Frontal lobe dysfunction from meningeal sarcoidosis.
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Brain Diseases↗
Biomedical subjects
M F Mendez
Publications and source records attributed to M F Mendez.
Clinically diagnosed Alzheimer disease: neuropathologic findings in 650 cases.
Despite the introduction of formal clinical criteria for Alzheimer disease (AD), the clinical diagnosis of AD remains one of exclusion of other dementias. To determine the accuracy of a clinical diagnosis of AD as made by practicing physicians, we reviewed the clinicopathologic records of a dementia brain bank and summarized the literature. Of 650 demented patients diagnosed during life as having AD, at autopsy 505 (78%) had AD with or without other neuropathologic conditions; only 390 (60%) of these had AD as the only neuropathologic condition. Of the remaining 145 (22%) patients with no neuropathologic evidence of AD, 39 had the nigrostriatal changes of Parkinson disease (PD), 25 had nonspecific degenerations, 15 had Pick disease, 14 had multiple infarcts, and 11 lacked any neuropathologic abnormality. Although the overall clinical accuracy for AD was lower than that summarized from the literature, clinical accuracy improved significantly between 1986 and 1990. In our broad sample of practitioners, accuracy of clinical diagnosis of AD may be improving, but continues to be hampered by difficulty in distinguishing the dementia of AD from certain dementing conditions and from AD mixed with other neuropathologic conditions.
Aged↗
Disturbances of person identification in Alzheimer's disease. A retrospective study.
Person identification disturbances in Alzheimer's disease (AD) add to the suffering of both patients and caregivers. We assessed the prevalence of person identification disturbances in the records of 217 outpatients with AD. These disturbances occurred in 25.4% (N = 55) and included transient misidentifications of familiar persons (N = 34), the Capgras syndrome (N = 11), misidentification of themselves in mirrors (N = 5), prosopagnosia (N = 3), misidentification of unfamiliar persons as familiar (N = 1), and misidentification of another person as oneself (N = 1). Transient misidentifications were easily corrected misperceptions, and the Capgras syndrome and mirror difficulties were associated with suspiciousness/paranoia and delusions. In AD, these findings suggest that misidentifications of familiar persons result from misinterpretations due to cognitive impairments, and the Capgras syndrome and mirror difficulties ensue when these misinterpretations are elaborated by paranoid delusions.
Aged↗
Development of scoring criteria for the clock drawing task in Alzheimer's disease.
OBJECTIVE: To investigate the reliability and validity of free-hand clock drawings, a frequently used measure of constructional apraxia, in patients with Alzheimer's disease. DESIGN: Survey for the purpose of testing reliability and validity of a new scale. SETTING: Memory Disorder Clinic at a university-affiliated hospital in the Upper Midwest. PATIENTS: Forty-six patients were diagnosed with clinically probable dementia of the Alzheimer type after a dementia evaluation, and 26 normal elderly controls were research volunteers without a history of cognitive dysfunction. MEASUREMENTS: Neuropsychological tests, dementia-related scales, and clock drawings rated by a new 20-item Clock Drawing Interpretation Scale. Reliability measures, correlations, and clustering of items in the CDIS. RESULTS: The CDIS had inter-rater reliability (r = .94), internal consistence (rtt = .95), and reproducibility over a 6-month interval. CDIS scores were significantly correlated with two dementia-related scales and all neuropsychological tests and had the highest correlations with other measures of constructional apraxia. All but four Alzheimer patients (91%) and none of the controls had CDIS scores of 18 or less. CONCLUSION: Clinicians may reliably screen patients with Alzheimer's disease with the clock-drawing task, a measure sensitive to deficits in constructional apraxia.
Activities of Daily Living↗
A clinicopathological study of CT scans in Alzheimer's disease.
OBJECTIVE: To investigate the accuracy of cranial computerized tomography (CT) scans in distinguishing patients with Alzheimer's disease from those with other dementing conditions. DESIGN: Retrospective clinicopathological correlation with pre-mortem CT scans. SETTING: Urban and rural hospitals and nursing homes in the Upper Midwest. PATIENTS: All 507 patients had clinical dementia diagnosed as Alzheimer's disease during life and the subsequent referral of their brains to a dementia brain bank. Of these, 375 patients had had CT scans as part of the diagnostic work-up for dementia. MAIN OUTCOME MEASURES: The presence of neuropathological evidence of Alzheimer's disease and the specific findings on CT scans. RESULTS: Of the 375 patients evaluated with a CT, 28% were misdiagnosed (lacked neuropathological evidence of Alzheimer's disease); of the 132 patients evaluated without a CT scan, only 18% were misdiagnosed (P less than 0.05). The degree of atrophy and other CT findings were similar in the correctly diagnosed and misdiagnosed groups except for increased ventricular size in the correctly diagnosed patients (P less than 0.05). CONCLUSION: Although CT scans do not usually contribute to the recognition of Alzheimer's disease, the presence of ventricular enlargement may help distinguish Alzheimer's disease from other dementias.
Aged↗
Pavor nocturnus from a brainstem glioma.
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Adolescent↗
Delusional misidentification of persons in dementia.
The misidentification of a familiar person or of oneself may occur as a complication of dementia. Seven patients experienced alterations of the sense of familiarity for a familiar object or place, for the misidentified person in a novel role, for personal characteristics, or for unfamiliar events as familiar. Five of these had persecutory delusions. These cases suggest that person misidentification in dementia begins with an altered sense of familiarity for a familiar person from a mismatch of new perceptions with past memories. They are sustained by paranoid elaboration or confabulatory rationalisation of a double.
Aged↗
Risk factors in Alzheimer's disease: a clinicopathologic study.
We investigated potential risk factors for Alzheimer's disease (AD) in a clinicopathologic study of 407 patients with definite AD, 100 non-Alzheimer dementia patients, and 50 normal subjects. The AD patients had more first-degree relatives with dementia than the non-AD dementia group (odds ratio of 1.85, 95% confidence interval of 1.07-3.20) or the normal elderly (odds ratio of 3.60, 95% confidence interval of 1.50-8.64) but did not have significantly more head injuries, medical and psychiatric illnesses, or relatives with Down's syndrome. The AD patients with a family history of dementia had their dementia at a later age than those without an affected relative. These findings indicate a familial risk for AD that is greater than for other dementing illnesses and has age-related penetrance. This study does not support other putative risk factors for AD such as head trauma and familial Down's syndrome.
Aged↗
Ictal and psychiatric aspects of suicide in epileptic patients.
OBJECTIVE: To evaluate the ictal and psychiatric aspects underlying the high risk of suicide among epileptic patients. METHOD: We surveyed the records of 1611 epileptic patients seen in a neurology clinic during an eight-year period, found four who died by suicide, and characterized their ictal and psychiatric features. RESULTS: All four epileptic patients had partial complex seizures and temporal lobe foci. Two had an associated paranoid schizophrenia with suicidal ideation, and good or improving seizure control at the time of their deaths. Another patient killed himself during a brief psychotic episode associated with increasing epileptiform discharges. The fourth patient had ictal depression and committed suicide during a flurry of partial complex seizures. CONCLUSIONS: These findings suggest that the high suicide rate among epileptic patients has a greater association with psychotic behaviors and psychic auras than with major depression or the psychosocial burden of being epileptic. We further review other reported risk factors for suicide in epilepsy.
Adult↗
Mania self-induced with cough syrup.
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Adult↗
Differences between multi-infarct dementia and Alzheimer's disease on unstructured neuropsychological tasks.
Although patients with multi-infarct dementia (MID) may have greater spontaneity than those with dementia of the Alzheimer's type (DAT), conventional neuropsychological tests often fail to distinguish between these two dementias. We studied 18 patients with MID and compared them to 18 comparably demented patients with DAT and 18 normal elderly controls on conventional structured tests and two unstructured tasks, a 3-minute verbal description of the Cookie Theft Picture and the Lezak Tinker Toy Test. On the structured tests, the only significant difference between the two dementia groups was worse performance by the DAT patients on several memory measures. On the unstructured tasks, the MID group had significantly fewer words/minute and constructional assemblages. These results suggest that unstructured tasks help distinguish patients with MID from those with DAT, and that MID patients have decreased spontaneous behavior and initiation, possibly reflecting frontal-subcortical pathology and compromised executive abilities.
Aged↗
Word deafness mistaken for Alzheimer's disease: differential characteristics.
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Aged↗
Dementia presenting with aphasia: clinical characteristics.
Dementia, a disorder of multiple cognitive functions, may atypically present as an aphasia. The clinical characteristics are reported of 13 patients with up to 14 years of progressive language impairment before developing dementia. In reviewing the literature, it was found that these patients were similar to those reported with progressive aphasia. It is concluded that dementia may present with an anomic, dysfluent language disorder due to the focal left sylvian onset of several dementing illnesses.
Aged↗
The postictal psychosis of epilepsy: investigation in two patients.
Patients with epilepsy have a higher incidence of psychosis. Epilepsy-related psychotic behaviors include a chronic interictal schizophreniform illness, an "alternating psychosis" which remits with seizure activity, and ictal or perictal psychotic behaviors. In addition, there is an uncommon and less understood psychosis characterized by brief psychotic episodes during the postictal period. This report describes two patients with postictal psychosis and correlates their behavior with the pattern of seizures, electroencephalographic discharges, and anticonvulsant and psychotropic medications. The findings suggest that postictal psychosis results from increased epileptiform activity and continued cerebral dysrhythmia, has a latency in onset and is not due to the immediate postictal delirium, and reflects an exacerbation of underlying psychopathological tendencies. This report further discusses the potential pathophysiological mechanisms and management of this disorder.
Adult↗
Psychiatric symptoms associated with Alzheimer's disease.
A retrospective chart review was undertaken to assess the prevalence of specifically defined psychiatric symptoms in 217 outpatients with clinically probable Alzheimer's disease. A weak but significant correlation was found between Alzheimer's disease and suspiciousness and paranoia (reported by 35.5% of patients), delusions (30%), and formed visual hallucinations (18.4%). Mild depressive symptoms, such as sad affect, hopelessness, and helplessness were reported by 40.6% of patients, anxiety and fearfulness by 30.9%, and aggressive acts by 24.9%. Psychotropic medications used to manage these symptoms included antipsychotics, in 11.5% of patients, anxiolytics, in 9.2%, and antidepressants, in 7.4%.
Activities of Daily Living↗
Complex visual disturbances in Alzheimer's disease.
Although Alzheimer's disease (AD) involves visual association cortex, previous studies have not systematically investigated complex visual disturbances in AD. We examined 30 community-based AD patients, 13 (43%) of whom had complex visual complaints, and compared them with 30 controls on 7 types of complex visual tasks. Despite preserved visual acuity and color recognition, the AD patients were impaired in the visual evaluation of common objects, famous faces, spatial locations, and complex figures. In the AD patients, we found that all 30 had disturbances in figure-ground analysis; 17 (57%) had difficulties visually recognizing actual objects ("agnosia"); those with worse dementia disability had the most complex visual disturbances; and a subgroup (6) with Balint's syndrome performed the most poorly on the complex visual tasks. This study demonstrates that a range of complex visual disturbances are common in AD and suggests that they may result from the known neuropathology in the visual association cortex.
Aged↗