Counting-backward test for executive function in idiopathic normal pressure hydrocephalus.

OBJECTIVES: The aim of this study was to develop and validate a bedside test for executive function in patients with idiopathic normal pressure hydrocephalus (INPH). MATERIALS AND METHODS: Twenty consecutive patients with INPH and 20 patients with Alzheimer's disease (AD) were enrolled in this study. We developed the counting-backward test for evaluating executive function in patients with INPH. Two indices that are considered to be reflective of the attention deficits and response suppression underlying executive dysfunction in INPH were calculated: the first-error score and the reverse-effect index. Performance on both the counting-backward test and standard neuropsychological tests for executive function was assessed in INPH and AD patients. RESULTS: The first-error score, reverse-effect index and the scores from the standard neuropsychological tests for executive function were significantly lower for individuals in the INPH group than in the AD group. The two indices for the counting-backward test in the INPH group were strongly correlated with the total scores for Frontal Assessment Battery and Phonemic Verbal Fluency. The first-error score was also significantly correlated with the error rate of the Stroop colour-word test and the score of the go/no-go test. In addition, we found that the first-error score highly distinguished patients with INPH from those with AD using these tests. CONCLUSION: The counting-backward test is useful for evaluating executive dysfunction in INPH and for differentiating between INPH and AD patients. In particular, the first-error score may reflect deficits in the response suppression related to executive dysfunction in INPH.

Heat shock protein hsp72 induction in cortical and striatal astrocytes and neurons following infarction.

Transient global and transient focal ischemia induced the 72 kDa heat shock protein (hsp72) in neurons in cortex, striatum, and other regions known to be injured during transient ischemia. A novel finding was the induction of hsp72 in islands (cylinders in three dimensions) of cells composed of astrocytes around the perimeter and neurons in the interior. Since histology showed pale staining in these regions, it is proposed that these islands represent areas of focal infarction in the distribution of small cortical and lenticulostriate arteries. Although the factors responsible for hsp72 induction during ischemia and infarction are unknown, these results suggest differences in mechanisms of hsp72 induction in astrocytes compared to neurons.

Increase in peripheral CD4 bright+ CD8 dull+ T cells in Parkinson disease.

BACKGROUND: Immune abnormalities are known to be involved in the pathogenesis of sporadic Parkinson disease. OBJECTIVE: To examine whether abnormalities in peripheral lymphocytes exist in Parkinson disease. METHODS: Immune mediators, including CD1a, CD3, CD4, CD8, CD45RO, and Fas (CD95), were examined in peripheral lymphocytes of patients by 3-color flow cytometry. RESULTS: Patients with Parkinson disease displayed a significantly greater population of circulating CD3+ CD4 bright+ CD8 dull+ lymphocytes than age-matched control subjects (P =.005) and patients with cerebrovascular disease (P =.002). The increase in these cells appeared to continue for at least 17 months. These T cells also expressed CD45RO and Fas, markers for activated T cells, while CD1a, a marker for thymic T cells, was negative, suggesting that these cells are mature T cells with immune activities. CONCLUSIONS: As CD4+ CD8+ T cells are known to increase after some specific viral infections, the continuous increase in CD4 bright+ CD8 dull+ T cells shown here may indicate postinfectious immune abnormalities that are possibly associated with the pathogenesis of this slowly progressive, multifactorial neurodegenerative disease.

"Neuro-sweet disease": benign recurrent encephalitis with neutrophilic dermatosis.

OBJECTIVE: To describe benign recurrent encephalitis in a case of Sweet syndrome that also showed clinical features of Behçet disease. CASE REPORT: A 37-year-old Japanese man developed relapsing and remitting encephalitis and mucocutaneous symptoms mimicking Behçet disease. Magnetic resonance images showed at least 5 episodes of transient abnormal signal intensity in various cerebral regions over a period of 5 years. A skin biopsy specimen of the cutaneous edematous erythematous plaques revealed neutrophilic dermatitis compatible with Sweet syndrome. HLA typing showed B54, which is frequent in Sweet syndrome but rare in Behçet disease. Oral prednisolone therapy (10-60 mg/d) was remarkably effective for the encephalitis as well as for the mucocutaneous symptoms. CONCLUSION: We propose that there is an entity that is like Sweet disease, but with recurrent encephalitis characterized by an association with HLA-B54 and a high responsiveness to corticosteroid therapy, which we have tentatively named neuro-Sweet disease, that is distinct from the classic central nervous system involvement of Behçet disease.

High speed rotating scanner for transesophageal cross-sectional echocardiography.

In conventional cross-sectional echocardiography, the configuration of the chest or the presence of excessive chest wall tissue or air-containing lung often limits the resolution and field of view. To increase the diagnostic capability of cross-sectional echocardiography, a transesophageal ultrasonic high speed rotating scanner that can obtain cardiac images without hindrance from ribs, sternum and lung was developed. The scanner uses a single small transducer with a flexible shaft to permit easy swallowing by adults and mechanically scans ultrasonic beams within the esophagus. The small transducer in the esophagus is rotated through a full 360 degrees at a rate of 15 to 50 cycles/s, and cardiac images obtained through the esophageal wall are displayed on a cathode ray tube in real time. The transesophageal scanning technique was evaluated in more than 50 adult patients. Aside from some slight gagging, no serious complications were encountered. In all patients, high quality images of most portions of the heart were obtained. There was little difference in the image quality among various patients.

c-fos proto-oncogene expression in astrocytes associated with differentiation or proliferation but not depolarization.

Expression of the c-fos proto-oncogene in rat neocortical astrocytes in culture was examined using Northern blotting and immunocytochemistry. Marked induction of c-fos mRNA in astrocytes was observed after treatment with epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), dibutyryl cyclic AMP (db-cAMP), and phorbol diester (TPA; 12-O-tetra-decanoylphorbol 13-acetate), which are known to induce the proliferation or differentiation of astrocytes. Increase of c-fos protein immunoreactivity (IR) was obtained after treatment with fetal calf serum, EGF, bFGF, db-cAMP and TPA. High concentrations of calcium ionophore A23187, which were lethal to cultured astrocytes, also increased c-fos protein-IR. Treatment with lower concentrations of calcium ionophore (which slightly increase Ca2+ uptake), high K+ and nerve growth factor had no detectable effect on c-fos expression. These results show that depolarization does not induce c-fos in astrocytes and suggest that c-fos may play a role in differentiation and proliferation of astrocytes.

Heat shock proteins as markers of neural injury.

Systemic or intracerebral injections of kainic acid induced immunoreactivity for the 72 kDa heat shock protein (HSP72) in individual neurons of the rat brain in patterns matching the known histopathology of the particular injury. HSP72 immunostaining was also induced in and around areas of infarction following experimental strokes. These results suggest that HSP72 immunocytochemistry may be used as a marker of cellular injury in the mammalian brain.

Structure and expression of the glycine cleavage system in rat central nervous system.

The glycine cleavage system (GCS) is a mitochondrial multienzyme system consisting of four individual proteins, three specific components (P-, T-, and H-proteins) and one house-keeping enzyme, dihydrolipoamide dehydrogenase. Inherited deficiency of the GCS causes nonketotic hyperglycinemia (NKH), an inborn error of glycine metabolism. NKH is characterized by massive accumulation of glycine in serum and cerebrospinal fluids and severe neuronal dysfunction in neonates. To elucidate the neuropathogenesis of NKH, we cloned cDNAs encoding three specific components of the GCS and studied the gene expression in rat central nervous system. P-, T-, and H-protein cDNAs encoded 1024, 403, and 170 amino acids, respectively. In situ hybridization analysis revealed that P-protein mRNA was expressed mainly in glial-like cells, including Bergmann glias in the cerebellum, while T- and H-protein mRNAs were detected in both glial-like cells and neurons. T- and H-protein mRNAs, but not P-protein mRNA, were expressed in the spinal cord. Primary astrocyte cultures established from cerebral cortex had higher GCS activities than hepatocytes whereas those from spinal cord expressed only H-protein mRNA and had no enzymatic activity. An important role of glycine as inhibitory neurotransmitter has been established in the brainstem and spinal cord and another role of glycine as an excitation modulator of N-methyl-D-aspartate receptor is suggested in the hippocampus, cerebral cortex, olfactory bulbus, and cerebellum. Our results suggest that the GCS plays a major role in the forebrain and cerebellum rather than in the spinal cord, and that N-methyl-D-aspartate receptor may participate in neuropathogenesis of NKH.

Transplantation of fetal and early postnatal rat septal cholinergic neurons cultured in serum-free and serum-containing medium with nerve growth factor.

Fetal rat (E17-E19) septal neurons were cultured in a defined, serum-free medium for 6-8 days with or without nerve growth factor (NGF) and transplanted into the hippocampus or the surrounding ventricle of 28 adult rats denervated of its septal input by a fimbria-fornix transection. The cholinergic septal neurons, which were visualized by acetylcholinesterase (AChE) histochemistry, always survived in transplantation to the adult brains from nearly pure neuronal cultures. Although choline acetyltransferase (ChAT) activity of septal neurons in culture was greatly increased (5.59-fold) by the addition of NGF to the defined medium, this ChAT induction appeared to have little effect on the subsequent survival or growth of the septal neurons after transplantation. These results demonstrate that survival of cultured fetal septal cholinergic neurons following transplantation is not dependent upon the presence of NGF or serum- or glia-derived factors during the preliminary culture. Postnatal rat (P4) septal neurons cultured for 5 days in serum-containing medium with NGF were also successfully transplanted in one of 3 cases.

Apoptotic cell death of a temperature-sensitive central neuronal cell line.

A neuron-like cell line HS-2, derived from a primary fetal rat (E17) hippocampal cell culture using the temperature-sensitive SV 40 large T antigen, exhibits flat shape and grows well in culture medium with 5% fetal calf serum (FCS) at the permissive temperature (PT, 33.5 degrees C). At the non-permissive temperature (NPT, 38.5 degree C), many, but not all cells, have a neuronal shape with processes. The addition of dibutyryl-cAMP promotes the morphological changes in the cells to a neuron-like shape with long neurite-like processes and the cells exhibit neuron-specific enolase- and glutamic acid decarboxylase-immunoreactivity. Apoptotic cell death also occurs in these cultures at the NPT. DNA fragmentation and chromatin condensation that are characteristic of apoptosis occur within 8 h of being placed at the NPT. By 48 h after being placed at the NPT, the number of surviving cells decreases by 40% in the presence of 5% FCS. This cell line should be useful for investigating the mechanisms of 'programmed cell death' of neurons, which appears to occur during brain development and possibly in CNS degenerative diseases.

Marked neurotrophic effects of diffusible substances released from non-target cerebellar cells on thalamic neurons in culture.

A primary culture of thalamic cells from 6-day-old postnatal rats was co-cultured for 6 days with neocortical or cerebellar cells (neurons and astrocytes) from the same litter using a Transwell mesh system. The survival of thalamic neurons grown on the lower well, which were affected by substances released from cells grown on the upper wells, was remarkably promoted by both neocortical co-cultures (target for thalamic projection neurons) and cerebellar co-cultures (non-target). When the cells were seeded on mesh at lower density, the neurotrophic effects of neocortical co-cultures on thalamic neurons (204% of control) were significantly greater than those of cerebellar co-cultures (138%). When the cells were seeded on mesh at higher density, the effects of cerebellar co-cultures increased dramatically (517% of control), while the neurotrophic effects of neocortical co-cultures did not change. Morphologically, the survival of multipolar-shaped thalamic neurons was remarkably improved, as compared to the survival of monopolar, bipolar, and tripolar-shaped thalamic neurons. Basic fibroblast growth factor slightly promoted thalamic neuronal survival (136%), whereas nerve growth factor had no effect. These results suggest that neocortical and cerebellar cells release diffusible factor(s) that promote the survival of specific subpopulation of thalamic neurons, and that at least one of the non-target cerebellar cell-derived factor(s) might be more potent than those released from target neocortical cells.

VIP-induced stellation and immediate early gene expression in astrocytes: effects of dexamethasone.

To investigate the actions of glucocorticoids (GCs) on astrocyte functions, interactions of dexamethasone and immediate early genes (IEGs) were studied in cell cultures of rat cerebral cortical astrocytes. Vasoactive intestinal peptide (VIP) induces rapid c-fos mRNA expression and morphological changes (stellation) in cultured astrocytes. Dexamethasone pretreatment decreases this ligand-induced stellation without affecting levels of c-fos mRNA. Moreover VIP does not induce c-jun, jun-B, and NGFI-A mRNA, suggesting that these IEGs may not mediate ligand-induced stellation. The expression of c-fos, c-jun, jun-B, and NGFI-A mRNA are rapidly induced in cultured astrocytes after treatment with phorbol ester, epidermal growth factor, and basic fibroblast growth factor. Dexamethasone pretreatment has no effect on the IEG response induced by any of these agents, suggesting that GCs may not have direct effects on the promoter of these IEGs in cortical astrocytes.

Increase in choline acetyltransferase activity in septum of rats after transient forebrain ischemia: a possible role of factors released in the hippocampus.

Choline acetyltransferase (ChAT) activity increased in rat septum 2 weeks after a transient forebrain ischemia. Extracts were prepared from hippocampus in which CA1 pyramidal neurons had been selectively destroyed by the ischemic insult. ChAT activity in septal neuronal cultures treated with these extracts for 6 days was significantly higher than that in control cultures.

Induction of the c-fos gene product in rat forebrain following cortical lesions and NGF injections.

Neocortical lesions and NGF injections into neocortex induce the immunostaining of Fos, the c-fos gene product, in neuronal nuclei in ipsilateral cortex, and amygdala. Adjacent structures including hippocampus, septal nuclei, globus pallidus, and thalamus were unaffected. It is hypothesized that trophic molecules or other chemicals are released at the injury site and these induce the c-fos gene in cells throughout the ipsilateral hemisphere. Fos induction might mediate metabolic or plasticity responses to the focal injury.

Induction of heat shock protein 72-like immunoreactivity in the hippocampal formation following transient global ischemia.

Global ischemia was produced in adult rats by combining bilateral carotid artery occlusions with systemic hypotension for 5 or 10 minutes. Induction of the 72 kD heat shock protein (HSP72) in the hippocampus was examined immunocytochemically 18-24 hours later. Several patterns of HSP72-like immunoreactivity (HSP72LI) were observed. Five minutes of ischemia induced HSP72 in isolated columns of CA1a pyramidal neurons, or throughout CA1 pyramidal neurons and dentate hilar neurons. Ten minutes of ischemia induced marked HSP72LI in CA3 pyramidal neurons, moderate HSP72LI in dentate granule cells, and minimal HSP72LI in CA1 pyramidal, dentate hilar neurons, and hippocampal glia. Two hippocampi subjected to 10 minutes of ischemia exhibited marked HSP72LI in capillary endothelial cells but no neuronal or glial HSP72LI. It is proposed that (a) the induction of HSP72 in hippocampal sectors correlates with their vulnerability to global ischemia (CA1 greater than hilus greater than CA3 greater than dentate gyrus); (b) the induction of HSP72 in hippocampal cells correlates with their vulnerability to global ischemia in that mild ischemia induced HSP72 only in neurons, moderate ischemia in neurons and glia, and severe ischemia only in capillary endothelial cells; (c) the failure to induce HSP72 in hippocampal neurons in 2 cases of 10 min ischemia may be related to severe injury causing disruption of protein synthesis in these cells.

[Diffuse Lewy body disease searched out from 114 patients with parkinsonism].

From 114 patients who had been previously diagnosed as Parkinson's disease, we diagnosed six cases as clinically definite "diffuse Lewy body disease (DLBD)" according to McKeith's criteria with more strict modifications. Besides a central feature, dementia, and core features including parkinsonism, fluctuating cognition, and recurrent visual hallucinations, the patients presented some of supportive features, that is, repeated falls (4 cases), syncope (5 cases), and transient loss of consciousness (all cases). Autopsy, which was performed in 2 of the cases, revealed Lewy bodies in various nervous tissues including autonomic nervous systems in both cases. 7 cases of probable DLBD and 8 cases of possible DLBD, which lacked fluctuating cognition and/or visual hallucinations, demonstrated neither of repeated falls, syncope, nor transient loss of consciousness. Episodes of these supportive features, which seem to be associated with autonomic dysfunctions and/or fluctuating cognition, should be important in the differential diagnosis of DLBD.