Biomedical subjects

I Lavenu

Publications and source records attributed to I Lavenu.

7 recordsLinked to original sources

PubMed1999

The clinical picture of frontotemporal dementia: diagnosis and follow-up.

Frontotemporal dementia (FTD) was diagnosed in 74 outpatients with a standardized assessment including neuropsychological tests, behavioural scale, structural and functional imaging. Clinical characteristics were consistent with the literature data. The cohort was followed for 2-6 years to determine the reliable variable for evaluating the progression of FTD. Every fourth patient died after a mean duration of 7 years. At first, FTD manifests itself in behavioural changes with relatively stable global cognition although language, verbal fluency and memory tests were reliable tools to follow the progression of the disease. Below 18 of Mini-Mental State Examination, mutism and apathy prevented from neuropsychological testing within the next 6 months. Behavioural disorders evolved with time but restlessness and hyperorality were long-lasting. Imaging showed the progression of a consistent pattern of anterior abnormalities with frequent leukoaraiosis.

Activities of Daily Living↗

PubMed1998

[Clinical diagnosis of frontotemporal dementia].

Frontotemporal dementia (FTD) is poorly recognized clinically. Of the 1,517 patients examined at the Lille Outpatients Memory Clinic data bank (1991-1995), 74 fulfilled the criteria of the Lund and Manchester groups for FTD. They accounted for 5 p, 100 of all patients, 1 for 10 probable or possible Alzheimer's disease. Mean patient age was 63 years, duration of the disease was 5 years, mean Mini Mental State score was 23; 45 p. 100 belonged to the active population. Behavioral disorders occurred before the cognitive decline and remained the major feature. All patients had at least 3 of the following symptoms: self-control impairment, affective disorder, loss of interest and self-neglect. Memory impairment consisted of correct encoding and impaired retrieval processes, without major storage impairment. No patients had spatial disorientation. Language was usually reduced, EEG was normal. Two diagnoses were confirmed by autopsy: both consisted of aspecific frontal and temporal degeneration, 41 p. 100 of the patients were referred by a general practitioner, 30 p. 100 by a psychiatrist, 16 p. 100 by a neurologist, 2 p. 100 by other specialists, and 11 p. 100 following the advice of their relatives. FTD had never been suspected. Alzheimer's disease or non specified degenerative dementia was suspected in 2/3 of patients and a psychiatric disorder in 1/3. With the advent of novel pharmacological agents for the treatment of dementing disorders and for research purposes, the identification and accurate differentiation of FTD from Alzheimer's disease and psychiatric disorder is essential. Therefore, the role of multidisciplinary memory clinic is crucial to differentiate FTD from other degenerative dementias.

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PubMed1997

Association between medial temporal lobe atrophy on CT and parietotemporal uptake decrease on SPECT in Alzheimer's disease.

OBJECTIVES: Alzheimer's disease is the most frequent cause of degenerative dementia. Despite the available diagnostic criteria, improvement of diagnosic accuracy is still required. The aim of this prospective study was to assess in a large population of patients referred to a memory clinic the diagnostic value of the combination of medial temporal lobe atrophy on temporal oriented CT and decreased temporoparietal uptake on HMPAO single photon emission tomography (SPECT). METHODS: The study was conducted in 125 patients aged 51-93: 64 with probable Alzheimer's disease (Mean (SD) mini mental state examination (MMSE)=18.34 (6.93)), duration of disease=6.48 (2.93) years, 13 possible Alzheimer's disease (MMSE=21.58 (5.48), duration of disease=6.08 (2.56)), 48 patients with miscellaneous memory disorders (MMSE=21.98 (6.10), duration the disease = 6.85 (3.91)). RESULTS: For the diagnosis of probable Alzheimer's disease, the sensitivity of this association was 0.56, the specificity 0.93, the positive predictive value 0.95, and the negative predictive value 0.45. The diagnosic accuracy was 0.68. Both medial temporal atrophy and parietotemporal decrease in uptake were present in four of 13 patients with possible Alzheimer's disease and 11 of 48 with miscellaneous memory disorders. The association was absent in 27 of 29 patients with frontotemporal dementia. In mild stages (MMSE>18; n = 32), the sensitivity of the association was 0.34, the specificity 0.93, the positive predictive value 0.85, and the negative predictive value 0.57. The diagnosic accuracy was 0.53. CONCLUSION: This association, although not sensitive, helps to select patients with high probability of Alzheimer's disease at an early stage which can be of interest for clinical and research purposes.

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PubMed1994

Anterior choroidal artery territory infarcts. Study of presumed mechanisms.

BACKGROUND AND PURPOSE: A previous study suggested that occlusive diseases of small penetrating arteries account for most anterior choroidal artery (AChA) territory infarcts, but half of the patients did not have an echocardiogram. Cases of AChA territory infarcts associated with internal carotid artery stenosis or atrial fibrillation suggest that this hypothesis may be wrong. The aim of this study was to determine the mechanism of 16 nonselected consecutive AChA territory infarcts. METHODS: The study population consisted of 8 men and 8 women aged 17 to 89 years. They underwent a computed tomographic scan at the acute stage, Doppler ultrasonography and B-mode echotomography of the cervical arteries, bidimensional transthoracic echocardiography, and cerebral magnetic resonance imaging, replaced by a second computed tomographic scan in 3 patients. Ten patients underwent cerebral angiography. We defined the presumed cause of stroke according to the criteria used in the trial of Org 10172 in acute stroke treatment. RESULTS: The presumed cause of stroke was definite cardio-embolism in 4 patients (atrial fibrillation in 2, paradoxical embolism in 1, and left ventricular akinesia in 1); definite large-vessel atherosclerosis in 2; dissection of the internal carotid artery in 2; and definite small-vessel occlusion in 1. Seven patients had a negative diagnostic workup. Six patients had no risk factors for small-vessel occlusion. The AChA was not visible on angiography in 4 patients. One patient had two arterial cutoffs, suggestive of emboli in other cerebral arteries. CONCLUSIONS: This study suggests that AChA territory infarcts are rarely related to small-vessel occlusion and therefore require a complete diagnostic workup.

Adolescent↗

PubMedDate not supplied

Perception of emotion in frontotemporal dementia and Alzheimer disease.

Frontotemporal dementia (FTD) is the second cause of degenerative dementia. Behavioral changes occur before the cognitive decline and remain the major feature. A poor perception of emotion could account for some behavioral symptoms. The aim of this study was to assess the perception of emotion in patients with FTD and to compare it with that of patients with Alzheimer disease (AD). Fifty subjects performed the tests: 20 patients with probable AD, 18 patients with FTD, and 12 matched controls. The two patient groups did not differ in age, sex, severity of dementia, duration of the disease, and language tests. Subjects had to recognize and point out the name of one of seven basic emotions (anger, disgust, happiness, fear, sadness, surprise, and contempt) on a set of 28 faces presented on slides. The three groups were equally able to distinguish a face displaying affect from one not displaying affect. Naming of emotion was worse in patients with FTD than in patients with AD (correct answers 46% vs. 62%; p = 0.0006) who did not differ significantly from controls (72%). Anger, sadness, and disgust were less recognized in FTD than in AD patients who did not differ from controls, whereas fear and contempt were poorly recognized in both groups of patients compared with controls. These findings argue for different neural substrates underlying the recognition of various basic emotions. Behavioral disorders in FTD may be partly due to an impaired interpretation of the emotional environment.

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PubMedDate not supplied

Explicit memory in frontotemporal dementia: the role of medial temporal atrophy.

In our memory clinic experience, memory impairment differs widely in patients with frontotemporal dementia (FTD). We searched for a correlation between explicit memory disturbance assessed with the Grober and Buschke test and medial temporal atrophy on CT scan in 22 consecutive patients with FTD. Five of the 22 patients had a medial temporal lobe (MTL) atrophy. There was no significant difference between the two groups for the demographic characteristics. Free recall, cued recall and the learning curve were significantly better in patients without MTL atrophy. The patients with MTL atrophy made more intrusions. We found a positive correlation between total recall and cued recall and the mean of medial temporal lobe measurement. These results are in agreement with the role of the hippocampal formation in the memory process. In our group, the ratio of patients with MTL atrophy is similar to the ratio of Pick's disease in frontotemporal dementia. In histological series more severe hippocampal atrophy are reported in Pick's disease. Therefore MTL atrophy on CT scan could be a marker of Pick's disease in FTD.

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PubMedDate not supplied

The use of SPECT in a multidisciplinary memory clinic.

We tested the interobserver reliability of visual rating of HMPAO-SPECT imaging in 271 outpatients referred to a memory clinic, and followed over 1 year. The clinical diagnoses were Alzheimer's disease (n = 156), frontotemporal dementia (n = 47); vascular dementia (n = 21), senile dementia of Lewy body type (n = 12), anxiety/depressive disorders (n = 14) and miscellaneous memory disorders (n = 21). The interobserver agreement was good (k = 0.68). However, the heterogeneity of the patterns-independent from demographic data, age at onset and duration of the disease- and their lack of sensibility and specificity limited the contribution of SPECT for diagnostic purposes in routine practice.

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