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Chronic cerebral hypoperfusion by permanent internal carotid ligation produces learning impairment without brain damage in rats.

To investigate the influence of cerebral hypoperfusion on learning behaviours, we developed a novel rat cerebral hypoperfusion model, in which the bilateral internal carotid arteries were permanently ligated to reduce the cerebral blood flow, and examined its behavioural and histopathological consequences in comparison to those occurring after bilateral common carotid ligation. In the Morris water maze task, rats with common carotid ligation exhibited a learning deficit, whereas rats with internal carotid ligation exhibited normal learning. Both models exhibited significant learning impairments in the eight-arm radial maze task, although the impairment was less severe in internal carotid-ligated rats than in common carotid-ligated rats. The cerebral blood flow of rats with common carotid ligation was reduced significantly both two and 10 days after ligation, and was still below normal three months after ligation. A milder, but significant reduction in the cerebral blood flow was observed in internal carotid-ligated rats. Shrinkage of the optic nerves and a circadian activity rhythm desynchronized to the light/dark cycle were exhibited by the rats with common carotid ligation, whereas these parameters remained unaffected in the rats with internal carotid ligation, suggesting that permanent ligation of common carotid arteries but not internal carotid arteries impairs visual functions. The main pathological changes observed in the brain following common carotid ligation were rarefaction and gliosis of the white matter and neuronal loss in the hippocampal CA1 region. On the other hand, the rats with internal carotid ligation had no significant brain damage. Chronic treatment with idebenone (1.5 and 15 mg/kg/day), a cerebral energy metabolism enhancer, over a three-month period, commencing five days after ligation, ameliorated the impairment of water maze learning in rats with common carotid ligation. The treatment also significantly improved the learning impairment in the radial maze task of internal carotid-ligated rats. Idebenone had no effect on the histopathological changes that followed cerebral hypoperfusion. It is concluded that cerebral hypoperfusion induced by permanent internal carotid ligation impairs the working memory without causing pathological damage to the brain tissues and the visual system, and the learning impairment can be ameliorated by a cerebral energy metabolism enhancer. These findings have the clinical implication that a reduction in blood flow may be an important factor that causes or exacerbates cognitive decline in dementias.

Animals↗

Chronic alcoholic brain damage: trends in the use of services in North Canterbury.

National published data, Sunnyside Hospital records and a survey of private institutions were used to ascertain trends over time in the use of services for alcohol-related brain damage in the Canterbury region. One hundred and forty-three individuals in long-term care in 1982 were identified, a rate of 42 per 100 000 population. The proportion of psychiatric hospital beds occupied by these patients rose from 3% in 1971 to 12% in 1981. The rate of first admissions remained stable during this period while readmissions rose sharply, then levelled off. Average length of stay and number of readmissions increased and average age of admissions dropped; however these differences were not statistically significant. The data, together with changes in hospital programmes and diagnostic practice over the same period, suggest that the rise in bed occupancy may reflect an extension of the hospital's services to a group not previously offered long-term care, particularly less disabled persons.

Adult↗

Neuropsychological differentiation of chronic schizophrenia.

Four groups of 20 each (chronic brain-damaged schizophrenics, chronic non-brain-damaged schizophrenics, chronic non-brain-damaged with "acute" exacerbation, and control subjects) were individually administered Form I of the Luria Nebraska Neuropsychological Battery (LNNB). Control subjects scored significantly lower than all clinical groups on all scales except for the chronic non-brain-damaged schizophrenics on the Reading Scale. "Acute" schizophrenics scored higher on Motor, Visual, Receptive Speech, Intellectual Processes, Pathognomonic, Right Hemisphere and Profile Elevations scales than the other clinical groups. Chronic brain-damaged schizophrenics scored significantly higher than chronic non-brain-damaged schizophrenics on the Profile Elevation scale. To examine the possibility that LNNB performance of the schizophrenic groups may have been related to neuroleptic medication, analyses were completed on the relationship between medication levels and LNNB scores. These results suggested that while the three clinical groups differed in their chlorpromazine equivalents (CPZE), LNNB scores were not related to CPZE dosage.

Acute Disease↗

Clinical and biochemical parameters during neuroleptic treatment. II. Antipsychotic effect of haloperidol in patients with chronic organic brain damage.

The time-course of psychopathological symptoms, of extrapyramidal side effects, and of changes in cerebrospinal fluid (CSF) concentration of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were simultaneously studied during Haloperidol treatment of 14 psychotic patients with chronic organic brain damage. After 15 days of treatment significant antipsychotic effect was found, while Parkinsonism scores in clinical and experimental tests increased only slightly. CSF concentration of HVA increased significantly by 150% compared to the baseline value (p less than 0.05) and 5-HIAA remained unchanged. No correlation was found between the clinical and biochemical variables studied. The comparison of these results with those obtained in patients without brain damage suggests that different psychopathological and extrapyramidal responses to neuroleptics are not strictly associated with specific HVA changes in CSF.

Adult↗

Clinical correlates of quantitative EEG alterations in alcoholic patients.

OBJECTIVE: To evaluate the incidence and clinical correlations of abnormal QEEG features in alcoholic patients. METHODS: Quantitative EEG (frequency analysis, absolute and relative powers of the four classical bands) was assessed in 191 male alcoholic patients admitted in our facility for detoxification process. All underwent psychiatric, medical and neurological examination prior to the EEG recording, in search for specific clinical or paraclinical findings. The presence or absence of relevant clinical features was codified as nominal dichotomic variables to be related to specific QEEG features. RESULTS: Only 7 patients had normal QEEG. The most frequent alteration (81 cases) was decreased power in slow (delta and theta) bands with a concurrent increase in beta band, followed by decreased power only in slow bands (33), increase only in beta band (29), decrease in both slow and alpha bands without beta alterations (28), decrease only in alpha band (6) and others. Alterations in slow and beta bands were uncorrelated. However, a significant correlation was found between decreased power in slow bands and cortical atrophy as revealed by MRI (especially in patients with early onset of alcoholism), time elapsed from the beginning of alcoholic habits (but only in younger or early onset subjects) and in a lesser degree arterial hypertension, but neither with age nor any other clinical or psychiatric feature. On the other hand, increased power in beta band correlated mainly with the use of benzodiazepines, sensoperceptual alterations (hallucinations, illusions), clinical seizures and family history of alcoholism. The effects of those variables were strongly interrelated. CONCLUSIONS: Decreased power in slow bands in alcoholic patients may be an indicator of brain atrophy or chronic brain damage, while increase in beta band is related to medication use, family history of alcoholism, hallucinations and seizures, suggesting a state of cortical hyperexcitability. SIGNIFICANCE: This study show the relation of specific QEEG alterations to certain clinical features found in alcoholics, in a further attempt to elucidate the semiological value of those alterations in individual patients.

Adult↗

Cognitive rehabilitation of the hemineglect disorder in chronic patients with unilateral right brain damage.

Thirteen patients with a stabilized hemineglect symptomatology due to right-hemisphere lesions were subjected to a rehabilitation training specifically aimed at reducing the scanning deficit. The training consisted of four procedures (visual-spatial scanning, reading and copying training, copying of line drawings on a dot matrix, and figure description) which lasted 40 sessions. By the end of therapy, the patients as a group showed significant improvements on several standard tests of hemineglect. The results on a Semi-structured Scale for the Functional Evaluation of Hemineglect pointed to the extension of exploratory improvements to situations similar to those of daily life. In contrast, patients improved very slightly on a variety of standard visual-spatial tests, indicating the specificity of training in reducing the scanning defect. Seven patients were examined at a follow-up several months after the end of therapy and appeared stable on both standard and functional tests of neglect.

Aged↗

Low nosetip temperatures in the old.

A study was made of the significance of cold nosetips as a simple prognostic sign in the elderly sick. This sign was thought to be due to the presence of chronic brain damage. Nosetip temperatures were compared with forehead and ambient temperatures in 400 patients until recovery, death or transfer. Weekly readings were taken, and may have failed to give an accurate record in those observed for 4 weeks or less, though here 56% of the 154 fatalities had low nosetip temperatures. A longer-stay group consisted of 177 cases, of whom 155 had low nosetip temperatures at some time. 87 patients in this group died, 43 remained disabled and only 25 regained their previous state of health. It is concluded that low nosetip temperatures provide a useful indicator that adequate recovery is unlikely to occur.

Aged↗

The essential steps cognitive orthotic.

A multifunction cognitive orthotic system is designed to assist people with cognitive disorders in the performance of ecologically relevant activities. This personal computer-based compensatory approach applies neuroscience and technology to the rehabilitation needs and challenges of people with chronic brain damage. The primary goal of this approach is the independent accomplishment of practical, applied tasks integral to daily living, at home, at work, at school and in the community. This paper will describe the "Essential Steps" cognitive orthotic system, and describe its potential to facilitate skill acquisition and enhance self-sufficient life management. The software was designed to guide and protect the user as he or she progresses through each "essential step" in the progression required for completion of a targeted task. The discussion will explicate the underlying principles promoting skill acquisition with this application of a cognitive orthotic. Data have shown that this compensatory aid can promote rapid skill acquisition and support reliable performance, even long past the time when rapid recovery and progress are customarily expected. Discussion will focus on issues of design for people with brain damage, the significance of this system's prototypical structure, and research findings and clinical observations made with people using "Essential Steps".

Adult↗

Some functional consequences of chronic GM1 ganglioside administration in brain damaged rats.

Systemic injections of GM1 gangliosides can enhance behavioral recovery from brain damage as measured by a number of cognitive tasks. The functional recovery is not due to GM1-induced alterations in activity, emotional arousal, or heightened sensitivity to mild, noxious stimulation. In addition, the recovery endures long after all treatments are terminated. Although the specific actions by which GM1 treatments facilitate recovery are unknown, evidence does suggest that both anomalous sprouting and protection of neurons from secondary consequences of injury may be involved in the repair process.

Animals↗

[Clinical significance of sleep status following-large scale epileptic attacks (grand mal)].

Certain clinical criteria of grand mal seizures, and particularly the post-convulsive sleep phase (PCS), appear to be manifestations of some more deep-rooted disturbance of the functional cerebral mechanisms. The symptoms of the chronic organic psychosyndrome were observed distinctly more often in patients with PCS than in those without it. The frequency of seizures is also important when considering the cause of chronic brain damage. Etiological aspects (genuinely-symptomatological) appear to be of secondary importance.

Adult↗