Progressive focal degenerative disease of the posterior associative cortex.

A 72-year-old man developed a very progressive neuropsychologic deficit 6 years ago, beginning with isolated visual topographic memory disturbances and visuo-constructive apraxia without additional manifestations of dementia. The syndrome worsened thereafter with the emergence of visual agnosia, simultagnosia, psychic paralysis of gaze, auditivo-verbal agnosia, and recently an amnestic syndrome with confabulation and confusion (at the end of 1989). CT scans, which remained unchanged over the years, showed mild, focal atrophic changes revealed by dilatation of the right occipital horn. His angiograms were normal. Two SPECT studies (with HMPAO measurements), performed 6 years from the onset, detected marked hypoperfusion in both parieto-occipital regions, mainly on the right side. Progressive focal degenerative disease without dementia is a relatively new syndrome, especially in cases with progressive aphasia. As noted in our patient, progressive disturbances initially localized in the right parieto-occipital region followed by posterior bilobar degeneration (pronounced on the right side) without dementia until late in the course may represent another exceptionally reported characteristic of this new syndrome. It is suggested that this variant of the Mesulam syndrome is more likely explained by progressive atrophy of the Alzheimer type.

[Cognitive evoked potentials in the diagnosis of senile dementia and dementia of Parkinson's disease: significance of multivariate analysis]. / Potentiels évoqués cognitifs dans le diagnostic de la démence sénile et de la démence de la maladie de Parkinson: intérêt de l'analyse multivariée.

P300 latency is often delayed in dementia but some authors have questioned its value in clinical practice, because of the relatively low specificity and sensibility of the method. Numerous parameters (latency, duration, amplitude and surface) of N100, N200 and P300 waves were therefore studied in patients with senile dementia, subjects suffering from Parkinson's disease with dementia, and non-demented elderly patients. Using discriminant analysis, more than 90% of the patients were correctly classified. This method could thus be contributory in diagnosing dementia in clinical practice.

[Contingent negative variation and regional cerebral blood flow in senile dementia and cerebral aging]. / Etude de la variation contingente négative et du débit sanguin cérébral dans la démence sénile et le vieillissement cérébral.

Relationships between contingent negative variation (CNV) amplitude, regional cerebral blood flow (CBF), mini mental status examination score (MMSE) and reaction time (RT) have been studied in young subjects, non-demented old subjects and patients with primary degenerative senile dementia. Significant correlations have been found between CNV amplitude and global CBF, MMSE score and reaction time. Factorial analysis has shown 3 factors weighted respectively by MMSE and CNV, antero-posterior ratio fort left hemispheric CBF and age, and antero-posterior ratio for right hemispheric CBF and reaction time. Discriminant analysis has shown 2 discriminant functions differentiating young from old subjects with 90% accuracy and demented from non-demented patients with 75% accuracy.

[The value of cognitive evoked potentials in the diagnosis of senile dementia and dementia of Parkinson disease]. / Intérêt des potentiels évoqués cognitifs dans le diagnostic de la démence sénile et de la démence de la maladie de Parkinson.

P300 latency is often delayed in dementia but some authors have questioned its interest in clinical practice, because of the relatively low specificity and sensibility of the method. Therefore, we studied numerous parameters (latency, duration, amplitude and surface) of N100, N200 and P300 waves in patients with senile dementia, patients suffering from Parkinson's disease with dementia and non demented elderly patients. Using discriminant analysis, more than 90% of the patients were correctly classified. This method could thus be contributive in clinical practice.

[Opsoclonus associated with multisystemic sarcoidosis]. / Opsoclonus associé a une sarcoïdose multisystémique.

A 32 year old patient with unexplained cough developed an opsoclonus-ataxic-myoclonic syndrome. Chest X-ray film were normal at this onset but became pathologic, and the diagnosis of multisystemic sarcoidosis was made. The possibility of sarcoidosis being the cause of the opsoclonus is discussed.

[The five-word test in memory deficiency]. / Le diagnostic d'un trouble mnésique: le test des 5 mots.

The 5-Word test is a bedside memory test with free and cued selective recollection. Here, we evaluated its reliability Belgian French speakers. Five groups were studied : normal subjects, depressive patients, patients with AD, patients with vascular dementia and 47 patients for a validation of a logistic model. The results of the 5-Word test with the MMSE, both values were included as variables in a logistic regression model. The probability of diagnosis of AD and dementia can be calculated and used prospectively for assessment of new cases in a validation study. The importance of the study of free and cued response during immediate and delayed recall was assessed by variance analysis in 4 groups. A third order interaction (p < 0.001) was observed between the normal and AD groups, the normal and vascular dementia (VD) groups and between AD and VD groups. With this initial model, 98% of the 62 normal subjects and the 57 patients with AD were correctly classified (p < 0.001). For AD diagnosis at the onset, the sensitivity of the MMSE is increased when it is associated with the 5-Word. This low-tech bedside method associating the 5-Word test and MMSE has a good specificity for the diagnosis of AD. It is very useful for screening a population of patients at the onset of cognitive and memory deficiency and for selecting the patients requiring an examination at a memory clinic.

[Immunocytochemical evidence for the binding of insulin to the somatotrophic cells of the human hypophysis]. / Mise en évidence par immunocytochimie de la fixation d'insuline aux cellules somatotropes de l'hypophyse humaine

An immunocytochemical method has demonstrated a hypophyseal cell surface fixation of molecules exhibiting immunological properties of insulin. This fixation occurs massively on GH-cells and on a minority of ACTH cells of the human antehypophysis.

Insulin receptor sites as membrane markers during embryonic development. I. Data obtained with unfertilized and fertilized sea urchin eggs.

Binding of insulin to sea urchin egg plasma membrane has been studied by biochemical and immunocytochemical methods. Unfertilized and fertilized eggs as well as embryos during the first cell division have been used. 1. Competition experiments between 125I-insulin (1 nM) and an excess of native insulin (30 muM) indicate a specific hormone fixation to membrane crude extracts from unfertilized and fertilized eggs. The magnitude of "specific binding" is comparable to values recorded for mammalian cells. 2. Inhibition of insulin fixation by concanavalin A (100 mug/ml) suggests the glycoprotein composition of plasma membrane receptors. 3. An 30-min incubation of unfertilized and fertilized eggs in the presence of insulin leads to a significant increase in cyclic AMP content. 4. An immunocytochemical method demonstrates that insulin is selectively and specifically bound to the plasma membrane of eggs incubated in the presence of insulin before fixation. It can be concluded that insulin receptor sites are components of sea urchin eggs plasma membrane. Insulin binding which leads to cyclic AMP accumulation is not deeply modified by fertilization and does not include visible morphological changes in the eggs.

[Endocrinological and neurophysiological modifications in a case of atropinic delusional state]. / Modifications endocriniennes et neurophysiologiques dans un cas de délire atropinique.

In this case report, we observed a delirium probably owing to toxic effects of homatropine eye drops. We reproduced this syndrome and we reversed it with physostigmine salicylate as an antidote. We observed a decrease of cortisol at 9.00 a.m. and impairment of regional cerebral blood flow with increase in the previous right side. The unusual susceptibility of this patient to the anticholinergic effect of homatropine is perhaps related to a preexisting mild cognitive defect possibly related to a cholinergic neurotransmitter deficit.

Regional cerebral blood flow and lateralized hemispheric dysfunction in depression.

Cerebral blood flow is known as an indicator of cerebral metabolism. Using the 133Xenon inhalation method, we studied the regional cerebral blood flow (r-CBF) in patients with different subtypes of depression and in remission. A left frontal hypervascularization and a right posterior hypovascularization were found in major depressives, compared to normal subjects, minor depressives, and normothymic bipolar patients. These results tend to confirm the existence of cerebral dysfunction in both hemispheres in major depression, as reported by other authors using different techniques.

A Belgian multicentre study of fluvoxamine in depressive outpatients.

Fluvoxamine, a new antidepressant that specifically inhibits serotonin reuptake, was studied in 272 outpatients in a six-week multicentre trial in Belgium. On the Hamilton Depression Scale, the mean score dropped from 25.2 to 8 after six weeks (p less than 0.00001). The Clinical Global Impression scores showed similar evolution. Fluvoxamine is a real antidepressant with a marked effect on mood. Its effective dosage is 100 mg to 200 mg/day. Its tolerance, notably at the cardiovascular level, is excellent.

[Cerebral blood flow and depression]. / Débit sanguin cérébral et dépression.

Regional cerebral blood flow is an index of cerebral metabolism. We have studied with the Xenon 113 inhalation method, regional cerebral blood flow (CBF) in patients with various types of depression and in remission. A left frontal hypervascularisation and a right posterior hypovascularisation have been found in primary major depression, but not in minor depression and bipolar depression in remission. These results confirm and complete results from other authors who have studied the physiopathology of depression with other technics.