Nonspecificity of semantic impairment in dementia of Alzheimer's type.

Two psychometric tests designed to evaluate "verbal fluency" and "naming" as a measure of semantic memory were presented to 18 patients with Alzheimer's-type dementia, 16 other patients with multi-infarct dementia, and 14 age-matched control subjects. The diagnosis of multi-infarct dementia and Alzheimer's-type dementia was based on the commonly accepted criteria of the Diagnostic and Statistical Manual of Mental Disorders, ed 3. Although the patients with Alzheimer and multi-infarct dementias, respectively, suffered from a comparable degree of dementia (as determined by the Mini-Mental State examination), semantic memory was not specifically impaired in Alzheimer's-type dementia as opposed to multi-infarct dementia. In contrast semantic memory was correlated with the degree of dementia in both disease entities.

Right-left disorientation in dementia of the Alzheimer type.

We demonstrated that right-left orientation (R/L-O) on a confronting subject is more impaired in patients with dementia of the Alzheimer type than in patients with multi-infarct dementia of comparable degree of dementia. The impairment in R/L-O is independent of aphasia and spatial disorientation.

Calculation abilities in dementia of Alzheimer's type and in vascular dementia.

Calculation abilities tested by 12 additive and 12 multiplicative tasks were investigated in 19 patients suffering from vascular dementia and in 23 patients suffering from dementia of Alzheimer's type as well as in 17 age-matched controls. Arithmetic impairment expressed by the number of correct results showed a significant correlation with the degree of dementia, measured by the Mini-Mental State Examination. An error type analysis was performed, but was of no help in the differential diagnosis of dementia. Calculation abilities are similarly impaired in both vascular dementia and dementia of Alzheimer's type.

Cardiac effects of sumatriptan: findings of Holter monitoring and review of the literature.

The aim of this study was to elucidate possible electrocardiographic effects of sumatriptan in a selected group of patients with severe headache requiring in-patient treatment. The patients (n = 21) were treated with sumatriptan in addition to various other compounds and were asked to record any symptoms following the administration of sumatriptan. In addition, Holter monitoring was performed in all subjects. In agreement with other studies, the adverse events reported by the patients were not related to ECG changes and, vice versa, ECG changes were not accompanied by clinical symptoms. The Holter findings before and after administration of sumatriptan were significantly different in three patients, i.e. recurrent episodes of ST depression and increase in extrasystoles. These changes occurred within a period of 1.45 to 18 hours and were not reproducible when Holter monitoring was repeated without sumatriptan. Even though the findings might be explained by spontaneous variability of Holter monitoring or other factors, this study does not definitely discount the possibility that sumatriptan may cause ST segment changes and increase pre-existing extrasystoles. Controlled studies are required to clarify this issue.

[Sumatriptan--side effects and problems in routine clinical practice]. / Sumatriptan--Nebenwirkungen und Probleme beim Einsatz im klinischen Alltag.

AIM: The study tried to investigate the efficacy, adverse events and possible risk factors of sumatriptan in daily clinical practice. PATIENTS AND METHODS: 72 outdoor patients, who had treated their headaches at least once with sumatriptan, partly prescribed to them by outdoor physicians, were asked about their experiences with the drug. According to the criteria of the International Headache Society (1988) 55 patients were suffering from migraine, 11 from cluster headache and 6 from tension-type headache. RESULTS: Migraine and cluster patients rated the drug as effective as described in literature. Adverse events were reported by 69% of the patients which was more frequent than in most clinic studies described. Adverse events were usually not serious and transient. They were reported significantly more often by migraine patients than by patients with cluster headache and might not all be correlated to the therapy of sumatriptan. CONCLUSION: Sumatriptan has shown to be effective in the treatment of an acute migraine- and cluster-headache. The risk as to severe adverse events, especially cardial adverse events, exists if contraindications for sumatriptan are not considered. Sumatriptan should therefore only be prescribed to carefully diagnosed migraine and cluster headache patients. It should, however, not be given to patients suffering from drug abuse, because they might just change over to sumatriptan.

[Drug therapy of migraine--a review of the literature]. / Die medikamentöse Therapie der Migräne--ein Literaturüberblick.

The medical treatment of migraine has two objective points: therapy for treating symptoms of an acute attack and prophylactic therapy for reducing frequency and severity of migraine attacks. A number of different therapeutic approaches for a symptomatic and a prophylactic therapy exists. The following article tries to give a survey of possible treatment strategies of migraine published within the last three years.

Memory deficits in advanced Parkinson's disease.

Apart from global dementia various isolated cognitive deficits have been described in Parkinson's disease (PD). We investigated 31 non-demented Parkinsonian patients in their late stages of disease and 50 control subjects with regard to verbal memory. Eleven patients suffered from an isolated verbal memory deficit as defined by two list learning tasks using the Buschke selective reminding procedure. The isolated memory impairment did not depend on depression but was associated with longer duration of PD. Twelve demented PD patients were comparable to PD patients with isolated memory impairment with regard to age at onset and duration of PD. We speculate that the isolated memory impairment in PD is associated with isolated neuronal loss in the nucleus basalis of Meynert, without cortical or limbic pathology of the Alzheimer's type.

Course characteristics in the differentiation of dementia of the Alzheimer type and multi-infarct dementia.

Clinico-pathological studies have shown that the clinical diagnosis of multi-infarct dementia (MID) is even more difficult than that of dementia of the Alzheimer type (DAT). The study evaluated the significance of course characteristics for the diagnosis of MID and DAT. Course characteristics were rated when 57 demented patients were admitted to our neurogeriatric department. Diagnosis of MID and DAT, respectively, was established after a follow-up study with repeated neurological, psychiatric and neuropsychological investigations. In 21 cases diagnosis was confirmed by postmortem neuropathology. MID lacked the typical course of the disease in about two thirds of patients, while most DAT patients presented with the typical course of primary degenerative dementia. Features of the "typical" clinical course of MID (abrupt onset, stepwise deterioration) helped to exclude DAT, whereas MID could not be excluded on the basis of a history of insidious onset and gradual decline.

Long-term outcome of patients with headache and drug abuse after inpatient withdrawal: five-year follow-up.

Thirty-eight patients with "chronic daily" headache and ergotamine and/or analgesics abuse according to the criteria proposed by the International Headache Society were re-investigated 5 years after inpatient drug withdrawal. At the end of the observation period, 19 patients (50.0%) had their headaches on only 8 days per month or less, 18 patients (47.4%) were free of symptoms or had only mild headaches. A close correlation was found between the frequency of headache and the duration of drug abuse, as well as between the intensity of headache and the number of tablets taken per month. Frequency and intensity of headache had changed within the first 2 years after withdrawal, but remained stable afterwards. Fifteen patients (39.5%) reported on recurrent drug abuse. Patients with migraine showed a tendency towards a better prognosis compared to patients with tension-type headache or with combined migraine and tension-type headache. The results of this study highlight the long-term efficacy of inpatient drug withdrawal in patients with headache and ergotamine and/or analgesics abuse.

Brain/behaviour dissociation on old/new distinction in a patient with amnesic syndrome.

Event-related potentials (ERP) were recorded in a recognition memory task in 5 healthy subjects and an amnesic patient. A list of high-imagery words with low probability in everyday language was presented visually for 200 ms each. A second list, consisting of 50% previously presented ('old') words and 50% 'new' words was presented immediately after the first list. Old/new distinction was determined by the subject's motor response. For each subject single trial analysis of ERPs was performed. In each healthy subjects, correct old/new distinction was associated with significant ERP differences from 500 to 900 ms after stimulus onset. It was, therefore, assumed that task and recording procedures were appropriate for the study of ERPs with recognition memory. The main finding is a dissociation between brain activity and behaviour with old/new distinction in the patient with amnesic syndrome. Frequently, the patient incorrectly classified previously shown words ('old' words) to be presented for the first time ('new'). But ERP showed that brain processing of 'old' words which had incorrectly been classified to be 'new' is different from correctly classified new words. ERP differences were significant between 900 and 1200 ms after stimulus presentation. These data indicate preserved memory functions which are not assessed at the behavioural level in the memory recognition task.

Altitudinal neglect in a patient with occipital infarction.

Visual neglect has been frequently described in a horizontal direction. Altitudinal neglect, however, has rarely been described and has been associated with bilateral lesions in the parieto-occipital or temporo-occipital region. The following case report presents a patient with marked altitudinal neglect of the inferior space which was elicited using a line bisection test. The previously healthy patient had well-defined lesions solely in the occipital cortex following an embolic infarction. The present case report underlines the possibility that bioccipital lesions themselves can be responsible for altitudinal neglect.

Ideomotor apraxia in Alzheimer's disease.

Ideomotor apraxia, tested on verbal command and by imitation, was checked in 23 patients suffering from dementia of Alzheimer's type of different severity and in 17 age-matched controls. A significant deterioration of ideomotor praxis could be shown even in mild dementia. Correlations of ideomotor apraxia and aphasia, tested by the Token test were found to be significant.

[Differential diagnosis of dementia diseases. A prospective clinical study with neuropathologic diagnostic verification]. / Die Differentialdiagnose der Demenzerkrankungen. Eine prospektive klinische Untersuchung mit neuropathologischer Diagnosestellung.

We present clinico-pathological correlations for a consecutive series of 44 demented patients in the Vienna longitudinal study on dementia. Prospective clinical diagnosis used the DSM-III-R and the NINCDS-ADRDA criteria. Not only the clinical, but also the neuropathological diagnosis of DAT is based on exclusion criteria, and depends on the interpretation of minimal vascular lesions. Although we did not exclude atypical cases from the study, 80% of diagnoses could be validated at autopsy. Nevertheless, our set of clinical criteria needs further validation in patients in the earliest stages of dementia.

[Alzheimer dementia. A clinical long-term study with quantitative neuropathology]. / Die Demenz vom Alzheimer-Typ. Eine klinische Längsschnittstudie mit quantitativer Neuropathologie.

Alzheimer's disease causes about 80% of dementias in old age. The pathological hallmarks of Alzheimer's disease are senile plaques (SP) and neurofibrillary tangles (NFT), which to a lesser degree can also be found in the brains of mentally intact elderly. The question whether SP or NFT or any other process are primarily correlated to severity of dementia can only be answered in prospective longitudinal clinical and neuropsychological studies with quantitative neuropathological investigation. We report the correlations between mini-mental-state scores and lesion counts in 3 isocortical and 3 hippocampal areas in a consecutive series of 19 Alzheimer's patients studied prospectively in the Vienna Longitudinal Study on Dementia. Lesion counts increased at very late stages of dementia and were rather low in mild to moderate severity of dementia. Mildly demented patients with very slow progression of dementia also had rather high lesion counts. Neurofibrillary changes in NFT and neuritic plaques were correlated with severity of dementia, but diffuse plaques, i.e. SP without neuritic degeneration, were not at all correlated with severity of dementia. We speculate that NFT and SP do not represent the primary process which leads to dementia.