease. New types of morphological magnetic resonsance imaging (MRI), and automated analysis of the images obtained, can improve the consistency of radiological assessment over the traditional visual method and thus enable more secure diagnosis. CONCLUSION: The early, preclinical phase of Alzheimer's disease involves what has been termed mild cognitive impairment and may last as long as five years until the onset of dementia. With the aid of the new biomarkers described here, the likelihood of diagnosing Alzheimer's disease correctly in this phase can be raised above 80%. Early detection of Alzheimer's disease before the onset of dementia provides an opportunity to study potential approaches for secondary prevention, which are now an object of intense clinical research.

Caracterización de síntomas neuropsiquiátricos en pacientes con DCL de tipo amnésico en una población colombiana / Characterization of neuropsychiatric symptoms in patients with amnestic-type MCI in a Colombian population

Introducción: el deterioro cognitivo leve (DCL) se caracteriza por la alteración de uno o varios procesos cognitivos sin afectación significativa en las actividades de la vida diaria del paciente y que puede presentarse acompañado de síntomas neuropsiquiátricos, lo que incrementa el riesgo a evolucionar a demencia. Objetivo: identificar la frecuencia y severidad de las alteraciones comportamentales en una población con deterioro cognitivo leve de tipo amnésico. (DCL-A)Procedimiento: estudio no experimental, transversal de alcance descriptivo, que contó con 70 personas, con diagnostico de DCL-A. Seleccionada la muestra los cuidadores respondieron el inventario neuropsiquiátrico. Resultados: el 65.7 por ciento de los participantes presentaron síntomas comportamentales, donde la irritabilidad fue la mas frecuente (32.9 por ciento), seguido por depresión (30 por ciento) y agitación (25.7 por ciento). La apatía fue el síntoma que se presenta con mayor severidad sin ser el más frecuente. Discusión: dentro del cuadro clínico propio del DCL-A se reportan síntomas neuropsiquiátricos que acompañan el déficit cognitivo. En la población estudiada el 65.7 por ciento presentaba dichos síntomas, dato que se aproxima a lo encontrado en la literatura; sin embargo el síntoma más frecuente fue la irritabilidad, no la depresión como se ha reportado en otros estudios; los síntomas menos frecuentes fueron conductas eufóricas y conductas motoras aberrantes.

Introduction: Mild Cognitive Impairment (MCI) is characterized by the alteration of one or more cognitive processes without significant impairment in the activities of patient’s daily life and may be accompanied by neuropsychiatric symptoms, which increase the risk to develop dementia. Objective: To identify the frequency and severity of behavioral alterations in a population with mild cognitive impairment amnesiac type (MCI-A) Procedure: non experimental study, with a cross-sectional descriptive scope, attended by 70 people with diagnosis of MCI-A.Selected sample of caregivers responded neuropsychiatric inventory. Results: 65.7 percent of participants had behavioral symptoms, where irritability was the most frequent (32.9 percent), followed by depression (30 percent) and agitation (25.7 percent). Apathy was the symptom presented with most severity but not the most frequent. Discussion: Neuropsychiatric symptoms that accompany cognitive deficits are reported in clinical features of MCI-A. In the population studied, 65.7 percent had such symptoms, data that approximates those found in literature. Nonetheless, the most common symptom was irritability and not depression, as has been reported in other studies; euphoric and aberrant motor behaviors were theless frequent symptoms.

The association between depressive and cognitive symptoms in amnestic mild cognitive impairment.

BACKGROUND: Depressive symptoms are frequently observed in older adults with mild cognitive impairment (MCI). However, little is known regarding the cognitive characteristics of this important subgroup. METHODS: We examined executive functions (controlled inhibition) and verbal episodic memory in 33 healthy older adults (control group), 18 older adults with amnestic MCI plus subclinical depressive symptoms (a-MCI/D+ group), and 26 older adults with amnestic MCI but no depressive symptoms (a-MCI group). RESULTS: Compared to the a-MCI and control groups, patients with a-MCI/D+ showed poor controlled inhibition. Moreover, in verbal episodic memory these patients recalled fewer words than control participants on immediate free, delayed free, and delayed total (free plus cued) recall. Performance on immediate recall suggested a self-retrieval deficit, but delayed performance also revealed the existence of an encoding impairment. In the a-MCI group, participants exhibited normal performance on the executive task, but pervasive memory impairment; the memory deficit concerned free and total recall on both immediate and delayed tasks, suggesting the existence of encoding and self-retrieval disturbances. CONCLUSIONS: This study reveals differences between the pattern of cognitive impairment for a-MCI/D+ and a-MCI subgroups particularly at the level of executive capacities. In terms of memory functioning, the differences between the subgroups were more subtle; more studies are needed in order to better characterize the memory impairment of a-MCI/D+ and a-MCI patients.

Beyond the "C" in MCI: noncognitive symptoms in amnestic and non-amnestic mild cognitive impairment.

INTRODUCTION: How frequent and how clinically important are mood and behavioral symptoms among older adults with mild cognitive impairment (MCI)? Although these noncognitive behavioral symptoms (NCBS) are not represented in the diagnostic criteria for MCI, their clinical significance is increasingly recognized. METHODS: To address this question, the authors identified a cohort of consecutively evaluated patients from a psychiatric hospital's outpatient memory clinic. These patients' records contained both a clinical assessment and a standardized set of evaluations including the Mini-Mental State Exam, the Neuropsychiatric Inventory (NPI), and the Geriatric Depression Scale. Using a standardized chart-review approach, the presence of any NPI-screened symptom was identified and the frequencies of specific NPI-screened symptoms were calculated for the Memory Clinic MCI cohort and for amnestic and non-amnestic MCI subgroups. RESULTS: A total of 116 patient records were reviewed. Thirty-eight patients with MCI were identified. Twenty-two of these met criteria for amnestic MCI by Mayo Clinic criteria while 16 met criteria for non-amnestic MCI. At least one NPI-screened mood or behavioral symptom was present in 86.8% of these MCI patients. Depression/dysphoria (63.3%), apathy (60.5%), anxiety (47.4%), irritability (44.7%), and nighttime behaviors (42.1%) were the most frequent. While depression/dysphoria was distributed similarly between amnestic and non-amnestic subgroups, apathy was significantly more frequently associated with the amnestic subtype of MCI, and nighttime behaviors were more frequently associated with the non-amnestic subtype. CONCLUSION: Although the presence of NCBS is not required for a diagnosis of MCI, these symptoms are frequently present and constitute an important source of morbidity. Apathy and depression may be difficult to differentiate, but targeted treatment of depression may fail to address apathy. Recognizing the limitations of this preliminary study, the authors suggest that apathy may be more characteristic of amnestic MCI while nighttime behaviors may be more characteristic of non-amnestic MCI.

Assessment of cognitive status in the elderly using telephone interviews.

OBJECTIVE: To examine the feasibility to assess cognitive status in the elderly using telephone interviews. RESEARCH DESIGN AND METHODS: From January to December 2003, 740 participants of the ongoing Heidelberg longitudinal study (HeiDE) aged 70 years or more were eligible for a telephone interview on cognitive status. Validated instruments to assess cognitive status, including the Telephone Interview of Cognitive Status (TICS) and the East Boston Memory Test (EBMT, immediate and delayed recall), the Verbal Fluency Test, the HAWIE-"Vocabulary Test" and the HAWIE-"General Knowledge", a prospective memory test, and a digit span backwards-test were translated into German, if applicable. RESULTS: Out of 740 participants at the age of 70 or older, 473 participants were interviewed (64.9%). The total score of the TICS (maximum=best: 41) ranged from 21 to 40 (mean 33.5, SD 3.1; median 34.0). The EBMT scores (immediate recall; maximum=best: 12) ranged from 4 to 12 (mean 9.2, SD 1.7; median 9.0). CONCLUSIONS: Cognitive status could be successfully assessed by telephone interview in elderly participants of an ongoing population-based cohort study. Specifically, some of the tests showed pronounced variability allowing cross-sectional analyses whereas others seem more valuable for longitudinal assessment.

Prevalence of mild cognitive impairment in 60- to 64-year-old community-dwelling individuals: The Personality and Total Health through Life 60+ Study.

This epidemiological study aimed at determining the prevalence of mild cognitive impairment (MCI) in 60- to 64-year-old individuals using different diagnostic criteria. Community dwelling individuals (n = 2,551) in the age range of 60-64 years were recruited randomly through the electoral roll. They were screened using the MMSE and a short cognitive battery, and those who screened positive underwent detailed medical and cognitive assessments. Extant MCI-related diagnoses were established by consensus. Predictive regression models on the sub-sample were used to determine population prevalence for the diagnoses. Of the 224 subjects who screened positive for MCI, 112 underwent a detailed assessment and 74% met the criteria for at least one recognised diagnosis of mild cognitive deficit (MCI and related diagnoses). By predictive regression modelling, the prevalence of any MCI diagnosis was 13.7% (95% CI 9.1-30.2) in the population of 60- to 64-year-olds. The estimated prevalence rates for specific diagnoses were: MCI 3.7%, ageing-associated cognitive decline 3.1%, Clinical Dementia Rating score (0.5) 2.8%, age-associated memory impairment 1%, other cognitive disorders 0.9%, and mild neurocognitive disorder 0.6%. Agreement on 'caseness' between various proposed diagnoses was at best fair and generally poor. Memory and other cognitive problems not meeting the threshold for dementia are relatively common in 60- to 64-year-old individuals living in the community. The prevalence rate varies up to six-fold according to the diagnostic criteria applied, with limited overlap between diagnoses. There is an urgent need for standardization of the criteria.

Significance of cerebellar atrophy in intractable temporal lobe epilepsy: a quantitative MRI study.

PURPOSE: To determine the incidence of cerebellar atrophy (CA) in patients with intractable temporal lobe epilepsy, whether any clinical factors are significantly associated with CA, whether CA is unilateral or asymmetric and whether this feature has any relationship to the side of epileptogenicity, and whether the presence of CA is related to epilepsy surgery outcome. METHODS: We developed a magnetic resonance imaging method of measuring the presurgical volumes of the cerebellar hemispheres of 185 patients who underwent temporal lobectomy for intractable epilepsy and of 80 control subjects. In addition, cerebellar volumes were normalized to the total brain volumes. CA was determined as being present when the measured volume was smaller than two standard deviations from the mean value found in control subjects. RESULTS: Both absolute and normalized cerebellar volumes were found to be significantly reduced in the epilepsy patients compared with the control subjects. Without normalization of the cerebellar volumes, CA was present in 25.9% of the epilepsy patients; with normalization, it was present in only 16.2%. The atrophy was symmetric between the cerebellar hemispheres, and there was no significant difference in volume between the hemisphere ipsilateral and the hemisphere contralateral to the side of the temporal lobectomy. The duration of epilepsy was significantly longer and the age at onset of epilepsy was younger in patients with CA than in those without CA. The presence of CA was not associated with the outcome of temporal lobectomy. CONCLUSIONS: CA is symmetric and common in patients with intractable temporal lobe epilepsy. However, the results suggest that the atrophy in one third of patients with CA also proportionately affects the cerebral hemispheres. The duration of epilepsy and the age at onset of epilepsy are associated with the occurrence of CA. Seizure control after temporal lobectomy is not influenced by the presence of CA.

Transient global amnesia and transient ischemic attack: a community-based case-control study.

OBJECTIVES: Few case-control studies of first-ever transient global amnesia (TGA), transient ischemic attack (TIA) and normal controls have been performed to date. We aimed to assess the prevalence of cerebrovascular risk factors in a well defined population of TGA patients. MATERIAL AND METHODS: We undertook a retrospective and prospective community-based case-control study of 170 first-ever TGA, 170 first-ever TIA and 170 normal controls. RESULTS: Age-matched analysis revealed that TGA cases had a significantly lower prevalence of atrial fibrillation and diabetes mellitus than TIA controls. The prevalence of cigarette smoking and diabetes mellitus was significantly higher in normal controls than in TGA cases. CONCLUSION: Our community-based case-control study showed that atrial fibrillation and diabetes mellitus, two important risk factors for cerebrovascular disease, were significantly more common in the TIA group than in the TGA one. These results make the thromboembolic pathogenesis of TGA unlikely.

[Effect of low intensity and ultra high frequency electromagnetic irradiation on memory functions]. / Deistvie nizkointensivnogo élektromagnitnogo izlucheniia sverkhvysokoi chastoty na mnesticheskie funktsii.

The experiments on rats proved that low intensity electromagnetic waves result in retrograde amnesia due to benzodiazepine, gamma-aminobutyric acid and cholinergic mechanisms. Nootropic drug pyracethamum was proved to reduce the pathologic effect.