Assuntos
Demência Vascular/diagnóstico , Erros de Diagnóstico , Meningite Criptocócica/diagnóstico , Infarto Cerebral/diagnóstico , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Transtornos da Memória/etiologia , Meningite Criptocócica/líquido cefalorraquidiano , Meningite Criptocócica/complicações , Meningite Criptocócica/patologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Paresia/etiologia , Incontinência Urinária/etiologia , Vertigem/etiologiaRESUMO
BACKGROUND AND PURPOSE: Behavioral abnormalities account for much of the morbidity of vascular dementia (VaD) and Alzheimer's disease (AD). The goals of the study were to compare the behavioral changes in patients with VaD associated with ischemic white matter subcortical changes and lacunar infarctions (VaD-WSI) to those in patients with AD. METHODS: Thirty outpatients with VaD and multiple lacunar infarctions in the periventricular white matter and 30 AD patients, matched for age and severity of dementia, were enrolled in this prospective study. The behavioral abnormalities of these patients were assessed by interviewing their caregivers with the Neuropsychiatric Inventory. RESULTS: A similar spectrum of noncognitive behavioral changes was found in AD and WSI patients. In VaD-WSI, the severity of delusions, hallucinations, aggression, irritability, aberrant motor behavior, nighttime behavior and appetite changes was correlated with cognitive decline, whereas depression, apathy, anxiety and euphoria were unrelated to the severity of dementia. In AD, none of the behavioral changes correlated with the severity of dementia. CONCLUSION: Behavioral changes are frequent in VaD-WSI and are present regardless of the severity of the cognitive decline. It is therefore important to assess behavioral as well as cognitive changes at early stages of the illness, to ensure appropriate treatment.
Assuntos
Doença de Alzheimer/psicologia , Comportamento/fisiologia , Córtex Cerebral/patologia , Infarto Cerebral/psicologia , Demência/psicologia , Idoso , Doença de Alzheimer/patologia , Isquemia Encefálica/patologia , Isquemia Encefálica/psicologia , Infarto Cerebral/patologia , Demência/patologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estudos ProspectivosRESUMO
The assessment of neurobehavioural outcome after head injury in older patients (> 60 year old) has met with difficultives, due to the obstacles in finding subjects who would constitute an appropriate control group. In the present study, survivors of closed head injury (CHI) of this age group were compared to two control groups: (1) orthopaedic patients (OP) who were injured in similar circumstances but did not sustain head injury and (2) healthy, age-matched volunteers (HC). Compared with HC, CHI and OP were impaired on word fluency, memory and reasoning. No differences were found between CHI and the OP. These results may indicate that, rather than resulting only from the head injury brought about by falling, the cognitive decline may predate the injury and increase the risk of accidents in old age.