Introduction to background papers for the suggested changes to DSM-IV: cognitive disorders.
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Amnesia↗
Biomedical subjects
E D Caine
Publications and source records attributed to E D Caine.
Rational suicide and the right to die. Reality and myth.
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Aged↗
Suicide in later life: psychological autopsy findings.
The authors report preliminary data from a psychological autopsy study of completed suicide in late life. Sixteen of 18 victims had diagnosable psychopathology, most commonly major depression of late onset. Symptoms manifest prior to death are described and directions for future investigation discussed. The psychological autopsy is shown to be a viable method for studying suicide in the elderly.
Aged↗
Manic syndrome in AIDS.
A manic syndrome in eight patients with AIDS is described. On the basis of clinical, neuropsychological, laboratory, magnetic resonance imaging, and epidemiological evidence, the authors suggest that the manic syndrome was secondary to HIV infection. The patients also developed concomitant cognitive impairment.
AIDS Dementia Complex↗
The neuropsychology of depression in the elderly: a comparative study of normal aging and Alzheimer's disease.
The neuropsychological testing of 23 elderly depressed patients was compared to that of 23 healthy controls and 20 Alzheimer's disease (AD) patients. Depressed subjects were deficient relative to controls on most tasks, including naming and cued memory. There was a greater negative influence of age on the performance of depressed subjects (relative to controls) on some tasks. Despite their significant deficits, depressed patients were clearly distinguishable from AD patients. It is suggested that the combined effects of age and depression produce a pattern of deficits that is distinct from that of younger depressives, but less severe than that of Alzheimer's patients.
Aged↗
Magnetic resonance imaging findings in HIV cognitive impairment.
Atrophy and white matter changes seen on magnetic resonance imaging scans have been observed in association with the acquired immunodeficiency syndrome dementia complex, but these appear to be late findings relative to clinical expression. We report a new magnetic resonance imaging observation in patients with early cognitive impairment due to human immunodeficiency virus infection. Fifty-two patients had a total of 86 magnetic resonance imaging scans during the study period. All scans were obtained with a 1.5-T system. The proton density spin echo (repetition time of 2000 milliseconds and echo delay time of 30 milliseconds) study demonstrated high-signal lesions in the region of the splenium of the corpus callosum and in the crura of the fornices. The lesions demonstrated no contrast enhancement with gadopentate dimeglumine. Pathological examination was performed in five patients. The fornix-subcallosal abnormality may be related to the memory dysfunction in patients with human immunodeficiency virus-related cognitive impairment.
Adult↗
Neurosurgical treatment of severe obsessive-compulsive disorder associated with Tourette's syndrome.
We describe two patients with Gilles de la Tourette's syndrome (TS) and disabling obsessive-compulsive and ritualistic behaviors who underwent bilateral radiofrequency anterior cingulotomy. Both achieved a limited but sustained improvement in behavioral symptoms and overall functional abilities. Our observations indicate involvement of limbic structures in this disorder. The procedure should be considered for patients with TS complicated by resistant obsessive-compulsive disorder.
Adult↗
Completed suicide at age 50 and over.
The authors present data abstracted from medical examiners' investigative reports of 246 completed suicides of persons over the age of 50 years classified into four age groups. The sample population conformed to epidemiologic studies with regard to sex distribution. With increasing age, more suicide victims were widowed, and significantly fewer were single, separated, or divorced. Violent methods of suicide were more prevalent and alcohol use and psychiatric histories less common with aging. Physical illness and loss became the most common definable precipitants to suicide, whereas job, financial, and family relationship problems became less frequent with increasing age. The indications for future research and intervention in primary care settings are discussed.
Aged↗
Suicide and cancer in late life.
In a controlled psychological autopsy study of suicide in late life, eight cases in which the victim's belief that he had cancer played a major role in the decision to end his life were examined. All victims were men. The majority had diagnosable major affective disorders, but none had been seen in mental health care settings. Other common characteristics were an active relationship with a primary physician, numerous losses, prior experience with cancer or debilitating disease, and a rigid, self-sufficient personality style. The cases illustrate the complex determinants of suicidal behavior in the elderly and suggest preventive strategies for the primary care setting.
Aged↗
Education to assist spouses in coping with Alzheimer's disease. A controlled trial.
This study investigates whether a brief educational program, provided to spouses of patients with Alzheimer's disease, improved the caregivers' coping skills; it also questions whether the gender of the spouse had an effect on coping ability. The sample consisted of 40 spouses who were caring for the Alzheimer patient at home, 20 who participated in the educational program, and 20 controls. The instrument used for the study was the Health Specific Family Coping Index (HSFCI). This instrument provided a quantitative assessment of overall family coping with both potential and actual health problems in the psychosocial and physical domains of health. It is rated in nine domains: physical independence, therapeutic competence, knowledge of the condition, application of principles of personal hygiene, attitude toward health care, emotional competence, family living patterns, physical environment, and use of community resources. A home visit was made by a registered nurse prior to the educational intervention and at the end of the four-week intervention period. The HSFCI was completed at each visit. There were no pretreatment differences between the intervention and control groups in coping ability. Findings indicate that the educational program was beneficial in assisting spouses to feel greater competence in the face of the disease process and to function with greater independence. In the treatment group, the greatest significant increase was in the knowledge domain, followed by therapeutic competence and emotional competence. There was no overall relationship between gender of the spouse and coping ability.
Adaptation, Psychological↗
Clinical-pathologic correlation in Huntington's disease: a neuropsychological and computed tomography study.
To examine the premise that cognitive impairment in Huntington's disease (HD) is related to striatal degeneration, we determined those cognitive deficits most closely associated with linear CT indices of brain atrophy in HD. We systematically evaluated 60 drug-free HD patients who were judged to be in stages I (n = 34) or II (n = 26) of illness. All subjects underwent comprehensive neuropsychological assessment covering a broad spectrum of cognitive operations and standardized head CT imaging for determination of frontal horn (FH), intercaudate (CC), and outer-table (OT) distances. We grouped the cognitive test results, based on a principal-component factor analysis, to form factors 1 (complex psychomotor), 2 (verbal memory), 3 (visuospatial), and 4 (general knowledge). Factors 1 and 3 sharply discriminated between subjects in stages I and II of illness. Factors 1, 2, and 3 correlated strongly with CC/OT, an index of caudate atrophy, whereas only factor 2 correlated with FH/OT, an index of frontal atrophy. These data demonstrate that cognitive impairment is a clear-cut characteristic of early HD that is linked closely to the extent of caudate atrophy as measured by CT.
Adult↗
Family data support a dominant major gene for Tourette syndrome.
A dominant major gene was supported by analyses of 50 large extended Tourette syndrome (TS) pedigrees and by a subset of families defined by proband's clinical response to the neuroleptic drug haloperidol. Relatives were defined as affected if they ever had tics or TS. Assuming a nearly even sex ratio for TS and related symptoms resulted in the best fit of the genetic model to observed rates in families.
Chromosome Mapping↗
Cued recall and release from proactive interference in Alzheimer's disease.
Two tasks were administered to 13 mildly to moderately impaired subjects who met clinical research criteria for AD, and 17 controls matched for age and education. In the first task, subjects were administered a cued recall test (Buschke, 1984). AD subjects were found to be variably impaired in their ability to perform the initial stimulus-processing procedure, which involved matching cues with referents. The subsequent cued recall test did not typically facilitate performance. In the second task, subjects were administered a release from proactive interference (PI) paradigm consisting of semantically related and unrelated word lists. AD subjects did not develop the expected proactive interference effect for the semantically related words or show a resulting "release from PI" on related word list recall compared to normal controls. Results are discussed in terms of the role of semantic processing in episodic memory tasks.
Aged↗
Tourette's syndrome in Monroe County school children.
We examined children from Monroe County, New York, to establish the prevalence of Gilles de la Tourette's syndrome (TS) in the county's schools. Patients were recruited for free evaluations from physicians, other health professionals, school personnel, and through extensive coverage in the local news media. Forty-one TS patients were detected among the 142,636 pupils enrolled in the county's public and private schools at the time of the study (estimated prevalence, 28.7 per 100,000). Twenty patients had obsessive-compulsive symptoms, but only three had an impairing, diagnosable disorder. Fifty-six percent had a positive family history for TS or tics. Eighteen needed pharmacotherapy, although, for most, TS was a mild disorder requiring no drug treatment.
Adolescent↗
Does "benign senescent forgetfulness" exist?
Age-related changes in memory functions are observed clinically and in the experimental psychology laboratory. The commonly used notion of "benign senescent forgetfulness" implies that such changes are part of "normal" aging and not associated with central nervous system pathology. Some investigators have advocated a diagnostic category, age-associated memory impairment, to define the memory loss that appears in healthy, elderly individuals. These concepts are problematic from a number of perspectives and need to be clarified and more rigorously investigated.
Aged↗
A controlled neuropsychological comparison of Huntington's disease and multiple sclerosis.
This study compared the intellectual deficits of patients who had the earliest stages of Huntington's disease (HD) with those of mildly or moderately affected patients suffering from multiple sclerosis; both groups were matched for age, education, and ability to function. Twenty-one HD patients, 30 multiple sclerosis subjects, and 15 matched controls were evaluated neuropsychologically; all were free of psychoactive medications. The two patient groups showed similar overall patterns of impairment, though the HD group had greater verbal and nonverbal memory deficits. The HD patients also demonstrated significant dyscalculia and showed indications of developing problems in language usage and copying. These results are discussed in light of each disorder's neuropathologic substrate.
Adult↗
Gilles de la Tourette's syndrome. A review of clinical and research studies and consideration of future directions for investigation.
Tourette syndrome (TS) is a complex neurobehavioral disorder that has recently become a topic for clinical, genetic, neurochemical, and therapeutic research. Substantial progress has been made defining the clinical features of the disorder, establishing its familial nature, and documenting its response to pharmacotherapeutic intervention. Despite these advances, significant problems remain. The separation between TS and other syndromes is imprecise, and there are no uniformly accepted criteria for measuring response to treatment. Although family studies are promising, no mechanism of genetic transmission has been defined and the number of available revealing kindred for future DNA linkage studies is small. Clinical neurochemical investigations have been hampered by poor design and small subject samples; detailed postmortem neurochemical and pathological studies of brains from patients with TS have not been undertaken thus far. Careful application of newer research technologies combined with appropriately chosen subjects with TS may add to our understanding of the physiologic, anatomic, and genetic factors that contribute to this intriguing disorder. Future postmortem central nervous system studies will be essential.
Adolescent↗