Biomedical subjects

S E Starkstein

Publications and source records attributed to S E Starkstein.

At least 55 records · Page 3Linked to original sources

PubMed1995

Prevalence and correlates of dysthymia and major depression among patients with Alzheimer's disease.

OBJECTIVE: The purpose of this study was to examine the prevalence, risk factors, and correlates of depression among patients with Alzheimer's disease. METHOD: A consecutive series of 103 patients with probable Alzheimer's disease were examined with a structured psychiatric interview and were assessed for the presence of cognitive impairments, deficits in activities of daily living, social functioning, and anosognosia. RESULTS: Fifty-one percent of the patients had depression (28% had dysthymia and 23% major depression). Women had a significantly higher prevalence of both major depression and dysthymia than men. Depressed and nondepressed patients had a similar frequency of family and personal histories of depression, a similar frequency of personality disorders before the onset of depression, and no significant differences in cognitive deficits and impairment in activities of daily living. Dysthymia usually started after the onset of dementia and was significantly more prevalent in the early stages of dementia; patients with dysthymia had a significantly better awareness of intellectual deficits than patients with major or no depression. On the other hand, patients with major depression had an earlier onset of depression (half of them before the onset of dementia), and the prevalence of major depression was similar across the different stages of the illness. CONCLUSIONS: This study demonstrates a high prevalence of dysthymia and major depression among patients with probable Alzheimer's disease. While dysthymia may be an emotional reaction to the progressive cognitive decline, major depression may be related to biological factors.

Activities of Daily Living↗

PubMed1995

A SPECT study of parkinsonism in Alzheimer's disease.

The authors examined the presence of significant regional cerebral blood flow (rCBF) differences between Alzheimer's disease (AD) patients with and without extrapyramidal signs (EPS). Nine patients with probable AD and EPS (resting tremor or rigidity and bradykinesia) and 9 AD patients without EPS, comparable in age, duration of illness, and global cognitive decline, were studied with [99mTc]HMPAO SPECT. Patients with AD and EPS showed significantly lower rCBF in the superior frontal, superior temporal, and parietal regions of the left hemisphere than AD patients without EPS. Rigidity and bradykinesia independently accounted for the decreased rCBF in these areas. These findings suggest that the presence of EPS in AD may result from dysfunction in specific brain regions.

Aged↗

PubMed1995

Anosognosia in Alzheimer's disease: a study of associated factors.

The authors examined the prevalence and correlates of anosognosia in a consecutive series of patients with probable Alzheimer's disease (AD). Patients were examined with the Anosognosia Questionnaire-Dementia (AQ-D), which showed good reliability and validity. On the basis of the AQ-D scores, patients were divided into those with anosognosia (n = 21) and those without anosognosia (n = 52). Patients with anosognosia showed a significantly longer duration of illness, more severe cognitive impairments and deficits in activities of daily living, and higher mania and pathological laughing scores than AD patients without anosognosia. These findings suggest that anosognosia in AD may be part of a specific neuropsychiatric syndrome.

Aged↗

PubMed1995

SPECT findings before and after ECT in a patient with major depression and Cotard's syndrome.

A patient's major depression and Cotard's syndrome (the delusion of being dead) both resolved completely after 12 ECT treatments. A SPECT study 1 week before ECT showed reduced blood flow in the frontoparietal medial and dorsolateral frontal cortex, basal ganglia, and thalamus; SPECT 1 month after ECT showed perfusion increments in those regions. This case study demonstrates that Cotard's syndrome in the context of major depression may be successfully treated with ECT and suggests that the psychiatric improvement was accompanied by increased blood flow in specific brain areas.

Brain↗

PubMed1995

Karl Ludwig Kahlbaum's concept of catatonia.

Catatonia is a neuropsychiatric syndrome described by Karl Ludwig Kahlbaum in 1874. Based on Kahlbaum's own description and Carl Wernicke's hypothesis about the mechanism of catatonia, we describe two types of catatonic domain: the akinetic motality psychosis, which is characterized by rigid immobility, fixed gaze, lack of blink, and cogwheel rigidity, and catatonia sensu strictu, which is characterized by spasms, iterations and verbigerations. The loss of motility allows the 'hypobulic levels' described by Kretschmer in 1920, which consist of aggressive acts, furious shouting, hyperactivity and orality, to break through. These behaviours are present in the hyperkinetic variant of catatonia and may result from a reduction of dopaminergic innervation and the release of limbic and neocortical mechanisms containing behavioural programmes.

Catatonia↗

PubMed1994

Specificity of changes in cerebral blood flow in patients with frontal lobe dementia.

Eight patients with a clinical diagnosis of probable Alzheimer's disease, eight patients with the clinical diagnosis of frontal lobe dementia, and eight controls were examined with single photon emission tomography (SPECT) using 99Tc-HMPAO. Patients with Alzheimer's disease and those with frontal lobe dementia met DSM-III-R criteria for mild dementia and were in the early stages of the illness. Compared with patients with Alzheimer's disease, the group with frontal lobe dementia had significantly lower blood flow in the frontal lobes (dorsolateral and orbital), the anterior temporal cortex, and the basal ganglia. Within the frontal lobe dementia group, blood flow was significantly lower in the orbital than in the dorsal frontal cortex, and in the anterior temporal than in the dorsal temporal cortex. The present study shows the specificity of changes in regional cerebral blood flow in the diagnosis of different types of dementia, and supports the importance of orbitofrontal, anterior temporal, and basal ganglia dysfunction in the production of the psychiatric syndrome of frontal lobe dementia.

Aged↗

PubMed1994

A SPECT study of delusions in Alzheimer's disease.

Although delusions are a frequent finding in patients with Alzheimer's disease (AD), their mechanism is not well known. We carried out Tc 99m HMPAO single-photon emission computed tomography studies in 16 AD patients with delusions and 29 AD patients without delusions comparable in age, years of education, duration of illness, and severity of dementia. Although we found no significant between-group differences in performance on neuropsychological tasks, AD patients with delusions had significantly lower mean cerebral blood flow in both the left and right temporal lobes.

Aged↗

PubMed1994

Neuropsychological and neuroradiologic correlates of emotional prosody comprehension.

We examined a series of 59 patients with acute stroke lesions for the presence of comprehension emotional aprosody. Based on a standardized assessment of comprehension of emotional intonation, 29 patients (49%) showed emotional aprosody (17% "mild" aprosody [n = 10] and 32% "severe" aprosody [n = 19]). Patients with comprehension emotional aprosody showed a higher frequency of extinction on double-simultaneous stimulation, anosognosia, and deficits in facial emotion comprehension. Patients with comprehension emotional aprosody also showed a higher frequency of right-hemisphere lesions involving the basal ganglia and the temporoparietal cortex and more severe frontal and diencephalic atrophy. Comprehension emotional aprosody was not necessarily associated with poststroke depression (PSD) since patients with and without PSD showed similar impairments in emotional prosody comprehension.

Adult↗

PubMed1994

Influence of major depression on 1-year outcome in patients with traumatic brain injury.

The authors examine those factors that contributed to deterioration in social functioning, activities of daily living, or intellectual functioning during a 1-year period after traumatic brain injury (TBI). Fifty-two patients suffering an acute TBI were evaluated for existence and severity of mood disorders and impairment during their hospital stays and at 3-, 6-, and 12-month follow-up examinations. Patients whose scores on intellectual function, social function, or daily activities deteriorated during the 1-year period after trauma were considered to have a poor outcome. Eleven of 52 patients had a poor outcome in social function, which was associated with race, right-hemisphere lesions, intellectual impairment, and prolonged major depression. Seven of 52 patients had a poor outcome in daily activities, which was associated with a major depression of more than 6 months' duration and severity of Hamilton Depression Rating Scale scores. Eleven of these patients had a poor outcome in cognitive function, which was associated with cognitive impairment immediately after TBI. A major depression lasting more than 6 months was associated with deterioration of social functioning and activities of daily living during the 1-year period after TBI.

Activities of Daily Living↗

PubMed1993

Neuropsychological correlates of brain atrophy in Parkinson's disease: a CT-scan study.

We examined the presence of cortical or subcortical brain atrophy (as shown by CT scans) in patients with Parkinson's disease (PD) and assessed whether there were significant correlations between CT measurements and the presence of cognitive deficits. There were three main findings. First, patients with bilateral symptoms of PD showed more severe cortical and subcortical atrophy than age-matched normal controls. Second, the presence of unilateral symptoms of PD was significantly associated with contralateral brain atrophy only in patients with right hemi-PD. Third, there was a significant correlation between neuropsychological deficits and atrophy in specific brain areas.

Atrophy↗

PubMed1993

Depression following traumatic brain injury: a 1 year longitudinal study.

A group of 66 patients hospitalized for the treatment of closed head injury, were assessed for the presence of mood disorders during their hospital admission and at 3, 6 and 12 months follow-up. A total 28 patients met DSM-III-R diagnostic criteria for major depression at some time during the study (17 in the acute stage, 11 during follow-up). The mean duration of major depression was 4.7 months. However, there appeared to be a group of transiently depressed patients (41%) who where depressed inhospital but were no longer depressed at 3 months follow-up. Throughout the follow-up period, major depression showed a strong relationship with poor social functioning. There was not, however, a consistent relationship between depression and quantitative measures of either physical or cognitive impairment. Location of the brain lesion was associated with the development of major depression only in the acute stage. Transient depressive syndromes were associated with left dorsolateral frontal and/or left basal ganglia lesions.

Adult↗

PubMed1993

Generalized anxiety disorder after stroke.

A series of 309 admissions to a stroke unit was examined for anxiety symptoms. Patients were diagnosed with DSM-III-R generalized anxiety disorder (GAD) symptom criteria. They were divided into groups of no anxiety (59.2%), worried but not fulfilling GAD criteria (13.9%), and GAD (26.9%). Patients were then divided into depressed and nondepressed groups based on the existence of DSM-III major or minor (dysthymic) depression. These groups were not significantly different in their background characteristics, family or personal psychiatric history, social support or the severity of physical impairment. Anxiety plus depression was associated with left cortical lesions, whereas anxiety alone was associated with right hemisphere lesions. Patients with worry had anterior and patients with GAD had posterior right hemisphere lesions. These findings suggest that anxiety disorder (independent of depression) is not related to background characteristics or to severity of impairment but is, in part, influenced by the brain structures that are injured.

Activities of Daily Living↗

PubMed1993

Apathy following cerebrovascular lesions.

BACKGROUND AND PURPOSE: Although apathy has been reported to constitute a frequent sequela of stroke lesions, there have been no prospective studies on the frequency and correlates of apathy after stroke lesions. In the present study, we examined the frequency and correlates of apathy in a consecutive series of 80 patients with cerebrovascular lesions. METHODS: We included patients within the first 10 days after a stroke lesion. Patients were examined with a comprehensive neuropsychiatric battery that included the Apathy Scale. RESULTS: Eighteen patients (22.5%) showed apathy, nine of whom were also depressed. On the other hand, 18 patients (22.5%) showed depression in the absence of apathy. Although depression and apathy may exist independent of one another, major depression (but not minor depression) was associated with an increased frequency of apathy. Apathy was also significantly associated with older age, cognitive impairments, and deficits in activities of daily living. Finally, apathy was significantly associated with lesions in the posterior limb of the internal capsule. CONCLUSIONS: These findings demonstrate that apathy is a frequent finding among patients with acute stroke lesions and may coexist with important emotional and cognitive poststroke disturbances.

Cerebral Hemorrhage↗

PubMed1993

Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study.

OBJECTIVE: This study was undertaken to test the reliability and validity of the Pathological Laughter and Crying Scale and the effectiveness of nortriptyline treatment for patients with emotional lability following stroke. METHOD: Eighty-two patients with ischemic brain injury-54 who had been hospitalized with acute stroke and 28 others who requested treatment for pathological laughing and crying--were given standardized psychiatric and neurological assessments and then administered the Pathological Laughter and Crying Scale. The 54 acute stroke patients were used to evaluate the Pathological Laughter and Crying Scale, and the 28 patients with pathological emotional display were randomly assigned to nortriptyline treatment or placebo in a 6-week double-blind trial to assess the efficacy of a tricyclic antidepressant in treatment of this disorder. RESULTS: The interrater reliability on the Pathological Laughter and Crying Scale for a subgroup of 15 patients was 0.93, and the test-retest reliability of the scale was excellent. After 4 and 6 weeks of treatment, scores on the Pathological Laughter and Crying Scale showed significantly greater improvement in the 14 patients given nortriptyline than in the 14 given placebo. Although almost one-half of these patients also had major depression, the improvement in emotional lability was independent of depression status. In addition, response to treatment was not significantly affected by lesion location or time since stroke. CONCLUSIONS: The severity of symptoms in pathological emotional display can be reliably quantified with the Pathological Laughter and Crying Scale, and treatment with nortriptyline can effectively ameliorate this emotional disorder.

Affective Symptoms↗

PubMed1993

Secondary mania following traumatic brain injury.

OBJECTIVE: In this study patients were examined during the first year after traumatic brain injury to determine the presence of secondary mania. METHOD: A consecutive series of 66 patients with closed-head injury were evaluated in the hospital and at 3-, 6-, and 12-month follow-ups. The patients were examined with a semistructured psychiatric interview and scales for measurement of impairment in activities of daily living, intellectual function, and social functioning. Patients fulfilling the DSM-III-R criteria for mania were compared to patients with major depression and to patients without affective disturbances in regard to their background characteristics, impairment variables, and lesion locations. RESULTS: Six patients (9%) met the criteria for mania at some point during follow-up. The presence of temporal basal polar lesions was significantly associated with secondary mania even when the effect of other lesion locations was taken into account. Secondary mania was not found to be associated with the severity of brain injury, degree of physical or cognitive impairment, level of social functioning, or previous family or personal history of psychiatric disorder. The duration of mania, however, appeared to be brief, lasting approximately 2 months. CONCLUSIONS: The 9% frequency of secondary mania in these patients with traumatic brain injury is significantly greater than that seen in other brain-injured populations (e.g., patients with stroke). The major correlate was the presence of a temporal basal polar lesion.

Adult↗

PubMed1993

Comparison between acute- and delayed-onset depression following traumatic brain injury.

Sixty-six patients admitted for the treatment of acute closed head injury were assessed for the presence of mood disorders during the in-hospital period and at 3-, 6-, and 12-month follow-ups. Diagnosis was made using a structured psychiatric interview and DSM-III criteria. A total of 28 patients had major depression at some time during the study: 17 had acute-onset depression and 11 had delayed-onset depression. Acute-onset depressions are related to lesion location and may have their etiology in biological responses of the injured brain, whereas delayed depressions may be mediated by psychosocial factors, suggesting psychological reaction as a possible mechanism.

Adult↗

PubMed1993

Catastrophic reaction after cerebrovascular lesions: frequency, correlates, and validation of a scale.

The frequency and correlates of the catastrophic reaction (CR) were examined in 52 consecutive patients with an acute stroke lesion. A new scale proved reliable for measuring the severity of CR. The CR was significantly associated with depression, a personal and family history of psychiatric disorder, and subcortical lesions, which were mostly located in the basal ganglia. Patients with and without a CR, when matched for the presence and type of depression, differed only in that CR patients had significantly more anterior lesions and a significantly higher frequency of subcortical damage. Results demonstrate that the CR is significantly associated with poststroke depression and may be a specific manifestation of certain types of poststroke depression.

Adult↗

PubMed1993

Depression and anxiety following traumatic brain injury.

The frequency, course, and clinical correlates of generalized anxiety disorder (GAD) and its relationship to major depression were examined in 66 patients with traumatic brain injury (TBI). Of 66 TBI patients, 7 (11%) had both GAD and major depression; 10 (15%) had major depression without GAD. Median duration was 1.5 months for nonanxious depressions, 7.5 months for anxious depressions, and 1.5 months for concurrent GAD. Anxious depressions were also associated with right hemisphere lesions, whereas major depressions alone were associated with left anterior lesions. These findings suggest that anxious major depression and major depression following TBI may be two different disorders with different underlying etiological mechanisms and perhaps differential response to treatment.

Adult↗