ABSTRACT
BACKGROUND/AIMS: Few studies have described mild cognitive impairment (MCI) and cognitive characteristics in early-onset Parkinson's disease (EOPD). This study describes attention/working memory, language, memory, visuospatial abilities, executive function, and frequency of MCI and dementia in EOPD. METHODS: Eighty-one EOPD patients were administered neuropsychological tests and the Beck Depression Inventory. Scores were compared with age/education-appropriate norms and were correlated to years of disease progression and severity of motor symptoms. The frequency of MCI and dementia was determined by the Movement Disorder Society criteria. RESULTS: Thirty-one percent of patients met the MCI criteria, but none had dementia. Commonly affected domains were memory, visuospatial, and executive function. Cognitive dysfunction was not explained by depression or severity of motor symptoms. CONCLUSION: One third of EOPD patients presented with MCI, which was not associated with the same risk factors as reported in late-onset Parkinson's disease. MCI could have a different prognostic value in EOPD.
Subject(s)
Cognitive Dysfunction , Executive Function , Parkinson Disease , Age of Onset , Aged , Agnosia/diagnosis , Agnosia/epidemiology , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/physiopathology , Cognitive Dysfunction/psychology , Dementia/diagnosis , Dementia/epidemiology , Depression/diagnosis , Depression/epidemiology , Disease Progression , Female , Humans , Male , Memory, Short-Term , Neuropsychological Tests , Parkinson Disease/diagnosis , Parkinson Disease/epidemiology , Parkinson Disease/physiopathology , Parkinson Disease/psychology , Psychiatric Status Rating Scales , Risk Factors , Statistics as TopicABSTRACT
BACKGROUND: Elderly adults with human immunodeficiency virus (HIV) are at greater risk of developing cognitive impairment. The purpose of this study was to describe clinical and tomographic characteristics of HIV-1 associated dementia (HIVD) in older adults. METHODS: A descriptive study was carried out involving eight HIVD patients. Seven tests were employed for cognitive assessment and transformed to whole number z-scores using appropriate normative sets. RESULTS: The average age of the patients was 71 years; seven cases described the route of HIV infection as being heterosexual; and mean schooling was 6.5 years. Six subjects were using highly active anti-retroviral therapy (HAART), with an average CD4 count of 407.8 cells/mm3. Mild dementia was detected in most cases (87.5%). Deficits on neuropsychological tests showed results similar to multi-center transversal studies on HIVD. The classic HIVD triad observed in younger adults was also seen in this population: i.e. cognitive changes, psychiatric changes and motor impairment. Cortical injury shown by dyscalculia, visual-spatial change and language deficits were frequent. Brain images showed cortical atrophy in all patients but was restricted to frontal lobes in five cases. CONCLUSION: The findings on brain imaging were non-specific, revealing images similar to those of the elderly brain and to HIVD in younger adults. HIVD in the elderly is a challenge and become an increasingly significant differential diagnosis for cognitive loss in old age. This dementia must be clinically suspected and image exams are useful in excluding other central disorders. Prospective studies of HIV-positive elderly people are warranted to better understand HIVD.
Subject(s)
AIDS Dementia Complex , Agnosia , Dyscalculia , Dyslexia, Acquired , Frontal Lobe/pathology , Neuroimaging/methods , AIDS Dementia Complex/complications , AIDS Dementia Complex/diagnosis , AIDS Dementia Complex/physiopathology , Aged , Agnosia/diagnosis , Agnosia/etiology , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Diagnosis, Differential , Dyscalculia/diagnosis , Dyscalculia/etiology , Dyslexia, Acquired/diagnosis , Dyslexia, Acquired/etiology , HIV/pathogenicity , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/immunology , Humans , Intelligence Tests , Neuropsychological Tests , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
Se presenta el caso de un hombre de 57 años que presenta un cuadro degenerativo con afasia fluente y moderadas alteraciones de conducta, sin defecto semántico significativo, agnosia visual ni agrafia lexical y su estudio imagenológico cerebral. Se discuten los conceptos de afasia progresiva fluente y demencia semántica, concluyendo que la primera puede evolucionar hacia esta última. Nuestro caso se encontraría en esta situación. Se señala que la patología de las afasias progresivas es variable, siendo lo más frecuente una degeneración frontotemporal (con o sin inclusiones de proteína tau); con menor frecuencia corresponde a una enfermedad de Alzheimer o una degeneración corticobasal.
We report a 57-year-old man presenting with progressive fluent aphasia and behaviour disorder, with no visual semantic loss, visual agnosia, lexical agraphia, nor alexia. We include in this report the brain images, and we discuss the borders between fluent progressive aphasia and semantic dementia. We conclude that fluent progressive aphasia may be the first stage of semantic dementia, noting that the neuropathology of progressive fluent aphasia usually corresponds to frontotemporal lobar degeneration, with or without Tau protein inclusions, as in Alzheimer's Disease or corticobasal degeneration.
Subject(s)
Humans , Male , Middle Aged , Aphasia, Primary Progressive/etiology , Dementia , Alzheimer Disease/etiology , Semantics , Language Disorders/etiology , Agnosia/diagnosis , Agnosia/etiology , Mental Disorders , Social BehaviorABSTRACT
OBJECTIVE: Attention phenomenology is a wide subject, in this revision we will explain attention and its relationship with behavioral neglect. DEVELOPMENT: Selective attention is the ability to throw the focus of awareness toward behaviorally relevant events in the personal and extrapersonal space. Severe alteration of these mechanisms constitutes unilateral neglect in patients with contralateral brain damage. Unilateral neglect is one of the most behaviorally devastating syndrome. There are different behavioral neglect: attentional (perceptual), intentional (motor), motivational and representational aspects of unilateral neglect. Left side neglect after right hemisphere lesions is more common (31 to 46%) than right sided neglect following lesions in the left hemisphere (2 to 12%). CONCLUSION: One year after a cerebrovascular accident only 1/3 of the patients with unilateral neglect persist with this handicap.
Subject(s)
Agnosia/diagnosis , Attention/physiology , Agnosia/etiology , Brain Diseases/complications , Brain Diseases/pathology , Functional Laterality/physiology , HumansABSTRACT
Awareness of cognitive deficits may rely on the implicit learning of intellectual limitations, and anosognosia in Alzheimer's disease (AD) may result from deficits in implicit learning. To examine this hypothesis, a consecutive series of 55 patients with probable AD were divided into groups with mild (n = 13), severe (n = 12), or no anosognosia (n = 30) and were assessed with a neuropsychological battery that included tests of declarative and procedural learning. Whereas there were no significant between-group differences in tests of declarative learning (the Buschke Selective Reminding Test and the Benton Visual Retention Test), patients with severe anosognosia showed a significantly worse performance on procedural learning (as measured with the Maze Learning Test) and a test assessing set shifting abilities (the Wisconsin Card Sorting Test) than AD patients without anosognosia. The authors' results suggest that deficits in procedural learning and anosognosia in AD may result from dysfunction in habit-learning systems.
Subject(s)
Agnosia/diagnosis , Alzheimer Disease/diagnosis , Awareness , Mental Recall , Retention, Psychology , Aged , Aged, 80 and over , Agnosia/classification , Agnosia/physiopathology , Agnosia/psychology , Alzheimer Disease/classification , Alzheimer Disease/physiopathology , Alzheimer Disease/psychology , Attention/physiology , Awareness/physiology , Discrimination Learning/physiology , Female , Frontal Lobe/physiopathology , Humans , Male , Maze Learning/physiology , Mental Recall/physiology , Middle Aged , Neuropsychological Tests , Problem Solving/physiology , Retention, Psychology/physiologyABSTRACT
We examined the prevalence, phenomenology, and clinical correlates of delusions in a consecutive series of 103 patients with probable Alzheimer's disease (AD). Patients were examined with the Present State Exam and the Dementia-Psychosis Scale. Twenty-one patients (20%) met DSM-III-R criteria for a delusional disorder. The most frequent delusion type was paranoid (71%), followed by hypochondriacal (67%), the Capgras syndrome (29%), house misidentification (29%), and grandiose delusions (29%). Out of the 21 AD patients with delusions, 76% had three or more different types of delusions simultaneously. The frequency of delusions was not significantly associated with age, education, or age at dementia onset, and the type and severity of cognitive impairments was similar for AD patients with and without delusions. However, AD patients with delusions had significantly higher mania and anosognosia scores.
Subject(s)
Alzheimer Disease/diagnosis , Delusions/diagnosis , Neurocognitive Disorders/diagnosis , Neuropsychological Tests , Activities of Daily Living/classification , Activities of Daily Living/psychology , Aged , Aged, 80 and over , Agnosia/diagnosis , Agnosia/psychology , Alzheimer Disease/psychology , Basal Ganglia Diseases/diagnosis , Basal Ganglia Diseases/psychology , Bipolar Disorder/diagnosis , Bipolar Disorder/psychology , Delusions/psychology , Female , Geriatric Assessment , Humans , Male , Neurocognitive Disorders/psychology , Paranoid Disorders/diagnosis , Paranoid Disorders/psychology , Psychiatric Status Rating ScalesABSTRACT
Presentamos un paciente (C.A.) de 38 años afectado de alteraciones en el reconocimiento visual secundarias a una lesión isquémica cerebral posterior bilateral (RNM). En el examen neuropsicológico encontramos dificultades en reconocer visualmente rostros, objetos y figuras de objetos, a pesar de que los puede ver, dibujar y describir. El reconocimiento táctil y auditivo fue normal. Nuestro paciente tiene una prosopoagnosia, una agnosia visual de objetos, una simultagnosia, una agnosia topográfica y una amnesia episódica global. El defecto en el reconocimiento de objetos y de rostros no responde sólo a un trastorno perceptivo (representación formal). El conocimiento semántico de objetos y rostros es correcto pues puede evocar verbalmente la imagen eidética de aquellos que no puede reconocer (representación semántica). El paciente falla en el estadio de integración jerarquización de las partes necesarias para el correcto apareamaiento entre la imagen visual que ingresa con la imagen eidética del conocimiento semántico correspondiendo a una agnosia visual de tipo integrativa
Subject(s)
Humans , Male , Adult , Agnosia/diagnosis , Brain Ischemia/complications , Agnosia/etiology , Agnosia/physiopathology , Neuropsychological Tests , Perceptual Disorders/diagnosis , Perceptual Disorders/physiopathologyABSTRACT
Presentamos un paciente (C.A.) de 38 años afectado de alteraciones en el reconocimiento visual secundarias a una lesión isquémica cerebral posterior bilateral (RNM). En el examen neuropsicológico encontramos dificultades en reconocer visualmente rostros, objetos y figuras de objetos, a pesar de que los puede ver, dibujar y describir. El reconocimiento táctil y auditivo fue normal. Nuestro paciente tiene una prosopoagnosia, una agnosia visual de objetos, una simultagnosia, una agnosia topográfica y una amnesia episódica global. El defecto en el reconocimiento de objetos y de rostros no responde sólo a un trastorno perceptivo (representación formal). El conocimiento semántico de objetos y rostros es correcto pues puede evocar verbalmente la imagen eidética de aquellos que no puede reconocer (representación semántica). El paciente falla en el estadio de integración jerarquización de las partes necesarias para el correcto apareamaiento entre la imagen visual que ingresa con la imagen eidética del conocimiento semántico correspondiendo a una agnosia visual de tipo integrativa (AU)
Subject(s)
Humans , Male , Adult , Agnosia/diagnosis , Agnosia/etiology , Agnosia/physiopathology , Neuropsychological Tests , Brain Ischemia/complications , Perceptual Disorders/diagnosis , Perceptual Disorders/physiopathologyABSTRACT
A study of specific neuropsychologic, neurolinguistic, and behavioral features of acquired epileptic aphasia or Landau-Kleffner syndrome was conducted in a group of 12 patients followed-up for 2-15 years (mean: 8 yr). Seventy-five percent had exhibited some language disturbance prior to acquired epileptic aphasia. Even when 9 patients had normal electroencephalographic findings in the long-term course of the disease, only 3 achieved normal language. No patient with persisting electroencephalographic abnormalities recovered normal or near normal language. The need to perform detailed neurolinguistic and neuropsychologic evaluations in the work-up and follow-up of children with acquired epileptic aphasia is stressed. An adapted neuropsychologic profile battery proved to be practical and objective for the follow-up of these patients.
Subject(s)
Aphasia/diagnosis , Epilepsy/diagnosis , Neuropsychological Tests , Agnosia/diagnosis , Anomia/diagnosis , Child , Child, Preschool , Electroencephalography , Female , Follow-Up Studies , Humans , Language Tests , Male , SyndromeABSTRACT
We examined the relationship between unawareness of cognitive deficits and psychiatric and neuropsychological manifestations in 181 patients with probable Alzheimer's disease (AD). Patients unaware of their cognitive deficits were more cognitively impaired, as measured by the Mini-Mental State Examination, and had a specific defect in 'frontal/executive' functions. The presence of major depression, delusions and hallucinations was no more likely among patients who were aware of their cognitive impairment than among those who were not. These findings have important implications for the understanding of anosognosia and deficit awareness in dementia.
Subject(s)
Agnosia/psychology , Alzheimer Disease/psychology , Awareness , Cognition Disorders/psychology , Aged , Aged, 80 and over , Agnosia/diagnosis , Alzheimer Disease/diagnosis , Cognition Disorders/diagnosis , Female , Humans , Male , Middle Aged , Neuropsychological Tests/statistics & numerical data , Psychiatric Status Rating Scales , Psychometrics , Reference Values , Sick RoleABSTRACT
Simultanagnosia is a disorder of visual perception characterized by the inability to interpret complex visual arrays despite preserved recognition of single objects. We report a series of investigations on a simultanagnosic patient which attempt to establish the nature of this visual processing disturbance. The patient performed normally on a feature detection task but was impaired on a test of attention-requiring visual search in which she was asked to distinguish between stimuli containing different numbers of targets. She was not impaired on a visual-spatial orienting task. She identified single briefly presented words and objects as rapidly and reliably as controls suggesting that access to stored structural descriptions was not impaired. With brief, simultaneous presentation of 2 words or drawings, she identified both stimuli significantly more frequently when the stimuli were semantically related than when they were unrelated. On the basis of these and other data, we suggest that the patient's simultanagnosia is attributable to an impairment in the process by which activated structural descriptions are linked to information coding the location of the object.
Subject(s)
Agnosia/physiopathology , Visual Perception/physiology , Aged , Agnosia/diagnosis , Agnosia/psychology , Attention , Brain/pathology , Female , Humans , Magnetic Resonance Imaging , Memory , Models, Psychological , Neurologic Examination , Neuropsychological Tests , Semantics , Time Factors , Vision TestsABSTRACT
A agnosia auditiva e sindromes correlatas podem ter seu diagnóstico confundido com o das afasias. Descrevemos o caso de uma mulher de 32 anos que subitamente perdeu a capacidade de compreender a palavra falada e sons näo verbais,, embora a leitura e a escrita estivessem intactas e a fala espontânea fosse apenas muito discretamente disfásica. A investigaçäo mostrou isquemia extensa e bilateral do córtex temporal, secundária a anticoagulaçäo inadequada, após colocaçäo de prótese aórtica. O segundo paciente é um homem de 43 anos com súbita dificuldade para compreender a palavra falada, estando preservadas a compreensäo de sons näo verbais, leitura e escrita. A nosso ver, o primeiro caso corresponde à agnosia auditiva e o segundo à afasia de Wernicke sem alexia. Säo discutidos aspectos do diagnóstico diferencial e prognóstico das diferentes síndromes