The pattern of depressive symptoms varies with progression of Parkinson's disease.

Whether or not depressive symptoms increase in severity with progression of Parkinson's disease (PD) remains uncertain. Unlike previous studies, we examined whether the severity of specific features of depression (mood, self reproach, vegetative, and somatic symptoms) differ with respect to the progression of PD. Results indicated that symptoms related to both mood and self-reproach were present in the early stages of PD but did not increase in severity with advancing disease. Somatic features of depression were evident early and increased with disease progression, and vegetative symptoms were seen only in the later stages of PD. The different patterns of these depressive features with progression of PD may account in part for the variations seen in previous studies.

A brief scale for the dementia of Parkinson's disease.

The lack of standardized criteria and methodologies to assess dementia in patients with Parkinson's disease has resulted in inconsistencies and controversies in the literature regarding the incidence and basis of this condition. The authors examined a large group of patients with Parkinson's disease using two standardized sets of criteria for dementia. The neuropsychological data obtained was analyzed using stepwise discriminant analysis, and a brief scale was developed. The results indicated that a regression equation derived from just three neuropsychological procedures (which take only 10 minutes to administer) provides maximum discrimination between patients originally classified as demented or non-demented according to standardized criteria. Cut-off values for the product of the regression equation were calculated to accurately and reliably classify patients using the brief scale.

Neuropsychological differences between the dementias of Alzheimer's and Parkinson's diseases.

The question of whether dementia of the Alzheimer type and dementia associated with Parkinson's disease are clinically separable is controversial. We examined possible neuropsychological differences in these two patient groups matched for overall severity of dementia. Patients with dementia of the Alzheimer type had more severe impairment on measurements of memory, language, and orientation, and, unlike patients with Parkinson's disease, there was evidence of apraxia. Patients with Parkinson's disease had more severe impairment related to speed of information processing, and, unlike patients with dementia of the Alzheimer type, they also had disturbance of mood. The nature of visuospatial abnormalities also differentiated the two groups. The pattern of neuropsychological differences is consistent with the cortical-subcortical hypothesis.

Magnetic resonance imaging in dementia of Parkinson's disease.

The possibility that dementia in Parkinson's disease is associated with specific cerebral abnormalities identifiable by magnetic resonance imaging (MRI) was examined. Sixty eight patients with Parkinson's disease and 28 age and education matched normal controls were evaluated using neuropsychological procedures that included assessment of language, memory, cognition, visuospatial skills and mood. Twenty three patients (34%) were found to have developed significant impairment in at least three of the five areas, thus meeting criteria for a dementia syndrome. Eleven patients (16%) had no intellectual impairment and thirty four patients (50%) had a mild to moderate intellectual disturbance. Patients with (n = 10) and without dementia (n = 20), matched for severity of Parkinson's disease, and normal controls (n = 10) matched for age with the two patients groups, were evaluated by MRI. MRI scans were analysed for evidence of generalised cerebral atrophy, ventricular enlargement, visualisation of the substantia nigra and severity of focal brain lesions. Results indicated that the presence of dementia in patients with Parkinson's disease was not associated with any specific pattern of MRI abnormalities.

Neuropsychological similarities in lateralized parkinsonism.

Parkinson's disease (PD) patients who have left or right predominance of motor symptoms may exhibit cognitive differences. Previous research found greater neuropsychological impairment in patients with both right and left motor predominance, and some found no differences. Variability in overall severity of disease among the patients studied makes evaluation of these reports difficult. We examined the possibility that neuropsychological differences may occur in different stages of disease by comparing patients with mild unilateral disease (Exp. 1) and advanced disease (Exp. 2). Results indicated that while overall cognitive impairment increased with advancing disease, the pattern of neuropsychological impairments were not different with respect to laterality of motor symptoms in either experiment.

The picture absurdities test in the evaluation of dementia.

Recognition of picture absurdities was found to be significantly impaired in a group of patients with dementia of Alzheimer type compared to patients with dementia syndrome of depression and cerebrovascular dementia, even when matched for age, education, and dementia severity. None of the other neuropsychological measures investigated, including visual recent memory, Raven's progressive matrices, geographic orientation, and copying of geometric figures, resulted in a similar pattern. Although uncertainty remains as to what the picture absurdities test measures, normal performance likely depends on the integrity of many independently assessable variables, in addition to cognition and judgment utilizing visual data.

Magnetic resonance imaging and clinical correlates of intellectual impairment in myotonic dystrophy.

Although intellectual impairment is common in patients with myotonic dystrophy, this aspect of the disease has received relatively little research attention. We examined 41 patients with myotonic dystrophy using objective neuropsychological procedures and magnetic resonance imaging. Ten patients (24%) had severe and generalized intellectual dysfunction, while lesser or no cognitive impairment characterized the remaining patients. Degree of intellectual impairment was not related to neuromuscular status or sex. Patients with severe intellectual disturbance had significantly earlier onset of both myotonia and weakness and were more likely to inherit the disease from their mother. Magnetic resonance imaging findings indicated that while degree of cerebral atrophy was not related to severity of intellectual impairment, skull thickness, focal white matter lesions, and anterior temporal lobe abnormalities were significantly more common in patients with severely disturbed intellect. This study reports a number of previously unreported cerebral magnetic resonance imaging findings associated with intellectual impairment in myotonic dystrophy, but the etiology of these changes awaits neuropathologic examination.

Dose-dependent memory impairment in Parkinson's disease.

Variation in plasma dopamine level between the time of original learning and subsequent memory retrieval causes a state-dependent memory impairment in Parkinson's disease. The occurrence of this phenomenon is not related to either progression of disease or duration of therapy, but is more likely to occur with high-dosage levels of levodopa-carbidopa.

Neuropsychological impairments associated with severity of Parkinson's disease.

Intellectual impairment and disease severity tend to parallel one another in patients with Parkinson's disease (PD), but the pattern of development of the neuropsychological impairments contributing to the overall intellectual decline is unknown. This problem was addressed by comparing neuropsychological performance in the early and later stages of PD. Impairment of recent memory, impairment of cognition, and somatic features of depression were seen early and worsened with more advanced disease. Impairment of visuospatial skills, remote memory, language, and mood were observed only in the later stages of PD. These findings suggest that neuropsychological impairments do not develop in a uniform manner with progression of PD.

Upsetting social interactions and distress among Alzheimer's disease family care-givers: a replication and extension.

Although several studies have suggested that negative aspects of relationships have a greater impact on mood than positive elements, the individuals in these studies have been victims of life crises. To assess the generality of these findings, social support and mood data were collected from two well-matched groups that differed with respect to the presence of a chronic stressor in their lives. The 34 family care-givers for Alzheimer's disease victims and 34 comparison persons (non-care-givers) did not differ in the frequency of contacts, the closeness of their relationships, or ratings of the helpfulness or upset associated with the relationships. However, while upset accounted for a significant portion of the variance in care-givers' depressive symptoms in regression equations, neither upset nor helpfulness was significantly related to mood in non-care-givers. Care-givers whose relatives had more symptomatic Alzheimer's disease behaviors were more distressed and described their relationships with others as more upsetting. Implications for interventions and for the contextual importance of upsetting or negative support are discussed.

The naming disorder of dementia of Alzheimer type.

We studied the characteristics of the naming disorder of dementia of the Alzheimer type (DAT) in 20 patients, who were divided on the basis of Mini-Mental State scores into a mild and a moderate-severe group. Our results confirmed the presence of a progressive anomia which was sensitive both to word frequency and to image quality. Although DAT patients as a group made a similar proportion of perceptual-recognition and aphasic errors as did our age and education-matched controls, evidence was obtained that suggested that variations in the character of the anomia exist among individual DAT patients.

Relationship of motor symptoms, intellectual impairment, and depression in Parkinson's disease.

The relationship between severity of disease, intellectual impairment, and depression was examined in 50 patients with Parkinson's disease. A significant correlation between severity of disease and intellectual impairment suggests that both may result from the same subcortical lesions. Depression was not significantly related either to severity of disease or to intellectual impairment. This suggests that the relationship between severity of disease and intellectual impairment was not an artifact of increasing depression. Severity of rigidity and of bradykinesia did predict severity of intellectual decline, but severity of tremor predicted better intellectual status. Patients with a predominance of tremor may have a more benign clinical course as well as better intellectual function than patients with a predominance of rigidity and bradykinesia.

Chronic stress and immunity in family caregivers of Alzheimer's disease victims.

Although acute stress has been associated with transient immunosuppression, little is known about the immunologic consequences of chronic stress in humans. In order to investigate possible health-related consequences of a long-term stressor, we obtained blood samples for immunologic and nutritional analyses and psychologic data from 34 family caregivers of Alzheimer's disease (AD) victims and 34 sociodemographically matched comparison subjects. Family caregivers for AD victims were more distressed than comparison subjects without similar responsibilities. Greater impairment in the AD victim was associated with greater distress and loneliness in caregivers. Caregivers had significantly lower percentages of total T lymphocytes and helper T lymphocytes than did comparison subjects, as well as significantly lower helper-suppressor cell ratios; caregivers also had significantly higher antibody titers to Epstein-Barr virus than did comparison subjects, presumably reflecting poorer cellular immune system control of the latent virus in caregivers. The percentages of natural killer cells and suppressor T lymphocytes did not differ significantly. These data suggest that chronically stressed AD family caregivers do not show immunologic or psychologic adaptation to the level of their well-matched age peers.

Fluctuations in plasma dopamine level impair memory in Parkinson's disease.

We found a causal relationship between variation in plasma dopamine level and memory impairment in Parkinson's disease. If the level of dopamine was changed between the time of original learning and a later time of attempted memory retrieval, memory performance was impaired when compared with a maintenance of similar dopamine levels on both occasions. The absolute level of dopamine did not influence memory performance. Side-effects of levodopa-carbidopa therapy include variation in dopamine level, parkinsonian symptoms, and possibly "state-dependent" impairment of memory.

Magnetic resonance imaging correlates of dementia in multiple sclerosis.

Thirty-two patients with clinically definite multiple sclerosis were evaluated with neuropsychological procedures and magnetic resonance imaging (MRI). Neuropsychological evaluation included assessment of language, memory, cognition, visuospatial skills, and depression. Significant impairment in any three areas, compatible with diagnosis of a dementia syndrome, was observed in 28% of these patients, and lesser or no cognitive impairment characterized the remaining patients. Magnetic resonance imaging was used to evaluate the number and distribution of lesions as well as the presence of cerebral atrophy and atrophy of specific anatomic structures such as the corpus callosum. Results suggest that neither the number of lesions, the distribution of lesions, nor the extent of generalized cerebral atrophy was significantly greater in demented compared with non-demented patients. The primary finding was that atrophy of the corpus callosum was significantly more extensive on MRI scans in demented patients. Although the callosum itself may not be implicated directly in the pathogenesis of dementia, the presence of callosal atrophy on MRI scans should alert the physician to the possible occurrence of dementia in patients with multiple sclerosis.

Depression in patients with dementia of Alzheimer type.

Depression in dementia of Alzheimer type (DAT) has classically been considered to diminish as the disorder progresses. Using the Zung Self-Rating Depression Scale and the Mini-Mental State Examination to gauge the severity of depression and dementia, respectively, the authors found that the magnitude of depression did not differ as a function of disease severity in patients with DAT. The use of appropriate antidepressant therapy is therefore encouraged at any stage of disease in these patients.

Asterixis after lacunar infarctions.

Asterixis is usually encountered in metabolic encephalopathy but has rarely been reported with thalamic and midbrain lesions. We report bilateral extremity asterixis as a novel manifestation of basal ganglia lacunar infarction.

Dementia in Parkinson's disease.

Estimates of the prevalence of dementia in patients with Parkinson's disease (PD) vary considerably. Dementia in PD has been linked to a visuospatial disturbance, impairment of memory, and depression. Previous research suggests that visuospatial deficits and depression do not vary with severity of intellectual decline and thus are not useful measures to distinguish demented from nondemented patients. We examined immediate, recent, and remote memory in patients with PD and found that unlike visuospatial performance and depression, a qualitatively distinct pattern emerged, which did vary with severity of intellectual decline.

Cortical vs subcortical dementia. Neuropsychological differences.

The distinction between cortical and subcortical syndromes of dementia is controversial. Clinical reports suggest that subcortical syndromes (eg, Parkinson's disease) involve less severe intellectual and memory dysfunction and lack the aphasia, agnosia, and apraxia typical of the cortical dementias (eg, dementia of the Alzheimer type). A recent neuropsychological investigation using a standardized procedure failed to confirm the distinction. We examined patients with Alzheimer's disease, patients with Parkinson's disease, and normal controls by using a neuropsychological procedure specifically designed to quantitatively evaluate the proposed clinical differences. The results differentiated these dementia syndromes, and the pattern of performance was consistent with the cortical-subcortical hypothesis.