[Prevention of dementia: is it possible?]. / Prévention de la démence: est-ce possible?

Development of dementia depends on genetic susceptibility and on risk factors accessible to primary prevention. Among the latter, vascular risk factors are well defined: prevention of hyperhomocysteinemia, diabetes mellitus, hypercholesterolemia, and, to some extent, of arterial hypertension could avoid the cognitive decline of dementia. Estrogen replacement therapy, antiinflammatory drugs, alcohol, vitamin E and intellectual activities seem efficacious in term of primary prevention. When dementia is present, only vitamin E, selegiline and some antiinflammatory drugs have proved efficacy compared to placebo to slow the cognitive decline. Long-term effects of cholinesterase inhibitors need to be investigated in future trials.

[Clinical case of the month. Whipple's disease: inaugural psychiatric symptoms]. / Le cas clinique du mois. Maladie de Whipple: tableau psychiatrique inaugural.

First considered to be a metabolic illness of the gastro-intestinal tract, Whipple's disease has progressively been recognized as a systemic bacterial disorder due to Tropheryma Whippelii and responding to antibiotics. Neurological symptoms occur in 10 to 20% of cases either initially or during the disease course. Involvement of the central nervous system alone is rare. Modern molecular biology methods, i.e. PCR amplification of 16S rRNA can be applied to accessible biological fluids and/or tissue allowing an early diagnosis, which can lead to earlier administration of adequate antibiotics as well as to a more accurate monitoring of disease evolution. We report a patient suffering from Whipple's disease and presenting initially with severe mental and behavioral disturbances which were thought to be due to a psychiatric disorder.

Motor and somatosensory evoked potentials in cervical spondylotic myelopathy.

We recorded upper and lower limb MEPs and SEPs in 55 patients with clinically suggestive and myelography-documented cervical cord compression due to spondylotic changes. MEPs were abnormal in biceps brachii of 21 patients (38%), in first dorsal interosseous muscle of the hand of 49 patients (89%) and in tibialis anterior of 47 patients (85%). Overall, MEP abnormalities were present in at least one muscle of 51/55 patients (93%). Median SEPs were abnormal in 20 cases (36%), ulnar SEPs in 24 (44%) and posterior tibial SEPs in 40 (73%). Overall incidence of SEP alterations was 73% (40/55) and SEPs detected clinically silent sensory dysfunction in 10 patients (18%). Among the 43 patients who underwent surgical decompression, first dorsal interosseous (FDI) MEPs and tibial SEPs remained abnormal in most cases 1 year after surgery, independently of clinical outcome. On the other hand, serial EP studies seemed useful to confirm and monitor the clinical evolution of unoperated patients.